Local travel plan groups : a practical guide to setting up an effective group

Shortly after becoming Mayor of London in July 2000, Ken Livingstone noted that “the single biggest problem for London and Londoners is the gridlock of our transport system” and that “remedying this will be my first priority”. Although predominantly concerned with the inadequacy of public transport in the capital, the Mayor added that “traffic speeds in central London are now just 10 miles per hour, while congestion costs London business £5 billion per year. Residents and commuters alike suffer from delays, stress, discomfort and the overall poor urban environment.”i To help address these problems,Transport for London (TfL) is encouraging businesses and other organisations to develop workplace travel plans. Developing and implementing a workplace travel plan requires resources and expertise, so it can be easier for businesses located in the same area to get together and form a local travel plan group. This good practice guide sets out the process of establishing a local travel plan group, based on research conducted for the Optimum2 project in the London Borough of Southwark, in which the Better Bankside Travel Plan Group was established (see Acknowledgments for further information)

The Dynamics of Dense Cores in the Perseus Molecular Cloud II: The Relationship Between Dense Cores and the Cloud

We utilize the extensive datasets available for the Perseus molecular cloud to analyze the relationship between the kinematics of small-scale dense cores and the larger structures in which they are embedded. The kinematic measures presented here can be used in conjunction with those discussed in our previous work as strong observational constraints that numerical simulations (or analytic models) of star formation should match. We find that dense cores have small motions with respect to the 13CO gas, about one third of the 13CO velocity dispersion along the same line of sight. Within each extinction region, the core-to-core velocity dispersion is about half of the total (13CO) velocity dispersion seen in the region. Large-scale velocity gradients account for roughly half of the total velocity dispersion in each region, similar to what is predicted from large-scale turbulent modes following a power spectrum of P(k) ~ k^{-4}.Comment: Accepted for publication in ApJ. 47 pages (preprint format), 20 figures, 5 table

Dense Gas Tracers in Perseus: Relating the N2H+, NH3, and Dust Continuum Properties of Pre- and Proto-Stellar Cores

We investigate 35 pre-stellar cores and 36 proto-stellar cores in the Perseus molecular cloud. We find a very tight correlation between the physical parameters describing the N2H+ and NH3 gas. Both the velocity centroids and the line widths of N2H+ and NH3 correlate much better than either species correlates with CO, as expected if the nitrogen-bearing species are probing primarily the dense core gas where the CO has been depleted. We also find a tight correlation in the inferred abundance ratio between N2H+ and para-NH3 across all cores, with N(p-NH3)/N(N2H+)= 22 +/- 10. We find a mild correlation between NH3 (and N2H+) column density and the (sub)millimeter dust continuum derived H2 column density for pre-stellar cores, N(p-NH3)/N(H2) ~ 10e-8, but do not find a fixed ratio for proto-stellar cores. The observations suggest that in the Perseus molecular cloud the formation and destruction mechanisms for the two nitrogen-bearing species are similar, regardless of the physical conditions in the dense core gas. While the equivalence of N2H+ and NH3 as powerful tracers of dense gas is validated, the lack of correspondence between these species and the (sub)millimeter dust continuum observations for proto-stellar cores is disconcerting and presently unexplained.Comment: ApJ accepted. 45 pages, 8 figure

HIV retesting in pregnant women in South Africa: Outcomes of a quality improvement project targeting health systems’ weaknesses

Introduction: South Africa is moving towards achieving elimination of mother-to-child transmission (eMTCT) but gaps remain in eMTCT programmes. Documenting successful outcomes of health systems interventions to address these gaps could encourage similar initiatives in the future.Methods: We describe the effectiveness of a Quality Improvement Project (QIP) to improve HIV retesting rates during pregnancy among women who had previously tested negative by redesigning the clinic process. Eight poorly-performing clinics were selected and compared with eight better-performing control clinics in a subdistrict in North West Province. Over nine months, root cause analysis and testing of change ideas using Plan-Do-Study-Act cycles were used to identify and refine interventions. Analysis of patient flow showed that women were referred for retesting following their nurse-driven antenatal visits, and many left without retesting as this would have further prolonged their visit. Processes were redesigned and standardised, where a counsellor was charged with retesting patients before antenatal consults. Staff were mentored on data collection and interpretation process. Quality improvement nurse advisors monitored indicators bi-weekly and adjusted interventions accordingly.Results: Retesting in intervention clinics rose from 36% in the three months pre-intervention to full coverage at month nine. At the end of the study, retesting in intervention clinics was 20% higher than in controls. Retesting also increased in the subdistrict overall.Conclusion: Service coverage and overall impact of HIV programmes can be raised through care-process analysis that optimises patient flow, supported by targeted QI interventions. These QI methodologies may be effective elsewhere for identifying new HIV infections in pregnant/breastfeeding women, and possibly in other services

