Land management for increased flood resilience

Natural Flood Management (NFM) (e.g. restoring watercourses, riparian tree planting, washland and wetland creation) is a core component of flood risk management strategies in Scotland. However little is known of its potential impact on the farming and land management communities, individual farm businesses, or the socioeconomic impacts and perceptions of its potential wide-spread introduction. To support policy implementation, information is required on land managers’ willingness to implement NFM, and to be able to relate willingness to generic farm characteristics (farming systems, land use types, geographical location), different types and locations of NFM measures, and to farm economics.The main objectives of the project are to undertake:1. A large scale survey of farmers’ attitudes to NFM and to the use of potential policy instruments to promote its uptake and delivery; and2. Farm-scale economic analyses of the impact of NFM measures under different scenarios

Regulation of the Cardiac Na+/K+ ATPase by Phospholemman

Hansraj Dhayan, Rajender Kumar, Andreas Kukol, ‘Regulation of the Cardiac Na+/K+ ATPase by Phospholemman’, in Sajal Chakraborti, Naranjan Dhalla, eds., Regulation of Membrane Na+-K+ ATPase, (Switzerland: Springer, 2016), ISBN 978-3-319-24748-9, eISBN 978-3-319-24750-2.Peer reviewe

Linking e-health records, patient-reported symptoms and environmental exposure data to characterise and model COPD exacerbations: protocol for the COPE study.

INTRODUCTION: Relationships between exacerbations of chronic obstructive pulmonary disease (COPD) and environmental factors such as temperature, humidity and air pollution are not well characterised, due in part to oversimplification in the assignment of exposure estimates to individuals and populations. New developments in miniature environmental sensors mean that patients can now carry a personal air quality monitor for long periods of time as they go about their daily lives. This creates the potential for capturing a direct link between individual activities, environmental exposures and the health of patients with COPD. Direct associations then have the potential to be scaled up to population levels and tested using advanced human exposure models linked to electronic health records. METHODS AND ANALYSIS: This study has 5 stages: (1) development and deployment of personal air monitors; (2) recruitment and monitoring of a cohort of 160 patients with COPD for up to 6 months with recruitment of participants through the Clinical Practice Research Datalink (CPRD); (3) statistical associations between personal exposure with COPD-related health outcomes; (4) validation of a time-activity exposure model and (5) development of a COPD prediction model for London. ETHICS AND DISSEMINATION: The Research Ethics Committee for Camden and Islington has provided ethical approval for the conduct of the study. Approval has also been granted by National Health Service (NHS) Research and Development and the Independent Scientific Advisory Committee. The results of the study will be disseminated through appropriate conference presentations and peer-reviewed journals.This work is funded by the Medical Research Council (MR/L019744/1). MRC-PHE funding has been obtained for a pilot study to collect blood and sputum samples on a subset of 20 participants. Enrolment will take place at The Royal Brompton and Harefield (RBH) and Guy's and St Thomas' (GSTT) NHS Foundation Trusts. Support will be provided by the Respiratory Clinical Research Facility at RBH and the Lane Fox Unit at GSTT. The project is a portfolio adopted by the National Institute for Health Research (NIHR) UK Clinical Research Network (CRN). Additional support was provided by the NIHR Biomedical Research Centre based at GSTT and King's College London.This is the final version of the article. It first appeared from the BMJ Publishing Group via http://dx.doi.org/10.1136/bmjopen-2016-01133

How are patients with rare diseases and their carers in the UK impacted by the way care is coordinated? An exploratory qualitative interview study

