Search Results (72)

Water-distribution-system failure records often contain nonlinear, heterogeneous patterns that are difficult to summarize with conventional statistics alone. This study evaluates how Random Forest and XGBoost reconstruct normalized water-pipe failure-rate patterns in a field-derived Malatya, Türkiye dataset and uses distributional diagnostics, empirical ranking, and multi-method explainability to identify stable model drivers. The analysis includes 1231 records from nine source-defined clusters and four modelling inputs: cluster identifier, normalized pipe length, normalized pipe diameter, and normalized second-failure age. Because the models were fitted to and evaluated on the same records, the reported performance represents apparent/full-data goodness of fit rather than independent predictive validation. XGBoost provided the closer reconstruction (R² = 0.9189 versus 0.8523 for Random Forest; MAE = 0.0230 versus 0.0321). Across permutation importance, SHAP attribution, and variable-removal sensitivity, pipe length and second-failure age emerged as the most robust model-relevant features, whereas native importance was more method-dependent. The framework demonstrates how ensemble models can support transparent retrospective database screening and pattern interpretation while maintaining a clear boundary between historical fit and forecasting. Temporal, spatial, pipe-grouped, or external validation is required before prospective decision use. Full article

Background/Objectives: Periodontal and peri-implant diseases are influenced by several risk factors, including smoking. While cigarette smoking (CS) is a well-established risk factor, the impact of heated tobacco products (HTPs), electronic cigarettes (E-Cigs), and waterpipe (WS) remains less clear. This systematic review aimed to update the current evidence evaluating the clinical, radiographical, and inflammatory biomarkers of periodontal and peri-implant status among different untreated adult users of inhaled tobacco and nicotine products. Methods: A systematic search of PubMed/MEDLINE, Scopus, and Cochrane Library was performed for studies published between April 2022 and December 2025. Data were extracted and synthesized qualitatively according to the study protocol (PROSPERO: CRD420261284851). Studies were qualitatively assessed using the Risk-of-Bias in Nonrandomized-I. Results: Thirty-one studies including 3106 subjects were analyzed. CS consistently showed the worst periodontal and peri-implant status, with higher plaque indices, probing depth (PD), clinical attachment level (CAL), marginal bone loss (MBL) and more missing teeth. WS showed parameters comparable to CS and worse than non-smokers, with particularly high plaque accumulation and probing depth, as well as a pro-inflammatory biomarker profile. E-Cigs and HTPs generally exhibited intermediate status; E-Cigs showed increased PD and CAL compared with non-smokers, with elevated bleeding on probing despite a lower gingival index, whereas MBL was notably higher, showing the highest overall values among all smoking categories, exceeding CS. HTPs presented slightly less harmful outcomes than other smokers, but the evidence was limited. Biomarker analysis indicated elevated pro-inflammatory and tissue-destructive markers, particularly in CS and WS. Conclusions: Smoking negatively affects periodontal and peri-implant status, with CS exhibiting the worst impact. E-Cigs and HTPs appear less harmful but are not risk-free. Longitudinal studies are warranted to define long-term effects, particularly on peri-implant status, for which robust evidence was restricted to CS. Full article

Hookah smoking has become a persistent social phenomenon among young adults in the United States, despite decades of tobacco control efforts. Moreover, hookah smoking presents unique public health challenges due to its strong social appeal, cultural relevance, and widespread use in urban centers and college communities. This paper provides a broad review of recent trends, health implications, regulatory responses, and sociocultural factors influencing hookah smoking. A narrative literature review was conducted using peer-reviewed articles and grey literature sources published between 2019–2025. Electronic databases included PubMed, CINAHL, and Google Scholar, along with reports from professional organizations and government agencies including CDC, FDA, WHO, and health department agencies, to review current public health recommendations and practice guidelines. Review materials were selected that focus on prevalence, health implications, and regulations of hookah smoking. Findings were synthesized to identify key applications, challenges and concerns, and future directions. This review provided a rapid and broad review of the current trends, health implications, regulatory responses, and sociocultural factors of hookah smoking among young adults in the United States. Interdisciplinary research and policy innovation are necessary to address the ongoing public health burden of hookah smoking among young adults in the United States. Full article

