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Spark plasma sintering (SPS) has been widely regarded as an advanced powder consolidation technique hich helps in the development of array of engineering materials. Many have been reported in the literature about sintering parameters such as temperature, pressure, heating rate and holding time. However, little or no reports has been made on some of the intricate features such as process time(s), power SPS (KW), pressing speed (mm/min), and average pressing force (KN) on which intering parameters are directly related to. This study aims to investigate the behaviour of spark plasma sintered Ni-17Cr binary alloys with emphasis on the densification, hardness value and spark plasma sintering features such as process time (s), power SPS (KW), pressing speed (mm/min), and the average pressing force (KN). Nickel and chromium powders were milled individually using High energy ball milling for durations of 5hr, 10 hr prior to mixing and subsequent sintering. The sintered 5 hr and 10 hr milled Ni-17Cr binary alloys attained relative densities of 98.72 % and 99.1 % respectively. The Microstructural morphology was examined using Scanning electron microscopy (SEM). The sintered 10 hr milled Ni-17Cr binary alloy revealed the higher hardness.

Palm fatty acid distillate (PFAD) and soybean deodorized distillate (SDD) are two prominent byproducts in the vegetable oil industry; hence, the objective of this paper was to characterize the physicochemical properties of palm fatty acid distillate (PFAD) and soybean deodorized distillate (SDD) biodiesel production. Various physicochemical properties, including fatty acid composition, acid value, iodine value, saponification value, and viscosity, underwent analysis. Moreover, the study identified impurities like moisture, free fatty acids, and unsaponifiable matter. This thorough assessment offers essential insights into the materials' suitability for biodiesel production, thus informing potential industrial applications. It underscores the significance of selecting appropriate feedstocks in biodiesel manufacturing, ensuring optimal quality and efficiency. By considering these factors, stakeholders can make informed decisions regarding material sourcing and processing methods, ultimately enhancing overall production outcomes. Additionally, this evaluation facilitates the identification of potential challenges and opportunities in the biodiesel industry, contributing to informed decision-making and strategic planning. Furthermore, the potential environmental and economic benefits of utilizing these byproducts in biodiesel production are discussed. [ABSTRACT FROM AUTHOR]

Aquaculture is a global practice that entails the breeding of different fish species. It is incessant in the Nigerian community as wastewater released from pond farms into surrounding drainages and water bodies cause pollution. In this study, a comparative analysis of the physico-chemical parameters (temperature, pH, salinity, conductivity, Dissolved Oxygen (DO) and Biological Oxygen Demand (BOD), and microbial evaluation of wastewater samples from concrete, plastic, wooden and earthen fish ponds located in Ogun and Lagos states followed with antibiotics sensitivity profile of the isolates were investigated. The values of temperature, pH, salinity, conductivity, DO and BOD of the wastewaters ranged from 23.83 - 24.67 °C, 6.57 - 9.68, 0.08 - 0.26 ppt, 65.67 - 200.7 µS/cm, 0.67 - 1.63 mg/L and 36.67 - 253.3 mg/L, respectively. Aerobic plate count and coliform count of bacteria isolated from different fish ponds wastewaters ranged from 6.40x105 to 4.20x106 cfu/mL and 2.80x10³ to 1.98x105 cfu/mL, respectively. Enterococcus spp., Staphylococcus spp, Streptococcus spp., and Micrococcus spp., Aeromonas spp., Chromobacterium spp., Escherichia spp., Klebsiella spp. Listeria spp., Pseudomonas spp., Proteus spp., Providencia sp., Shigella sp., and Salmonella spp. were isolated from different ponds wastewaters. All selected bacterial isolates were susceptible to ciprofloxacin with the exception of Streptococcus sp., Chromobacterium sp. and Providencia sp. Antibiotics susceptibility pattern of isolated bacteria showed that most of the isolates had very high rate of resistance to the common antibiotics which could pose danger to the environment. The results obtained from this study suggests that control of wastewater release from fishpond farms to environment is necessary in other to maintain a stable environment, thereby reducing pollution. [ABSTRACT FROM AUTHOR]

Keywords: virome; high-throughput sequencing EN virome high-throughput sequencing 1 2 2 06/29/22 20220401 NES 220401 I Apium virus Y i (ApVY), a member of the genus I Potyvirus i , infects cultivated, weedy, and wild I Apiaceae i species, in which it may be asymptomatic (Eastwell I et al i ., 2008) or cause symptoms such as leaf mosaic, interveinal chlorosis, vein clearing, deformation and/or stunting. Given the mixed infection status of the pool of plants sampled in the wild carrot population as evidenced by the HTS results, it is not possible to evaluate the pathogenicity of ApVY in this host. [Extracted from the article]

This paper considered the comparison of some tests for assessing the overall homogeneity of Kaplan-Meier survival curves under low and high censoring rates when the curves are disjointed towards the end. The performances of these tests were measured by their statistical powers. Monte Carlo simulation study was conducted to evaluate and numerically compare the relative performances of Log-rank,Wilcoxon, Tarone-Ware, Peto-Peto, Modified Peto-Peto, the Fleming-Harrington (1,1), and the Babalola-Adeleke tests. The result obtained shows that the Babalola-Adeleke and Fleming-Harrington (1,1) tests have more robust performances than the other five popular tests with relatively high power in detecting differences when the censoring rates in the groups are both low and high. The highest overall average powers under low and high censoring rates were produced by Babalola-Adeleke and Fleming-Harrington (1,1) tests respectively. Hence, these two tests are the most suitable tests for diagnosing homogeneity of survival curves under these conditions.

Aluminium matrix composites have been developed to replace other conventional engineering materials in specific industries where enhanced properties are required. The corrosion susceptibility of sintered unreinforced aluminium and composites in chloride medium (AMCs) were studied. The powders of pure as-received aluminium (matrix) and particles of ferrotitanium and silicon carbide particles were homogeneously dispersed using ball milling technique. Powder metallurgy route was utilised for consolidating the milled powders into a sintered compact. Microstructural examination of the compacted pure aluminium and composites confirmed an even distribution of the reinforcements in the aluminium matrix. The produced composites also recorded an improved corrosion resistance in a corrosive medium of 3.5 wt.% laboratory prepared sodium chloride, from the potentiodynamic polarization and chronoamperometry (potentiostatic) tests. The corroded specimens were further assessed for pitting using a field emission scanning electron microscope (FE-SEM). The resistance of the fabricated samples to corrosion was improved upon the addition of TiFe and SiC reinforcements.

The densification process and grain analysis of consolidated NiAl-CNT composites at 1000 °C, and at varied heating rates from 50 °C/min to 150 °C/min was investigated. The results revealed the effect of heating rate on the densification behaviour of the samples. The displacement of the composites decreased from 3.39 mm to 2.63 mm with increasing heating rate, while the porosity increased by 69% at rapid heating rate. The grain analysis of the sintered samples through the electron backscattered (EBSD) technique indicates the evolution of bigger grains as the heating rate proceeds higher. Furthermore, the mean grain size of the consolidated composites increased from 3.93 μm, to 8.05 μm due to the concentration of defects. Interestingly, there was no texture or predominance of any color evolution in the sintered materials.

Clinical trials powered to detect subgroup effects provide the most reliable data on heterogeneity of treatment effect among different subpopulations. However, pre-specified subgroup analysis is not always practical and post hoc analysis results should be examined cautiously. Bayesian hierarchical modelling provides grounds for defining a controlled post hoc analysis plan that is developed after seeing outcome data for the population but before unblinding the outcome by subgroup. Using simulation based on the results from a tobacco cessation clinical trial conducted among the general population, we defined an analysis plan to assess treatment effect among American Indians and Alaska Natives (AI/AN) enrolled in the study. Patients were randomized into two arms using Bayesian adaptive design. For the opt-in arm, clinicians offered a cessation treatment plan after verifying that a patient was ready to quit. For the opt-out arm, clinicians provided all participants with free cessation medications and referred them to a Quitline. The study was powered to test a hypothesis of significantly higher quit rates for the opt-out arm at one-month post randomization. Overall, one-month abstinence rates were 15.9% and 21.5% (opt-in and opt-out arm, respectively). For AI/AN, one-month abstinence rates were 10.2% and 22.0% (opt-in and opt-out arm, respectively). The posterior probability that the abstinence rate in the treatment arm is higher is 0.96, indicating that AI/AN demonstrate response to treatment at almost the same probability as the whole population.