Mass distributions of stars and cores in young groups and clusters

We investigate the relation of the stellar initial mass function (IMF) and the dense core mass function (CMF), using stellar masses and positions in 14 well-studied young groups. Initial column density maps are computed by replacing each star with a model initial core having the same star formation efficiency (SFE). For each group the SFE, core model, and observational resolution are varied to produce a realistic range of initial maps. A clumpfinding algorithm parses each initial map into derived cores, derived core masses, and a derived CMF. The main result is that projected blending of initial cores causes derived cores to be too few and too massive. The number of derived cores is fewer than the number of initial cores by a mean factor 1.4 in sparse groups and 5 in crowded groups. The mass at the peak of the derived CMF exceeds the mass at the peak of the initial CMF by a mean factor 1.0 in sparse groups and 12.1 in crowded groups. These results imply that in crowded young groups and clusters, the mass distribution of observed cores may not reliably predict the mass distribution of protostars which will form in those cores.Comment: 48 pages, 17 figures, accepted for publication in Astrophysical Journa

Prehabilitation in elective patients undergoing cardiac surgery: a randomised control trial (THE PrEPS TRIAL) – a study protocol

Introduction: Prehabilitation prior to surgery has been shown to reduce postoperative complications, reduce length of hospital stay and improve quality of life after cancer and limb reconstruction surgery. However, there are minimal data on the impact of prehabilitation in patients undergoing cardiac surgery, despite the fact these patients are generally older and have more comorbidities and frailty. This trial will assess the feasibility and impact of a prehabilitation intervention consisting of exercise and inspiratory muscle training on preoperative functional exercise capacity in adult patients awaiting elective cardiac surgery, and determine any impact on clinical outcomes after surgery. Methods and analysis: PrEPS is a randomised controlled single-centre trial recruiting 180 participants undergoing elective cardiac surgery. Participants will be randomised in a 1:1 ratio to standard presurgical care or standard care plus a prehabilitation intervention. The primary outcome will be change in functional exercise capacity measured as change in the 6 min walk test distance from baseline. Secondary outcomes will evaluate the impact of prehabilitation on preoperative and postoperative outcomes including; respiratory function, health-related quality of life, anxiety and depression, frailty, and postoperative complications and resource use. This trial will evaluate if a prehabilitation intervention can improve preoperative physical function, inspiratory muscle function, frailty and quality of life prior to surgery in elective patients awaiting cardiac surgery, and impact postoperative outcomes. Ethics and dissemination: A favourable opinion was given by the Sheffield Research Ethics Committee in 2019. Trial findings will be disseminated to patients, clinicians, commissioning groups and through peer-reviewed publication

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

A Three Species Model to Simulate Application of Hyperbaric Oxygen Therapy to Chronic Wounds

Chronic wounds are a significant socioeconomic problem for governments worldwide. Approximately 15% of people who suffer from diabetes will experience a lower-limb ulcer at some stage of their lives, and 24% of these wounds will ultimately result in amputation of the lower limb. Hyperbaric Oxygen Therapy (HBOT) has been shown to aid the healing of chronic wounds; however, the causal reasons for the improved healing remain unclear and hence current HBOT protocols remain empirical. Here we develop a three-species mathematical model of wound healing that is used to simulate the application of hyperbaric oxygen therapy in the treatment of wounds. Based on our modelling, we predict that intermittent HBOT will assist chronic wound healing while normobaric oxygen is ineffective in treating such wounds. Furthermore, treatment should continue until healing is complete, and HBOT will not stimulate healing under all circumstances, leading us to conclude that finding the right protocol for an individual patient is crucial if HBOT is to be effective. We provide constraints that depend on the model parameters for the range of HBOT protocols that will stimulate healing. More specifically, we predict that patients with a poor arterial supply of oxygen, high consumption of oxygen by the wound tissue, chronically hypoxic wounds, and/or a dysfunctional endothelial cell response to oxygen are at risk of nonresponsiveness to HBOT. The work of this paper can, in some way, highlight which patients are most likely to respond well to HBOT (for example, those with a good arterial supply), and thus has the potential to assist in improving both the success rate and hence the cost-effectiveness of this therapy

Combined point of care nucleic acid and antibody testing for SARS-CoV-2 following emergence of D614G Spike Variant

Rapid COVID-19 diagnosis in hospital is essential, though complicated by 30-50% of nose/throat swabs being negative by SARS-CoV-2 nucleic acid amplification testing (NAAT). Furthermore, the D614G spike mutant now dominates the pandemic and it is unclear how serological tests designed to detect anti-Spike antibodies perform against this variant. We assess the diagnostic accuracy of combined rapid antibody point of care (POC) and nucleic acid assays for suspected COVID-19 disease due to either wild type or the D614G spike mutant SARS-CoV-2. The overall detection rate for COVID-19 is 79.2% (95CI 57.8-92.9%) by rapid NAAT alone. Combined point of care antibody test and rapid NAAT is not impacted by D614G and results in very high sensitivity for COVID-19 diagnosis with very high specificity