Tobacco use remains a major public health challenge in Jordan, where cigarette smoking and waterpipe use are both common and dual use is increasingly prevalent. Community pharmacies are highly accessible healthcare settings, yet structured smoking-cessation services remain underutilized. This study evaluated the clinical effectiveness and implementation of Dual-Quit Digital, a pharmacist-delivered cessation counseling program tailored to the type of tobacco used, paired with a 6-month automated WhatsApp^® (Menlo Park, CA, USA) follow-up system. We conducted a pragmatic, two-arm, parallel-group, Hybrid Type 2 cluster randomized controlled trial in 16 community pharmacies in Jordan, randomized 1:1 to intervention or usual care. A total of 320 adult tobacco users were enrolled (160 per arm). The intervention combined a structured in-pharmacy pharmacist consultation, tailored behavioral support, phenotype-stratified pharmacotherapy support, and 6 months of semi-automated WhatsApp^® follow-up with telepharmacy escalation for predefined red-flag responses. The control arm received usual care, consisting of opportunistic brief advice and standard over-the-counter sales without proactive follow-up. The primary outcome was biochemically verified continuous abstinence at 6 months, defined as exhaled carbon monoxide (CO) < 10 ppm and analyzed using intention-to-treat principles. Secondary outcomes included 7-day point prevalence abstinence (PPA) at 3 and 6 months, 30-day PPA at 6 months, both-product abstinence among baseline dual users, pharmacotherapy uptake and adherence, and implementation-relevant outcomes, including service reach, feasibility of recruitment, and digital engagement metrics. All 16 pharmacies were retained, and all 320 randomized participants were included in the intention-to-treat analysis. At 6 months, CO-verified continuous abstinence was achieved by 26.3% of participants in the intervention arm compared with 11.3% in the control arm (adjusted odds ratio [aOR] 2.84, 95% CI 1.55–5.18; p < 0.001). The intervention also improved 7-day PPA at 3 months (33.1% vs. 15.6%; aOR 2.68, 95% CI 1.56–4.60; p < 0.001), 7-day PPA at 6 months (30.6% vs. 14.4%; aOR 2.62, 95% CI 1.48–4.62; p = 0.001), and 30-day PPA at 6 months (28.1% vs. 11.9%; aOR 2.89, 95% CI 1.59–5.24; p < 0.001). Among baseline dual users, both-product abstinence was higher in the intervention arm (21.9% vs. 7.8%; aOR 3.30, 95% CI 1.12–9.75; p = 0.026). Pharmacotherapy initiation was more frequent in the intervention arm (72.5% vs. 28.1%; p < 0.001), as was self-reported adherence for at least 8 weeks among initiators (56.0% vs. 26.7%; p = 0.002). In the intervention arm, active patient response rates to scheduled WhatsApp^® messages remained substantial, with 88.1% responding at Week 1, 73.8% at Week 4, 67.5% at Month 3, and 61.3% at Month 6; 145 red-flag triggers were captured from 62 participants, and 84.1% of escalations resulted in successful pharmacist follow-up within 48 h. The Dual-Quit Digital model significantly improved smoking-cessation outcomes compared with usual care and proved operationally feasible. These findings support integrating phenotype-stratified pharmacist counselling, pharmacotherapy support, and low-burden digital follow-up as a pragmatic cessation model for Jordan and similar settings. Full article

