A Multiple Component Intervention to Assist Young Pregnant Smokers to Cease Smoking: A Randomised Controlled Pilot Study

Objective: Australian rates of cigarette smoking are the lowest in the world. Young pregnant smokers are a sub population where smoking remains high. This pilot study assessed the feasibility of a multi-component intervention (Carbon Monoxide testing, motivational interviewing and a non-smoking buddy) to assist young pregnant women to cease smoking. Methods: Between October 2013 and June 2015, this multi-centred West Australian study recruited pregnant smokers aged 16 to 24, attending their first antenatal visit. Women (n=80) were randomised to the intervention and standard smoking cessation advice (n=43) or standard smoking cessation advice alone (n=37). At 36 weeks gestation and six weeks post birth, cessation rates were compared between groups using repeated measures survival analysis and reduction in smoking was examined using repeated measures linear regression on the number of cigarettes smoked. Results: The majority (89%) of women were unemployed or not in education, used illicit drugs (43%) and had experienced sexual abuse (23%). Involvement with child protection services was common (38%). Cigarette initiation occurred at a mean age of 13 years, median number of cigarettes smoked at baseline was 10 in both groups. Smoking cessation in intervention and controls were 17% vs. 14% at 36 weeks and 23% vs. 7% 6 weeks post birth. No significant differences in cessation or smoking reduction between groups were found individually or in the repeated events analysis. Conclusion: Given the low number of participants our findings cannot conclusively rule out this multi-component intervention. We believe it remains possible this intervention may prove effective in a larger group of participants and in another setting. Monitoring trends in this vulnerable, difficult to engage group of pregnant young women is important if we are to continue to devise effective interventions

An Exploration of Young Australian Women's Smoking Cessation Goals across the Trajectory of Pregnancy and Post Birth

Objective: Young pregnant women are more likely than other pregnant women to smoke tobacco during pregnancy and post birth. This study explored young women’s perceptions of the factors which impact their smoking cessation goals throughout pregnancy and post birth. Methods: This qualitative descriptive study was performed at two metropolitan obstetric hospitals in Western Australia. Forty three women aged 16 to 24 years old who reported smoking tobacco at their first antenatal visit were interviewed at each scheduled antenatal visit and every two weeks up to six weeks post birth. Interviews were subjected to thematic analysis. Results: A total of 244 interviews were performed; a mean of six interviews per woman (four in pregnancy and two post birth). Four overarching themes across three time periods were identified: the baby; the social bond of smoking; the chaotic nature of life; and access to social support. Pregnant women had a foetus-centric approach to cessation. Post birth those who sustained cessation held this belief for their newborn, whilst those who relapsed did not. The social bond of smoking highlighted smoking as the norm. Initially, women sought out non-smokers to support them. A partner’s smoking status post birth appeared pivotal to remaining tobacco free. The chaotic nature of life, reflected through multiple stressful, negative events, challenged women in achieving their smoking cessation goals. Women who sought social support appeared to stay smoke free post birth. Conclusion: The longitudinal nature of this study provides new insight into complex issues faced by this marginalised group of young, pregnant, tobacco smokers throughout the journey of pregnancy and post birth. Findings enhance our understanding of the complex real life issues some young pregnant Australian smokers face and may be considered when women focused smoking cessation interventions are developed

Gaining insight into how women conceptualize satisfaction: Western Australian women's perception of their maternity care experiences

