Aircraft observations and model simulations of concentration and particle size distribution in the Eyjafjallajökull volcanic ash cloud

The Eyjafjallajökull volcano in Iceland emitted a cloud of ash into the atmosphere during April and May 2010. Over the UK the ash cloud was observed by the FAAM BAe-146 Atmospheric Research Aircraft which was equipped with in-situ probes measuring the concentration of volcanic ash carried by particles of varying sizes. The UK Met Office Numerical Atmospheric-dispersion Modelling Environment (NAME) has been used to simulate the evolution of the ash cloud emitted by the Eyjafjallajökull volcano during the period 4–18 May 2010. In the NAME simulations the processes controlling the evolution of the concentration and particle size distribution include sedimentation and deposition of particles, horizontal dispersion and vertical wind shear. For travel times between 24 and 72 h, a 1/t relationship describes the evolution of the concentration at the centre of the ash cloud and the particle size distribution remains fairly constant. Although NAME does not represent the effects of microphysical processes, it can capture the observed decrease in concentration with travel time in this period. This suggests that, for this eruption, microphysical processes play a small role in determining the evolution of the distal ash cloud. Quantitative comparison with observations shows that NAME can simulate the observed column-integrated mass if around 4% of the total emitted mass is assumed to be transported as far as the UK by small particles (< 30 μm diameter). NAME can also simulate the observed particle size distribution if a distal particle size distribution that contains a large fraction of < 10 μm diameter particles is used, consistent with the idea that phraetomagmatic volcanoes, such as Eyjafjallajökull, emit very fine particles

Shared decision making in consultations for hypertension:Qualitative study in general practice

Abstract Background Hypertension is mainly managed in primary care. Shared decision making is widely recommended as an approach to treatment decision making. However, no studies have investigated; in detail, what happens during primary care consultations for hypertension. Aim To understand patients’ and clinicians’ experience of shared decision making for hypertension in primary care, in order to propose how it might be better supported. Design Longitudinal qualitative study. Setting Five general practices in south‐west England. Method Interviews with a purposive sample of patients with hypertension, and with the health‐care practitioners they consulted, along with observations of clinical consultations, for up to 6 appointments. Interviews and consultations were audio‐recorded and observational field notes taken. Data were analysed thematically. Results Forty‐six interviews and 18 consultations were observed, with 11 patients and nine health‐care practitioners (five GPs, one pharmacist and three nurses). Little shared decision making was described by participants or observed. Often patients’ understanding of their hypertension was limited, and they were not aware there were treatment choices. Consultations provided few opportunities for patients and clinicians to reach a shared understanding of their treatment choices. Opportunities for patients to engage in choices were limited by structured consultations and the distribution of decisions across consultations. Conclusion For shared decision making to be better supported, consultations need to provide opportunities for patients to learn about their condition, to understand that there are treatment choices, and to discuss these choices with clinicians. Patient or Public Contribution A patient group contributed to the design of this study

The Impact of Locoregional Therapy in Nonmetastatic Inflammatory Breast Cancer: A Population-Based Study

Background. Inflammatory breast cancer (IBC) is a rare but most aggressive breast cancer subtype. The impact of locoregional therapy on survival in IBC is controversial. Methods. Patients with nonmetastatic IBC between 1988 and 2013 were identified in the Surveillance, Epidemiology, and End Results (SEER) registry. Results. We identified 7,304 female patients with nonmetastatic inflammatory breast cancer (IBC) who underwent primary tumor surgery. Most patients underwent total mastectomy with only 409 (5.6%) undergoing a partial mastectomy. In addition, 4,559 (62.4%) were also treated with radiation therapy. The patients who underwent mastectomy had better survival compared to partial mastectomy (49% versus 43%, p = 0.003). The addition of radiation therapy was also associated with improved 5-year survival (55% versus 40%, p < 0.001). Multivariate analysis showed that black race HR (1.22, 95% CI 1.18-1.35), ER negative status (HR 1.22, 95% CI 1.16-1.28), and higher grade (HR 1.14, 95% CI 1.07-1.20) were associated with poor outcome. Cox proportional hazards model showed that total mastectomy (HR 0.75, 95% CI 0.65-0.85) and radiation (HR 0.64, 95% CI 0.61-0.69) were associated with improved survival. Conclusions. Optimal locoregional therapy for women with nonmetastatic IBC continues to be mastectomy and radiation therapy. These data reinforce the prevailing treatment algorithm for nonmetastatic IBC

Rethinking respite in Australia: a naturalistic effect study of a multicomponent community program to promote respite knowledge, attitudes and behaviours of carers of people with dementia