Introduction: This study aimed to analyze exhaled breath condensate (EBC) for 8-oxoguanine (8-oxoGua), an oxidative stress biomarker among waterpipe (WP) smokers. Methods: In a within-subject pre-post exposure design, thirty waterpipe smokers completed two 45 min laboratory sessions. EBC was analyzed for 8-oxoGua before and after WP smoking. Median differences between time points (pre vs. post) were assessed using the Wilcoxon sign rank test, with significance defined as p < 0.05. Results: The analysis included 59 WP smoking sessions. Participants had a median age of 24 years (IQR: 21–25), with 62.1% being female. Most had a bachelor’s degree or less (62.1%), and over half were students (55.2%), while 34.5% were employed. The average age for first WP use was 18.6 years, with participants reporting a median of three WP smoking sessions per month. Results indicate a median increase in 8-oxoGua among participants from 5.4 ng/mL (IQR: 8.8) before the smoking session to 7.6 ng/mL after (IQR: 15.7; p < 0.001). Conclusions: This study is the first to examine 8-oxoGua in EBC. Findings provide strong evidence of WP smoking’s contribution to oxidative stress in the airways. It justifies the use of EBC to study the exposure to markers of oxidative stress with emerging tobacco use methods such as the waterpipe. Full article

While the pulmonary effects of regular waterpipe smoking (R-WPS) are well-defined, the impact of occasional waterpipe smoking (O-WPS) on the lungs remains less established. This study investigated the pulmonary toxicity and underlying mechanisms of O-WPS versus R-WPS following 6 months of exposure, focusing on histopathology, inflammation in the lung, bronchoalveolar lavage fluid (BALF), and plasma, as well as oxidative stress, genotoxicity, mitochondrial dysfunction, and the expression of mitogen-activated protein kinases (MAPKs) in lung homogenates. Exposure to both O-WPS and R-WPS resulted in significant histological changes, including increased numbers of alveolar macrophages and lymphocytes, as well as interstitial fibrosis. Only R-WPS increased the number of neutrophil polymorphs and plasma cells. R-WPS also significantly increased the chemokines CXCL1, CXCL2, and CCL2 in the lung, BALF, and plasma, while O-WPS increased CXCL1 and CXCL2 in the lung and CXCL1 in the plasma. Both exposure regimens significantly increased lung injury markers, including matrix metalloproteinase-9 and myeloperoxidase. Additionally, R-WPS induced a significant increase in the cytokines IL1β, IL6, and TNFα in the lung, BALF, and plasma, while O-WPS elevated IL1β and IL6 in the lung. Oxidative stress was observed, with increased levels of thiobarbituric acid reactive substances and superoxide dismutase in both the O-WPS and R-WPS groups. Exposure to either O-WPS or R-WPS triggered genotoxicity and altered mitochondrial complex activities. R-WPS exposure also resulted in elevated expression of p-JNK/JNK, p-ERK/ERK, and p-p38/p38, while O-WPS augmented the p-ERK/ERK ratio in the lungs. Taken together, these findings indicate that both O-WPS and R-WPS contribute to lung injury and induce inflammation, oxidative stress, genotoxicity, and mitochondrial dysfunction, with R-WPS having a more pronounced effect. These effects were associated with the activation of MAPKs. Full article

