Valleys Regional Park: Interim progress and evaluation report

Following the decline of the coal mining sector in the latter half of the 20th Century, efforts at regeneration in the South Welsh Valleys have often lacked a holistic perspective: initially focusing on immediate safety concerns and environmental aesthetics, but in separation from socioeconomic policies and initiatives. However, amid the growing integration of social, economic and environmental interventions, the Valleys Regional Park (VRP) has explicitly aimed to promote socioeconomic regeneration through the specific investment in a high-quality network of green spaces and post industrial heritage assets. Through a holistic partnership approach, the VRP seeks to develop the green economy, encourage healthy lifestyles, offer outstanding outdoor recreation and learning opportunities and provide a quality visitor destination, thereby changing perceptions of the region and making the Valleys a prime location to live, work and visit. As such the VRP is a flagship component of the Welsh Government’s sustainable development programme (Welsh Government 2012a; 2012b, p. 20) and a key focus of regeneration activity. The VRP covers the former South Wales coalfield stretching from the western borders of Monmouthshire in the East, to the former anthracite-mining valleys of Carmarthenshire in the West. It spans an area of over 200,000 hectares and is home to over 1 million people, roughly one-third of the Welsh population

The use of geoscience methods for aquatic forensic searches

There have been few publications on the forensic search of water and fewer still on the use of geoforensic techniques when exploring aqueous environments. Here we consider what the nature of the aqueous environment is, what the forensic target(s) may be, update the geoforensic search assets we may use in light of these, and provide a search strategy that includes multiple exploration assets. Some of the good practice involved in terrestrial searches has not been applied to water to-date, water being seen as homogenous and without the complexity of solid ground: this is incorrect and a full desktop study prior to searching, with prioritized areas, is recommended. Much experimental work on the decay of human remains is focused on terrestrial surface deposition or burial, with less known about the nature of this target in water, something which is expanded upon here, in order to deploy the most appropriate geoforensic method in water-based detection. We include case studies where detecting other forensic targets have been searched for; from metal (guns, knives) to those of a nonmetallic nature, such as submerged barrels/packages of explosives, drugs, contraband and items that cause environmental pollution. A combination of the consideration of the environment, the target(s), and both modern and traditional search devices, leads to a preliminary aqueous search strategy for forensic targets. With further experimental research and criminal/humanitarian casework, this strategy will continue to evolve and improve our detection of forensic targets

Predicting lymphatic filariasis transmission and elimination dynamics using a multi-model ensemble framework

Mathematical models of parasite transmission provide powerful tools for assessing the impacts of interventions. Owing to complexity and uncertainty, no single model may capture all features of transmission and elimination dynamics. Multi-model ensemble modelling offers a framework to help overcome biases of single models. We report on the development of a first multi-model ensemble of three lymphatic filariasis (LF) models (EPIFIL, LYMFASIM, and TRANSFIL), and evaluate its predictive performance in comparison with that of the constituents using calibration and validation data from three case study sites, one each from the three major LF endemic regions: Africa, Southeast Asia and Papua New Guinea (PNG). We assessed the performance of the respective models for predicting the outcomes of annual MDA strategies for various baseline scenarios thought to exemplify the current endemic conditions in the three regions. The results show that the constructed multi-model ensemble outperformed the single models when evaluated across all sites. Single models that best fitted calibration data tended to do less well in simulating the out-of-sample, or validation, intervention data. Scenario modelling results demonstrate that the multi-model ensemble is able to compensate for variance between single models in order to produce more plausible predictions of intervention impacts. Our results highlight the value of an ensemble approach to modelling parasite control dynamics. However, its optimal use will require further methodological improvements as well as consideration of the organizational mechanisms required to ensure that modelling results and data are shared effectively between all stakeholders

Food for life partnership evaluation: Full report

Full report on the evaluation of the Food for Life Partnership programme. May 201

Effectiveness of a triple-drug regimen for global elimination of lymphatic filariasis : a modelling study