High technical and financial risks are involved in exploring and exploiting new fields; hence, greater focus has placed on the development of environmentally friendly, cost-effective, and enhanced oil recovery (EOR) options for existing fields. For reservoirs producing high-density crudes and those with high interfacial tensions, water flooding is usually less effective due to density differences-hence the advent of polymer and surfactant flooding. For cost-effective and eco-friendly EOR solutions, a biopolymer and a surfactant synthesized from Jatropha seeds are used in this study to determine their effectiveness in increasing the oil recovery during core flooding analysis. The experiment involved an initial water flooding that served as the base cases of three weight percentages of polymers and polymeric surfactant solutions. The results for the polymer flooding of 1 wt%, 1.5 wt%, and 2 wt% showed an incremental oil recovery in comparison to water flooding of 16.8%, 17%, and 26%, while the polymeric surfactant mixtures of 5 wt% of surfactant and 1 wt%, 1.5 wt%, and 2 wt% of a polymer recorded 16.5%, 22.3%, and 28.8%, and 10 wt% of surfactant and 1 wt%, 1.5 wt%, and 2 wt% of a polymer recorded incremental oil recoveries of 20%, 32.9%, and 38.8%, respectively.

Background: Hypertensive disorders of pregnancy (HDP) are key contributors to maternal morbidity, mortality, and future risk of cardiovascular disease. This exploratory study aimed to unearth the health-related needs of women with a reported history of HDP by inquiring about preferences for care., Method: Deductive, qualitative analysis was conducted of HDP survivors' retrospective 'wishes' about the care received., Results: In analyzing 244 open-ended, online survey responses, we identified a taxonomy of health-related needs arising across the trajectory of HDP: clinical information , needs requiring clinical knowledge, such as information about the etiology or prognosis of HDP; medical , needs associated with HDP intervention and management; logistical , needs regarding practical information, such as how to contact a provider or obtain the correct medical device; emotional , needs involving a desire for support or validation; and communication , needs for improved explanations and recognition of HDP., Conclusions: A taxonomy of diverse health-related needs may assist clinicians in approaching HDP patients more holistically. Additionally, opportunities exist for health communication research to inform standard approaches to HDP-related communication flowing from provider to patient.

Background: Insulin resistance (IR) is known to be prevalent amongst women with polycystic ovarian syndrome (PCOS). Its presence has been linked to chronic anovulation and marked long term complications in women. Hence, identification and treatment of IR in women with PCOS is required to prevent the metabolic and reproductive complications of the disease. The aim of this study is to determine if serum adiponectin could be used as a surrogate marker for insulin resistance among women with PCOS., Materials and Methods: A total number of 148 consenting women with PCOS diagnosed using the Rotterdam criteria were recruited for this study. Fifty-two of these women had insulin resistance were compared with 96 of the women who did not have insulin resistance. The serum Adiponectin levels, fasting blood glucose and fasting insulin levels were assayed in all study participants. Insulin resistance was assessed in all the study participants using the Homeostasis Model Assessment for Insulin Resistance (HOMA-IR). Data were analyzed using relevant inferential statistics at 95% confidence interval and p value of < 0.05., Results: The prevalence of insulin resistance among the study participants was 35.1%. Majority of the women (83.1%) had a high body mass index (BMI). More than half (68.2%) of the participants were in the age range of 21-30years and 76.4% (113) were nulliparous. There was no statistically significant difference in the median adiponectin level among insulin resistant (3.735 ug/ml) and non-insulin resistant participants vs. (3.705 ug/ml) (p = 0.6762). Both univariate and multivariate regression analysis did not show a statistically significant relationship between adiponectin and insulin resistance in PCOS., Conclusion: The prevalence of insulin resistance in women with PCOS is high and serum adiponectin is not a suitable surrogate marker of insulin resistance in women with PCOS., (© 2024. The Author(s).)

Introduction: Physician-brief advice has been utilized in high-income countries to promote smoking cessation among cancer patients. Empirical evidence on its effectiveness among cancer patients in low and middle-income countries (LMICs) is lacking. The gap could be due to inadequate training, and competing healthcare priorities, leading to insufficient implementation of targeted smoking cessation interventions in oncology settings. We undertook this scoping review to determine if physician-brief advice is effective in promoting smoking cessation among cancer patients in LMICs., Methods: We conducted a literature search of all relevant articles across five databases: Cochrane Central Register of Controlled Trials, Cochrane Library (Tobacco Addiction Group trials), World Conference on Lung Cancer proceedings, PubMed, and Google Scholar up to November 2023, using pre-defined inclusion criteria and keywords. The study population was cancer survivors in LMICs, the intervention was smoking cessation advice by a physician in a clinic or oncology center during a consultation, and the outcome was the effect of smoking cessation programs in discontinuing smoking among cancer survivors in LMICs., Results: Overall, out of every 10 cancer patients in LMICs, about seven were smokers, and one-half had received physician-brief advice for smoking cessation. Physician-brief advice was more likely to be delivered to patients with smoking-related cancer (Cohen's d = 0.396). This means that there is a noticeable difference between patients with smoking-related cancer compared to those with cancer unrelated to smoking. Smoking cessation failure was due to the inability to cope with the symptoms of withdrawal, missed smoking cessation clinic visits, mental health disorders, limited time and resources, and minimal patient-physician contact., Conclusion: There is very little literature on the frequency of use or the efficacy of physician-brief advice on smoking cessation in LMICs. The literature suggests that cancer patients in LMICs have low self-efficacy to quit smoking, and smoking cessation is rarely part of cancer care in LMICs. Physicians in LMICs should be trained to use motivational messages and good counseling techniques to improve smoking cessation among cancer patients. Policymakers should allocate the resources to implement physician-brief advice and design training programs for physicians focusing on physician-brief advice tailored to cancer patients., (© 2024. The Author(s).)

Surfactant flooding is adjudged one of the most promising chemicals enhanced oil recovery (cEOR) methods due to its high microscopic sweep efficiency. This surfactant shows high potential in mobilizing trapped residual oil (ganglia) through excellent lowering of the interfacial tension (IFT) between the crude oil-aqueous interface to ultra-low values while favorably altering the wettability (oil-wet to water-wet). Surfactant adsorption is a critical factor that determines how successful this cEOR method will be as well as the project economics. Surfactant retention due to adsorption caused majorly by electrostatic forces of attraction between hydrophilic head, and the positive and negative charges of the adsorbent solid surface leading to insufficiency of the remaining surfactant concentration in the injected slug to achieve the supposed ultralow IFT needed for mobilization. This article describes the experimental data on the adsorption of a natural surfactant derived from linseed oil and the results from its adsorption isotherm modelling. This anionic surfactant (LSO-derived) has a CMC value of 2500 ppm, average fractional removal of 0.60 under a range of concentrations (500, 1000, 2000, 4000, 8000, and 12000 ppm), with the adsorption kinetics revealing that adsorption density rises as a function of time with increasing adsorbate concentrations. Five different classical adsorption isotherm models were explored- in the form three (Redlich-Peterson or R-P ), two (Langmuir, Freundlich, Temkin), one (Linear-Henry) parameters models. Their characteristics adsorption parameters were calculated, with highest adsorption capacity value of 2.955mg/g obtained from the simulation using OriginPro 2021 Software. The analysis demonstrates that the R-P model provided the greatest fit as a hybrid model with the highest correlation coefficient value. The kinetic adsorption models Pseudo-First Order (PFO), Pseudo-Second Order (PSO), Pseudo-Nth Order (PNO), and Intra-Particle Diffusion (IPD), as well as their thermodynamic property model, were also examined in addition to static isotherm models. On average, using non-linear regression approach, PSO and PNO provided the best appropriate fit models under this hypothesis, with correlation values of the nth order ranging from 0.443 to 2.122 (excluding 5.847 the non-converged fit value). Prior to thermodynamic analysis, it was confirmed by the IPD with multi-linear graphical characteristics that intra-particle transport was not the only rate-limiting step in adsorption processes and proceeded spontaneously by the This model can be utilized to design a template for LSO surfactant-rock adsorption in chemical flooding schemes for EOR applications., (© 2023 The Author(s).)

