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Extreme rainfall and temporal loading in Great Britain: Analysis of present and future trends using a convection-permitting climate model
Get PDFStudy Region:
Great Britain
Study Focus:
While climate change is intensifying rainfall extremes, its effect on temporal loading remains poorly understood. Temporal loading, the distribution of rainfall over storm duration, influences flood risk for storms of a given volume and is critical for urban infrastructure planning. This research presents the first direct investigation of event temporal loading within climate projections, utilising UKCP Local convection-permitting ensemble simulations. At rain gauge locations, we sample the most extreme storm each year at durations from 1.5 to 24 hours and apply two classification metrics to evaluate storm temporal structure.
New Hydrological Insights for the Region:
Our analysis confirms that in today’s climate, shorter-duration storms tend to be front-loaded, while longer storms exhibit more centred, symmetrical intensity profiles. Spatial patterns emerge with central and southern England exhibiting a higher proportion of highly asymmetric events. However, no consistent changes in temporal loading are projected under future climates, challenging previous inferences based on temperature–rainfall relationships. These discrepancies may stem from differences in storm-generating mechanisms between Great Britain and tropical regions studied previously. Our findings highlight limitations of current metrics, which inadequately distinguish aspects of storm structure contributing to temporal loading. We recommend developing refined metrics to independently quantify event asymmetry, peak intensity, and timing. Such advancements are crucial for improving design flood modelling alongside future climate scenarios
Assessing the impact of intermediate care interventions on healthcare and patient-related outcomes: a systematic overview of systematic reviews
Get PDFIntroduction
Intermediate care interventions are widely used to support patients transitioning between hospital and home, aiming to reduce the burden on acute healthcare services. The effectiveness however of such interventions remains unclear. Previous reviews have highlighted mixed findings, with limited high-quality evidence available to guide policy and practice.
Aim & objectives
This overview aims to assess the impact of intermediate care interventions on key outcomes such as hospital length of stay (LOS), emergency department (ED) visits, readmissions, mortality, quality of life (QoL), and healthcare costs in developed countries. This overview has two key objectives: (i) to map existing widely-disseminated intermediate care interventions, and (ii) summarise evidence regarding the effectiveness of such interventions.
Methods
We conducted a comprehensive search of eight databases up to February 2024. Systematic reviews with or without meta-analyses assessing intermediate care interventions in OECD developed countries were included. Two reviewers independently assessed study quality using AMSTAR 2. Data on length of stay (LOS), ED visits, readmissions, mortality, quality of life (QoL), and costs were extracted and synthesised.
Results
Twenty-two reviews (570 unique primary studies) were included. Consistent evidence showed transitional care interventions (TCIs), rapid response teams, and virtual wards (VWs) were effective in reducing in-hospital LOS and ED/hospital readmissions. TCIs, person- and family-centred care, VWs, and telephone-based interventions were generally effective in lowering subsequent ED visits. Limited evidence supported effectiveness in reducing mortality, with VWs showing the most promise. No clear evidence was found for improving QoL. Cost-effectiveness findings were inconclusive. Most reviews reported low overall confidence ratings, and reviews reported that about half of primary studies were rated high risk of bias.
