Measuring Transport Resilience: A Manawatu-Wanganui Region Case Study

The resilience of transport networks is attracting greater scrutiny at the international, national and sub-national levels. This research report explores the current state of knowledge about measuring transport resilience and presents a case study to address the question is: How resilient is the road and rail infrastructure in the Manawatu-Wanganui Region? This region in New Zealand’s lower North Island provides an interesting case study due to its strategic location in the North Island’s and indeed New Zealand’s transport network. In addition, it has experienced significant disruptions in the recent past, most notably widespread failures caused by flooding in 2004, and the lengthy closure of a significant inter-regional road connection, the Manawatu Gorge State Highway 3 road, due to a landslide in 2011-2012. It also provides an opportunity to explore this topic outside of a major metropolitan region. The region’s transport networks and infrastructure also have important social and economic functions. This research report is structured around a proposed Transport Resilience Indicator Framework (RIF) which explores six key dimensions of transport infrastructure resilience: engineering, services, ecological, social, economic and institutional. This holistic approach to measuring transport resilience and is envisaged to accommodate both qualitative and quantitative indicators. Within this framework, data were gathered via analysis of secondary sources and nine key informant interviews. The interview participants were from public sector agencies responsible for managing aspects of the region’s transport network, the private sector and one social service provider. The participants had considerable knowledge relating to the planning of the road network and/or its economic and social significance. They also had knowledge of the impacts and/or management of recent disruptions. The institutions responsible for managing the region’s transport network can identify vulnerabilities in the network, but can also collaborate and learn from past disruptions. Concerns were expressed about the level of funding for maintaining and upgrading the region’s transport networks, particularly for territorial authorities with large networks and small rates bases. The region is strongly dependent on the roading network, with limited alternatives during roading network disruptions. It proved difficult to quantify the environmental impacts of transport disruptions. A case study of the response of a local ii health shuttle service provided an example of how a community, by drawing on social capital, was able to adapt and respond appropriately to a transport disruption. One key area identified for further research is assessing the capacity of private contractors to respond to natural hazard events of varying magnitudes. The RIF could also be strengthened by the use of indicators based on quantitative data, in addition to qualitative data. It is suggested that one method of achieving this could this could be to adopt a multi-disciplinary approach, drawing on expertise, methods and perspectives from related professions, such as engineering and economics. [Executive summary

Empowering change: Realist evaluation of a Scottish Government programme to support normal birth

Objective: Midwife-led care has consistently been found to be safe and effective in reducing routine childbirth interventions and improving women’s experience of care. Despite consistent UK policy support for maximising the role of the midwife as the lead care provider for women with healthy pregnancies, implementation has been inconsistent and the persistent use of routine interventions in labour has given rise to concern. In response the Scottish Government initiated Keeping Childbirth Natural and Dynamic, a maternity care programme that aimed to support normal birth by implementing multi-professional care pathways and making midwife-led care for healthy pregnant women the national norm. Design: The evaluation was informed by realist evaluation. It aimed to explore and explain the ways in which the KCND programme worked or did not work in different maternity care contexts. Methods: The evaluation was conducted in three phases. In phase one semi- structured interviews and focus groups were conducted with key informants to elicit the programme theory. At phase two, this theory was tested using a multiple case study approach. Semi-structured interviews and focus groups were conducted and a case record audit was undertaken. In the final phase the programme theory was refined through analyses and interpretation of the data. Setting and participants: The setting for the evaluation was NHS Scotland. In phase one, 12 national programme stakeholders and 13 consultant midwives participated. In phase two case, studies were undertaken in three health boards; overall 73 participants took part in interviews or focus groups. A case record audit was undertaken of all births in Scotland during one week in two consecutive years before and after pathway implementation. Findings: Government and health board level commitment to, and support of, the programme signalled its importance and facilitated change. Consultant midwives tailored change strategies, using different approaches in response to the culture of care and inter-professional relationships within contexts. In contexts where practice was already changing KCND was seen as validating and facilitating. In areas where a more medical culture existed there was strong resistance to change from midwives and medical staff and robust implementation strategies were required. Overall the pathways appeared to enable midwives to achieve change. Key conclusions: Our study highlighted the importance of those involved in a change programme working across levels of hierarchy within an organisation and from the macro-context of national policy and institutions to the meso-context of regional health service delivery and the micro-context of practitioner’s experiences of providing care. The assumptions and propositions that inform programmes of change, which are often left at a tacit level and unexamined by those charged with implementing them, were made explicit. This examination illuminated the roles of the three key change mechanisms adopted in the KCND programme - appointment of consultant midwives as programme champions, multidisciplinary care pathways, and midwife-led care. It revealed the role of the commitment mechanism, which built on the appointment of the local change champions. The analysis indicated that the process of change, despite these clear mechanisms, needed to be adapted to local contexts and responses to the implementation of KCND. Implications for practice: Initial formative evaluation should be conducted prior to development of complex healthcare programmes to ensure that 1. The interventions will address the changes required 2. Key stakeholders who may support or resist change are identified 3. Appropriate facilitation strategies are developed tailored to context

