A global metagenomic map of urban microbiomes and antimicrobial resistance.

We present a global atlas of 4,728 metagenomic samples from mass-transit systems in 60 cities over 3 years, representing the first systematic, worldwide catalog of the urban microbial ecosystem. This atlas provides an annotated, geospatial profile of microbial strains, functional characteristics, antimicrobial resistance (AMR) markers, and genetic elements, including 10,928 viruses, 1,302 bacteria, 2 archaea, and 838,532 CRISPR arrays not found in reference databases. We identified 4,246 known species of urban microorganisms and a consistent set of 31 species found in 97% of samples that were distinct from human commensal organisms. Profiles of AMR genes varied widely in type and density across cities. Cities showed distinct microbial taxonomic signatures that were driven by climate and geographic differences. These results constitute a high-resolution global metagenomic atlas that enables discovery of organisms and genes, highlights potential public health and forensic applications, and provides a culture-independent view of AMR burden in cities.

Bipolar impact and phasing of Heinrich-type climate variability.

During the last ice age, the Laurentide Ice Sheet exhibited extreme iceberg discharge events that are recorded in North Atlantic sediments1. These Heinrich events have far-reaching climate impacts, including widespread disruptions to hydrological and biogeochemical cycles2-4. They occurred during Heinrich stadials-cold periods with strongly weakened Atlantic overturning circulation5-7. Heinrich-type variability is not distinctive in Greenland water isotope ratios, a well-dated site temperature proxy8, complicating efforts to assess their regional climate impact and phasing against Antarctic climate change. Here we show that Heinrich events have no detectable temperature impact on Greenland and cooling occurs at the onset of several Heinrich stadials, and that both types of Heinrich variability have a distinct imprint on Antarctic climate. Antarctic ice cores show accelerated warming that is synchronous with increases in methane during Heinrich events, suggesting an atmospheric teleconnection9, despite the absence of a Greenland climate signal. Greenland ice-core nitrogen stable isotope ratios, a sensitive temperature proxy, indicate an abrupt cooling of about three degrees Celsius at the onset of Heinrich Stadial 1 (17.8 thousand years before present, where present is defined as 1950). Antarctic warming lags this cooling by 133 ± 93 years, consistent with an oceanic teleconnection. Paradoxically, proximal sites are less affected by Heinrich events than remote sites, suggesting spatially complex event dynamics.

"Like fighting a fire with a water pistol": A qualitative study of the work experiences of critical care nurses during the COVID-19 pandemic.

AIM: To understand the experience of critical care nurses during the COVID-19 pandemic, through the application of the Job-Demand-Resource model of occupational stress. DESIGN: Qualitative interview study. METHODS: Twenty-eight critical care nurses (CCN) working in ICU in the UK NHS during the COVID-19 pandemic took part in semi-structured interviews between May 2021 and May 2022. Interviews were guided by the constructs of the Job-Demand Resource model. Data were analysed using framework analysis. RESULTS: The most difficult job demands were the pace and amount, complexity, physical and emotional effort of their work. Prolonged high demands led to CCN experiencing emotional and physical exhaustion, burnout, post-traumatic stress symptoms and impaired sleep. Support from colleagues and supervisors was a core job resource. Sustained demands and impaired physical and psychological well-being had negative organizational consequences with CCN expressing increased intention to leave their role. CONCLUSIONS: The combination of high demands and reduced resources had negative impacts on the psychological well-being of nurses which is translating into increased consideration of leaving their profession. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The full impacts of the pandemic on the mental health of CCN are unlikely to resolve without appropriate interventions. IMPACT: Managers of healthcare systems should use these findings to inform: (i) the structure and organization of critical care workplaces so that they support staff to be well, and (ii) supportive interventions for staff who are carrying significant psychological distress as a result of working during and after the pandemic. These changes are required to improve staff recruitment and retention. REPORTING METHOD: We used the COREQ guidelines for reporting qualitative studies. PATIENT AND PUBLIC CONTRIBUTION: Six CCN provided input to survey content and interview schedule. Two authors and members of the study team (T.S. and S.C.) worked in critical care during the pandemic.

