Dose-response relationship of lung cancer to amount smoked, duration and age starting

AIM： To quantify smoking/lung cancer relationships accurately using parametric modelling.METHODS： Using the International Epidemiological Studies on Smoking and Lung Cancer database of all epidemiological studies of 100＋ lung cancer cases published before 2000, we analyzed 97 blocks of data for amount smoked, 35 for duration of smoking, and 27 for age started. Pseudo-numbers of cases and controls （or at risk） estimated from RRs by dose level formed the data modelled. We fitted various models relating loge RR to dose （d）, including βd, βdY and βloge （1 ＋ Wd）, and investigated goodness-of-fit and heterogeneity between studies.0.833 loge [1 ＋ （8.1c/10）] for cigarettes/d （c）, 0.792 （y/10）0.74 for years smoked （y） and 0.176 [（70 - a）/10]1.44 for age of start （a）. Each model fitted well overall, though some blocks misfitted. RRs rose from 3.86 to 22.31 between c = 10 and 50, from 2.21 to 13.54 be-tween y = 10 and 50, and from 3.66 to 8.94 between a = 30 and 12.5. Heterogeneity （P 〈 0.001） existed by continent for amount, RRs for 50 cigarettes/d being 7.23 （Asia）, 26.36 （North America） and 22.16 （Europe）. Little heterogeneity was seen for duration of smoking or age started.CONCLUSION： The models describe the dose-relation-ships well, though may be biased by factors including misclassification of smoking status and dose.

Influencing Factors on Cardiovascular Health in China

The Annual Report on Cardiovascular Health and Diseases in China(2022)intricate landscape of cardiovascular health in China.This is the first section of the report,which dissects influential factors across diverse domains.The investigation identifies tobacco use as a paramount concern,portraying China as the global epicenter of tobacco consumption.Cigarette smoking,exacerbated by second-hand smoke exposure,emerges as a critical and preventable risk factor,contributing to a surge in attributable deaths over the past three decades.In the realm of dietary nutrition,the study discerns an overall improvement,yet discerns worrisome deviations,notably an escalating fat intake surpassing recommended guidelines.The shifting dietary structure reveals diminished consumption of cereals and vegetables juxtaposed with an uptick in animal foods,while excessive intake of cooking oil and salt persists,straying substantially from endorsed levels.The exploration of physical activity patterns unfolds a nuanced narrative.Varied trends are observed among students,with concerns arising from sedentary behaviors and inadequate adherence to recommended guidelines.The analysis spans a trajectory of declining physical activity in Chinese adults,coupled with an alarming surge in sedentary leisure time,ultimately linking these factors to heightened risks of cardiovascular diseases and increased adiposity.An examination of overweight and obesity trends uncovers a relentless upward trajectory,projecting substantial prevalence by 2030.Noteworthy prevalence rates underscore the imperative for targeted interventions to curtail this burgeoning health crisis,with the anticipated prevalence extending to nearly two-thirds of the adult population.Psychological factors,notably depression,constitute an integral facet of cardiovascular health.Prevalence rates among patients with coronary artery disease and acute myocardial infarction underscore the intricate interplay between mental health and cardiovascular outcomes.Additionally,persistent depressive symptoms are shown to significantly elevate the risk of cardiovascular diseases and mortality.This first section underscores the multifaceted challenges facing cardiovascular health in China,emphasizing the imperative for tailored interventions across tobacco control,dietary habits,physical activity,obesity management,and psychological well-being to mitigate the escalating burden of cardiovascular diseases in the population.

Inhibition of the NF-κB Signaling Pathway Improves Cigarette Mainstream Smoke-Induced Lung Injury and Gut Microbiota Disturbance

Currently,cigarette smoke(CS)remains a major contributor to disease morbidity and mortality.CS can be divided into cigarette mainstream smoke(CMS)and side-stream smoke,depending on where it is produced by burning tobacco^([1]).CMS is inhaled by smokers from the filter end during cigarette combustion and is strongly associated with the development of several diseases^([2-4]).

