Medicine and Health Sciences Commons^™

Fluoroscopic Demonstration Of Thoracic Tumor Immobilization With High Frequency Percussive Ventilation, Ina M Sala, Beverly Maurer, Cristian Solano, Ronald Levitin, Thomas M Guerrero

Articles

Purpose: The purpose of this first-in-man study is to directly measure thoracic tumor immobilization by high frequency percussive ventilation (HFPV).

Methods: In an IRB approved protocol (IRB # 2017-046) we screened patients with conspicuous lung tumors that exhibited motion >10 mm to undergo kV fluoroscopy with HFPV. Two sets of consecutive AP (anterior posterior) fluoroscopy frames were acquired during multiple breathing cycles for free- and HFPV- breathing. All images were acquired using our kV source/panel of the therapeutic linear accelerator. Percussions were delivered via the intrapulmonary percussive ventilation device (IPV-2C) and phasitron (Percussionaire Corp., Sagle, Idaho). The baseline settings for …

A Review Of Bleeding Risk With Impella-Supported High-Risk Percutaneous Coronary Intervention, George W. Vetrovec, Amir Kaki, Thom G. Dahle

Articles

Complex, high-risk percutaneous coronary intervention (HR-PCI) is increasingly being performed, often with mechanical circulatory support (MCS), though to date, there are limited randomised data on the efficacy of MCS for HR-PCI. The majority of MCS is provided by intra-aortic balloon pumps, but increasingly Impella® (Abiomed, Danvers, MA, USA) heart pumps are being used. While the Impella pumps provide greater increases in cardiac output, these devices require large bore access, which has been associated with an increased risk of bleeding and vascular complications. Decisions regarding the use of Impella are often based on risk–benefit considerations, with Impella-related bleeding risk being a …

Recording Of Endoscopy And Fluoroscopy Of The Vocal Tract With Sound (Or Its Absence): A Disappointment, Robert J Shprintzen, Pablo Antonio Ysunza

Articles

There is an old say: “The devil knows more for being old than for being the devil”. One of the advantages of being old and observing clinical practice and clinical research advance is that successful procedures and methods can be selected and put into practice. Indeed, it is possible to define when practices we thought could be used by our peers simply by being reported in the literature have proven to be doubtful hopes that leave us trying to find out what went wrong. Such is the case with imaging procedures of the vocal tract during speech tasks.

Association Of Metabolomic Biomarkers With Sleeve Gastrectomy Weight Loss Outcomes, Wendy Miller, Kathryn Ziegler, Stewart Graham, Michael Maddens, Matthew Sims

Articles

Background: Factors influencing weight loss variability following sleeve gastrectomy (SG) are not well understood. We evaluated the correlation of metabolomic biomarkers with weight loss outcomes. Methods: This prospective study evaluated the metabolomic profile of feces and serum prior to SG and three months post-SG, along with weight loss outcomes at three months post-SG (N=45). Serum and fecal samples were quantitatively profiled using a combination of 1H NMR and DI-LC-MS/MS (AbsoluteIDQ P180 kit (Biocrates, Innsbruck)). Results: Percent total weight loss (%TWL) for the lowest versus the highest weight loss tertiles (T1 vs T3) was 11.1 + 0.8% and 17.0 + 1.3%, …

A Reference Data Set For Image Registration Of The Pelvis Using Combinatorial Rigid Registration Optimization (Corro)., Afua A Yorke, David Solis Jr, Thoas Guerrero

Articles

Purpose Clinical image pairs provide the most realistic test data for image registration evaluation. However, the optimal registration is unknown. Using combinatorial rigid registration optimization (CORRO) we demonstrate a method to estimate the optimal alignment for rigid-registration of clinical image pairs.

