Radio frequency superconductivity is a cornerstone technology for many future HEP particle accelerators and experiments from colliders to proton drivers for neutrino facilities to searches for dark matter. While the performance of superconducting RF (SRF) cavities has improved significantly over the last decades, and the SRF technology has enabled new applications, the proposed HEP facilities and experiments pose new challenges. To address these challenges, the field continues to generate new ideas and there seems to be a vast room for improvements. In this paper we discuss the key research directions that are aligned with and address the future HEP needs.

Thomas et al. found associations between nicotine replacement therapy use and neuropsychiatric and cardiovascular adverse events using a case–cross-over study design. This contradicts randomized controlled trials that have found the pharmacotherapies to be safe. Many smokers may have comorbidities or are using medications that may impact upon adverse events. A range of study designs is needed to explore every aspect of pharmacotherapy use and effects. The lack of alignment between the outcomes of randomized controlled trials (RCTs) and real-world application of treatments and interventions is well documented [1]. One clear example is over-the-counter nicotine replacement therapy (NRT) for smoking cessation, which demonstrates higher effect sizes in RCTs than in observational reports of real-world use of NRT [2]. For this reason it is important to combine the evidence of not only RCTs, but a variety of study designs answering similar research questions [3]. In their study, Thomas et al. [4] have applied a case–cross-over design, using national UK primary care electronic data linked to hospital and mortality data, to explore whether NRT or varenicline increase the risk of cardiovascular or neuropsychiatric events. The authors describe the inconsistency in the evidence to date on this topic, and offer an additional analysis approach in an effort to provide some clarity. Their primary analysis found an association between experiencing a myocardial infarction (MI) and NRT prescribing (in the preceding 90 days). In other analyses, using multiple reference periods (during 90 days prior to the event), they found that varenicline and NRT prescribing were positively associated with a number of cardiovascular and neuropsychiatric events. These findings conflict with the RCT evidence base, which demonstrate the safety of both types of medication [5, 6]. The authors acknowledge the inability of their study design to attribute causality and the inability to adjust for potential time-varying confounders. In addition, it cannot be assumed that the smoking cessation medication prescribed was actually picked up from a pharmacy and used by the consumer, given that past studies have found that 20% of people prescribed NRT do not try to fill it [7]. Other limitations to note include the potential for Type 1 error (given multiple tests of significance), and the large effect sizes and extremely wide confidence intervals observed for the analysis exploring the impact of varenicline prescribing on ‘suicide deaths’ (suggestive of a sparse data issue and thus probably a spurious finding). Smoking status is related to at least a doubling of risk of 29 of 36 cardiovascular disease (CVD) subtypes, including acute MI- and CVD-related mortality [8]. Smoking is highly prevalent among people with mental illness; rates of smoking is these populations have been estimated at approximately 40% in the United Kingdom [9], 67% in Australians with severe mental illness [10] and up to 95% among people with substance use disorders [11]. Given the high smoking rates among people who develop CVD and people with mental illness, it is critical that methods are used to account for these confounders when examining neuropsychiatric and cardiovascular events associated with the use of medications to assist with stopping smoking. The over-reliance on RCTs or even ‘big data’ observational studies to provide a single-number answer to a question as complex as the safety of smoking cessation medications (against the risk of continued use of tobacco) is producing an evidence base with contested and contradictory research findings [12]. The consequences of these actions are dire. In the case of varenicline, the US Food and Drug Administration issued a black box warning which was subsequently retracted [13]. In Australia, prescribers are often cautious to prescribe smoking cessation medications due to lingering uncertainty regarding product safety [14], and many consumers are wary of taking smoking cessation medications due to safety concerns [15]. These behaviours will result in fewer people quitting smoking. Subgroups of the smoking population with higher smoking rates, such as those with CVD and/or mental illness, can ill afford these types of uncertainty and delays in receiving assistance to quit. Clearly, with complex interventions for population groups that experience complex health and social issues a study such as Thomas et al.’s is unlikely to provide the solution. However, the study contributes important information to the existing evidence base. Not only do we need to know if NRT or varenicline result in neuropsychiatric or cardiovascular events (i.e. is it safe?) but we need a clearer understanding of what happens when [16, 17], for example: whether these smokers actually picked up and used their medication; what other cessation products they were using to help with their quit attempts during these times; what doses of NRT or varenicline were linked to events; what other prescription medication they were using (e.g. for CVD or mental illness); what other underlying health conditions or dangerous consumptions (e.g. alcohol and drug use) played a role in health events; were the events noted incident or repeat events; and how long individuals had been smoking? By understanding all the interconnecting ‘white matter’ between the main variables and outcomes, we come closer to developing interventions and treatments that are effective both in RCTs and in real-world settings. B.B. has received investigator-initiated research funding from Pfizer and Boehringer Ingelheim in the past.

