A Description and Analysis of Mediterranean Cities and Regions Planning for Climate Impacts

The current literature on local climate change adaptation contains comparatively little research into local and regional adaptation to climate change, and few comparisons of local climate adaptation initiatives across broad climate regions. Our conjecture is that areas with similar climates will face similar sets of climate risks and therefore can share adaptation solutions. This paper examines 36 adaptation plans (cases) selected from across the five Mediterranean climate regions in order to find if there is evidence that groups of cities and/or regions share similar responses to climate risks. We examined adaptation strategies for sea level rise, increased temperatures, flooding, reduced water supply and drought, wildfires, extreme weather events, and increased GHGs and air pollution. We examined the cities’ adaptation plans and categorized them into four stages: training, assessment, recommendations, and implementation. A contribution of the paper is a new way of analyzing adaptation by building a matrix of adaptation policy stage and climate impact area that shows which policy options have advanced from planning to implementation in our cases. We found that a wide variety of cities have completed assessments in one or more of the climate adaptation areas. Our major finding is that these Mediterranean cities often have quite similar plans for dealing with several climate risks. Many cities are planning stormwater runoff infrastructure overhauls in order to ameliorate the impacts of climate-related water supply and flooding effects. Similarly, many cities are proposing greening strategies to deal with heat island effects. Finally, we observe that the adaptation plans imply large cross-cutting infrastructure investment with their concomitant financial demands. We also observe a common gap, that while retreat from threatened areas is likely to be a necessary strategy for sea level rise, flooding, and perhaps wildfire, retreat is seldom mentioned, and not at all at the implementation stage. The key contribution of this paper is to provide a starting point for researchers and policymakers to consider the similarities and differences in adaptation approaches across Mediterranean climate zone cities. This paper establishes a baseline for adaptation policy in our urban cases that additional research can use to examine adaptation progress moving forward

A new simple six-step model to promote recruitment to RCTs was developed and successfully implemented

How a randomised controlled trial (RCT) is explained to patients is a key determinant of recruitment to that trial. This study developed and implemented a simple six-step model to fully inform patients and to support them in deciding whether to take part.Ninety-two consultations with 60 new patients were recorded and analysed during a pilot RCT comparing surgical and non-surgical interventions for hip impingement. Recordings were analysed using techniques of thematic analysis and focused conversation analysis.Early findings supported the development of a simple six-step model to provide a framework for good recruitment practice. Model steps are: 1) Explain the condition; 2) Reassure patients about receiving treatment; 3) Establish uncertainty; 4) Explain the study purpose; 5) Give a balanced view of treatments and 6) Explain study procedures. There are also two elements throughout the consultation: i) Responding to patients' concerns and ii) showing confidence. The pilot study was successful, with 70% (n= 60) of patients approached across 9 centres agreeing to take part in the RCT, so that the full-scale trial was funded.The six-step model provides a promising framework for successful recruitment to RCTs. Further testing of the model is now required

Virtual Reality & Gamification for Pre-Occupancy Training

The objective of this research is to analyze and compare user behavior and learning retention via gamified and non-gamified virtual reality for use in pre-occupancy training. After completing trials for both gamified and non-gamified virtual reality we issued a standardized post-experience survey to collect data on what the participants learned, then compared and analyzed the results. The benefits of virtual reality and gamification have both been extensively studied and both suggest they are independently effective teaching tools. In our trials we have found that participants who went through the gamified virtual reality training were 50% more likely to come away with the desired learning objectives than participants who went through the non-gamified virtual reality. The benefits of virtual reality and gamification can be effectively combined and retain the benefits of that learning method in this situation. Based on our small sample and our literature review this technology can be used to train a more informed population regarding the effective operation of passive building systems.https://pdxscholar.library.pdx.edu/research_based_design/1085/thumbnail.jp

What does a good RCT recruitment consultation look like? A new simple six-step model to promote information sharing and recruitment to RCTs

