Smoking in pregnancy: who makes quit attempts whilst pregnant and what types of cessation support do they prefer?

Background Smoking in pregnancy is strongly associated with adverse pregnancy and birth outcomes. In England, 26% of women smoke at some point during pregnancy, and 12% smoke throughout. Reducing smoking during pregnancy is therefore an NHS priority. Despite this, little is known about women who make a quit attempt during pregnancy. This study examined sociodemographic and psychological characteristics associated with making a quit attempt during pregnancy, and explored preferences for cessation support. Methods Cross-sectional, baseline data collected as part of the Pregnancy Lifestyle Survey cohort was analysed. Self-reported current or recent ex-smokers (smoked within 3 months of pregnancy) completed a questionnaire between 8-26 weeks gestation. Logistic regression analysis was used to examine characteristics associated with making a quit attempt. Descriptive statistics were used to investigate interest in accessing different forms of cessation support. Results Of the 850 participants, 57% were self-reported current smokers. Cigarettes smoked per day, smoking beliefs, previous pregnancy and a planned pregnancy were found to be significantly associated with whether women made a quit attempt whilst pregnant. Primiparous women were more than twice as likely (OR 2.20: 95% CI 1.33-3.66) to have made a quit attempt than multiparous women, and those who smoked ≥11 cigarettes per day were 72% less likely to have made a quit attempt than those who smoked ≤5 cigarettes per day (OR 0.28: 95% CI 0.16-0.48). Over 70% of women who had made a quit attempt were interested in accessing health professional led support and self-help materials. Conclusions Understanding the characteristics of women who make a quit attempt whilst pregnant and their cessation support preferences could inform future smoking cessation service design, and improve uptake of support services by allowing healthcare providers to target the women most likely to make a quit attempt, and provide support tailored specifically to meet their needs

GoPrime: development of an in silico framework to predict the performance of real-time PCR primers and probes using foot-and-mouth disease virus as a model

Real-time PCR (rPCR) is a widely accepted diagnostic tool for the detection and quantification of nucleic acid targets. In order for these assays to achieve high sensitivity and specificity, primer and probe-template complementarity is essential; however, mismatches are often unavoidable and can result in false-negative results and errors in quantifying target sequences. Primer and probe sequences therefore require continual evaluation to ensure they remain fit for purpose. This paper describes the development of a linear model and associated computational tool (GoPrime) designed to predict the performance of rPCR primers and probes across multiple sequence data. Empirical data were generated using DNA oligonucleotides (n = 90) that systematically introduced variation in the primer and probe target regions of a diagnostic assay routinely used to detect foot-and-mouth disease virus (FMDV); an animal virus that exhibits a high degree of sequence variability. These assays revealed consistent impacts of patterns of substitutions in primer and probe-sites on rPCR cycle threshold (CT) and limit of detection (LOD). These data were used to populate GoPrime, which was subsequently used to predict rPCR results for DNA templates (n = 7) representing the natural sequence variability within FMDV. GoPrime was also applicable to other areas of the FMDV genome, with predictions for the likely targets of a FMDV-typing assay consistent with published experimental data. Although further work is required to improve these tools, including assessing the impact of primer-template mismatches in the reverse transcription step and the broader impact of mismatches for other assays, these data support the use of mathematical models for rapidly predicting the performance of rPCR primers and probes in silico

Putting context centre stage: evidence from a systems evaluation of an area based empowerment initiative in England

It is now widely accepted that context matters in evaluations of the health inequalities impact of community-based social initiatives. Systems thinking offers a lens for uncovering the dynamic relationship between such initiatives and their social contexts. However, there are very few examples that show how a systems approach can be applied in practice and what kinds of evidence are produced when this happens. In this paper, we use data from ethnographic fieldwork embedded within a multi-site mixed method evaluation to demonstrate how a systems approach can be applied in practice to evaluate the early stages of an area-based empowerment initiative – Big Local (funded by the Big Lottery Fund and delivered by Local Trust). Taking place in 150 different local areas in England and underpinned by an ethos of resident-led collective action, Big Local offers an illustration of the applicability of a systems approach to better understand the change processes that emerge as social initiatives embed and co-evolve within a series of local contexts. Findings reveal which parts of the social system are likely to be changed, by what mechanisms, and with what implications. They also raise some salient considerations for knowledge generation and methods development in public health evaluation, particularly for the evaluation of social initiatives where change does not necessarily happen in linear or predictable ways. We suggest future evaluations of such initiatives require the use of more flexible designs, encompassing qualitative approaches capable of capturing the complexity of relational systems processes, alongside more traditional quantitative methods

Smoking and quit attempts during pregnancy and postpartum: a longitudinal UK cohort.