BACKGROUND: The concept of maternal satisfaction is challenging, as women's and clinicians' expectations and experiences can differ. Our aim was to investigate women's experiences of maternity care in an urban tertiary obstetric setting, to gain insight into conceptualization of satisfaction across the childbirth continuum. METHODS: This mixed method study was conducted at a public maternity hospital in Western Australia. A questionnaire was sent to 733 women two weeks post birth, which included an invitation for an audio-recorded, telephone interview. Frequency distributions and univariate comparisons were employed for quantitative data. Thematic analysis of interview transcripts was undertaken to extract common themes. RESULTS: A total of 54 % (399 of 733) returned the questionnaire. Quantitative results indicated that women were less likely to feel: involved if they did not have a spontaneous vaginal birth (P?=?0.020); supported by a midwife if they had a caesarean (P?=?<0.001); or supported by an obstetrician if they had a spontaneous vaginal birth (P?=?<0.001). Qualitative findings emerged from 63 interviews which highlighted the influence that organization of care, resources and facilities had on women's satisfaction. These paradigms unfolded as three broad themes constructed by four sub-themes, each illustrating a dichotomy of experiences. The first theme 'how care was provided' encompassed: familiar faces versus a different one every time and the best place to be as opposed to so disappointed. The second theme 'attributes of staff' included: above and beyond versus caring without caring and in good hands as opposed to handled incorrectly. The third theme 'engaged in care' incorporated: explained everything versus did not know why and had a choice as opposed to did not listen to my needs. CONCLUSIONS: Quantitative analysis confirmed that the majority of women surveyed were satisfied. Mode of birth influenced women's perception of being involved with their birth. Being able to explore the diversity of women's experiences in relation to satisfaction with their maternity care in an urban, tertiary obstetric setting has offered greater insight into what women value: a sensitive, respectful, shared relationship with competent clinicians who recognise and strive to provide woman focused care across the childbirth continuum

Forward modelling of carbonate platforms:Sedimentological and diagenetic constraints from an application to a flat-topped greenhouse platform (Triassic, Southern Alps, Italy)

Quantitative analysis of depositional systems using numerical models can provide insights into the interaction of sedimentological and diagenetic processes, difficult to interpret from observation of the geological products alone. Numerical models can highlight the interactions between controlling parameters, and generate best estimate simulations of case studies from the geological record. Different data sources (e.g., outcrop data, uniformitarian constraints, paleogeography) need to be considered in the process of defining the parameters required to produce models that honour individual case studies. We present a best-estimate forward model of a high-relief Triassic carbonate platform (Southern Alps, Italy) generated using CARB3D+, a 3D process-based forward modelling package able to simulate sedimentary facies, geometries and early diagenesis of isolated carbonate platforms. The parameters used for the presented forward model have been deduced by the study of architectural, sedimentological and diagenetic features of the platform, and by data from modern and ancient analogues. Sensitivity analysis is used to tune values of the parameters within ranges defined from field, laboratory and uniformitarian constraints. Critical evaluation of the model allowed 1) verification of the validity of the used parameters; 2) evaluation of the interaction between controlling parameters; 3) development of a numerical model that can be used for quantitative elaborations. Furthermore, the process of generating the numerical model required a detailed interpretation of field and laboratory data, crucial to define the required input parameters. Modelling the studied carbonate platform also enabled evaluation of the effects of the interaction between productivity, environmental energy and creation of accommodation space, promoting the understanding of their role on the architecture of carbonate systems. Forward modelling also allows the integration of data from conventional data sets with data from present-day observations and seismic geometries, promoting a transition from a qualitative to a semi-quantitative/quantitative sedimentological approach. Forward models can further be used to parameterise petrophysical properties of complex geobodies, with potential application for the management of georesources

Can Sustainable Livestock Systems and Alternative Proteins Address the Climate Crisis? Presentations

Climate change is severely impacting our food systems, making it increasingly challenging to provide food security and healthy diets for all people. At the same time, food systems contribute 25–30% of all greenhouse gas emissions. The livestock sector alone contributes about half of these GHGs, and has a large land and water footprint. The livestock sector is also the fastest growing agricultural sector in Africa and other parts of the Global South, where access to healthy, affordable milk, meat, and egg remains low. Clearly food system adaptation, including in the livestock sector, must deliver both mitigation and healthy diets. The CGIAR’s 2023 Achieving Agriculture Breakthrough report identifies seven key technological areas and approaches for driving real change in the agriculture sector. Three of these are related to livestock: reducing methane emissions from livestock, livestock breeding for climate resilience, and alternative proteins to replace traditional animal-source proteins. The third seminar of the CGIAR Policy Seminar Series on Strengthening Food Systems will delve into findings and recommendations around sustainable livestock technologies, healthy diets, methane emissions, and alternative proteins, including promising initiatives and technologies that can be pursued to address climate change and healthy diets