In 1950, two landmark articles were published by researchers in the United States and the United Kingdom demonstrating the relationship between smoking and lung cancer. Yet, today, 70 years later, tobacco smoking remains the leading cause of preventable death globally. Each year, 7.1 million people who smoke will die from diseases caused by smoking, and an additional 1.2 million people will die from exposure to second-hand smoke. In Australia, smoking causes nearly one in seven deaths and 9% of the disease burden. While smoking prevalence is declining in Australia, progress is slow, with an average fall of only 0.4% per year since 2010. Currently, around 2.3 million Australians smoke tobacco daily. Smoking prevalence is declining among Indigenous Australians (from 49% of adults in 2004–05 to 37% in 2018–19), but remains substantially higher than among non-Indigenous Australians. Smoking also reduces the life expectancy of people with severe mental illness, people with alcohol and other drug use disorders, and people who are homeless, among whom smoking prevalence remains much higher than the general population. These statistics, and the sustained harm caused by smoking, have given rise to discussion of how to end the cigarette epidemic. Often described as “the tobacco endgame”, this goal means permanently reducing overall smoking prevalence to a minimal level within a defined timeframe. Once seen as unthinkable, this goal is now part of mainstream public health research, and incorporated into government health policy in some countries.

This commentary addresses critical questions regarding the impact of the reduction of nicotine on changes in smoking behavior. There appears to be moderate evidence that use of reduced nicotine cigarettes (RNC) increases the likelihood of making a quit attempt among smokers unmotivated to quit and among smokers motivated to quit who also used nicotine replacement therapy (NRT). There was limited evidence that RNC combined with NRT increased smoking abstinence, regardless of motivation to quit. Several plausible mechanisms via which RNC may influence smoking behavior, including reducing dependence, are reviewed. The moderate evidence that abrupt reduction in nicotine reduces self-reported dependence as well as smoking behavior and likelihood of relapse is also reviewed. The data reviewed here suggest that abrupt switching to, and extended use of, RNC can reduce cigarette dependence and several related constructs, including the ability to quit smoking. The data reviewed in this commentary suggest that abrupt reduction in the level of nicotine in combustible cigarettes could reduce smoking behavior, nicotine dependence, and other related constructs and increase quit attempts and eventual smoking cessation.

ABSTRACT Introduction: Pacific people in New Zealand have one of the highest rates of smoking. Cytisine is a plant-based alkaloid that has proven efficacy, effectiveness and safety compared to a placebo and nicotine replacement therapy (NRT) for smoking cessation. Cytisine, like varenicline, is a partial agonist of nicotinic acetylcholine receptors, and blocks the rewarding effects of nicotine. Cytisine is naturally found in some plants in the Pacific region, and so may appeal to Pacific smokers wanting to quit. This paper investigates the acceptability of cytisine as a smoking cessation product for Pacific smokers in New Zealand, using a qualitative study design. Methods: In December 2015, advertisements and snowball sampling was used to recruit four Pacific smokers and three Pacific smoking cessation specialists in Auckland, New Zealand. Semi-structured interviews where undertaken, whereby participants were asked about motivations to quit and their views on smoking cessation products, including cytisine (which is currently unavailable in New Zealand). Interviews were recorded and transcribed verbatim, with thematic analysis conducted manually. Findings: Pacific smokers reported wanting to quit for loved ones and family, but did not find currently available smoking cessation products effective. Almost all participants had not previously heard of cytisine, but many of the Pacific smokers were keen to try it. Participants identified with cytisine on a cultural basis (given its natural status), but noted that their use would be determined by the efficacy of the medicine, its cost, side-effects, and accessibility. They were particularly interested in cytisine being made available in liquid form, which could be added to a “smoothie” or drunk as a “traditional tea”. Participants thought cytisine should be promoted in a culturally-appropriate way, with packaging and advertising designed to appeal to Pacific smokers. Conclusions: Cytisine is more acceptable to Pacific smokers than other smoking cessation products, because of their cultural practices of traditional medicine and the natural product status of cytisine.

