Improving Quit Rates For Tobacco-Dependent Hospitalized Patients

Abstract Purpose: The purpose of this project was to evaluate outcomes of an existing inpatient tobacco cessation counseling program with 30-day follow-up among recently admitted tobacco-dependent patients who were tobacco-dependent. Background/Significance: Tobacco use is considered the number one most preventable cause of disease, disability, and death in the United States. Despite associated dangers, approximately 21% Americans currently smoke. This has led to increased hospital admissions and chronic disease management, costing the United States approximately $96 billion per year. Decades of research and evidence-based clinical practice guidelines substantiate that inpatient tobacco cessation counseling has the potential to improve quit rates post-hospital discharge. Method: This quality improvement project utilized existing hospital data containing demographic and medical information about patients and tobacco use behaviors. The goal was to answer the question: Does the provision of a tobacco cessation program initiated during hospitalization for persons who are tobacco-dependent (a) increase quit attempts or (b) reduce tobacco consumption? The electronic medical record was queried for data related to: demographics, insurance type, and diagnosis. Data related to smoking status and the intervention was extracted from a paper chart maintained by the certified tobacco treatment specialist. Results: Out of 176 tobacco-dependent patients admitted to the hospital, 100 (57%) indicated an intention to quit (at admission time) while only 40 (23%) reported having quit within 30 days post discharge (McNemar Test, p=0.000, n=176). The mean number of cigarettes smoked per day dropped from 19 cigarettes on admission to 13 cigarettes post discharge. [t (158)=6.7476, p=0.000]. Conclusions: This quality improvement project showed that although an inpatient smoking cessation program did not improve quit rates, it did significantly improve reduction in tobacco consumption

On the ground the reality is different: policymakers in Kenyan agriculture should beware limits to platform knowledge

Evidence that digital technologies are widely used among Kenya’s smallholder farmers is scarce, despite depictions by tech companies. New research exposes the potential danger of relying too much on platforms for understanding the realities of farmers, as their visions of the rural environment remains focussed on specific groups. Policymakers should be sensitive to these biases, asking questions about what data is being captured and how this may impact rural areas

Randomised prospective study for the effect of therapy on residual beta cell function in type-1 diabetes mellitus [ISRCTN70703138]

BACKGROUND: Newly diagnosed insulin-dependent diabetes mellitus is characterised by a temporary recovery of endogeneous insulin ("remission") after the beginning of medical treatment with subcutaneous insulin injections. Although most diabetologists think, that insulin reserve is related to reduced occurrence of diabetic long-term complications, such as eye, nerve and kidney disease, there is only one prospective controlled clinical study (the DCCT) addressing this question, however as secondary hypothesis. METHODS/DESIGN: Therefore, we composed a trial consisting of two cohorts with two therapeutic options within each cohort (conventional versus intensive therapy) and a three-year follow-up. In one group the patients are randomly assigned to the treatment regimes to test the statistical alternative hypothesis if variable insulin dosage is superior to fixed insulin injection in preserving insulin reserve measured by C-peptide in serum. Another group includes patients who prefer one of the two therapies, decline randomisation, but consent to follow-up. Apart from the determination of insulin reserve as a biological parameter a second primary endpoint was defined as 'therapeutic failure' according to the criteria of the European Association for the Study of Diabetes. Patients pass a training program to help them self-manage diabetes. A standardised protocol is being set up to minimize centre effects and bias of health care providers. Potential patient dependent bias will be investigated by questionnaires measuring psychic coping processes of people with diabetes. Management of visit dates is directly navigated by the database. Automated visit-reminders are mailed to patients and caregivers to optimise the number of visits on schedule. Data quality is regularly monitored and centres are informed on the results of continuous data management

Defining micro-habitat relationships for juvenile black rockfish, Sebastes melanops