U-Net Inspired Deep Neural Network-Based Smoke Plume Detection in Satellite Images

Industrial activities, through the human-induced release of Green House Gas (GHG) emissions, have beenidentified as the primary cause of global warming. Accurate and quantitative monitoring of these emissions isessential for a comprehensive understanding of their impact on the Earth’s climate and for effectively enforcingemission regulations at a large scale. This work examines the feasibility of detecting and quantifying industrialsmoke plumes using freely accessible geo-satellite imagery. The existing systemhas so many lagging factors such aslimitations in accuracy, robustness, and efficiency and these factors hinder the effectiveness in supporting timelyresponse to industrial fires. In this work, the utilization of grayscale images is done instead of traditional colorimages for smoke plume detection. The dataset was trained through a ResNet-50 model for classification and aU-Net model for segmentation. The dataset consists of images gathered by European Space Agency’s Sentinel-2 satellite constellation from a selection of industrial sites. The acquired images predominantly capture scenesof industrial locations, some of which exhibit active smoke plume emissions. The performance of the abovementionedtechniques and models is represented by their accuracy and IOU (Intersection-over-Union) metric.The images are first trained on the basic RGB images where their respective classification using the ResNet-50model results in an accuracy of 94.4% and segmentation using the U-Net Model with an IOU metric of 0.5 andaccuracy of 94% which leads to the detection of exact patches where the smoke plume has occurred. This work hastrained the classification model on grayscale images achieving a good increase in accuracy of 96.4%.

Epidemiological and clinical characteristics of lung cancer in Saudi Arabia:a retrospective study in single oncology center

Background:Lung cancer(LC)is one of the most common neoplastic diseases and a leading cause of death in Saudi Arabia.Its incidence in Saudi Arabia has increased by more than 3%within two decades.Our study aimed to describe the epidemiological and genetic landscapes of LC in Al-Madinah city in Saudi Arabia.Methods:A retrospective analysis was conducted on the medical records of 65 patients diagnosed with lung cancer between 2015 and 2021 at a single medical oncology center in Al-Madinah city of Saudi Arabia.Results:The mean patients’age was 59.2 years,with 50(76.9%)males and 15(23.1%)females;37(57%)smokers,and 28(43%)non-smokers.The number of cases per year has increased gradually over six years from 2015(n=3)to 2020(n=13).The most prevalent histopathological diagnosis was non-small cell lung cancer(NSCLC)(n=58,89%)followed by small cell lung cancer(SCLC)(n=5,7.8%).NSCLC was frequently more common in smokers while squamous cell carcinoma was more frequent in non-smokers.Around 89%(n=58)of the cases were diagnosed in late stage IV and the most common metastatic sites were to pleura and lymph nodes(n=32,49.2%).Program Death Legend-1(PDL-1)was fairly expressed in 7/10(70%)patients.Epidermal Growth Factor Receptor(EGFR)was mutated in 5/17(29%)patients.Other mutations detected include Anaplastic Lymphoma Kinase(ALK)and phosphatidylinositol 3-kinase(PIK3C)mutations in two patients.Conclusions:Our study revealed that lung cancer is a significant burden in AlMadinah city of Saudi Arabia.If the risk factors are not controlled,the number of cases may increase considerably.Health education about the risk factors and cancer prevention helps in early lung cancer detection.

An Improved YOLOv5s-Based Smoke Detection System for Outdoor Parking Lots

In the rapidly evolving urban landscape,outdoor parking lots have become an indispensable part of the city’s transportation system.The growth of parking lots has raised the likelihood of spontaneous vehicle combus-tion,a significant safety hazard,making smoke detection an essential preventative step.However,the complex environment of outdoor parking lots presents additional challenges for smoke detection,which necessitates the development of more advanced and reliable smoke detection technologies.This paper addresses this concern and presents a novel smoke detection technique designed for the demanding environment of outdoor parking lots.First,we develop a novel dataset to fill the gap,as there is a lack of publicly available data.This dataset encompasses a wide range of smoke and fire scenarios,enhanced with data augmentation to ensure robustness against diverse outdoor conditions.Second,we utilize an optimized YOLOv5s model,integrated with the Squeeze-and-Excitation Network(SENet)attention mechanism,to significantly improve detection accuracy while maintaining real-time processing capabilities.Third,this paper implements an outdoor smoke detection system that is capable of accurately localizing and alerting in real time,enhancing the effectiveness and reliability of emergency response.Experiments show that the system has a high accuracy in terms of detecting smoke incidents in outdoor scenarios.