Annotating unknown species of urban microorganisms on a global scale unveils novel functional diversity and local environment association.

In urban ecosystems, microbes play a key role in maintaining major ecological functions that directly support human health and city life. However, the knowledge about the species composition and functions involved in urban environments is still limited, which is largely due to the lack of reference genomes in metagenomic studies comprises more than half of unclassified reads. Here we uncovered 732 novel bacterial species from 4728 samples collected from various common surface with the matching materials in the mass transit system across 60 cities by the MetaSUB Consortium. The number of novel species is significantly and positively correlated with the city population, and more novel species can be identified in the skin-associated samples. The in-depth analysis of the new gene catalog showed that the functional terms have a significant geographical distinguishability. Moreover, we revealed that more biosynthetic gene clusters (BGCs) can be found in novel species. The co-occurrence relationship between BGCs and genera and the geographical specificity of BGCs can also provide us more information for the synthesis pathways of natural products. Expanded the known urban microbiome diversity and suggested additional mechanisms for taxonomic and functional characterization of the urban microbiome. Considering the great impact of urban microbiomes on human life, our study can also facilitate the microbial interaction analysis between human and urban environment.

Potential Socioeconomic and Environmental Effects of an Expanding U.S. Bioeconomy: An Assessment of Near-Commercial Cellulosic Biofuel Pathways.

This paper showcases the suitability of an environmentally extended input-output framework to provide macroeconomic analyses of an expanding bioeconomy to allow for adequate evaluation of its benefits and trade-offs. It also exemplifies the framework's applicability to provide early design stage evaluations of emerging technologies expected to contribute to a future bioeconomy. Here, it is used to compare the current United States (U.S.) bioeconomy to a hypothetical future containing additional cellulosic ethanol produced from two near-commercial pathways. We find that the substitution of gasoline with cellulosic ethanol is expected to yield socioeconomic net benefits, including job growth and value added, and a net reduction in global warming potential and nonrenewable energy use. The substitution fares comparable to or worse than that for other environmental impact categories including human toxicity and eutrophication potentials. We recommend that further technology advancement and commercialization efforts focus on reducing these unintended consequences through improved system design and innovation. The framework is seen as complementary to process-based technoeconomic and life cycle assessments as it utilizes related data to describe specific supply chains while providing analyses of individual products and portfolios thereof at an industrial scale and in the context of the U.S. economy.

Understanding patient factors to increase uptake of cancer screening: a review.

Early detection of cancer through organized screening is a central component of population-level strategies to reduce cancer mortality. For screening programs to be effective, it is important that those invited to screening participate. However, uptake rates are suboptimal in many populations and vary between screening programs, indicating a complex combination of patient factors that require elucidation to develop evidence-based strategies to increase participation. In this review, the authors summarize individual-level (sociodemographic and psychosocial) factors associated with cancer screening uptake and evidence for the effectiveness of behavioral interventions to increase uptake. The authors reflect on current trends and future directions for behavioral cancer screening research to overcome challenges and address unmet needs in reducing cancer mortality.

Developing logic models to inform public health policy outcome evaluation: an example from tobacco control.

BACKGROUND: The evaluation of large-scale public health policy interventions often relies on observational designs where attributing causality is challenging. Logic models-visual representations of an intervention's anticipated causal pathway-facilitate the analysis of the most relevant outcomes. We aimed to develop a set of logic models that could be widely used in tobacco policy evaluation. METHODS: We developed an overarching logic model that reflected the broad categories of outcomes that would be expected following the implementation of tobacco control policies. We subsequently reviewed policy documents to identify the outcomes expected to result from the implementation of each policy and conducted a literature review of existing evaluations to identify further outcomes. The models were revised according to feedbacks from a range of stakeholders. RESULTS: The final models represented expected causal pathways for each policy. The models included short-term outcomes (such as policy awareness, compliance and social cognitive outcomes), intermediate outcomes (such as changes in smoking behaviour) and long-term outcomes (such as mortality, morbidity and health service usage). CONCLUSIONS: The use of logic models enables transparent and theory-based planning of evaluation analyses and should be encouraged in the evaluation of tobacco control policy, as well as other areas of public health.

