Health professionals' perceptions of the barriers and facilitators to providing smoking cessation advice to women in pregnancy and during the post-partum period : a systematic review of qualitative research

Background: Reducing smoking in pregnancy is a policy priority in many countries and as a result there has been a rise in the development of services to help pregnant women to quit. A wide range of professionals are involved in providing these services, with midwives playing a particularly pivotal role. Understanding professionals' experiences of providing smoking cessation support in pregnancy can help to inform the design of interventions as well as to improve routine care. Methods: A synthesis of qualitative research of health professionals' perceptions of the barriers and facilitators to providing smoking cessation advice to women in pregnancy and the post-partum period was conducted using meta-ethnography. Searches were undertaken from 1990 to January 2015 using terms for maternity health professionals and smoking cessation advisors, pregnancy, post-partum, smoking, and qualitative in seven electronic databases. The review was reported in accordance with the 'Enhancing transparency in reporting the synthesis of qualitative research' (ENTREQ) statement. Results: Eight studies reported in nine papers were included, reporting on the views of 190 health professionals/ key informants, including 85 midwives and health visitors. The synthesis identified that both the professional role of participants and the organisational context in which they worked could act as either barriers or facilitators to an individual's ability to provide smoking cessation support to pregnant or post-partum women. Underpinning these factors was an acknowledgment that the association between maternal smoking and social disadvantage was a considerable barrier to addressing and supporting smoking cessation Conclusions: The review identifies a role for professional education, both pre-qualification and in continuing professional development that will enable individuals to provide smoking cessation support to pregnant women. Key to the success of this education is recognising the centrality of the professional-client/patient relationship in any interaction. The review also highlights a widespread professional perception of the barriers associated with helping women give up smoking in pregnancy, particularly for those in disadvantaged circumstances. Improving the quality and accessibility of evidence on effective healthcare interventions, including evidence on 'what works' to support smoking cessation in disadvantaged groups, should therefore be a priority

Demonstration of a switchable damping system to allow low-noise operation of high-Q low-mass suspension systems

Low mass suspension systems with high-Q pendulum stages are used to enable quantum radiation pressure noise limited experiments. Utilising multiple pendulum stages with vertical blade springs and materials with high quality factors provides attenuation of seismic and thermal noise, however damping of these high-Q pendulum systems in multiple degrees of freedom is essential for practical implementation. Viscous damping such as eddy-current damping can be employed but introduces displacement noise from force noise due to thermal fluctuations in the damping system. In this paper we demonstrate a passive damping system with adjustable damping strength as a solution for this problem that can be used for low mass suspension systems without adding additional displacement noise in science mode. We show a reduction of the damping factor by a factor of 8 on a test suspension and provide a general optimisation for this system.Comment: 5 pages, 5 figure

Glycaemic (HbA1c) variability and mortality in older people (age ≥70 years) with diabetes mellitus:a retrospective cohort study

Background: Glycaemic targets for older people have been revised in recent years over concern that more stringent levels are associated with elevated mortality hazard. In this study, we explore this association considering glycaemic control and variability. Methods: A 5 year retrospective cohort study using a large primary care dataset examining glycaemic control and variability exposures on all-cause mortality. The cohort comprised 54,803 patients with Type 1 and 2 diabetes aged ≥70 years, mean age 78.3(SD5·7) and 51% were female. Glycaemic control(HbA1c) was assessed in three models using: a baseline mean; whole follow-up period mean; and time-varying yearly updated mean. Glycaemic variation was assessed using an instability metric based on number of changes in HbA1c≥0·5%(5·5mmol/mol), scored low to high,0-100. Findings: There were 17,680 deaths during the observation period, the mortality rate was 77 per 1000 person years. The data showed a 'J' shaped distribution for mortality hazard with significant elevations with HbA1c values >8% (64mmol/mol) and <6% (42mmol/mol). Survival diminished markedly with increasing instability in all models. For the whole period HbA1c measure the hazard ratios in patients with the highest instability metric(>80-100) (n=1,227) were 2·47 for females and 2·21 for males. Fitting the glycaemic control models with the instability metric softened the hazard distribution with significant hazard only being observed with HbA1c values >10%(86mmol/mol) in males and >9·5%(80mmol/mol) in females. Interpretation: The data suggests that glycaemic variability may be an important factor in understanding mortality hazard in older people with diabetes

Amino acid-dependent cMyc expression is essential for NK cell metabolic and functional responses in mice