OBJECTIVES: Pregnancy motivates women to try stopping smoking, but little is known about timing of their quit attempts and how quitting intentions change during pregnancy and postpartum. Using longitudinal data, this study aimed to document women's smoking and quitting behaviour throughout pregnancy and after delivery. DESIGN: Longitudinal cohort survey with questionnaires at baseline (8-26 weeks' gestation), late pregnancy (34-36 weeks) and 3 months after delivery. SETTING: Two maternity hospitals in one National Health Service hospital trust, Nottingham, England. PARTICIPANTS: 850 pregnant women, aged 16 years or over, who were current smokers or had smoked in the 3 months before pregnancy, were recruited between August 2011 and August 2012. OUTCOME MEASURES: Self-reported smoking behaviour, quit attempts and quitting intentions. RESULTS: Smoking rates, adjusting for non-response at follow-up, were 57.4% (95% CI 54.1 to 60.7) at baseline, 59.1% (95% CI 54.9 to 63.4) in late pregnancy and 67.1% (95% CI 62.7 to 71.5) 3 months postpartum. At baseline, 272 of 488 current smokers had tried to quit since becoming pregnant (55.7%, 95% CI 51.3 to 60.1); 51.3% (95% CI 44.7 to 58.0) tried quitting between baseline and late pregnancy and 27.4% (95% CI 21.7 to 33.2) after childbirth. The percentage who intended to quit within the next month fell as pregnancy progressed, from 40.4% (95% CI 36.1 to 44.8) at baseline to 29.7% (95% CI 23.8 to 35.6) in late pregnancy and 14.2% (95% CI 10.0 to 18.3) postpartum. Postpartum relapse was lower among women who quit in the 3 months before pregnancy (17.8%, 95% CI 6.1 to 29.4) than those who stopped between baseline and late pregnancy (42.9%, 95% CI 24.6 to 61.3). CONCLUSIONS: Many pregnant smokers make quit attempts throughout pregnancy and postpartum, but intention to quit decreases over time; there is no evidence that smoking rates fall during gestation

Reframing “participation” and “inclusion” in public health policy and practice to address health inequalities: Evidence from a major resident-led neighbourhood improvement initiative

There is a need for greater conceptual clarity in place‐based initiatives that seek to give residents of disadvantaged neighbourhoods more control over action to address the social determinants of health inequalities at a local level. In this article, we address this issue as it relates to the concepts of participation and inclusion. We draw on qualitative data generated during the first phase of the Communities in Control Study, a longitudinal multisite independent evaluation of the impact of Big Local on the social determinants of health and health inequalities. Big Local is a resident‐led area improvement initiative in England, funded by the UK Big Lottery Fund. Initiatives focused on community empowerment are increasingly prominent in public health policy and practice globally. Approaches emphasise the promotion of greater control over decisions and action among individuals, groups, and communities, particularly those living in disadvantaged circumstances. However, when it comes to participation and inclusion in taking action and making decisions, the field is characterised by conceptual confusion. This risks undermining the impact of these initiatives. While participation and inclusion are necessary conditions for empowerment and collective control, they are not necessarily sufficient. Sufficiency requires attention to the breadth of participation (i.e., to inclusion) and to the depth of participation (i.e., the extent to which it is experienced as empowering and ultimately enables the exercise of collective control over decisions and actions). In observing how different Big Local resident‐led partnerships across England are tackling the day‐to‐day challenges of engaging with their communities, we reveal the potential for policy and practice of reframing, and therefore clarifying (to highlight the different roles they have) the concepts of participation and inclusion in terms of depth and breadth

