An investigation into the effects of complex topography on particle dry deposition

There is a requirement to predict the spatial variation of particle dry deposition following a nuclear accident. The interaction of landscape features, atmospheric flow and particle dry deposition has been investigated with this in mind. Wind tunnel studies have been used with computational fluid dynamics to predict the deposition rate relative to a flat landscape. Good quantitative agreement was seen for this relative deposition rate. Landscape shapes showed significant effects on deposition rate, increasing it by more than two in some cases, over limited areas. The effect of turbulence intensity, in the absence of landscape features, was also studied and a weak relationship to dry deposition was observed. Computational fluid dynamics methods used in wind tunnel comparisons were extended to a wide range of landscape cases. Deposition rates varied spatially around the landscape features. In general, for hills and ridges, deposition was seen to increase on the windward face, decrease on the leeward face and near wake, and increase in the further wake, before returning to the flat case value. The computational results were applied to a real landscape with the use of a customised geographical information system. Good general agreement was seen when compared with a test case

Impact of community based peer support in type 2 diabetes: a cluster randomised controlled trial of individual and/or group approaches

Background: Diabetes peer support, where one person with diabetes helps guide and support others, has been proposed as a way to improve diabetes management. We have tested whether different diabetes peer support strategies can improve metabolic and/or psychological outcomes.<p></p> Methods: People with type 2 diabetes (n=1,299) were invited to participate as either ‘peer’ or ‘peer support facilitator’ (PSF) in a 2x2 factorial pragmatic randomised cluster controlled trial across rural communities (130 clusters) in England. Peer support was delivered over 8-12 months by trained PSFs, supported by monthly meetings with a diabetes educator. Primary end point was HbA1c. Secondary outcomes included quality of life, diabetes distress, blood pressure, waist, total cholesterol and weight. Outcome assessors and investigators were masked to arm allocation. Main factors were 1:1 or group intervention. Analysis was by intention-to-treat adjusting for baseline.<p></p> Results: The 4 arms were well matched (Group n=330, 1:1 n=325, combined n=322, control n=322); 1035 (79·7%) completed the mid-point postal questionnaire and 1064 (81·9%) had a final HbA1c. A limitation was that although 92.6% PSFs and peers were in telephone contact, only 61.4% of intervention participants attended a face to face session.<p></p> Mean baseline HbA1c was 57 mmol/mol (7·4%), with no significant change across arms. Systolic blood pressure was reduced by -2·3mm Hg (-4·0 to -0·6) among those allocated group peer-support and -3·0mm Hg (-5·0 to -1·1) among those who attended group peer-support at least once. There was no impact on other outcomes by intention to treat or significant differences between arms in self-reported adherence or medication.<p></p> Conclusions: Group diabetes peer support over 8-12 months was associated with a small improvement in blood pressure but no other benefits. Long term benefits should be investigated

Impact of an informed choice invitation on uptake of screening for diabetes in primary care (DICISION): trial protocol.

BACKGROUND: Screening invitations have traditionally been brief, providing information only about population benefits. Presenting information about the limited individual benefits and potential harms of screening to inform choice may reduce attendance, particularly in the more socially deprived. At the same time, amongst those who attend, it might increase motivation to change behavior to reduce risks. This trial assesses the impact on attendance and motivation to change behavior of an invitation that facilitates informed choices about participating in diabetes screening in general practice. Three hypotheses are tested: 1. Attendance at screening for diabetes is lower following an informed choice compared with a standard invitation. 2. There is an interaction between the type of invitation and social deprivation: attendance following an informed choice compared with a standard invitation is lower in those who are more rather than less socially deprived. 3. Amongst those who attend for screening, intentions to change behavior to reduce risks of complications in those subsequently diagnosed with diabetes are stronger following an informed choice invitation compared with a standard invitation. METHOD/DESIGN: 1500 people aged 40-69 years without known diabetes but at high risk are identified from four general practice registers in the east of England. 1200 participants are randomized by households to receive one of two invitations to attend for diabetes screening at their general practices. The intervention invitation is designed to facilitate informed choices, and comprises detailed information and a decision aid. A comparison invitation is based on those currently in use. Screening involves a finger-prick blood glucose test. The primary outcome is attendance for diabetes screening. The secondary outcome is intention to change health related behaviors in those attenders diagnosed with diabetes. A sample size of 1200 ensures 90% power to detect a 10% difference in attendance between arms, and in an estimated 780 attenders, 80% power to detect a 0.2 sd difference in intention between arms. DISCUSSION: The DICISION trial is a rigorous pragmatic denominator based clinical trial of an informed choice invitation to diabetes screening, which addresses some key limitations of previous trials.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Impact of an informed choice invitation on uptake of screening for diabetes in primary care (DICISION): randomised trial

Objective To compare the effect of an invitation promoting informed choice for screening with a standard invitation on attendance and motivation to engage in preventive action

A randomised controlled trial of three very brief interventions for physical activity in primary care.