Background: Lymphatic filariasis is targeted for elimination as a public health problem by 2020. The principal approach used by current programmes is annual mass drug administration with two pairs of drugs with a good safety profile. However, one dose of a triple-drug regimen (ivermectin, diethylcarbamazine, and albendazole) has been shown to clear the transmissible stage of the helminth completely in treated individuals. The aim of this study was to use modelling to assess the potential value of mass drug administration with the triple-drug regimen for accelerating elimination of lymphatic filariasis in different epidemiological settings. Methods: We used three different transmission models to compare the number of rounds of mass drug administration needed to achieve a prevalence of microfilaraemia less than 1% with the triple-drug regimen and with current two-drug regimens. Findings: In settings with a low baseline prevalence of lymphatic filariasis (5%), the triple-drug regimen reduced the number of rounds of mass drug administration needed to reach the target prevalence by one or two rounds, compared with the two-drug regimen. For areas with higher baseline prevalence (10–40%), the triple-drug regimen strikingly reduced the number of rounds of mass drug administration needed, by about four or five, but only at moderate-to-high levels of population coverage (>65%) and if systematic non-adherence to mass drug administration was low. Interpretation: Simulation modelling suggests that the triple-drug regimen has potential to accelerate the elimination of lymphatic filariasis if high population coverage of mass drug administration can be achieved and if systematic non-adherence with mass drug administration is low. Future work will reassess these estimates in light of more clinical trial data and to understand the effect on an individual country's programme

T1 based oxygen-enhanced MRI in tumours; a scoping review of current research

Objective: Oxygen-enhanced MRI (OE-MRI) or tissue oxygen-level dependent (TOLD) MRI is an imaging technique under investigation for its ability to quantify and map oxygen distributions within tumours. The aim of this study was to identify and characterise the research into OE-MRI for characterising hypoxia in solid tumours. Methods: A scoping review of published literature was performed on the PubMed and Web of Science databases for articles published before 27th May 2022. Studies imaging solid tumours using proton-MRI to measure oxygen induced T1/R1 relaxation time/rate changes were included. Grey literature was searched from conference abstracts and active clinical trials. Results: 49 unique records met the inclusion criteria consisting of 34 journal articles and 15 conference abstracts. The majority of articles were pre-clinical studies (31 articles) with 15 human only studies. Pre-clinical studies in a range of tumour types demonstrated consistent correlation of OE-MRI with alternative hypoxia measurements. No clear consensus on optimal acquisition technique or analysis methodology was found. No prospective, adequately powered, multicentre clinical studies relating OE-MRI hypoxia markers to patient outcomes were identified. Conclusions: There is good preclinical evidence of the utility of OE-MRI in tumour hypoxia assessment however there are significant gaps in clinical research that need to be addressed to develop OE-MRI into a clinically applicable tumour hypoxia imaging technique. Advances in knowledge: The evidence base of OE-MRI in tumour hypoxia assessment is presented along with a summary of the research gaps to be addressed to transform OE-MRI derived parameters into tumour hypoxia biomarkers

Sociodemographic and clinical predictors of delay to and length of stay with early intervention for psychosis service: findings from the CRIS-FEP study

