WireWall – a new approach to measuring coastal wave hazard

In the UK £150bn of assets and 4 million people are at risk from coastal flooding, whilst the construction of sea wall defence schemes typically cost at least £10,000 per linear meter. With reductions in public funding, rising sea level, changing storm conditions and 3200 km of coastal defences (i.e. about £3bn), cost savings are required that do not cause a reduction in flood resistance. The design of new coastal flood defences and the setting of tolerable hazard thresholds requires site-specific information of wave overtopping during storms of varying severity. By converting an existing wave measurement technology into a prototype overtopping monitoring system "WireWall", field observations of the wave-by-wave horizontal overtopping speeds and volumes were made at our case study site Crosby, in the North West of England. The new data quantify the wave overtopping conditions observed, which varied with the wind, waves and tide, allowing better understanding of how wave hazard at Crosby changes with the local conditions

Healthy Cities Phase V evaluation: further synthesizing realism

In this article we reflect on the quality of a realist synthesis paradigm applied to the evaluation of Phase V of the WHO European Healthy Cities Network. The programmatic application of this approach has led to very high response rates and a wealth of important data. All articles in this Supplement report that cities in the network move from small-scale, time-limited projects predominantly focused on health lifestyles to the significant inclusion of policies and programmes on systems and values for good health governance. The evaluation team felt that, due to time and resource limitations, it was unable to fully exploit the potential of realist synthesis. In particular, the synthetic integration of different strategic foci of Phase V designation areas did not come to full fruition. We recommend better and more sustained integration of realist synthesis in the practice of Healthy Cities in future Phase

Integrating maternal, newborn, child health and non-communicable disease care in the sustainable development goal era

Noncommunicable diseases (NCDs) and maternal newborn and child health (MNCH) are two deeply intertwined health areas that have been artificially separated by global health policies, resource allocations and programming. Optimal MNCH care can provide a unique opportunity to screen for, prevent and manage early signs of NCDs developing in both the woman and the neonate. This paper considers how NCDs, NCD modifiable risk factors, and NCD metabolic risk factors impact MNCH. We argue that integrated management is essential, but this faces challenges that manifest across all levels of domestic health systems. Progress toward Sustainable Development targets requires joined-up action

International genome-wide meta-analysis identifies new primary biliary cirrhosis risk loci and targetable pathogenic pathways.

Primary biliary cirrhosis (PBC) is a classical autoimmune liver disease for which effective immunomodulatory therapy is lacking. Here we perform meta-analyses of discovery data sets from genome-wide association studies of European subjects (n=2,764 cases and 10,475 controls) followed by validation genotyping in an independent cohort (n=3,716 cases and 4,261 controls). We discover and validate six previously unknown risk loci for PBC (Pcombined<5 × 10(-8)) and used pathway analysis to identify JAK-STAT/IL12/IL27 signalling and cytokine-cytokine pathways, for which relevant therapies exist

A Shared Longing: Rewriting Nâzım Hikmet in Turkish and Turkish-German Literature, 1963-2017

This dissertation is a comparative study of Turkish and Turkish-German literature that traces the afterlife of Turkey’s foremost modernist poet, Nâzım Hikmet Ran (1902-1963). After Hikmet was convicted of sedition in 1938 for writing communist poetry, his works were banned until 1965 and remained only semi-legal in Turkey until the end of the Cold War. Meanwhile, allusions to his poetry proliferated both in his native Turkey and in Turkish communities in West Germany. Today, Hikmet’s words continue to haunt the very spaces from which he was excluded during his lifetime. His poetry is continually rewritten in poems and novels, and frequently quoted in diverse political movements ranging from pro-multiculturalism campaigns of West Germany in the 1980s to the Gezi Park protests of 2013. Neither purely literary nor simply political, these persistent citations of Hikmet’s poetry push the boundaries of contemporary understandings of intertextuality, commemoration, and the imagination of communities in and through shared texts. A Shared Longing examines texts that make reference to Hikmet’s poetry and biographical persona from his death in 1963 to the present day. The title makes reference to hasret (longing), an affect that takes on both romantic and political registers in Hikmet’s poetry, and which governs posthumous constructions of the author as an absent presence in Turkish public life. Departing from studies of authorial legacy focused on the limiting principle of “influence,” I examine texts that reference Hikmet’s work through a diverse array of intertextual modes. Conversely, I also use Hikmet’s afterlife to raise questions about the persistence of authorial biographies after poststructuralism, arguing that “Nâzım Hikmet” becomes a shared intertext of what I call “interpretive communities of allusion.” Five chapters situate the literary works of Oğuz Atay, Emine Sevgi Özdamar, Saliha Scheinhardt, Berkan Karpat, Zafer Şenocak, and Nedim Gürsel in a broader constellation of literary and non-literary texts that make reference to Hikmet’s poetry. Examining posthumous constructions of Hikmet as both the narrator of a “speaker for death” and as an absent beloved, I propose a reexamination of the way counter- and transnational communities are imagined through shared intertexts

Capacity building of health care professionals to perform interprofessional management of non-communicable diseases in primary care – experiences from Ukraine

Background: Non-communicable diseases are leading causes of death and disability across the world. Countries with the highest non-communicable disease (NCD) burden in the WHO European Region are often those that have some of the greatest health system challenges for achieving good outcomes in prevention and care. The aim of this study was to evaluate the effect of an interprofessional capacity building intervention carried out in Ukraine to improve the management non-communicable diseases in primary health care. Methods: A mixed-methods evaluation study was performed in 2018 to analyse the effect of a capacity building intervention carried out for over 10,000 primary care professionals in Ukraine in 2018. Quantitative data were collected from primary health care records of intervention and control areas preceding the intervention and 1.5 to 2 years after the intervention. Altogether 2798 patient records before and 2795 after the intervention were reviewed. In control areas, 1202 patient records were reviewed. Qualitative data were collected carrying out focus group interviews for health professionals, clinic managers and patients. Also, observations of clinical practice and patient pathways were performed. Results: The capacity building intervention improved the capacity of professionals in detection and management of non-communicable disease risk factors. Significant improvement was seen in detection rates of both behavioural and biological risk factors and in medication prescription rates in the intervention areas. However, almost similar improvement in prescription rates was also observed in control clinics. Improvements in control of blood pressure, blood glucose and cholesterol were not seen during the evaluated implementation period. Qualitative analyses highlighted the improved knowledge and skills but challenges in changing the current practice. Conclusions: A large scale capacity building intervention improved primary health care professionals’ knowledge, skills and clinical practice on NCD risk detection and reduction. We were not able to detect improvements in treatment outcomes - at least within 1.5 to 2 years follow-up. Improvement of treatment outcomes would most likely need more comprehensive systems change.Other UBCNon UBCReviewedFacult