Ecological strategies for resource utilisation are important features of pathogens, yet have been overshadowed by stronger interest in genetic mechanisms underlying disease emergence. The purpose of this study is to ask whether host range and transmission traits translate into ecological strategies for host-species utilisation in a heterogeneous ecosystem, and whether host utilisation corresponds to genetic differentiation among three bromoviruses. We combine high-throughput sequencing and population genomics with analyses of species co-occurrence to unravel the ecological strategies of the viruses across four habitat types. The results show that the bromoviruses that were more closely related genetically did not share similar ecological strategies, but that the more distantly related pair did. Shared strategies included a broad host range and more frequent co-occurrences, which both were habitat-dependent. Each habitat thus presents as a barrier to gene flow, and each virus has an ecological strategy to navigate limitations to colonising non-natal habitats. Variation in ecological strategies could therefore hold the key to unlocking events that lead to emergence., Competing Interests: The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Background: People with mental health (MH) and substance use disorders (SUD) have high rates of tobacco use and tobacco-related mortality. They want to stop smoking and studies have shown they can quit, but few behavioral health facilities provide tobacco treatment. The purpose of this paper is to describe how a midwestern statewide behavioral health collaboration used regional data to pinpoint strengths and weaknesses in tobacco treatment trends, identified policies in neighboring states that were associated with high rates of tobacco treatment, and worked with state leaders to implement these policies to enhance treatment., Methods: We used publicly available data from 2 SAMHSA annual national surveys of MH/SUD facilities to describe tobacco treatment services and policies in behavioral health facilities in Kansas and 3 neighboring states (Missouri, Nebraska and Oklahoma). We interviewed neighboring state leaders to identify policies they had implemented to boost tobacco recovery services in behavioral health. We collaborated with our state behavioral health agency to encourage adoption of similar policies., Results: Using 7 years of survey data (2014-2020), rates for screening, counseling, and medications for tobacco dependence were highest in Oklahoma and Missouri facilities. Oklahoma had the highest percentages of facilities reporting smoke-free campuses. In all states, rates of tobacco service provision and smoke-free campuses were lower among SUD facilities than in MH facilities. State leaders associated several policies with high performance, including (a) requiring programs contracting with the state to conduct screening, provide counseling, and adopt smoke-free campuses (Oklahoma and Missouri); (b) state-based collection of tobacco treatment service provision data (Oklahoma); (c) providing facilities with free NRT for clients (Oklahoma); (d) setting benchmarks for service provision (Oklahoma); (e) comprehensive Medicaid coverage of cessation medications (Missouri). Upon review of these findings, Kansas behavioral health officials adopted a 2-year process to implement similar policies and are integrating tobacco treatment requirements into the state Certified Community Behavioral Health Clinic program., Conclusions: Summarizing and sharing freely-available data across states laid the groundwork for cross-border networking and policy change. State and federal agencies should integrate these policies into contracts and block grants to reduce tobacco-related disparities among individuals with behavioral health conditions., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: COVID-19, which is caused by the SARS-CoV-2 virus, is associated with abnormalities of biochemical parameters. There are indications that some of these biochemical parameters can differ according to the severity of the disease and the outcome of the infection. This study describes and compares laboratory findings among COVID-19 patients hospitalized at a facility in Southwestern Nigeria according to disease severity and mortality., Methodology: Records of 223 patients with COVID-19 disease admitted between March 2020 and May 2021 were retrospectively collected. Socio-demographic characteristics, laboratory parameters, and patient outcomes were obtained. Patients were classified according to COVID-19 severity. Laboratory parameters were compared between patients with severe and non-severe disease and between survivors and non-survivors., Results: Of the 215 patients with some laboratory data included in the analysis, there were 133 (62%) males, and 56.7% were aged above 60 years. A total of 71.6% had severe COVID-19 and 48.4% died during hospitalization. The severe disease occurred significantly more frequently among non-survivors ( P 0.01). Higher leukocyte and neutrophil counts, urea levels, D-Dimer, and fasting blood glucose levels occurred significantly more frequently in both severe disease and mortality categories. Additionally, elevated GGT and CRP were significantly more common in those with severe than non-severe disease while lower hemoglobin, hematocrit, albumin, and higher creatinine levels were significantly more common in non-survivors., Conclusion: Our study found that certain readily obtainable biochemical parameters occur more frequently with severe disease and/or mortality amongst patients hospitalized with COVID-19 in sub-Saharan Africa and might be useful for prognostication and allocation of resources., (Copyright © 2023 Nigerian Medical Association.)

Background: The effect of the current COVID-19 pandemic on economies and health systems has been profound. Knowledge of the virus continues to evolve over time. This study aimed to assess the knowledge and the factors associated with the perceived risk of contracting COVID-19 infection during the pandemic., Methodology: This was a cross-sectional study conducted in different parts of Nigeria which were stratified into east, north, and west. A self-administered questionnaire that contained questions related to socio-demographics, medical history, knowledge of COVID-19 (knowledge of viral transmission and infection symptoms), and risk perception of contracting COVID-19 among consenting individuals. The information was extracted and analysed electronically, descriptive variables were summarized in simple proportions and a chi-square test was used to test for association between dependent and non-dependent variables. The level of significance was set at p-value <0.05., Results: The study had 350 participants with 189 (52.8%) females while almost 50% (171) were aged less than 30 Years. Over 90% of participants had good knowledge of viral transmission while 37.7% and 47.2% respectively had good symptom and risk perception scores. The socio-demographic factors - education and geographical location had an association with risk perception (p = 0.02 and 0.04 respectively)., Conclusion: Participants had good knowledge of viral transmission but poor symptom and risk perception scores. This could have implications for their health habits. However, proper education remains the most viable tool for bridging the existing gaps., (Copyright © 2023 Nigerian Medical Association.)

Importance: Tobacco use causes 7 million deaths per year; most national guidelines require people who use tobacco to opt in to care by affirming they are willing to quit. Use of medications and counseling is low even in advanced economy countries., Objective: To evaluate the efficacy of opt-out care vs opt-in care for people who use tobacco., Design, Setting, and Participants: In Changing the Default (CTD), a Bayesian adaptive population-based randomization trial, eligible patients were randomized into study groups, treated according to group assignment, and debriefed and consented for participation at 1-month follow-up. A total of 1000 adult patients were treated at a tertiary care hospital in Kansas City. Patients were randomized from September 2016 to September 2020; final follow-up was in March 2021., Interventions: At bedside, counselors screened for eligibility, conducted baseline assessment, randomized patients to study group, and provided opt-out care or opt-in care. Counselors and medical staff provided opt-out patients with inpatient nicotine replacement therapy, prescriptions for postdischarge medications, a 2-week medication starter kit, treatment planning, and 4 outpatient counseling calls. Patients could opt out of any or all elements of care. Opt-in patients willing to quit were offered each element of treatment described previously. Opt-in patients who were unwilling to quit received motivational counseling., Main Outcomes and Measures: The main outcomes were biochemically verified abstinence and treatment uptake at 1 month after randomization., Results: Of a total of 1000 eligible adult patients who were randomized, most consented and enrolled (270 [78%] of opt-in patients; 469 [73%] of opt-out patients). Adaptive randomization assigned 345 (64%) to the opt-out group and 645 (36%) to the opt-in group. The mean (SD) age at enrollment was 51.70 (14.56) for opt-out patients and 51.21 (14.80) for opt-out patients. Of 270 opt-in patients, 123 (45.56%) were female, and of 469 opt-out patients, 226 (48.19%) were female. Verified quit rates for the opt-out group vs the opt-in group were 22% vs 16% at month 1 and 19% vs 18% at 6 months. The Bayesian posterior probability that opt-out care was better than opt-in care was 0.97 at 1 month and 0.59 at 6 months. Treatment use for the opt-out group vs the opt-in group was 60% vs 34% for postdischarge cessation medication (bayesian posterior probability of 1.0), and 89% vs 37% for completing at least 1 postdischarge counseling call (bayesian posterior probability of 1.0). The incremental cost-effectiveness ratio was $678.60, representing the cost of each additional quit in the opt-out group., Conclusions and Relevance: In this randomized clinical trial, opt-out care doubled treatment engagement and increased quit attempts, while enhancing patients' sense of agency and alliance with practitioners. Stronger and longer treatment could increase cessation., Trial Registration: ClinicalTrials.gov Identifier: NCT02721082.

