Potential for Forecasting UK Summer Grass Growth from the North Atlantic Oscillation

The North Atlantic Oscillation (NAO) is a large-scale atmospheric circulation pattern which is well-known to influence the UK winter climate (Wilby et al., 1997). Recently, it has been shown that the winter NAO also affects summer rainfall in the UK (Kettlewell et al., 2003). Since water supply is an important limitation to summer grass growth in many parts of the UK, the winter NAO may influence summer growth. The objective of this study was to test the hypothesis that there is a relationship between the winter NAO and summer grass growth using data from reference plots at North Wyke in Devon

A study of mapping usual care and unmet need for vocational rehabilitation and psychological support following major trauma in five health districts in the UK

Objective: Traumatic injuries are common in working age adults. Survivors may experience physical and psychological problems that affect their ability to work. Rehabilitation pathways are complex, and it is unclear whether adequate vocational/psychological support exists post-injury. Aim: To understand where and how trauma survivors' rehabilitation needs are met post-trauma, and map rehabilitation across five UK major trauma networks. Design: Qualitative study (interviews, focus groups, workshops) using soft-systems methodology to map usual care across trauma networks and explore service gaps. Publicly available documents were consulted. CATWOE (Customers, Actors, Transformation, Worldview, Owners, Environment) was used as an analytic thematic framework to explore the relationship between stakeholders in the pathway. Setting: Five major trauma networks across the UK. Subjects: 106 key rehabilitation stakeholders (service providers, trauma survivors) were recruited to interviews (n=46), focus groups (n=4 groups, 17 participants) and workshops (n=5 workshops, 43 participants). Interventions: None. Results: Mapping of rehabilitation pathways identified several issues: 1) lack of vocational/psychological support particularly for musculoskeletal injuries; 2) inconsistent service provision in areas located further from major trauma centres; 3) lack of communication between acute and community care; 4) long waiting lists (up to 12 months) for community rehabilitation; 5) most well-established pathways were neurologically focused. Conclusions: The trauma rehabilitation pathway is complex and varies across the UK with few, if any patients following an 'ideal' pathway. Services have developed piecemeal to address specific issues, but rarely meet the needs of individuals with multiple impairments post-trauma, with a lack of vocational rehabilitation and psychological support for this population

Patients views on which return to work outcomes should be prioritised: a nominal group technique focus group

Objective: Injuries can have a long-lasting effect on ability to return-to-work, but there is little research on which outcomes are most important to patients. This study aims to identify and prioritise return-to-work outcomes important to patients for evaluating vocational rehabilitation interventions. Methods: Nominal group technique focus group with trauma patients. Results: Focus group participants (n=6) included mostly traumatic brain injuries, a range of occupation types, ages and both genders. Participants identified and prioritised their eight most important outcomes which were: sense of purpose and life satisfaction, understanding the impact of injury, assessment of readiness to return-to-work, using SMART (specific, measurable, achievable, relevant, time-bound) goals, facilitated reintegration to work, assessing capacity to return to work, collaboration between key stakeholders and improved employer and employee knowledge. Many of these were measures of the process of, rather than change outcomes of vocational rehabilitation. Conclusions: The range of outcomes identified by trauma patients highlights the complex process of return-to-work and the need for vocational rehabilitation evaluations to incorporate a broader range of outcomes. Measures of the process of vocational rehabilitation are also important to trauma patients and should be included in such evaluations

Adaptive Social Protection in Rwanda: ‘Climate?proofing’ the Vision 2020 Umurenge Programme

Rwanda has a high rate of rural poverty, population density and pressures on its natural resource base. One government response has been a social protection intervention, the Vision 2020 Umurenge Programme (VUP). VUP provides ‘public works’ employment for members of extremely poor households with able?bodied members, and ‘direct support’ cash transfers for poor households without members who can work. Many public works projects focus on environmental protection. VUP also promotes risk reduction activities related to food security and related health or nutrition issues. With increasing weather?related hazards and possibly climate change, administrators recognise the need to ‘climate?proof’ VUP in a manner that integrates social protection with disaster risk management, climate change adaptation and food security. This article highlights the potential for social protection policies and programmes in Rwanda to increase household and community resilience, by applying concepts of adaptive social protection and ‘no regrets’ approaches in a territorial context

Vocational rehabilitation to enhance return to work after trauma (ROWTATE): protocol for a non-randomised single arm mixed-methods feasibility study

Background: Traumatic injuries are common amongst working-age adults. Survivors often experience physical and psychological problems, reduced quality of life and difficulty returning to work. Vocational rehabilitation improves work outcomes for a range of conditions but evidence of effectiveness for those with traumatic injuries is lacking. This study assesses feasibility of delivering a vocational rehabilitation intervention to enhance return to work and improve quality of life and wellbeing in people with at least moderate trauma to inform design of a definitive randomised controlled trial (RCT). Methods: Non-randomised, single-arm, multi-centre mixed-methods feasibility study with nested case studies and qualitative study. The case studies comprise interviews, observations of clinical contacts and review of clinical records. The qualitative study comprises interviews and/or focus groups. Participants will be recruited from two UK major trauma centres. Participants will comprise 40 patients aged 16–69 with an injury severity score of > 8 who will receive the intervention and complete questionnaires. Interviews will be conducted with 10 patients and their occupational therapists (OTs), clinical psychologists (CPs), employers and commissioners of rehabilitation services. Fidelity will be assessed in up to six patients by observations of OT and CP—patient contacts, review of patient records and intervention case report forms. OT and CP training will be evaluated using questionnaires and competence to deliver the intervention assessed using a team objective structured clinical examination and written task. Patients participating in and those declining participation in the study will be invited to take part in interviews/focus groups to explore barriers and facilitators to recruitment and retention. Outcomes include recruitment and retention rates, intervention fidelity, OT and CP competence to deliver the intervention, experiences of delivering or receiving the intervention and factors likely to influence definitive trial delivery. Discussion: Effective vocational rehabilitation interventions to enhance return to work amongst trauma patients are urgently needed because return to work is often delayed, with detrimental effects on health, financial stability, healthcare resource use and wider society. This protocol describes a feasibility study delivering a complex intervention to enhance return to work in those with at least moderate trauma

