University College London

The global hospitality industry is fast-turning sustainable and environmentally friendly. Behaviour-driven energy conservation is an emerging green hotel operation strategy to support this change. The long-stay accommodation services have gained momentum in the hospitality sector since the COVID-19 pandemic. However, the characteristics of long-stay hotel guests are often overlooked in sustainable interventions. Based on an empirical survey in China, this study aims to explore the factors driving energy-saving behaviours of long-stay hotel guests and to compare their effects on guests for different visiting purposes (leisure, business, and extended-stay resident). The analysis indicates that attitude, personal norm and place attachment present a direct contribution to energy-saving behaviour. Besides, the results support that attitude and personal norm connect environmental values and energy-saving behaviour. Both altruistic and biospheric values have positive effects, while egoistic values seem to play a negative role. Biospheric values have stronger impact on attitude and personal norm of business guests. Place attachment has a stronger influence on extended-stay residents while its contribution to energy-saving behaviours of business guests is smaller than other guests. Besides, leisure guests are more sensitive to moral obligations. This research sheds novel lights on the psychological perspectives of the observed heterogeneity of energy-saving behaviours of hotel guests with different visiting purposes. The findings provide hotel operators with a novel theoretical reference for targeted energy-saving interventions to promote energy-saving actions of long-term hotel guests. The study, therefore, can contribute to sustainable tourism policymaking and behaviour-driven hotel energy management.

Over the last few years, several policies and new technological solutions have targeted the construction sector with the aim of reducing the sector's impacts on the environment. Among the different technological advances proposed, the reuse of materials in construction has been reported as a promising solution for an increase in sustainability and circularity. In particular, a type of cities' undergrounds assets for which materials' reuse is being explored are trenches for protecting services (i.e., water and gas transport pipelines, and optic fibre and other telecommunications services). Nonetheless, the economic and environmental benefits and impact of this type of system is still insufficiently quantified. In this research study, the economic and environmental impacts of four scenarios of trenches were assessed by using Life Cycle Costing (LCC) and Life Cycle Assessment (LCA). The four alternatives analysed consisted of: (1) the classical solution; (2) the classical solution with the reuse of soil; (3) the control low-strength material, and (4) the eco-trench. The results allowed concluding that in the eco-trench system, for which all material is reused, the environmental and economic impacts could be reduced by more than 80% and 50%, respectively. A parametric study for which the dimensions of the trenches were varied, permitted to reinforce these results and to quantify the impact's change along with the width and depth of the trench. Overall, this study provides a comprehensive view of the high-impact potential of reusing material for the construction of trenches in cities. The outcomes allow also remarking that the eco-trench system could be an attractive and advantageous solution for urban infrastructure stakeholders, both from an economic and environmental perspective.

We introduce a novel approach for learning a complex multi-stage needle pick-and-place manipulation task for surgical applications using Reinforcement Learning without expert demonstrations or explicit curriculum. The proposed method is based on a recursive decomposition of the original task into a sequence of sub-tasks with increasing complexity and utilizes an actor-critic algorithm with deterministic policy output. In this work, exploratory bottlenecks have been used by a human expert as convenient boundary points for partitioning complex tasks into simpler subunits. Our method has successfully learnt a policy for the needle pick-and-place task, whereas the state-of-the-art TD3+HER method is unable to achieve success without the help of expert demonstrations. Comparison results show that our method achieves the highest performance with a 91% average success rate.

The Light Mantle landslide is a hypermobile landslide on the Moon. Apollo 17 astronauts collected a core sample of the top 60 cm of the Light Mantle deposit, which is currently being analysed as part of the NASA's Apollo Next Generation Sample Analysis (ANGSA) programme. The origin of its hypermobility remains undetermined, as the proposed mechanisms are difficult to prove because of lack of theoretical and experimental support and the scarcity of field data related to the internal structures of its deposit. Regardless of the emplacement mechanisms, it has been proposed that localised dynamic frictional weakening is responsible for the early stage instability that leads to catastrophic failure. Here, we conduct friction experiments under vacuum to investigate the viability of dynamic friction weakening in lunar analogue anorthosite-bearing gouges (i.e., rock powders). Our results show that localised dynamic friction weakening does not occur in these gouges at loading conditions where, instead, weakening is observed in other materials on Earth. Therefore, possibly other fluidization-related mechanisms contributed to the initiation of the hypermobile Light Mantle landslide. Finally, we describe the microstructures formed in the experiments, including the presence of clast cortex aggregates.