Natural killer (NK) cells are lymphocytes with important anti-tumour functions. Cytokine activation of NK cell glycolysis and oxidative phosphorylation (OXPHOS) are essential for robust NK cell responses. However, the mechanisms leading to this metabolic phenotype are unclear. Here we show that the transcription factor cMyc is essential for IL-2/IL-12-induced metabolic and functional responses in mice. cMyc protein levels are acutely regulated by amino acids; cMyc protein is lost rapidly when glutamine is withdrawn or when system L-amino acid transport is blocked. We identify SLC7A5 as the predominant system L-amino acid transporter in activated NK cells. Unlike other lymphocyte subsets, glutaminolysis and the tricarboxylic acid cycle do not sustain OXPHOS in activated NK cells. Glutamine withdrawal, but not the inhibition of glutaminolysis, results in the loss of cMyc protein, reduced cell growth and impaired NK cell responses. These data identify an essential role for amino acid-controlled cMyc for NK cell metabolism and function

Mean HbA, HbA variability, and mortality in people with diabetes aged 70 years and older:a retrospective cohort study

BACKGROUND: Glycaemic targets for older people have been revised in recent years because of concern that more stringent targets are associated with increased mortality. We aimed to investigate the association between glycaemic control (mean HbA1c) and variability (variability of HbA1c over time) and mortality in older people with diabetes.METHODS: We did a 5-year retrospective cohort study using The Health Improvement Network database, which includes data from 587 UK primary care practices. We included patients of either sex who were aged 70 years and older with type 1 or type 2 diabetes. The primary outcome was time to all-cause mortality. Our primary exposure variables were mean HbA1c and variability of HbA1c over time. The observation included a 4-year run-in period (from 2003) as a baseline, with a 5-year follow-up (from 2007 to 2012). We assessed mean HbA1c in three models: a baseline mean HbA1c for 2003-06 (model 1), the mean across the whole follow-up period (model 2), and a time-varying yearly updated mean (model 3). A variability score (from 0 [low] to 100 [high]) was calculated on the basis of number of changes in HbA1c of 0·5% (5·5 mmol/mol) or more from 2003 to 2012 or to the point of mortality, based on changes in the annual mean as per each model with a minimum of six readings.FINDINGS: The cohort consisted of 54 803 people, of whom 17 680 (8614 [30·7%] of 28 017 women and 9066 [33·8%] of 26 786 men) died during the observation period. The overall mortality rate was 77 per 1000 person-years (73 per 1000 person-years for women and 80 per 1000 person-years for men). The data showed a J-shaped distribution for mortality risk in both sexes, with significant increases with HbA1c values greater than 8% (64 mmol/mol) and less than 6% (42 mmol/mol), although excess mortality risk was non-significant in model 1 for men at HbA1c values of 8% (64 mmol/mol) to less than 8·5% (&lt;69 mmol/mol) and in models 1 and 3 for both sexes assessed individually at HbA1c values less than 6% (42 mmol/mol). Mortality increased substantially with increasing HbA1c variability in all models (overall and for both sexes). For the model 2 HbA1c measure, the adjusted hazard ratios comparing patients with a glycaemic variability score of more than 80 to 100 with those with a score of 0 to 20 were 2·47 (95% CI 2·08-2·93) for women and 2·21 (1·87-2·61) for men. Fitting the mean HbA1c models with the glycaemic variability score altered the risk distribution; this observation was most marked in the model 2 analysis, in which a significant increased risk was only apparent with HbA1c values greater than 9·5% (80 mmol/mol) in women and 9% (75 mmol/mol) in men.INTERPRETATION: Both low and high levels of glycaemic control were associated with an increased mortality risk, and the level of variability also seems to be an important factor, suggesting that a stable glycaemic level in the middle range is associated with lower risk. Glycaemic variability, as assessed by variability over time in HbA1c, might be an important factor in understanding mortality risk in older people with diabetes.FUNDING: King's College London and Diabetes Frail.</p

On legitimacy in impact assessment: An epistemologically-based conceptualisation

Impact assessment (IA) is carried out as an ex ante process to inform decision-making. It includes requirements for engagement with stakeholders (including the public) regarding actions proposed by a proponent. A key issue with the various stakeholders involved is the perceived legitimacy of the IA, which can have implications both for the reputation of the proponent, and the likelihood of conflict over the decision. But the understanding of legitimacy in the IA literature has changed over time in line with an ontological shift from positivism (that scientifically generated information leads to better informed decisions) to the post-positivist acknowledgement of the limitations of scientific method whereby assumptions must be subject to transparency, deliberation and openness. This has led to an epistemological shift towards greater subjectivism which, we suggest, has created new opportunities (which have been realised in political decision-making) to subvert knowledge through the increased use of the Internet and social media. To address the potential for such subversion of legitimacy, we seek to conceptualise legitimacy in the IA context through framing IA around a critical realist ontology and a reliabilist virtue epistemology. This allows us to identify ‘knowledge legitimacy’ as an equally important component of IA legitimacy along with organisational legitimacy. We conceptualise knowledge legitimacy through literature review drawing on rich understandings of knowledge from IA and other fields of research in order to develop a four-dimensional typology. This includes the dimensions of: knowledge accuracy; knowledge restriction; knowledge diffusion; and knowledge spectrum. This is the first theoretically grounded attempt to understand legitimacy in IA. It is hoped that it will provoke discussion in the IA community to further advance theoretical understandings of IA and legitimacy of practice