CES1 is associated with cisplatin resistance and poor prognosis of head and neck squamous cell carcinoma

Background:Head and neck squamous cell carcinoma(HNSCC)is a prevalent form of cancer globally,with chemoresistance posing a major challenge in treatment outcomes.The efficacy of the commonly used chemotherapeutic agent,cisplatin,is diminished in patients with poor prognoses.Methods:Various bioinformatics databases were utilized to examine Carboxylesterase 1(CES1)gene expression,clinicopathologic features,patient survival analysis,and gene function.An organoid model of HNSCC was established,along with the induction of drug-resistant HNSCC in the organoid model.CES1 expression was assessed using qRT-PCR and Western Blot,and differential markers were identified through transcriptome sequencing.Knockdown and overexpression models of CES1 were created in SCC-9 and patient-derived organoid(PDO)cells using shRNA and lentivirus to investigate the tumor biology and cisplatin resistance associated with CES1.Results:Research in bioinformatics has uncovered a strong correlation between the expression level of CES1 and the prognosis of HNSCC.The data suggests a significant link between CES1 expression and tobacco smoking.RNA-sequencing revealed a notable increase in CES1 expression in HNSCC-PDOcis-R cells compared to the parental PDO cells.Subsequently,we performed in vitro studies by HNSCC-PDO and SCC-9 and found that CES1-overexpressing cells exhibited reduced sensitivity to cisplatin and stronger tumor malignant biological behavior compared with CES1-knockdown cells.Conclusion:The observed association between CES1 expression and tobacco smoking implies a potential influence of smoking on the efficacy of cisplatin-based chemotherapy in HNSCC through the regulation of CES1 expression.

Small-scale fire tests in the underwater tunnel section model with new sidewall smoke extraction

The Shenzhen–Zhongshan Bridge is a 24‐km‐long bridge and tunnel system,including a 6.8-km-long super cross section subsea tunnel.To solve the smoke exhaust problem of a super large cross-section subsea tunnel,the tunnel has a new smoke exhaust system that combines a horizontal smoke exhaust cross section at the top and sidewall smoke exhaust holes.In order to evaluate the potential fire hazards of this type of tunnel,a 1:30 tunnel model was established and 140 smallscale experiments on underwater tunnel fires were conducted.By changing the fire power,fire location,and fan operation mode,different scenarios of submarine immersed tunnel fire were simulated and the related key parameters such as fire smoke diffusion behavior and smoke temperature distribution were studied.On this basis,the optimal smoke control strategy was proposed for different fire scenarios.The research results indicate that the new smoke exhaust system can fully utilize the smoke flow characteristics,significantly improve smoke exhaust efficiency,and increase available evacuation time,thus further enhancing the fire safety of super large cross-section subsea tunnels.

Net Effect of Short-Term Smoking Cessation on Mental Health Changes:Inverse Probability of Treatment Weighting and Difference-in-Differences Method

Background:In response to the need for research clearly demonstrating the net effect of smoking cessation on mental health status,considering the causal relationship between smoking cessation and changes in mental health status,this study was undertaken.Thus,this study aimed to examine the net effect of short-term smoking cessation on five specific mental health metrics and the overall mental health status score.Methods:We used data from the first wave of the Korean Health Panel(KHP)Survey(2011–2013,2016–2018)and focused on men aged 19 years and older,to explore the effects of smoking cessation.We compared mental health status before and after cessation among current non-smokers who had quit smoking and continuous smokers.We ensured homogeneity between the two groups via inverse probability of treatment weighting(IPTW)and employed a difference-in-differences(DID)analysis to assess changes in mental health status.This study controlled for factors that could influence mental health and explored the net effect of short-term smoking cessation through difference-in-differences model using multiple regression analysis.Results:The results showed that short-term smoking cessation significantly alleviated mental and physical stress(p<0.1),reduced experiences of frustration(p<0.01),and improved the overall mental health status score(p<0.1).Conclusion:Thus,these results highlight a meaningful link between positive health behavior changes,such as smoking cessation,and enhanced mental health.Moreover,the application of temporal variables further improved the understanding of the causal relationship between health behaviors and mental health.

