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Background and Aims: Nicotine vaping products (NVPs) can potentially help adult tobacco users quit smoking. This study evaluated how adult consumers compare the costs between NVPs and cigarettes. Method: We used data from the US arm of the 2016–2020 International Tobacco Control Four Country Smoking and Vaping (ITC 4CV) surveys to perform a multinomial logit model with two‐way fixed effects to measure how perceived cost comparisons are associated with NVP and cigarette taxes, use patterns, NVP device types and individual sociodemographic factors. Results: Higher cigarette taxes are associated with a greater likelihood of perceiving NVPs and cigarettes as costing the same for the overall population and among people who exclusively smoke, and a lower likelihood of perceiving NVPs as more expensive among people who exclusively vape, compared with lower cigarette taxes. Pre‐filled cartridge and tank users are more likely to perceive NVPs as less expensive than cigarettes, compared with people who use other types of NVPs. The associations between taxes and perceived cost comparison were more pronounced among males, younger and low‐income populations. Conclusions: Higher cigarette taxes are associated with perceived financial incentives for nicotine vaping products (NVPs) over cigarettes, whereas NVP taxes are not associated with perceived cost comparison between NVPs and cigarettes. [ABSTRACT FROM AUTHOR]

Issue addressed: High levels of testing are crucial for minimising the spread of COVID‐19. The aim of this study is to investigate what prevents people from getting a COVID‐19 test when they are experiencing respiratory symptoms. Methods: Semi‐structured, qualitative interviews were conducted with 14 purposively sampled adults between 20 November 2020 and 3 March 2021 in two capital cities of Australia and analysed thematically. The analysis included people who reported having respiratory symptoms but who did not undergo a COVID‐19 test. Results: Participants appraised risks of having COVID‐19, of infecting others or being infected whilst attending a testing site. They often weighed these appraisals against practical considerations of knowing where and how to get tested, inconvenience or financial loss. Conclusions: Clear public health messages communicating the importance of testing, even when symptoms are minor, may improve testing rates. Increasing the accessibility of testing centres, such as having them at transport hubs is important, as is providing adequate information about testing locations and queue lengths. So what?: The findings of our study suggest that more needs to be done to encourage people to get tested for COVID‐19, especially when symptoms are minor. Clear communication about the importance of testing, along with easily accessible testing clinics, and financial support for those concerned about financial impacts may improve testing rates. [ABSTRACT FROM AUTHOR]

Aims: To estimate associations between e‐cigarette flavour and smoking cessation and study product use at 6 months or longer. Methods: Secondary analysis of data from a living systematic review, with meta‐analyses and narrative synthesis, incorporating data up to January 2022. Included studies provided people who smoked combustible cigarettes with nicotine e‐cigarettes for the purpose of smoking cessation compared with no treatment or other stop smoking interventions. Measurements included smoking cessation and study product use at 6 months or longer reported as risk ratios (RR) with 95% confidence intervals (CI); and flavour use at any time‐points. Results: We included 16 studies (n = 10 336); 14 contributed to subgroup analyses and 10 provided participants with a choice of e‐cigarette flavour. We judged nine, five and two studies at high, low and unclear risk of bias, respectively. Subgroup analyses showed no clear associations between flavour and cessation or product use. In all but one analysis, tests for subgroup differences resulted in I2 values between 0 and 35%. In the comparison between nicotine e‐cigarettes and nicotine replacement therapy (NRT) (I2 = 65.2% for subgroup differences), studies offering tobacco flavour e‐cigarettes showed evidence of a greater proportion of participants still using at 6 months or longer (RR = 3.81; 95% CI = 1.45–10.05; n = 1181; I2 = 84%), whereas there was little evidence for greater 6‐month use when studies offered a choice of flavours (RR = 1.44; 95% CI = 0.80–2.56; n = 454; I2 = 82%). However, substantial statistical heterogeneity within subgroups makes interpretation of this result unclear. In the 10 studies where participants had a choice of flavours, and this was tracked over time, some switching between flavours occurred, but there were no clear patterns in flavour preferences. Conclusions: There does not appear to be a clear association between e‐cigarette flavours and smoking cessation or longer‐term e‐cigarette use, possibly due to a paucity of data. There is evidence that people using e‐cigarettes to quit smoking switch between e‐cigarette flavours. [ABSTRACT FROM AUTHOR]

Aims: To estimate whether and to what extent extending indoor smoking restrictions to include electronic cigarettes (ECs) impact the use of ECs and cigarette smoking among adults in the United States. Design: Observational study using a linear probability model and applying a difference‐in‐differences analysis. Setting: United States. Participants: People aged 18–54 who lived in US counties where comprehensive indoor smoking laws in bars, restaurants and private work‐places have been in place prior to 2010 (n = 45 111 for EC use analysis, n = 75 959 for cigarette use analysis). Measurements Data on cigarette smoking, use of ECs and place of residence from the Tobacco Use Supplement of the Current Population Survey (TUS‐CPS 2010–11, 2014–15 and 2018–19) were combined with the American Nonsmokers' Rights Foundation (ANRF) database of state and local indoor smoking and vaping restriction laws. Findings Indoor vaping restriction (IVR) coverage was not significantly associated with the likelihood of adult EC use [coefficient estimate = 0.001; 95% confidence interval (CI) = −0.009, 0.013, P‐value = 0.783]. In addition, IVR coverage was not significantly associated with adult cigarette smoking (coefficient estimate = −0.00; 95% CI = −0.016, 0.015, P‐value = 0.954). The non‐significant results appeared in different socio‐demographic subgroups. Conclusions: IVRs do not appear to decrease electronic cigarette use among US adults. There is no evidence that IVRs increase or decrease cigarette smoking among US adults. [ABSTRACT FROM AUTHOR]

