A systematic review of human behaviour in and around floodwater

Flooding can have a major impact on people's safety and livelihood. Understanding people's flood-related behaviours may assist in the development of more effective strategies aimed at lessening the impact of floods including mortality and morbidity. This systematic review examined peer-reviewed literature published from January-1989 to April-2019 on human behaviour in and around floodwater to identify behaviour patterns as well as protective and risk factors. We extracted three main themes from a thematic analysis of included studies (N = 54): activities and risk-taking behaviours (n = 24); loss reduction, knowledge, and warnings (n = 37); and diet and hygiene (n = 4). This review had limitations which prevented definitive conclusions being made. What does seem apparent is the limited knowledge of the social psychological mechanisms that guide behavioural responses in a flood event. Further exploration of methods to improve preparedness, increase the likelihood of evacuation, and reduce ‘risky’ behaviour during floods is needed. Future studies should prioritise addressing these gaps to enhance the evidence-base for reducing the impact of floods including flood-related mortality and morbidity

Changing driver behavior during floods: Testing a novel e-health intervention using implementation imagery

We tested the efficacy of a novel implementation imagery intervention (N = 460) in promoting safer intentions regarding driving into floodwater post-intervention, and at a four-week follow-up using a pre-registered randomized controlled design. Results showed that the intervention reduced intentions and subjective norms regarding driving into floodwater. The control condition also improved on intentions and subjective norms, but the changes appeared to only be maintained at the follow-up for the intervention group and the between group difference at the follow-up was not significant based on our pre-specified cutoff level for statistical significance of 0.01. Results also indicated that changes in intentions may be stronger for males than females. Further exploratory analyses indicated that the intervention showed greater effects on post-intervention intentions, subjective norms, perceived behavioral control, perceived severity, anticipated regret, barrier self-efficacy, and action planning in individuals who indicated a modest level of intention to drive into floodwater prior to the intervention

Towards precision medicine for hypertension: a review of genomic, epigenomic, and microbiomic effects on blood pressure in experimental rat models and humans

Compelling evidence for the inherited nature of essential hypertension has led to extensive research in rats and humans. Rats have served as the primary model for research on the genetics of hypertension resulting in identification of genomic regions that are causally associated with hypertension. In more recent times, genome-wide studies in humans have also begun to improve our understanding of the inheritance of polygenic forms of hypertension. Based on the chronological progression of research into the genetics of hypertension as the "structural backbone," this review catalogs and discusses the rat and human genetic elements mapped and implicated in blood pressure regulation. Furthermore, the knowledge gained from these genetic studies that provide evidence to suggest that much of the genetic influence on hypertension residing within noncoding elements of our DNA and operating through pervasive epistasis or gene-gene interactions is highlighted. Lastly, perspectives on current thinking that the more complex "triad" of the genome, epigenome, and the microbiome operating to influence the inheritance of hypertension, is documented. Overall, the collective knowledge gained from rats and humans is disappointing in the sense that major hypertension-causing genes as targets for clinical management of essential hypertension may not be a clinical reality. On the other hand, the realization that the polygenic nature of hypertension prevents any single locus from being a relevant clinical target for all humans directs future studies on the genetics of hypertension towards an individualized genomic approach

An evaluation of a video-based intervention targeting alcohol consumption during aquatic activities