Introduction: Schools remain at the frontlines of addressing issues, such as e-cigarette use, that impact students. Despite e-cigarette use remaining a significant public health concern in the U.S., schools have limited resources (e.g., staff, capacity, programming) to address it, especially in rural and frontier areas. This ECHO Pilot Project aimed to build capacity and equip schools and school staff in the state of Kansas to address high rates of youth e-cigarette use by providing prevention support and information on best practices for e-cigarette cessation., Methods and Analysis: The pilot used the established Project ECHO model to disseminate evidence-based strategies for e-cigarette prevention and cessation among youth to schools across Kansas. The pilot selected 20 interdisciplinary school teams representing both rural and urban middle and high schools across the state to participate in seven ECHO sessions. ECHO sessions proceeded throughout Fall 2021, with the final session in Spring 2022. School participants completed pre-post surveys as well as component-specific surveys following each ECHO session. In addition, each school team created an individualized action plan to comprehensively address e-cigarette use at their school based on the information provided throughout the ECHO. Survey data, school tobacco/nicotine policies, and action plans will be analyzed to assess process and final outcomes., Discussion: If successful, this pilot will demonstrate that the ECHO model is an effective platform for building school staff knowledge and skills to implement evidence-based strategies in both urban and rural settings. It is anticipated that the pilot will build capacity and equip schools and school staff to address high rates of youth e-cigarette use by providing support for school-based prevention programs and referrals for e-cigarette cessation which will lessen the burden of nicotine-related problems in Kansas schools and communities. Finally, the pilot will provide evidence that the ECHO model can be successfully and equitably applied in a school setting and may be a viable method for addressing other public health-related issues faced by schools., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Leavens, Roberts, Faseru, Thompson, Denes-Collar and Shah.)

Importance: African American smokers have among the highest rates of tobacco-attributable morbidity and mortality in the US, and effective treatment is needed for all smoking levels., Objectives: To evaluate the efficacy of varenicline vs placebo among African American adults who are light, moderate, and heavy daily smokers., Design, Setting, and Participants: The Kick It at Swope IV (KIS-IV) trial was a randomized, double-blind, placebo-controlled clinical trial conducted at a federally qualified health center in Kansas City. A total of 500 African American adults who were daily smokers of all smoking levels were enrolled from June 2015 to December 2017; final follow-up was completed in June 2018., Interventions: Participants were provided 6 sessions of culturally relevant individualized counseling and were randomized (in a 3:2 ratio) to receive varenicline (1 mg twice daily; n = 300) or placebo (n = 200) for 12 weeks. Randomization was stratified by sex and smoking level (1-10 cigarettes/d [light smokers] or >10 cigarettes/d [moderate to heavy smokers])., Main Outcomes and Measures: The primary outcome was salivary cotinine-verified 7-day point prevalence smoking abstinence at week 26. The secondary outcome was 7-day point prevalence smoking abstinence at week 12, with subgroup analyses for light smokers (1-10 cigarettes/d) and moderate to heavy smokers (>10 cigarettes/d)., Results: Among 500 participants who were randomized and completed the baseline visit (mean age, 52 years; 262 [52%] women; 260 [52%] light smokers; 429 [86%] menthol users), 441 (88%) completed the trial. Treating those lost to follow-up as smokers, participants receiving varenicline were significantly more likely than those receiving placebo to be abstinent at week 26 (15.7% vs 6.5%; difference, 9.2% [95% CI, 3.8%-14.5%]; odds ratio [OR], 2.7 [95% CI, 1.4-5.1]; P = .002). The varenicline group also demonstrated greater abstinence than the placebo group at the end of treatment week 12 (18.7% vs 7.0%; difference, 11.7% [95% CI, 6.0%-17.7%]; OR, 3.0 [95% CI, 1.7-5.6]; P < .001). Smoking abstinence at week 12 was significantly greater for individuals receiving varenicline compared with placebo among light smokers (22.1% vs 8.5%; difference, 13.6% [95% CI, 5.2%-22.0%]; OR, 3.0 [95% CI, 1.4-6.7]; P = .004) and among moderate to heavy smokers (15.1% vs 5.3%; difference, 9.8% [95% CI, 2.4%-17.2%]; OR, 3.1 [95% CI, 1.1-8.6]; P = .02), with no significant smoking level × treatment interaction (P = .96). Medication adverse events were generally comparable between treatment groups, with nausea reported more frequently in the varenicline group (163 of 293 [55.6%]) than the placebo group (90 of 196 [45.9%])., Conclusions and Relevance: Among African American adults who are daily smokers, varenicline added to counseling resulted in a statistically significant improvement in the rates of 7-day point prevalence smoking abstinence at week 26 compared with counseling and placebo. The findings support the use of varenicline in addition to counseling for tobacco use treatment among African American adults who are daily smokers., Trial Registration: ClinicalTrials.gov Identifier: NCT02360631.

Background: Food insecurity (FI) has been associated with poor access to health care. It is unclear whether this association is beyond that predicted by income, education, and health insurance. FI may serve as a target for intervention given the many programs designed to ameliorate FI. We examined the association of FI with being up-to-date to colorectal cancer and breast cancer screening guidelines., Methods: Nine NCI-designated cancer centers surveyed adults in their catchment areas using demographic items and a two-item FI questionnaire. For the colorectal cancer screening sample (n = 4,816), adults ages 50-75 years who reported having a stool test in the past year or a colonoscopy in the past 10 years were considered up-to-date. For the breast cancer screening sample (n = 2,449), female participants ages 50-74 years who reported having a mammogram in the past 2 years were up-to-date. We used logistic regression to examine the association between colorectal cancer or breast cancer screening status and FI, adjusting for race/ethnicity, income, education, health insurance, and other sociodemographic covariates., Results: The prevalence of FI was 18.2% and 21.6% among colorectal cancer and breast cancer screening participants, respectively. For screenings, 25.6% of colorectal cancer and 34.1% of breast cancer participants were not up-to-date. In two separate adjusted models, FI was significantly associated with lower odds of being up-to-date with colorectal cancer screening [OR, 0.7; 95% confidence interval (CI), 0.5-0.99)] and breast cancer screening (OR, 0.6; 95% CI, 0.4-0.96)., Conclusions: FI was inversely associated with being up-to-date for colorectal cancer and breast cancer screening., Impact: Future studies should combine FI and cancer screening interventions to improve screening rates., (©2022 American Association for Cancer Research.)

Background: Rural populations experience a disproportionate cancer burden relative to urban populations. One possibility is that rural populations are more likely to hold counterproductive cancer beliefs such as fatalism and information overload that undermine prevention and screening behaviors., Methods: Between 2016 and 2020, 12 U.S. cancer centers surveyed adults in their service areas using online and in-person survey instruments. Participants ( N = 10,362) were designated as rural ( n = 3,821) or urban ( n = 6,541). All participants were 18 and older (M = 56.97, SD = 16.55), predominately non-Hispanic White (81%), and female (57%). Participants completed three items measuring cancer fatalism ("It seems like everything causes cancer," "There's not much you can do to lower your chances of getting cancer," and "When I think about cancer, I automatically think about death") and one item measuring cancer information overload ("There are so many different recommendations about preventing cancer, it's hard to know which ones to follow")., Results: Compared with urban residents, rural residents were more likely to believe that (i) everything causes cancer (OR = 1.29; 95% CI, 1.17-1.43); (ii) prevention is not possible (OR = 1.34; 95% CI, 1.19-1.51); and (iii) there are too many different recommendations about cancer prevention (OR = 1.26; 95% CI, 1.13-1.41), and cancer is always fatal (OR = 1.21; 95% CI, 1.11-1.33)., Conclusions: Compared with their urban counterparts, rural populations exhibited higher levels of cancer fatalism and cancer information overload., Impact: Future interventions targeting rural populations should account for higher levels of fatalism and information overload., (©2022 American Association for Cancer Research.)

