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Background Limited evidence suggests that exposure to traffic related air pollution is associated with graft failure among lung transplant recipients. We explored associations between pollution and transplant failure among lung and other solid organ transplant recipients in Great Britain through a retrospective cohort study. Methods All patients who received a lung, heart, liver, or kidney transplant between 2000 and 2008 in Great Britain were included, as recorded in the National Health Service Blood and Transplant (NHSBT) register and followed to March 2015. Using residential addresses at time of transplant we calculated distance to nearest (major) road and modelled annual average exposures to airborne nitrogen oxides and particulate matter of diameter ≤10µm and ≤2.5µm for each transplant recipient. All-cause mortality or graft failure (kidney) during follow up was the main outcome; median follow-up was around 10 years for each organ type. We fitted Cox regression models with adjustment for age, sex, year of transplant and donor age/smoking status. Results 780 lung, 1213 heart, 3650 liver and 11966 graft kidney transplant patients were analysed. We did not find any consistent associations between mortality or graft failure and any of the analysed air pollutants or road metrics. Although, exposure to particulate matter was associated with renal transplant failure in univariable analyses but not after adjustment for confounders. Conclusions Our analysis does not confirm previously reported associations between traffic-related air pollution exposure and the risk of transplant failure.

Background In order to increase the levels of physical activity in urban population, it is essential to evaluate how real-life policy interventions affect the population cycling attitudes and behaviour. There is evidence to support that policies of different nature have the potential to influence cycling behaviour, but few studies have done longitudinal and multiple interventions assessments. Methods As part of the PASTA European project (Physical Activity through Sustainable Travel Approaches), a longitudinal survey in 7 European cities provides data for the analysis. The questionnaires in the survey feature socio-demographic, psycho-social and city-specific policy-related questions. For each of the 7 cities, a selection of the highest impact policy measures implemented during the survey (November 2014 – January 2017) has been made. The effect of the policy interventions is studied as a natural experiment, with exposed and non-exposed population based on the distance to the infrastructure. The study includes unique a dose-response function which considers the exposure to multiple interventions, the technical quality of these interventions and an adapted bikeability index associated to each participant in each time stamp. Results Our sample includes 10,557 participants across the seven cities. Results will be shown for the complete dataset. Preliminary results from the initial questionnaire (baseline) are already available. A substantial part of the participants are initially either non-cyclists (24%) or cycling less than once a month (23%), which means that 47% of the sample could potentially start cycling or increase their frequency. Furthermore, 52% of the participants intend to increase their cycling rates in the future. All the cities have selected “top measures” and details are being collected. Measures range from bike to work campaigns, to cycle superhighways or other built environment interventions. For example, we have an estimate of a 36% of the participants in London being exposed to any kind of cycling policies. Once the evaluation model will be applied, results will show which profiles of participants are influenced by which types and dose of policies in their attitudes and decisions around cycling for transport. Conclusions The PASTA project explores the bridges between science and policymaking. This study develops and tests an innovative evaluation model which seeks to account for the impact in cycling behaviour of multiple interventions and for the quality of the build environment and interventions themselves. The relation between cycling policies and cycling behavioural aspects will help to determine the most promising policy avenues to promote cycling.

Background In order to increase the levels of physical activity in urban population, it is essential to know how a behavioural change towards cycling as active mobility can be produced and what factors influence people in their choice to cycle. But few studies have done longitudinal analysis of behavioural changes in cycling in relation to their policy context. Methods As part of the PASTA European project (Physical Activity through Sustainable Travel Approaches), a longitudinal survey in 7 European cities will provide the core data for the analysis. This survey was closed the 13th January 2017, after 2 years of data collection. The PASTA survey features specific questions designed to determine the attitudinal and behavioural profile of the participants. The conceptual framework used for the behavioural change assessment features an adaptation of the Transtheoretical Model of Behaviour Change and further developments, which describes five stages of change: Precontemplation, Contemplation, Preparation, Action and Maintenance. The sub-set of questions to determine the stage of change diagnosis are included in the initial (baseline) and final questionnaires, so that a “before” and “after” analysis can be undertaken. Other relevant psycho-social variables featured in the questionnaires will also be explored. The survey data is being complemented with background information including cycling policy and GIS data. Results Our sample is 10,557 participants across the seven cities (subject to further data cleaning). For this sample, a cross-city analysis of behavioural questions will be explored and compared for the initial (baseline) and final questionnaires. The baseline questionnaire has been already analysed and is showing a share of 23% of the sub-sampled participants (n=7,580) in the Precontemplation stage, 7% in Contemplation, 18% in Preparation, 41% in Action and 11% in Maintenance. In this presentation, results will be shown from the complete dataset (that is including all questionnaires) detailed for each of the seven cities, which is being analysed at the moment. The results of the stage diagnosis will be crossed with several socio-demographic variables, such as income, age, education level and sex. As an example, mean age is 40.08 (13.04) years and 54% of the participants are female. Conclusions Understanding the relative importance of the factors influencing mobility behaviour will help to determine the most promising policy avenues for the change towards cycling. This study puts together a unique mix of theories and methods in order to explore the bridges between behavioural change science and policy making.