Hospital doctors' attitudes to brief educational messages that aim to modify diagnostic test requests: a qualitative study.

BACKGROUND: Avoidable use of diagnostic tests can both harm patients and increase the cost of healthcare. Nudge-type educational interventions have potential to modify clinician behaviour while respecting clinical autonomy and responsibility, but there is little evidence how this approach may be best used in a healthcare setting. This study aims to explore attitudes of hospital doctors to two nudge-type messages: one concerning potential future cancer risk after receiving a CT scan, another about the financial costs of blood tests. METHODS: We added two brief educational messages to diagnostic test results in a UK hospital for one year. One message on the associated long-term potential cancer risk from ionising radiation imaging to CT scan reports, and a second on the financial costs incurred to common blood test results. We conducted a qualitative study involving telephone interviews with doctors working at the hospital to identify themes explaining their response to the intervention. RESULTS: Twenty eight doctors were interviewed. Themes showed doctors found the intervention to be highly acceptable, as the group had a high awareness of the need to prevent harm and optimise use of finite resources, and most found the nudge-type approach to be inoffensive and harmless. However, the messages were not seen as personally relevant because doctors felt they were already relatively conservative in their use of tests. Cancer risk was important in decision-making but was not considered to represent new knowledge to doctors. Conversely, financial costs were considered to be novel information that was unimportant in decision-making. Defensive medicine was commonly cited as a barrier to individual behaviour change. The educational cancer risk message on CT scan reports increased doctors' confidence to challenge decisions and explain risks to patients and there were some modifications in clinical practice prompted by the financial cost message. CONCLUSION: The nudge-type approach to target avoidable use of tests was acceptable to hospital doctors but there were barriers to behaviour change. There was evidence doctors perceived this cheap and light-touch method can contribute to culture change and form a foundation for more comprehensive educational efforts to modify behaviour in a healthcare environment.

Criteria Air Pollutant and Greenhouse Gases Emissions from U.S. Refineries Allocated to Refinery Products.

Using Greenhouse Gas Reporting Program data (GHGRP) and National Emissions Inventory data from 2014, we investigate U.S. refinery greenhouse gas (GHG) emissions (CO2, CH4, and N2O) and criteria air pollutant (CAP) emissions (VOC, CO, NO x, SO2, PM10, and PM2.5). The study derives (1) combustion emission factors (EFs) of refinery fuels (e.g., refinery catalyst coke and refinery combined gas), (2) U.S. refinery GHG emissions and CAP emissions per crude throughput at the national and regional levels, and (3) GHG and CAP emissions attributable to U.S. refinery products. The latter two emissions were further itemized by source: combustion emission, process emission, and facility-wide emission. We estimated U.S. refinery product GHG and CAP emissions via energy allocation at the refinery process unit level. The unit energy demand and unit flow information were adopted from the Petroleum Refinery Life Cycle Inventory Model (PRELIM version 1.1) by fitting individual U.S. refineries. This study fills an important information gap because it (1) evaluates refinery CAP emissions along with GHG emissions and (2) provides CAP and GHG emissions not only for refinery main products (gasoline, diesel, jet fuel, etc.) but also for refinery secondary products (asphalt, lubricant, wax, light olefins, etc.).

Expansion of the Petroleum Refinery Life Cycle Inventory Model to Support Characterization of a Full Suite of Commonly Tracked Impact Potentials.