Methods Expert selected landmark pairs were selected for each CT/CBCT image pair for six cases representing head and neck, thoracic, and pelvic anatomic regions. Combination subsets of a k number of landmark pairs (k-combination set) were generated without repeat to form a large set of k-combination sets (k-set) for k = 4,8,12. The rigid transformation between the image pairs …

A Hybrid Agent-Based And Equation Based Model For The Spread Of Infectious Diseases, Elizabeth Hunter, Brian Mac Namee, John D. Kelleher

Articles

Both agent-based models and equation-based models can be used to model the spread of an infectious disease. Equation-based models have been shown to capture the overall dynamics of a disease outbreak while agent-based models are able to capture heterogeneous characteristics of agents that drive the spread of an outbreak. However, agent-based models are computationally intensive. To capture the advantages of both the equation-based and agent-based models, we create a hybrid model where the disease component of the hybrid model switches between agent-based and equation-based. The switch is determined using the number of agents infected. We first test the model at …

A Population-Based Analysis Of Outcomes In Patients With Enteropathy-Associated T-Cell Lymphoma (Eatl), Nwabundo Anusim, Bana Antonios, Ruby Gupta, Vishal Jindal, John Khoury, Ishmael Jaiyesimi

Articles

Background: EATL is very rare and accounts for less than 1 percent of all non-Hodgkin lymphomas. EATL occurs most commonly in patients with celiac disease and carries a uniformly poor prognosis. The optimal treatment for EATL is unclear and the data is limited to case reports and small retrospective studies.

Methods: ICD-O-3 (9717) histological code was used to identify cases of EATL from the population-based cancer registries of the Surveillance Epidemiology and End Results program (SEER) between 2006 and 2016. Frequency, demographics, and survival data were assessed using SPSS statistical software.

Results: A total of 138 cases were found. The …

Investigation Of Surrogate Biomarkers Associated With Macular Pigment Status In A Group Of Older Irish Adults, Grainne Scanlon, John S. Butler, Daniel Mccartney, Ekaterina Lostutova, Rose Anne Kenny, James Loughman

Articles

SIGNIFICANCE: Macular pigment (MP) confers potent antioxidant and anti-inflammatory effects at the macula; however, its optical density in the eye is not routinely measured in clinical practice.

PURPOSE: This study explored a range of surrogate biomarkers including anthropometric, clinical, and plasma measures that may be associated with lower MP optical density (MPOD).

METHODS: Two thousand five hundred ninety-four subjects completed a full MP assessment as part of wave 1 of The Irish Longitudinal Study of Aging. Macular pigment optical density was measured using customized heterochromatic flicker photometry. Clinical (blood pressure), plasma (lipoproteins, inflammatory markers), and anthropometric (waist, hip, height, weight) …

Mast Cells As A Surrogate Marker For Diagnosis Of Persistent Eosinophilic Esophagitis., Subhashree Mallika Krishnan, Ping Zhang, Zhenhong Qu

Articles

Context: Histologically, the hallmark of active eosinophilic esophagitis (EoE) is the presence of intraepithelial eosinophils (iEos). Recently, studies have evaluated the etiologic role of intraepithelial mast cells (iMCs) in pathogenesis of EoE and residual disease. We aimed to evaluate diagnostic and prognostic value of iMCs in EoE by its prevalence in esophageal biopsy cases in association with presence of iEos and/or lymphocytes. Design: Esophageal biopsy cases were prospectively reviewed for presence of iEos, lymphocytes, and/or iMCs. An experienced gastroenterology pathologist at our institution quantitated the number of inflammatory cells. Immunohistochemistry (CD117) was used to highlight iMCs. Unpaired Student t test …

Not All Free Air In The Nicu Is Necrotizing Enterocolitis., Paul Holtrop, Paras Khandar, Nathan Novotny

Articles

When a tiny preterm baby in our neonatal intensive care unit (NICU) has an intestinal perforation, it is always necrotizing enterocolitis (NEC), right? Not so fast, my friend. Many of these preterm infants who perforate have free air from spontaneous intestinal perforation (SIP) and not NEC. As it turns out, not all free air in the NICU is NEC. How can you tell the difference and does it matter?

It can be challenging to tell the difference, but SIP tends to occur earlier in life, often within the first week, whereas NEC usually occurs slightly later. One analysis of a …

High Flow Nasal Cannula In The Surgical Patient, Morta Lapkus, Paras Khandhar

Articles

No matter how much they want it, airway management and the decision to place a surgical patient on a ventilator should not just be for the PICU physicians to decide. The type of ventilation a patient receives can affect the surgical patient both positively and negatively. Could High Flow Nasal Cannula in the surgical patient be beneficial? Imagine a patient with an esophageal anastomosis that is extubated to CPAP. Now imagine the tears that would flow from the surgeon when they discover bilateral pneumothoraces and a blown-out anastomosis. Tragic. Therefore, we must weigh the risks and benefits of intubation versus …