Smoking cessation prior to elective total joint arthroplasty results in sustained abstinence postoperatively

BACKGROUND Tobacco use is a well-documented modifiable risk factor for perioperative complications.AIM To determine the tobacco abstinence rates of patients who made cessation efforts prior to a total joint arthroplasty(TJA)procedure.METHODS A retrospective evaluation was performed on 88 self-reported tobacco users who underwent TJA between 2014-2022 and had tobacco cessation dates within 3 mo of surgery.Eligible patients were contacted via phone survey to understand their tobacco use pattern,and patient reported outcomes.A total of 37 TJA patients participated.RESULTS Our cohort was on average 61-years-old,60%(n=22)women,with an average body mass index of 30 kg/m^(2).The average follow-up time was 2.9±1.9 years.A total of 73.0%(n=27)of patients endorsed complete abstinence from tobacco use prior to surgery.Various cessation methods were used perioperatively including prescription therapy(13.5%),over the counter nicotine replacement(18.9%),cessation programs(5.4%).At final follow up,43.2%(n=16)of prior tobacco smokers reported complete abstinence.Patients who were able to maintain cessation postoperatively had improved Patient-Reported Outcomes Measurement Information System(PROMIS)-10 mental health scores(49 vs 58;P=0.01),and hip dysfunction and osteoarthritis outcome score for joint replacement(HOOS.JR)scores(63 vs 82;P=0.02).No patients in this cohort had a prosthetic joint infection or required revision surgery.CONCLUSION We report a tobacco cessation rate of 43.2%in patients undergoing elective TJA nearly 3 years postoperatively.Patients undergoing TJA who were able to remain abstinent had improved PROMIS-10 mental health scores and HOOS.JR scores.The perioperative period provides clinicians a unique opportunity to assist active tobacco smokers with cessation efforts and improve postoperative outcomes.

Effect of smoking on the risk of gastrointestinal cancer after cholecystectomy: A national population-based cohort study

BACKGROUND The role of smoking in the incidence of colorectal cancer(CRC)or gastric cancer(GC)in populations undergoing cholecystectomy has not been investigated.AIM To evaluate the effect of smoking on CRC or GC development in cholecystectomy patients.METHODS A total of 174874 patients who underwent cholecystectomy between January 1,2010 and December 31,2017 were identified using the Korean National Health Insurance Service claims database.These patients were matched 1:1 with mem-bers of a healthy population according to age and sex.CRC or GC risk after cholecystectomy and the association between smoking and CRC or GC risk in cholecystectomy patients were evaluated using adjusted hazard ratios(HRs)and 95%CIs.RESULTS The risks of CRC(adjusted HR:1.15;95%CI:1.06-1.25;P=0.0013)and GC(adjusted HR:1.11;95%CI:1.01-1.22;P=0.0027)were significantly higher in cholecystectomy patients.In the population who underwent cholecystectomy,both CRC and GC risk were higher in those who had smoked compared to those who had never smoked.For both cancers,the risk tended to increase in the order of non-smokers,ex-smokers,and current smokers.In addition,a positive correlation was observed between the amount of smoking and the risks of both CRC and GC.CONCLUSION Careful follow-up and screening should be performed,focusing on the increased risk of gastrointestinal cancer in the cholecystectomy group,particularly considering the individual smoking habits.

Does Smoking Weaken the Immune System: A Narrative Review

Smoking has a complex impact on the immune system, affecting both innate and adaptive immunity. It can exacerbate pathogenic immune responses and attenuate defensive immunity, leading to a higher susceptibility to infections and certain diseases. The chemicals in cigarette smoke, such as nicotine and carbon monoxide, can alter immune cell functions and inflammatory responses. Smoking can also have long-term effects on the immune system, with some changes persisting even after quitting [1]. According to a Penn Medicine Physician, the Medical Oncologist Dr. David Porter, “People who are smokers tend to get sicker from infections”, “It may be that smoking impacts the immune system’s ability to respond appropriately”. Thus, such individuals within smoking exposure history might be considered as immunocompromised due to the altered and weakened immune system. Cigarette smoking is a prevalent habit with far-reaching health implications. Among its many adverse effects, smoking significantly alters the immune system’s functionality [1].

Exploring the Impact of Alcohol Consumption and Smoking on Primary Open Angle Glaucoma: A Mendelian Randomization Study