This study updates the Petroleum Refinery Life Cycle Inventory Model (PRELIM) to provide a more complete gate-to-gate life cycle inventory and to allow for the calculation of a full suite of impact potentials commonly used in life cycle assessment (LCA) studies. Prior to this update, PRELIM provided results for energy use and greenhouse gas emissions from petroleum refineries with a level of detail suitable for most LCA studies in support of policy decisions. We updated the model to add criteria air pollutants, hazardous air pollutants, releases to water, releases to land, and managed wastes reflecting 2014 reported releases and waste management practices using data from the U.S. Environmental Protection Agency Greenhouse Gas Reporting Program, National Emissions Inventory, Discharge Monitoring Reports, and Toxic Release Inventory together with process unit capacities and fuel consumption data from the U.S. Energy Information Administration (U.S. EIA). The variability of refinery subprocess release factors is characterized using log-normal distributions with parameters set based on the distribution of release factors across facilities. The U.S. EPA Tool for the Reduction and Assessment of Chemical and Environmental Impacts life cycle impact assessment (LCIA) method is used together with the updated inventory data to provide impact potentials in the PRELIM dashboard interface. Release inventories at the subprocess level enable greater responsiveness to variable selection within PRELIM, such as refinery configuration, and allocation to specific refinery products. The updated version also provides a template to allow users to import PRELIM inventory results into the openLCA software tool as unit process data sets. Here we document and validate the model updates. Impact potentials from the national crude mix in 2014 are compared to impacts from the 2005 mix to demonstrate the impact of assay and configuration on the refining sector over time. The expanded version of PRELIM offers users a reliable, transparent, and streamlined tool for estimating the effect of changes in petroleum refineries on LCIA results in the context of policy analysis.

Criteria Air Pollutants and Greenhouse Gas Emissions from Hydrogen Production in U.S. Steam Methane Reforming Facilities.

The global and U.S. domestic effort to develop a clean energy economy and curb environmental pollution incentivizes the use of hydrogen as a transportation fuel, owing to its zero tailpipe pollutant emissions and high fuel efficiency in fuel cell electric vehicles (FCEVs). However, the hydrogen production process is not emissions free. Conventional hydrogen production via steam methane reforming (SMR) is energy intensive, coproduces carbon dioxide, and emits air pollutants. Thus, it is necessary to quantify the environmental impacts of SMR hydrogen production alongside the use-phase of FCEVs. This study fills the information gap, analyzing the greenhouse gas (GHG) and criteria air pollutant (CAP) emissions associated with hydrogen production in U.S. SMR facilities by compiling and matching the facility-reported GHG and CAP emissions data with facilities' hydrogen production data. The actual amounts of hydrogen produced at U.S. SMR facilities are often confidential. Thus, we have developed four approaches to estimate the hydrogen production amounts. The resultant GHG and CAP emissions per MJ of hydrogen produced in individual facilities were aggregated to develop emission values for both a national median and a California state median. This study also investigates the breakdown of facility emissions into combustion emissions and noncombustion emissions.

Lung cancer screening: does pulmonary nodule detection affect a range of smoking behaviours?

BACKGROUND: Lung cancer screening can reduce lung cancer mortality by 20%. Screen-detected abnormalities may provide teachable moments for smoking cessation. This study assesses impact of pulmonary nodule detection on smoking behaviours within the first UK trial of a novel auto-antibody test, followed by chest x-ray and serial CT scanning for early detection of lung cancer (Early Cancer Detection Test-Lung Cancer Scotland Study). METHODS: Test-positive participants completed questionnaires on smoking behaviours at baseline, 1, 3 and 6 months. Logistic regression compared outcomes between nodule (n = 95) and normal CT groups (n = 174) at 3 and 6 months follow-up. RESULTS: No significant differences were found between the nodule and normal CT groups for any smoking behaviours and odds ratios comparing the nodule and normal CT groups did not vary significantly between 3 and 6 months. There was some evidence the nodule group were more likely to report significant others wanted them to stop smoking than the normal CT group (OR across 3- and 6-month time points: 3.04, 95% CI: 0.95, 9.73; P = 0.06). CONCLUSION: Pulmonary nodule detection during lung cancer screening has little impact on smoking behaviours. Further work should explore whether lung cancer screening can impact on perceived social pressure and promote smoking cessation.