Background There is limited evidence that exposure to traffic related air pollution is associated with the development of chronic lung allograft dysfunction and graft failure among lung transplant recipients. The aim of the study is to explore associations between traffic related air pollution and transplant failure among lung and other solid organ transplant recipients in Great Britain. Methods All lung, heart, liver, and kidney transplants between 2000 and 2008 were included. The last follow up date was 2 nd March 2015. Using residential postcode at time of transplant, we calculated distance to nearest road and distance to nearest major road. In addition, annual average air pollution exposures were modelled for each transplant recipient, including nitrogen dioxide, nitrogen oxides and particulate matter (PM 10 , PM 2.5 ). Cox regression models were fitted to assess associations between each air pollutant and transplant failure after adjustment for age, sex, transplant year and donor age/smoking status. Results 780 lung, 1213 heart, 3650 liver and 11966 graft kidney transplant patients were included in the analysis. The estimated median follow up time (years) was 9.1, 10.0, 9.1 and 8.8 for lung, heart, liver and kidney respectively. We did not find any consistent association between first lung, liver and kidney transplant failure and any of the analysed air pollutants. Conclusions Our analysis does not confirm associations between traffic related air pollution exposure and the risk of transplant failure as reported by previous studies.

Background Cycling in urban environments is seen as an activity providing many environmental, social and health benefits. There is potential for significant mode shifts towards cycling in many cities, and a better understanding of enabling factors and barriers could help guide more targeted cycle-promoting policies. Eastern-European cities such as Warsaw in particular tend to have low cycling rates and to be under-studied with regards to active travel behaviour. Methods We investigated travel mode choices and perceptions of cycling through surveys administered to two groups of adult population in Warsaw between December 2012 and January 2013. One was a paper and pencil survey of a representative random sample of citizens (“random” sample), while the other was an online survey of respondents who had cycled at least once in the past 6 months (“cyclists” sample). In both surveys, respondents were classified according to their behaviour in the past 6 months as either non-cyclists (did not cycle, for random sample only) utilitarian cyclists (cycled for transport) and recreational cyclists (cycled for recreation). Socio-demographics, travel habits and perceptions of cycling were compared across the categories using the χ2 test or fisher exact test, means using one-way ANOVA and medians using the Kruskal Wallis test. Results The “cyclist” sample (N=505) consisted of 41% recreational cyclists, and 59% utilitarian cyclist (of which 84% were also recreational). Utilitarian cyclists cycled on average 35 minutes per week more than recreational cyclists. They were more likely to perceive more benefits such as rapidity and sense of freedom, while recreational cyclists were more concerned about weather conditions. In the random sample (N=563), there were 46% non-cyclist, 37% recreational, and 15% utilitarian (of which 97% were also recreational) cyclists. The results show that, in general, cyclists tended to perceive less fear of being injured, saw cycling as being cheaper and faster than other modes, believed they had the time and resources needed for bicycle maintenance, felt a sense of freedom and observed to be faster when using bike. In addition, cyclists perceived the lack of cycle lane as less of a barrier to cycling than non-cyclists. Conclusions Cycling is more typically a recreational rather than a utilitarian activity in Warsaw. People who cycle at least occasionally tend to perceive more benefits and fewer barriers to cycling than non-cyclists, and cycling for travel enhances further these beliefs. Improving infrastructure but also making benefits of cycling more salient may increase cycling rates in Warsaw.

Objectives The UK CF Registry annual reports include comparisons between centres on key outcomes such as FEV 1 using rankings. While illustrating the distribution between centres, they promote the assumption that those with the highest measures provide "better" care. We hypothesised a more scientific approach based on statistical "process control" and adjustment for case-mix may identify exceptional CF care services in terms of clinically meaningful outcomes. Methods We extracted FEV 1 and BMI on patients aged 12–21 from annual review data (2007–2012). Funnel plots were generated with confidence limits at 2 and 3 standard deviations (SD). Centres with mean values outside these limits are said to display "special cause variation" – variability outside what one would expect. Outcomes were then adjusted for case mix (including gender, genotype, pancreatic sufficiency and socio-economic deprivation) and analysed using funnel plots. Results Using a primary outcome of FEV 1 at age 15, data for 1066 patients from 31 paediatric centres were available. Funnel plots of unadjusted data showed 8 centres with evidence of special cause variation (at 2SD limits). Initial adjustment for case-mix reduced the number of centres outside these limits to 3. None of the centres were outside the 3SD limits in either analysis. Similar patterns were found for BMI percentile in this age group. Conclusion In conclusion the work to-date illustrates that funnel plots can be used to identify differences in FEV 1 and BMI between specialist paediatric centres. Case-mix adjustment models should develop into a useful tool for making centre comparisons which can continue to be used by stakeholders.