Objective: Utilizing Mendelian Randomization, this study employs Single Nucleotide Polymorphisms (SNPs) as instrumental variables to explore the causal relationships between bibulosity, smoking, and Primary Open Angle Glaucoma (POAG). Methods: GWAS data for bibulosity, smoking, and POAG were obtained from the Social Science Genetic Association Consortium website and the IEU OpenGWAS Project website, respectively. Using a P-value threshold of −8, a linkage disequilibrium coefficient (r2) of 0.001, and a linkage disequilibrium region width of 10,000 kb, the data were aggregated, resulting in 6 SNPs for bibulosity and 253 SNPs for smoking. Three regression models, MR-Egger, Weighted Median Estimator (WME), and Random-Effects Inverse-Variance Weighted (IVW) were applied to analyze the causal impact of bibulosity and smoking on POAG. Results: The GWAS data for alcohol consumption and smoking were derived from European populations, while the GWAS data for Primary Open-Angle Glaucoma (POAG) were sourced from East Asian populations, with no gender restrictions. Analysis using three different regression models revealed that neither excessive alcohol consumption nor smoking significantly increased the risk of developing POAG. Specifically, the odds ratios with 95% confidence intervals for the alcohol consumption group were 0.854 (0.597 - 1.221) in MR-Egger regression, 0.922 (0.691 - 1.231) in WME regression, and 0.944 (0.711 - 1.252) in IVW regression. For the smoking group, the odds ratios were 1.146 (0.546 - 2.406) in MR-Egger regression, 0.850 (0.653 - 1.111) in WME regression, and 0.939 (0.780 - 1.131) in IVW regression. Given the significant heterogeneity in the SNPs associated with smoking, the focus was primarily on the results from the IVW regression model. Conclusion: Alcohol consumption and smoking are not significant risk factors for the development of POAG.

Paclitaxel for second-line treatment of squamous cell carcinoma of the head and neck:A multicenter retrospective Italian study

BACKGROUND Squamous cell carcinoma of the head and neck(SCCHN)accounts for 3%of all malignant tumors in Italy.Immune checkpoint inhibitors combined with chemotherapy is first-line treatment for SCCHN;however,second-line treatment options are limited.Taxanes are widely used for combination therapy of SCCHN,as clinical trials have shown their efficacy in patients with this disease,partic ularly in patients with prior therapy.AIM To perform a multicenter retrospective study on the efficacy and safety of weekly paclitaxel for SCCHN.METHODS All patients were previously treated with at least one systemic therapy regimen,which included platinum-based therapy in the vast majority.No patient received prior immunotherapy.RESULTS Median progression-free survival(mPFS)was 3.4 months and median overall survival(mOS)was 6.5 months.Subgroup analysis was performed according to three principal prognostic factors:Smoking,alcohol consumption,and body mass index.Analysis demonstrated reduced survival,both mOS and mPFS,in the unfavorable prognostic groups,with the biggest deltas observed in mOS.CONCLUSION Weekly paclitaxel provided favorable survival and disease control rates,with low severe adverse events.Paclitaxel is a safe and valid therapeutic option for patients with SCCHN who received prior therapy.

Association between tobacco exposure and bladder cancer recurrence:A systematic review and meta-analysis

BACKGROUND However,the connection between smoking and the prognosis of patients with bladder cancer remains unclear.AIM To determine whether smoking is linked to the recurrence and progression of bladder cancer.METHODS As of July 20,2022,relevant English-language research was identified by searching PubMed,the Web of Science,and the Cochrane Library.We pooled the available data from the included studies using a random effects model.Subgroup analysis and sensitivity analysis were also conducted.RESULTS A total of 12 studies were included in this meta-analysis.The combined analysis revealed that tobacco exposure was associated with a significantly greater recurrence rate than nonsmoking status[odd ratios(OR)=1.76,95%CI:1.84-2.93],and the progression of bladder cancer was significantly greater in smokers than in nonsmokers(OR=1.21,95%CI:1.02-1.44).Stratified analysis further revealed that current smokers were more likely to experience relapse than never-smokers were(OR=1.85,95%CI:1.11-3.07).Former smokers also had a greater risk of relapse than did never-smokers(OR=1.73,95%CI:1.09-2.73).Subgroup analysis indicated that non-Caucasians may be more susceptible to bladder cancer recurrence than Caucasians are(OR=2.13,95%CI:1.74-2.61).CONCLUSION This meta-analysis revealed that tobacco exposure may be a significant risk factor for both the recurrence and progression of bladder cancer.

The Prevalence of Smoking in Caribbean Towns and Correlation with Disease States: A Survey

Background: Smoking continues to be one of the most popular recreational practices despite its known harmful effects. Aim: The purpose of this survey was to assess the prevalence of smoking in the Caribbean and the correlation of smoking with the disease states of high blood pressure, diabetes and high cholesterol whose risk is known to be higher among smokers. Findings: Our study found a smoking prevalence of 22% in the population, similar to that reported by the World Health Organization (20%) and a positive correlation between smoking and diabetes. Conclusion: The survey shows that smoking numbers within the population are still high and that smoking increases the risk of certain disease states within smokers. Aggressive global efforts to reduce smoking should continue so as to minimize the negative impact of smoking on health.

