Using non-participant observation to uncover mechanisms: insights from a realist evaluation

This article outlines how a realist evaluation of dementia care in hospitals used non-participant observation to support the refinement and testing of mechanisms likely to lead to the use of person-centred care. We found that comments and explanations of their actions from hospital staff during observation periods provided insights into the reasoning that generated their actions for care in real time. This informed subsequent data collection and analysis. Two worked examples of mechanisms first identified during non-participant observation demonstrate (1) how they were uncovered, and (2) how this informed research activities for theory refinement. Early, iterative engagement with the analytic process, primarily involving reflection and debate with the research team, maximised the potential of observation data to support surfacing underlying mechanisms, linking them to specific contexts and outcomes.Peer reviewedFinal Accepted Versio

Introducing EMMIE: An evidence rating scale to encourage mixed-method crime prevention synthesis reviews

Objectives This short report describes the need for, and the development of, a coding system to distil the quality and coverage of systematic reviews of the evidence relating to crime prevention interventions. The starting point for the coding system concerns the evidence needs of policymakers and practitioners. Methods The coding scheme (EMMIE) proposed builds on previous scales that have been developed to assess the probity, coverage and utility of evidence both in health and criminal justice. It also draws on the principles of realist synthesis and review. Results The proposed EMMIE scale identifies five dimensions to which systematic reviews intended to inform crime prevention should speak. These are the Effect of intervention, the identification of the causal Mechanism(s) through which interventions are intended to work, the factors that Moderate their impact, the articulation of practical Implementation issues, and the Economic costs of intervention

Developing a model to estimate the potential impact of municipal investment on city health

This article summarizes a process which exemplifies the potential impact of municipal investment on the burden of cardiovascular disease (CVD) in city populations. We report on Developing an evidence-based approach to city public health planning and investment in Europe (DECiPHEr), a project part funded by the European Union. It had twin objectives: first, to develop and validate a vocational educational training package for policy makers and political decision takers; second, to use this opportunity to iterate a robust and user-friendly investment tool for maximizing the public health impact of 'mainstream' municipal policies, programs and investments. There were seven stages in the development process shared by an academic team from Sheffield Hallam University and partners from four cities drawn from the WHO European Healthy Cities Network. There were five iterations of the model resulting from this process. The initial focus was CVD as the biggest cause of death and disability in Europe. Our original prototype 'cost offset' model was confined to proximal determinants of CVD, utilizing modified 'Framingham' equations to estimate the impact of population level cardiovascular risk factor reduction on future demand for acute hospital admissions. The DECiPHEr iterations first extended the scope of the model to distal determinants and then focused progressively on practical interventions. Six key domains of local influence on population health were introduced into the model by the development process: education, housing, environment, public health, economy and security. Deploying a realist synthesis methodology, the model then connected distal with proximal determinants of CVD. Existing scientific evidence and cities' experiential knowledge were 'plugged-in' or 'triangulated' to elaborate the causal pathways from domain interventions to public health impacts. A key product is an enhanced version of the cost offset model, named Sheffield Health Effectiveness Framework Tool, incorporating both proximal and distal determinants in estimating the cost benefits of domain interventions. A key message is that the insights of the policy community are essential in developing and then utilising such a predictive tool

The Roles of Climate Change and Climate Variability in the 2017 Atlantic Hurricane Season

The 2017 hurricane season was extremely active with six major hurricanes, the third most on record. The sea-surface temperatures (SSTs) over the eastern Main Development Region (EMDR), where many tropical cyclones (TCs) developed during active months of August/September, were approximately 0.96 degrees Centigrade above the 1901-2017 average (warmest on record): about 0.42 degrees Centigrade from a long-term upward trend and the rest (around 80 percent) attributed to the Atlantic Meridional Mode (AMM). The contribution to the SST from the North Atlantic Oscillation over the EMDR was a weak warming, while that from ENSO was negligible. Nevertheless, ENSO, the NAO, and the AMM all contributed to favorable wind shear conditions, while the AMM also produced enhanced atmospheric instability. Compared with the strong hurricane years of 2005-2010, the ocean heat content (OHC) during 2017 was larger across the tropics, with higher SST anomalies over the EMDR and Caribbean Sea. On the other hand, the dynamical/thermodynamical atmospheric conditions, while favorable for enhanced TC activity, were less prominent than in 2005-2010 across the tropics. The results suggest that unusually warm SST in the EMDR together with the long fetch of the resulting storms in the presence of record-breaking OHC were key factors in driving the strong TC activity in 2017

