Social Assessment of Section 3 of the A465 Heads of the Valleys Road: Brynmawr to Tredegar

The aim of this report is to provide a social assessment of the impacts of Section 3 of the A465 Heads of the Valleys Road: Brynmawr to Tredegar, using a mixed methods approach which adapts and builds on the UK WebTAG appraisal guidance units 4.1 and 4.2. We define social assessment in this document as a study of the social and distributional impacts which estimate the impacts of the implemented scheme at the point of opening rather than a detailed ex-ante appraisal. In the absence of detailed ex-ante appraisal, this report sets a baseline from which future evaluation may be conducted. This is the first application of a new mixed methods approach to social assessment of the impacts of transport infrastructure investment in the UK. It was commissioned by the Welsh Government in specific recognition of the need for improved guidance in this area of project delivery. The results reported here, along with its accompanying annexes, also contribute to greater understanding of social and distributional impacts, which builds upon and extends the current quantitative approach in WelTAG / WebTAG. This will hopefully lead to better understanding of the wider social effects of transport projects in order to inform future considerations as to how new transport schemes affect wellbeing

A mixed methods approach to the social assessment of transport infrastructure projects

In this paper, we propose a mixed methods quantitative and qualitative approach to capture fully the measurable and less tangible social impacts of transport projects on local people and communities. The approach was used to assess the potential social impacts of a strategic road by-pass project case study in a deprived region of Wales in the UK. The project specifically aimed to stimulate local economic growth and regeneration in the local areas it serves. In a ‘before and after’ case study, we combined fine-grained, GIS-based spatial analysis of secondary datasets with qualitative participative exercises with the local residents of the five communities living adjacent to the road, and interviews with professional local stakeholders. This mixed methods approach significantly enhanced understanding of both the social benefits and disbenefits of the road project. It helped to reveal local concerns that would not otherwise have been apparent from secondary dataset analysis alone. The qualitative studies were also successful in bringing to the table new ‘hard to reach’ voices that had not been heard through the formal consultation and public engagement process. The study revealed that the social benefits accruing to local people from the project could have been significantly enhanced, whilst a number of its locally occurring negative social impacts could have been avoided had social assessment been employed earlier in the decision processes concerning its routing and design. Recommendations to improve the practice and uptake of social assessments at the option appraisal, project design mitigation and post evaluation stages of transport projects are included in the paper

Framework for Participatory Quantitative Health Impact Assessment in Low- and Middle-Income Countries

Background: Conducting health impact assessments (HIAs) is a growing practice in various organizations and countries, yet scholarly interest in HIAs has primarily focused on the synergies between exposure and health outcomes. This limits our understanding of what factors influence HIAs and the uptake of their outcomes. This paper presents a framework for conducting participatory quantitative HIA (PQHIA) in low- and middle-income countries (LMICs), including integrating the outcomes back into society after an HIA is conducted. The study responds to the question: what are the different components of a participatory quantitative model that can influence HIA implementation in LMICs? Methods: To build the framework, we used a case study from a PQHIA fieldwork model developed in Port Louis (Mauritius). To explore thinking on the participatory components of the framework, we extract and analyze data from ethnographic material including fieldnotes, interviews, focus group discussions and feedback exercises with 14 stakeholders from the same case study. We confirm the validity of the ethnographic data using five quality criteria: credibility, transferability, dependability, confirmability, and authenticity. We build the PQHIA framework connecting the main HIA steps with factors influencing HIAs. Results: The final framework depicts the five standard HIA stages and summarizes participatory activities and outcomes. It also reflects key factors influencing PQHIA practice and uptake of HIA outcomes: costs for participation, HIA knowledge and interest of stakeholders, social responsibility of policymakers, existing policies, data availability, citizen participation, multi-level stakeholder engagement and multisectoral coordination. The framework suggests that factors necessary to complete a participatory HIA are the same needed to re-integrate HIA results back into the society. There are three different areas that can act as facilitators to PQHIAs: good governance, evidence-based policy making, and access to resources. Conclusions: The framework has several implications for research and practice. It underlines the importance of applying participatory approaches critically while providing a blueprint for methods to engage local stakeholders. Participatory approaches in quantitative HIAs are complex and demand a nuanced understanding of the context. Therefore, the political and cultural contexts in which HIA is conducted will define how the framework is applied. Finally, the framework underlines that participation in HIA does not need to be expensive or time consuming for the assessor or the participant. Yet, participatory quantitative models need to be contextually developed and integrated if they are to provide health benefits and be beneficial for the participants. This integration can be facilitated by investing in opportunities that fuel good governance and evidence-based policy making