Evaluation of the impact of a brief educational message on clinicians' awareness of risks of ionising-radiation exposure in imaging investigations: a pilot pre-post intervention study.

BACKGROUND: In the context of increasing availability of computed tomography (CT) scans, judicious use of ionising radiation is a priority to minimise the risk of future health problems. Hence, education of clinicians on the risks and benefits of CT scans in the management of patients is important. METHODS: An educational message about the associated lifetime cancer risk of a CT scan was added to all CT scan reports at a busy acute teaching hospital in the UK. An online multiple choice survey was completed by doctors before and after the intervention, assessing education and knowledge of the risks involved with exposure to ionising radiation. RESULTS: Of 546 doctors contacted at baseline, 170 (31%) responded. Over a third (35%) of respondents had received no formal education on the risks of exposure to ionising radiation. Over a quarter (27%) underestimated (selected 1 in 30,000 or negligible lifetime cancer risk) the risk associated with a chest, abdomen and pelvis CT scan for a 20 year old female. Following exposure to the intervention for 1 year there was a statistically significant improvement in plausible estimates of risk from 68.3 to 82.2% of respondents (p < 0.001). There was no change in the proportion of doctors correctly identifying imaging modalities that do or do not involve ionising radiation. CONCLUSIONS: Training on the longterm risks associated with diagnostic radiation exposure is inadequate among hospital doctors. Exposure to a simple non-directional educational message for 1 year improved doctors' awareness of risks associated with CT scans. This demonstrates the potential of the approach to improve knowledge that could improve clinical practice. This approach is easily deliverable and may have applications in other areas of clinical medicine. The wider and longer term impact on radiation awareness is unknown, however, and there may be a need for regular mandatory training in the risks of radiation exposure.

Effectiveness of Mass Media Campaigns to Reduce Alcohol Consumption and Harm: A Systematic Review.

AIMS: To assess the effectiveness of mass media messages to reduce alcohol consumption and related harms using a systematic literature review. METHODS: Eight databases were searched along with reference lists of eligible studies. Studies of any design in any country were included, provided that they evaluated a mass media intervention targeting alcohol consumption or related behavioural, social cognitive or clinical outcomes. Drink driving interventions and college campus campaigns were ineligible. Studies quality were assessed, data were extracted and a narrative synthesis conducted. RESULTS: Searches produced 10,212 results and 24 studies were included in the review. Most campaigns used TV or radio in combination with other media channels were conducted in developed countries and were of weak quality. There was little evidence of reductions in alcohol consumption associated with exposure to campaigns based on 13 studies which measured consumption, although most did not state this as a specific aim of the campaign. There were some increases in treatment seeking and information seeking and mixed evidence of changes in intentions, motivation, beliefs and attitudes about alcohol. Campaigns were associated with increases in knowledge about alcohol consumption, especially where levels had initially been low. Recall of campaigns was high. CONCLUSION: Mass media health campaigns about alcohol are often recalled by individuals, have achieved changes in knowledge, attitudes and beliefs about alcohol but there is little evidence of reductions in alcohol consumption. SHORT SUMMARY: There is little evidence that mass media campaigns have reduced alcohol consumption although most did not state that they aimed to do so. Studies show recall of campaigns is high and that they can have an impact on knowledge, attitudes and beliefs about alcohol consumption.

Determinants of motivation to quit in smokers screened for the early detection of lung cancer: a qualitative study.

