"Changing habits of a lifetime": an investigation of the factors that influence behaviour change to reduce domestic energy consumption

Concerns about the impact of climate change are increasingly relevant and problematic to modern society. Since the establishment of the Climate Change Act in 2008, the UK is committed to reducing carbon dioxide emissions by at least 80%, by the year 2050, from 1990 levels. Improving the way in which energy is used in the domestic sector has the potential to play a major role in the achievement of this overall target. This exploratory study uses in-depth interviews and focus groups to investigate the values, motivations and routes to engagement of UK homeowners in adopting pro-environmental behavioural changes. The findings suggest that the greatest barriers homeowners feel prevent them from adopting a lower carbon lifestyle are issues related to a lack of money, time and a perception that their actions are insignificant. Typically, concern for the environment and future generations are drivers of environmentally beneficial behaviour. However, people are generally unaware of any relevant initiatives or schemes to aid them in becoming more energy efficient. The results suggest that people are generally energy conscious, but not energy knowledgeable. Therefore, there is an opportunity for effective communication to bridge this gap in inspiring collective change in reducing energy consumption through behaviour modification. Keywords: Environment, Behaviour Change, Barriers, Motivation, Energy Use

Use of trans-anastomotic tubes in congenital duodenal obstruction

Aim : Despite data to suggest benefit of trans- anastomotic tube (TAT) feeding in infants following repair of congenital duodenal obstruction (CDO), TAT usage is limited. We aimed to report a large series of infants with CDO treated with or without TAT in order to improve the evidence underlying this simple intervention. Method : Single centre retrospective review of all infants CDO over a 20-year period (January 1999 – November 2020, inclusive). Important outcomes were compared between infants treated with or without TAT. Data are median [IQR]. Results : Ninety-six infants were included. A TAT was placed in 54 infants (56%). Median time to full enteral feed was significantly shorter in the TAT group (6 [5-8] days vs 10 [7.5-12], p <0.001). Time to first feed was shorter in the TAT group (2 [2-2.8] days vs 3 [2-5], p<0.001). Significantly fewer infants with a TAT placed received a central venous catheter (CVC, 15% vs 76%, p <0.001). Infants without a TAT received parenteral nutrition (PN) for longer (0 [0-0] vs 7 [0-11] days, p <0.001). There was no change in length of stay between TAT and no TAT group (16 [13-21.8] vs 15 [12-21.8] days, p=0.722). Eight infants (15%) in the TAT group required a CVC and PN. One infant in the TAT group developed a perforation that required surgical management and nine infants in the non-TAT group had complications related to the CVC (21%), including one infant that required general anaesthetic for tunnelled central line placement (2.3%). Conclusion : In infants with CDO, TAT use was associated with earlier establishment of full enteral feeds, reduced need for CVC and PN and reduced complications. Further research should focus on the barriers to wider use of TAT by surgeons and neonatologists in infants with CDO