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Purpose The purpose of this paper is to provide first-hand reflective narratives from participants of their involvement in the overall process, with particular reference to the benefits and challenges of engagement. Design/methodology/approach Five participants agreed to write a reflective piece of approximately 500 words on their involvement in the PhotoVoice project. Findings The reflective narratives in this paper demonstrate the personal and professional benefits of sustained and meaningful engagement, while challenges such as power imbalances, identity management, time and cost commitments are discussed. Practical implications PhotoVoice is a methodology that has the potential to democratise knowledge production and dissemination. Originality/value There are scant examples in the PhotoVoice literature of the inclusion of participants involvement in dissemination activities. The reflective narratives in this paper demonstrate the personal and professional benefits of sustained and meaningful engagement, while challenges such as power imbalances, identity management, time and cost commitments are discussed.

Road ecology has traditionally focused on the impact of in-situ and functional roads on wildlife. However, road construction also poses a major, yet understudied, threat and the implications for key aspects of animal behaviour are unknown. Badgers (Meles meles) have been implicated in the transmission of tuberculosis to cattle. There are concerns that environmental disturbances, including major road construction, can disrupt badger territoriality, promoting the spread of the disease to cattle. To address these knowledge gaps the ranging behaviour of a medium-density Irish badger population was monitored using GPS-tracking collars before, during, and after a major road realignment project that bisected the study area. We estimated badgers’ home range sizes, nightly distances travelled, and the distance and frequency of extra-territorial excursions during each phase of the study and quantified any changes to these parameters. We show that road construction had a very limited effect on ranging behaviour. A small increase in nightly distance during road construction did not translate into an increase in home range size, nor an increase in the distance or frequency of extra-territorial excursions during road construction. In addition, suitable mitigation measures to prevent badger deaths appeared to ensure that normal patterns of ranging behaviour continued once the new road was in place. We recommend that continuous badger-proof fencing be placed along the entire length of new major roads, in combination with appropriately sited underpasses. Our analysis supports the view that road construction did not cause badgers to change their ranging behaviour in ways likely to increase the spread of tuberculosis.

OBJECTIVE The frequency and seasonality of viruses in tropical regions are scarcely reported. We estimated the frequency of seven respiratory viruses and assessed seasonality of respiratory syncytial virus (RSV) and influenza viruses in a tropical city. METHODS Children (age ≤ 18 years) with acute respiratory infection were investigated in Salvador, Brazil, between July 2014 and June 2017. Respiratory viruses were searched by direct immunofluorescence and real-time polymerase chain reaction for detection of RSV, influenza A virus, influenza B virus, adenovirus (ADV) and parainfluenza viruses (PIV) 1, 2 and 3. Seasonal distribution was evaluated by Prais-Winsten regression. Due to similar distribution, influenza A and influenza B viruses were grouped to analyse seasonality. RESULTS The study group comprised 387 cases whose median (IQR) age was 26.4 (10.5-50.1) months. Respiratory viruses were detected in 106 (27.4%) cases. RSV (n = 76; 19.6%), influenza A virus (n = 11; 2.8%), influenza B virus (n = 7; 1.8%), ADV (n = 5; 1.3%), PIV 1 (n = 5; 1.3%), PIV 3 (n = 3; 0.8%) and PIV 2 (n = 1; 0.3%) were identified. Monthly count of RSV cases demonstrated seasonal distribution (b3 = 0.626; P = 0.003). More than half (42/76 [55.3%]) of all RSV cases were detected from April to June. Monthly count of influenza cases also showed seasonal distribution (b3 = -0.264; P = 0.032). Influenza cases peaked from November to January with 44.4% (8/18) of all influenza cases. CONCLUSIONS RSV was the most frequently detected virus. RSV and influenza viruses showed seasonal distribution. These data may be useful to plan the best time to carry out prophylaxis and to increase the number of hospital beds.

Political momentum and funding for combatting antimicrobial resistance (AMR) continues to build. Numerous major international and national initiatives aimed at financially incentivising the research and development (R&D) of antibiotics have been implemented. However, it remains unclear how to effectively strengthen the current set of incentive programmes to further accelerate antibiotic innovation. Based on a literature review and expert input, this study first identifies and assesses the major international, European Union, US and UK antibiotic R&D funding programmes. These programmes are then evaluated across market and public health criteria necessary for comprehensively improving the antibiotic market. The current set of incentive programmes are an important initial step to improving the economic feasibility of antibiotic development. However, there appears to be a lack of global coordination across all initiatives, which risks duplicating efforts, leaving funding gaps in the value chain and overlooking important AMR goals. This study finds that incentive programmes are overly committed to early-stage push funding of basic science and preclinical research, while there is limited late-stage push funding of clinical development. Moreover, there are almost no pull incentives to facilitate transition of antibiotic products from early clinical phases to commercialisation, focus developer concentration on the highest priority antibiotics and attract large pharmaceutical companies to invest in the market. Finally, it seems that antibiotic sustainability and patient access requirements are poorly integrated into the array of incentive mechanisms.