Background: Enrollment in smoking cessation trials remain sub-optimal. The aim of this analysis was to determine the effectiveness of a modified Zelen's design in engaging hospitalized patients who smoke in a pragmatic OPT-IN versus OPT-OUT tobacco treatment trial. Methods: At bedside, clinical staff screened smokers for eligibility, randomized eligible into study arms, and delivered the appropriate treatment approach. Study staff called randomized patients at one-month post-discharge, debriefed patients on the study design, and collected consent to participate. We used frequencies and percentages for categorical variables and means and standard deviations for quantitative variables to describe the characteristics of those who consented and were enrolled versus those who did not enroll. We also compared the characteristics of participants who consented and those who were reached and explicitly refused consent at one-month follow-up. We used the Cohen's d measure of effect size to evaluate differences. Results: Of the 1,000 randomized, 741 (74.1%) consented to continue in the study at one-month follow-up. One hundred and twenty-seven (12.7%) refused consent and 132 (13.2%) were unreachable. Cohen's d effect size differences between those who consented/enrolled ( n  = 741) and those who were not enrolled ( n  = 259) were negligible (<0.2) for age, gender, race/ethnicity, and most forms of insurance. The effect size was small for Medicaid (0.36), and other public insurance (0.48). After excluding those unreached at 1 month (12.7%), there were medium Cohen's d effect size differences between those who consented to participate ( n  = 741) and those who explicitly refused ( n  = 127) with respect to age (0.55) and self-pay or no insurance (0.51). There were small to negligible effect size differences with respect to sex, race/ethnicity, and other forms of health insurance. Conclusions: The modified Zelen's design resulted in successful enrollment of most participants who were initially randomized into the trial, including those not motivated to quit.

Background : In the U.S., excessive drinking accounts for one in 10 deaths among adults aged 20-64 years old. Binge drinking is a common form of excessive alcohol consumption that contributes to this chilling statistic. Binge drinking is defined as women consuming four or more drinks or men consuming five or more drinks within a 2-h time span. Examining existing data on risk factors for binge drinking can inform strategies to prevent this deadly practice. Methods : The 2019 Kansas Behavioral Risk Factor Surveillance System (BRFSS) dataset consists of data collected from 11,368 non-institutionalized adults aged 18 years and older with landline or cell phones. The dependent variable in this study was binge drinking status. The independent variables included several sociodemographic variables and risk factors. Data were analyzed using descriptive statistics, bivariate analysis, single logistic regression, and multivariable logistic regression. Results : In the population, 1,447 (17.4%) were reported to be binge drinkers. Significant factors associated with binge drinking in the final model included sex (aOR = 0.53 (0.45-0.63)), age (18-24 years old aOR = 8.77 (6.02-12.79); 25-34 years old aOR = 7.10 (5.35-9.42); 35-44 years old aOR = 6.23 (4.73-8.19); 45-54 years old aOR = 3.87 (2.92-5.14); and 55-64 years old aOR = 2.58 (1.96-3.38)), income ($15,000-$24,999 aOR = 1.00 (0.63-1.58); $25,000-$34,999 aOR = 1.61 (1.04-2.50); $35,000-$49,999 aOR = 1.69 (1.13-2.55); ≥$50,000 aOR = 1.97 (1.34-2.89)), smokeless tobacco use (aOR = 2.09 (1.55-2.82)), and smoking/e-cigarette use (Cigarette user only aOR = 2.11 (1.69-2.65); E-cigarette user only aOR = 2.67 (1.62-3.17); dual cigarette and e-cigarette user = 3.43 (2.21-5.33)). Conclusion : Developing interventions that take into account elevated risk for binge drinking amongst demographic characteristics (i.e., age, sex, income) and lifestyle factors (i.e., smokeless tobacco use, and smoking/e-cigarette use) is crucial to lowering morbidity and mortality related to this form of excessive alcohol consumption.

Objectives To evaluate disparities in youth e-cigarette use patterns and flavor use by race/ethnicity over time. Methods We used data from the US 2014-2019 National Youth Tobacco Survey (NYTS) to examine trends in dual use (co-use of e-cigarettes and cigarettes or other tobacco products), occasional (≤ 5 days) versus frequent use (≥ 20 days) in the past 30 days, and flavor use among current (past-30-day) e-cigarette users (n = 13 178) across racial/ethnic groups (non-Hispanic Whites, non-Hispanic Blacks, Hispanics/Latinos, and non-Hispanic others). Results Among current e-cigarette users, dual use and occasional use decreased significantly from 2014 to 2019 across racial and ethnic groups except for non-Hispanic Blacks; frequent use and flavored e-cigarette use increased among non-Hispanic Whites, Hispanics/Latinos, and non-Hispanic others but not among non-Hispanic Blacks. In 2019, non-Hispanic Black e-cigarette users were more likely to report dual use (adjusted odds ratio [AOR] = 2.2; 95% confidence interval [CI] = 1.5, 3.2; P  < .001) and occasional use of e-cigarettes (AOR = 3.7; 95% CI = 2.3, 5.9; P  < .001) but less likely to report frequent use (AOR = 0.2; 95% CI = 0.1, 0.4; P  < .001) and flavored e-cigarette use (AOR = 0.4; 95% CI = 0.3, 0.5; P  < .001) than their White peers. Conclusions Youth e-cigarette use patterns differed considerably across racial/ethnic groups, and tailored strategies to address disparities in e-cigarette use are needed. ( Am J Public Health . 2021;111(11):2050-2058. https://doi.org/10.2105/AJPH.2021.306448).

Importance: Screening for breast and colorectal cancer has resulted in reductions in mortality; however, questions remain regarding how these interventions are being diffused to all segments of the population. If an intervention is less amenable to diffusion, it could be associated with disparities in mortality rates, especially in rural vs urban areas., Objectives: To compare the prevalence of breast and colorectal cancer screening adherence and to identify factors associated with screening adherence among women residing in rural vs urban areas in the United States., Design, Setting, and Participants: This population-based cross-sectional study of women aged 50 to 75 years in 11 states was conducted from 2017 to 2020., Main Outcomes and Measures: Adherence to cancer screening based on the US Preventative Services Task Force guidelines. For breast cancer screening, women who had mammograms in the past 2 years were considered adherent. For colorectal cancer screening, women who had (1) a stool test in the past year, (2) a colonoscopy in the past 10 years, or (3) a sigmoidoscopy in the past 5 years were considered adherent. Rural status was coded using Rural Urban Continuum Codes, and other variables were assessed to identify factors associated with screening., Results: The overall sample of 2897 women included 1090 (38.4%) rural residents; 2393 (83.5%) non-Hispanic White women; 263 (9.2%) non-Hispanic Black women; 68 (2.4%) Hispanic women; 1629 women (56.2%) aged 50 to 64 years; and 712 women (24.8%) with a high school education or less. Women residing in urban areas were significantly more likely to be adherent to colorectal cancer screening compared with women residing in rural areas (1429 [82%] vs 848 [78%]; P = .01), whereas the groups were equally likely to be adherent to breast cancer screening (1347 [81%] vs 830 [81%]; P = .78). Multivariable mixed-effects logistic regression analyses confirmed that rural residence was associated with lower odds of being adherent to colorectal cancer screening (odds ratio [OR], 0.81; 95% CI, 0.66-0.99, P = .047). Non-Hispanic Black race was associated with adherence to breast cancer screening guidelines (OR, 2.85; 95% CI, 1.78-4.56; P < .001) but not colorectal cancer screening guidelines., Conclusions and Relevance: In this cross-sectional study, women residing in rural areas were less likely to be adherent to colorectal cancer screening guidelines but were similarly adherent to breast cancer screening. This suggests that colorectal cancer screening, a more recent intervention, may not be as available in rural areas as breast cancer screening, ie, colorectal screening has lower amenability.