Objective: This study’s objective was to identify the factors and impact of serums calcium 25-Hydroxy vitamin D, ferritin, uric acid, and sleeping disorders on benign paroxysmal positional vertigo (BPPV) patients. Methods: This is a case and control design study. The consecutive patients’ visits (age, older than 25 years) with idiopathic BPPV were recruited in the present study. For each patient, 3:1 sex and age-matched healthy people were assigned as the control. The study comprised 177 patients with BPPV and 656 controls. The study included biochemical, clinical, physical examinations, PSQI sleep quality, supine roll test, and Dix–Hallpike test for the diagnosis of all patients, and pure-tone audiometry (PTA) was used to assess hearing. Univariate and multivariate stepwise regression analyses were used for statistical analysis. Results: The study comprised 833 patients with 295 males (35.4%) and 538 females (64.6%) who were between 25 and 70 years old. Of a total of 833 participants, 177 were BPPV patients, and 656 subject were normal. The results shown that there were significant differences between the BPPV and the normal group in terms of BMI (p = 0.039), physical activity (p = 0.003), cigarette smoking (p = 0.035), nargile-waterpipe use (p < 0.001), diabetes (p < 0.001), hypertension (p < 0.001), congestive heart failure (CHF) (p < 0.001), neurology (p < 0.001), tinnitus (p < 0.001), dizziness (p < 0.001), headache (p < 0.001), vitamin D (p = 0.004), calcium (p = 0.004), magnesium (p < 0.001), potassium (p = 0.019), phosphorus (p < 0.001), haemoglobin (p < 0.001), serum glucose (p < 0.001), HbA1c (p < 0.001), triglyceride (p < 0.001), systolic BP (p = 0.004), diastolic BP (p = 0.008), and microalbuminuria (p = 0.005); ATP III metabolic syndrome (p = 0.038), IDF metabolic syndrome (p = 0.034), and poor sleep (p = 0.033). In terms of the type of BPPV, the posterior canal was the most commonly affected (n = 126, 71.2%), followed by the horizontal (n = 43, 24.3%) and anterior canal (n = 8, 4.5%). The analysis indicated that serum ferritin (p < 0.001), uric acid (p < 0.001), blood pressure (p < 0.001), dizziness (p < 0.001), cigarette–water-pipe smokers (p = 0.004), headaches/migraines (p = 0.005), calcium (p = 0.007), vitamin D deficiency (p = 0.008), sleepiness (p = 0.016), physical activity (p = 0.022), CHF (p = 0.024), and tinnitus (p = 0.025) were considered as risk predictors for BPPV. Conclusions: The results revealed that the serum levels of vitamin D, ferritin, uric acid, and calcium are low among the study population and supplementation could be considered as prevention in BPPV patients. Full article

The prevalence of waterpipe tobacco smoking (WPS) is increasing worldwide and is relatively high among youth and young adults. It has been shown, both experimentally and clinically, that WPS exposure adversely affects the cardiovascular and hematological systems through the generation of oxidative stress and inflammation. Our study aimed to evaluate the impact of WPS exposure on erythrocytes, a major component of the hematological system, of BALB/c mice. Here, we assessed the effect of nose-only WPS exposure for four consecutive weeks on erythrocyte inflammation, oxidative stress, and eryptosis. The duration of the session was 30 min/day, 5 days/week. Control mice were exposed to air. Our results showed that the levels of C-reactive protein, lipid peroxidation (LPO), superoxide dismutase, and total nitric oxide (NO) were significantly increased in the plasma of WPS-exposed mice. The number of erythrocytes and the hematocrit were significantly decreased in WPS-exposed mice compared with the control group. Moreover, there was an increase in the erythrocyte fragility in mice exposed to WPS compared with those exposed to air. The levels of lactate dehydrogenase, LPO, reduced glutathione, catalase, and NO were significantly increased in the red blood cells (RBCs) of WPS-exposed mice. In addition, erythrocytes of the WPS-exposed group showed a significant increase in ATPase activity, Ca²⁺, annexin V binding, and calpain activity. Taken together, our findings suggest that WPS exposure elevated inflammation and oxidative stress in the plasma and induced hemolysis in vivo. It also caused alterations of RBCs oxidative stress and eryptosis in vitro. Our data confirm the detrimental impact of WPS on erythrocyte physiology. Full article