Novel Role For The Golgi Membrane Protein Tmem165 In Control Of Migration And Invasion For Breast Carcinoma, Pavitra Murali, Blake P. Johnson, Zhongpeng Lu, Leslie Climer, Danielle A. Scott, Francois Foulquier, Gabriela Oprea-Ilies, Vladimir Lupashin, Richard R. Drake, Karen L. Abbott

Articles

The TMEM165 gene encodes for a multiple pass membrane protein localized in the Golgi that has been linked to congenital disorders of glycosylation. The TMEM165 protein is a putative ion transporter that regulates H+/Ca++/Mn++ homeostasis and pH in the Golgi. Previously, we identified TMEM165 as a potential biomarker for breast carcinoma in a glycoproteomic study using late stage invasive ductal carcinoma tissues with patient-matched adjacent normal tissues. The TMEM165 protein was not detected in non-malignant matched breast tissues and was detected in invasive ductal breast carcinoma tissues by mass spectrometry. Our hypothesis is that the TMEM165 protein confers a growth …

Post-Op Day 1 Fever Is Never Atelectasis, Elizabeth Boudiab, Paras Khandhar

Articles

Postop day 1 fever is never atelectasis. It has been blamed for decades while even the latest editions of surgical textbooks disseminate this myth1. Whilst both fever and atelectasis are extraordinarily common after surgery – occurring in up to 40% and 90% of patients, respectively2 this is NOT the cause on Day 1. It is time that we exonerate this myth.

Postop day 1 fever is never atelectasis, it is due to inflammation and trauma of surgery. The concept that atelectasis was causing fever was derived principally from a study showing that alveolar macrophages sampled from an atelectatic rat lung …

Genomic Diversity Of Bacteriophages Infecting Microbacterium Spp, Deborah Jacobs-Sera, Nathan S. Reyna, Lawrence A. Abad, Richard M. Alvey, Kirk R. Anders, Haley G. Aull, Suparna S. Bhalla, Lawrence S. Blumer, David W. Bollivar, J. Alfred Bonilla, Kristen A. Butela, Roy J. Coomans, Steven G. Cresawn, Tom D'Elia, Arturo Diaz, Ashley M. Divens, Nicholas P. Edgington, Gregory D. Frederick, Maria D. Gainey, Rebecca A. Garlena, Kenneth W. Grant, Susan M.R. Gurney, Heather L. Hendrickson, Lee E. Hughes, Margaret A. Kenna, Karen K. Klyczek, Hari Kotturi, Travis N. Mavrich, Angela L. Mckinney, Evan C. Merkhofer, Jordan Moberg Parker, Sally D. Molloy, Denise L. Monti, Dana A. Pape-Zambito

Articles

The bacteriophage population is vast, dynamic, old, and genetically diverse. The genomics of phages that infect bacterial hosts in the phylum Actinobacteria show them to not only be diverse but also pervasively mosaic, and replete with genes of unknown function. To further explore this broad group of bacteriophages, we describe here the isolation and genomic characterization of 116 phages that infect Microbacterium spp. Most of the phages are lytic, and can be grouped into twelve clusters according to their overall relatedness; seven of the phages are singletons with no close relatives. Genome sizes vary from 17.3 kbp to 97.7 kbp, …

Raman Spectroscopy Of Lymphocytes For The Identification Of Prostate Cancer Patients With Late Radiation Toxicity Following Radiotherapy, Daniel Cullen, Jane Bryant, Adrian Maguire, Denish Medipally, Brendan Mcclean, Laura Shields, Emma Noone, Shirley Bradshaw, Marie Finn, Mary Dunne, Aoife M .Shannon, John Armstrong, Orla Howe, Aidan Meade, Fiona Lyng

Articles

The success of radiotherapy in tumour control depends on the total dose given. However, the tolerance of the normal tissues surrounding the tumour limits this dose. It is not known why some patients develop radiation toxicity and, currently, it is not possible to predict before treatment which patients will experience adverse effects. Thus, there is an unmet clinical need for a new test to identify patients at risk of radiation toxicity. Here, we report a new approach based on Raman spectroscopy.Blood samples were collected from 42 patients who had undergone radiotherapy for prostate cancer and had shown either severe or …

National Trends For Intra-Operative Radiation Therapy In Favorable, Early-Stage Breast Cancer: A Propensity Scoring Analysis Of The National Cancer Database, Mohamad Sebai, Muayad F. Almahariq, Joshua Dilworth, Patrick Karabon, Rachel Kalthoff, Sayee Kiran, Jayant Vaidya, Kyle J Feldmann, Nayan Dekhne

Articles

No abstract provided.