Background Irbesartan, a long acting selective angiotensin-1 receptor inhibitor, in Marfan syndrome might reduce aortic dilatation, which is associated with dissection and rupture. We aimed to determine the effects of irbesartan on the rate of aortic dilatation in children and adults with Marfan syndrome. Methods We did a placebo-controlled, double-blind randomised trial at 22 centres in the UK. Individuals aged 6–40 years with clinically confirmed Marfan syndrome were eligible for inclusion. Study participants were all given 75 mg open label irbesartan once daily, then randomly assigned to 150 mg of irbesartan (increased to 300 mg as tolerated) or matching placebo. Aortic diameter was measured by echocardiography at baseline and then annually. All images were analysed by a core laboratory blinded to treatment allocation. The primary endpoint was the rate of aortic root dilatation. This trial is registered with ISRCTN, number ISRCTN90011794. Findings Between March 14, 2012, and May 1, 2015, 192 participants were recruited and randomly assigned to irbesartan (n=104) or placebo (n=88), and all were followed for up to 5 years. Median age at recruitment was 18 years (IQR 12–28), 99 (52%) were female, mean blood pressure was 110/65 mm Hg (SDs 16 and 12), and 108 (56%) were taking β blockers. Mean baseline aortic root diameter was 34·4 mm in the irbesartan group (SD 5·8) and placebo group (5·5). The mean rate of aortic root dilatation was 0·53 mm per year (95% CI 0·39 to 0·67) in the irbesartan group compared with 0·74 mm per year (0·60 to 0·89) in the placebo group, with a difference in means of −0·22 mm per year (−0·41 to −0·02, p=0·030). The rate of change in aortic Z score was also reduced by irbesartan (difference in means −0·10 per year, 95% CI −0·19 to −0·01, p=0·035). Irbesartan was well tolerated with no observed differences in rates of serious adverse events. Interpretation Irbesartan is associated with a reduction in the rate of aortic dilatation in children and young adults with Marfan syndrome and could reduce the incidence of aortic complications. Funding British Heart Foundation, the UK Marfan Trust, the UK Marfan Association.

The importance of daylight in homes is widely understood Site Layout Planning for Daylight and Sunlight: A Guide to Good Practice (BR209), Bracknell: BRE Press, 2011 [Extracted from the article] Copyright of Lighting Research & Technology is the property of Sage Publications, Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

Summary Background Antibacterial resistant infections are rising continuously, resulting in increased morbidity and mortality worldwide. With no new antibiotic classes entering the market and the possibility of returning to the pre-antibiotic era, the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR) was established to address this problem. We aimed to quantify the scale and scope of publicly funded antibacterial resistance research across JPIAMR countries and at the European Union (EU) level to identify gaps and future opportunities. Methods We did a systematic observational analysis examining antibacterial resistance research funding. Databases of funding organisations across 19 countries and at EU level were systematically searched for publicly funded antibacterial resistance research from Jan 1, 2007, to Dec 31, 2013. We categorised studies on the basis of the JPIAMR strategic research agenda's six priority topics (therapeutics, diagnostics, surveillance, transmission, environment, and interventions) and did an observational analysis. Only research funded by public funding bodies was collected and no private organisations were contacted for their investments. Projects in basic, applied, and clinical research, including epidemiological, public health, and veterinary research and trials were identified using keyword searches by organisations, and inclusion criteria were based on the JPIAMR strategic research agenda's six priority topics, using project titles and abstracts as filters. Findings We identified 1243 antibacterial resistance research projects, with a total public investment of €1·3 billion across 19 countries and at EU level, including public investment in the Innovative Medicines Initiative. Of the total amount invested in antibacterial resistance research across the time period, €646·6 million (49·5%) was invested at the national level and €659·2 million (50·5%) at the EU level. When projects were classified under the six priority topics we found that 763 (63%) of 1208 projects funded at national level were within the area of therapeutics, versus 185 (15%) in transmission, 131 (11%) in diagnostics, 53 (4%) in interventions, and only 37 (3%) in environment and 39 (3%) in surveillance. Interpretation This was the first systematic analysis of research funding of antibacterial resistance of this scale and scope, which relied on the availability and accuracy of data from organisations included. Large variation was seen between countries both in terms of number of projects and associated investment and across the six priority topics. To determine the future direction of JPIAMR countries a clear picture of the funding landscape across Europe and Canada is needed. Countries should work together to increase the effect of research funding by strengthening national and international coordination and collaborations, harmonising research activities, and collectively pooling resources to fund multidisciplinary projects. The JPIAMR have developed a publicly available database to document the antibacterial resistance research collected and can be used as a baseline to analyse funding from 2014 onwards. Funding JPIAMR and the European Commission.