BACKGROUND: The promotion of smoking cessation within lung cancer screening could lead to benefits for smoking-related disease and improve cost-effectiveness of screening. Little is known about how smokers respond to lung cancer screening and how this impacts smoking behaviour. We aimed to understand how lung cancer screening influences individual motivations about smoking, including in those who have stopped smoking since screening. METHODS: Thirty one long-term smokers aged 51-74 took part in semi-structured interviews about smoking. They had been screened with the EarlyCDT-Lung Test (13 positive result; 18 negative) as part of the Early Cancer Detection Test Lung Cancer Scotland Study. They were purposively sampled for interview based on their self-reported post-screening smoking behaviour. Eleven participants had stopped smoking since screening. Verbatim interview transcripts were analysed using thematic analysis. RESULTS: Two key overarching themes were interpretations of screening test results and emotional responses to those interpretations. Participants' understanding of the risk implied by their test result was often inaccurate, for example a negative result interpreted as an 'all-clear' from lung cancer and a positive result as meaning lung cancer would definitely develop. Those interpretations led to emotional responses (fear, shock, worry, relief, indifference) influencing motivations about smoking. Other themes included a wake-up call causing changes in perceived risk of smoking-related disease, a feeling that now is the time to stop smoking and family influences. There was no clear pattern in smoking motivations in those who received positive or negative test results. Of those who had stopped smoking, some cited screening experiences as the sole motivation, some cited screening along with other coinciding factors, and others cited non-screening reasons. Cues to change were experienced at different stages of the screening process. Some participants indicated they underwent screening to try and stop smoking, while others expressed little or no desire to stop. CONCLUSIONS: We observed complex and individualised motivations about smoking following lung cancer screening. To be most effective, smoking cessation support in this context should explore understanding of screening test results and may need to be highly tailored to individual emotional responses to screening.

Detection in blood of autoantibodies to tumour antigens as a case-finding method in lung cancer using the EarlyCDT®-Lung Test (ECLS): study protocol for a randomized controlled trial.

BACKGROUND: Lung cancer is the most common cause of cancer related death worldwide. The majority of cases are detected at a late stage when prognosis is poor. The EarlyCDT®-Lung Test detects autoantibodies to abnormal cell surface proteins in the earliest stages of the disease which may allow tumour detection at an earlier stage thus altering prognosis. The primary research question is: Does using the EarlyCDT®-Lung Test to identify those at high risk of lung cancer, followed by X-ray and computed tomography (CT) scanning, reduce the incidence of patients with late-stage lung cancer (III & IV) or unclassified presentation (U) at diagnosis, compared to standard practice? METHODS: A randomised controlled trial of 12 000 participants in areas of Scotland targeting general practices serving patients in the most deprived quintile of the Scottish Index of Multiple Deprivation. Adults aged 50-75 who are at high risk of lung cancer and healthy enough to undergo potentially curative therapy (Performance Status 0-2) are eligible to participate. The intervention is the EarlyCDT®-Lung Test, followed by X-ray and CT in those with a positive result. The comparator is standard clinical practice in the UK. The primary outcome is the difference, after 24 months, between the rates of patients with stage III, IV or unclassified lung cancer at diagnosis. The secondary outcomes include: all-cause mortality; disease specific mortality; a range of morbidity outcomes; cost-effectiveness and measures examining the psychological and behavioural consequences of screening. Participants with a positive test result but for whom the CT scan does not lead to a lung cancer diagnosis will be offered 6 monthly thoracic CTs for 24 months. An initial chest X-ray will be used to determine the speed and the need for contrast in the first screening CT. Participants who are found to have lung cancer will be followed-up to assess both time to diagnosis and stage of disease at diagnosis. DISCUSSION: The study will determine the clinical and cost effectiveness of EarlyCDT®-Lung Test for early lung cancer detection and assess its suitability for a large-scale, accredited screening service. The study will also assess the potential psychological and behavioural harms arising from false positive or false negative results, as well as the potential benefits to patients of true negative EarlyCDT lung test results. A cost-effectiveness model of lung cancer screening based on the results of the EarlyCDT Lung Test study will be developed. TRIAL REGISTRATION: NCT01925625 . August 19, 2013.

Network meta-analysis to evaluate the effectiveness of interventions to prevent falls in children under age 5 years.