The Coronavirus And The Risks To The Elderly In Long-Term Care, William Gardner, David States, Nicholas Bagley

Articles

The elderly in long-term care (LTC) and their caregiving staff are at elevated risk from COVID-19. Outbreaks in LTC facilities can threaten the health care system. COVID-19 suppression should focus on testing and infection control at LTC facilities. Policies should also be developed to ensure that LTC facilities remain adequately staffed and that infection control protocols are closely followed. Family will not be able to visit LTC facilities, increasing isolation and vulnerability to abuse and neglect. To protect residents and staff, supervision of LTC facilities should remain a priority during the pandemic.

Trends, Survival Outcomes, And Predictors Of Non-Adherence To Mastectomy Guidelines For Non-Metastatic Inflammatory Breast Cancer: Stage-Stratified Propensity Scoring Analysis Of Ncdb, Mohamad Sebai, Patrick Karabon, David Lee, Sayee Kiran, Nayana Dekhne

Articles

Background/Objective: Current National Comprehensive Cancer Network (NCCN) guidelines recommend modified radical mastectomy (MRM) as the surgical treatment of choice for nonmetastatic inflammatory breast cancer (IBC). Using data from the National Cancer Database (NCDB), our study compared the national trends and outcomes of breast-conserving surgery (BCS) vs. MRM for the treatment of IBC. Methods: NCDB data from 2004 to 2014 were retrospectively analyzed. Patients’ demographics, tumor characteristics, and overall mortality (OM) trends were compared between BCS and MRM cases of IBC. Univariate, multivariate, and propensity score weighted analyses were done to compare study groups and build a predictive model for undergoing …

A Model For The Spread Of Infectious Diseases In A Region, Elizabeth Hunter, Brian Mac Namee, John D. Kelleher

Articles

In understanding the dynamics of the spread of an infectious disease, it is important to understand how a town’s place in a network of towns within a region will impact how the disease spreads to that town and from that town. In this article, we take a model for the spread of an infectious disease in a single town and scale it up to simulate a region containing multiple towns. The model is validated by looking at how adding additional towns and commuters influences the outbreak in a single town. We then look at how the centrality of a town …

Optimisation Of Vitamin D Status For Enhanced Immuno-Protection Against Covid-19, Daniel Mccartney, Declan G. Byrne

Articles

Abstract

Background

Vitamin D deficiency (serum 25(OH)D<50nmol/l) is common in Ireland, particularly amongst older adults, hospital inpatients and nursing home residents. Vitamin D deficiency is associated with increased risk of acute viral respiratory infection and community acquired pneumonia, with several molecular mechanisms proposed to explain this association. Vitamin D supplementation has also been shown to reduce the risk of respiratory infection.

Vitamin D and Covid-19

Correction of vitamin D deficiency is thought to suppress CD26, a putative adhesion molecule for Covid-19 host cell invasion. Vitamin D may also attenuate interferon gamma (IFNγ) and interleukin-6 (IL-6) inflammatory responses, both potent predictors of poorer outcome in critically-ill ventilated patients including those with Covid-19.

Vitamin D Requirements

Irish adults require 25-30μg/d of vitamin D3, an intake not achievable by diet alone, to reliably maintain serum 25(OH)D levels >50nmol/l. Supplementation with doses up to 100μg/d has been shown to be safe for adults, and many agencies and expert …

The Relationship Between Serum Zinc Levels And Myopia, Niamh Burke, John Butler, Daniel Ian Flitcroft, James Loughman

Articles

Clinical significance: Myopia is inherently associated with eye growth and thereby possibly amenable to nutritional influence. However, little attention has been given to possible die- tary influences. This study demonstrates that serum zinc does not play a role in myopia development. Background: Myopia is inherently associated with eye growth and thereby possibly amena- ble to nutritional influence. A number of Asian studies have reported lower levels of serum zinc in myopic children. This study was designed to assess the relationship between serum zinc and myopia in the Korean population – using a subsample of participants from nation- ally representative data.