Purpose: Effective communication and collaboration with patients, carers and between healthcare professionals improves patient management. This study aimed to explore essential communication and collaboration skills training (CCST) for a radiation oncologist (RO) to inform competencies, learning outcomes and enhance curriculum training methods. Materials and Methods: Eight focus group discussions with 10 fellows and 14 trainees of the Faculty of Radiation Oncology, Royal Australian and New Zealand College of Radiologists (FRO RANZCR) were conducted face to face between October 2018 and March 2019. Participants included doctors from culturally and linguistically diverse backgrounds, working in public and private, metropolitan, and rural sectors. Data were recorded, transcribed verbatim, managed in Excel, and coded using a qualitative content analysis framework. The study was approved by South Eastern Sydney Local Health District HREC (18/186). Participants provided informed written consent. Results: After achieving thematic saturation, four predominant themes emerged. These were as follows: (1) Enablers and barriers to effective communication and collaboration; (2) written communication; (3) communicating bad news; and (4) multidisciplinary team meeting collaboration. Managing uncertainty and workplace culture emerged as interconnected sub‐themes. Conclusions: There is a current lack of CCST in radiation oncology in Australia and New Zealand. The most common theme that emerged to improve CCST focused on increasing the exposure to a variety of communication and collaboration clinical scenarios, which are observed and upon which immediate structured feedback is given. Consultants and trainees offered tangible suggestions on how to improve the curriculum. These findings underscore the importance of using a combination of structured teaching methods and work‐based assessments. CCST templates are recommended. [ABSTRACT FROM AUTHOR]

Background and Aims: Tobacco control policies may differentially impact smoking initiation among socio-demographic groups. We measured longitudinal associations between exposure to smoke-free laws in grade 12 (modal age 18 years) and patterns of smoking initiation in the United States. Design: Prospective longitudinal analysis. Setting and Participants: We used data on US young adults sampled at modal age 18 years from the Monitoring the Future Survey. Baseline data were collected between 2000 and 2017, with the last year of follow-up in 2018. The sample number varied by outcome and time-point, ranging from 7314 to 17 702. Measurements: Smoke-free law coverage in work-places and hospitality venues (restaurants/bars) was measured as the percentage of the county population covered by each type of law. We examined associations with any past 30-day smoking initiation and daily smoking initiation at modal ages 19/20, 21/22 and 23/24, using Poisson regression and calculating average marginal effects. We explored effect modification by sex, race/ethnicity and parental education by testing the significance of interaction terms. Findings: Work-place law coverage at modal age 18 was associated with a lower probability of daily smoking initiation at modal ages 21/22 [-2.4 percentage points (p.p.); 95% confidence interval (CI) = -3.9, -0.9] and 23/24 (-2.0 p.p.; 95% CI = -3.9, -0.2). Hospitality law coverage was associated with a lower probability of daily smoking initiation at modal ages 19/20 (-1.6 p.p.; 95% CI = -2.8, -0.4), 21/22 (-2.3 p.p.; 95% CI = -3.7, -0.9) and 23/24 (-1.8 p.p.; 95% CI = -3.6, -0.0). Findings were inconclusive with regard to associations with any past 30-day smoking initiation and with regard to effect modification, after adjusting for multiple testing. Conclusions: Exposure to smoke-free laws at age 18 appears to be prospectively associated with reduced daily smoking initiation 1-6 years later. [ABSTRACT FROM AUTHOR]

Background and Aims: Whereas the use of nicotine vaping products (NVPs) is widespread, their impact on smoking prevalence is controversial. This study considered the potential impact of NVPs on smoking prevalence in England. Design Indirect simulation model. The England SimSmoke model is validated through 2012, before NVP use became more widely used by smokers. Because information on NVP‐related transitions is limited, an indirect method is used; the difference in observed smoking prevalence (reflecting NVPs) is compared with a 2012–2019 counterfactual No‐NVP scenario (without NVPs) to estimate the impact of NVPs on smoking and smoking‐attributable deaths. Setting: England, 2000–2019. Participants: Nationally representative sample of population. Measurements England's population, mortality rates and smoking prevalence estimates from three national surveys and tobacco control policies. Findings Between 2000 and 2012, SimSmoke projected a decline in age 18+ smoking prevalence of 23.5% in men and 27.0% in women. These projections, as well as those by specific age groups, were generally consistent with findings from the three national surveys. Comparing 2012–2019 relative reduction in age 18+ prevalence from the Annual Population Survey (males, 27.5%) with the model‐predicted No‐NVP reduction (males, 7.3%), the implied NVP‐attributable relative reduction in adult smoking prevalence was 20.2% (95% CI, 18.8%–22.0%) for males and 20.4% (18.7%–22.2%) for females. The NVP‐attributable reduction was 27.2% (22.8%–31.6%) for males and 31.7% (27.4%–36.5%) for females ages 18–24 and 18.6% (15.2%–21.8%) for males and 15.0% (11.1%–18.8%) for females ages 25–34, with similar reductions for ages 35+. The implied reduction in smoking prevalence between 2012 and 2019 equates to 165 660 (132 453–199 501) averted deaths by 2052. Other surveys yielded smaller, but relatively consistent results. Conclusions: An indirect method of simulation modelling indicates that substantial reductions in smoking prevalence occurred in England from 2012–2019 coinciding with the growth in nicotine vaping product use. [ABSTRACT FROM AUTHOR]

