The developing role of evidence based environmental health: perceptions, experiences and understandings from the front line

There has been renewed recognition that proactive strategies and interventions can address the social determinants of health, and the environmental health profession is well placed to effect positive change in many of these determinants. This qualitative research has revealed differences in the perceptions, experiences, and understandings of evidence-based practice among public health professionals from different backgrounds across different services in health care and local government in England. The absence of a strong tradition of evidence-based practice in environmental health appears to be a disadvantage in securing funding and playing a full role, as it has become the expectation in the new public health system. This has, at times, resulted in tensions between professionals with different backgrounds and frustration on the part of environmental health practitioners, who have a tradition of responding quickly to new challenges and “getting on with the job.” There is generally a willingness to develop evidence-based practice in environmental health; however, this will take time and investment

Affordable warmth: Housing strategies for older people

Purpose The purpose of this paper is to consolidate policy, research, evidence and good practice around strategies tackling fuel poverty and affordable warmth for older people aged over 60 to support the development of more effective services for this life course stage and to tackle physical and mental health inequalities. Design/methodology/approach We consolidate current policy, research, evidence and examples of good practice in exploring effective interprofessional approaches that contribute to affordable warmth for older people through ‘desktop analysis’. We support this with qualitative data from Health and Wellbeing Boards, health inequalities and environmental health from research comprising 4 longitudinal case studies in the Midlands and North of England over 18 months and semi structured interviews with members and support officers. A total of 50 interviews were undertaken and 55 hours of Health and Wellbeing Board meetings observed. Findings There are numerous older people living in fuel poverty. The depth of fuel poverty increases with age particularly the over 75s and physical and mental ill health are affected. There are an increasing number of tools to help estimate health care costs around the cost effectiveness of interventions and there is a real need for more local evidence about what is working well, how and why. However there is no mandatory requirement for fuel poverty strategies and more creative local strategies are required taking organisational and interprofessional relationships into account. The emphasis in integrated care provides new impetus and scope to encourage preventative services but these new partnerships need to be effective in what is a complex policy environment. There is still a long way to go in places. The challenges of ageing are numerous, complex and not fully understood and sit across multiple policy areas. Originality/value Fuel poverty strategies tend to be delivered on a geographical or income bases rather than by life course approach and a focus on older people. We need to focus more specifically on older people, a rapidly growing population and to better understand thermal properties of our ageing housing stock and how best to intervene to protect and improve health and safety. Emerging approaches need to overcome artificial statutory and non statutory divides and move toward sustainable, evidence based affordable warmth strategies for older people to protect and improve health

The physician’s role in perioperative management of older patients undergoing surgery

Life-sustaining and life-improving surgical interventions are increasingly available to older, frailer patients, many of whom have multimorbidity. Physicians can help support perioperative multidisciplinary teams with assessment and preoperative optimisation of physiological reserve, comorbidities and associated geriatric syndromes. Similar structured support can be useful in the postoperative period where older patients are at increased risk of delirium, medical complications, increased functional dependency and where discharge planning can prove more difficult than in younger cohorts. Comprehensive geriatric assessment has been shown to improve outcomes and is now embedded in most UK-based services for traumatic hip fracture. Perioperative comprehensive geriatric assessment has been explored in other surgical disciplines and procedures and, where evaluated, has been associated with improved outcomes. The need to support older patients with frailty undergoing surgery exceeds the capacity of specialist geriatricians. Other groups of healthcare professionals need to nurture the core competencies to support this group perioperatively

Research and evidence based environmental health

Environmental health (EH) professionals have often spoken of the need to become more research active (Burke et al., 2002; McCarthy, 1996) and make their work more evidence based, but to date little has been written about how to achieve this in practice. This chapter is therefore written as an introductory guide to research for EH professionals, students, and policy makers. By developing your knowledge it is hoped you will feel more confident navigating the world of research; motivated towards making your own work more evidence based; and enthused about contributing to the evidence base from which others can learn. This chapter is not a research methods textbook, a step by step guide to research or evidence based environmental health, nor does it seek to make definitive statements about these complex areas. However it highlights the most important issues regarding research in environmental health, considers the importance of research to the environmental health profession and provides useful signposts towards further resources. The chapter is divided into three sections. The first defines evidence based environmental health and why it remains a priority for EH professionals. The second section explores the key stages of environmental health research and provides guidance on the development of your reading skills. The final section suggests ways to become more research active and evidence based, acknowledging the many challenges EH professionals face and concluding with a vision for evidence based environmental health. The chapter ends with an annex including a glossary of environmental health research terms, a list of references and suggested further reading

Rapid and Point-of-Care Testing in Respiratory Tract Infections: An Antibiotic Guardian?