Background:Graphic health warning labels (GHWLs) on tobacco products attempt to leverage avoidance-promoting emotions, such as anxiety and disgust, to encourage cessation. Prior studies have relied on self-report or attentional metrics that may not accurately illuminate GHWLs' ability to motivate change. This report evaluates the impact of disgust- and anxiety-based GHWLs on electroencephalograph (EEG) measures of motivated attention among two groups of smokers-those that report higher versus lower cigarette dependence. We hypothesized that both anxiety and disgust GHWLs would reduce appetitive attention, as indexed by lowered P300 (P3) and late positive potential (LPP) activations.Methods:Sixty-one smokers provided demographic and smoking history before completing an oddball paradigm consisting of three counterbalanced stimuli blocks. Each block (100 trials) contained a neutral, GHWL-anxiety, or GHWL-disgust frequent image and a smoking cue as the oddball image (20%). Oddball trials for each block were averaged, P3 and LPP were identified at midline electrode positions (Fz, Cz, and Pz), and mean amplitude was analyzed.Results:Separate mixed-model ANOVAs of P3 and LPP reactivity revealed disgust-focused GHWLs reduced motivated attentional processing. Conversely, the anxiety-focused GHWL appeared to increase the salience of the smoking cue (Fz only). Less-dependent smokers showed lower P3 reactivity than those with higher dependence at Fz, but greater P3 reactivity at Cz and Pz.Conclusion:These results extend prior work in demonstrating that disgust, but not anxiety-based GHWLs, may reduce EEG-assessed motivated attention to smoking cues. Disgust may thus represent a more fruitful target for public health cessation efforts.Implications:Most GHWL evaluations have focused on fear (or anxiety) elicitation rather than disgust, an emotion that may have a unique link to smoking, having evolved specifically to facilitate the avoidance of contaminants via oral incorporation. Analyses of P300 and LPP responses to GHWLs suggest that disgust-focused images interfere with the EEG-indexed attentional processing of smoking cues and do so better than health anxiety-focused messages. However, interaction effects at different electrode sites indicated that GHWLs have complex effects in more versus less-dependent smokers and that an understanding of how smoking cues and anti-smoking imagery become associated over time is needed to identify relevant targets for public health efforts.

Importance:Binocular amblyopia treatment using contrast-rebalanced stimuli showed promise in laboratory studies and requires clinical trial investigation in a home-based setting. Objective:To compare the effectiveness of a binocular video game with a placebo video game for improving visual functions in older children and adults. Design, Setting, and Participants:The Binocular Treatment of Amblyopia Using Videogames clinical trial was a multicenter, double-masked, randomized clinical trial. Between March 2014 and June 2016, 115 participants 7 years and older with unilateral amblyopia (amblyopic eye visual acuity, 0.30-1.00 logMAR; Snellen equivalent, 20/40-20/200) due to anisometropia, strabismus, or both were recruited. Eligible participants were allocated with equal chance to receive either the active or the placebo video game, with minimization stratified by age group (child, age 7 to 12 years; teenager, age 13 to 17 years; and adult, 18 years and older). Interventions:Falling-blocks video games played at home on an iPod Touch for 1 hour per day for 6 weeks. The active video game had game elements split between eyes with a dichoptic contrast offset (mean [SD] initial fellow eye contrast, 0.23 [0.14]). The placebo video game presented identical images to both eyes. Main Outcomes and Measures:Change in amblyopic eye visual acuity at 6 weeks. Secondary outcomes included compliance, stereoacuity, and interocular suppression. Participants and clinicians who measured outcomes were masked to treatment allocation. Results:Of the 115 included participants, 65 (56.5%) were male and 83 (72.2%) were white, and the mean (SD) age at randomization was 21.5 (13.6) years. There were 89 participants (77.4%) who had prior occlusion. The mean (SD) amblyopic eye visual acuity improved 0.06 (0.12) logMAR from baseline in the active group (n = 56) and 0.07 (0.10) logMAR in the placebo group (n = 59). The mean treatment difference between groups, adjusted for baseline visual acuity and age group, was -0.02 logMAR (95% CI, -0.06 to 0.02; P = .25). Compliance with more than 25% of prescribed game play was achieved by 36 participants (64%) in the active group and by 49 (83%) in the placebo group. At 6 weeks, 36 participants (64%) in the active group achieved fellow eye contrast greater than 0.9 in the binocular video game. No group differences were observed for any secondary outcomes. Adverse effects included 3 reports of transient asthenopia. Conclusions and Relevance:The specific home-based binocular falling-blocks video game used in this clinical trial did not improve visual outcomes more than the placebo video game despite increases in fellow eye contrast during game play. More engaging video games with considerations for compliance may improve effectiveness. Trial Registration:anzctr.org.au Identifier: ACTRN12613001004752.