Signal transducer and activator of transcription 3 (STAT3) is a transcription factor with roles in inflammation and tumorigenicity. A fraction of STAT3 localizes in mitochondria, where it augments tumorigenesis via regulation of mitochondrial functions, including modulation of respiration and redox status. We show a novel mechanism for mitochondrial STAT3 regulation of redox homeostasis in triple‐negative breast cancer cells. Loss of STAT3 diminished complex I dehydrogenase activity and impaired NAD+ regeneration, leading to impaired expression of glutathione biosynthetic genes and other antioxidant genes. Expressing mitochondrially restricted STAT3 or replenishment of the cellular NAD pool restored antioxidant gene expression, as did complementation of the NADH dehydrogenase activity by expression of the STAT3‐independent yeast dehydrogenase, NDI1. These NAD‐regulated processes contributed to malignant phenotypes by promoting clonal cell growth and migration. Proximity interaction and protein pull‐down assays identified three components of complex I that associated with mitochondrial STAT3, providing a potential mechanistic basis for how mitochondrial STAT3 affects complex I activity. Our data document a novel mechanism through which mitochondrial STAT3 indirectly controls antioxidant gene regulation through a retrograde NAD+ signal that is modulated by complex I dehydrogenase activity. [ABSTRACT FROM AUTHOR]

Background and aims: The long‐term population health impact of nicotine vaping products (NVPs) use among smokers is unknown, and subject to a range of plausible assumptions about the use and health consequences of NVPs. While NVPs use may substitute for cigarette smoking and thereby aid in quitting cigarette use, it is also possible that smokers who would have otherwise quit would instead delay quitting cigarettes. We aimed to develop a cohort‐specific simulation model of the impact of NVPs on smoking cessation by adult smokers and resulting premature deaths (PD) and life years lost (LYL). Design A cohort‐specific simulation model of the impact of NVPs on smoking cessation by adult smokers and resulting premature deaths (PD) and life years lost (LYL) was developed by gender for two birth cohorts, aged 30 and 50 years in 2012. Extensive sensitivity analyses were conducted. Setting: United States. Participants: Smokers in two birth cohorts, aged 30 and 50 years in 2012. Measurements Data were from the 1965–2012 National Health Interview Surveys and the 2014/15 Tobacco Use Supplement of the Current Population Survey. The model incorporated a range of plausible assumptions from published literature about transition rates from regular smoking to exclusive NVP and dual use, from dual use to exclusive NVP use and from exclusive NVP use to no use. Findings Compared with the no‐NVP scenario, the male (female) model projected 17.8% (19.3%) fewer PDs and 22.9% (26.6%) fewer LYL for the 1982 cohort and 5.4% (7.3%) fewer PDs and 7.9% (11.4%) fewer LYL for the 1962 cohort. These gains were sensitive to NVP use over time, age of initial NVP use, transitions from smoking to dual, exclusive NVP and no use and relative NVP mortality risks. Conclusions: Nicotine vaping product (NVP) use in the United States is projected to have a net positive impact on population health over a wide range of plausible levels of NVP use, transitions to dual, exclusive NVP and no use and NVP risks. However, net impact is sensitive to parameter estimates. [ABSTRACT FROM AUTHOR]

