The cessation in pregnancy incentives trial (CPIT): study protocol for a randomized controlled trial

Background: Seventy percent of women in Scotland have at least one baby, making pregnancy an opportunity to help most young women quit smoking before their own health is irreparably compromised. By quitting during pregnancy their infants will be protected from miscarriage and still birth as well as low birth weight, asthma, attention deficit disorder and adult cardiovascular disease. In the UK, the NICE guidelines: 'How to stop smoking in pregnancy and following childbirth' (June 2010) highlighted that little evidence exists in the literature to confirm the efficacy of financial incentives to help pregnant smokers to quit. Its first research recommendation was to determine: Within a UK context, are incentives an acceptable, effective and cost-effective way to help pregnant women who smoke to quit? <p/>Design and Methods: This study is a phase II exploratory individually randomised controlled trial comparing standard care for pregnant smokers with standard care plus the additional offer of financial voucher incentives to engage with specialist cessation services and/or to quit smoking during pregnancy. Participants (n=600) will be pregnant smokers identified at maternity booking who when contacted by specialist cessation services agree to having their details passed to the NHS Smokefree Pregnancy Study Helpline to discuss the trial. The NHS Smokefree Pregnancy Study Helpline will be responsible for telephone consent and follow-up in late pregnancy. The primary outcome will be self reported smoking in late pregnancy verified by cotinine measurement. An economic evaluation will refine cost data collection and assess potential cost-effectiveness while qualitative research interviews with clients and health professionals will assess the level of acceptance of this form of incentive payment. Research questions What is the likely therapeutic efficacy? Are incentives potentially cost-effective? Is individual randomisation an efficient trial design without introducing outcome bias? Can incentives be introduced in a way that is feasible and acceptable? <p/>Discussion: This phase II trial will establish a workable design to reduce the risks associated with a future definitive phase III multicentre randomised controlled trial and establish a framework to assess the costs and benefits of financial incentives to help pregnant smokers to quit

The magmatic and eruptive evolution of the 1883 caldera-forming eruption of Krakatau: Integrating field- to crystal-scale observations

Explosive, caldera-forming eruptions are exceptional and hazardous volcanic phenomena. The 1883 eruption of Krakatau is the largest such event for which there are detailed contemporary written accounts, allowing information on the eruptive progression to be integrated with the stratigraphy and geochemistry of its products. Freshly exposed sequences of the 1883 eruptive deposits of Krakatau, stripped of vegetation by a tsunami generated by the flank collapse of Anak Krakatau in 2018, shed new light on the eruptive sequence. Matrix glass from the base of the stratigraphy is chemically distinct and more evolved than the overlying sequence indicating the presence of a shallow, silicic, melt-rich region that was evacuated during the early eruptive activity from May 1883 onwards. Disruption of the shallow, silicic magma may have led to the coalescence and mixing of chemically similar melts representative of a range of magmatic conditions, as evidenced by complex and varied plagioclase phenocryst zoning profiles. This mixing, over a period of two to three months, culminated in the onset of the climactic phase of the eruption on 26th August 1883. Pyroclastic density currents (PDCs) emplaced during this phase of the eruption show a change in transport direction from north east to south west, coinciding with the deposition of a lithic lag breccia unit. This may be attributed to partial collapse of an elevated portion of the island, resulting in the removal of a topographic barrier. Edifice destruction potentially further reduced the overburden on the underlying magmatic system, leading to the most explosive and energetic phase of the eruption in the morning of 27th August 1883. This phase of the eruption culminated in a final period of caldera collapse, which is recorded in the stratigraphy as a second lithic lag breccia. The massive PDC deposits emplaced during this final phase contain glassy blocks up to 8 m in size, observed for the first time in 2019, which are chemically similar to the pyroclastic sequence. These blocks are interpreted as representing stagnant, shallow portions of the magma reservoir disrupted during the final stages of caldera formation. This study provides new evidence for the role that precursory eruptions and amalgamation of shallow crustal magma bodies potentially play in the months leading up to caldera-forming eruptions