Optical treatment alone can improve visual acuity (VA) in children with amblyopia, thus clinical trials investigating additional amblyopia therapies (such as patching or videogames) for children require a preceding optical treatment phase. Emerging therapies for adult patients are entering clinical trials. It is unknown whether optical treatment is effective for adults with amblyopia and whether an optical correction phase is required for trials involving adults.

Objectives Smoking during pregnancy is harmful for the woman and the unborn child, and the harms raise risks for the child going forward. Indigenous women often have higher rates of smoking prevalence than non-indigenous. Exercise has been proposed as a strategy to help pregnant smokers to quit. Māori (New Zealand Indigenous) women have high rates of physical activity suggesting that an exercise programme to aid quitting could be an attractive initiative. This study explored attitudes towards an exercise programme to aid smoking cessation for Māori pregnant women. Methods Focus groups with Māori pregnant women, and key stakeholder interviews were conducted. Results Overall, participants were supportive of the idea of a physical activity programme for pregnant Māori smokers to aid smoking cessation. The principal, over-arching finding, consistent across all participants, was the critical need for a Kaupapa Māori approach (designed and run by Māori, for Māori people) for successful programme delivery, whereby Māori cultural values are respected and infused throughout all aspects of the programme. A number of practical and environmental barriers to attendance were raised including: cost, the timing of the programme, accessibility, transport, and childcare considerations. Conclusions A feasibility study is needed to design an intervention following the suggestions presented in this paper with effort given to minimising the negative impact of barriers to attendance.

Consumption of sugar-sweetened beverages (SSBs) is associated with increased risk of obesity, diabetes, heart disease and dental caries. Our aim was to assess the effects of plain packaging, warning labels, and a 20 % tax on predicted SSB preferences, beliefs and purchase probabilities amongst young people.

Introduction: Brief smoking cessation advice from physicians is an effective smoking cessation intervention and is therefore an important skill medical students should master. We sought to assess the ability of medical students at the University of Auckland, New Zealand at different stages of their clinical education to provide accurate smoking cessation advice.Methods: Seventy-five medical students participated in a five-minute videotaped objective structured clinical examination (VOSCE) with a standardized patient. We marked them using a 10-point scale based on the 5As of smoking cessation, with a score of 7/10 or more considered a pass. We used the general inductive method to analyze student feedback for key themes.Results: The mean score was 5.81/10, with only 15 (20%) students reaching the pass mark. Qualitative analysis revealed three themes: students had breadth of knowledge but lacked depth; their preference was to prescribe medications; and students were unable to identify where further smoking cessation support could be sourced.Discussion and conclusion: University of Auckland medical students performed poorly when giving smoking cessation advice. Inclusion of smoking cessation education in the undergraduate curriculum is required to ensure all graduates are capable of providing evidence-based and accurate cessation advice.