The SAO and Kelvin waves in the EuroGRIPS GCMS and the UK Met. Office analyses

International audienceWe compare the tropical oscillations and planetary scale Kelvin waves in four troposphere-stratosphere climate models and the assimilated dataset produced by the United Kingdom Meteorological Office (UKMO). The comparison has been made in the GRIPS framework "GCM-Reality Intercomparison Project for SPARC", where SPARC is Stratospheric Processes and their Role in Climate, a project of the World Climate Research Program. The four models evaluated are European members of GRIPS: the UKMO Unified Model (UM), the model of the Free University in Berlin (FUB–GCM), the ARPEGE-climat model of the French National Centre for Meteorological Research (CNRM), and the Extended UGAMP GCM (EUGCM) of the Centre for Global Atmospheric Modelling (CGAM). The integrations were performed with different, but annually periodic external conditions (e.g., sea-surface temperature, sea ice, and incoming solar radiation). The structure of the tropical winds and the strengths of the Kelvin waves are examined. In the analyses where the SAO (Semi-Annual Oscillation) and the QBO (Quasi-Biennal Oscillation) are reasonably well captured, the amplitude of these analysed Kelvin waves is close to that observed in independent data from UARS (Upper Atmosphere Research Satellite). In agreement with observations, the Kelvin waves generated in the models propagate into the middle atmosphere as wave packets, consistent with a convective forcing origin. In three of the models, slow Kelvin waves propagate too high and their amplitudes are overestimated in the upper stratosphere and in the mesosphere, the exception is the UM which has weaker waves. None of the modelled waves are sufficient to force realistic eastward phases of the QBO or SAO. Although the SAO is represented by all models, only two of them are able to generate westerlies between 10 hPa and 50 hPa. The importance of the role played in the SAO by unresolved gravity waves is emphasized. Although it exhibits some unrealistic features, the EUGCM, which includes a parametrization of gravity waves with a non-zero phase speed, is able to simulate clear easterly to westerly transitions as well as westerlies with down-ward propagation. Thermal damping is also important for the westerly forcing in the stratosphere

Nonlinear Response of Tropical Lower Stratospheric Temperature and Water Vapor to ENSO

A series of simulations using the NASA Goddard Earth Observing System Chemistry-Climate Model are analyzed in order to aid in the interpretation of observed interannual and sub-decadal variability in the tropical lower stratosphere over the past 35 years. The impact of El Nino-Southern Oscillation on temperature and water vapor in this region is nonlinear in boreal spring. While moderate El Nino events lead to cooling in this region, strong El Nino events lead to warming, even as the response of the large-scale Brewer Dobson circulation appears to scale nearly linearly with El Nino. This nonlinearity is shown to arise from the response in the Indo-West Pacific to El Nino: strong El Nino events lead to tropospheric warming extending into the tropical tropopause layer and up to the cold point in this region, where it allows for more water vapor to enter the stratosphere. The net effect is that both strong La Nina and strong El Nino events lead to enhanced entry water vapor and stratospheric moistening in boreal spring and early summer. These results lead to the following interpretation of the contribution of sea surface temperatures to the decline in water vapor in the early 2000s: the very strong El Nino event in 1997/1998, followed by more than 2 consecutive years of La Nina, led to enhanced lower-stratospheric water vapor. As this period ended in early 2001, entry water vapor concentrations declined. This effect accounts for approximately one-quarter of the observed drop

Fluvial organic carbon flux from an eroding peatland catchment, southern Pennines, UK

