Integrated health and care systems in England : can they help prevent disease?

Objectives: Over the past 12 months, there has been increasing policy rhetoric regarding the role of the NHS in preventing disease and improving population health. In particular, the NHS Long Term Plan sees integrated care systems (ICSs) and sustainability and transformation partnerships (STPs) as routes to improving disease prevention. Here, we place current NHS England integrated care plans in their historical context and review evidence on the relationship between integrated care and prevention. We ask how the NHS Long Term Plan may help prevent disease and explore the role of the 2019 ICS and STP plans in delivering this change. Methods: We reviewed the evidence underlying the relationship between integrated care and disease prevention, and analysed 2016 STP plans for content relating to disease prevention and population health. Results: The evidence of more integrated care leading to better disease prevention is weak. Although nearly all 2016 STP plans included a prevention or population health strategy, fewer than half specified how they will work with local government public health teams, and there was incomplete coverage across plans about how they would meet NHS England prevention priorities. Plans broadly focused on individual-level approaches to disease prevention, with few describing interventions addressing social determinants of health. Conclusions: For ICSs and STPs to meaningfully prevent disease and improve population health, they need to look beyond their 2016 plans and fill the gaps in the Long Term Plan on social determinants

Potential for energy savings by heat recovery in an integrated steel supply chain

Heat recovery plays an important role in energy saving in the supply chain of steel products. Almost all high temperature outputs in the steel industry have their thermal energy exchanged to preheat inputs to the process. Despite the widespread development of heat recovery technologies within process stages (process heat recovery), larger savings may be obtained by using a wider integrated network of heat exchange across various processes along the supply chain (integrated heat recovery). Previous pinch analyses have been applied to optimise integrated heat recovery systems in steel plants, although a comparison between standard process heat recovery and integrated heat recovery has not yet been explored. In this paper, the potential for additional energy savings achieved by using integrated heat recovery is estimated for a typical integrated steel plant, using pinch analysis. Overall, process heat recovery saves approximately 1.8 GJ per tonne of hot rolled steel (GJ/t hrs), integrated heat recovery with conventional heat exchange could save 2.5 GJ/t hrs, and an alternative heat exchange that also recovers energy from hot steel could save 3.0 GJ/t hrs. In developing these networks, general heat recovery strategies are identified that may be applied more widely to all primary steel production to enhance heat recovery. Limited additional savings may be obtained from the integration of the steel supply chain with other industries.Dr. McBrien’s work on this paper was funded by EPSRC grant EP/G007217/1, and Dr. Serrenho and Professor Allwood were funded by EPSRC grant EP/N02351X/1.This is the final version of the article. It first appeared from Elsevier via http://dx.doi.org/10.1016/j.applthermaleng.2016.04.09

Viability and performance of demountable composite connectors

AbstractMaterial production, and associated carbon emissions, could be reduced by reusing products instead of landfilling or recycling them. Steel beams are well suited to reuse, but are difficult to reuse when connected compositely to concrete slabs using welded studs. A demountable connection would allow composite performance but also permit reuse of both components at end-of-life. Three composite beams, of 2m, 10m and 5m length, are constructed using M20 bolts as demountable shear connectors. The beams are tested in three-, six- and four-point bending, respectively. The former two are loaded to service, unloaded, demounted and reassembled; all three are tested to failure. The results show that all three have higher strengths than predicted using Eurocode 4. The longer specimens have performance similar to previously published comparable welded-connector composite beam results. This suggests that demountable composite beams can be safely used and practically reused, thus reducing carbon emissions

Designing climate change mitigation plans that add up.

Mitigation plans to combat climate change depend on the combined implementation of many abatement options, but the options interact. Published anthropogenic emissions inventories are disaggregated by gas, sector, country, or final energy form. This allows the assessment of novel energy supply options, but is insufficient for understanding how options for efficiency and demand reduction interact. A consistent framework for understanding the drivers of emissions is therefore developed, with a set of seven complete inventories reflecting all technical options for mitigation connected through lossless allocation matrices. The required data set is compiled and calculated from a wide range of industry, government, and academic reports. The framework is used to create a global Sankey diagram to relate human demand for services to anthropogenic emissions. The application of this framework is demonstrated through a prediction of per-capita emissions based on service demand in different countries, and through an example showing how the "technical potentials" of a set of separate mitigation options should be combined

Consent for critical care research after death from COVID-19: Arguments for a waiver