Deleterious effects of phosphate on vascular and endothelial function via disruption to the nitric oxide pathway

Background: Hyperphosphataemia is an independent risk factor for accelerated cardiovascular disease in chronic kidney disease (CKD), although the mechanism for this is poorly understood. We investigated the effects of sustained exposure to a high-phosphate environment on endothelial function in cellular and preclinical models, as well as in human subjects. Methods: Resistance vessels from rats and humans (± CKD) were incubated in a normal (1.18 mM) or high (2.5 mM) phosphate concentration solution and cells were cultured in normal- (0.5 mM) or high-phosphate (3 mM) concentration media. A single-blind crossover study was performed in healthy volunteers, receiving phosphate supplements or a phosphate binder (lanthanum), and endothelial function measured was by flow-mediated dilatation. Results: Endothelium-dependent vasodilatation was impaired when resistance vessels were exposed to high phosphate; this could be reversed in the presence of a phosphodiesterase-5-inhibitor. Vessels from patients with CKD relaxed normally when incubated in normal-phosphate conditions, suggesting that the detrimental effects of phosphate may be reversible. Exposure to high-phosphate disrupted the whole nitric oxide pathway with reduced nitric oxide and cyclic guanosine monophosphate production and total and phospho endothelial nitric oxide synthase expression. In humans, endothelial function was reduced by chronic phosphate loading independent of serum phosphate, but was associated with higher urinary phosphate excretion and serum fibroblast growth factor 23. Conclusions: These directly detrimental effects of phosphate, independent of other factors in the uraemic environment, may explain the increased cardiovascular risk associated with phosphate in CKD

Informing evaluation of a smartphone application for people with acquired brain injury: a stakeholder engagement study

Background Brain in Hand is a smartphone application (app) that allows users to create structured diaries with problems and solutions, attach reminders, record task completion and has a symptom monitoring system. Brain in Hand was designed to support people with psychological problems, and encourage behaviour monitoring and change. The aim of this paper is to describe the process of exploring the barriers and enablers for the uptake and use of Brain in Hand in clinical practice, identify potential adaptations of the app for use with people with acquired brain injury (ABI), and determine whether the behaviour change wheel can be used as a model for engagement. Methods We identified stakeholders: ABI survivors and carers, National Health Service and private healthcare professionals, and engaged with them via focus groups, conference presentations, small group discussions, and through questionnaires. The results were evaluated using the behaviour change wheel and descriptive statistics of questionnaire responses. Results We engaged with 20 ABI survivors, 5 carers, 25 professionals, 41 questionnaires were completed by stakeholders. Comments made during group discussions were supported by questionnaire results. Enablers included smartphone competency (capability), personalisation of app (opportunity), and identifying perceived need (motivation). Barriers included a physical and cognitive inability to use smartphone (capability), potential cost and reliability of technology (opportunity), and no desire to use technology or change from existing strategies (motivation). The stakeholders identified potential uses and changes to the app, which were not easily mapped onto the behaviour change wheel, e.g. monitoring fatigue levels, method of logging task completion, and editing the diary on their smartphone. Conclusions The study identified that both ABI survivors and therapists could see a use for Brain in Hand, but wanted users to be able to personalise it themselves to address individual user needs, e.g. monitoring activity levels. The behaviour change wheel is a useful tool when designing and evaluating engagement activities as it addresses most aspects of implementation, however additional categories may be needed to explore the specific features of assistive technology interventions, e.g. technical functions

What explains rare and conspicuous colours in a snail? A test of time-series data against models of drift, migration or selection

It is intriguing that conspicuous colour morphs of a prey species may be maintained at low frequencies alongside cryptic morphs. Negative frequency-dependent selection by predators using search images ('apostatic selection') is often suggested without rejecting alternative explanations. Using a maximum likelihood approach we fitted predictions from models of genetic drift, migration, constant selection, heterozygote advantage or negative frequency-dependent selection to time-series data of colour frequencies in isolated populations of a marine snail (Littorina saxatilis), re-established with perturbed colour morph frequencies and followed for >20 generations. Snails of conspicuous colours (white, red, banded) are naturally rare in the study area (usually <10%) but frequencies were manipulated to levels of ~50% (one colour per population) in 8 populations at the start of the experiment in 1992. In 2013, frequencies had declined to ~15-45%. Drift alone could not explain these changes. Migration could not be rejected in any population, but required rates much higher than those recorded. Directional selection was rejected in three populations in favour of balancing selection. Heterozygote advantage and negative frequency-dependent selection could not be distinguished statistically, although overall the results favoured the latter. Populations varied idiosyncratically as mild or variable colour selection (3-11%) interacted with demographic stochasticity, and the overall conclusion was that multiple mechanisms may contribute to maintaining the polymorphisms.Heredity advance online publication, 21 September 2016; doi:10.1038/hdy.2016.77