Objective: The mode of delivery of trial information is a key determinant of recruitment to randomised controlled trials (RCTs), which can be modified in order to encourage patients to participate. This paper presents the development and initial validation of a simple six-step model to support recruitment. Study design and setting: 92 recruitment consultations with 60 new patients were recorded and analysed during a pilot RCT comparing surgical and non-surgical interventions for hip impingement. Recordings were analysed using techniques of thematic analysis and focused conversation analysis pioneered in previous studies. Analysis of recordings continued during the full-scale trial. Results: The pilot study was successful, with 70% of patients approached across 9 centres agreeing to take part in the RCT, and the full-scale trial has achieved 75% recruitment in 19 centres. A simple six-step model providing a framework for good recruitment practice was developed at the pilot phase and then validated, and tested in the main trial. The model enabled recruiters to explain the design and conduct of the RCT and provide reassuring information for patients in the context of consultations very different from routine practice. Conclusion: The six-step model provides a useful framework for recruitment to RCTs. It encourages the implementation of good RCT recruitment practice and provides strategies to support recruiters. The model requires further testing in a wide range of RCTs and clinical contexts

High Throughput Petrochronology and Sedimentary Provenance Analysis by Automated Phase Mapping and LAICPMS

The first step in most geochronological studies is to extract dateable minerals from the host rock, which is time consuming, removes textural context, and increases the chance for sample cross contamination. We here present a new method to rapidly perform in situ analyses by coupling a fast scanning electron microscope (SEM) with Energy Dispersive X-ray Spectrometer (EDS) to a Laser Ablation Inductively Coupled Plasma Mass Spectrometer (LAICPMS) instrument. Given a polished hand specimen, a petrographic thin section, or a grain mount, Automated Phase Mapping (APM) by SEM/EDS produces chemical and mineralogical maps from which the X-Y coordinates of the datable minerals are extracted. These coordinates are subsequently passed on to the laser ablation system for isotopic analysis. We apply the APM1LAICPMS method to three igneous, metamorphic, and sedimentary case studies. In the first case study, a polished slab of granite from Guernsey was scanned for zircon, producing a 60968 Ma weighted mean age. The second case study investigates a paragneiss from an ultra high pressure terrane in the north Qaidam terrane (Qinghai, China). One hundred seven small (25 mm) metamorphic zircons were analyzed by LAICPMS to confirm a 41964 Ma age of peak metamorphism. The third and final case study uses APM1LAICPMS to generate a large provenance data set and trace the provenance of 25 modern sediments from Angola, documenting longshore drift of Orange River sediments over a distance of 1,500 km. These examples demonstrate that APM1LAICPMS is an efficient and cost effective way to improve the quantity and quality of geochronological data

Protocol for a multi-centre, parallel-arm, 12-month, randomised controlled trial of arthroscopic surgery versus conservative care for femoroacetabular impingement syndrome (FASHIoN)

INTRODUCTION: Femoroacetabular impingement (FAI) syndrome is a recognised cause of young adult hip pain. There has been a large increase in the number of patients undergoing arthroscopic surgery for FAI; however, a recent Cochrane review highlighted that there are no randomised controlled trials (RCTs) evaluating treatment effectiveness. We aim to compare the clinical and cost-effectiveness of arthroscopic surgery versus best conservative care for patients with FAI syndrome. METHODS: We will conduct a multicentre, pragmatic, assessor-blinded, two parallel arm, RCT comparing arthroscopic surgery to physiotherapy-led best conservative care. 24 hospitals treating NHS patients will recruit 344 patients over a 26-month recruitment period. Symptomatic adults with radiographic signs of FAI morphology who are considered suitable for arthroscopic surgery by their surgeon will be eligible. Patients will be excluded if they have radiographic evidence of osteoarthritis, previous significant hip pathology or previous shape changing surgery. Participants will be allocated in a ratio of 1:1 to receive arthroscopic surgery or conservative care. Recruitment will be monitored and supported by qualitative intervention to optimise informed consent and recruitment. The primary outcome will be pain and function assessed by the international hip outcome tool 33 (iHOT-33) measured 1-year following randomisation. Secondary outcomes include general health (short form 12), quality of life (EQ5D-5L) and patient satisfaction. The primary analysis will compare change in pain and function (iHOT-33) at 12 months between the treatment groups, on an intention-to-treat basis, presented as the mean difference between the trial groups with 95% CIs. The study is funded by the Health Technology Assessment Programme (13/103/02). ETHICS AND DISSEMINATION: Ethical approval is granted by the Edgbaston Research Ethics committee (14/WM/0124). The results will be disseminated through open access peer-reviewed publications, including Health Technology Assessment, and presented at relevant conferences. TRIAL REGISTRATION NUMBER: ISRCTN64081839; Pre-results

The gender paradox: understanding the role of masculinity in suicidal ideation

It is important to understand the role of social determinants, such as gender, in suicidal ideation. This study examined whether conformity to specific masculine norms, particularly high self-reliance and emotional self-control, moderated the relationship between psychological distress and suicidal ideation for men. The other norms explored were those pertaining to behavioral–emotional or social hierarchy status aspects of masculinity, and whether they moderated the psychological distress–suicidal ideation relationship for men and women. The Conformity to Masculine Norms Inventory, the Kessler Psychological Distress Scale, and the Suicidal Ideation Attributes Scale were administered to an Australian community sample in an online survey ( n = 486). As predicted, higher psychological distress was associated with higher suicidal ideation. Self-reliance enhanced the relationship and was the only moderator among men. High self-reliance levels might be an important indicator of risk, which can be used when assessing and working with men who are hesitant to openly discuss suicidal ideation with clinicians. For female participants, higher endorsement of behavioral–emotional norms and lower conformity to social hierarchy status norms appear to increase suicide risk in the presence of psychological distress. Our findings suggest that high self-reliance is of particular concern for men experiencing psychological distress. It is also important to consider the roles of masculine norm endorsement in the psychological distress–suicidal ideation relationship among women

The r-Process Enriched Low Metallicity Giant HD 115444

New high resolution, very high signal-to-noise spectra of ultra-metal-poor (UMP) giant stars HD 115444 and HD 122563 have been gathered with the High-Resolution Echelle Spectrometer of the McDonald Observatory 2.7m Telescope. With these spectra, line identification and model atmosphere analyses have been conducted, emphasizing the neutron-capture elements. Twenty elements with Z > 30 have been identified in the spectrum of HD 115444. This star is known to have overabundances of the neutron-capture elements, but it has lacked a detailed analysis necessary to compare with nucleosynthesis predictions. The new study features a line-by-line differential abundance comparison of HD 115444 with the bright, well-studied halo giant HD 122563. For HD 115444, the overall metallicity is [Fe/H]~ -3.0. The abundances of the light and iron-peak elements generally show the same pattern as other UMP stars (e.g. overdeficiencies of manganese and chromium, overabundances of cobalt), but the differential analysis indicates several nucleosynthesis signatures that are unique to each star.Comment: To Appear in the Astrophysical Journa

Clinical and cost-effectiveness of a diabetes education and behavioural weight management programme versus a diabetes education programme in adults with a recent diagnosis of type 2 diabetes: study protocol for the Glucose Lowering through Weight management (GLoW) randomised controlled trial

Introduction: People with type 2 diabetes (T2D) can improve glycaemic control or even achieve remission through weight loss and reduce their use of medication and risk of cardiovascular disease. The Glucose Lowering through Weight management (GLoW) trial will evaluate whether a tailored diabetes education and behavioural weight management programme (DEW) is more effective and cost-effective than a diabetes education (DE) programme in helping people with overweight or obesity and a recent diagnosis of T2D to lower their blood glucose, lose weight and improve other markers of cardiovascular risk. Methods and analysis: This study is a pragmatic, randomised, single-blind, parallel group, two-arm, superiority trial. We will recruit 576 adults with body mass index>25 kg/m2 and diagnosis of T2D in the past 3 years and randomise them to a tailored DEW or a DE programme. Participants will attend measurement appointments at a local general practitioner practice or research centre at baseline, 6 and 12 months. The primary outcome is 12-month change in glycated haemoglobin. The effect of the intervention on the primary outcome will be estimated and tested using a linear regression model (analysis of covariance) including randomisation group and adjusted for baseline value of the outcome and the randomisation stratifiers. Participants will be included in the group to which they were randomised, under the intention-to-treat principle. Secondary outcomes include 6-month and 12-month changes in body weight, body fat percentage, systolic and diastolic blood pressure and lipid profile; probability of achieving good glycaemic control; probability of achieving remission from diabetes; probability of losing 5% and 10% body weight and modelled cardiovascular risk (UKPDS). An intention-to-treat within-trial cost-effectiveness analysis will be conducted from NHS and societal perspectives using participant-level data. Qualitative interviews will be conducted with participants to understand why and how the programme achieved its results and how participants manage their weight after the programme ends. Ethics and dissemination: Ethical approval was received from East of Scotland Research Ethics Service on 15 May 2018 (18/ES/0048). This protocol (V.3) was approved on 19 June 2019. Findings will be published in peer-reviewed scientific journals and communicated to other stakeholders as appropriate. Trial registration number: ISRCTN18399564