Pandemics challenge clinicians and scientists in many ways, especially when the virus is novel and disease expression becomes variable or unpredictable. Under such circumstances, research becomes critical to inform clinical care and protect future patients. Given that severely ill patients admitted to intensive care units are at high risk of mortality, establishing the cause of death at a histopathological level could prove invaluable in contributing to the understanding of COVID-19. Postmortem examination including autopsies would be optimal. However, in the context of high contagion and limited personal protective equipment, full autopsies are not being conducted in South Africa (SA). A compromise would require tissue biopsies and samples to be taken immediately after death to obtain diagnostic information, which could potentially guide care of future patients, or generate hypotheses for finding needed solutions. In the absence of an advance written directive (including a will or medical record) providing consent for postmortem research, proxy consent is the next best option. However, obtaining consent from distraught family members, under circumstances of legally mandated lockdown when strict infection control measures limit visitors in hospitals, is challenging. Their extreme vulnerability and emotional distress make full understanding of the rationale and consent process difficult either before or upon death of a family member. While it is morally distressing to convey a message of death telephonically, it is inhumane to request consent for urgent research in the same conversation. Careful balancing of the principles of autonomy, non-maleficence and justice becomes an ethical imperative. Under such circumstances, a waiver of consent, preferably followed by deferred proxy consent, granted by a research ethics committee in keeping with national ethics guidance and legislation, would fulfil the basic premise of care and research: first do no harm. This article examines the SA research ethics framework, guidance and legislation to justify support for a waiver of consent followed by deferred proxy consent, when possible, in urgent research after death to inform current and future care to contain the pandemic in the public interest

Controls on development and diversity of Early Archean stromatolites

The ≈3,450-million-year-old Strelley Pool Formation in Western Australia contains a reef-like assembly of laminated sedimentary accretion structures (stromatolites) that have macroscale characteristics suggestive of biological influence. However, direct microscale evidence of biology—namely, organic microbial remains or biosedimentary fabrics—has to date eluded discovery in the extensively-recrystallized rocks. Recently-identified outcrops with relatively good textural preservation record microscale evidence of primary sedimentary processes, including some that indicate probable microbial mat formation. Furthermore, we find relict fabrics and organic layers that covary with stromatolite morphology, linking morphologic diversity to changes in sedimentation, seafloor mineral precipitation, and inferred microbial mat development. Thus, the most direct and compelling signatures of life in the Strelley Pool Formation are those observed at the microscopic scale. By examining spatiotemporal changes in microscale characteristics it is possible not only to recognize the presence of probable microbial mats during stromatolite development, but also to infer aspects of the biological inputs to stromatolite morphogenesis. The persistence of an inferred biological signal through changing environmental circumstances and stromatolite types indicates that benthic microbial populations adapted to shifting environmental conditions in early oceans

Materials & Manufacturing: Business growth in a transformative journey to zero emissions

Facing the reality that new energy-sector technologies won’t solve climate change fast enough reveals rich opportunities for innovation and growth in UK materials and manufacturing sectors. UK law commits us to zero emissions by 2050 with most of the reduction occurring by 2035. But we’re not on track to deliver. That’s because corporate and political strategy today is counting on new technologies, like carbon capture and storage, biofuels, hydrogen and negative emissions technologies to meet the challenge, while business elsewhere continues largely as usual. It isn’t going to happen in time. The new technologies are mainly still on drawing boards, and it takes time to deploy them at scale. Instead, delivering zero emissions in reality by 2050 requires a different economy. It’s one that can deliver high quality lifestyles, but it’s an economy that will be powered only by emissions free electricity. We won’t have as much electricity as we’d otherwise like, so we’ll reduce our use of two-tonne cars and badly insulated houses, for example. For some time we’ll have to restrain our use of goods, like ruminants and cement, that can’t be electrified. But this new economy can deliver great lifestyles and great businesses. In manufacturing, we won’t be able to access the same volumes of material as in the emitting past, but we have the opportunity for huge growth in the UK. The closure of high-emitting international freight will open up new demand for domestic production. The need to close the high-emitting material suppliers of the past creates new opportunities for electric materials production. The business of matching material supply to consumer demand for goods will transform and grow

Scrap, carbon and cost savings from the adoption of flexible nested blanking

Abstract: Steel accounts for 6% of anthropogenic CO2 emissions, most of which arises during steelmaking rather than downstream manufacturing. While improving efficiency in steelmaking has received a great deal of attention, improving material yield downstream can have a substantial impact and has received comparatively less attention. In this paper, we explore the conditions required for manufacturers to switch to a more materially efficient process, reducing demand for steel and thus reducing emissions without reducing the supply of goods to consumers. Furthermore, we present an alternative processing route where parts can be cut in flexible arrangements to take advantage of optimal nesting across multiple part geometries. For the first time, we determine the potential savings that flexible nested blanking of parts could achieve by calculating the potential for grouping orders with tolerably similar thickness, strengths, ductility and corrosion-resistance. We found that 1080 kt of CO2 and 710 kt of steel worth €430M could be saved each year if this scheme was adopted across all European flat steelmills serving the automotive sector