Heavily advertised as a harmless tobacco alternative, hookah (i.e., waterpipe)-flavored tobacco smoking has contributed to the wider epidemic of smoking, especially amongst marginalized sexual minority (SM) populations. Evidence regarding the concurrent use of substances and other drugs, among SM current hookah smokers, is scarce. We utilized nationally representative data from the Population Assessment of Tobacco and Health (PATH) Study (2016–2019) to examine patterns of the concurrent use of substances (i.e., marijuana, painkillers, sedatives, tranquilizers, cocaine, stimulants (specifically methamphetamines), and others), in SM adult hookah smokers and their heterosexual counterparts. Current hookah smoking is higher among SM adults (Wave 4: 4.22% [95% CI = 2.94–5.94] and Wave 5: 2.65% [95% CI = 1.81–3.48]) than heterosexuals (Wave 4: 1.31% [95% CI = 1.13–1.50] and Wave 5: 1.07% [95% CI = 0.89–1.25]). Among current SM hookah users, the co-use of substances, including alcohol, marijuana, and cocaine, is comparable to heterosexuals (p = ns). Adjusting for gender alone and all covariates, including age, sex, race/ethnicity, education, income, and education, no differences in concurrent substance use were observed between SM and heterosexual hookah users. While the co-use of substances is comparable between SM and heterosexual hookah smoker adults, the prevalence of current hookah use more than doubled among SM individuals than heterosexual individuals during 2018–2019. Our findings highlight the critical value of prevention efforts directed to increase education and awareness about hookah smoking use and known health effects, particularly tailored towards sexual minorities. Full article

The marketing of sweetened and flavoured tobacco in the early 1990s resulted in an upsurge in waterpipe smoking (WPS), mainly among young people and women. Here, we estimate prevalence rates among school-attending adolescents aged 14–19 (girls 52%) for a lifetime experience of WPS and within the last 30 days (WPS < 30 days) and identify influential factors for such smoking in Bissau, Guinea-Bissau. A random sample (N = 2039) was drawn from a class-based register created for 16 schools in Bissau; attending students in June 2017 were invited to respond to a locally adapted Planet Youth questionnaire. Descriptive statistics, odds ratio with 95% confidence interval, and multinomial logistic regression analysis were used to identify influential factors for WPS. The prevalence rates for a lifetime experience of WPS and within < 30 days were high, 17.7% and 15.0%, respectively, with no significant gender difference. For both groups, a multinomial logistic regression analysis identified attending higher grades in school, use of alcohol and being a victim of sexual violence as significant, influential factors. The overlapping of influential factors suggests preventive work against substance abuse should focus on less stigmatising behaviour, such as WPS and firmer implementation of the Framework Convention of Tobacco Control (FCTC). Full article

Fixing waterpipes using cryogenic technology is a complicated activity because it is difficult to see the transformation of water into ice inside a pipe. To solve this problem, a series of experiments and testing was carried out on three types of waterpipes—75, 100, and 150 mm cast-iron pipes (CIP), respectively—to monitor the external characteristics and the frost growth to accurately predict the completion of ice plug formation inside the pipe before applying the freeze-fixing method. A CCD camera was set up to capture four frosting images per minute and to send one image every 15 s to the computer for processing and for identifying the interface between frost and no frost. The results showed that when the brightness distribution along the pipe axis goes down from the 100% brightest and coldest region near the freezing jacket to 90% and hits the 1/10th mark away from the brightest area, which is the interface, the freezing process is finished, and the ice plug has completely formed and can effectively block water flow to allow safe repairs. In other words, the findings determined that the frost length was more or less equal to the ice plug length. Additional testing was done to increase water pressure up to 35 kg/cm² for about 10 min on one end of the freezing jacket, which is higher than the regular pressure testing of 10 kg/cm². When 0 kg/cm² was recorded on the other end of the freezing jacket, it was concluded that the ice plug was strong enough to resist high pressure. The success of these experiments and testing confirmed that this innovative freezing method was safe, cost-effective, and suitable to be used efficiently in semiconductor factories and modern buildings. Full article