Background and Aims: The regulatory environment for nicotine vaping products (NVPs) varies widely across countries and this will probably affect the devices used, nicotine content and usage, and hence the ability of NVPs to substitute for cigarettes. We aimed to describe the types of NVPs used by current vapers in four countries with varying regulatory and enforcement approaches toward the marketing and sale of NVPs. Methods: Data are from wave 1 (July–November 2016) of the ITC Four Country Smoking and Vaping Survey (4CV1), conducted among a cohort of current and former smokers, and current NVP users (n = 5147 adults; ≥ 18 years) in Australia (AU), Canada (CA), England (EN) and the United States (US) reporting either current daily, weekly or occasional NVP use. Devices were described by type, brand, voltage variability and refill capacity. Refill solutions were described by flavour and nicotine content. Descriptive statistics and bivariate analyses were conducted on the overall sample and stratified by country. A multinomial logistic regression examined factors associated with device preference across the whole sample. Results: The types of NVPs used differed by pattern of use and country. Exclusive, daily vapers were more likely to use refillable pen‐shaped devices [odds ratio (OR) = 10.0] or refillable box‐shaped devices (OR = 5.4) than disposable cigalike devices, when compared with other (non‐daily/dual) users. Nearly all respondents reported using flavoured NVPs, fruit (28.3%) being the most common flavour. Refillable devices were the most popular: refillable box‐shaped devices were more commonly reported by vapers in AU (36.8%) and US (31.4%), whereas in EN (47.4%) and CA (29.7%), vapers more often reported using refillable pen‐style devices. Most users also reported that their products contained nicotine, even in CA (87.8%) and AU (91.2%), where vaping products containing nicotine were technically illegal. Conclusions: In Australia, Canada, England and the United States in 2016, refillable nicotine vaping products were the most common type of nicotine vaping products used by daily vapers. Most daily vapers reported using flavoured e‐liquids/refills (with variance across countries) and most reported using products that contain nicotine, even where vaping products with nicotine were banned. [ABSTRACT FROM AUTHOR]

Aims: To determine whether a simple combination of level of smoking and level of vaping results in a useful typology for characterizing smoking and vaping behaviours. Methods: Cross‐sectional data from adults (≥ 18 years) in the 2016 wave 1 ITC Four Country Smoking and Vaping Survey in the United States (n = 2291), England (n = 3591), Australia (n = 1376) and Canada (n = 2784) were used. Participants who either smoked, vaped or concurrently used both at least monthly were included and divided into eight groups based on use frequency of each product (daily, non‐daily, no current use). This resulted in four concurrent use groups (predominant smokers, dual daily users, predominant vapers and concurrent non‐daily users). These groups were compared with each other and with the four exclusive use groups, on socio‐demographics, nicotine dependence, beliefs and attitudes about both products, and quit‐related measures using data weighted to reference population surveys in each country. Results: Of the sample, 10.8% were concurrent users, with daily smokers vaping non‐daily (predominant smokers), constituting 51.6% of this group. All eight categories differed from other categories on at least some measures. Concurrent daily nicotine users reported higher levels of indicators of nicotine dependence, and generally more positive attitudes toward both smoking and vaping than concurrent non‐daily users. Among daily nicotine users, compared with exclusive daily smokers, reports of interest in quitting were higher in all concurrent use groups. Dual daily users had the most positive attitudes about smoking overall, and saw it as the least denormalized, and at the same time were equally interested in quitting as other concurrent users and were most likely to report intending to continue vaping. Conclusions: In Australia, Canada, England and the United States in 2016, daily nicotine users differed considerably from non‐daily nicotine users. Among daily nicotine users, dual daily users (those who smoke and vape concurrently) should be treated as a distinct grouping when studying relationships between smoking and vaping. The eight‐level typology characterizing concurrent and exclusive use of smoking and vaping should be considered when studying both products. [ABSTRACT FROM AUTHOR]

Aims: To determine if there are associations between changes in the explicit (i.e. price) and implicit (i.e. use restrictions in public places) costs of cigarettes and nicotine vaping products (NVPs) and their use patterns in the United States. Methods: Data came from wave 1 (2016) US data of the ITC Four Country Smoking and Vaping Survey (ITC US 4CV1) and Nielsen Scanner Track database. A multiple logistic regression model was applied to estimate the likelihoods of NVP use (vaping at least monthly), cigarette/NVP concurrent use (vaping and smoking at least monthly) and switch from cigarettes to NVPs (had quit smoking < 24 months and currently vape) among ever smokers, conditioning upon cigarette/NVP prices, use restrictions and socio‐demographics. Results: Living in places where vaping is allowed in smoke‐free areas was significantly associated with an increase in the likelihood of vaping [marginal effect (ME) = 0.17; P < 0.05] and the concurrent use of cigarettes and NVPs (ME = 0.11; P < 0.05). Higher NVP prices were associated with decreased likelihood of NVP use, concurrent use, and complete switch (P > 0.05). Higher cigarette prices were associated with greater likelihood of cigarette and NVP concurrent use (P > 0.05). Working in places where vaping is banned is associated with lower likelihood of vaping and NVP and cigarette concurrent use (P > 0.05). Conclusions: Higher prices for nicotine vaping products (NVPs) and vaping restrictions in public places are associated with less NVP use and less concurrent use of vaping and smoking. Public policies that increase prices for vaping devices and supplies (i.e. regulations, taxes) and restrict where vaping is allowed are likely to suppress vaping. [ABSTRACT FROM AUTHOR]