Organochlorine pesticides (OCPs) have been used globally to boost food production. Although banned, due to their prolonged toxic effects but their residue still impacts the quality of primary and processed agricultural products. This study assesses the levels of residual OCPs (α,β,δ-HCH, heptachlor, heptachlor epoxide, chlordane, methoxychlor, aldrin, dieldrin, endrin, endrin aldehyde, endrin ketone, endosulfan, endosulfan sulfate, 1,1-dichloro-2,2-bis(p-chlorophenyl)ethane (DDD), 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDE), and 1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane (DDT)) in food commonly consumed in Lagos and Ibadan, Southwest, Nigeria. Health risk associated with human exposure via food intake was evaluated with a statistical predictive model. About 248 composite food samples from 8 categories were analyzed in Lagos and Ibadan. Sample extraction and clean-up were by QueChERS method and extracts injected into GC-μECD. ƩDDT concentration was highest in meat products, aquatic foods, dairy products, edible oils, fruits, and cereals, while ƩHCHs were highest in chicken eggs and vegetables. ƩOCP concentrations (ng/g) in food categories were 6.09±1.6-6.85±0.9 (meat), 5.29±2.0-12.3±14 (aquatic foods), 4.86±1.7-5.89±0.8 (dairy products), 4.53±0.8-6.32±1.1 (edible oils), 3.32±1.3 (eggs), 3.54±1.0-4.80±1.5 (fruits), 4.16±2.7-4.40±0.8 (vegetables), and 6.12±2.0-6.62±0.9 (cereals). The estimated average daily intake of OCPs was 5.91, 12.5, 4.41, 6.40, 1.53, 5.14, 3.95, and 16.7 ng/kg bw/day through the consumption of meat products, aquatic foods, dairy products, edible oils, chicken eggs, fruits, vegetables, and cereals, respectively. The health risk of residual OCPs via ingestion of foods considered in this study was <1, which implied no potential health risk at the current consumption rate. However, regular monitoring of OCPs residues in food is highly recommended. Finally, the method scaled the analytical Eco-Scale evaluation and Green Analytical Chemical Procedure Index as "an acceptable green analysis method."

American Indians have the highest rates of smokeless tobacco (SLT) use of any racial/ethnic group in the United States, yet no proven effective cessation programs exist for them. Because tobacco is a sacred plant to many American Indians, cessation programs must not portray it in a completely negative manner. Based on our successful All Nations Breath of Life smoking cessation program, we developed and pilot-tested the All Nations Snuff Out Smokeless (ANSOS) program. Of 48 participants who began the program, 33 completed to six months (68.8% retention rate). Among participants who completed the program, 11 (34%) self-reported abstinence. When those lost to follow-up are considered current users, the cessation rate is 22.9%. An additional 14 individuals reported decreasing use (29.2% of all participants), with an average of 3.4 days per week decrease. All Nations Snuff Out Smokeless shows promise as a culturally appropriate SLT cessation program and is ready for efficacy testing.

American Indian (AI) smokeless tobacco use rates are the highest of all racial/ethnic groups within the United States. Despite this, no effective cessation program currently exists that acknowledges the cultural significance of tobacco among many American Indian tribal nations. Participants were smokeless tobacco users, over 18 years of age, and were recruited through community partners. We modified the All Nations Snuff Out Smokeless Tobacco group-based program to be delivered as a one-time education session intervention. This was delivered to 80 participants and follow-up data was collected by self-report at 6-months. The mean age of participants was 35 and most were male (70%). A majority (69%) grew up on a AI reservation; the mean age of first smokeless tobacco use was 16 years of age. Of program completers reached for 6-month post baseline, 46% reported 0 days of SLT use; 13.5% of participants reduced; while 36% reported continued daily use. In intention to treat analysis those lost to follow-up are considered current users, the quit rate was 12.5% and among those who were still using, 4.0% reduced their use. In this study, a one-time education session intervention was effective for those who prefer an individual based approach to quitting SLT use. Follow up strategies to increase participant retention at 6-months should be explored.

(1) Background: leadership behaviour is a poorly explored phenomenon among early-career doctors (ECDs). Good leadership is vital in maximising the effective management of patients in a clinical setting. While a good number of studies, though with small sample surveys, have researched the role of leadership in clinical setting quantitatively, qualitative investigations are yet to be done in Nigeria. This study aims to explore the attitudes, skills, and experience of ECDs in Nigeria on issues pertaining to leadership in a medical setting, using a mixed-method approach. (2) Methods: we conducted two sessions of key informant focus group discussion (FGD) that involved 14 ECD leaders in Nigeria, exploring their leadership experience in a clinical setting. Furthermore, we used a self-administered questionnaire to quantitatively survey 474 ECDs from seven Nigerian teaching hospitals to explore their attitudes, skills, and experience on issues pertaining to medical leadership. (3) Results: taking on leadership roles is a common phenomenon (52.7%) among the surveyed ECDs; however, the medical leadership position can be very challenging for ECDs in Nigeria. Despite the fact that many (91.1%) of the surveyed ECDs perceived leadership skills as essential skills needed by a doctr, many (44.1%) of them were yet to be formally trained on medical leadership. About three out of every 10 (23.6%) of surveyed ECDs that have ever held leadership positions in a medical setting experienced major leadership challenges while in such office due to their lack of training on leadership skills. Leadership skill acquisition programmes are highly recommended to become an integral part of medical training programmes in Nigeria. (4) Conclusion: there is a need for a structured leadership skill acquisition programme for ECDs in Nigeria. This programme will help in the robust delivery of highly effective healthcare services in Nigeria, as effective leadership is crucial to patient care services.

Background: Physician-led smoking cessation services are suboptimal in Nigeria. Objectives: This study evaluated a text messaging intervention designed to increase the knowledge and practices of physicians in Nigeria to help smokers quit. Methods: Using a pre-post study design, all physicians ( N  = 946) in 3 tertiary care hospitals located in 3 geopolitical zones in Nigeria were sent 2-3 text messages weekly over a 13-week period to create awareness and improve cessation practices using the "Ask, Advise and Refer" (AAR) model. The primary outcomes were the awareness of AAR and the proportion of physicians who offered each of the components of the brief intervention (AAR) to at least half of eligible patients. Secondary outcomes included the attitudes and self-reported effects of the messages on motivation to offer AAR to patients who smoke. Results: Of the 946 eligible respondents, only 165 responded to both the before and after intervention surveys (17.4% participation rate). Participants were more likely to indicate awareness of the AAR approach after the intervention (60%) than before (21.2%). Overall, physicians' practice of each component of the AAR changed significantly after the intervention ( P  < .001; McNemar test). Of the participants, 71.5% reported reading the messages most/all of the time and 84.8% reported that the frequency of the messages was just adequate. Conclusions: A brief and low-cost text messaging intervention to physicians increased the awareness and practice of AAR in those who participated in the study. However, the relatively low participation rate highlights the importance of new research to improve and expand text messaging as an intervention among physicians to help them foster tobacco treatment among their patients.

This study was piloted to evaluate bioaccessibility of particulate-bound trace elements using synthetic epithelia lung fluid; in which dipalmitoylphophatidylcholine was substituted with locus bean gum (LBSFL). The resulting data reveal that no significant change in physicochemical characteristics of the stimulated lung fluid compare with similar synthetic fluids; pH value of 7.3, density (0.998gcm -3 ), conductivity (13.9 mS m -1 ), surface viscosity (1.136 × 10 -12 pas) and surface tension (50.6 mN m -1 ). To prove the potential applicability of the fluid in in vitro bioaccessibility test, we compared bioaccessibility of particulates-bound trace elements using this fluid with those of stimulated epithelial lung fluid. Bioaccessibility were relatively low values (<30%) in locus bean substituted lung fluid and stimulated epithelial lung fluid. Specifically, As and Cd had significantly higher bioaccessibility values in locus bean substituted lung fluid than stimulated epithelial lung fluid. The data demonstrate that fluid formulated and used in this study can provide a suitable means of evaluate bioaccessibility of trace elements-bound to airborne particulates. •The fluid was used for assessing bioaccessibility of particulate matters-bound trace elements•The formulated fluid can be applied to study in toxicity assessment•The data can be used for inter-laboratory comparison of bioaccessibility of particulate -bound trace element and could stimulate environmental concerns on the impacts of airborne particulates., (© 2019 The Authors.)