BACKGROUND: Care coordination is considered important for patients with rare conditions, yet research addressing the impact of care coordination is limited. This study aimed to explore how care coordination (or lack of) impacts on patients and carers. Semi-structured interviews were conducted with 15 patients and carers/parents in the UK, representing a range of rare conditions (including undiagnosed conditions). Transcripts were analysed thematically in an iterative process. RESULTS: Participants described a range of experiences and views in relation to care coordination. Reports of uncoordinated care emerged: appointments were uncoordinated, communication between key stakeholders was ineffective, patients and carers were required to coordinate their own care, and care was not coordinated to meet the changing needs of patients in different scenarios. As a result, participants experienced an additional burden and barriers/delays to accessing care. The impacts described by patients and carers, either attributed to or exacerbated by uncoordinated care, included: impact on physical health (including fatigue), financial impact (including loss of earnings and travel costs), and psychosocial impact (including disruption to school, work and emotional burden). Overall data highlight the importance of flexible care, which meets individual needs throughout patients'/carers' journeys. Specifically, study participants suggested that the impacts may be addressed by: having support from a professional to coordinate care, changing the approach of clinics and appointments (where they take place, which professionals/services are available and how they are scheduled), and improving communication through the use of technology, care plans, accessible points of contact and multi-disciplinary team working. CONCLUSION: This study provides further evidence of impacts of uncoordinated care; these may be complex and influenced by a number of factors. Approaches to coordination which improve access to care and lessen the time and burden placed on patients and carers may be particularly beneficial. Findings should influence future service developments (and the evaluation of such developments). This will be achieved, in the first instance, by informing the CONCORD Study in the UK

Future hot-spots for hydro-hazards in Great Britain: a probabilistic assessment

In an increasing hydro-climatic risk context as a result of climate change, this work aims to identify future hydro-hazard hot-spots as a result of climate change across Great Britain. First, flood and drought hazards were defined and selected in a consistent and parallel approach with a threshold method. Then, a nation-wide systematic and robust statistical framework was developed to quantify changes in frequency, magnitude, and duration, and assess time of year for both droughts and floods, and the uncertainty associated with climate model projections. This approach was applied to a spatially coherent statistical database of daily river flows (Future Flows Hydrology) across Great Britain to assess changes between the baseline (1961–1990) and the 2080s (2069–2098). The results showed that hydro-hazard hot-spots are likely to develop along the western coast of England and Wales and across north-eastern Scotland, mainly during the winter (floods) and autumn (droughts) seasons, with a higher increase in drought hazard in terms of magnitude and duration. These results suggest a need for adapting water management policies in light of climate change impact, not only on the magnitude, but also on the timing of hydro-hazard events, and future policy should account for both extremes together, alongside their potential future evolution.</p

Air pollution, ethnicity and telomere length in east London schoolchildren: An observational study

This study was funded/supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London, Dr. and Mrs. Lee Iu Cheung Fund, and Hackney Primary Care Trust (PCT)

Global Associations between Air Pollutants and Chronic Obstructive Pulmonary Disease Hospitalizations: A Systematic Review.

BACKGROUND: Exacerbations are key events in Chronic Obstructive Pulmonary Disease (COPD), affecting lung function decline and quality of life. The effect of exposure to different air pollutants on COPD exacerbations is not clear. OBJECTIVE: To carry out a systematic review examining associations between air pollutants and hospital admissions for COPD exacerbations. DATA SOURCES: MEDLINE, EMBASE, BIOSIS & Science Citation Index, and the Air Pollution Epidemiology Database were searched from 1980 until September 2015. DATA EXTRACTION: Inclusion criteria focused on studies presenting solely a COPD outcome defined by hospital admissions, and a measure of gaseous air pollutants and particle fractions. The association between each pollutant with COPD admissions was investigated in metaanalyses using random-effects models. Analyses were stratified by geographical clusters to investigate the consistency of the evidence worldwide. SYNTHESIS: 46 studies were included and results for all the pollutants under investigation showed marginal positive associations; however the number of included studies was small with high heterogeneity between them and there was evidence of small-study bias. Geographical clustering of the effects of pollution on COPD hospital admissions was evident and reduced heterogeneity significantly. CONCLUSIONS: The most consistent associations was between a 1mg/m3 increase in carbon monoxide levels with COPD related admissions; Odds Ratio: 1.02 (95%CI: 1.01-1.03). The heterogeneity was moderate and there was a consistent positive association in both Europe and North America, although levels were clearly below WHO guideline values. There is mixed evidence on the effects of environmental pollution on COPD exacerbations. Limitations of previous studies included the low spatiotemporal resolution of pollutants, inadequate control for confounding factors, and the use of aggregated health data that ignore personal characteristics. The need for more targeted exposure estimates in a large number of geographical locations is evident.This research was funded by the Medical Research Council (MR/L019744/1 [B.B.]). It was also supported by the Medical Research Council-Public Health England (MRC-PHE) Centre for Environment and Health and the National Ins titute for Health Resear ch (NIHR) Biomedical Research Centre based at Guy’s and St . Thomas’ NHS Foundation Trust and King’s College London