The Kuramoto-Sivashinsky Equation

The Kuramoto-Sivashinsky equation was introduced as a simple 1-dimensional model of instabilities in flames, but it turned out to mathematically fascinating in its own right. One reason is that this equation is a simple model of Galilean-invariant chaos with an arrow of time. Starting from random initial conditions, manifestly time-asymmetric stripe-like patterns emerge. As we move forward in time, it appears that these stripes are born and merge, but do not die or split. We pose a precise conjecture to this effect, which requires a precise definition of 'stripes'.Comment: 3 pages, 2 figure

Barriers to active transport in Palmerston North

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Comparative transcriptomic analysis of whole blood mycobacterial growth assays and tuberculosis patients’ blood RNA profiles

In vitro whole blood infection models are used for elucidating the immune response to Mycobacterium tuberculosis (Mtb). They exhibit commonalities but also differences, to the in vivo blood transcriptional response during natural human Mtb disease. Here, we present a description of concordant and discordant components of the immune response in blood, quantified through transcriptional profiling in an in vitro whole blood infection model compared to whole blood from patients with tuberculosis disease. We identified concordantly and discordantly expressed gene modules and performed in silico cell deconvolution. A high degree of concordance of gene expression between both adult and paediatric in vivo-in vitro tuberculosis infection was identified. Concordance in paediatric in vivo vs in vitro comparison is largely characterised by immune suppression, while in adults the comparison is marked by concordant immune activation, particularly that of inflammation, chemokine, and interferon signalling. Discordance between in vitro and in vivo increases over time and is driven by T-cell regulation and monocyte-related gene expression, likely due to apoptotic depletion of monocytes and increasing relative fraction of longer-lived cell types, such as T and B cells. Our approach facilitates a more informed use of the whole blood in vitro model, while also accounting for its limitations

Health state utility values for diabetic retinopathy: protocol for a systematic review and meta-analysis

Background People with diabetic retinopathy tend to have lower levels of health-related quality of life than individuals with no retinopathy. Strategies for screening and treatment have been shown to be cost-effective. In order to reduce the bias in cost-effectiveness estimates, systematic reviews of health state utility values (HSUVs) are crucial for health technology assessment and the development of decision analytic models. A review and synthesis of HSUVs for the different stages of disease progression in diabetic retinopathy has not previously been conducted. Methods/Design We will conduct a systematic review of the available literature that reports HSUVs for people with diabetic retinopathy, in correspondence with current stage of disease progression and/or visual acuity. We will search Medline, EMBASE, Web of Science, Cost-Effectiveness Analysis Registry, Centre for Reviews and Dissemination Database, and EconLit to identify relevant English-language articles. Data will subsequently be synthesized using linear mixed effects modeling meta-regression. Additionally, reported disease severity classifications will be mapped to a four-level grading scale for diabetic retinopathy. Discussion The systematic review and meta-analysis will provide important evidence for future model-based economic evaluations of technologies for diabetic retinopathy. The meta-regression will enable the estimation of utility values at different disease stages for patients with particular characteristics and will also highlight where the design of the study and HSUV instrument have influenced the reported utility values. We believe this protocol to be the first of its kind to be published