Numerous studies have tested the effect of multicomponent post-discharge smoking cessation interventions on post-discharge smoking cessation, and many are effective. However, little is known regarding the relative efficacy of the different intervention components on short or long-term cessation. The present study is a secondary analysis ( n  = 984) of a randomized controlled trial for hospitalized smokers that took place at two large hospitals in Kansas from 2011 to 2014. All study participants were offered post-discharge quitline services. Pharmacotherapy was recommended during bedside tobacco treatment. The study outcomes were self-reported cessation at 1-month and biochemically verified cessation at 6-months post-randomization. During the post-discharge period, 69% of participants completed at least one quitline call and 28% of participants reported using cessation pharmacotherapy. After controlling for known predictors of cessation among hospitalized smokers, both the number of total quitline calls completed post-discharge and use of cessation pharmacotherapy post-discharge were predictive of cessation at 1-month. After accounting for predictors of cessation and quitting at 1-month, total post-discharge quitline calls was associated with cessation at 6-months ( OR [95% CI] = 1.23 [1.12, 1.35], p  < 0.001) while post-discharge cessation pharmacotherapy use was not. The results suggest that both engagement in quitline services and use pharmacotherapy independently facilitate cessation beyond the influence of known clinical characteristics associated with cessation. Over the longer term, the effect of engaging in quitline services persists while the effect of pharmacotherapy diminishes. To optimize outcomes, future research should investigate methods to increase utilization of medications and promote sustained counseling engagement in order to sustain the effects of treatment during the post-discharge period., Competing Interests: The authors have no conflicts of interest to disclose.

Many of nearly 7 million smokers who are hospitalized each year plan to stay quit after they leave the hospital. Most, however, relapse after discharge. This is a secondary analysis of a large Midwestern hospital-based smoking cessation trial that occurred between July 2011 and May 2013 to better understand how quickly smokers relapse and the predictors of rapid relapse. Of 942 participants who completed follow up, 25% returned to smoking within a day after hospital discharge. Among these rapid relapses, 36.6% relapsed within one-hour of leaving the hospital, 35.3% between one and 24 h, and 28.1% relapsed one-day post-discharge. Predictors with the highest odds for rapid relapse (within a day of hospital discharge) included tobacco use during hospitalization (OR, 7.37, [95% CI, 3.85-14.13], P  < 0.01); low confidence for quitting (OR, 2.07, [95% CI, 1.49-2.88], P  < 0.01); and not setting a quit date (OR, 1.76, [95% CI, 1.25-2.48], P  < 0.01). Other significant predictors included higher nicotine dependence, shorter length of stay, and depression. Patients who are vulnerable to rapid relapse may benefit from policies that discourage leaving the hospital to smoke. In addition, hospital interventions that target smokers' confidence in quitting, encourage setting a quit date, and addressing nicotine dependence and depression may also be effective at supporting smoker's intentions to make their pre-admission cigarette their last. Clinical Trials Registration NCT01305928.

Background: Hospital-initiated smoking cessation interventions utilizing pharmacotherapy increase post-discharge quit rates. Use of smoking cessation medications following discharge may further increase quit rates. This study aims to identify individual, smoking-related and hospitalization-related predictors of engagement in three different steps in the smoking cessation pharmacotherapy utilization process: 1) receiving medications as inpatient, 2) being discharged with a prescription and 3) using medications at 1-month post-hospitalization, while accounting for associations between these steps., Methods: Study data come from a clinical trial (N = 1054) of hospitalized smokers interested in quitting who were randomized to recieve referral to a quitline via either warm handoff or fax. Variables were from the electronic health record, the state tobacco quitline, and participant self-report. Relationships among the predictors and the steps in cessation medication utilization were assessed using bivariate analyses and multivariable path analysis., Results: Twenty-eight percent of patients reported using medication at 1-month post-discharge. Receipt of smoking cessation medications while hospitalized (OR = 2.09, 95%CI [1.39, 3.15], p < .001) and discharge with a script (OR = 4.88, 95%CI [3.34, 7.13], p < .001) were independently associated with medication use at 1-month post-hospitalization. The path analysis also revealed that the likelihood of being discharged with a script was strongly influenced by receipt of medication as an inpatient (OR = 6.61, 95%CI [4.66, 9.38], p < .001). A number of other treatment- and individual-level factors were associated with medication use in the hospital, receipt of a script, and use post-discharge., Conclusions: To encourage post-discharge smoking cessation medication use, concerted effort should be made to engage smokers in tobacco treatment while in hospital. The individual and hospital-level factors associated with each step in the medication utilization process provide good potential targets for future implementation research to optimize treatment delivery and outcomes., Trial Registration: Number: NCT01305928 . Date registered: February 24, 2011.

Outpatient cardiac rehabilitation (OCR) reinforces patients' efforts to quit smoking, but the association between participation in OCR and long-term smoking status after acute myocardial infarction (AMI) is unknown. We studied hospitalized smokers with confirmed AMI from two multicenter prospective registries (PREMIER, from January 1, 2003, to June 28, 2004, and TRIUMPH, from April 11, 2005, to December 31, 2008) to describe the association of OCR participation with smoking cessation. Eligible patients smoked at least 1 cigarette per day on average in the 30 days prior to enrollment and completed 12-month follow-up (N = 1307). Structured interviews were completed on subjects at baseline and during follow-up. OCR participation and abstinence from smoking within the prior 30-days (30-day point prevalence abstinence, PPA) were self-reported. We constructed a propensity model of OCR participation based on 22 baseline sociodemographic and clinical characteristics, and constructed hierarchical modified Poisson regression models of 30-day PPA at 12 months after matching on the propensity for OCR participation (with clinical site treated as a random effect). Seventy-four percent of subjects were referred to OCR at hospital discharge, but only 36% participated during follow-up. At 12-month follow-up, 30-day PPA was 57% in OCR participants, compared to 41% in matched OCR non-participants. Participation in OCR was a significant predictor of 30-day PPA at 12 months (adjusted RR 1.38, 95% CI 1.20-1.57). In conclusion, smokers who participated in OCR were significantly more likely to abstain from smoking 12 months after AMI hospitalization., (Published by Elsevier Inc.)

Polybrominated diphenyl ethers are non-reactive flame retardants listed among the persistent organic pollutants. This study assesses the levels and health risk of PBDEs in foods commonly consumed by the adult population in Southwest Nigeria. Eight different food categories were collected and extracted using standard QuEChERS protocol prior to analysis by gas chromatography with micro electron capture detector. Aquatic foods had the highest maximum concentration of the eight PBDEs congeners, 748 pg/g; followed by 80.3 pg/g and 54.9 pg/g in edible oil and meat products, respectively. Dairy products had the lowest concentration (0.46 pg/g). The estimated average dietary intake of PBDEs by an adult was 131 pg/kg bw/day. Based on the levels of PBDEs found in common foods consumed by the adult population in Southwest Nigeria, there is unlikely to be a health risk. However, there is a need to investigate the dietary intake of PBDEs in other food categories, especially by vulnerable groups, such as children and the elderly., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

This dataset focuses on the causes and effects of sick building syndrome among users of selected facilities in Lagos. A mixed research approach of field measurement and cross-sectional survey was adopted. Descriptive statistics were implemented on the data acquired and are reported on tables and figures. The significance of this data leverages on providing insight and consciousness of sick building syndrome to users and occupants of constructed facilities. The survey dataset when analyzed can show direction on physical quantities levels that can be experienced in public buildings in tropical region.