AIMS To investigate patterns of exposure to tobacco smoke in pregnancy among a representative sample of New Zealand women. METHODS Analyses of smoking-related data from the first wave of the Growing Up in New Zealand cohort study, ie from the first data-collection point during the antenatal period in 2009-10. RESULTS Twenty percent of mothers reporting smoking before pregnancy and 9.9% of mothers continued during pregnancy. These figures were higher in younger women (p<.0001), women with lower educational achievement (p<.001) and Māori women (p<.001). Similarly, being Māori (p<.0001) and having a lower education achievement (p<.0029) were associated with smoking during an unplanned compared to a planned pregnancy. Multiparous mothers were more likely to be smokers than primaparous mothers (11%: 95% Confidence Interval [CI] 10.0-12.1 vs 8.3%: 95% CI 7.2-9.4). Second-hand smoke exposure was more common for younger women (Odds Ratio [OR] 3.2: 95% CI 1.6-6.4), Māori women (OR 1.9: 95% CI 1.4-2.5), and women with unplanned pregnancies (OR 3.4 95% CI 12.0-14.8). CONCLUSIONS There are differences in a range of contextual and behavioural factors related to smoking before and during pregnancy. Low educational achievement, being young, Māori and multiparous were all associated with smoking during pregnancy. A better understanding of why these differences exist is needed in order to find appropriate interventions to support women in becoming smoke-free.

INTRODUCTION:Smoking prevalence among pregnant indigenous women is disproportionately higher than for nonindigenous pregnant women. Incentives have been shown to increase retention in and the effectiveness of smoking cessation programs. To trial if this could work for indigenous women, we aimed to recruit and observe retention of Māori (New Zealand indigenous people) pregnant women that smoke into a cessation program using incentives.METHODS:A parallel group, randomized controlled feasibility trial was undertaken in New Zealand. Pregnant Māori women who smoked were recruited through health practitioners, social media, and general media advertising. Outcomes included ease of recruitment, enrollment rate, retention, cost, and time and distance traveled to visit participants.RESULTS:Seventy-four women were referred for the trial over 7 months. The highest enrollment rate was among self-referrals from media (6 of 10), then women referred from cessation providers (47%, 8 of 17). About three-quarters of women referred from health professionals did not enroll. Only 32% (24) were randomized. Nine women completed the intervention, three withdrew, and 12 were lost to follow-up. On average, it took less time to contact abstinent participants (29 vs. 43 minutes for nonabstinent women). No deception was noted.CONCLUSIONS:Recruitment was difficult and varied by source of first contact. Once enrolled, it was feasible to maintain intensive contact with participants who stayed engaged. The number lost to follow-up was high. We concluded that the tenor of trial promotion could have influenced recruitment and retention rates. Further research with indigenous women is needed to identify better recruitment and retention methods.IMPLICATION:With the rising cost of research and the increased competition for funds, it is important to have evidence that intervention studies with minority group pregnant women who smoke are feasible. Maintaining contact with participants seemed feasible, but the tenor of trial promotion and type of recruitment strategy could influence enrollment and retention of sufficient numbers of participants. Nonjudgmental supportive advertising and invitations direct to women may work better than relying on health professionals as recruiters.

Large reductions in nicotine content could dramatically reduce reinforcement from and dependence on cigarettes. In this article, we summarise the potential benefits of reducing nicotine in combusted tobacco and address some of the common concerns. We focus specifically on New Zealand because it may be ideally situated to implement such a policy. The available data suggest that, in current smokers, very low nicotine content (VLNC) cigarettes decrease nicotine exposure, decrease cigarette dependence, reduce the number of cigarettes smoked per day and increase the likelihood of contemplating, making and succeeding at a quit attempt. New smokers would almost certainly be exposed to far less nicotine as a result of smoking VLNC cigarettes and, consequently, would probably be less likely to become chronic, dependent, smokers. Many of the concerns about reducing nicotine including compensatory smoking, an exacerbation of psychiatric symptoms, the perception that VLNC cigarettes are less harmful, and the potential for a black market are either not supported by the available data, likely mitigated by other factors including the availability of nicotine-containing e-cigarettes, or unlikely to offset the potential benefit to public health. Although not all concerns have been addressed or can be a priori, the magnitude of the potential benefits and the growing evidence of relatively few potential harms should make nicotine reduction one of the centrepieces for discussion of how to rapidly advance tobacco control. Policies that aim to render the most toxic tobacco products less addictive could help New Zealand attain their goal of becoming smokefree by 2025.