Background and Aims: Government regulations of nicotine vaping products (NVP) have evolved rapidly during the past decade. The impact of NVP regulatory environment and vaping on cigarette demand is unknown. The current study aims to investigate whether or not respondents' reported cigarette demand, as measured by a hypothetical cigarette purchase task, varies with (1) smoking status, (2) vaping status or (3) NVP regulatory environment (country used as proxy). Design Cross‐sectional survey data from wave 1 of the International Tobacco Control (ITC) Four Country Smoking and Vaping (4CV) Survey (2016). Setting: Australia, Canada, England and the United States. Participants: A total of 10 316 adult smokers. Measurements A hypothetical purchase task asked smokers to estimate how many cigarettes they would purchase for consumption in a single day across multiple cigarette prices. Responses were used to derive measures of cigarette demand. Overall sensitivity of cigarette consumption to price increases was quantified to index cigarette demand elasticity, whereas estimated consumption when cigarettes are free was used to index cigarette demand intensity. Findings A majority of the non‐daily smokers had previously smoked daily (72.3%); daily vapers were more likely to be former daily smokers (89.9%) compared to non‐daily vapers (70.1%) and non‐vapers (69.2%) (P < 0.001). The smoking status × vaping status interaction was significant for cigarette demand intensity (F = 4.93; P = 0.007) and elasticity (F = 7.30; P = 0.001): among non‐daily smokers, vapers reported greater intensity but lower elasticity (i.e. greater demand) relative to non‐vapers (Ps < 0.05). Among daily smokers, daily vapers reported greater intensity relative to non‐vapers (P = 0.005), but vaping status did not impact elasticity (Ps > 0.38). Intensity was higher in Australia compared with all other countries (Ps < 0.001), but elasticity did not vary by country (F = 2.15; P = 0.09). Conclusions: In a hypothetical purchase task, non‐daily smokers showed lower price elasticity if they used e‐cigarettes than if they did not, while there was no clear difference in elasticity between e‐cigarette users and non‐users among daily smokers or according to regulatory environment of their country with regard to e‐cigarettes. [ABSTRACT FROM AUTHOR]

This paper argues that chaos theory provides a useful theorectical framework for understanding the dynamic evolution of industries and the complex interactions among industry actors. It is argued that industries can be conceptualized and modeled as complex, dynamic systems, which exhibit both unpredictability and underlying order. The relevance of chaos theory for strategy is discussed, and a number of managerial implications are suggested. To illustrate the application of chaos theory, a simulation model is presented that depicts the interactions between a manufacturer of computers, its suppliers, and its market. The results of the simulation demonstrate how managers might underestimate the costs of international production. The paper concludes that, by understanding industries as complex systems, managers can improve decision making and search for innovative solutions. [ABSTRACT FROM AUTHOR]

Abstract: The article describes a new concept of an optical hybrid thin‐film material that exhibits reversible humidity‐driven light transmittance (scattering) properties. The film consists of a dispersive porous structure, with embedded hygroscopic and deliquescent compounds, that is able to scavenge water molecules from humid air to fill up the pores and become transparent to the incident light. Upon exposure to dry air, water is released from the structure and the material recovers its original light scattering properties. The developed thin films can change their transparency when exposed to air with different relative humidity (RH), adjusting the light throughput. This material can, therefore, be used to design new optical switching systems, having the advantage that they do not require liquid crystal, transparent conductive glass substrates, or complex layer‐by‐layer architectures for operation. In this work, a thin film was prepared by the sol–gel technique using calcium chloride as deliquescent substance embedded in a hybrid silica–titania matrix. At dry air, the thin films show a highly dispersive state, with a light transmittance T = 0.06, while at 51% RH the film exhibits a transparent state with a transmittance T =0.67 (measured at 633 nm). [ABSTRACT FROM AUTHOR]

The use of vaporized nicotine products (VNPs), especially e-cigarettes and, to a lesser extent, pressurized aerosol nicotine products and heat-not-burn tobacco products, are being adopted increasingly as an alternative to smoking combusted products, primarily cigarettes. Considerable controversy has accompanied their marketing and use. We propose a framework that describes and incorporates patterns of VNP and combustible cigarette use in determining the total amount of toxic exposure effects on population health. We begin by considering toxicity and the outcomes relevant to population health. We then present the framework and define different measures of VNP use; namely, trial and long-term use for exclusive cigarette smokers, exclusive VNP and dual (cigarette and VNP) use. Using a systems thinking framework and decision theory we considered potential pathways for current, former and never users of VNPs. We then consider the evidence to date and the probable impacts of VNP use on public health, the potential effects of different policy approaches and the possible influence of the tobacco industry on VNP and cigarette use. [ABSTRACT FROM AUTHOR]

Commentary to: A framework for evaluating the public health impact of e‐cigarettes and other vaporized nicotine products [ABSTRACT FROM AUTHOR]