Genome-Wide Dna Methylation Meta-Analysis In The Brains Of Suicide Completers, Stefanie Policicchio, Sam Washer, Joana Viana, Artemis Latrou, Joe Burrage, Eilis Hannon, Gustavo Turecki, Zachary Kaminsky, Jonathan Mill, Emma L. Dempster, Therese Murphy

Articles

Suicide is the second leading cause of death globally among young people representing a significant global health burden. Although the molecular correlates of suicide remains poorly understood, it has been hypothesised that epigenomic processes may play a role. The objective of this study was to identify suicide-associated DNA methylation changes in the human brain by utilising previously published and unpublished methylomic datasets. We analysed prefrontal cortex (PFC, n = 211) and cerebellum (CER, n = 114) DNA methylation profiles from suicide completers and non-psychiatric, sudden-death controls, meta-analysing data from independent cohorts for each brain region separately. We report evidence for …

Gender Differences And Survival Outcomes In Breast Cancer Patients: Stage Stratified Propensity Scoring Analysis Of The National Cancer Database, M Sebai, Pe Karabon, T Luan, S Kiran, N Dekhne

Articles

Background: There is limited research examining breast cancer gender differences. This study compares the trends and survival outcomes over the years between male (MBC) and female (FBC) breast cancer patients using the National Cancer Database (NCDB). Methods: We retrospectively analyzed the NCDB registry for MBC and FBC cases diagnosed between 2004 and 2014. Patient demographics, tumor characteristics, overall mortality (OM), and trends were compared between MBC and FBC Patients. Univariate, multivariate, and propensity score weighted analyses were done to compare MBC and FBC. Results: 19,488 MBC patients (0.9%) and 2,138,730 FBC patients (99.1%) were identified. Median follow-up was 59.63 months. …

Producing Urban Aerobiological Risk Map For Cupressaceae Family In The Sw Iberian Peninsula From Lidar Technology, Raúl Pecero‐Casimiro, Santiago Fernández‐Rodríguez, Rafael Tormo‐Molina, Inmaculada Silva‐Palacios, Ángela Gonzalo‐Garijo, Alejandro Monroy‐Colín, Juan Francisco Coloma, José María Maya‐Manzano

Articles

Given the rise in the global population and the consequently high levels of pollution, urban green areas, such as those that include plants in the Cupressaceae family, are suitable to reduce the pollution levels, improving the air quality. However, some species with ornamental value are also very allergenic species whose planting should be regulated and their pollen production reduced by suitable pruning. The Aerobiological Index to create Risk maps for
Ornamental Trees (AIROT), in its previous version, already included parameters that other indexes did not consider, such as the width of the streets, the height of buildings and the geographical …

Biopharmaceutical Revolution In Saudi Arabia: Progress And Development, Rihana Alzahran, Elaine Harris

Articles

Purpose This paper aimed to analyze the situation of the biopharmaceutical industry in Saudi Arabia to improve the situation in a way that achieves high levels of development similar to those in Europe, the United States of America (USA), and Japan. Methods To achieve the objective of the study, the authors surveyed 18 out of 21 Saudi pharmaceutical companies that have received licensing for manufacturing from the Saudi Food and Drug Authority (SFDA) to diagnose the situation of manufacturing in relation to biopharmaceuticals. An interview with SFDA officials was carried out as a supplement to the survey. Results Findings revealed …

A Hybrid System Dynamics, Discrete Event Simulation And Data Envelopment Analysis To Investigate Boarding Patients In Acute Hospitals, Leila Keshtkar, Wael Rashwan, Waleed Abo Hamad, Amr Arisha

Articles

Timely access to health services has become increasingly difficult due to demographic change and aging people growth. These create new heterogeneous challenges for society and healthcare systems. Congestion at acute hospitals has reached unprecedented levels due to the unavailability of acute beds. As a consequence, patients in need of treatment endure prolonged waiting times as a decision whether to admit, transfer, or send them home is made. These long waiting times often result in boarding patients in different places in the hospital. This threatens patient safety and diminishes the service quality while increasing treatment costs. It is argued in the …

Quantification And Identification Of Microproteinuria Using Ultrafiltration And Atr-Ftir Spectroscopy, David Perezguaita, Zack Richardson, Phil Heraud, Bayden Wood