BACKGROUND: This study aimed to simultaneously evaluate the effectiveness of a range of interventions to increase the possession of safety equipment or behaviours to prevent falls in children under 5 years of age in the home. METHODS: A recently published systematic review identified studies to be included in a network meta-analysis; an extension of pairwise meta-analysis that enables comparison of all evaluated interventions simultaneously, including comparisons not directly compared in individual studies. RESULTS: 29 primary studies were identified, of which 16 were included in at least 1 of 4 network meta-analyses. For increasing possession of a fitted stair gate, the most intensive intervention (including education, low cost/free home safety equipment, home safety inspection and fitting) was the most likely to be the most effective, with an OR versus usual care of 7.80 (95% CrI 3.08 to 21.3). For reducing possession or use of a baby walker: education only was most likely to be most effective, with an OR versus usual care of 0.48 (95% CrI 0.31 to 0.84). Little difference was found between interventions for possession of window locks (most intensive intervention versus usual care OR=1.56 (95% CrI 0.02 to 89.8)) and for not leaving a child alone on a high surface (education vs usual care OR=0.89 (95% CrI 0.10 to 9.67)). There was insufficient evidence for network meta-analysis for possession and use of bath mats. CONCLUSIONS: These results will inform healthcare providers of the most effective components of interventions and can be used in cost-effectiveness analyses.

Dataset of 2012-2020 U.S. National- and State-Level Greenhouse Gas Emissions by Sector.

The dataset contains ∼1.1 million records of total greenhouse gases directly emitted annually by economic sectors and households in the US from 2012-2020. Data are given for 16 unique greenhouse gases by 118 aggregate sectors for each state, and as totals by these aggregate sectors as well as by 540 detailed sectors at the national level. The dataset is a product of updated sector attribution models that improve upon the National Greenhouse Gas Industry Attribution Model. This paper provides documentation of the methods used to produce these datasets and proof of validation of the dataset, along with relevant supporting tables, figures, and source code.

Increasing uptake of FIT colorectal screening: protocol for the TEMPO randomised controlled trial testing a suggested deadline and a planning tool.

INTRODUCTION: Screening can reduce deaths from colorectal cancer (CRC). Despite high levels of public enthusiasm, participation rates in population CRC screening programmes internationally remain persistently below target levels. Simple behavioural interventions such as completion goals and planning tools may support participation among those inclined to be screened but who fail to act on their intentions. This study aims to evaluate the impact of: (a) a suggested deadline for return of the test; (b) a planning tool and (c) the combination of a deadline and planning tool on return of faecal immunochemical tests (FITs) for CRC screening. METHODS AND ANALYSIS: A randomised controlled trial of 40 000 adults invited to participate in the Scottish Bowel Screening Programme will assess the individual and combined impact of the interventions. Trial delivery will be integrated into the existing CRC screening process. The Scottish Bowel Screening Programme mails FITs to people aged 50-74 with brief instructions for completion and return. Participants will be randomised to one of eight groups: (1) no intervention; (2) suggested deadline (1 week); (3) suggested deadline (2 weeks); (4) suggested deadline (4 weeks); (5) planning tool; (6) planning tool plus suggested deadline (1 week); (7) planning tool plus suggested deadline (2 weeks); (8) planning tool plus suggested deadline (4 weeks). The primary outcome is return of the correctly completed FIT at 3 months. To understand the cognitive and behavioural mechanisms and to explore the acceptability of both interventions, we will survey (n=2000) and interview (n=40) a subgroup of trial participants. ETHICS AND DISSEMINATION: The study has been approved by the National Health Service South Central-Hampshire B Research Ethics Committee (ref. 19/SC/0369). The findings will be disseminated through conference presentations and publication in peer-reviewed journals. Participants can request a summary of the results. TRIAL REGISTRATION NUMBER: clinicaltrials.govNCT05408169.

Home safety education and provision of safety equipment for injury prevention.

