Objective-To describe the waste produced by and environmental implications of individual cigarette consumption (filter tips, packages, and cartons) and tobacco manufacturing. Study selection-All available articles and reports published since 1970 related to cigarette consumption and production waste were reviewed. Data sources-Global cigarette consumption data were used to estimate cigarette butt and packaging waste quantities.

Transient ADC normalization after cerebral IH does not necessarily mean that histologic normalization has occurred. The transient ADC recovery phase appeared to have limited potential for neuronal salvage.

Background Food insecurity refers to uncertain access to food on a consistent basis and the stress experienced by families who worry about having sufficient resources to provide balanced meals in their households. Food insecurity has a disproportionate influence on people of color. A robust body of evidence links food insecurity to poor health outcomes.Objective To document experiences of food insecurity among linguistically and ethnically diverse residents of the East Harlem neighborhood of New York City by exploring the ways in which food availability and cost intersect with household budgets, personal preferences, and shopping strategies.Design In-depth qualitative interviews were conducted with adult residents of New York City's East Harlem neighborhood to provide insights about the links between food insecurity, well-being, and quality of life.Participants/setting Thirty-seven adult residents of East Harlem were recruited through purposive sampling. Eligibility requirements included living in an East Harlem zip code (10029 or 10035); being aged 18 years or older; being the main food shopper and food decision-maker in the household; and speaking English, Spanish, or Mandarin Chinese. The study was conducted from February to May 2018. Statistical analyses performedInterviews were analyzed using a grounded theory approach. Codes were organized into broad thematic topics and cross-case analyses were conducted. ResultsParticipants discussed overall perceptions of food insecurity and seven themes related to the challenges of and strategies for coping with food insecurity: intermittent vs chronic food insecurity, shopping and budgeting strategies, pantries as a vital community resource, social support systems, food insecurity and health, frustration with an unjust system, and pride in "making it work."Conclusions To manage food insecurity, many study participants carefully managed food spending, dedicated substantial time to visiting stores and accessing food pantries, and relied on a public benefits cycle that left many without sufficient financial resources at the end of each month.

Keywords Paroxysmal supraventricular tachycardia Á P6 acupressure Á Alternative therapy To the Editor:Paroxysmal supraventricular tachycardia (PSVT) is a common arrhythmia characterized with sudden onset of regular and narrow QRS complex tachycardia. P6 (Neiguan) is a well-known acupoint lessening postoperative nausea and vomiting (PONV) [1]. Here, we present a case of PSVT successfully terminated by P6 acupressure during anesthesia.A 51-year-old woman underwent titanium plate removal surgery with spinal anesthesia. Preoperative 12-lead electrocardiogram (ECG) showed sinus rhythm and normal heart rate ( Supplementary Fig. 1). Spinal anesthesia was performed with ropivacaine 15 mg, and adequate anesthesia was controlled at the L1 level. When the supine posture was changed to Trendelenburg position, she complained of chest tightness. Her BP was 131/84 mmHg. The ECG showed a narrow complex tachycardia with heart rate of 138-160 beats per minute and absence of P waves. ST depression with 3 mm is also noted in lead II (Supplementary Fig. 2). A diagnosis of PSVT was made. Immediate management included changing to supine posture, carotid sinus massage, and slight ocular compression, but these interventions failed. Just before adenosine (50 lg/kg) was given intravenously, P6 acupressure was suggested. Obtaining the patient's permission, P6 acupressure was performed with the thumb for continuous compression at the acupoint. To our surprise, her heart rate dropped to 76 bpm in 5 s, and the ECG converted to sinus rhythm from then on ( Supplementary Fig. 3). No further episodes of PSVT occurred, and she was discharged home 5 days later.P6 stimulation was reported to reduce heart rate through increasing vagal modulation [2]. Compared with vagal stimulation maneuvers and anti-arrhythmic drugs, P6 acupressure is relative safe and easy to perform. Further confirmation should include randomized controlled clinical studies.Conflict of interest There is no conflict of interest about this article. Electronic supplementary material The online version of this article

Aim. This study investigated the effect of P6 EA on droperidol-induced QTc interval prolongation and Cx43 expression in ventricular muscle of rats. Methods. Twenty-four rats were randomly divided into control group (C), droperidol group (D), or EA group (E). C group rats were injected with normal saline. D group rats were injected with droperidol 0.13 mg/kg. E group rats were pretreated with EA at left P6 acupoint for 30 min and then injected with droperidol (0.13 mg/kg). QTc intervals were recorded at lead II in ECG within 120 min. Cx43 expression was measured by RT-PCR and western blotting. Result. Droperidol significantly prolonged QTc intervals compared with controls at 5 min, 10 min, 15 min, and 30 min (P < 0.05). P6 EA could significantly abbreviate the prolongation of QTc interval compared with droperidol group at 5 min, 10 min, 15 min, and 30 min (P < 0.05). Cx43 mRNA and proteins were significantly increased by P6 EA compared with droperidol group at 120 min (P < 0.05). There were no significant differences in Cx43 mRNA and protein expression between droperidol and control group at 120 min (P > 0.05). Conclusion. P6 EA could improve QTc interval prolongation induced by droperidol, which may relate to upregulation of Cx43 mRNA and protein. Antiemetic dose of droperidol had minor effects on Cx43 mRNA and protein expression at 120 min.