What's known on the subject? and What does the study add? Previous studies have identified the most important prognostic factors of the likely outcomes of salvage prostate whole-gland ablation, including initial clinical stage, biopsy Gleason score, and PSA (total and doubling time). There is potential for further optimization of candidate selection for salvage cryoablation with curative intent and nadir PSA achieved after whole-gland cryotherapy may provide additional prognostic value., The study shows that the most important prognostic factors of biochemical progression-free survival for patients who have undergone whole-gland salvage prostate cryotherapy are nadir PSA achieved after therapy and pre-therapy biopsy Gleason score. Based on these two prognostic variables, we have identified risk stratification groups (low, intermediate and high) which help predict the expected outcomes of salvage whole-gland prostate cryotherapy in a given patient. This risk stratification constitutes a useful clinical tool in defining which patients maybe best suited for this local salvage treatment method., Objective To assess the prognostic variables predicting the risk of biochemical progression-free survival ( bPFS) after salvage prostate whole-gland cryotherapy using the Phoenix definition of bPFS., Patients and Methods A total of 132 patients underwent prostate whole-gland salvage cryotherapy with curative intent. No patient underwent neoadjuvant/adjuvant hormonal ablative therapy, and all had extended post-salvage prostate-specific antigen ( PSA) follow-up data., Cox univariate and multivariate logistic regression analyses of potential predictors of bPFS were conducted., Kaplan- Meier analyses of b PFS was also performed., Results At a mean (range) follow-up of 4.3 (0.9-12.7) years, the median (range) post-cryotherapy nadir PSA achieved was 0.17 (0-33.9) ng/ mL., On multivariate analysis, predictors of bPFS were nadir PSA post-cryotherapy and pre-salvage biopsy Gleason score ( P < 0.001 and 0.009, respectively)., Risk stratification groups (low, intermediate and high) were developed based on the presence of zero, one or two adverse risk factors, the risk factors being either a nadir PSA >2.5 ng/ mL or biopsy Gleason score ≥7, with the Kaplan- Meier bPFS curves of these risk groups being significantly different ( P = 0.02 and <0.001, respectively)., Conclusions Post-salvage nadir PSA and pre-salvage biopsy Gleason score are important predictors of outcome in this patient cohort., Low-, intermediate- and high-risk groups can be determined based on these variables and can define patients best suited for prostate cryotherapy. [ABSTRACT FROM AUTHOR]

Childhood obesity is a significant public health problem requiring innovative solutions. While recent reviews indicate that some policies show promise, there is a lack of information regarding which policies, and policy combinations, work best. Low-nutrition, energy-dense foods and beverages such as sugar-sweetened beverages (SSBs) have been identified as a major contributor to the problem. The purpose of this paper is to use simulation modeling to show how changes in three categories of SSB policies-school nutrition, school-based education, and taxes-impact SSB and other food consumption. The model shows that policies directed at SSBs, particularly tax hikes, could lead to substantial reductions in the number of calories consumed by youth. The estimates, however, are subject to a high degree of uncertainty. Estimates from school-based nutrition and school-based education policies, while also helping to reduce caloric intake, generally show smaller effects than tax policies and considerable variation around parameter estimates for individual and combined policies. We conclude with a discussion of the limits of the model, and suggest where additional information is needed. Limitations notwithstanding, simulation modeling is a promising methodology that can help advance our understanding of policy effects, thereby helping policymakers to better formulate effective policies to reduce obesity prevalence and the associated social harms. [ABSTRACT FROM AUTHOR]

Study Type - Disagnostic (exploratory cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Many patients undergo serial biopsy with a low rate of detection of prostate cancer, and the rate of detection declines as more biopsies are pursued. Furthermore, the clinical significance of detected cancer appears to decline as well. It is important to follow all possible methods to detect cancer; however, there should be a parallel consideration for the clinical value for detection of these tumours with low malignant potential. The present study investigated in detail the total rate of cancer detection in serial biopsy and how many of these were deemed clinically insignificant. Moreover, it addressed the impact of detecting premalignant lesions on further detection of cancer in serial biopsy. OBJECTIVE Many patients pursue serial prostate biopsies after two consecutive negative biopsy sessions. The objective of this study is to determine the indications of serial prostate biopsy and to compare outcomes, including the risk of detecting clinically insignificant cancer using different biopsy protocols in this highly selected population., PATIENTS AND METHODS Most cases of prostate cancer are detected on initial or one repeat biopsy, but persistent suspicion of prostate cancer occasionally leads to serial biopsy, which we define as more than two biopsy sessions. We recently showed that transrectal saturation biopsy (sPBx) significantly increases cancer detection when compared with extended schemes (ePBx) in the initial repeat biopsy (second overall biopsy) population, and that most cases identified are clinically significant., In the past decade, 479 men underwent 749 repeat prostate biopsies after two prior negative biopsy sessions., The ePBx group included 347 biopsies with 10-14 cores., The sPBx group included 402 biopsies with >20 cores., We analysed overall cancer detection and risk of detecting clinically significant vs insignificant tumours., RESULTS Prostate cancer was detected in 15.9% of 749 serial biopsies, representing a cumulative prostate cancer detection rate of 24.8% (119/479 patients)., The sPBx group had a significantly higher detection rate per biopsy session (18.6% vs 12.7%, P= 0.026)., Nevertheless, most positive biopsies 75/119 (63%) revealed clinically insignificant cancer, including 74.6% of cancers detected by sPBx., CONCLUSION In men with two prior negative prostate biopsies, prostate cancer detection remains low regardless of clinical indication or transrectal biopsy protocol; most cancers identified are clinically insignificant, suggesting the threshold to repeat biopsy after more than one negative session should be very high. [ABSTRACT FROM AUTHOR]