This study investigates for the first time the relative importance of dissolved organic carbon (DOC) and particulate organic carbon (POC) in the fluvial carbon flux from an actively eroding peatland catchment in the southern Pennines, UK. Event scale variability in DOC and POC was examined and the annual flux of fluvial organic carbon was estimated for the catchment. At the event scale, both DOC and POC were found to increase with discharge, with event based POC export accounting for 95% of flux in only 8% of the time. On an annual cycle, exports of 35.14 t organic carbon (OC) are estimated from the catchment, which represents an areal value of 92.47 g C m<sup>−2</sup> a<sup>−1</sup>. POC was the most significant form of organic carbon export, accounting for 80% of the estimated flux. This suggests that more research is required on both the fate of POC and the rates of POC export in eroding peatland catchments

The Impact of SST-Forced and Unforced Teleconnections on 2015/16 El Nino Winter Precipitation over the Western United States

The factors impacting western U.S. winter precipitation during the 2015/16 El Nio are investigated using the Modern-Era Retrospective analysis for Research and Applications version 2 (MERRA-2) data, and simulations with the Goddard Earth Observing System version 5 (GEOS-5) atmospheric general circulation model forced with specified sea surface temperatures (SSTs). Results reveal that the simulated response to the tropical Pacific SST associated with the 2015/16 El Nio was to produce wetter than normal conditions over much of the west coast including California - a result at odds with the negative precipitation anomalies observed over much of the Southwestern U.S. It is shown that two factors acted to partly counter the canonical ENSO response in that region. First, a potentially predictable but modest response to the unusually strong and persistent warm SST in the northeastern Pacific decreased precipitation in the Southwestern U.S. by increasing sea level pressure, driving anticyclonic circulation and atmospheric descent, and reducing moisture transport into that region. Second, large-scale unforced (by SST) components of atmospheric variability (consisting of the leading modes of unpredictable intra-ensemble variability) resembling the positive phase of the North Atlantic Oscillation and Arctic Oscillation are found to be an important contributor to the drying over the western U.S. While a statistical reconstruction of the precipitation from our simulations that account for internal atmospheric variability does much to close the gap between the ensemble mean and observed precipitation in the Southwestern U.S., some differences remain, indicating that model error is also playing a role

A new 147-56 hPa water vapor product from the UARS Microwave Limb Sounder

Measurements of H2O in the tropopause region have been obtained by production of a new data set from the Microwave Limb Sounder (MLS) on the Upper Atmosphere Research Satellite (UARS). A modified version of the retrieval scheme used to produce upper tropospheric humidity (UTH) from the MLS 203 GHz radiometer was applied to the MLS 183 GHz radiometer measurements to produce useful H2O data at 147, 121, 100, 83, 68, and 56 hPa. These new data, for the first 18 months of the UARS mission when the MLS 183 GHz radiometer was operational, fill an important “gap” around 100 hPa where previous MLS H2O data were generally not useful. Characteristics of the new data set are discussed and compared with National Oceanic and Atmospheric Administration (NOAA), Climate Monitoring and Diagnostics Laboratory (CMDL) frost-point hygrometer, and UARS Halogen Occultation Experiment (HALOE) measurements

Exploring complex causal pathways between urban renewal, health and health inequality using a theory-driven approach

Urban populations are growing and to accommodate these numbers, cities are becoming more involved in urban renewal programs to improve the physical, social and economic conditions in different areas. This paper explores some of the complexities surrounding the link between urban renewal, health and health inequalities using a theory-driven approach. ; We focus on an urban renewal initiative implemented in Barcelona, the Neighbourhoods Law, targeting Barcelona’s (Spain) most deprived neighbourhoods. We present evidence from two studies on the health evaluation of the Neighbourhoods Law, while drawing from recent urban renewal literature, to follow a four-step process to develop a program theory. We then use two specific urban renewal interventions, the construction of a large central plaza and the repair of streets and sidewalks, to further examine this link. ; In order for urban renewal programs to affect health and health inequality, neighbours must use and adapt to the changes produced by the intervention. However, there exist barriers that can result in negative outcomes including factors such as accessibility, safety and security. ; This paper provides a different perspective to the field that is largely dominated by traditional quantitative studies that are not always able to address the complexities such interventions provide. Furthermore, the framework and discussions serve as a guide for future research, policy development and evaluation