Chronic pain affects millions of people worldwide and new treatments are needed urgently. One way to identify novel analgesic strategies is to understand the biological dysfunctions that lead to human inherited pain insensitivity disorders. Here we report how the recently discovered brain and dorsal root ganglia-expressed FAAH-OUT long non-coding RNA (lncRNA) gene, which was found from studying a pain-insensitive patient with reduced anxiety and fast wound healing, regulates the adjacent key endocannabinoid system gene FAAH, which encodes the anandamide-degrading fatty acid amide hydrolase enzyme. We demonstrate that the disruption in FAAH-OUT lncRNA transcription leads to DNMT1-dependent DNA methylation within the FAAH promoter. In addition, FAAH-OUT contains a conserved regulatory element, FAAH-AMP, that acts as an enhancer for FAAH expression. Furthermore, using transcriptomic analyses in patient-derived cells we have uncovered a network of genes that are dysregulated from disruption of the FAAH-FAAH-OUT axis, thus providing a coherent mechanistic basis to understand the human phenotype observed. Given that FAAH is a potential target for the treatment of pain, anxiety, depression and other neurological disorders, this new understanding of the regulatory role of the FAAH-OUT gene provides a platform for the development of future gene and small molecule therapies.

Objective We describe the development and structure of a novel mobile application in a mixed model of prenatal care, in the context of the COVID-19 pandemic. Furthermore, we assess the acceptability of this mobile app in a cohort of patients. Methods First, we introduced a mixed model of prenatal care; second, we developed a comprehensive, computer-based clinical record to support our system. Lastly, we built a novel mobile app as a tool for prenatal care. We used Flutter Software version 2.2 to build the app for Android and iOS smartphones. A cross-sectional study was carried out to assess the acceptability of the app. Results A mobile app was also built with the main attribute of being connected in real-time with the computer-based clinical records. The app screens detail information about activities programmed and developed in the prenatal care according to gestational age. A downloadable maternity book is available and some screens show warning signs and symptoms of pregnancy. The acceptability assessment was mostly rated positively regarding the characteristics of the mobile app, by 50 patients. Conclusion This novel mobile app was developed as a tool among pregnant patients to increase the information available about their pregnancies in the provision of a mixed model of prenatal care in the context of the COVID-19 pandemic. It was fully customized to the needs of our users following the local protocols. The introduction of this novel mobile app was highly accepted by the patients.

Background: The excess risk of cardiovascular disease associated with a wide array of infectious diseases is unknown. We quantified the short- and long-term risk of major cardiovascular events in people with severe infection and estimated the population-attributable fraction. Methods: We analyzed data from 331 683 UK Biobank participants without cardiovascular disease at baseline (2006-2010) and replicated our main findings in an independent population from 3 prospective cohort studies comprising 271 533 community-dwelling participants from Finland (baseline 1986-2005). Cardiovascular risk factors were measured at baseline. We diagnosed infectious diseases (the exposure) and incident major cardiovascular events after infections, defined as myocardial infarction, cardiac death, or fatal or nonfatal stroke (the outcome) from linkage of participants to hospital and mortality registers. We computed adjusted hazard ratios (HRs) and 95% CIs for infectious diseases as short- and long-term risk factors for incident major cardiovascular events. We also calculated population-attributable fractions for long-term risk. Results: In the UK Biobank (mean follow-up, 11.6 years), 54 434 participants were hospitalized for an infection, and 11 649 had an incident major cardiovascular event at follow-up. Relative to participants with no record of infectious disease, those who were hospitalized experienced increased risk of major cardiovascular events, largely irrespective of the subtype of infection. This association was strongest during the first month after infection (HR, 7.87 [95% CI, 6.36-9.73]), but remained elevated during the entire follow-up (HR, 1.47 [95% CI, 1.40-1.54]). The findings were similar in the replication cohort (HR, 7.64 [95% CI, 5.82-10.03] during the first month; HR, 1.41 [95% CI, 1.34-1.48] during mean follow-up of 19.2 years). After controlling for traditional cardiovascular risk factors, the population-attributable fraction for severe infections and major cardiovascular events was 4.4% in the UK Biobank and 6.1% in the replication cohort. Conclusions: Infections severe enough to require hospital treatment were associated with increased risks for major cardiovascular disease events immediately after hospitalization. A small excess risk was also observed in the long-term, but residual confounding cannot be excluded.