Association of cannabis use disorder with atrial fibrillation in young men without concomitant tobacco use:Insights from nationwide propensity matched analysis

BACKGROUND Recent data are inconclusive regarding the risk of arrhythmias among young cannabis users.Furthermore,many young adults use both cannabis and tobacco,which could add a residual confounding effect on outcomes.So,we studied young men who have cannabis use disorder(CUD)excluding tobacco use disorder(TUD)to understand their independent association with atrial fibrillation(AF)and related outcomes.AIM To study the association of CUD with AF and related outcomes.METHODS We used weighted discharge records from National Inpatient Sample(2019)to assess the baseline characteristics and mortality rates for AF-related hospitalizations in young(18-44 years)men in 1:1 propensity-matched CUD+vs CUD-cohorts without TUD.RESULTS Propensity matched CUD+and CUD-cohorts consisted of 108495 young men in each arm.Our analysis showed an increased incidence of AF in black population with CUD.In addition,the CUD+cohort had lower rates of hyperlipidemia(6.4%vs 6.9%),hypertension(5.3%vs 6.3%),obesity(9.1%vs 10.9%),alcohol abuse(15.5%vs 16.9%),but had higher rates of anxiety(24.3%vs 18.4%)and chronic obstructive pulmonary disease(COPD)(9.8%vs 9.4%)compared to CUD-cohort.After adjustment with covariates including other substance abuse,a non-significant association was found between CUD+cohort and AF related hospitalizations(odd ratio:1.27,95%confidence interval:0.91-1.78,P=0.15).CONCLUSION Among hospitalized young men,the CUD+cohort had a higher prevalence of anxiety and COPD,and slightly higher proportion of black patients.Although there were higher odds of AF hospitalizations in CUD+cohort without TUD,the association was statistically non-significant.The subgroup analysis showed higher rates of AF in black patients.Large-scale prospective studies are required to evaluate long-term effects of CUD on AF risk and prognosis without TUD and concomitant substance abuse.

Unveiling the dynamic role of innate and adaptive immune cells in COPD pathogenesis induced by cigarette smoke

Chronic obstructive pulmonary disease(COPD)is a multifaceted syndrome characterized by a dysregulated inflammatory cascade within the respiratory system,primarily triggered by exposure to harmful particles and gases,notably from cigarette smoke.This inflammatory response is orchestrated by innate immune cells like macrophages and epithelial cells,which recognize danger signals released from damaged cells.Prolonged inflammation prompts an adaptive immune reaction mediated by dendritic cells,culminating in the formation of lymphoid follicles and involving a complex interplay of T and B cells,as well as cytotoxic activity.Additionally,both viral and bacterial infections exacerbate COPD by further igniting inflammatory pathways,perpetuating the chronic inflammatory state.This comprehensive review encapsulates the intricate interplay between innate and adaptive immunity in COPD,with a particular focus on the role of cigarette smoke in its pathogenesis and potential therapeutic targets.

The Analysis of Human Behaviour and Evacuation in a Fire Situation in a Building for Higher Education

The paper presents the analysis of a human evacuation from a higher education building located in Iassy,Romania,by means of engineering techniques to approach fire safety.Because in Romania(as in other European countries)fire safety design of buildings is prescriptive and not performance-based,a fire safety engineering approach arouse great interest in many countries such as the U.S.A.,Australia,New Zealand,England,Sweden,Finland,etc.This paper is based on the assumption of starting a fire in the space of a hall for festivities,located on the ground floor of the building,near two human evacuation routes;We consider two building evacuation scenarios:two exits and,respectively,just one exit(assuming that the second would be accidentally blocked).

Pursuing a smoke-free generation

The United Kingdom may soon become a world leader in forging a smoke-free generation.Last month,the country passed a bill that bans the sale of cigarettes to anyone born in 2009 or later.The prime minister claims the policy will"phase out smoking in young people almost completely as early as 2040."A final vote by Parliament is expected next month.Tobacco claims 8 million lives every year,and could claim a billion lives over this century-mostly in low-and middle-income countries.For every person that dies,at least 30 more suffer from smokingrelated chronic disease.The benefits of a tobacco-free society would be transformational.