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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]

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.