Tobacco smoking is an independent risk factor in the onset of kidney disease. To date, there have been no reports on the influence of waterpipe smoke (WPS) in experimentally induced chronic kidney disease (CKD) models. We studied the effects and mechanisms of actions of WPS on a mouse model of adenine-induced CKD. Mice fed either a normal diet, or an adenine-added diet and were exposed to either air or WPS (30 min/day and 5 days/week) for four consecutive weeks. Plasma creatinine, urea and indoxyl sulfate increased and creatinine clearance decreased in adenine + WPS versus either WPS or adenine + saline groups. The urinary concentrations of kidney injury molecule-1 and adiponectin and the activities of neutrophil gelatinase-associated lipocalin and N-acetyl-β-D-glucosaminidase were augmented in adenine + WPS compared with either adenine + air or WPS groups. In the kidney tissue, several markers of oxidative stress and inflammation were higher in adenine + WPS than in either adenine + air or WPS groups. Compared with the controls, WPS inhalation in mice with CKD increased DNA damage, and urinary concentration of 8-hydroxy-2-deoxyguanosine. Furthermore, the expressions of nuclear factor κB (NF-κB) and mitogen-activated protein kinases (MAPKs) (ERK and p38) were elevated in the kidneys of adenine + WPS group, compared with the controls. Likewise, the kidneys of adenine + WPS group revealed more marked histological tubular injury, chronic inflammation and interstitial fibrosis. In conclusion, WPS inhalation aggravates kidney injury, oxidative stress, inflammation, DNA damage and fibrosis in mice with adenine-induced CKD, indicating that WPS exposure intensifies CKD. These effects were associated with a mechanism involving NF-κB, ERK and p38 activations. Full article

With the advent of the “Internet of Things” (IoT), insurers are increasingly leveraging remote sensor technology in the development of novel insurance products and risk management programs. For example, Hartford Steam Boiler’s (HSB) IoT freeze loss program uses IoT temperature sensors to monitor indoor temperatures in locations at high risk of water-pipe burst (freeze loss) with the goal of reducing insurances losses via real-time monitoring of the temperature data streams. In the event these monitoring systems detect a potentially risky temperature environment, an alert is sent to the end-insured (business manager, tenant, maintenance staff, etc.), prompting them to take remedial action by raising temperatures. In the event that an alert is sent and freeze loss occurs, the firm is not liable for any damages incurred by the event. For the program to be effective, there must be a reliable method of verifying if customers took appropriate corrective action after receiving an alert. Due to the program’s scale, direct follow up via text or phone calls is not possible for every alert event. In addition, direct feedback from customers is not necessarily reliable. In this paper, we propose the use of a non-linear, auto-regressive time series model, coupled with the time series intervention analysis method known as causal impact, to directly evaluate whether or not a customer took action directly from IoT temperature streams. Our method offers several distinct advantages over other methods as it is (a) readily scalable with continued program growth, (b) entirely automated, and (c) inherently less biased than human labelers or direct customer response. We demonstrate the efficacy of our method using a sample of actual freeze alert events from the freeze loss program. Full article

(1) Background: Sexual satisfaction (SS) is an essential component of quality of life. There is a scarcity of research about sexual satisfaction in Lebanon, a country where discussing sexual issues is still considered a taboo. The present study aimed to assess the reliability and validity of responses to the items in the Arabic version of the Sexual Satisfaction Questionnaire (SSQ), as well as the correlates of sexual satisfaction, among a sample of Lebanese adults. (2) Methods: Two cross-sectional studies were conducted between June and September 2022 with 270 and 359 participants, respectively. (3) Results: The results showed that the Sexual Satisfaction Questionnaire is adequate to be used in Lebanon (McDonald’s ω = 0.90 and 0.86, respectively). Multivariate analysis showed that higher waterpipe dependence (Beta = −0.17) was substantially linked to lower sexual satisfaction, while better emotional intelligence (EI) (Beta = 0.27) and physical activity (Beta = 0.17) were significantly associated with greater sexual satisfaction. (4) Conclusions: The reliability and validity of the responses to the Arabic version of the Sexual Satisfaction Questionnaire were supported by our findings. Also, practical implications for sexual satisfaction enhancement strategies in the Lebanese population might be beneficial since many associated factors are considered to be modifiable. Full article