Articles

The presence of low amounts of specific proteins in urine can be an indicator of diagnosis and prognosis of several diseases including renal failure and cancer. Hence, there is an urgent need for Point-of-care (PoC) methods, which can quantify microproteinuria levels (30-300 ppm) and identify the major proteins associated with the microproteinuria. In this study, we coupled ultracentrifugation with attenuated total reflectance-Fourier transform infrared (ATR-FTIR) to identify and quantify proteins in urine at low parts per million levels. The process involves the preconcentration of proteins from 500 μL of urine using an ultrafiltration device. After several washings, the isolated proteins …

Does Smoke-Free Legislation Work For Teens Too?: A Logistic Regression Analysis Of Smoking Prevalence And Gender Among Sixteen Years Old In Ireland Using The 1995-2015 Espad School Surveys, Shasha Li, Sheila Keogan, Luke Clancy

Articles

Objectives: To assess the role of tobacco control legislation (TCL) in youth smoking in Ireland. To examine the effects of smoke-free legislation in youth. To consider whether TCL contributed to the gender equalisation in prevalence in 16 years old seen between 2003 and 2015.

Setting Data are from the 4 yearly European School Survey Project on Alcohol and Other Drugs from 1995 to 2015. Total sample size was 12.394. A logistic regression model on grouped data was used. Dependent variable is whether a student was a smoker in last 30 days. Independent variables are time, gender and the policy indicators, …

Secondhand Smoke Exposure And Other Signs Of Tobacco Consumption At Outdoor Entrances Of Primary Schools In Eleven European Countries, Elisabet Henderson, Xavier Continente, Esteve Fernandez, Olena Tigova, Nuria Cortes-Francisco, Silvano Gallus, Alessandra Lugo, Sean Semple, Rachel O'Donnell, Luke Clancy, Sheila Keogan, Ario Ruprecht, Alessandro Borgini, Anna Tzortzi, Vergina K. Vyzikidou, Giuseppe Gornini, Angel Lopez-Nicolas, Joan B. Soriano, Gergana Geshanova, Joseph Osman, Ute Mons, Krzysztof Przewozniak, Jose Precioso, Ramona Brad, Maria J. Lopez, Tackshs Project Investigators

Articles

Introduction: Although smoking restrictions at child-related settings are progressively being adopted, school out-door entrances are neglected in most smoke-free policies across Europe.

Objectives:To describe secondhand smoke (SHS) exposure and tobacco-related signs in outdoor entrances of primary schools in Europe according to area-level socioeconomic status (SES), smoke-free policy, national smoking prevalence, and geographical region.

Methods:In this cross-sectional study we monitored vapor-phase nicotine concentrations at 220 school outdoor entrances in 11 European countries (March 2017–October 2018). To account for nicotine presence, we used the laboratory's limit of quantification of 0.06μg/m3as point threshold. We also recorded the presence of smell of smoke, people …

Who Smokes In Europe? Data From Twelve European Countries In The Tackshs Survey (2017-2018), Silvano Gallus, Alessandra Lugo, Xiaoqiu Liu, Panagiotis Behrakis, Roberto Boffi, Cristina Bosetti, Giulia Carreras, Liliane Chatenoud, Luke Clancy, Xavier Continente, Ruaraidh Dobson, Tobias Effertz, Filippos T. Filippidis, Marcela Fu, Gergana Geshanova, Giuseppe Gorini, Sheila Keogan, Hristo Ivanov, Maria J. Lopez, Angel Lopez-Nicolas, Jose Precioso, Krzysztof Przewozniak, Cornel Radu-Loghin, Ario Ruprecht, Sean Semple, Joan B. Soriano, Polina Starchenko, Marta Trapero-Bertran, Olena Tigova, Anna S. Tzortzi, Constantine Vardavas, Vergina K. Vyzikidou, Paola Colombo, Esteve Fernandez, Tackshs Project Investigators

Articles

Background: Population data on tobacco use and its determinants require continuous monitoring and careful inter-country comparison. We aimed to provide the most up-to-date estimates on tobacco smoking from a large cross-sectional survey, conducted in selected European countries.

Methods: Within the TackSHS Project, a face-to-face survey on smoking was conducted in 2017–2018 in 12 countries: Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania, and Spain, representing around 80% of the 432 million European Union (EU) adult population. In each country, a representative sample of around 1,000 subjects aged 15 years and older was interviewed, for a total of …