BACKGROUND: Very brief interventions (VBIs) for physical activity are promising, but there is uncertainty about their potential effectiveness and cost. We assessed potential efficacy, feasibility, acceptability, and cost of three VBIs in primary care, in order to select the most promising intervention for evaluation in a subsequent large-scale RCT. METHODS: Three hundred and ninety four adults aged 40-74 years were randomised to a Motivational (n = 83), Pedometer (n = 74), or Combined (n = 80) intervention, delivered immediately after a preventative health check in primary care, or control (Health Check only; n = 157). Potential efficacy was measured as the probability of a positive difference between an intervention arm and the control arm in mean physical activity, measured by accelerometry at 4 weeks. RESULTS: For the primary outcome the estimated effect sizes (95 % CI) relative to the Control arm for the Motivational, Pedometer and Combined arms were respectively: +20.3 (-45.0, +85.7), +23.5 (-51.3, +98.3), and -3.1 (-69.3, +63.1) counts per minute. There was a73% probability of a positive effect on physical activity for each of the Motivational and Pedometer VBIs relative to control, but only 46 % for the Combined VBI. Only the Pedometer VBI was deliverable within 5 min. All VBIs were acceptable and low cost. CONCLUSIONS: Based on the four criteria, the Pedometer VBI was selected for evaluation in a large-scale trial. TRIAL REGISTRATION: Current Controlled Trials ISRCTN02863077 . Retrospectively registered 05/10/2012.This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number RP-PG-0608-10079). ATP and JV were supported by the NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The funder had no role in study design, data collection, data analysis, data interpretation, the writing of the manuscript, and decision to submit the manuscript for publication.This is the final version of the article. It first appeared from BioMed Central via https://doi.org/10.1186/s12889-016-3684-

Evaluation of wetland CH4 in the Joint UK Land Environment Simulator (JULES) land surface model using satellite observations

Wetlands are the largest natural source of methane. The ability to model the emissions of methane from natural wetlands accurately is critical to our understanding of the global methane budget and how it may change under future climate scenarios. The simulation of wetland methane emissions involves a complicated system of meteorological drivers coupled to hydrological and biogeochemical processes. The Joint UK Land Environment Simulator (JULES) is a process-based land surface model that underpins the UK Earth System Model (UKESM) and is capable of generating estimates of wetland methane emissions. In this study, we use GOSAT satellite observations of atmospheric methane along with the TOMCAT global 3-D chemistry transport model to evaluate the performance of JULES in reproducing the seasonal cycle of methane over a wide range of tropical wetlands. By using an ensemble of JULES simulations with differing input data and process configurations, we investigate the relative importance of the meteorological driving data, the vegetation, the temperature dependency of wetland methane production and the wetland extent. We find that JULES typically performs well in replicating the observed methane seasonal cycle. We calculate correlation coefficients to the observed seasonal cycle of between 0.58 and 0.88 for most regions; however, the seasonal cycle amplitude is typically underestimated (by between 1.8 and 19.5 ppb). This level of performance is comparable to that typically provided by state-of-the-art data-driven wetland CH4 emission inventories. The meteorological driving data are found to be the most significant factor in determining the ensemble performance, with temperature dependency and vegetation having moderate effects. We find that neither wetland extent configuration outperforms the other, but this does lead to poor performance in some regions. We focus in detail on three African wetland regions (Sudd, Southern Africa and Congo) where we find the performance of JULES to be poor and explore the reasons for this in detail. We find that neither wetland extent configuration used is sufficient in representing the wetland distribution in these regions (underestimating the wetland seasonal cycle amplitude by 11.1, 19.5 and 10.1 ppb respectively, with correlation coefficients of 0.23, 0.01 and 0.31). We employ the Catchment-based Macro-scale Floodplain (CaMa-Flood) model to explicitly represent river and floodplain water dynamics and find that these JULES-CaMa-Flood simulations are capable of providing a wetland extent that is more consistent with observations in this regions, highlighting this as an important area for future model development.</p

Multiple behaviour change intervention and outcomes in recently diagnosed type 2 diabetes: the ADDITION-Plus randomised controlled trial.