Adeno-associated virus 2 infection in children with non-A–E hepatitis

Funding Information: We wish to acknowledge the contribution of the participating children and their parents who agreed to participate in the ISARIC CCP-UK and DIAMONDS studies, and the research teams who recruited the patients; S. Bennett-Slater from NHS Greater Glasgow and Clyde for assisting with sample location and testing; the histopathology team, Veterinary Diagnostic, University of Glasgow, for excellent technical assistance; P. Murcia for providing resources and advice; P. Olmo for administrative assistance; and E. J. Kremer from the Institut de Génétique Moléculaire de Montpellier, Université de Montpellier and A. Baker, University of Edinburgh, for advice. The work was funded by Public Health Scotland, the National Institute for Health Research (NIHR; award CO-CIN-01) and the Medical Research Council (MRC; grants MR/X010252/1, MC_UU_1201412, MC_UU_12018/12, MC_PC_19059, MC_PC_19025 and MC_PC_22004). DIAMONDS is funded by the European Union Horizon 2020 programme; grant 848196). M.P. acknowledges funding support from the Wellcome Trust (206369/Z/17/Z). M.G.S. acknowledges funding support from The Pandemic Institute, Liverpool and the NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool, and UK Health Security Agency. J.K.B. acknowledges funding support from a Wellcome Trust Senior Research Fellowship (223164/Z/21/Z), and MC_PC_20029, Sepsis Research (Fiona Elizabeth Agnew Trust), a BBSRC Institute Strategic Programme Grant to the Roslin Institute (BB/P013732/1, BB/P013759/1), and the Intensive Care Society of the United Kingdom. We acknowledge the support of Baillie Gifford and the Baillie Gifford Science Pandemic Hub at the University of Edinburgh. Parts of this research has been conducted using the UK Biobank Resource under project 788 and we would like to acknowledge the assistance of A. Tenesa in making this possible. Additional replication was also conducted using the UK Biobank Resource (Project 26041). This research was also funded by the National Institute for Health and Care Research (CO-CIN-01) and jointly by NIHR and UK Research and Innovation (CV220-169, MC_PC_19059). The views expressed in this article are those of the author(s) and not necessarily those of UKRI, the NIHR, or the Department of Health and Social Care. We also acknowledge the support of NHS Research Scotland (NRS) Greater Glasgow and Clyde Biorepository team. For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. Funding Information: We wish to acknowledge the contribution of the participating children and their parents who agreed to participate in the ISARIC CCP-UK and DIAMONDS studies, and the research teams who recruited the patients; S. Bennett-Slater from NHS Greater Glasgow and Clyde for assisting with sample location and testing; the histopathology team, Veterinary Diagnostic, University of Glasgow, for excellent technical assistance; P. Murcia for providing resources and advice; P. Olmo for administrative assistance; and E. J. Kremer from the Institut de Génétique Moléculaire de Montpellier, Université de Montpellier and A. Baker, University of Edinburgh, for advice. The work was funded by Public Health Scotland, the National Institute for Health Research (NIHR; award CO-CIN-01) and the Medical Research Council (MRC; grants MR/X010252/1, MC_UU_1201412, MC_UU_12018/12, MC_PC_19059, MC_PC_19025 and MC_PC_22004). DIAMONDS is funded by the European Union Horizon 2020 programme; grant 848196). M.P. acknowledges funding support from the Wellcome Trust (206369/Z/17/Z). M.G.S. acknowledges funding support from The Pandemic Institute, Liverpool and the NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool, and UK Health Security Agency. J.K.B. acknowledges funding support from a Wellcome Trust Senior Research Fellowship (223164/Z/21/Z), and MC_PC_20029, Sepsis Research (Fiona Elizabeth Agnew Trust), a BBSRC Institute Strategic Programme Grant to the Roslin Institute (BB/P013732/1, BB/P013759/1), and the Intensive Care Society of the United Kingdom. We acknowledge the support of Baillie Gifford and the Baillie Gifford Science Pandemic Hub at the University of Edinburgh. Parts of this research has been conducted using the UK Biobank Resource under project 788 and we would like to acknowledge the assistance of A. Tenesa in making this possible. Additional replication was also conducted using the UK Biobank Resource (Project 26041). This research was also funded by the National Institute for Health and Care Research (CO-CIN-01) and jointly by NIHR and UK Research and Innovation (CV220-169, MC_PC_19059). The views expressed in this article are those of the author(s) and not necessarily those of UKRI, the NIHR, or the Department of Health and Social Care. We also acknowledge the support of NHS Research Scotland (NRS) Greater Glasgow and Clyde Biorepository team. For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. Publisher Copyright: © 2023, The Author(s), under exclusive licence to Springer Nature Limited.An outbreak of acute hepatitis of unknown aetiology in children was reported in Scotland 1 in April 2022 and has now been identified in 35 countries2. Several recent studies have suggested an association with human adenovirus with this outbreak, a virus not commonly associated with hepatitis. Here we report a detailed case–control investigation and find an association between adeno-associated virus 2 (AAV2) infection and host genetics in disease susceptibility. Using next-generation sequencing, PCR with reverse transcription, serology and in situ hybridization, we detected recent infection with AAV2 in plasma and liver samples in 26 out of 32 (81%) cases of hepatitis compared with 5 out of 74 (7%) of samples from unaffected individuals. Furthermore, AAV2 was detected within ballooned hepatocytes alongside a prominent T cell infiltrate in liver biopsy samples. In keeping with a CD4+ T-cell-mediated immune pathology, the human leukocyte antigen (HLA) class II HLA-DRB1*04:01 allele was identified in 25 out of 27 cases (93%) compared with a background frequency of 10 out of 64 (16%; P = 5.49 × 10−12). In summary, we report an outbreak of acute paediatric hepatitis associated with AAV2 infection (most likely acquired as a co-infection with human adenovirus that is usually required as a ‘helper virus’ to support AAV2 replication) and disease susceptibility related to HLA class II status.Peer reviewe