Discussion
While intermediate care interventions show promise in addressing ED overcrowding, the generally low-certainty evidence highlights the need for further high-quality research. Future studies should focus on long-term effectiveness, cost-effectiveness, and identifying the most effective intervention components across different patient populations
Sanitary inspection characteristics, precipitation, and microbial water quality - A three-country study of rural boreholes in Sub-Saharan Africa
Get PDFMicrobial contamination of drinking water contributes to disease burdens that disproportionately impact infants and children and are largely preventable through suitable design, operation, monitoring, and management of improved water systems. The World Health Organization (WHO) has published guidance on water safety planning, water quality monitoring, and management approaches, including recommendations on sanitary inspection (SI) of water systems to detect and manage microbial hazards associated with fecal contamination. SI is a low-cost risk assessment tool for water systems based on observable risk factors (RFs) associated with potential water safety hazards. While SI has been previously studied, much of the literature has not quantitatively explored rainfall interactions with SI risk as drivers of fecal contamination. We merged remote-sensing rainfall estimates with SI and water quality data collected from 966 rural boreholes in Ethiopia, Ghana, and Burkina Faso. Logistic regressions (binary and ordinal) were used to characterize associations of total SI score, as well as individual risk factors (RFs), and classes of RFs (i.e., “Source,” “Transport,” and “Barrier” risks) with fecal indicator bacteria (FIB) occurrence, controlling for rainfall (over the past 1–15 days before sampling). We found associations (P < 0.05, OR: 3.5, 95% CI 1.05-11.66) between SI scores and E. coli risk categories controlling for fifteen-day total rainfall. Furthermore, interactions between rainfall and risk factors in the “barrier” category, and the “transport” category were associated with E. coli occurrence. Several individual RFs were also significantly associated with microbial contamination. Incorporating precipitation into models improved model fit characteristics (improved Pseudo R squared and AIC value); specifically, accounting for cumulative rainfall during the fifteen days before sampling improved model fit (increased pseudo-R2 from 0.035 to 0.05) for E. coli contamination. These findings can inform design, construction, maintenance, and monitoring of boreholes and prompt timely remediation of defects in such systems, potentially enhancing water safety
Hand-finger kinematics and sEMG-based muscular effort for ergonomic analysis of colonoscopy insertion: a preliminary study
Get PDFEndoscopic procedures involve repetitive movements of the fingers, wrists, and upper limbs, contributing to a rising prevalence of musculoskeletal pain and injuries (MSPI), affecting up to 89% of surveyed endoscopists [1]. Although recent advances in robotic endoscopy have helped reduce certain musculoskeletal demands [2], [3], these efforts mainly address arm and shoulder loads while overlooking the fine motor requirements of individual digits and overall muscular effort in the forearms. Once injuries are acquired, they can impact the operator’s productivity and well-being, and potentially impact the patient. Consequently, investigating the effort required by endoscopists during colonoscopy is paramount to reduce MSPI. Surface electromyography (sEMG) has been widely used to assess muscle activity in minimally invasive surgeries [4], yet many studies do not capture digit-level joint motions or their correlation with respective muscle effort. To bridge this gap, we simultaneously recorded hand motion and muscular effort at different stages of colonoscope insertion. This paper contributes: a) A sensor-based ergonomic evaluation framework for digit-joint capture and sEMG recordings. b) Principal component analysis (PCA) to identify dominant digits and muscle activation, correlating their activity with colonoscope insertion stages
AGS-v PLUS, a Mosquito Salivary Peptide Vaccine, Modulates the Response to Aedes Mosquito Bites in Humans
No full textBackground: The global health burden of mosquito-borne viruses, including dengue, yellow fever, Zika, and chikungunya, is rising due to climate change and globalisation, which favour mosquito habitat expansion. The genetic diversity of these viruses complicates the development of virus-specific vaccines or antivirals, highlighting the need for pan-viral strategies. As the common vector for these pathogens, mosquitoes and specifically their salivary proteins represent a promising target for such interventions. Mosquito saliva, secreted into the skin during biting, has immunomodulatory effects that can enhance host susceptibility to infection, but these mechanisms are not well defined in humans.
Methods: The objective of this study was to determine whether AGS-v PLUS, a vaccine targeting mosquito salivary antigens, could modulate the human skin immune response to mosquito biting and potentially promote antiviral bystander immunity. In a Phase I trial, healthy volunteers were vaccinated with AGS-v PLUS (with or without adjuvant) or placebo, and three weeks later, they were exposed to bites from Aedes albopictus and Aedes aegypti mosquitoes. Skin biopsies from bitten and unbitten sites were analysed by transcriptomic profiling.
Results: In placebo recipients, mosquito biting elicited a marked adaptive immune response at 48 h, characterised by CD4+ Th1 and CD8+ T cell signatures and leukocyte recruitment. While responses to Ae. aegypti and Ae. albopictus bites were broadly similar, those to Ae. albopictus were stronger. Vaccination with AGS-v PLUS, particularly with adjuvant, enhanced Th1 and CD8+ T cell-associated gene expression while suppressing pathways linked to neutrophilic inflammation and epithelial stress, which together may provide enhanced antiviral capacity.
