A before-after implementation trial of smoking cessation guidelines in hospitalized veterans

Abstract Background Although most hospitalized smokers receive some form of cessation counseling during hospitalization, few receive outpatient cessation counseling and/or pharmacotherapy following discharge, which are key factors associated with long-term cessation. US Department of Veterans Affairs (VA) hospitals are challenged to find resources to implement and maintain the kind of high intensity cessation programs that have been shown to be effective in research studies. Few studies have applied the Chronic Care Model (CCM) to improve inpatient smoking cessation. Specific objectives The primary objective of this protocol is to determine the effect of a nurse-initiated intervention, which couples low-intensity inpatient counseling with sustained proactive telephone counseling, on smoking abstinence in hospitalized patients. Key secondary aims are to determine the impact of the intervention on staff nurses' attitudes toward providing smoking cessation counseling; to identify barriers and facilitators to implementation of smoking cessation guidelines in VA hospitals; and to determine the short-term cost-effectiveness of implementing the intervention. Design Pre-post study design in four VA hospitals Participants Hospitalized patients, aged 18 or older, who smoke at least one cigarette per day. Intervention The intervention will include: nurse training in delivery of bedside cessation counseling, electronic medical record tools (to streamline nursing assessment and documentation, to facilitate prescription of pharmacotherapy), computerized referral of motivated inpatients for proactive telephone counseling, and use of internal nursing facilitators to provide coaching to staff nurses practicing in non-critical care inpatient units. Outcomes The primary endpoint is seven-day point prevalence abstinence at six months following hospital admission and prolonged abstinence after a one-month grace period. To compare abstinence rates during the intervention and baseline periods, we will use random effects logistic regression models, which take the clustered nature of the data within nurses and hospitals into account. We will assess attitudes of staff nurses toward cessation counseling by questionnaire and will identify barriers and facilitators to implementation by using clinician focus groups. To determine the short-term incremental cost per quitter from the perspective of the VA health care system, we will calculate cessation-related costs incurred during the initial hospitalization and six-month follow-up period. Trial number NCT00816036http://deepblue.lib.umich.edu/bitstream/2027.42/112349/1/13012_2009_Article_190.pd

Combinations of single-top-quark production cross-section measurements and |fLVVtb| determinations at s \sqrt{s} = 7 and 8 TeV with the ATLAS and CMS experiments

Abstract This paper presents the combinations of single-top-quark production cross-section measurements by the ATLAS and CMS Collaborations, using data from LHC proton-proton collisions at $$\sqrt{s}$$ s = 7 and 8 TeV corresponding to integrated luminosities of 1.17 to 5.1 fb−1 at $$\sqrt{s}$$ s = 7 TeV and 12.2 to 20.3 fb−1 at $$\sqrt{s}$$ s = 8 TeV. These combinations are performed per centre-of-mass energy and for each production mode: t-channel, tW, and s-channel. The combined t-channel cross-sections are 67.5 ± 5.7 pb and 87.7 ± 5.8 pb at $$\sqrt{s}$$ s = 7 and 8 TeV respectively. The combined tW cross-sections are 16.3 ± 4.1 pb and 23.1 ± 3.6 pb at $$\sqrt{s}$$ s = 7 and 8 TeV respectively. For the s-channel cross-section, the combination yields 4.9 ± 1.4 pb at $$\sqrt{s}$$ s = 8 TeV. The square of the magnitude of the CKM matrix element V tb multiplied by a form factor f LV is determined for each production mode and centre-of-mass energy, using the ratio of the measured cross-section to its theoretical prediction. It is assumed that the top-quark-related CKM matrix elements obey the relation |V td |, |V ts | ≪ |V tb |. All the |f LV V tb |2 determinations, extracted from individual ratios at $$\sqrt{s}$$ s = 7 and 8 TeV, are combined, resulting in |f LV V tb | = 1.02 ± 0.04 (meas.) ± 0.02 (theo.). All combined measurements are consistent with their corresponding Standard Model predictions. </jats:p