Background: While many cessation programmes are available to assist smokers in quitting, research suggests that support from individual partners, family members, or 'buddies' may encourage abstinence., Objectives: To determine if an intervention to enhance one-to-one partner support for smokers attempting to quit improves smoking cessation outcomes, compared with cessation interventions lacking a partner-support component., Search Methods: We limited the search to the Cochrane Tobacco Addiction Group Specialised Register, which was updated in April 2018. This includes the results of searches of the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (via OVID); Embase (via OVID); and PsycINFO (via OVID). The search terms used were smoking (prevention, control, therapy), smoking cessation and support (family, marriage, spouse, partner, sexual partner, buddy, friend, cohabitant and co-worker). We also reviewed the bibliographies of all included articles for additional trials., Selection Criteria: We included randomised controlled trials recruiting people who smoked. Trials were eligible if they had at least one treatment arm that included a smoking cessation intervention with a partner-support component, compared to a control condition providing behavioural support of similar intensity, without a partner-support component. Trials were also required to report smoking cessation at six months follow-up or more., Data Collection and Analysis: Two review authors independently identified the included studies from the search results, and extracted data using a structured form. A third review author helped resolve discrepancies, in line with standard methodological procedures expected by Cochrane. Smoking abstinence, biochemically verified where possible, was the primary outcome measure and was extracted at two post-treatment intervals where possible: at six to nine months and at 12 months or longer. We used a random-effects model to pool risk ratios from each study and estimate a summary effect., Main Results: Our update search identified 465 citations, which we assessed for eligibility. Three new studies met the criteria for inclusion, giving a total of 14 included studies (n = 3370). The definition of partner varied among the studies. We compared partner support versus control interventions at six- to nine-month follow-up and at 12 or more months follow-up. We also examined outcomes among three subgroups: interventions targeting relatives, friends or coworkers; interventions targeting spouses or cohabiting partners; and interventions targeting fellow cessation programme participants. All studies gave self-reported smoking cessation rates, with limited biochemical verification of abstinence. The pooled risk ratio (RR) for abstinence was 0.97 (95% confidence interval (CI) 0.83 to 1.14; 12 studies; 2818 participants) at six to nine months, and 1.04 (95% CI 0.88 to 1.22; 7 studies; 2573 participants) at 12 months or more post-treatment. Of the 11 studies that measured partner support at follow-up, only two reported a significant increase in partner support in the intervention groups. One of these studies reported a significant increase in partner support in the intervention group, but smokers' reports of partner support received did not differ significantly. We judged one of the included studies to be at high risk of selection bias, but a sensitivity analysis suggests that this did not have an impact on the results. There were also potential issues with detection bias due to a lack of validation of abstinence in five of the 14 studies; however, this is not apparent in the statistically homogeneous results across studies. Using the GRADE system we rated the overall quality of the evidence for the two primary outcomes as low. We downgraded due to the risk of bias, as we judged studies with a high weighting in analyses to be at a high risk of detection bias. In addition, a study in both analyses was insufficiently randomised. We also downgraded the quality of the evidence for indirectness, as very few studies provided any evidence that the interventions tested actually increased the amount of partner support received by participants in the relevant intervention group., Authors' Conclusions: Interventions that aim to enhance partner support appear to have no impact on increasing long-term abstinence from smoking. However, most interventions that assessed partner support showed no evidence that the interventions actually achieved their aim and increased support from partners for smoking cessation. Future research should therefore focus on developing behavioural interventions that actually increase partner support, and test this in small-scale studies, before large trials assessing the impact on smoking cessation can be justified.

Objectives: Although many states have expanded Medicaid coverage of cessation medications, utilization remains low. Anecdotal reports suggest that beneficiaries are at times denied coverage of cessation medications at the pharmacy counter. We conducted an observational community-wide case study of Medicaid beneficiary attempts to fill over-the-counter nicotine replacement therapy at pharmacies., Methods: We recruited tobacco-using beneficiaries from a Federally Qualified Health Center, whose providers wrote paper prescriptions for nicotine patches. Study staff escorted beneficiaries to all eligible pharmacies (n = 18) in a Midwestern community to observe fill attempts. Study staff recorded encounters via smartphone into a secure database on a university server., Results: Seven of 18 pharmacies (39%) did not fill the prescription on the day of the attempt. Of these, 6 offered to order the patch for pick-up at a later date. All (4/4) chain pharmacies filled the prescription; 2/3 mass merchant pharmacies failed to fill. Combining successful same-day fills with offers to order for pick-up, 17/18 (94%) would ultimately have been able to obtain patches., Conclusion: This pilot study found that many beneficiaries left pharmacies without a prescription in hand. Successful same-day fills varied markedly by store type. For people with low incomes, transportation presents a major barrier for delayed pick-up. In addition, delays can fuel ambivalence toward quitting. Future research based on this pilot study might address whether patients who fail to secure a same-day prescription ever fill the prescription and, if not, the degree to which this barrier contributes to success or failure in quitting., (Copyright © 2018 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

This research investigated the production of biodiesel from soybean oil (transesterification process) using pure calcium oxide and calcium oxide obtained from eggshell as heterogeneous catalysts. Uncalcined eggshell and calcined eggshell catalysts produced were analysed using XRF and XRD spectrometers. The processing parameters considered during the transesterification of the soybean were methanol/oil mole ratio, catalyst concentration and reaction time and their effects on biodiesel yield were evaluated. Reaction temperature of 60 °C and stirring rate of 450 rpm (revolution per minute) were kept constant. As a result of calcination, XRF analysis revealed an increase in CaO percentage composition of eggshell catalyst from 96% to 97%. Also, the biodiesel yields obtained revealed similar performance patterns for both the calcined eggshell catalyst and the pure CaO catalyst.

Sub-Saharan Africa reports repeated outbreaks of measles, a vaccine preventable disease, which is notifiable under the Integrated Disease Surveillance and Response strategy in Nigeria. Nigeria has reported several outbreaks of measles in the last three years. Poor immunization coverage and weak health systems have been related with measles. This case study is based on real events that occurred during the 2015 outbreak of measles in Kaduna state Northwestern Nigeria. This case study was based upon real events that occurred in community X in Igabi LGA of Kaduna state. However, some of the results were edited to allow the case study to be completed in a facilitated classroom session. Knowledge and practice of investigating outbreaks is a key public health function of public health workers. The purpose of this case study is to simulate outbreak investigation for teaching of postgraduate public health practitioners. The participants should have received lectures or other training on outbreak investigation without the practical experience of investigating an outbreak but are being prepared to investigate outbreaks in the field. This case study should be taken in a classroom setting and should take two hours to complete.

Introduction: The prevalence of smoking among people living with HIV/AIDS (PLWHA) remains higher than the general population. Life expectancy among PLWHA has increased over the past decade, however, PLWHA who smoke will die younger than their non-smoking peers. The primary aim of this pilot study was to examine the effects of warm handoff versus fax referral to the quitline for smoking cessation among hospitalized smokers living with HIV/AIDS., Methods: 25 smokers with a diagnosis of HIV/AIDS hospitalized at a Midwestern academic medical center in 2012-2013 (19 male; mean age=47.7; 48% African-American) were identified, approached, and randomized to one of two treatment arms. At the bedside for patients in warm handoff, staff telephoned the quitline for on-the-spot enrollment and counseling. Participants randomized to fax were fax-referred to the quitline on the day of discharge. The quitline provided continued outpatient counseling to participants in both conditions. The main outcome was verified tobacco abstinence at 6-months post randomization., Results: Enrollment and participation in quitline counseling was high among both warm handoff (100%) and fax-referred (71.4%) PLWHA participants. Nearly all completed follow up for outcome data collection at 6months. Verified abstinent rates were 45.5% in warm handoff versus 14.3% in fax referral at 6months (not significant)., Conclusions: Hospitalized smokers living with HIV/AIDS were highly engaged in quitline services. Warm handoff seems a promising intervention for hospitalized PLWHA that requires further exploration. Clinical Trials Registration NCT01305928., (Published by Elsevier Ltd.)

This study describes a multiphasic approach to the development of a smokeless tobacco cessation program targeted for American Indians (AI) of different tribal nations. The authors gathered formative data from a series of focus groups and interviews to investigate the knowledge, attitudes, and beliefs of AI and smokeless tobacco (SLT) use. Predominant themes emerged from four major topic areas (SLT use, initiation and barriers, policy, and program development) across both studies. This study further assessed educational materials developed for the cessation program for scientific accuracy, readability, and cultural appropriateness. Program materials were scientifically accurate and culturally appropriate. The average corrected reading grade level was 6.3 using the Fry formula and 7.1 using the SMOG formula. Based on this research, a detailed approach to formative research can be used in combination with input from community members to develop health interventions that address health disparities for a specific population., Competing Interests: Conflict of interest: All authors declare that they have no conflicts of interest.