The Physical Processes of CME/ICME Evolution

As observed in Thomson-scattered white light, coronal mass ejections (CMEs) are manifest as large-scale expulsions of plasma magnetically driven from the corona in the most energetic eruptions from the Sun. It remains a tantalizing mystery as to how these erupting magnetic fields evolve to form the complex structures we observe in the solar wind at Earth. Here, we strive to provide a fresh perspective on the post-eruption and interplanetary evolution of CMEs, focusing on the physical processes that define the many complex interactions of the ejected plasma with its surroundings as it departs the corona and propagates through the heliosphere. We summarize the ways CMEs and their interplanetary CMEs (ICMEs) are rotated, reconfigured, deformed, deflected, decelerated and disguised during their journey through the solar wind. This study then leads to consideration of how structures originating in coronal eruptions can be connected to their far removed interplanetary counterparts. Given that ICMEs are the drivers of most geomagnetic storms (and the sole driver of extreme storms), this work provides a guide to the processes that must be considered in making space weather forecasts from remote observations of the corona.Peer reviewe

CATCH: development of a home-based midwifery intervention to support young pregnant smokers to quit

Objective to develop, implement and evaluate a supportive midwifery intervention, Community Action on Tobacco for Children's Health (CATCH), to help young pregnant smokers to quit. Design action research project funded from April 2002 to June 2005. Setting and participants CATCH was based in a single hospital maternity unit in the West of Scotland and targeted a deprived population of pregnant smokers aged 25 years and under. Outreach work was undertaken in the local community and cessation support was provided in women's own homes. Intervention CATCH aimed to meet the particular needs of young pregnant women through a tailored, non-judgmental approach. The service was distinctive as it employed a holistic approach to smoking cessation which focused not only on individual choices and motivations, but on the wider life circumstances that may preclude behaviour change. Measures internal and external teams collaborated to ensure a comprehensive evaluation, gathering of both process and outcome data. Outcomes (including self-reported and carbon monoxide validated quit status) were assessed by quantitative surveys undertaken at enrolment to the service and at 3- and 12-month follow-up. All those lost to follow-up were assumed to still be smoking. Participants’ views of the service were gathered independently by an external evaluation team, and a detailed qualitative case study, capturing ongoing learning, was undertaken. Data were collected from participants who joined the project over a 16-month period (November 2002–February 2004). Findings the study demonstrated a feasible approach to engaging young pregnant smokers to help them quit. Obstetricians and midwives were willing to refer to a service based in their maternity unit run by a specially trained midwife, and users reported a positive experience of the service. Of 152 eligible clients referred within the 16-month period, 79 (52%) joined CATCH. Of those who joined, 18 (22.8%) were self-reported non-smokers at 3 months, of whom 16 (20.3%) were validated as non-smokers using carbon monoxide monitoring. Thirteen (16.5%) clients reported being smoke free at 12 months, of whom 10 (12.7%) were validated as non-smokers at 12 months. Implications for practice CATCH suggests that close partnership with the multi-disciplinary maternity team and integration into the maternity system is invaluable for smoking cessation services targeting pregnant women. It points to the benefits of the service being delivered by a trained midwife in clients’ own homes. Flexibility and a non-judgmental approach are essential to engagement. Attention to the context and wider circumstances of clients’ lives and involving friends and family enables clients to focus on their own smoking

Unlinked anonymous HIV study of hospital patients and general practice attenders in Glasgow, 1991–1997

Aim—To determine whether HIV is spreading from injecting drug users and homosexual/bisexual males into lower risk heterosexual populations in Glasgow, Scotland, and to pilot a method of monitoring HIV prevalence which involves testing routine biochemistry specimens. Methods—An unlinked anonymous HIV testing study of hospital patients and general practice attenders was conducted during January 1992 to December 1997. Testing was performed on routine biochemistry specimens from patients aged 16–49 years attending two hospitals with catchment areas covering the north and the east of the city. Results—78 260 specimens were tested in the study period and no patient objected to their samples being tested anonymously. HIV prevalence rates among male and female subjects were 0.63% and 0.01%, respectively; the large difference in prevalence resulted, in part, from the inclusion of HIV infected haemophiliac patients who attended one of the hospitals. Prevalence among male general practice patients ranged between 0.1% and 0.2%, while that for male patients attending surgical or surgically related specialties was 0.1%. Conclusions—The prevalence data indicate that HIV has not seeded from the high risk groups into the wider heterosexual population, and that the risk of a surgeon acquiring HIV occupationally is extremely low in a city which has an HIV prevalence similar to or greater than that seen in most other parts of the United Kingdom. Large numbers of residual specimens from busy biochemistry laboratories can be processed for unlinked anonymous testing without interfering with the laboratories' routine functions. This survey approach might be best suited to monitoring HIV trends in developing countries with relatively high prevalence rates and where transmission is principally heterosexual. Key Words: HIV prevalence • routine biochemistry • anonymous testin