BACKGROUND: In industrialised countries injuries (including burns, poisoning or drowning) are the leading cause of childhood death and steep social gradients exist in child injury mortality and morbidity. The majority of injuries in pre-school children occur at home but there is little meta-analytic evidence that child home safety interventions reduce injury rates or improve a range of safety practices, and little evidence on their effect by social group. OBJECTIVES: We evaluated the effectiveness of home safety education, with or without the provision of low cost, discounted or free equipment (hereafter referred to as home safety interventions), in reducing child injury rates or increasing home safety practices and whether the effect varied by social group. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2009, Issue 2) in The Cochrane Library, MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED), ISI Web of Science: Social Sciences Citation Index (SSCI), ISI Web of Science: Conference Proceedings Citation Index- Science (CPCI-S), CINAHL (EBSCO) and DARE (2009, Issue 2) in The Cochrane Library. We also searched websites and conference proceedings and searched the bibliographies of relevant studies and previously published reviews. We contacted authors of included studies as well as relevant organisations. The most recent search for trials was May 2009. SELECTION CRITERIA: Randomised controlled trials (RCTs), non-randomised controlled trials and controlled before and after (CBA) studies where home safety education with or without the provision of safety equipment was provided to those aged 19 years and under, and which reported injury, safety practices or possession of safety equipment. DATA COLLECTION AND ANALYSIS: Two authors independently assessed study quality and extracted data. We attempted to obtain individual participant level data (IPD) for all included studies and summary data and IPD were simultaneously combined in meta-regressions by social and demographic variables. Pooled incidence rate ratios (IRR) were calculated for injuries which occurred during the studies, and pooled odds ratios were calculated for the uptake of safety equipment or safety practices, with 95% confidence intervals. MAIN RESULTS: Ninety-eight studies, involving 2,605,044 people, are included in this review. Fifty-four studies involving 812,705 people were comparable enough to be included in at least one meta-analysis. Thirty-five (65%) studies were RCTs. Nineteen (35%) of the studies included in the meta-analysis provided IPD.There was a lack of evidence that home safety interventions reduced rates of thermal injuries or poisoning. There was some evidence that interventions may reduce injury rates after adjusting CBA studies for baseline injury rates (IRR 0.89, 95% CI 0.78 to 1.01). Greater reductions in injury rates were found for interventions delivered in the home (IRR 0.75, 95% CI 0.62 to 0.91), and for those interventions not providing safety equipment (IRR 0.78, 95% CI 0.66 to 0.92).Home safety interventions were effective in increasing the proportion of families with safe hot tap water temperatures (OR 1.41, 95% CI 1.07 to 1.86), functional smoke alarms (OR 1.81, 95% CI 1.30 to 2.52), a fire escape plan (OR 2.01, 95% CI 1.45 to 2.77), storing medicines (OR 1.53, 95% CI 1.27 to 1.84) and cleaning products (OR 1.55, 95% CI 1.22 to 1.96) out of reach, having syrup of ipecac (OR 3.34, 95% CI 1.50 to 7.44) or poison control centre numbers accessible (OR 3.30, 95% CI 1.70 to 6.39), having fitted stair gates (OR 1.61, 95% CI 1.19 to 2.17), and having socket covers on unused sockets (OR 2.69, 95% CI 1.46 to 4.96).Interventions providing free, low cost or discounted safety equipment appeared to be more effective in improving some safety practices than those interventions not doing so. There was no consistent evidence that interventions were less effective in families whose children were at greater risk of injury. AUTHORS' CONCLUSIONS: Home safety interventions most commonly provided as one-to-one, face-to-face education, especially with the provision of safety equipment, are effective in increasing a range of safety practices. There is some evidence that such interventions may reduce injury rates, particularly where interventions are provided at home. Conflicting findings regarding interventions providing safety equipment on safety practices and injury outcomes are likely to be explained by two large studies; one clinic-based study provided equipment but did not reduce injury rates and one school-based study did not provide equipment but did demonstrate a significant reduction in injury rates. There was no consistent evidence that home safety education, with or without the provision of safety equipment, was less effective in those participants at greater risk of injury. Further studies are still required to confirm these findings with respect to injury rates.