Background: Environmental tobacco smoke has an adverse association with preterm birth and birth weight. England introduced a new law to make virtually all enclosed public places and workplaces smoke free on July 1, 2007. We investigated the effect of smoke-free legislation on birth outcomes in England using Hospital Episode Statistics (HES) maternity data.Methods: We used regression discontinuity, a quasi-experimental study design, which can facilitate valid causal inference, to analyze short-term effects of smoke-free legislation on birth weight, low birth weight, gestational age, preterm birth, and small for gestational age.Results: We analyzed 1,800,906 pregnancies resulting in singleton live-births in England between 1 January 2005 and 31 December 2009. In the 1 to 5 months following the introduction of the smoke-free legislation, for those entering their third trimester, the risk of low birth weight decreased by between 8% (95% confidence interval [CI]: 4%, 12%) and 14% (95% CI: 5%, 23%), very low birth weight between 28% (95% CI: 19%, 36%) and 32% (95% CI: 21%, 41%), preterm birth between 4% (95% CI: 1%, 8%) and 9% (95% CI: 2%, 16%), and small for gestational age between 5% (95% CI: 2%, 8%) and 9% (95% CI: 2%, 15%). The estimated impact of the smoke-free legislation varied by maternal age, deprivation, ethnicity, and region.Conclusions: The introduction of smoke-free legislation in England had an immediate estimated beneficial impact on birth outcomes overall, although we did not observe improvements across all age, ethnic, or deprivation groups.See video abstract at http://links.lww.com/EDE/B85.

The threat of antimicrobial resistance causing drug-resistant infections and the escalating health, social and economic consequences are now becoming visible at a global level. Here, we discuss the economic and political considerations for creating a truly global and effective response to antimicrobial resistance.

Energy-efficient building performance requires sophisticated control systems that are based on realistic occupant behaviour models. To provide robust data for the development of these models, research studies in real-world settings are needed. Yet, such studies are challenging and necessitate careful design in terms of data collection methods and procedures. This paper describes and critiques the design of a mixed methods approach for occupant behaviour research. It reviews the methodology developed for a longitudinal study in a real-world office environment where occupants’ experience with a novel facade technology (electrochromic glazing) was investigated. The methodology integrates objective physical measurements, observational data and self-reported experience data. Using data from one day of the study, this paper illustrates how the different sources can be combined in order to derive an in-depth understanding of the interplay between external daylight conditions, characteristics of the facade technology, occupant interaction with the technology and the resulting occupant experience. It was found that whilst the individual methods may be affected by practical limitations, these can be partially offset by combining physical measurements and observations with self-reported data. The paper critically evaluates the individual techniques, as well as the benefits of their integration and makes recommendations for the design of future occupant behaviour studies in real-world settings.

© 2015 Wiley-VCH Verlag GmbH & Co. KGaA. A major application area for electrochromic devices is architectural glazing, particularly that for office buildings which are often highly glazed. This chapter begins with an overview of daylighting in non-residential buildings and explains why the traditional control solutions, for example, blinds, often lead to the under-exploitation of the daylighting potential of the building. It reviews the control of daylight in buildings together with reasons why the traditional methods, for example, venetian blinds, are habitually used in a sub-optimal fashion, often negating the daylight potential afforded by the glazing design. Various types of chromogenic and variable transmission glazing (VTG) are outlined, and the potential for practical use in buildings together with operational factors and performance issues is discussed. The chapter concludes with a description of and preliminary findings from a case study evaluation of a pair of offices spaces in the United Kingdom fitted with EC glazing.

Human migration is often considered an important driver of land use change and a threat to protected area integrity, but the reasons for in-migration, the effectiveness of conservation restrictions at stemming migration, and the extent to which migrants disproportionately contribute to land use change has been poorly studied, especially at fine spatial scales. Using a case study in eastern Madagascar (603 household surveys, mapping agricultural land for a sub-set of 167 households, and 49 focus group discussions and key informant interviews), we explore the patterns and drivers of migration within the lifetime of those currently alive. We investigate how this influences forest conversion on the border of established protected areas and sites without a history of conservation restrictions. We show that in-migration is driven, especially in sites with high migration, by access to land. There is a much higher proportion of migrant households at sites without a long history of conservation restrictions than around long-established protected areas, and migrants tend to be more educated and live closer to the forest edge than non-migrants. Our evidence supports the engulfment model (an active forest frontier later becoming a protected area); there is no evidence that protected areas have attracted migrants. Where there is a perceived open forest frontier, people move to the forest but these migrants are no more likely than local people to clear land (i.e. migrants are not ‘exceptional resource degraders’). In some parts of the tropics, out-migration from rural areas is resulting in forest regrowth; such a forest transition is unlikely to occur in Madagascar for some time. Those seeking to manage protected areas at the forest-frontier will therefore need to prevent further colonisation; supporting tenure security for existing residents is likely to be an important step.