Purpose We investigated the influence of sociodemographic and clinical characteristics on delay to early intervention service (EIS) and the length of stay (LOS) with EIS. Methods We used incidence data linked to the Clinical Record Interactive Search—First Episode Psychosis (CRIS-FEP) study. We followed the patients from May 2010 to March 2016. We performed multivariable Cox regression to estimate hazard ratios of delay to EIS. Negative binomial regression was used to determine LOS with EIS by sociodemographic and clinical characteristics, controlling for confounders. Results 343 patients were eligible for an EIS, 34.1% of whom did not receive the service. Overall, the median delay to EIS was 120 days (IQR; 15–1668); and the median LOS was 130.5 days (IQR 0–663). We found that women (adj.HR 0.58; 95%C I 0.42–0.78), living alone (adj.HR: 0.63; 95% CI 0.43–0.92) and ethnicity (‘Other’: adj.HR 0.47; 95% CI 0.23–0.98) were associated with prolonged delay to EIS. However, family involvement in help-seeking for psychosis (adj.HR 1.37; 95% CI 1.01–1.85) was strongly associated with a shorter delay to EIS. Patients who have used mental health services previously also experienced long delays to EIS. Conclusions Our analyses highlight the link between sociodemographic status, help-seeking behaviours, and delay to EIS. Our findings also show the vulnerability faced by those with a previous mental health problem who later develop psychosis in receiving specialist treatment for psychosis. Initiatives that ameliorate indicators of social disadvantage are urgently needed to reduce health inequalities and improve clinical outcomes

Complementary role of cardiac CT in the assessment of aortic valve replacement dysfunction

Aortic valve replacement is the second most common cardiothoracic procedure in the UK. With an ageing population, there are an increasing number of patients with prosthetic valves that require follow-up. Imaging of prosthetic valves is challenging with conventional echocardiographic techniques making early detection of valve dysfunction or complications difficult. CT has recently emerged as a complementary approach offering excellent spatial resolution and the ability to identify a range of aortic valve replacement complications including structural valve dysfunction, thrombus development, pannus formation and prosthetic valve infective endocarditis. This review discusses each and how CT might be incorporated into a multimodal cardiovascular imaging pathway for the assessment of aortic valve replacements and in guiding clinical management

Oxygen-enhanced MRI assessment of tumour hypoxia in head and neck cancer is feasible and well tolerated in the clinical setting

Background: Tumour hypoxia is a recognised cause of radiotherapy treatment resistance in head and neck squamous cell carcinoma (HNSCC). Current positron emission tomography-based hypoxia imaging techniques are not routinely available in many centres. We investigated if an alternative technique called oxygen-enhanced magnetic resonance imaging (OE-MRI) could be performed in HNSCC. Methods: A volumetric OE-MRI protocol for dynamic T1 relaxation time mapping was implemented on 1.5-T clinical scanners. Participants were scanned breathing room air and during high-flow oxygen administration. Oxygen-induced changes in T1 times (ΔT1) and R2* rates (ΔR2*) were measured in malignant tissue and healthy organs. Unequal variance t-test was used. Patients were surveyed on their experience of the OE-MRI protocol. Results: Fifteen patients with HNSCC (median age 59years, range 38 to 76) and 10 non-HNSCC subjects (median age 46.5years, range 32 to 62) were scanned; the OE-MRI acquisition took less than 10min and was well tolerated. Fifteen histologically confirmed primary tumours and 41 malignant nodal masses were identified. Median (range) of ΔT1 times and hypoxic fraction estimates for primary tumours were -3.5% (-7.0 to -0.3%) and 30.7% (6.5 to 78.6%) respectively. Radiotherapy-responsive and radiotherapy-resistant primary tumours had mean estimated hypoxic fractions of 36.8% (95% confidence interval [CI] 17.4 to 56.2%) and 59.0% (95% CI 44.6 to 73.3%), respectively (p = 0.111). Conclusions: We present a well-tolerated implementation of dynamic, volumetric OE-MRI of the head and neck region allowing discernment of differing oxygen responses within biopsy-confirmed HNSCC. Trial registration: ClinicalTrials.gov, NCT04724096. Registered on 26 January 2021. Relevance statement: MRI of tumour hypoxia in head and neck cancer using routine clinical equipment is feasible and well tolerated and allows estimates of tumour hypoxic fractions in less than ten minutes. Key points: • Oxygen-enhanced MRI (OE-MRI) can estimate tumour hypoxic fractions in ten-minute scanning. • OE-MRI may be incorporable into routine clinical tumour imaging. • OE-MRI has the potential to predict outcomes after radiotherapy treatment. Graphical Abstract: (Figure presented.