Provision of relapse prevention interventions in UK NHS Stop Smoking Services: a survey

Background UK NHS Stop Smoking Services provide cost effective smoking cessation interventions but, as yet, there has been no assessment of their provision of relapse prevention interventions. Methods Electronic questionnaire survey of 185 UK Stop Smoking Services Managers. Results Ninety six Stop Smoking Service managers returned completed questionnaires (52% response rate). Of these, 58.3% (n = 56) ran NHS Stop Smoking Services which provided relapse prevention interventions for clients with the most commonly provided interventions being behavioural support: telephone (77%), group (73%), and individual (54%). Just under half (48%, n = 27) offered nicotine replacement therapy (NRT), 21.4% (n = 12) bupropion; 19.6% (n = 11) varenicline. Over 80% of those providing relapse prevention interventions do so for over six months. Nearly two thirds of all respondents thought it was likely that they would either continue to provide or commence provision of relapse prevention interventions in their services. Of the remaining respondents, 66.7% (n = 22) believed that the government focus on four-week quit rates, and 42.9% (14 services) believed that inadequate funding for provision of relapse prevention interventions, were major barriers to introducing these interventions into routine care. Conclusions Just over half of UK managers of NHS Stop Smoking Services who responded to the questionnaire reported that, in their services, relapse prevention interventions were currently provided for clients, despite, at that time, there being a weak evidence base for their effectiveness. The most commonly provided relapse prevention interventions were those for which there was least evidence. If these interventions are found to be effective, barriers would need to be removed before they would become part of routine care

ICT, Financial Sector Development and Financial Access

This study assesses the role of ICT (internet and mobile phone penetration) in complementing financial sector development (financial formalization and informalization) for financial access. The empirical evidence is based on generalized method of moments with 53 African countries for the period 2004–2011. The following findings are established from linkages between ICT, financial sector development and financial activity. First, the interaction between ICT and financial formalization (informalization) decreases (increases) financial activity. Second, with regard to net effects, the expected signs are established for the most part. In spite of the negative marginal effects from financial informalization, the overall net effects are positive. Third, the potentially appealing interaction between ICT and informalization produces positive thresholds that are within ranges. Policy implications are discussed in three main strands. They include implications for (i) mobile/internet banking, (ii) a quiet life and (iii) ICT in reducing information asymmetry and surplus liquidity

Carbon nanotube-enhanced photoelectrochemical properties of metallo-octacarboxyphthalocyanines

The photoelectrochemistry of metallo-octacarboxyphthalocyanines (MOCPc, where M = Zn or Si(OH)2) integrated with MWCNTs for the development of dye-sensitized solar cells (DSSCs) is reported. The DSSC performance (obtained from the photo-chronoamperometric and photo-impedimetric data) decreased as ZnOCPc > (OH)2SiOCPc. The incorporation of the MWCNTs on the surface of the TiO2 film (MOCPc–MWCNT systems) gave higher photocurrent density than the bare MOCPc complexes. Also, from the EIS results, the MOCPc–MWCNT hybrids gave faster charge transport kinetics (approximately three times faster) compared to the bare MOCPc complexes. The electron lifetime was slightly longer (ca. 6 ms) at the ZnOCPc systems than at the (OH)2SiOCPc system (ca. 4 ms) meaning that the presence of the MWCNTs on the surface of the TiO2 film did not show any significant improvement on preventing charge recombination process

Temperament and Impulsivity Predictors of Smoking Cessation Outcomes

Aims: Temperament and impulsivity are powerful predictors of addiction treatment outcomes. However, a comprehensive assessment of these features has not been examined in relation to smoking cessation outcomes.Methods: Naturalistic prospective study. Treatment-seeking smokers (n = 140) were recruited as they engaged in an occupational health clinic providing smoking cessation treatment between 2009 and 2013. Participants were assessed at baseline with measures of temperament (Temperament and Character Inventory), trait impulsivity (Barratt Impulsivity Scale), and cognitive impulsivity (Go/No Go, Delay Discounting and Iowa Gambling Task). The outcome measure was treatment status, coded as “dropout” versus “relapse” versus “abstinence” at 3, 6, and 12 months endpoints. Participants were telephonically contacted and reminded of follow-up face to face assessments at each endpoint. The participants that failed to answer the phone calls or self-reported discontinuation of treatment and failed to attend the upcoming follow-up session were coded as dropouts. The participants that self-reported continuing treatment, and successfully attended the upcoming follow-up session were coded as either “relapse” or “abstinence”, based on the results of smoking behavior self-reports cross-validated with co-oximetry hemoglobin levels. Multinomial regression models were conducted to test whether temperament and impulsivity measures predicted dropout and relapse relative to abstinence outcomes.Results: Higher scores on temperament dimensions of novelty seeking and reward dependence predicted poorer retention across endpoints, whereas only higher scores on persistence predicted greater relapse. Higher scores on the trait dimension of non-planning impulsivity but not performance on cognitive impulsivity predicted poorer retention. Higher non-planning impulsivity and poorer performance in the Iowa Gambling Task predicted greater relapse at 3 and 6 months and 6 months respectively.Conclusion: Temperament measures, and specifically novelty seeking and reward dependence, predict smoking cessation treatment retention, whereas persistence, non-planning impulsivity and poor decision-making predict smoking relapse.This research was funded by the Occupational Medicine Area (Prevention Service); Department of Personality, Assessment and Psychological Treatment, University of Granada (Spain); and Ministerio de Economía y Competitividad grant (MINICO, ref. # PSI2013-45055-P) for the first and second authors