Objective: Alcohol consumption and being male are drowning risk factors. Changing beliefs and intentions to undertake risky aquatic-related behaviours, such as consuming alcohol, is key to reducing loss of life and injury. We evaluated the impact of a video encouraging change in young males’ social cognitions and intentions to discourage their mates as well as their own alcohol consumption around the water. Method: A three-wave non-controlled pre-test-post-test design was adopted. A convenience sample of Australian males aged 18–34 years (N = 97) who self-reported drinking alcohol and engaging in aquatic activities was recruited. Participants were surveyed at baseline (T1) regarding social cognition constructs and intentions, immediately after viewing the video (T2) and at a one-month follow-up (T3). Results: Repeated measures ANOVAs revealed significant main effects of time on intentions, subjective norms, and attitudes regarding discouraging mates from drinking and swimming, but no significant main effects of time on perceived behavioural control or risk perceptions. The same patterns of effects were observed regarding drinking and swimming on males’ own behaviour. Conclusions: The video has the potential to influence young males’ social cognitions regarding their mates’ and their own risky drinking behaviour around water in the short term, although sustained interventions are required. Messaging delivered on-site at popular aquatic locations in the lead-up to traditionally risky periods for alcohol-related drowning should be considered. Provision of strategies to combat social pressures among young males to act on their intentions to engage in drinking and swimming are needed. KEY POINTS What is already known about this topic: (1) Drowning is a significant cause of injury-related mortality and morbidity. (2) Alcohol is a risk factor for drowning, with young males commonly represented in alcohol-related drowning statistics. (3) Achieving lasting improvement in behaviour among males is challenging, despite the use of water safety interventions based on theory. What this topic adds: (1) This study presents the first evaluation of a video that aimed to encourage change in young males’ social cognitions and intentions to discourage their mates alcohol consumption around water. (2) Results indicate significant main effects of time on intentions, subjective norms, and attitudes regarding discouraging mates from drinking and swimming, as well as drinking and swimming themselves. (3) The video has potential to influence young male’s social cognition for their mates’ and their own behaviour in the short term, although sustained interventions are required

A Comparison of Accuracy of Image- versus Hardware-based Tracking Technologies in 3D Fusion in Aortic Endografting

OBJECTIVES: Fusion of three-dimensional (3D) computed tomography and intraoperative two-dimensional imaging in endovascular surgery relies on manual rigid co-registration of bony landmarks and tracking of hardware to provide a 3D overlay (hardware-based tracking, HWT). An alternative technique (image-based tracking, IMT) uses image recognition to register and place the fusion mask. We present preliminary experience with an agnostic fusion technology that uses IMT, with the aim of comparing the accuracy of overlay for this technology with HWT. METHOD: Data were collected prospectively for 12 patients. All devices were deployed using both IMT and HWT fusion assistance concurrently. Postoperative analysis of both systems was performed by three blinded expert observers, from selected time-points during the procedures, using the displacement of fusion rings, the overlay of vascular markings and the true ostia of renal arteries. The Mean overlay error and the deviation from mean error was derived using image analysis software. Comparison of the mean overlay error was made between IMT and HWT. The validity of the point-picking technique was assessed. RESULTS: IMT was successful in all of the first 12 cases, whereas technical learning curve challenges thwarted HWT in four cases. When independent operators assessed the degree of accuracy of the overlay, the median error for IMT was 3.9 mm (IQR 2.89-6.24, max 9.5) versus 8.64 mm (IQR 6.1-16.8, max 24.5) for HWT (p = .001). Variance per observer was 0.69 mm(2) and 95% limit of agreement ±1.63. CONCLUSION: In this preliminary study, the error of magnitude of displacement from the "true anatomy" during image overlay in IMT was less than for HWT. This confirms that ongoing manual re-registration, as recommended by the manufacturer, should be performed for HWT systems to maintain accuracy. The error in position of the fusion markers for IMT was consistent, thus may be considered predictable

Structure determination, thermal stability and dissolution rate of 6-indomethacin

The structure solution of the δ-polymorph of indomethacin was obtained using three-dimensional electron diffraction. This form shows a significantly enhanced dissolution rate compared with the more common and better studied α- and γ-polymorphs, indicating better biopharmaceutical properties for medicinal applications. The structure was solved in non-centrosymmetric space group P21 and comprises two molecules in the asymmetric unit. Packing and molecule conformation closely resemble indomethacin methyl ester and indomethacin methanol solvate. Knowledge of the structure allowed the rational interpretation of spectroscopic IR and Raman data for δ-polymorph and a tentative interpretation for still unsolved indomethacin polymorphs. Finally, we observed a solid–solid transition from δ-polymorph to α-polymorph that can be driven by similarities in molecular conformation

Ovarian cancer symptom awareness and anticipated delayed presentation in a population sample

