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This systematic review described the association between electronic nicotine delivery systems and electronic non-nicotine delivery systems (ENDS/ENNDS) use among non-smoking children and adolescents aged <20 years with subsequent tobacco use. We searched five electronic databases and the grey literature up to end of September 2020. Prospective longitudinal studies that described the association between ENDS/ENNDS use, and subsequent tobacco use in those aged < 20 years who were non-smokers at baseline were included. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess risk of bias. Data were extracted by two reviewers and pooled using a random-effects meta-analysis. We generated unadjusted and adjusted risk ratios (ARRs) describing associations between ENDS/ENNDS and tobacco use. A total of 36 publications met the eligibility criteria, of which 25 were included in the systematic review (23 in the meta-analysis) after exclusion of overlapping studies. Sixteen studies had high to moderate risk of bias. Ever users of ENDS/ENNDS had over three times the risk of ever cigarette use (ARR 3·01 (95% CI: 2·37, 3·82; p<0·001, I2: 82·3%), and current cigarette use had over two times the risk (ARR 2·56 (95% CI: 1·61, 4·07; p<0·001, I2: 77·3%) at follow up. Among current ENDS/ENNDS users, there was a significant association with ever (ARR 2·63 (95% CI: 1·94, 3·57; p<0·001, I2: 21·2%)), but not current cigarette use (ARR 1·88 (95% CI: 0·34, 10·30; p = 0·47, I2: 0%)) at follow up. For other tobacco use, ARR ranged between 1·55 (95% CI 1·07, 2·23) and 8·32 (95% CI: 1·20, 57·04) for waterpipe and pipes, respectively. Additionally, two studies examined the use of ENNDS (non-nicotine devices) and found a pooled adjusted RR of 2·56 (95% CI: 0·47, 13·94, p = 0.035). There is an urgent need for policies that regulate the availability, accessibility, and marketing of ENDS/ENNDS to children and adolescents. Governments should also consider adopting policies to prevent ENDS/ENNDS uptake and use in children and adolescents, up to and including a ban for this group.

In a review of strategies for preventing oral cancer, an expert panel reports that the use of tobacco (both smoking and smokeless), areca nut exposure, and heavy alcohol consumption are major contributors to this illness.

Each year, tobacco use causes approximately 7 million deaths worldwide, including approximately 6 million among tobacco users and an estimated 890,000 among nonsmokers exposed to secondhand smoke (1). Tobacco use is a leading preventable cause of disease globally and has been determined to cause adverse health outcomes such as coronary heart disease, stroke, and multiple types of cancer, including lung cancer (2-4). Approximately 80% of the world's 1.1 billion tobacco smokers reside in low- and middle-income countries (4). Some persons do not fully understand the health risks associated with tobacco smoking (5-9), and studies have indicated that increasing knowledge about the adverse health effects of smoking can contribute to decreases in smoking, increases in cessation attempts, and increases in successful cessation (3,7,10). CDC analyzed 2008-2016 Global Adult Tobacco Survey (GATS) data from 28 countries to assess tobacco smoking prevalence, quit attempts, and knowledge about tobacco smoking risks among persons aged ≥15 years. Across countries, the median prevalence of tobacco smoking was 22.5%, and a median of 42.5% of tobacco smokers had made a quit attempt in the preceding 12 months. The median prevalences of knowing that tobacco smoking causes stroke, heart attack, and lung cancer were 73.6%, 83.6%, and 95.2%, respectively. Implementation of proven tobacco control interventions, including strategies that increase knowledge about the health risks posed by tobacco use, might help to reduce tobacco use and tobacco-related disease, including heart disease, stroke, and lung cancer (3-5).