Arthroscopic hip surgery compared with personalised hip therapy in people over 16 years old with femoroacetabular impingement syndrome : UK FASHIoN RCT

Background: Femoroacetabular impingement syndrome is an important cause of hip pain in young adults. It can be treated by arthroscopic hip surgery or with physiotherapist-led conservative care. Objective: To compare the clinical effectiveness and cost-effectiveness of hip arthroscopy with best conservative care. Design: The UK FASHIoN (full trial of arthroscopic surgery for hip impingement compared with non-operative care) trial was a pragmatic, multicentre, randomised controlled trial that was carried out at 23 NHS hospitals. Participants: Participants were included if they had femoroacetabular impingement, were aged ≥ 16 years old, had hip pain with radiographic features of cam or pincer morphology (but no osteoarthritis) and were believed to be likely to benefit from hip arthroscopy. Intervention: Participants were randomly allocated (1 : 1) to receive hip arthroscopy followed by postoperative physiotherapy, or personalised hip therapy (i.e. an individualised physiotherapist-led programme of conservative care). Randomisation was stratified by impingement type and recruiting centre using a central telephone randomisation service. Outcome assessment and analysis were masked. Main outcome measure: The primary outcome was hip-related quality of life, measured by the patient-reported International Hip Outcome Tool (iHOT-33) 12 months after randomisation, and analysed by intention to treat. Results: Between July 2012 and July 2016, 648 eligible patients were identified and 348 participants were recruited. In total, 171 participants were allocated to receive hip arthroscopy and 177 participants were allocated to receive personalised hip therapy. Three further patients were excluded from the trial after randomisation because they did not meet the eligibility criteria. Follow-up at the primary outcome assessment was 92% (N = 319; hip arthroscopy, n = 157; personalised hip therapy, n = 162). At 12 months, mean International Hip Outcome Tool (iHOT-33) score had improved from 39.2 (standard deviation 20.9) points to 58.8 (standard deviation 27.2) points for participants in the hip arthroscopy group, and from 35.6 (standard deviation 18.2) points to 49.7 (standard deviation 25.5) points for participants in personalised hip therapy group. In the primary analysis, the mean difference in International Hip Outcome Tool scores, adjusted for impingement type, sex, baseline International Hip Outcome Tool score and centre, was 6.8 (95% confidence interval 1.7 to 12.0) points in favour of hip arthroscopy (p = 0.0093). This estimate of treatment effect exceeded the minimum clinically important difference (6.1 points). Five (83%) of six serious adverse events in the hip arthroscopy group were related to treatment and one serious adverse event in the personalised hip therapy group was not. Thirty-eight (24%) personalised hip therapy patients chose to have hip arthroscopy between 1 and 3 years after randomisation. Nineteen (12%) hip arthroscopy patients had a revision arthroscopy. Eleven (7%) personalised hip therapy patients and three (2%) hip arthroscopy patients had a hip replacement within 3 years. Limitations: Study participants and treating clinicians were not blinded to the intervention arm. Delays were encountered in participants accessing treatment, particularly surgery. Follow-up lasted for 3 years. Conclusion: Hip arthroscopy and personalised hip therapy both improved hip-related quality of life for patients with femoroacetabular impingement syndrome. Hip arthroscopy led to a greater improvement in quality of life than personalised hip therapy, and this difference was clinically significant at 12 months. This study does not demonstrate cost-effectiveness of hip arthroscopy compared with personalised hip therapy within the first 12 months. Further follow-up will reveal whether or not the clinical benefits of hip arthroscopy are maintained and whether or not it is cost-effective in the long term. Trial registration: Current Controlled Trials ISRCTN64081839. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 16. See the NIHR Journals Library website for further project information