AIMS/HYPOTHESIS: The aim of this study was to assess whether or not a theory-based behaviour change intervention delivered by trained and quality-assured lifestyle facilitators can achieve and maintain improvements in physical activity, dietary change, medication adherence and smoking cessation in people with recently diagnosed type 2 diabetes. METHODS: An explanatory randomised controlled trial was conducted in 34 general practices in Eastern England (Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen Detected Diabetes in Primary Care-Plus [ADDITION-Plus]). In all, 478 patients meeting eligibility criteria (age 40 to 69 years with recently diagnosed screen or clinically detected diabetes) were individually randomised to receive either intensive treatment (n = 239) or intensive treatment plus a theory-based behaviour change intervention led by a facilitator external to the general practice team (n = 239). Randomisation was central and independent using a partial minimisation procedure to balance stratifiers between treatment arms. Facilitators taught patients skills to facilitate change in and maintenance of key health behaviours, including goal setting, self-monitoring and building habits. Primary outcomes included physical activity energy expenditure (individually calibrated heart rate monitoring and movement sensing), change in objectively measured fruit and vegetable intake (plasma vitamin C), medication adherence (plasma drug levels) and smoking status (plasma cotinine levels) at 1 year. Measurements, data entry and laboratory analysis were conducted with staff unaware of participants' study group allocation. RESULTS: Of 475 participants still alive, 444 (93%; intervention group 95%, comparison group 92%) attended 1-year follow-up. There were no significant differences between groups in physical activity (difference: +1.50 kJ kg(-1) day(-1); 95% CI -1.74, 4.74), plasma vitamin C (difference: -3.84 μmol/l; 95% CI -8.07, 0.38), smoking (OR 1.37; 95% CI 0.77, 2.43) and plasma drug levels (difference in metformin levels: -119.5 μmol/l; 95% CI -335.0, 95.9). Cardiovascular risk factors and self-reported behaviour improved in both groups with no significant differences between groups. CONCLUSIONS/INTERPRETATION: For patients with recently diagnosed type 2 diabetes receiving intensive treatment in UK primary care, a facilitator-led individually tailored behaviour change intervention did not improve objectively measured health behaviours or cardiovascular risk factors over 1 year. TRIAL REGISTRATION: ISRCTN99175498 FUNDING: The trial is supported by the Medical Research Council, the Wellcome Trust, National Health Service R&D support funding (including the Primary Care Research and Diabetes Research Networks) and National Institute of Health Research under its Programme Grants for Applied Research scheme. The Primary Care Unit is supported by NIHR Research funds. Bio-Rad provided equipment for HbA1c testing during the screening phase

Evaluation of wetland CH4 in the Joint UK Land Environment Simulator (JULES) land surface model using satellite observations

Wetlands are the largest natural source of methane. The ability to model the emissions of methane from natural wetlands accurately is critical to our understanding of the global methane budget and how it may change under future climate scenarios. The simulation of wetland methane emissions involves a complicated system of meteorological drivers coupled to hydrological and biogeochemical processes. The Joint UK Land Environment Simulator (JULES) is a process-based land surface model that underpins the UK Earth System Model (UKESM) and is capable of generating estimates of wetland methane emissions. In this study, we use GOSAT satellite observations of atmospheric methane along with the TOMCAT global 3-D chemistry transport model to evaluate the performance of JULES in reproducing the seasonal cycle of methane over a wide range of tropical wetlands. By using an ensemble of JULES simulations with differing input data and process configurations, we investigate the relative importance of the meteorological driving data, the vegetation, the temperature dependency of wetland methane production and the wetland extent. We find that JULES typically performs well in replicating the observed methane seasonal cycle. We calculate correlation coefficients to the observed seasonal cycle of between 0.58 and 0.88 for most regions; however, the seasonal cycle amplitude is typically underestimated (by between 1.8 and 19.5 ppb). This level of performance is comparable to that typically provided by state-of-the-art data-driven wetland CH4 emission inventories. The meteorological driving data are found to be the most significant factor in determining the ensemble performance, with temperature dependency and vegetation having moderate effects. We find that neither wetland extent configuration outperforms the other, but this does lead to poor performance in some regions. We focus in detail on three African wetland regions (Sudd, Southern Africa and Congo) where we find the performance of JULES to be poor and explore the reasons for this in detail. We find that neither wetland extent configuration used is sufficient in representing the wetland distribution in these regions (underestimating the wetland seasonal cycle amplitude by 11.1, 19.5 and 10.1 ppb respectively, with correlation coefficients of 0.23, 0.01 and 0.31). We employ the Catchment-based Macro-scale Floodplain (CaMa-Flood) model to explicitly represent river and floodplain water dynamics and find that these JULES-CaMa-Flood simulations are capable of providing a wetland extent that is more consistent with observations in this regions, highlighting this as an important area for future model development

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy