Women as moral pioneers? Experiences of first trimester antenatal screening

Copyright @ 2005 Elsevier Ltd.The implementation of innovative medical technologies can raise unprecedented ethical, legal and social dilemmas. This is particularly so in the area of antenatal screening, which is dominated by the language of risk and probabilities. Second trimester serum screening for Down's syndrome and neural tube defects has a well-established place in antenatal care. Increasingly, first trimester screening with biochemical and ultrasound markers is being proposed as advance on this, yielding higher detection rates of Down's syndrome at an earlier gestational age. This article explores the experiences of 14 women offered innovative first trimester screening, which takes place within the context of a detailed ultrasound scan. The study is set within the UK, where recent policy changes mean that the offer of screening for fetal anomalies, particularly Down's syndrome, will become a routine part of antenatal care and offered to all pregnant women. This paper focuses on the significance of the scan in first trimester screening, and some of the potential dilemmas for women that can result from this. It then discusses the ways in which women made their decisions about screening, in particular, their work as ‘moral pioneers’. We found that the part played by the ultrasound scan in first trimester screening, particularly in relation to the higher-quality images now being obtained, has the potential to introduce new and novel ethical dilemmas for pregnant women. Although concerns have been raised about pregnant women viewing ultrasound scans as benign, many of the women reported having thought carefully through their own moral beliefs and values prior to screening. It seems that whatever other implications they may have, first trimester screening technologies will continue the tradition of pregnant women acting as ‘moral pioneers’ in increasingly complex settings.ESRC/MRC Innovative Health Technologies Programme for funding the project (grant no: L218252042). CW acknowledges the support of The Wellcome Trust Biomedical Ethics Programme in funding her postdoctoral fellowship, which enabled her to work on this project

Antiplasmodial Activity of Nitroaromatic Compounds : Correlation with Their Reduction Potential and Inhibitory Action on Plasmodium falciparum Glutathione Reductase

With the aim to clarify the mechanism(s) of action of nitroaromatic compounds against the malaria parasite Plasmodium falciparum, we examined the single-electron reduction by P. falciparum ferredoxin:NADP+ oxidoreductase (PfFNR) of a series of nitrofurans and nitrobenzenes (n = 23), and their ability to inhibit P. falciparum glutathione reductase (PfGR). The reactivity of nitroaromatics in PfFNR-catalyzed reactions increased with their single-electron reduction midpoint potential (E17). Nitroaromatic compounds acted as non- or uncompetitive inhibitors towards PfGR with respect to NADPH and glutathione substrates. Using multiparameter regression analysis, we found that the in vitro activity of these compounds against P. falciparum strain FcB1 increased with their E17 values, octanol/water distribution coefficients at pH 7.0 (log D), and their activity as PfGR inhibitors. Our data demonstrate that both factors, the ease of reductive activation and the inhibition of PfGR, are important in the antiplasmodial in vitro activity of nitroaromatics. To the best of our knowledge, this is the first quantitative demonstration of this kind of relationship. No correlation between antiplasmodial activity and ability to inhibit human erythrocyte GR was detected in tested nitroaromatics. Our data suggest that the efficacy of prooxidant antiparasitic agents may be achieved through their combined action, namely inhibition of antioxidant NADPH:disulfide reductases, and the rapid reduction by single-electron transferring dehydrogenases-electrontransferases

Generating evidence in support of site planning and design

This is the final version. Available on open access from Routledge via the DOI in this recordThis chapter presents the development and application of the BlueHealth Environmental Assessment Tool (BEAT). It also introduces the online tool, which is an output of the project and free to use by readers. The evidence-based approach to planning requires that various kinds of data be collected and analysed before and after any intervention is made. This provides the necessary understanding of the balance of risks and benefits associated with changes in an environment, in its usage, in the activities conducted in that space and in the health and well-being of its users and subsequently to plan in a way that maximises benefits and minimises risks. The BEAT is primarily designed to be used as an online tool, but it is also available for download, which allows for a printed version to be used on sites where assessors are not connected to the internet. There are several opportunities for using BEAT in tandem with the decision support tool

A Transdisciplinary Approach to Recovering Natural and Cultural Landscape and Place Identification : A Case Study of Can Moritz Spring (Rubí, Spain)

Altres ajuts: Mireia Gascon holds a Miguel Servet fellowship (Grant CP19/00183) funded by Acción Estratégica de Salud-Instituto de Salud Carlos III, co-funded by the European Social Fund "Investing in your future". ISGlobal acknowledges support from the Spanish Ministry of Science and Innovation through the "Centro de Excelencia Severo Ochoa 2019-2023" Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program.The perception of the quality of green and blue spaces can be key in the relationship between a community and its local landscape (i.e., place identification). The lack of transdisciplinary training and social-specific education of landscape architects regarding the complexity of landscape as a participative cultural artefact limits reaching the general population. Bridging this gap of landscape and place identification and evaluation by a local community was the main objective of the present case study conducted at an abandoned spring and seasonal stream area in Rubí (Spain). The "Steinitz method" of landscape evaluation was used as a participatory method to activate community members to learn about and express their visual preferences regarding this neglected landscape. Bottom-up interventions applying an "urban acupuncture" approach in the area identified as the least attractive by the residents were co-designed and combined with a top-down restoration of a nearby, existing but derelict and hidden, spring. In addition, before and after planning and implementing the intervention, we conducted surveys about the community perception, sense of belonging and use of the space. We observed that the lack of awareness of the inhabitants about this spring was an obstacle preventing the community from embracing the potential for health and wellbeing presented by the spring and adjacent landscape. Following the work, the landscape saw increasing use, and the historic spring was brought back to life as a resource to help people to improve their health and wellbeing

Recreational visits to marine and coastal environments in England: Where, what, who, why, and when?

Health and economic benefits may accrue from marine and coastal recreation. In England, few national-level descriptive analyses exist which examine predictors of recreation in these environments. Data from seven waves (2009–2016) of a representative survey of the English population (n = 326,756) were analysed to investigate how many recreational visits were made annually to coastal environments in England, which activities were undertaken on these visits, and which demographic, motivational, temporal, and regional factors predict them. Inland environments are presented for comparison. Approximately 271 million recreational visits were made to coastal environments in England annually, the majority involving land-based activities such as walking. Separately, there were around 59 million instances of water-based recreation undertaken on recreational visits (e.g. swimming, water sports). Visits to the coast involving walking were undertaken by a wide spectrum of the population: compared to woodland walks, for instance, coastal walks were more likely to be made by females, older adults, and individuals from lower socioeconomic classifications, suggesting the coast may support reducing activity inequalities. Motivational and temporal variables showed distinct patterns between visits to coastal and inland comparator environments. Regional variations existed too with more visits to coastal environments made by people living in the south-west and north-east compared to London, where more visits were made to urban open spaces. The results provide a reference for current patterns of coastal recreation in England, and could be considered when making policy-level decisions with regard to coastal accessibility and marine plans. Implications for future public health and marine plans are discussed

BlueHealth: a study programme protocol for mapping and quantifying the potential benefits to public health and well-being from Europe's blue spaces

This is the final version of the article. Available from BMJ Publishing Group via the DOI in this record.INTRODUCTION: Proximity and access to water have long been central to human culture and accordingly deliver countless societal benefits. Over 200 million people live on Europe's coastline, and aquatic environments are the top recreational destination in the region. In terms of public health, interactions with 'blue space' (eg, coasts, rivers, lakes) are often considered solely in terms of risk (eg, drowning, microbial pollution). Exposure to blue space can, however, promote health and well-being and prevent disease, although underlying mechanisms are poorly understood. AIMS AND METHODS: The BlueHealth project aims to understand the relationships between exposure to blue space and health and well-being, to map and quantify the public health impacts of changes to both natural blue spaces and associated urban infrastructure in Europe, and to provide evidence-based information to policymakers on how to maximise health benefits associated with interventions in and around aquatic environments. To achieve these aims, an evidence base will be created through systematic reviews, analyses of secondary data sets and analyses of new data collected through a bespoke international survey and a wide range of community-level interventions. We will also explore how to deliver the benefits associated with blue spaces to those without direct access through the use of virtual reality. Scenarios will be developed that allow the evaluation of health impacts in plausible future societal contexts and changing environments. BlueHealth will develop key inputs into policymaking and land/water-use planning towards more salutogenic and sustainable uses of blue space, particularly in urban areas. ETHICS AND DISSEMINATION: Throughout the BlueHealth project, ethics review and approval are obtained for all relevant aspects of the study by the local ethics committees prior to any work being initiated and an ethics expert has been appointed to the project advisory board. So far, ethical approval has been obtained for the BlueHealth International Survey and for community-level interventions taking place in Spain, Italy and the UK. Engagement of stakeholders, including the public, involves citizens in many aspects of the project. Results of all individual studies within the BlueHealth project will be published with open access. After full anonymisation and application of any measures necessary to prevent disclosure, data generated in the project will be deposited into open data repositories of the partner institutions, in line with a formal data management plan. Other knowledge and tools developed in the project will be made available via the project website (www.bluehealth2020.eu). Project results will ultimately provide key inputs to planning and policy relating to blue space, further stimulating the integration of environmental and health considerations into decision-making, such that blue infrastructure is developed across Europe with both public health and the environment in mind.This work was supported by funding received from the European Union’s Horizon 2020 research and innovation programme under grant agreement no. 666773