Targeted cancer therapies involve chemotherapeutic agents that attack, directly or indirectly, a specific genetic biomarker found in a given cancer. Targeted oncology includes monoclonal antibodies, small molecule inhibitors, antibody-drug conjugates, and immunotherapy. For example, the monoclonal antibodies trastuzumab and pertuzumab target human epidermal growth factor receptor 2 (HER2) and are used when treating HER2-positive breast cancer. Although targeted oncology has improved survival by years for some incurable cancers such as metastatic breast and lung cancer, as few as 8% of patients with advanced cancer qualify for targeted oncology medications, and even fewer benefit. Other limitations include serious adverse events, illustrated by a 20% to 30% rate of heart attack, stroke, or peripheral vascular events among patients taking ponatinib, which is used in treating chronic myelogenous leukemia. Immune checkpoint inhibitor therapy-related adverse effects such as hypothyroidism are common, and more severe adverse events such as colitis and pneumonitis can be fatal and require immediate intervention. Drug interactions with widely prescribed medications such as antacids and warfarin are common. Additionally, financial toxicities are a problem for patients with cancer who are using costly targeted therapies. Future directions for targeted oncology include tumor-agnostic drugs, which target a given mutation and could be used in treating cancers from multiple organ types. An overview of indications, mechanism of action, and toxicities of targeted cancer therapies is offered here.

Background:  India made 2 important policy statements regarding tobacco control in the past decade. First, the India Tobacco Control Act (ITCA) was signed into law in 2003 with the goal to reduce tobacco consumption and protect citizens from exposure to secondhand smoke (SHS). Second, in 2005, India ratified the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). During this same period, India conducted the Global Youth Tobacco Survey (GYTS) in 2003 and 2006 in an effort to track tobacco use among adolescents. Methods:  The GYTS is a school‐based survey of students aged 13‐15 years. Representative national estimates for India in 2003 and 2006 were used in this study. Results:  In 2006, 3.8% of students currently smoked cigarettes and 11.9% currently used other tobacco products. These rates were not significantly different than those observed in 2003. Over the same period, exposure to SHS at home and in public places significantly decreased, whereas exposure to pro‐tobacco ads on billboards and the ability to purchase cigarettes in a store did not change significantly. Conclusions:  The ITCA and the WHO FCTC have had mixed impacts on the tobacco control effort for adolescents in India. The positive impacts have been the reduction in exposure to SHS, both at home and in public places. The negative impacts are seen with the lack of change in pro‐tobacco advertising and ability to purchase cigarettes in stores. The Government of India needs to consider new and stronger provisions of the ITCA and include strong enforcement measures.

Nickel super alloy (IN625) widely employed in mechanical moving parts is subjected to sliding contact between mating pairs, which causes wear losses. Wear loss in functional parts causes dimensional inaccuracies, which results in deteriorated performance (vibration and noise) and finally leads to catastrophic failure during their service life. The present work aims at minimizing the wear rate by enhancing the density of IN625 parts printed viz. selective laser melting (SLM) process. SLM parts quality (i.e., density and wear rate) is influenced mainly by process variables (laser power LP, scan speed SS, and hatch distance HD). Taguchi method is employed to study the influencing process variables that could affect the part quality at limited experimental trials and cost. Laser power resulted with highest contribution for both the outputs. Scan speed resulted with least contribution for density and hatch distance for wear rate. Taguchi determined optimal conditions for individual outputs are identical, and this could be because of wear rates’ strong dependency on density (i.e., higher the density lesser the wear rate and vice versa). Although the optimal conditions are same, but the percent contribution corresponding to each output variables are found to be different. Therefore, super ranking concept (SRC) method was applied to perform multi-objective optimization and locate optimal conditions. SRC determined optimized conditions (LP: 270 W, SS: 800 mm/s, and HD: 0.10 mm) resulted in lesser wear rate of 0.0031 mg/m and higher density of 8.53 g/cm 3 in SLM parts. The SRC model determined optimized conditions are not the set of Taguchi L 9 experiments and confirmation results revealed the efficacy of the model. SEM analysis on wear track of optimized conditioned parts resulted in minor grooves, coupled with few cracks, and voids. Therefore, Taguchi-SRC model can be applied to analyse and optimize a process for better quality in printed parts at industries.

Core–shell magnetic nanostructures (MNS) such as Fe 3 O 4 –SiO x , are being explored for their potential applications in biomedicine, such as a T 2 (dark) contrast enhancement agent in magnetic resonance imaging (MRI). Herein, we present the effect of silica shell thickness on its r 2 relaxivity in MRI as it relates to other physical parameters. In this effort initially, monodispersed Fe 3 O 4 MNS (nominally 9 nm size) were synthesized in organic phase via a simple chemical decomposition method. To study effect of shell thickness of silica of Fe 3 O 4 –SiO x core shell on r 2 relaxivity, the reverse micro-emulsion process was used to form silica coating of 5, 10 and 13 nm of silica shell around the MNS, while polyhedral oligomeric silsesquioxane was used to form very thin layer on the surface of MNS; synthesized nanostructures were characterized by transmission electron microscopy (TEM) and high resolution TEM (HRTEM), superconducting quantum interference device magnetometry and MRI. Our observation suggests that, with increase in thickness of silica shell in Fe 3 O 4 –SiO x core–shell nanostructure, r 2 relaxivity decreases. The decrease in relaxivity could be attributed to increased distance between water molecules and magnetic core followed by change in the difference in Larmor frequencies (Δ ω ) of water molecules. These results provide a rational basis for optimization of SiO x -coated MNS for biomedical applications.

