In-hospital opioid consumption, but not pain intensity scores, predicts 6-month levels of pain catastrophizing following hepatic resection : a trajectory analysis

Background The study aims were to model acute pain intensity and opioid consumption trajectories up to 72 hr after open hepatic resection, identify predictors of trajectory membership and examine the association between trajectory memberships and 6-month pain and psychological outcomes. This is a long-term analysis of a published randomized controlled trial on the impact of medial open transversus abdominis plane catheters on post-operative outcomes. Methods A total of 152 patients (89 males; mean age 63.0 [range: 54–72]) completed questionnaires on pain and related characteristics pre-operatively and 6 months post-operatively. Total opioid use was recorded several times over a 72-hr period while self-reported pain intensity scores were collected multiple times until hospital discharge. Analyses were carried out using growth mixture modelling, logistic regression and general linear models. Results Both pain intensity and opioid consumption showed that a four-trajectory model best fits the data. Patients in the lowest opioid consumption trajectory were more likely to be classified in the constant mild pain intensity trajectory. Age and baseline levels of anxiety significantly predicted opioid trajectory membership while baseline depressive symptoms significantly predicted pain intensity trajectory membership. Patients in the two highest opioid consumption trajectories reported significantly higher levels of pain catastrophizing at 6 months compared to patients in the other 3 trajectories (all p < 0.05). Conclusion High consumption of opioids after surgery is associated with higher levels of pain catastrophizing 6 months later. Identification of patients within these trajectories may lead to the development of early interventions targeted to high risk individuals. Significance Differences in initial levels of opioid consumption and rates of change in opioid consumption shortly after surgery can help predict long-term psychological responses to pain. Identifying key characteristics associated with initial opioid consumption can lead to the development of cost-effective early interventions targeted to high risk individuals

Workplace interventions for smoking cessation

BACKGROUND: The workplace has potential as a setting through which large groups of people can be reached to encourage smoking cessation. OBJECTIVES: To categorize workplace interventions for smoking cessation tested in controlled studies and to determine the extent to which they help workers to stop smoking or to reduce tobacco consumption. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group Specialized Register in April 2008, MEDLINE (1966 - April 2008), EMBASE (1985 - Feb 2008) and PsycINFO (to March 2008). We searched abstracts from international conferences on tobacco and the bibliographies of identified studies and reviews for additional references. SELECTION CRITERIA: We selected interventions conducted in the workplace to promote smoking cessation. We included only randomized and quasi-randomized controlled trials allocating individuals, workplaces or companies to intervention or control conditions. DATA COLLECTION AND ANALYSIS: Information relating to the characteristics and content of all kinds of interventions, participants, outcomes and methods of the study was abstracted by one author and checked by another. Because of heterogeneity in the design and content of the included studies, we did not attempt formal meta-analysis, and evaluated the studies using qualitative narrative synthesis. MAIN RESULTS: We include 51 studies covering 53 interventions in this updated review. We found 37 studies of workplace interventions aimed at individual workers, covering group therapy, individual counselling, self-help materials, nicotine replacement therapy and social support. The results were consistent with those found in other settings. Group programmes, individual counselling and nicotine replacement therapy increased cessation rates in comparison to no treatment or minimal intervention controls. Self-help materials were less effective. We also found 16 studies testing interventions applied to the workplace as a whole. There was a lack of evidence that comprehensive programmes reduced the prevalence of smoking. Incentive schemes increased attempts to stop smoking, though there was less evidence that they increased the rate of actual quitting. AUTHORS' CONCLUSIONS: 1. We found strong evidence that interventions directed towards individual smokers increase the likelihood of quitting smoking. These include individual and group counselling and pharmacological treatment to overcome nicotine addiction. All these interventions show similar effects whether offered in the workplace or elsewhere. Self-help interventions and social support are less effective. Although people taking up these interventions are more likely to stop, the absolute numbers who quit are low.2. There was limited evidence that participation in programmes can be increased by competitions and incentives organized by the employer.3. We failed to detect an effect of comprehensive programmes in reducing the prevalence of smoking

Workplace interventions for smoking cessation.