The relationship between smoking and lung cancer is well established and cohort studies pro-vide estimates of risk for individual cohorts. While population trends are qualitatively consistent with smoking trends, the rates do not agree well with results from analytical studies. Four carcinogenesis models for the effect of smoking on lung cancer mortality were used to estimate lung cancer mortality rates for U.S. males: two-stage clonal expansion and multistage models using parameters estimated from two Cancer Prevention Studies (CPS I and CPS II). Calibration was essential to adjust for both shift and temporal trend. The age-period-cohort model was used for calibration. Overall, models using parameters derived from CPS I performed best, and the corresponding two-stage clonal expansion model was best overall. However, temporal calibration did significantly improve agreement with the population rates, especially the effect of age and cohort. [ABSTRACT FROM AUTHOR]

Background: A consortium of six research groups estimated the impact on lung cancer mortality of changes in smoking behavior that began around the publication of the Surgeon General's report (SGR). This chapter presents the results of that effort. We quantified the cu-mulative impact of changes in smoking behaviors on lung cancer mortality in the United States over the period 1975-2000. Methods: The six groups used common inputs and independent models to estimate the number of U.S. lung cancer deaths averted over the period 1975-2000 as a result of changes in smoking behavior beginning in the mid fifties, and the number of deaths that could have been averted if tobacco control had completely eliminated all smoking following issuance of the first SGR on Smoking and Health in 1964. Results: Approximately 795,000 deaths (550,000 men and 245,000 women) were averted over the period 1975-2000 as a result of changes in smoking behavior since in 1950s. In the year 2000 alone approximately 70,000 lung cancer deaths were averted (44,000 among men and 26,000 among women). However, these represent approximately 30% of lung cancer deaths that could have potentially been averted over the period 1975-2000 if smoking was eliminated completely. In the 10-year period 1991-2000, this fraction increased to about 37%. Conclusions: Our results show the substantial impact of changes in smoking behavior since the 1950s. Despite a major impact of changing smoking behaviors, tobacco control effort are still needed to further reduce the burden of this disease. [ABSTRACT FROM AUTHOR]

The smoking history generator (SHG) developed by the National Cancer Institute simulates individual life/smoking histories that serve as inputs for the Cancer Intervention and Surveillance Modeling Network (CISNET) lung cancer models. In this chapter, we review the SHG inputs, describe its outputs, and outline the methodology behind it. As an example, we use the SHG to simulate individual life histories for individuals born between 1890 and 1984 for each of the CISNET smoking scenarios and use those simulated histories to compute the corresponding smoking prevalence over the period 1975-2000. [ABSTRACT FROM AUTHOR]

Past studies have examined the relationship of lung cancer to smoking using longitudinal data for select samples. This study applies the two-stage clonal expansion (TSCE) model to U.S. + smoking data over a 25-year period. Smoking Base Case (SBC) data on actual smoking duration and intensity from the years 1975-2000 are applied by gender to separate TSCE models, which are then calibrated to historical trends in lung cancer death rates using regression analysis. The uncalibrated and calibrated TSCE models are also applied to SBC data for two scenarios: (1) no tobacco control and (2) complete tobacco control. The results are used to develop estimates of the number of lives saved as a result of tobacco control and how many lives would be saved if cigarette use had ceased in 1965. Predictions of lung cancer from the TSCE models with CPS-II and the CPS-I data for males and especially females are considerably below historical rates with the deviations from historical rates increasing over time. Residual trends unrelated to the smoking models were also found. Tobacco control activities saved approximately 625,000 lives between the years 1975 and 2000. An additional 2,110,000 lives would have been saved if all smoking was stopped in 1965. Tobacco control has successfully prevented lung cancer deaths, but many more lives could be saved with further reductions in smoking rates. Systematic biases were observed from TSCE models using CPS-I and CPS-II data to estimate smoking-related lung cancer deaths. [ABSTRACT FROM AUTHOR]

To better understand the contribution of cigarette smoking, and its changing role in lung cancer, this article provides an introduction to a special issue of Risk Analysis, which considers the relationship between smoking and lung cancer death rates during the period 1975-2000 for U.S. men and women aged 30-84 years. Six models are employed, which are part of a consortium of lung cancer modelers funded by National Cancer Institute's Cancer Intervention and Surveillance Modeling Network (CISNET). Starting with birth-cohort-specific smoking histories derived from National Health Interview Surveys, three scenarios are modeled: Actual Tobacco Control (observed trends in smoking), Complete Tobacco Control (a counter-factual lower bound on smoking rates that could have been achieved had all smoking ceased after the first Surgeon General's report in 1964), and No Tobacco Control (a counterfactual upper bound on smoking rates if smoking patterns that prevailed before the first studies in the 1950s began to inform the public about the hazards of smoking). Using these three scenarios and the lung cancer models, the number and percentage of lung cancer deaths averted from 1975-2000, among all deaths that could have been averted if tobacco control efforts been immediate and perfect, can be estimated. The variability of the results across multiple models provides a measure of the robustness of the results to model assumptions and structure. The results provide not only a portrait of the achieved impact of tobacco control on lung cancer mortality, but also the bounds of what still needs to be achieved. [ABSTRACT FROM AUTHOR]