Relapse prevention for addictive behaviors

The Relapse Prevention (RP) model has been a mainstay of addictions theory and treatment since its introduction three decades ago. This paper provides an overview and update of RP for addictive behaviors with a focus on developments over the last decade (2000-2010). Major treatment outcome studies and meta-analyses are summarized, as are selected empirical findings relevant to the tenets of the RP model. Notable advances in RP in the last decade include the introduction of a reformulated cognitive-behavioral model of relapse, the application of advanced statistical methods to model relapse in large randomized trials, and the development of mindfulness-based relapse prevention. We also review the emergent literature on genetic correlates of relapse following pharmacological and behavioral treatments. The continued influence of RP is evidenced by its integration in most cognitive-behavioral substance use interventions. However, the tendency to subsume RP within other treatment modalities has posed a barrier to systematic evaluation of the RP model. Overall, RP remains an influential cognitive-behavioral framework that can inform both theoretical and clinical approaches to understanding and facilitating behavior change

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Effect of Biochar and Cowdung on Nodulation, Growth and Yield of Soybean (Glycine max L. Merrill)

ABSTRACT The experiment was conducted at the Kogi State University Research and Student Demonstration Farm, Anyigba, Kogi State. The objective of this study was to examine effects of biochar and cowdung on nodulation, growth, yield of soybean and nutrient contribution of organic fertilizer used to soil. The study consisted of 5 treatments: combined biochar and cowdung (0, 2, 4, 6 and 8 t ha -1 ). The experiment was laid out in a randomized complete block design (RCBD) with 5 replicates in plots of 2 m × 1 m. Soybean variety TGX 1448-2E was used in the trial. Growth (number of leaves, height, and stem girth), nodulation (nodules number, nodules weight), yield (number of pods, pod dry weight, number of seeds, seed weight per plant, grain yield) and post cropping soil analyses were determined. Analysis of variance showed that biochar and cowdung increased growth and yield of soybean while nodulation decreased. Soil pH, organic carbon, soil nitrogen, calcium, magnesium, potassium, sodium and CEC significantly increased; available phosphorus insignificantly increased, while exchangeable acidity decreased significantly. Soybean responded well to the application of combined biochar and cowdung. These results showed the potential role of combined biochar and cowdung in improving soil fertility and soybean yields

Dietary supplementation of probiotics and synbiotics on intestinal microbial populations and gut morphology of turkey poults

The effect of dietary supplementation of probiotics and synbiotics on gut microbial population and histomorphological characteristics was examined in a 56-day experiment using 128 seven-day-old turkey poults fed with antibiotic, probiotic and synbiotic supplemented diets. The experimental design was a Randomised Complete Block Design. Poults were brooded for 7 days, after which they were allotted to 4 dietary treatments with 4 replicates of 8 birds per replicate. Treatment 1 was the basal diet with nosupplements while treatments 2, 3, and 4 were supplemented with  antibiotics, probiotics and synbiotics respectively. On day 56, birds were slaughtered and digesta samples from the ileum were collected formicrobial load count and intestinal pH. After flushing out the digesta samples, sections of the ileum (5cm posterior to Meckel’s diverticulum) were removed for ileal morphological measurements. Probiotic andsynbiotic supplementation significantly (P&lt;0.05) reduced the total coliform and total bacteria counts, meanwhile, lactic acid bacteria were significantly increased in birds on the experimental diets. The intestinal pH was slightly acidic across the treatment groups (6.45 – 6.83). However, the probiotic and synbiotic treatment groups had the lowest pH at 6.53 and 6.45 respectively. Probiotic and synbiotic supplementation significantly (P&lt;0.05) improved the villus height and crypt depth of poults which was comparable to those on antibiotic diet. In summary, dietary inclusion of probiotics and synbiotics improved the overall gut integrity of the turkey poults as well as reduction in the populations of coliform and total bacteria, while the population of lactic acid bacteria was significantly increased.Keywords: Antibiotics, Probiotics, Synbiotics, Turkey poult