Conclusions: These findings demonstrate that targeting the host response to mosquito saliva via vaccination can reprogram the skin’s immune response to mosquito bites, supporting a novel and broadly applicable pan-viral strategy to mitigate the impact of arboviral diseases
Constructing and cultivating a national theatrical system, 1806–24
Get PDFMuch has been written about the beginnings and decline of the French system for theatrical infrastructure first devised by Napoleon to oversee performance culture across the nation and lasting for almost sixty-years (1806-1864). In this article, though, I argue that new perspectives on the relationship between state governance and French theatre can be illuminated by exploring previously neglected reforms and debates between ministers about the function of provincial theatre during the first quarter of the century. I reconstruct the archival trail of ministerial plans, draft proposals, and marginal scribbles concerning provincial theatre to trace the process whereby theatrical issues were discussed, acted upon or abandoned between 1806 to 1824. These documents, I suggest, reveal the steady development of ministerial conceptions of the social and political role of the provincial French stage, charting a shift from the government’s focus on the theatrical system’s political and moral issues to the new importance placed on fostering social and artistic priorities. I highlight that such a shift, in turn, allowed a state-led conception of the national value of the work of regional companies in terms that had been previously reserved for the capital’s institutions
Metaphors for good digital identities
Get PDFDigital identities are often discussed or explained as digital versions of physical documents such as passports. This metaphor tends to ignore, intentionally or not, the social challenges associated with real-world implementation of these technologies. This paper presents eight alternative metaphors for “good" digital identities which are derived from a 12-month Research-through-Design process. This process is presented as an annotated portfolio showcasing insights from a variety of design activities and stakeholder engagements, including design sprints, workshops, an artist residency and an exhibition, with the metaphors operating as “meta-annotations" on the portfolio. The eight metaphors intend to provoke and enable wider conversation with various stakeholders including academics, non-profits, industry professionals and policy makers about what “good" digital identities might mean, by focusing on societal rather than common technical concerns
Investigating the effects of ridesourcing on the dynamics of household car ownership
Get PDFCar ownership influences car use, but the emergence of ridesourcing has reshaped this dynamic. The emergence of ridesourcing presents a dual possibility regarding car ownership: it can reduce the need for private car ownership by providing a viable alternative, or it can encourage car ownership by providing an opportunity to earn extra income through ridesourcing. Using the United Kingdom Household Longitudinal Study dataset from 2009 to 2019, this study examines how ridesourcing affects the changes in household car ownership. After controlling for various factors, our results suggest that households are less likely to acquire a car in the presence of ridesourcing while car disposal decisions are mainly driven by household composition and residential relocation factors. We also examine the heterogeneous effects that vary by different numbers of household cars and residential areas. Our results can inform transport authorities and policymakers when planning a sustainable transport system with reduced car dependency
A phase 1 clinical trial shows safe, sustained, AAV-mediated expression of IL-1Ra in the human osteoarthritic knee joint
Get PDFOsteoarthritis (OA) is a major global health problem with no disease-modifying therapies. Interleukin-1 (IL-1) is a critical cytokine associated with the pathophysiology of OA and can be inhibited by IL-1 receptor antagonist (IL-1Ra). Here, we tested the delivery of a gene therapeutic encoding the human IL-1Ra to the knee in a phase 1, open-label clinical trial that enrolled nine patients with radiographic knee OA. The IL-1Ra gene was delivered by a self-complementary (sc)–recombinant adeno-associated virus (rAAV) serotype 2.5 (sc-rAAV2.5IL-1Ra) by intra-articular injection into an index knee at one of three doses: low [1 × 10¹¹ viral genomes (vg)], mid (1 × 10¹² vg), or high (1 × 10¹³ vg). The primary outcome was safety. There were no serious adverse events (AEs) related to sc-rAAV2.5IL-1Ra. Two AEs occurred that were possibly related to the vector. Both were effusions with increased pain and resolved with conservative treatment. sc-rAAV2.5IL-1Ra did not cause changes in vital signs, physical findings, or clinical laboratory measures. Less than 1% of the injected dose of sc-rAAV2.5IL-1Ra vg was detected in circulation after 1 day and was cleared within a week. Titers of neutralizing antibodies to AAV2.5 rose in serum and synovial fluid. In all cases, IL-1Ra concentration increased in the synovial fluid, and IL-1Ra concentrations remained elevated after 1 year. Baseline pain and function scores improved during the study. Therefore, we found that intra-articular gene therapy with sc-rAAV2.5IL-1Ra was safe. The sustained increase in local IL-1Ra in human knee joints supports the further clinical examination of this therapy to provide therapeutic benefit in OA
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