Past studies have examined the relationship of lung cancer to smoking using longitudinal data for select samples. This study applies the two-stage clonal expansion (TSCE) model to U.S. +xsmoking data over a 25-year period. Smoking Base Case (SBC) data on actual smoking duration and intensity from the years 1975-2000 are applied by gender to separate TSCE models, which are then calibrated to historical trends in lung cancer death rates using regression analysis. The uncalibrated and calibrated TSCE models are also applied to SBC data for two scenarios: (1) no tobacco control and (2) complete tobacco control. The results are used to develop estimates of the number of lives saved as a result of tobacco control and how many lives would be saved if cigarette use had ceased in 1965. Predictions of lung cancer from the TSCE models with CPS-II and the CPS-I data for males and especially females are considerably below historical rates with the deviations from historical rates increasing over time. Residual trends unrelated to the smoking models were also found. Tobacco control activities saved approximately 625,000 lives between the years 1975 and 2000. An additional 2,110,000 lives would have been saved if all smoking was stopped in 1965. Tobacco control has successfully prevented lung cancer deaths, but many more lives could be saved with further reductions in smoking rates. Systematic biases were observed from TSCE models using CPS-I and CPS-II data to estimate smoking-related lung cancer deaths. [ABSTRACT FROM AUTHOR]

Background: A consortium of six research groups estimated the impact on lung cancer mortality of changes in smoking behavior that began around the publication of the Surgeon General's report (SGR). This chapter presents the results of that effort. We quantified the cumulative impact of changes in smoking behaviors on lung cancer mortality in the United States over the period 1975-2000. Methods: The six groups used common inputs and independent models to estimate the number of U.S. lung cancer deaths averted over the period 1975-2000 as a result of changes in smoking behavior beginning in the mid fifties, and the number of deaths that could have been averted if tobacco control had completely eliminated all smoking following issuance of the first SGR on Smoking and Health in 1964. Results: Approximately 795,000 deaths (550,000 men and 245,000 women) were averted over the period 1975-2000 as a result of changes in smoking behavior since in 1950s. In the year 2000 alone approximately 70,000 lung cancer deaths were averted (44,000 among men and 26,000 among women). However, these represent approximately 30% of lung cancer deaths that could have potentially been averted over the period 1975-2000 if smoking was eliminated completely. In the 10-year period 1991-2000, this fraction increased to about 37%. Conclusions: Our results show the substantial impact of changes in smoking behavior since the 1950s. Despite a major impact of changing smoking behaviors, tobacco control effort are still needed to further reduce the burden of this disease. [ABSTRACT FROM AUTHOR]

The smoking history generator (SHG) developed by the National Cancer Institute simulates individual life/smoking histories that serve as inputs for the Cancer Intervention and Surveillance Modeling Network (CISNET) lung cancer models. In this chapter, we review the SHG inputs, describe its outputs, and outline the methodology behind it. As an example, we use the SHG to simulate individual life histories for individuals born between 1890 and 1984 for each of the CISNET smoking scenarios and use those simulated histories to compute the corresponding smoking prevalence over the period 1975-2000. [ABSTRACT FROM AUTHOR]

The relationship between smoking and lung cancer is well established and cohort studies provide estimates of risk for individual cohorts. While population trends are qualitatively consistent with smoking trends, the rates do not agree well with results from analytical studies. Four carcinogenesis models for the effect of smoking on lung cancer mortality were used to estimate lung cancer mortality rates for U.S. males: two-stage clonal expansion and multistage models using parameters estimated from two Cancer Prevention Studies (CPS I and CPS II). Calibration was essential to adjust for both shift and temporal trend. The age-period-cohort model was used for calibration. Overall, models using parameters derived from CPS I performed best, and the corresponding two-stage clonal expansion model was best overall. However, temporal calibration did significantly improve agreement with the population rates, especially the effect of age and cohort. [ABSTRACT FROM AUTHOR]

To better understand the contribution of cigarette smoking, and its changing role in lung cancer, this article provides an introduction to a special issue of Risk Analysis, which considers the relationship between smoking and lung cancer death rates during the period 1975-2000 for U.S. men and women aged 30-84 years. Six models are employed, which are part of a consortium of lung cancer modelers funded by National Cancer Institute's Cancer Intervention and Surveillance Modeling Network (CISNET). Starting with birth-cohort-specific smoking histories derived from National Health Interview Surveys, three scenarios are modeled: Actual Tobacco Control (observed trends in smoking), Complete Tobacco Control (a counterfactual lower bound on smoking rates that could have been achieved had all smoking ceased after the first Surgeon General's report in 1964), and No Tobacco Control (a counterfactual upper bound on smoking rates if smoking patterns that prevailed before the first studies in the 1950s began to inform the public about the hazards of smoking). Using these three scenarios and the lung cancer models, the number and percentage of lung cancer deaths averted from 1975-2000, among all deaths that could have been averted if tobacco control efforts been immediate and perfect, can be estimated. The variability of the results across multiple models provides a measure of the robustness of the results to model assumptions and structure. The results provide not only a portrait of the achieved impact of tobacco control on lung cancer mortality, but also the bounds of what still needs to be achieved. [ABSTRACT FROM AUTHOR]