Background Uremic pruritus has an impact on the quality of life and sleep of hemodialysis patients, but the majority of cases go unreported and untreated unless severe, due to a lack of awareness. The purpose of this study is to determine the prevalence, associated factors, and impact on health-related quality of life (HR-QOL) and sleep in hemodialysis patients. Methodology A single-center observational study of 3 months wherein 120 adults on maintenance hemodialysis were included. Baseline characteristics, dialysis-related factors, and lab parameters influencing uremic pruritus were recorded. Those with uremic pruritus completed “12-item pruritus severity scale (12-PSS)”, “SKINDEX10”, and “Itch-MOS” questionnaires to evaluate severity, impact on HR-QOL, and sleep respectively. Results Sixty seven over one hundred twenty (55.83%) patients had pruritus and majority were mild (40.83%) as per 12-PSS. Those with pruritus (n=67) had a mean age of 56.5±11.3 years, most were males (82%), chronic glomerulonephritis (29.1%) was the commonest cause of end-stage kidney disease, 3 active smokers, and 4 seropositive. 65(97%) patients were on twice-weekly dialysis, 36/67 had <5 years’ dialysis vintage and acceptable adequacy. There was no significant association between uremic pruritus and dialysis-related/laboratory parameters. Patients with uremic pruritus demonstrated significantly worse “HR-QOL” (p<0.001) on the “SKINDEX-10”, and patients' “Itch-MOS” scores demonstrated a significant decline in sleep quality with increasing pruritus severity (p<0.001). Conclusion The majority of patients on maintenance hemodialysis experience uremic pruritus. None of the clinical characteristics, dialysis-related factors, and laboratory parameters affected uremic pruritus. Uremic pruritus patients had the worst HR-QOL & their sleep quality significantly declined as pruritus severity escalated. Trial registration number and date of registration Study approval was obtained from Institutional Research Committee and Institutional Ethical Committee (IEC 642/2021). Clinical Trial Registry of India (CTRI) registration (CTRI/2022/01/039143) was also obtained.

Atrial fibrillation (AF) is the most common sustained arrhythmia, affects over 2.5 million people in the USA and is responsible for one fifth of the 700,000 ischemic strokes per year. For the last 50 years, long-term anticoagulation with warfarin has been the most effective therapy for preventing stroke in patients with AF and other risk factors. However, many AF patients are poor candidates for this treatment, and management of the drug can be challenging. Such challenges include the need for frequent monitoring, interactions with food and other medications, variability in metabolism and a delayed onset of action. Antiplatelet therapy has also been evaluated, and though it is not as effective at preventing ischemic strokes, it may provide some benefit for patients who cannot tolerate warfarin. Recent clinical trials have tested pharmacologic alternatives to warfarin, and new treatment options have emerged. Of these alternatives, the direct oral thrombin inhibitor dabigatran and the oral factor Xa inhibitor rivaroxaban, which have minimal interactions and require no INR monitoring, have already been approved by the FDA. The field may soon be further expanded as the oral factor Xa inhibitor apixaban has shown promise in its recent phase 3 trial and is under consideration for FDA approval. Nonpharmacologic approaches to stroke prevention in AF are under development as well. These approaches focus on occlusion or ligation of the left atrial appendage, which is frequently the location of thrombus formation. While such procedures have been done often during other cardiac surgeries, newer methods have focused on percutaneous techniques, including ones that may not require anticoagulation afterwards. In addition, new diagnostic modalities may detect paroxysmal AF with more sensitivity, potentially expanding the population to be treated and the potential impact of stroke preventive strategies on the population. This review provides a practical guide to current treatment and diagnostic options and focuses on emerging therapies.