\u27Rethink Respite\u27 was a prospective, naturalistic cohort study conducted in the Illawarra‐Shoalhaven (NSW, Australia) to improve knowledge, attitudes and uptake of respite strategies in carers of people with dementia. A convenience sample of n = 70 carers were recruited in 2014-15 to establish a baseline for knowledge, attitudes and use of respite for a cohort of carers in the region. Carer perceived need for respite, burden and self‐efficacy were also assessed. A co‐designed multi‐component community‐based intervention was subsequently rolled at in the region from 2015 to 2016. The intervention supported: awareness raising media; carer education sessions; access to web and print respite information resources; and an option to participate in a tailored one‐on‐one in‐home coaching program. At program completion, a follow‐up survey was administered to the cohort, with n = 44/70 responding. All n = 44 respondents reported participation in and exposure to \u27Rethink Respite\u27 media, information and education during the intervention period. Eighteen of the 44 also self‐selected to receive the active tailored coaching support. At follow‐up, few positive results were reported on the assessed carer variables for the cohort over time. However, post hoc sub‐group analyses found those who also self‐selected to receive active support (provided through coaching) (n = 18), showed improvements to their respite knowledge, attitudes and self‐efficacy (p \u3c .05). Intention to use respite, and levels of personal gain from caring in this sub‐group also increased (p \u3c .05). In contrast, carers who only participated in the informational/educational aspects of the program (and did not self‐select to the respite coaching), experienced negative changes over time to their respite beliefs and \u27role captivity\u27. Overall, this pilot study suggests that passive respite information and educational strategies are insufficient, without more active supports (tailored respite coaching) to address observed carer decline over time. Future research should seek to replicate these results using a larger sample and an experimental design

Promoting respite for carers of people with dementia: a case study of social marketing effectiveness in hard to reach audiences

Purpose This study aims to describe the development and approach of a theory-informed social marketing intervention that aimed to promote respite for carers of people with dementia. Despite a high need for respite, carers of people with dementia are often low users of available respite services. The reasons for this are complex, including knowledge, attitudinal, behavioural and systemic barriers. In the context of an aging population, effective strategies to support respite use by carers of people with dementia are needed. Design/methodology/approach Via formative research, the authors gained an in-depth understanding of a hard-to-reach and vulnerable group (carers of people with dementia). The resulting intervention informed, persuaded and supported carers to rethink the use of respite addressing specific barriers to service use. The intervention was evaluated using a naturalistic effects model. Findings Carers of people with dementia who were exposed to community-level campaign activities and also self-selected to take part in tailored coaching showed improvements to their respite knowledge, attitudes and self-efficacy. Intention to use respite and levels of personal gain from caring also increased. In contrast, carers only exposed to informational activities experienced negative changes to their respite beliefs and their sense of role captivity. Practical implications Social marketing can be used to support carer respite knowledge, attitudes and service-use behaviours in carers of people with dementia. The case study highlights an untapped role for social marketers to work in partnership with health professionals to support improvements in aged care services. Originality/value To the best of the authors’ knowledge, this is the first known social marketing intervention promoting the use of respite to carers of people with dementia. Findings demonstrate that tailored support services are most effective in helping carers navigate and use respite services

Coral reef potential connectivity in the southwest Indian Ocean

The tropical southwest Indian Ocean is a coral biodiversity hotspot, with remote reefs physically connected by larval dispersal through eddies and a complex set of equatorial and boundary currents. Based on multidecadal, 2 km resolution hydrodynamic and larval dispersal models that incorporate temporal variability in dispersal, we find that powerful zonal currents, current bifurcations, and geographic isolation act as leaky dispersal barriers, partitioning the southwest Indian Ocean into clusters of reefs that tend to consistently retain larvae, and therefore gene flow, over many generations. Whilst exceptionally remote, the Chagos Archipelago can broadcast (and receive) considerable numbers of larvae to (and from) reefs across the wider southwest Indian Ocean, most significantly exchanging larvae with the Inner Islands of Seychelles, but also the Mozambique Channel region. Considering multi-generational dispersal indicates that most coral populations in the southwest Indian Ocean are physically connected within a few hundred steps of dispersal. These results suggest that regional biogeography and population structure can be largely attributed to geologically recent patterns of larval dispersal, although some notable discrepancies indicate that palaeogeography and environmental suitability also play an important role. The model output and connectivity matrices are available in full and will provide useful physical context to regional biogeography and connectivity studies, as well as supporting marine spatial planning efforts

Embedding effective depression care: using theory for primary care organisational and systems change