Introduction: In cosmetic practices, non-surgical rhinoplasty using filler injections has become increasingly common. Nevertheless, the outcome and overall complications have not been studied as a systematic review in the literature. This study provides a high-quality systematic review of studies reporting clinical and patient-reported outcomes following non-surgical rhinoplasty with hyaluronic acid (HA) to further guide practitioners. Methods: This systematic review was conducted in accordance with PRISMA guidelines and was registered in PROSPERO. The search was conducted using MEDLINE, EMBASE, and Cochrane. The literature retrieval was conducted by three independent reviewers, and the remaining articles were screened by two independent reviewers. The quality of included articles was assessed using the MINORS and methodological quality and synthesis of case series and case reports tools. Results: A total of 874 publications were found based on the search criteria. A total of 3928 patients were reviewed for this systematic review from 23 full-text articles. For non-surgical rhinoplasty, Juvéderm ultra was the most commonly used HA filler. The nasal tip was most commonly injected (13 studies), followed by the columella (12 studies). Nasal hump deformities are the most common reason for non-surgical rhinoplasty. All studies showed high patient satisfaction. Among all patients reviewed, eight developed major complications. Conclusion: Non-surgical rhinoplasty performed with HA has minimal side effects and a short recovery period. Furthermore, non-surgical rhinoplasty with HA results in high satisfaction. To strengthen the presently available evidence, further well-designed RCTs are needed. Level of evidence iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266.

In this work, we describe and forecast the fourth wave of the SARS-CoV-2 epidemic, driven by the Delta variant, using pDyn — a detailed epidemiological agent-based model. It is designed to explain the spatiotemporal dynamics of the SARS-CoV-2 spread across Polish society, predicting the number and locations of disease-related states for agents living in the virtual society in response to varying properties of the pathogen and the social structure and behavior. We evaluate the validity of the dynamics generated by the model, including the succession of pathogen variants, immunization dynamics, and the ratio of vaccinated individuals among confirmed cases. Additionally, we assess the model’s predictive power in estimating pandemic dynamics (peak timing, peak value, and wave length) of disease-related states (number of confirmed cases, hospitalizations, ICU hospitalizations, and deaths) both at the national level and in the highest administrative units in Poland (voivodships). When testing the model’s validity, we compared real-world data (excluding data used for calibration) to our model estimates to evaluate whether pDyn accurately reproduced the epidemic dynamics up to the simulation time (October 28, 2021). To assess the accuracy of pDyn’s predictions, we retrospectively compared simulation results with real-world data acquired after the simulation date, evaluating pDyn as a tool for predicting future epidemic spread. Our results indicate that pDyn accurately predicts and can help us better understand the mechanisms underlying the SARS-CoV-2 dynamics.

The development of future quantum devices such as the maser, i.e., the microwave analog of the laser, could be well-served by the exploration of chemically tunable organic materials. Current iterations of room-temperature organic solid-state masers are composed of an inert host material that is doped with a spin-active molecule. In this work, we systematically modulated the structure of three nitrogen-substituted tetracene derivatives to augment their photoexcited spin dynamics and then evaluated their potential as novel maser gain media by optical, computational, and electronic paramagnetic resonance (EPR) spectroscopy. To facilitate these investigations, we adopted an organic glass former, 1,3,5-tri(1-naphthyl)benzene to act as a universal host. These chemical modifications impacted the rates of intersystem crossing, triplet spin polarization, triplet decay, and spin−lattice relaxation, leading to significant consequences on the conditions required to surpass the maser threshold.