This is a narrative review on the potential of rapid and point-of-care microbiological testing in pneumonia patients, focusing particularly on hospital-acquired and ventilator-associated pneumonia, which have substantial mortality and diverse microbiology. This work is written from a United Kingdom perspective, but much of it is generalizable internationally. In a world where antimicrobial resistance is a major international threat, the use of rapid molecular diagnostics has great potential to improve both the management of pneumonia patients and the stewardship of antibiotics. Rapid tests potentially can distinguish patients with bacterial versus viral infection and can swiftly identify bacterial pathogens and their resistances. We seek to answer the question: "Can such tests be used as an antibiotic guardian?"Their availability at the bedside rather than in the laboratory should best ensure that results are swiftly used to optimize patient management but will raise new challenges, not the least with respect to maintaining quality control and microbiology/infection control input. A further challenge lies in assessing the degree of trust that treating clinicians will place in these molecular diagnostic tests, particularly when early de-escalation of antibiotic therapy is indicated

The emerging specialty of perioperative medicine: a UK survey of the attitudes and behaviours of anaesthetists

Background: In 2014, the Royal College of Anaesthetists (RCoA) launched the Perioperative Medicine Programme to facilitate the delivery of best preoperative, intraoperative and postoperative care through implementation of evidence-based medicine to reduce variation and improve postoperative outcomes. However, variation exists in the establishment of perioperative medicine services in the UK. This survey explored attitudes and behaviours of anaesthetists towards perioperative medicine, described current anaesthetic-led perioperative medicine services across the UK and explored barriers to anaesthetic involvement in perioperative medicine. / Methods: Survey content based on the RCoA vision document was refined and validated using an expert panel. An anonymous electronic survey was then sent by email to the members of the RCoA. / Results: Seven hundred fifty-eight UK anaesthetists (4.5% of the RCoA mailing list) responded to the survey. Of these, 64% considered themselves a perioperative doctor, with 65% having changed local services in response to the RCoA vision. Barriers to developing perioperative medicine included insufficient time (75%) and inadequate training (51%). Three quarters of respondents advocate anaesthetists leading the development of perioperative medicine. / Conclusions: Despite evidence of emerging services, this survey describes barriers to ongoing development of perioperative medicine. Facilitators may include increased clinical exposure, targeted education and training and collaborative working with other specialties

Driving magnetic order in a manganite by ultrafast lattice excitation

Optical control of magnetism, of interest for high-speed data processing and storage, has only been demonstrated with near-infrared excitation to date. However, in absorbing materials, such high photon energies can lead to significant dissipation, making switch back times long and miniaturization challenging. In manganites, magnetism is directly coupled to the lattice, as evidenced by the response to external and chemical pressure, or to ferroelectric polarization. Here, femtosecond mid-infrared pulses are used to excite the lattice in La0.5Sr1.5MnO4 and the dynamics of electronic order are measured by femtosecond resonant soft x-ray scattering with an x-ray free electron laser. We observe that magnetic and orbital orders are reduced by excitation of the lattice. This process, which occurs within few picoseconds, is interpreted as relaxation of the complex charge-orbital-spin structure following a displacive exchange quench - a prompt shift in the equilibrium value of the magnetic and orbital order parameters after the lattice has been distorted. A microscopic picture of the underlying unidirectional lattice displacement is proposed, based on nonlinear rectification of the directly-excited vibrational field, as analyzed in the specific lattice symmetry of La0.5Sr1.5MnO4. Control of magnetism through ultrafast lattice excitation has important analogies to the multiferroic effect and may serve as a new paradigm for high-speed optomagnetism.Comment: 10 pages manuscript, 4 figure

Valence band photoemission from the GaN(0001) surface

A detailed investigation by one-step photoemission calculations of the GaN(0001)-(1x1) surface in comparison with recent experiments is presented in order to clarify its structural properties and electronic structure. The discussion of normal and off-normal spectra reveals through the identified surface states clear fingerprints for the applicability of a surface model proposed by Smith et al. Especially the predicted metallic bonds are confirmed. In the context of direct transitions the calculated spectra allow to determine the valence band width and to argue in favor of one of two theoretical bulk band structures. Furthermore a commonly used experimental method to fix the valence band maximum is critically tested.Comment: 8 pages, 11 eps files, submitted to PR

Momentum resolved spin dynamics of bulk and surface excited states in the topological insulator Bi2Se3\mathrm{Bi_{2}Se_{3}}

The prospective of optically inducing a spin polarized current for spintronic devices has generated a vast interest in the out-of-equilibrium electronic and spin structure of topological insulators (TIs). In this Letter we prove that only by measuring the spin intensity signal over several order of magnitude in spin, time and angle resolved photoemission spectroscopy (STAR-PES) experiments is it possible to comprehensively describe the optically excited electronic states in TIs materials. The experiments performed on $\mathrm{Bi_{2}Se_{3}}$ reveal the existence of a Surface-Resonance-State in the 2nd bulk band gap interpreted on the basis of fully relativistic ab-initio spin resolved photoemission calculations. Remarkably, the spin dependent relaxation of the hot carriers is well reproduced by a spin dynamics model considering two non-interacting electronic systems, derived from the excited surface and bulk states, with different electronic temperatures.Comment: 5 pages and 4 figure