Have a Good Trip! Expanding our Concepts of the Quality of Everyday Travelling with Flow Theory

The dominant tradition in transport planning and policy practice considers travel as a derived activity and travel time as an economic disutility. A growing body of literature is challenging this perspective, demonstrating that being ‘on the move’ is a rich experience interlaced with profound shared and individual meanings that can have positive implications on quality of life, well-being and personal development. Yet, mobility in general, and commuting in particular, is often reported as one of the least pleasant daily experiences and as a source of massive environmental impacts. This exploratory article hypothesizes that flow theory, based on Csikszentmihalyi´s seminal work on optimal states of consciousness, has the potential to offer important insights that can contribute to research and policy action on achieving both sustainable and satisfying forms of daily mobility. The article draws on an online exploratory questionnaire in order to reflect on flow theory in relation to the capacity of different mobility modes to either facilitate or constrain the occurrence and duration of optimal states of consciousness. Preliminary conclusions provide a basis for outlining a set of future research directions aimed at better understanding mobility experiences and their relationships with flow theory

The role of funding in the ‘performative decarbonisation’ of transport in England

The scale of the decarbonisation challenge and the short timeframes over which action is required demand urgent action. This paper is set within the surface transport sector, now the largest sector of emissions with the slowest pace of change in many advanced liberal economies. It focuses on the strategies and actions of local government which is recognised to be a central player in catalysing change. Our evidence is derived from the actions of two UK local areas which claim to be at the forefront of the decarbonisation challenge. The paper focuses on the role of funding and financial mechanisms in addressing the climate crisis. In the face of an established pattern of austerity and hollowing out of local government we explore how deep transformation is being envisaged. We find a recursive set of issues which derive from a dependence on funding from outwith. This dependence means that despite comprehensive overarching strategies and goals the funding available is the core of the strategy. This means that the nature of the funds, such as the requirement for experimentation, innovation or private sector leverage, defines direction. In turn, and to maintain success in attracting funds, there is an emphasis on presenting ‘premium spaces of ambition’ with little evidence of attention to broader systemic change. This duality is openly recognised. This paper advances a wider point that greater emphasis should be placed on the ‘financialisation’ of climate policy and the reality rather than the rhetoric of change

Circulating microRNAs in sera correlate with soluble biomarkers of immune activation but do not predict mortality in ART treated individuals with HIV-1 infection: A case control study

Introduction: The use of anti-retroviral therapy (ART) has dramatically reduced HIV-1 associated morbidity and mortality. However, HIV-1 infected individuals have increased rates of morbidity and mortality compared to the non-HIV-1 infected population and this appears to be related to end-organ diseases collectively referred to as Serious Non-AIDS Events (SNAEs). Circulating miRNAs are reported as promising biomarkers for a number of human disease conditions including those that constitute SNAEs. Our study sought to investigate the potential of selected miRNAs in predicting mortality in HIV-1 infected ART treated individuals. Materials and Methods: A set of miRNAs was chosen based on published associations with human disease conditions that constitute SNAEs. This case: control study compared 126 cases (individuals who died whilst on therapy), and 247 matched controls (individuals who remained alive). Cases and controls were ART treated participants of two pivotal HIV-1 trials. The relative abundance of each miRNA in serum was measured, by RTqPCR. Associations with mortality (all-cause, cardiovascular and malignancy) were assessed by logistic regression analysis. Correlations between miRNAs and CD4+ T cell count, hs-CRP, IL-6 and D-dimer were also assessed. Results: None of the selected miRNAs was associated with all-cause, cardiovascular or malignancy mortality. The levels of three miRNAs (miRs -21, -122 and -200a) correlated with IL-6 while miR-21 also correlated with D-dimer. Additionally, the abundance of miRs -31, -150 and -223, correlated with baseline CD4+ T cell count while the same three miRNAs plus miR- 145 correlated with nadir CD4+ T cell count. Discussion: No associations with mortality were found with any circulating miRNA studied. These results cast doubt onto the effectiveness of circulating miRNA as early predictors of mortality or the major underlying diseases that contribute to mortality in participants treated for HIV-1 infection

Development and Validation of a Risk Score for Chronic Kidney Disease in HIV Infection Using Prospective Cohort Data from the D:A:D Study

Ristola M. on työryhmien DAD Study Grp ; Royal Free Hosp Clin Cohort ; INSIGHT Study Grp ; SMART Study Grp ; ESPRIT Study Grp jäsen.Background Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. Methods and Findings A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with >= 3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1: 393 chance of developing CKD in the next 5 y in the low risk group (risk score = 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. Conclusions Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.Peer reviewe