Matrix-dependent size modifications of iron oxide nanoparticles (Ferumoxytol) spiked into rat blood cells and plasma : Characterisation with TEM, AF4-UV-MALS-ICP-MS/MS and spICP-MS

KN gratefully acknowledges the University of Aberdeen for an Elphinstone Ph.D. studentship and the Niger Delta Development Commission (NDDC) for a research grant (RG-13451-10). The authors also gratefully acknowledge Postnova Analytics UK especially Dr. Bassem Sabagh for the loan of the AF4 system together with training, support, and advice on the technique. Microscopy was performed at the Microscopy and Histology Core facility, University of Aberdeen.Peer reviewedPostprin

Qualitative evaluation of a rapid rollout of home blood pressure monitoring in pregnancy during Covid-19

In March 2020, the World Health Organisation named the severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2), which causes corona virus disease 2019 (COVID -19), as a pandemic. Pregnant women were considered at increased risk of developing severe COVID-19 after viral infection. In response maternity services reduced face-to-face consultations with high-risk pregnant women by supplying blood pressure monitors for supported self-monitoring. This paper explores the experiences of patients and clinicians of the rapid roll-out of supported self-monitoring programme in Scotland during the first and second wave of the COVID-19 pandemic. We conducted semi-structured telephone interviews with high-risk women and healthcare professionals who were using supported self-monitoring of blood pressure (BP) In four case studies during the COVID-19 pandemic. 20 women, 15 midwives and 4 obstetricians took part in the interviews. Interviews with healthcare professionals showed that while implementation occurred at pace and at scale across the National Health Service (NHS) in Scotland, implementation differed locally, resulting in mixed experiences. Study Participants observed several barriers and facilitators to implementation. Women value the simplicity of use and convenience of the digital communications platforms while health professionals were more interested in their impact on reducing workload for both women and health professionals largely found self-monitoring acceptable, with only a few exceptions. These results show that rapid change can occur in the NHS at a national level when there is a shared motivation. While self-monitoring is acceptable to most women, decisions regarding self-monitoring should be made jointly and on an individual basis

Induction of labour during the COVID-19 pandemic: a national survey of impact on practice in the UK

BACKGROUND: Induction of labour (IOL) is one of the most commonly performed interventions in maternity care, with outpatient cervical ripening increasingly offered as an option for women undergoing IOL. The COVID-19 pandemic has changed the context of practice and the option of returning home for cervical ripening may now assume greater significance. This work aimed to examine whether and how the COVID-19 pandemic has changed practice around IOL in the UK. METHOD: We used an online questionnaire to survey senior obstetricians and midwives at all 156 UK NHS Trusts and Boards that currently offer maternity services. Responses were analysed to produce descriptive statistics, with free text responses analysed using a conventional content analysis approach. FINDINGS: Responses were received from 92 of 156 UK Trusts and Boards, a 59% response rate. Many Trusts and Boards reported no change to their IOL practice, however 23% reported change in methods used for cervical ripening; 28% a change in criteria for home cervical ripening; 28% stated that more women were returning home during cervical ripening; and 24% noted changes to women's response to recommendations for IOL. Much of the change was reported as happening in response to attempts to minimise hospital attendance and restrictions on birth partners accompanying women. CONCLUSIONS: The pandemic has changed practice around induction of labour, although this varied significantly between NHS Trusts and Boards. There is a lack of formal evidence to support decision-making around outpatient cervical ripening: the basis on which changes were implemented and what evidence was used to inform decisions is not clear