Smoking and vaping are especially prevalent among people with experience of psychosis (EoP), potentially increasing their toxicant exposure. Switching from tobacco smoking to vaping e-cigarettes reduces exposure to tobacco-related toxicants and likely associated diseases. We compared levels of nicotine and tobacco-related toxicant exposure among people with versus without EoP.

Cross-sectional study, secondary data analysis of Wave 5 (2018) of the Population Assessment of Tobacco and Health Study.

Data collection took place in the USA at the home of participants.

Data were from 5750 adults (aged >18 years) with and without EoP who smoked, vaped, did both or did neither. EoP was defined as ever being told by a health professional that you have schizophrenia, schizoaffective disorder, psychosis, a psychotic illness or psychotic episode.

Levels of urinary toxicants: nicotine metabolites, metals, volatile organic compounds (VOCs) and tobacco-specific nitrosamines (TSNAs) among people with and without EoP. Analyses were adjusted for demographics, cannabis use and past 30-day smoking/vaping status, and were repeated after stratifying by smoking /vaping status.

Of the 5750 participants, 6.3% (n=361) reported EoP, and 93.7% reported no EoP. Levels of nicotine and TSNA metabolites, cadmium, uranium and some VOCs were significantly higher among participants with EoP compared with those without. However, when smoking, vaping and cannabis use were taken into account, the associations of EoP with nicotine and TSNA metabolites, and most of the VOCs, were attenuated and no longer significant.

Participants with EoP are exposed to more nicotine and tobacco-related toxicants than those without EoP, likely largely due to the high prevalence of smoking, vaping and cannabis use among this population.

Thanks to the introduction of recent national guidelines for treating herpes simplex virus (HSV) encephalitis, health outcomes have improved. This paper evaluates the health system costs and the health-related quality of life implications of these guidelines.

A sub-analysis of data from a prospective, multi-centre, observational cohort ENCEPH-UK study conducted across 29 hospitals in the UK from 2012 to 2015.

Data for patients aged ≥16 years with a confirmed HSV encephalitis diagnosis admitted for treatment with aciclovir were collected at discharge, 3 and 12 months.

Patient health outcomes were measured by the Glasgow outcome score (GOS), modified ranking score (mRS) and the EuroQoL; healthcare costs were estimated per patient at discharge from hospital and at 12 months follow-up. In addition, Quality Adjusted Life Years (QALYs) were calculated from the EQ-5D utility scores. Cost–utility analysis was performed using the NHS and Social Care perspective.

A total of 49 patients were included; 35 were treated within 48 hours, ‘early’ (median (IQR) 8.25 [3.7–20.5]) and 14 were treated after 48 hours ‘delayed’ (median (IQR) 93.9 [66.7–100.1]). At discharge, 30 (86%) in the early treatment group had a good mRS outcome score (0–3) compared with 4 (29%) in the delayed group. According to GOS, 10 (29%) had a good recovery in the early treatment group, but only 1 (7%) in the delayed group. EQ-5D-3L utility value at discharge was significantly higher for early treatment (0.609 vs 0.221, p

This study suggests that early treatment may be associated with better health outcomes and reduced patient healthcare costs, with a potential for savings to the NHS with faster treatment.

To evaluate inhaler sustainability in asthma and Chronic Obstructive Pulmomary Disease (COPD) by analysing how inhaler design typology, prescribing and usage patterns, disposal and recycling practices influence human health and environmental outcomes, using a People-Process-Product (PPP) framework to identify actionable opportunities for improvement.

A systematic review was conducted in May 2024, with reporting structured around the PPP framework using narrative synthesis.

MEDLINE, Scopus, Cochrane Library and relevant grey literature were searched for publications over the period from April 2014 to April 2024.

Studies were included if published between 2014 and 2024, involved patients with asthma or COPD and healthcare professionals and specifically examined aspects of inhaler sustainability, including patient behaviours, healthcare provider prescribing practices and environmental impacts.

Two independent reviewers screened and extracted data from 63 studies. Due to diverse methodologies, quality assessment focused on research design robustness, completeness of outcome reporting and potential biases. Findings were synthesised narratively to address each research question using the PPP framework.

33% of included studies focused on two or more domains of the PPP framework as both primary and/or secondary outcomes. Studies mapped to the ‘People’ domain (n=34) showed limited awareness among patients and clinicians regarding the environmental impact of inhaler prescription patterns, use patterns and disposal methods, with over 75% of patients discarding inhalers in household waste. In the ‘Process’ domain (n=11), switching from pressurised metered-dose inhalers (pMDIs) to dry powder inhalers (DPIs) or soft mist inhalers (SMIs) was associated with improved inhaler adherence and asthma control, though uptake of new inhalers was influenced by patients’ prior experience, competence, proficiency and perceived usability. The ‘Product’ domain (n=41) showed that DPIs and SMIs consistently had lower carbon footprints than pMDIs, with short-acting beta-agonists (SABAs) pMDIs having the highest emissions due to prescription, use patterns and disposal.

Improving patient education on sustainable inhaler use and disposal and providing healthcare professionals with focused training on low-carbon prescribing are critical steps towards achieving significant clinical benefits and supporting environmental sustainability in asthma and COPD management.

CRD42024541927.

While survival rates following neonatal surgery for congenital heart disease (CHD) have improved over the years, neurodevelopmental delays are still highly prevalent in these patients. After correcting for the CHD subtype, the severity of developmental impairment is dependent on multiple factors, including intraoperative brain injury, which is more frequent and more severe in those undergoing aortic arch repair with deep hypothermic circulatory arrest (DHCA). It is proposed that brain injury may be reduced if cooling is stopped at the point of electrocerebral inactivity (ECI) on electroencephalogram (EEG), but there is limited evidence to support this as few centres perform perioperative EEG routinely. This study aims to assess the feasibility of EEG monitoring during neonatal aortic arch repair and investigate the relationship between temperature and EEG to inform the design of a future clinical trial.

Single-centre prospective observational cohort study in a UK specialist children’s hospital, aiming to recruit 74 neonates (≤4 weeks corrected age) undergoing aortic arch repair with DHCA. EEG will be acquired at least 1–3 hours before surgery, and brain activity will be monitored continuously until 24 hours following admission to intensive care. Demographic, clinical, surgical and outcome variables will be collected. Feasibility will be measured by the number of patients recruited, data collection procedures, technically successful EEG recordings and adverse events. The main outcomes are the temperature at which ECI is achieved and its duration, EEG patterns at key perioperative steps and neurodevelopmental outcomes at 24 months postsurgery.

The study was approved by the Yorkshire and The Humber Sheffield National Health Service Research Ethics Committee (20/YH/0192) on 18 June 2020. Written informed consent will be obtained from the participant’s parent/guardian prior to surgery. Findings will be disseminated to the academic community through peer-reviewed publications and presentations at conferences. Parents/guardians will be informed of the results through a newsletter in conjunction with local charities.