RELEASE (REdressing Long-tErm Antidepressant uSE): protocol for a 3-arm pragmatic cluster randomised controlled trial effectiveness-implementation hybrid type-1 in general practice

BACKGROUND: Many people experience withdrawal symptoms when they attempt to stop antidepressants. Withdrawal symptoms are readily misconstrued for relapse or ongoing need for medication, contributing to long-term use (> 12 months). Long-term antidepressant use is increasing internationally yet is not recommended for most people. Long-term use is associated with adverse effects including weight gain, sexual dysfunction, lethargy, emotional numbing and increased risk of falls and fractures. This study aims to determine the effectiveness of two multi-strategy interventions (RELEASE and RELEASE+) in supporting the safe cessation of long-term antidepressants, estimate cost-effectiveness, and evaluate implementation strategies. METHODS: DESIGN: 3-arm pragmatic cluster randomised controlled trial effectiveness-implementation hybrid type-1. SETTING: primary care general practices in southeast Queensland, Australia. POPULATION: adults 18 years or older taking antidepressants for longer than 1 year. Practices will be randomised on a 1.5:1:1 ratio of Usual care:RELEASE:RELEASE+. INTERVENTION: RELEASE for patients includes evidence-based information and resources and an invitation to medication review; RELEASE for GPs includes education, training and printable resources via practice management software. RELEASE+ includes additional internet support for patients and prescribing support including audit and feedback for GPs. OUTCOME MEASURES: the primary outcome is antidepressant use at 12 months self-reported by patients. Cessation is defined as 0 mg antidepressant maintained for at least 2 weeks. SECONDARY OUTCOMES: at 6 and 12 months are health-related quality of life, antidepressant side effects, well-being, withdrawal symptoms, emotional numbing, beliefs about antidepressants, depressive symptoms, and anxiety symptoms; and at 12 months 75% reduction in antidepressant dose; aggregated practice level antidepressant prescribing, and health service utilisation for costs. SAMPLE SIZE: 653 patients from 28 practices. A concurrent evaluation of implementation will be through mixed methods including interviews with up to 40 patients and primary care general practitioners, brief e-surveys, and study administrative data to assess implementation outcomes (adoption and fidelity). DISCUSSION: The RELEASE study will develop new knowledge applicable internationally on the effectiveness, cost-effectiveness, and implementation of two multi-strategy interventions in supporting the safe cessation of long-term antidepressants to improve primary health care and outcomes for patients. TRIAL REGISTRATION: ANZCTR, ACTRN12622001379707p. Registered on 27 October 2022

Economic impacts on West Virginia from projected future coal production and implications for policymakers

Multiple economic and geologic factors are driving fundamental changes in the nation’s energy system, weakening coal’s dominance as a fuel for electricity generation, with significant implications for places like West Virginia that are heavily dependent on coal for economic activity. Some of these factors include low natural gas prices, rising labor costs and declining productivity, economic competition with other coal mining regions, environmental regulations to reduce pollution and safeguard public health, state energy efficiency and renewable electricity standards, falling costs of renewable energy resources like wind and solar, and the likely prospect of future limits on greenhouse gas emissions. This analysis uses an input–output model to examine the effects on West Virginia’s economy from these multiple factors by exploring a range of scenarios for coal production through 2020. In addition to changes in the coal industry, hypothetical investments in additional sectors of the economy are considered as a way to gauge potential alternative economic opportunities. This paper offers recommendations to policymakers for alternative economic development strategies needed to create new jobs and diversify the state’s economy, and highlights the importance of transition assistance at the federal level

Comments on the U.S. Social Cost of Carbon

Our organizations respectfully submit these comments regarding EPA’s use of the Interagency Working Group’s valuation of the Social Cost of Carbon to assess the costs and benefits of its greenhouse gas emissions guidelines for existing fossil fuel-fired power plants (the Clean Power Plan). Our organizations have separately and independently submitted other comments regarding the proposed emissions guidelines themselves. We strongly affirm that the current Social Cost of Carbon (SCC) values are sufficiently robust and accurate to continue to be the basis for regulatory analysis going forward. As demonstrated below, if anything, current values are significant underestimates of the SCC. As economic and scientific research continues to develop in the future, the value should be revised, and we also offer recommendations for that future revision

Barriers to the Uptake of Concurrent Engineering in the Nigerian Construction Industry

It is the consensus of scholars that the productivity of the construction industry is very low when compared with other industries. Concurrent Engineering (CE), which has a primary goal of reducing the total time from designing a product to releasing it into the market, while creating better designs as well, has been identified as one of the concepts that has yielded effective adaptation in the construction industry. An exploratory survey was used to identify 63 variables with the capacity to influence the uptake of Concurrent Engineering in Nigeria and was used to design a questionnaire, which was distributed to 50 stratified construction industry stakeholders. A statistical software package (STATISTI-XL) was used to analyse the severity index of each variable, in order to establish the importance of each variable in influencing the uptake of Concurrent engineering and also to compute the Kendall's coefficient of concordance, which assess the levels of agreement among the judges on the consistency of the rankings. A Kendall's coefficient of concordance of W=0.57365 was recorded. A lack of awareness emerged as the most important barrier against the integration of this concept into the Nigerian construction industry. The top five variables are all human factors that can be ameliorated by proper education