The functioning of marine habitats needs to be understood in the context of the ecological relationships and associations between organisms and the physical and biogenic environment they inhabit. Thus, it becomes important to explore and define habitat features which contribute to these relationships and which are important in the life history of a species. Juvenile habitat needs and associations have rarely been studied, but Essential Fish Habitat (EFH) guidelines require description of habitat for all life stages of managed stocks. Given observational data in the natural environment, there is a strong need to determine if structural or biogenic habitat matters to fish. To explore direct relationships with habitat features, based on cause and effect, requires controlled laboratory studies. In this work, the extent and nature of habitat relationships for juvenile black rockfish, Sebastes melanops, were systematically investigated in four consecutive controlled experiments. I examined habitat choices of juvenile rockfish with respect to (1) a diurnal light cycle, (2) the nature of structure use with respect to the importance of crevices, (3) the effect of additional complexity in structure, and (4) the role of biotic components of structure independent of their physical attributes. In the first experiment (1), juvenile rockfish behavior was video taped during day, crepuscular and night conditions. To observe fish behavior at night an infrared tank set-up was used, with lights projecting through the bottom of the tanks. The sand layer was required to be very thin, such that the light could penetrate through both tank wall and sand and get picked up by an overhead camera. This exposed many crevices and ledges at the base of the boulders which were extensively used by all groups of fish. In the second experiment (2), burying the boulders in deep sand reduced this crevice availability and took away those types of refuge opportunities. Complexity was then examined by attaching white plumed anemones, Metridium spp. to half of the boulders in the tanks (experiment 3). White plumed anemones occur as two species on the west coast of North America, Metridium farcimen and M. senile fimbriatum, which are visually indistinguishable and have overlapping distributions. For the purposes of our experiments, it was not necessary to identify them to species level, and all the experimental animals were collected by scuba in Yaquina Bay. Artificial replicates of Metridium spp. in comparison with live animals were used to test for biogenic contributions to habitat preference (experiment 4). To see if associations and behaviors observed in the laboratory also occur in the field, habitat use by unidentified reef-associated juvenile rockfish in their natural environment was examined using video data collected by the Oregon Department of Fish and Wildlife with a remotely operated vehicle. The results of the experiments indicate that (1) the odds of juvenile black rockfish being present in boulders during daylight were 7.2 times greater than at nighttime. It is likely that refuge needs for juveniles of this species are greatest during daylight given the diversity of visual predators. (2) Crevice availability plays an important role in providing refuge, but juvenile black rockfish in my trials did not change boulder use based on crevice availability. (3) Juvenile black rockfish also clearly preferred habitat complexity (added anemones) and preferred boulders with attached Metridium spp. over plain boulders. (4) Preference was given not only to higher structural complexity, but also to habitat that offered a biotic component to the boulder/anemone arrangement. Juvenile black rockfish showed a significant association with boulder habitat containing attached live Metridium spp. over boulder habitat with the same structural construct using plastic replicas. The specific nature of this biogenic contribution to habitat choice is unknown and could be the result of an important symbiotic relationship. In their natural environment, unidentified juvenile rockfish also occurred in greater numbers in micro-habitats highly populated by Metridium spp. This work demonstrates that reef associated juvenile black rockfish engage in complex micro-habitat relationships that are not only based on structural complexity but also on biogenic influences. Biogenic habitats frequently involve invertebrate species that are fragile and long lived, and thus vulnerable to disturbance (e.g. from global warming, fishing activities and other extraction processes). Although survival and growth of juvenile black rockfish was not investigated in this work, the loss of biogenic habitat is likely to impact post settlement survival of reef-associated fishes, thus ultimately affecting population recruitment. Habitat limitations in the juvenile stage are particularly important to understand because density-dependent factors can dampen high stochasticity in recruitment to adult populations

ATP hydrolysis by the viral RNA sensor RIG-I prevents unintentional recognition of self-RNA

The cytosolic antiviral innate immune sensor RIG-I distinguishes 5' tri- or diphosphate containing viral double-stranded (ds) RNA from self-RNA by an incompletely understood mechanism that involves ATP hydrolysis by RIG-I's RNA translocase domain. Recently discovered mutations in ATPase motifs can lead to the multi-system disorder Singleton-Merten Syndrome (SMS) and increased interferon levels, suggesting misregulated signaling by RIG-I. Here we report that SMS mutations phenocopy a mutation that allows ATP binding but prevents hydrolysis. ATPase deficient RIG-I constitutively signals through endogenous RNA and co-purifies with self-RNA even from virus infected cells. Biochemical studies and cryo-electron microscopy identify a 60S ribosomal expansion segment as a dominant self-RNA that is stably bound by ATPase deficient RIG-I. ATP hydrolysis displaces wild-type RIG-I from this self-RNA but not from 5' triphosphate dsRNA. Our results indicate that ATP-hydrolysis prevents recognition of self-RNA and suggest that SMS mutations lead to unintentional signaling through prolonged RNA binding

ATP hydrolysis by the viral RNA sensor RIG-I prevents unintentional recognition of self-RNA

The cytosolic antiviral innate immune sensor RIG-I distinguishes 5' tri- or diphosphate containing viral double-stranded (ds) RNA from self-RNA by an incompletely understood mechanism that involves ATP hydrolysis by RIG-I's RNA translocase domain. Recently discovered mutations in ATPase motifs can lead to the multi-system disorder Singleton-Merten Syndrome (SMS) and increased interferon levels, suggesting misregulated signaling by RIG-I. Here we report that SMS mutations phenocopy a mutation that allows ATP binding but prevents hydrolysis. ATPase deficient RIG-I constitutively signals through endogenous RNA and co-purifies with self-RNA even from virus infected cells. Biochemical studies and cryo-electron microscopy identify a 60S ribosomal expansion segment as a dominant self-RNA that is stably bound by ATPase deficient RIG-I. ATP hydrolysis displaces wild-type RIG-I from this self-RNA but not from 5' triphosphate dsRNA. Our results indicate that ATP-hydrolysis prevents recognition of self-RNA and suggest that SMS mutations lead to unintentional signaling through prolonged RNA binding

Cold atom Clocks and Applications

This paper describes advances in microwave frequency standards using laser-cooled atoms at BNM-SYRTE. First, recent improvements of the $^{133}$Cs and $^{87}$Rb atomic fountains are described. Thanks to the routine use of a cryogenic sapphire oscillator as an ultra-stable local frequency reference, a fountain frequency instability of $1.6\times 10^{-14}\tau^{-1/2}$ where $\tau$ is the measurement time in seconds is measured. The second advance is a powerful method to control the frequency shift due to cold collisions. These two advances lead to a frequency stability of $2\times 10^{-16}$ at $50,000s for the first time for primary standards. In addition, these clocks realize the SI second with an accuracy of$7\times 10^{-16}$, one order of magnitude below that of uncooled devices. In a second part, we describe tests of possible variations of fundamental constants using$^{87}$Rb and$^{133}$Cs fountains. Finally we give an update on the cold atom space clock PHARAO developed in collaboration with CNES. This clock is one of the main instruments of the ACES/ESA mission which is scheduled to fly on board the International Space Station in 2008, enabling a new generation of relativity tests.Comment: 30 pages, 11 figure