Background: While ovarian cancer is recognised as having identifiable early symptoms, understanding of the key determinants of symptom awareness and early presentation is limited. A population-based survey of ovarian cancer awareness and anticipated delayed presentation with symptoms was conducted as part of the International Cancer Benchmarking Partnership (ICBP). Methods: Women aged over 50 years were recruited using random probability sampling (n = 1043). Computer-assisted telephone interviews were used to administer measures including ovarian cancer symptom recognition, anticipated time to presentation with ovarian symptoms, health beliefs (perceived risk, perceived benefits/barriers to early presentation, confidence in symptom detection, ovarian cancer worry), and demographic variables. Logistic regression analysis was used to identify the contribution of independent variables to anticipated presentation (categorised as < 3 weeks or ≥ 3 weeks). Results: The most well-recognised symptoms of ovarian cancer were post-menopausal bleeding (87.4%), and persistent pelvic (79.0%) and abdominal (85.0%) pain. Symptoms associated with eating difficulties and changes in bladder/bowel habits were recognised by less than half the sample. Lower symptom awareness was significantly associated with older age (p ≤ 0.001), being single (p ≤ 0.001), lower education (p ≤ 0.01), and lack of personal experience of ovarian cancer (p ≤ 0.01). The odds of anticipating a delay in time to presentation of ≥ 3 weeks were significantly increased in women educated to degree level (OR = 2.64, 95% CI 1.61 – 4.33, p ≤ 0.001), women who reported more practical barriers (OR = 1.60, 95% CI 1.34 – 1.91, p ≤ 0.001) and more emotional barriers (OR = 1.21, 95% CI 1.06 – 1.40, p ≤ 0.01), and those less confident in symptom detection (OR = 0.56, 95% CI 0.42 – 0.73, p ≤ 0.001), but not in those who reported lower symptom awareness (OR = 0.99, 95% CI 0.91 – 1.07, p = 0.74). Conclusions: Many symptoms of ovarian cancer are not well-recognised by women in the general population. Evidence-based interventions are needed not only to improve public awareness but also to overcome the barriers to recognising and acting on ovarian symptoms, if delays in presentation are to be minimised

Investigation into Adaptation in Genes Associated with Response to Estrogenic Pollution in Populations of Roach (Rutilus rutilus) Living in English Rivers

UK Natural Environmental Research Council (NERC; NE/K004263/1); NERC Biomolecular Analysis Facility for funding (NBAF866); Medical Research Council Clinical Infrastructure award (MR/M008924/1); Wellcome Trust Institutional Strategic Support Fund (WT097835MF); Wellcome Trust Multi User Equipment Award (WT101650MA); BBSRC LOLA award (BB/ K003240/1)

Risk factors for delay in symptomatic presentation: a survey of cancer patients

Background: Delay in symptomatic presentation leading to advanced stage at diagnosis may contribute to poor cancer survival. To inform public health approaches to promoting early symptomatic presentation, we aimed to identify risk factors for delay in presentation across several cancers. Methods: We surveyed 2371 patients with 15 cancers about nature and duration of symptoms using a postal questionnaire. We calculated relative risks for delay in presentation (time from symptom onset to first presentation >3 months) by cancer, symptoms leading to diagnosis and reasons for putting off going to the doctor, controlling for age, sex and deprivation group. Results: Among 1999 cancer patients reporting symptoms, 21% delayed presentation for >3 months. Delay was associated with greater socioeconomic deprivation but not age or sex. Patients with prostate (44%) and rectal cancer (37%) were most likely to delay and patients with breast cancer least likely to delay (8%). Urinary difficulties, change of bowel habit, systemic symptoms (fatigue, weight loss and loss of appetite) and skin symptoms were all common and associated with delay. Overall, patients with bleeding symptoms were no more likely to delay presentation than patients who did not have bleeding symptoms. However, within the group of patients with bleeding symptoms, there were significant differences in risk of delay by source of bleeding: 35% of patients with rectal bleeding delayed presentation, but only 9% of patients with urinary bleeding. A lump was a common symptom but not associated with delay in presentation. Twenty-eight percent had not recognised their symptoms as serious and this was associated with a doubling in risk of delay. Embarrassment, worry about what the doctor might find, being too busy to go to the doctor and worry about wasting the doctor’s time were also strong risk factors for delay, but were much less commonly reported (<6%). Interpretation: Approaches to promote early presentation should aim to increase awareness of the significance of cancer symptoms and should be designed to work for people of the lowest socioeconomic status. In particular, awareness that rectal bleeding is a possible symptom of cancer should be raised