Background: depression and related disorders represent a significant part of general practitioners (GPs) daily work. Implementing the evidence about what works for depression care into routine practice presents a challenge for researchers and service designers. The emerging consensus is that the transfer of efficacious interventions into routine practice is strongly linked to how well the interventions are based upon theory and take into account the contextual factors of the setting into which they are to be transferred. We set out to develop a conceptual framework to guide change and the implementation of best practice depression care in the primary care setting.Methods: we used a mixed method, observational approach to gather data about routine depression care in a range of primary care settings via: audit of electronic health records; observation of routine clinical care; and structured, facilitated whole of organisation meetings. Audit data were summarised using simple descriptive statistics. Observational data were collected using field notes. Organisational meetings were audio taped and transcribed. All the data sets were grouped, by organisation, and considered as a whole case. Normalisation Process Theory (NPT) was identified as an analytical theory to guide the conceptual framework development.Results: five privately owned primary care organisations (general practices) and one community health centre took part over the course of 18 months. We successfully developed a conceptual framework for implementing an effective model of depression care based on the four constructs of NPT: coherence, which proposes that depression work requires the conceptualisation of boundaries of who is depressed and who is not depressed and techniques for dealing with diffuseness; cognitive participation, which proposes that depression work requires engagement with a shared set of techniques that deal with depression as a health problem; collective action, which proposes that agreement is reached about how care is organised; and reflexive monitoring, which proposes that depression work requires agreement about how depression work will be monitored at the patient and practice level. We describe how these constructs can be used to guide the design and implementation of effective depression care in a way that can take account of contextual differences.Conclusions: ideas about what is required for an effective model and system of depression care in primary care need to be accompanied by theoretically informed frameworks that consider how these can be implemented. The conceptual framework we have presented can be used to guide organisational and system change to develop common language around each construct between policy makers, service users, professionals, and researchers. This shared understanding across groups is fundamental to the effective implementation of change in primary care for depressio

Sources of marine debris for Seychelles and other remote islands in the western Indian Ocean

Vast quantities of debris are beaching at remote islands in the western Indian Ocean. We carry out marine dispersal simulations incorporating currents, waves, winds, beaching, and sinking, for both terrestrial and marine sources of debris, to predict where this debris comes from. Our results show that most terrestrial debris beaching at these remote western Indian Ocean islands drifts from Indonesia, India, and Sri Lanka. Debris associated with fisheries and shipping also poses a major risk. Debris accumulation at Seychelles is likely seasonal, peaking during February–April. This pattern is driven by monsoonal winds and may be amplified during positive Indian Ocean Dipole and El-Niño events. Our results underline the vulnerability of small island states to marine plastic pollution, and are a crucial step towards improved management of the issue. The trajectories used in this study are available for download, and our analyses can be rerun under different parameter choices.journal articl

Effect of HPV vaccination and cervical cancer screening in England by ethnicity: a modelling study.

BACKGROUND: Health equality is increasingly being considered alongside overall health gain when assessing public health interventions. However, the trade-off between the direct effects of vaccination and herd immunity could lead to unintuitive consequences for the distribution of disease burden within a population. We used a transmission dynamic model of human papillomavirus (HPV) to investigate the effect of ethnic disparities in vaccine and cervical screening uptake on inequality in disease incidence in England. METHODS: We developed an individual-based model of HPV transmission and disease, parameterising it with the latest data for sexual behaviour (from National Survey of Sexual Attitudes and Lifestyles [Natsal-3]) and vaccine and screening uptake by ethnicity (from Public Health England [PHE]) and fitting it to data for HPV prevalence (from ARTISTIC, PHE, Natsal-3) and HPV-related disease incidence (from National Cancer Registry [ONS]). The outcome of interest was the age-adjusted incidence of HPV-related cancer (both cervical and non-cervical) in all women in England in view of differences and changes in vaccination and screening uptake by ethnicity in England, over time. We also studied three potential public health interventions aimed at reducing inequality in HPV-related disease incidence: increasing uptake in black and Asian females to match that in whites for vaccination; cervical screening in women who turn 25 in 2018 or later; and cervical screening in all ages. FINDINGS: In the pre-vaccination era, before 2008, women from ethnic minorities in England reported a disproportionate share of cervical disease. Our model suggests that Asian women were 1·7 times (95% credibility interval [CI] 1·1-2·7) more likely to be diagnosed with cervical cancer than white women (22·8 vs 13·4 cases per 100 000 women). Because HPV vaccination uptake is lower in ethnic minorities, we predict an initial widening of this gap, with cervical cancer incidence in Asian women up to 2·5 times higher (95% CI 1·3-4·8) than in white women 20 years after vaccine introduction (corresponding to an additional 10·8 [95% CI 10·1-11·5] cases every year). In time, we predict that herd immunity benefits will diffuse from the larger white sub-population and the disparity will narrow. Increased cervical screening uptake in vaccinated women from ethnic minorities would lead to rapid improvement in equality with parity in incidence after 20 years of HPV vaccination. INTERPRETATION: Our study suggests that the introduction of HPV vaccination in England will initially widen a pre-existing disparity in the incidence of HPV-related cancer by ethnicity, partly due to herd immunity disproportionately benefiting subgroups with high vaccination rates. Although in time this induced disparity will narrow, increasing cervical screening uptake in girls from ethnic minorities should be encouraged to eliminate the inequality in cervical cancer incidence in the medium term. We recommend that dynamic effects should be considered when estimating the effect of public health programmes on equality. FUNDING: Cancer Research UK