The cytotoxic T cell proteome and its shaping by the kinase mTOR

High-resolution mass spectrometry maps the cytotoxic T lymphocyte (CTL) proteome and the impact of mammalian target of rapamycin complex 1 (mTORC1) on CTLs. The CTL proteome was dominated by metabolic regulators and granzymes and mTORC1 selectively repressed and promoted expression of subset of CTL proteins (~10%). These included key CTL effector molecules, signaling proteins and a subset of metabolic enzymes. Proteomic data highlighted the potential for mTORC1 negative control of phosphatidylinositol (3,4,5)-trisphosphate (PtdIns(3,4,5)P(3)) production in CTL. mTORC1 was shown to repress PtdIns(3,4,5)P(3) production and to determine the mTORC2 requirement for activation of the kinase Akt. Unbiased proteomic analysis thus provides a comprehensive understanding of CTL identity and mTORC1 control of CTL function

A game theory perspective on Environmental Assessment: what games are played and what does this tell us about decision making rationality and legitimacy?

Game theory provides a useful theoretical framework to examine the decision process operating in the context of environmental assessment, and to examine the rationality and legitimacy of decision-making subject to Environmental Assessment (EA). The research uses a case study of the Environmental Impact Assessment and Sustainability Appraisal processes undertaken in England. To these are applied an analytical framework, based on the concept of decision windows to identify the decisions to be assessed. The conditions for legitimacy are defined, based on game theory, in relation to the timing of decision information, the behaviour type (competitive, reciprocal, equity) exhibited by the decision maker, and the level of public engagement; as, together, these control the type of rationality which can be brought to bear on the decision. Instrumental rationality is based on self-interest of individuals, whereas deliberative rationality seeks broader consensus and is more likely to underpin legitimate decisions. The results indicate that the Sustainability Appraisal process, conducted at plan level, is better than EIA, conducted at project level, but still fails to provide conditions that facilitate legitimacy. Game theory also suggests that Sustainability Appraisal is likely to deliver ‘least worst’ outcomes rather than best outcomes when the goals of the assessment process are considered; this may explain the propensity of such ‘least worst’ decisions in practice. On the basis of what can be learned from applying this game theory perspective, it is suggested that environmental assessment processes need to be redesigned and better integrated into decision making in order to guarantee the legitimacy of the decisions made

Sustainability assessment: the state of the art in 2026

Sustainability Assessment (SA) has developed over the past three decades as a decision-support process explicitly directing choices towards sustainability. This paper provides an updated state-of-the-art review of SA in 2025, building on the 2012 assessment by Bond, Morrison-Saunders and Pope. We examine progress in theory, practice and process across selected jurisdictions, considering how SA has evolved conceptually and in application. While the volume of academic research on SA continues to grow, practical uptake remains uneven and context-dependent. Key innovations shaping the field include the embedding of sustainability provisions within Canada’s next generation impact assessment framework, the incorporation of holistic assessment principles in Western Australia, the global adoption of the Sustainable Development Goals (SDGs), and the rise of sustainable finance taxonomies. Together, these developments sharpen debates about definitions, scope, and trade-offs inherent in SA, highlighting both its strengths—such as integrated treatment of cumulative effects—and weaknesses, including costs, jurisdictional constraints, and challenges of transdisciplinarity. Opportunities exist to enhance SA through improved design, cross-jurisdictional cooperation, and clearer sustainability benchmarks, but threats remain from political pressures to streamline assessment and reduce costs. We conclude by reflecting on the contested future of SA and the need to communicate its value more effectively

Gearing up impact assessment as a vehicle for achieving the UN sustainable development goals

This article reflects on the potential for impact assessment (IA) to be a major vehicle for implementing the UN Sustainable Development Goals (SDGs). While it is acknowledged that the SDGs are intended to deliver broader outcomes than IA currently does, we nevertheless argue there is significant convergence between IA and the SDGs, which we explore utilising the key dimensions of sustainability assessment: comprehensiveness, strategicness and integratedness. We conclude that ‘geared up’ IA might be used as a major vehicle to facilitate achievement of the SDGs. However, IA must become more comprehensive and integrated, such that the full suite of SDGs and their relationships, including trade-offs, can be dealt with in a transparent and inclusive way. © 2019, © 2019 IAIA