Exploring young pregnant smokers' experiences with a self-nominated non-smoking buddy

Introduction psychosocial interventions can increase the proportion of women who stop smoking in pregnancy. There is limited research exploring self-nominated, non-smoking buddy support, to assist young pregnant smokers to quit. Methods this qualitative descriptive study was embedded within a randomised controlled study assisting young (16 to 24 years) pregnant smokers to quit. Women were recruited from two public maternity hospitals in Western Australia. Interviews were performed every two weeks from recruitment to six weeks post birth. The study aim was to explore women's experiences with a self-nominated non-smoking buddy. Thematic analysis was utilised to identify common themes. Findings a total of 204 interviews were performed with 36 women, who had a mean of six interviews, with four conducted in pregnancy and two post birth. Two themes were revealed. The first ‘Challenges of finding the right buddy’ reflected the experiences women had in finding a non-smoking buddy to provide support and encompassed three sub themes; 'The only non-smoker I know', ‘Reluctance to alter the existing relationship' and ‘Limited discussion around expectations of buddy support’. The second theme ‘Sustaining the buddy relationship’ centred on the continuing relationship the woman had with her buddy and encompassed three sub themes; ‘Consistent relationship’, ‘Changeable buddies’ and ‘Unofficial buddies’. Conclusion our findings reveal the complexity of incorporating non–smoking buddy support into smoking cessation programs for young pregnant smokers. The characteristics and social environment of individual women may have the capacity to influence their ability to engage and sustain a relationship with a non-smoking buddy

Mutations in the SPG7 gene cause chronic progressive external ophthalmoplegia through disordered mitochondrial DNA maintenance

Despite being a canonical presenting feature of mitochondrial disease, the genetic basis of progressive external ophthalmoplegia remains unknown in a large proportion of patients. Here we show that mutations in SPG7 are a novel cause of progressive external ophthalmoplegia associated with multiple mitochondrial DNA deletions. After excluding known causes, whole exome sequencing, targeted Sanger sequencing and multiplex ligation-dependent probe amplification analysis were used to study 68 adult patients with progressive external ophthalmoplegia either with or without multiple mitochondrial DNA deletions in skeletal muscle. Nine patients (eight probands) were found to carry compound heterozygous SPG7 mutations, including three novel mutations: two missense mutations c.2221G>A; p.(Glu741Lys), c.2224G>A; p.(Asp742Asn), a truncating mutation c.861dupT; p.Asn288*, and seven previously reported mutations. We identified a further six patients with single heterozygous mutations in SPG7, including two further novel mutations: c.184-3C>T (predicted to remove a splice site before exon 2) and c.1067C>T; p.(Thr356Met). The clinical phenotype typically developed in mid-adult life with either progressive external ophthalmoplegia/ptosis and spastic ataxia, or a progressive ataxic disorder. Dysphagia and proximal myopathy were common, but urinary symptoms were rare, despite the spasticity. Functional studies included transcript analysis, proteomics, mitochondrial network analysis, single fibre mitochondrial DNA analysis and deep re-sequencing of mitochondrial DNA. SPG7 mutations caused increased mitochondrial biogenesis in patient muscle, and mitochondrial fusion in patient fibroblasts associated with the clonal expansion of mitochondrial DNA mutations. In conclusion, the SPG7 gene should be screened in patients in whom a disorder of mitochondrial DNA maintenance is suspected when spastic ataxia is prominent. The complex neurological phenotype is likely a result of the clonal expansion of secondary mitochondrial DNA mutations modulating the phenotype, driven by compensatory mitochondrial biogenesis