IntroductionRepresentations activated during handwriting production code information on morphological structure and reflect decomposition of the root and suffix. Children with Developmental Language Disorder (DLD) have significant difficulties in spelling morphologically complex words, but previous research has not sought evidence for a morphological decomposition effect via an examination of handwriting processes in this population.Method Thirty-three children aged 9–10 years with DLD, 33 children matched for chronological age (CA), and 33 younger children aged 7–8 years matched for oral language ability (LA) completed a dictated spelling task (21 words; 12 with inflectional suffixes, nine with derivational suffixes). The task was completed on paper with an inking pen linked to a graphics tablet running the handwriting software Eye and Pen. Pause analyses and letter duration analyses were conducted.ResultsThe three groups showed similar handwriting processes, evidencing a morphological decomposition effect in a natural writing task. Pause durations observed at the root/suffix boundary were significantly longer than those occurring in the root. Letter durations were also significantly longer for the letter immediately prior to the boundary compared to the letter after it. Nevertheless, despite being commensurate to their LA matches for mean pause durations and letter durations, children with DLD were significantly poorer at spelling derivational morphemes. Handwriting processes did significantly predict spelling accuracy but to a much lesser extent compared to reading ability.DiscussionIt is suggested that derivational spelling difficulties in DLD may derive more from problems with underspecified orthographic representations as opposed to handwriting processing differences.

Background: Magnetic resonance imaging (MRI) T2-lesions resolve more often in myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) than aquaporin-4 IgG-positive neuromyelitis optica spectrum disorder (AQP4 + NMOSD) and multiple sclerosis (MS) in adults but few studies analyzed children. Objective: The main objective of this study is to investigate MRI T2-lesion evolution in pediatric MOGAD, AQP4 + NMOSD, and MS. Methods: Inclusion criteria were as follows: (1) first clinical attack; (2) abnormal MRI (⩽6 weeks); (3) follow-up MRI beyond 6 months without relapses in that region; and (4) age < 18 years. An index T2-lesion (symptomatic/largest) was identified, and T2-lesion resolution or persistence on follow-up MRI was determined. Results: We included 56 patients (MOGAD, 21; AQP4 + NMOSD, 8; MS, 27) with 69 attacks. Index T2-lesion resolution was more frequent in MOGAD (brain 9 of 15 [60%]; spine 8 of 12 [67%]) than AQP4 + NMOSD (brain 1 of 4 [25%]; spine 0 of 7 [0%]) and MS (brain 0 of 18 [0%]; spine 1 of 13 [8%]), p < 0.01. Resolution of all T2-lesions occurred more often in MOGAD (brain 6 of 15 [40%]; spine 7 of 12 [58%]) than AQP4 + NMOSD (brain 1 of 4 [25%]; spine 0 of 7 [0%]), and MS (brain 0 of 18 [0%]; spine 1 of 13 [8%]), p < 0.01. Reductions in median index T2-lesion area were greater in MOGAD (brain, 305 mm; spine, 23 mm) than MS (brain, 42 mm [p<0.001]; spine, 10 mm [p<0.001]) without differing from AQP4 + NMOSD (brain, 133 mm [p=0.42]; spine, 19.5 mm [p=0.69]). Conclusion: In children, MRI T2-lesions resolved more often in MOGAD than AQP4 + NMOSD and MS which is similar to adults suggesting these differences are related to pathogenesis rather than age.

Background There has been a growing focus on functional communication interventions for primary progressive aphasia (PPA). These interventions aim to support individuals to participate in life situations. One such intervention, communication partner training (CPT) aims to change conversation behaviours in both the person with PPA and their communication partner (CP). CPT has a growing evidence base in stroke aphasia; however, these programmes are not designed to meet the needs of people with progressive communication difficulties. To address this, the authors developed a CPT program entitled Better Conversations with PPA (BCPPA) and undertook a pilot trial to establish for a future full trial; predicted recruitment rates, acceptability, an assessment of treatment fidelity and an appropriate primary outcome measure. Methodology This was a single-blind, randomised controlled pilot study comparing BCPPA to no treatment, delivered across 11 National Health Service Trusts in the UK. A random sample of eight recordings of local collaborators delivering the intervention were analysed to examine fidelity. Participants completed feedback forms reporting on acceptability. Pre- and post-intervention measures targeted conversation behaviours, communication goals and quality of life. Results Eighteen people with PPA and their CPs (9 randomised to BCPPA, 9 randomised to no treatment) completed the study. Participants in the intervention group rated BCPPA positively. Treatment fidelity was 87.2%. Twenty-nine of 30 intervention goals were achieved or over-achieved and 16 of 30 coded conversation behaviours demonstrated change in the intended direction. The Aphasia Impact Questionnaire was identified as the preferred outcome measure. Conclusion The first randomised controlled UK pilot study of a CPT program for people with PPA and their families demonstrates BCPPA is a promising intervention. The intervention was acceptable, treatment fidelity high and an appropriate measure identified. Results of this study indicate a future RCT of BCPPA is feasible. Trial registration Registered 28/02/2018 ISRCTN10148247.