Vertical Structure and Color of Jovian Latitudinal Cloud Bands during the Juno Era

The identity of the coloring agent(s) in Jupiter's atmosphere and the exact structure of Jupiter's uppermost cloud deck are yet to be conclusively understood. The Cr\`{e}me Br\^ul\'ee model of Jupiter's tropospheric clouds, originally proposed by Baines et al. (2014) and expanded upon by Sromovsky et al. (2017) and Baines et al. (2019), presumes that the chromophore measured by Carlson et al. (2016) is the singular coloring agent in Jupiter's troposphere. In this work, we test the validity of the Cr\`{e}me Br\^ul\'ee model of Jupiter's uppermost cloud deck using spectra measured during the Juno spacecraft's 5$^{\mathrm{th}}$ perijove pass in March 2017. These data were obtained as part of an international ground-based observing campaign in support of the Juno mission using the NMSU Acousto-optic Imaging Camera (NAIC) at the 3.5-m telescope at Apache Point Observatory in Sunspot, NM. We find that the Cr\`{e}me Br\^ul\'ee model cloud layering scheme can reproduce Jupiter's visible spectrum both with the Carlson et al. (2016) chromophore and with modifications to its imaginary index of refraction spectrum. While the Cr\`{e}me Br\^ul\'ee model provides reasonable results for regions of Jupiter's cloud bands such as the North Equatorial Belt and Equatorial Zone, we find that it is not a safe assumption for unique weather events, such as the 2016-2017 Southern Equatorial Belt outbreak that was captured by our measurements.Comment: 38 pages, 21 figures; Accepted for publication in AAS Planetary Science Journa

Factors influencing the commissioning and implementation of health and social care interventions for people with dementia: commissioner and stakeholder perspectives

BackgroundDespite several interventions demonstrating benefit to people living with dementia and their caregivers, few have been translated and implemented in routine clinical practice. There is limited evidence of the barriers and facilitators for commissioning and implementing health and social care interventions for people living with dementia. The aim of the current study was to explore the barriers and facilitators to commissioning and implementing health and social care interventions for people with dementia, using a dementia friendly exercise and physical activity-based intervention (PrAISED [Promoting Activity, Stability and Independence in Early Dementia and Mild Cognitive Impairment]) as a case study.MethodsQualitative semi-structured interviews were conducted with stakeholders from a range of backgrounds including individuals from health and social care, local government, the voluntary and community sector, universities, and research centres in England. The Consolidated Framework for Intervention Research (CFIR) was used to guide the design and analysis.ResultsFourteen participants took part, including commissioning managers, service managers, partnership managers, charity representatives, commercial research specialists, academics/researchers, and healthcare professionals. Data were represented in 33 constructs across the five CFIR domains. Participants identified a need for greater support for people diagnosed with dementia and their caregivers immediately post dementia diagnosis. Key barriers included cost/financing, the culture of commissioning, and available resources. Key facilitators included the adaptability of the intervention, cosmopolitanism/partnerships and connections, external policy and incentives, and the use of already existing (and untapped) workforces.ConclusionSeveral barriers and facilitators for commissioning and implementing health and social care interventions for people with dementia were identified which need to be addressed. Recommended actions to facilitate the commissioning and implementation of dementia friendly services are: 1) map out local needs, 2) evidence the intervention including effectiveness and cost-effectiveness, 3) create/utilise networks with stakeholders, and 4) plan required resources

Convective storms in closed cyclones in Jupiter's South Temperate Belt: (I) observations