BACKGROUND: The workplace has potential as a setting through which large groups of people can be reached to encourage smoking cessation. OBJECTIVES: To categorise workplace interventions for smoking cessation tested in controlled studies and to determine the extent to which they help workers to stop smoking or to reduce tobacco consumption. SEARCH STRATEGY: We searched the Tobacco Addiction Review Group trials register in November 2002, Medline (1966 - November 2002), EMBASE (1985 - November 2002) and PsycINFO (to November 2002). We searched abstracts from international conferences on tobacco and we checked the bibliographies of identified studies and reviews for additional references. SELECTION CRITERIA: We categorised interventions into two groups: a) Interventions aimed at the individual to promote smoking cessation and b) interventions aimed at the workplace as a whole. We applied different inclusion criteria for the different types of study. For interventions aimed at helping individuals to stop smoking, we included only randomised controlled trials allocating individuals, workplaces or companies to intervention or control conditions. For studies of smoking restrictions and bans in the workplace, we also included controlled trials with baseline and post-intervention outcomes and interrupted times series studies. DATA COLLECTION AND ANALYSIS: Information relating to the characteristics and content of all kinds of interventions, participants, outcomes and methods of the study was abstracted by one reviewer and checked by two others. Because of heterogeneity in the design and content of the included studies, we did not attempt formal meta-analysis, and evaluated the studies using qualitative narrative synthesis. MAIN RESULTS: Workplace interventions aimed at helping individuals to stop smoking included nine studies of group therapy, three studies of individual counselling, eight studies of self-help materials and four studies of nicotine replacement therapy. The results were consistent with those found in other settings. Group programmes, individual counselling and nicotine replacement therapy increased cessation rates in comparison to no treatment or minimal intervention controls. Self-help materials were less effective. Workplace interventions aimed at the workforce as a whole included 13 studies of tobacco bans, two studies of social support, four studies of environmental support, four studies of incentives, six studies of comprehensive (multi-component) programmes and two studies of competitions and recruitment. Tobacco bans decreased cigarette consumption during the working day but their effect on total consumption was less certain. We failed to detect an increase in quit rates from adding social and environmental support to these programmes. There was a lack of evidence that comprehensive programmes reduced the prevalence of smoking. Competitions and incentives increased attempts to stop smoking, though there was less evidence that they increased the rate of actual quitting. REVIEWER'S CONCLUSIONS: We found 1. Strong evidence that interventions directed towards individual smokers increase the likelihood of quitting smoking. These include advice from a health professional, individual and group counselling and pharmacological treatment to overcome nicotine addiction. Self-help interventions are less effective. All these interventions are effective whether offered in the workplace or elsewhere. Although people taking up these interventions are more likely to stop, the absolute numbers who quit are low. 2. Limited evidence that participation in programmes can be increased by competitions and incentives organised by the employer. 3. Consistent evidence that workplace tobacco policies and bans can decrease cigarette consumption during the working day by smokers and exposure of non-smoking employees to environmental tobacco smoke at work, but conflicting evidence about whether they decrease prevalence of smoking or overall consumption of tobacco by smokers. 4. A lack of evidence that comprehensive approaches reduce the prevalence of smoking, despite the strong theoretical rationale for their use. 5. A lack of evidence about the cost-effectiveness of workplace programmes

Minimal erosion of Arctic alpine topography during late Quaternary glaciation

The alpine topography observed in manymountainous regions is thought to have formed during repeated glaciations of the Quaternary period1,2. Before this time, landscapes had much less relief1–3. However, the spatial patterns and rates of Quaternary exhumation at high latitudes—where cold-based glaciers may protect rather than erode landscapes—are not fully quantified. Here we determine the exposure and burial histories of rock samples from eight summits of steep alpine peaks in northwestern Svalbard (79.5 ◦ N) using analyses of 10Be and 26Al concentrations4,5. We find that the summits have been preserved for at least the past one million years. The antiquity of Svalbard’s alpine landscape is supported by the preservation of sediments older than one million years along a fjord valley6, which suggests that both mountain summits and low-elevation landscapes experienced very lo

Isotope ratios of H, C, and O in CO2 and H2O of the Martian atmosphere

Stable isotope ratios of H, C, and O are powerful indicators of a wide variety of planetary geophysical processes, and for Mars they reveal the record of loss of its atmosphere and subsequent interactions with its surface such as carbonate formation. We report in situ measurements of the isotopic ratios of D/H and O-18/O-16 in water and C-13/C-12, O-18/O-16, O-17/O-16, and (CO)-C-13-O-18/(CO)-C-12-O-16 in carbon dioxide, made in the martian atmosphere at Gale Crater from the Curiosity rover using the Sample Analysis at Mars (SAM)'s tunable laser spectrometer (TLS). Comparison between our measurements in the modern atmosphere and those of martian meteorites such as ALH 84001 implies that the martian reservoirs of CO2 and H2O were largely established similar to 4 billion years ago, but that atmospheric loss or surface interaction may be still ongoing