Background Therapy resistance in cancer is often driven by a subpopulation of cells that are temporarily arrested in a non-proliferative G0 state, which is difficult to capture and whose mutational drivers remain largely unknown. Results We develop methodology to robustly identify this state from transcriptomic signals and characterise its prevalence and genomic constraints in solid primary tumours. We show that G0 arrest preferentially emerges in the context of more stable, less mutated genomes which maintain TP53 integrity and lack the hallmarks of DNA damage repair deficiency, while presenting increased APOBEC mutagenesis. We employ machine learning to uncover novel genomic dependencies of this process and validate the role of the centrosomal gene CEP89 as a modulator of proliferation and G0 arrest capacity. Lastly, we demonstrate that G0 arrest underlies unfavourable responses to various therapies exploiting cell cycle, kinase signalling and epigenetic mechanisms in single-cell data. Conclusions We propose a G0 arrest transcriptional signature that is linked with therapeutic resistance and can be used to further study and clinically track this state.

Genetic data contain a record of our evolutionary history. The availability of large-scale datasets of human populations from various geographic areas and timescales, coupled with advances in the computational methods to analyze these data, has transformed our ability to use genetic data to learn about our evolutionary past. Here, we review some of the widely used statistical methods to explore and characterize population relationships and history using genomic data. We describe the intuition behind commonly used approaches, their interpretation, and important limitations. For illustration, we apply some of these techniques to genome-wide autosomal data from 929 individuals representing 53 worldwide populations that are part of the Human Genome Diversity Project. Finally, we discuss the new frontiers in genomic methods to learn about population history. In sum, this review highlights the power (and limitations) of DNA to infer features of human evolutionary history, complementing the knowledge gleaned from other disciplines, such as archaeology, anthropology, and linguistics. Expected final online publication date for the Annual Review of Genomics and Human Genetics, Volume 24 is August 2023. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Messenger RNA uridylation is pervasive and conserved among eukaryotes, but the consequences of this modification for mRNA fate are still under debate. Utilising a simple model organism to study uridylation may facilitate efforts to understand the cellular function of this process. Here we demonstrate that uridylation can be detected using simple bioinformatics approach. We utilise it to unravel widespread transcript uridylation in fission yeast and demonstrate the contribution of both Cid1 and Cid16, the only two annotated terminal uridyltransferases (TUT-ases) in this yeast. To detect uridylation in transcriptome data, we used a RNA-sequencing (RNA-seq) library preparation protocol involving initial linker ligation to fragmented RNA-an approach borrowed from small RNA sequencing that was commonly used in older RNA-seq protocols. We next explored the data to detect uridylation marks. Our analysis show that uridylation in yeast is pervasive, similarly to the one in multicellular organisms. Importantly, our results confirm the role of the cytoplasmic uridyltransferase Cid1 as the primary uridylation catalyst. However, we also observed an auxiliary role of the second uridyltransferase, Cid16. Thus both fission yeast uridyltransferases are involved in mRNA uridylation. Intriguingly, we found no physiological phenotype of the single and double deletion mutants of cid1 and cid16 and only minimal impact of uridylation on steady-state mRNA levels. Our work establishes fission yeast as a potent model to study uridylation in a simple eukaryote, and we demonstrate that it is possible to detect uridylation marks in RNA-seq data without the need for specific methodologies.