On May 31, 2020 a short-lived convective storm appeared in one of the small cyclones of Jupiter's South Temperate Belt (STB) at planetographic latitude 30.8S. The outbreak was captured by amateur astronomer Clyde Foster in methane-band images, became widely known as Clyde's Spot, and was imaged at very high resolution by the Junocam instrument on board the Juno mission 2.5 days later. Junocam images showed a white two-lobed cyclonic system with high clouds observed in the methane-band at 890 nm. The storm evolved over a few days to become a dark feature that showed turbulence for months, presented oscillations in its drift rate, and slowly expanded, first into a Folded Filamentary Region (FFR), and later into a turbulent segment of the STB over a timescale of one year. On August 7, 2021, a new storm strikingly similar to Clyde's Spot erupted in a cyclone of the STB. The new storm exhibited first a similar transformation into a turbulent dark feature, and later transformed into a dark cyclone fully formed by January 2022. We compare the evolution into a FFR of Clyde's Spot with the formation of a FFR observed by Voyager 2 in 1979 in the South South Temperate Belt (SSTB) after a convective outburst in a cyclone that also developed a two-lobed shape. We also discuss the contemporaneous evolution of an additional cyclone of the STB, which was similar to the one were Clyde's Spot developed. This cyclone did not exhibit visible internal convective activity, and transformed from pale white in 2019, with low contrast with the environment, to dark red in 2020, and thus, was very similar to the outcome of the second storm. This cyclone became bright again in 2021 after interacting with Oval BA. We present observations of these phenomena obtained by amateur astronomers, ground-based telescopes, Hubble Space Telescope and Junocam. This study reveals that short-lived small storms that are active for only a few days can produce complex longterm changes that extend over much larger areas than those initially covered by the storms. In a second paper [In tilde urrigarro et al., 2022] we use the EPIC numerical model to simulate these storms and study moist convection in closed cyclones.We are very thankful to the large community of amateur observers operating small telescopes that submit their Jupiter observations to databases such as PVOL and ALPO-Japan. We are also grateful to two anonymous reviewers for their comments that improved the clarity of this paper. This work has been supported by Grant PID2019-109467GB-I00 funded by MCIN/AEI/10.13039/501100011033/and by Grupos Gobierno Vasco IT1366-19. PI acknowledges a PhD scholarship from Gobierno Vasco. GSO and TM were supported by NASA with funds distributed to the Jet Propulsion Laboratory, California Institute of Technology under contract 80NM0018D0004. C. J. Hansen was sup-ported by funds from NASA, USA to the Juno mission via the Planetary Science Institute. IOE was supported by a contract funded by Europlanet 2024 RI to navigate Junocam images, now available as maps in PVOL at http://pvol2.ehu.eus. Europlanet 2024 RI has received funding from the European Unions Horizon 2020 research and innovation programme under grant agreement No 871149. G.S. Orton, S. R. Brueshaber, T. W. Momary, K. H. Baines and E. K. Dahl were visiting Astronomers at the Infrared Telescope Facility, which is operated by the University of Hawaii under contract 80HQTR19D0030 with the National Aeronautics and Space Administration. In addition, support from NASA Juno Participating Scientist award 80NSSC19K1265 was provided to M.H. Wong. This work has used data acquired from the NASA/ESA Hubble Space Telescope (HST) , which is operated by the Association of 807 Universities for Research in Astronomy, Inc., under NASA contract NAS 5-26555. These HST observations are associated with several HST observing programs: GO/DD 14661 (PI: M.H. Wong) , GO/DD 15665 (PI: I. de Pater) , GO/DD 15159 (PI: M. H. Wong) , GO/DD 15502 (PI: A. Simon) , GO/DD 14661 (PI: M. H. Wong) , GO/DD 16074 (PI: M.H. Wong) , GO/DD 16053 (PI: I. de Pater) , GO/DD 15929 (PI: A. Simon) , GO/DD 16269 (PI: A. Simon) . PlanetCam observations were collected at the Centro Astronomico Hispanico en Andalucia (CAHA) , operated jointly by the Instituto de Astrofisica de Andalucia (CSIC) and the Andalusian Universities (Junta de Andalucia) . This work was enabled by the location of the IRTF and Gemini North telescopes within the Mauakea Science Reserve, adjacent to the summit of Maunakea. We are grateful for the privilege of observing Kaawela (Jupiter) from a place that is unique in both its astronomical quality and its cultural signifi-cance. This research has made use of the USGS Integrated Software for Imagers and Spectrometers (ISIS) . Voyager 2 images were accessed through The PDS Ring-Moon Systems Nodes OPUS search service