Comparing the evolution of distantly related viruses can provide insights into common adaptive processes related to shared ecological niches. Phylogenetic approaches, coupled with other molecular evolution tools, can help identify mutations informative on adaptation, whilst the structural contextualization of these to functional sites of proteins may help gain insight into their biological properties. Two zoonotic betacoronaviruses capable of sustained human-to-human transmission have caused pandemics in recent times (SARS-CoV-1 and SARS-CoV-2), whilst a third virus (MERS-CoV) is responsible for sporadic outbreaks linked to animal infections. Moreover, two other betacoronaviruses have circulated endemically in humans for decades (HKU1 and OC43). To search for evidence of adaptive convergence between established and emerging betacoronaviruses capable of sustained human-to-human transmission (HKU1, OC43, SARS-CoV-1 and SARS-CoV-2), we developed a methodological pipeline to classify shared non-synonymous mutations as putatively denoting homoplasy (repeated mutations that do not share direct common ancestry) or stepwise evolution (sequential mutations leading towards a novel genotype). In parallel, we look for evidence of positive selection, and draw upon protein structure data to identify potential biological implications. We find 30 candidate mutations, from which four [codon sites 18121 (nsp14/residue 28), 21623 (spike/21), 21635 (spike/25) and 23948 (spike/796); SARS-CoV-2 genome numbering] further display evolution under positive selection and proximity to functional protein regions. Our findings shed light on potential mechanisms underlying betacoronavirus adaptation to the human host and pinpoint common mutational pathways that may occur during establishment of human endemicity.

Background: Effective treatments for dry mouth of Sjogren's syndrome are limited and hampered by adverse effects. The aim of LEONIDAS-1 was to explore the feasibility of salivary electrostimulation in individuals with primary Sjogren's syndrome, as well as parameters required to inform the design of a future phase III trial. Methods: Multicentre, parallel-group, double-blind, randomised sham-controlled trial in two UK centres. Participants were randomised (1:1, computer-generated) to active or sham electrostimulation. The feasibility outcomes included screening/eligibility ratio, consent, and recruitment and drop-out rates. Preliminary efficacy outcome included dry mouth visual analogue scale, Xerostomia Inventory, the EULAR Sjögren's syndrome patient reported index-Q1, and unstimulated sialometry. Results: Forty-two individuals were screened, of whom 30 (71.4%) met the eligibility criteria. All eligible individuals consented to recruitment. Out of the 30 randomised participants (active n = 15, sham n = 15), 4 dropped out and 26 (13 vs. 13) completed all study visits as per protocol. Recruitment rate was 2.73 participants/month. At 6-month post-randomisation the difference in mean reduction in visual analogue scale, xerostomia inventory and EULAR Sjögren's syndrome patient reported index-Q1 scores between groups were 0.36 (95% CI: -0.84, 1.56), 3.31 (0.43, 6.18), and 0.23 (-1.17, 1.63), respectively; unstimulated salivary flow increased by a mean of 0.98 mL/15 min, all in favour of the active group. No adverse events were reported. Conclusion: LEONIDAS-1 results support progression to a phase III definitive randomised controlled trial of salivary electrostimulation in individuals with Sjogren's syndrome. Xerostomia inventory could be considered the primary patient-centred outcome measure and the corresponding observed treatment effect could inform the sample size of a future trial.

Background: Smoking and excessive drinking place a strain on household budgets. We aimed to examine the impact of the cost-of-living crisis in Great Britain on the nature of smoking cessation and alcohol reduction attempts, and explore changes in health professionals offering support. Methods: Data were from 14,567 past-year smokers and high-risk drinkers (AUDIT-C ≥5) participating in monthly representative surveys, January-2021 through December-2022. We estimated time trends in cost as a motive driving the most recent (smoking cessation/alcohol reduction) attempt, use of paid or evidence-based support, and receipt of GP offer of support for smoking cessation or alcohol reduction, and tested for moderation by occupational social grade. Results: The proportion of attempts motivated by cost did not change significantly over time among smokers (25.4% [95%CI = 23.8-26.9%]), but increased between December-2021 and December-2022 among high-risk drinkers from less advantaged social grades (from 15.3% [95%CI 12.1-19.3] to 29.7% [20.1-44.1]). The only change in support use was an increase in smokers using paid support, specifically e-cigarettes (from 28.1% [23.7-33.3] to 38.2% [33.0-44.4]). Among those visiting their GP, the proportion who received an offer of support was similar over time among smokers (27.0% [25.7-28.2]) and high-risk drinkers (1.4% [1.1-1.6%]). Conclusions: There is limited evidence that the 2021/22 cost-of-living crisis affected the nature of attempts to stop smoking and reduce alcohol consumption, or receipt of GP offer of support. It is encouraging that use of evidence-based support has not declined and that use of e-cigarettes in quit attempts has increased. However, cost is increasingly motivating alcohol reduction attempts among less advantaged drinkers, and rates of GPs offering support, especially for alcohol reduction, remain very low.