Research was undertaken within the Irish Environmental Protection Agency (EPA) Environmental RTDI Programme during the six‐month period from March to August 2001 by a partnership formed by the Centre for Environmental Research (CER), University of Limerick, and the Centre for Urban and Regional Ecology (CURE), University of Manchester. This project aimed to inform the development of spatial policies emerging from the National Spatial Strategy (NSS) aimed at finding optimal ways in which to accommodate Ireland’s growing population in a manner consistent with balanced regional development and environmental sustainability. To obtain data and information on settlements, three modes of analysis were adopted. First, for a single city and two villages, both quantitative and qualitative data were collected to provide a comprehensive analysis of the local social, economic and physical environments, track record in enhancing sustainability, current policies in place, and the likelihood of these policies proving successful. Second, for 11 Irish settlements selected to include a range of functions and locations, 29 quantified sustainability indicators were developed and used to compare the level of sustainability achieved by settlements of differing sizes. Third, a review of international literature was undertaken to search for comparable data, models and case studies, so as to provide a context for analysis of Irish data. The framework of significant environmental themes adopted here is taken from recent Irish EPA publications. Results based on all three research methods suggest that on balance larger settlements in the recent past, at present and in the foreseeable future are more likely to create conditions in which sustainability is enhanced. This work provides the basis for a large‐scale three‐year study which commenced in March 2002, which examines the sustainability and future development patterns of settlements in Ireland.

Local Agenda 21 stresses the importance of local accountability, interaction, active citizenship and quality of life. To be effective at local and regional levels, sustainability indicators must reflect community values, concerns and hopes for the future. Meaningful interactive participation in the development of a set of indicators demands enduring and effective communication between researchers, policy makers and 'user groups'. In 1998 the Centre for Environmental Research, University of Limerick, in association with the four main local authorities in the Mid-west region of Ireland (Limerick City Council, Limerick County Council, Clare County Council and Tipperary County Council) commenced a project to promote sustainable development in the region. This paper provides a description and critique of a case study in the interactive research process as a novel methodology designed to encourage active citizenship and participation. Interaction occurred among groups representative of the local authorities, th...

We report the case of a 76-year-old lady who had a mitral valve (MV) replacement for severe MV stenosis. Several days following the procedure, a routine transthoracic echocardiogram (TTE) was performed. Despite the prosthesis leaflets opening well anterograde maximum velocities were elevated; MV peak velocity of 2.4 m/s. A transoesophageal echocardiogram (TEE) demonstrated the superior strut of the prosthesis appearing to rotate inwards such that the ventricular (non-fixed) end of the struts approximate to one another during systole, reducing the effective orifice area for anterograde flow. A 3D TEE was performed. This showed that the valve struts were not parallel, with the planes of the struts converging from the base to the apex. However, this abnormal conformation appeared to be fixed rather than worsening in systole. The apparent movement of the posterior strut seen in the 2D TEE images appears to have resulted from systole movement of this strut partially out of the plane of the TEE (2D) cut. We believe the case demonstrates the value of 3D real-time TEE in the assessment of the MV prosthesis function.

Introduction: Femoral fractures are often the result of high-velocity injuries, and the early identification of associated injuries is important. The purpose of this study was to review the associated injuries present in a current UK series of patients who sustain femoral fractures as a result of motor vehicle accidents. Materials and methods: All cases of femoral fractures were extracted from the UK co-operative crash injury study (CCIS) database, from 1998 to 2002. Associated injuries, skeletal and non-skeletal, were identified by body region and severity (according to the abbreviated injury scale and injury severity scale). Results: A total of 5,841 crashes were investigated in that time period, and there were 365 car occupants who sustained a femoral fracture. The 16–35 age group accounted for nearly half of all cases. A total of 313 patients (85.2%) had at least one other concomitant significant injury, of which 84 (23.0%) had skeletal injury only, 45 (12.3%) had non-skeletal injury only, and 184 (50.4%) had both. The opposite lower limb was the most common skeletal injury, and thoracic injuries were the most common visceral injuries. Thoracic injuries also accounted for the most serious injuries (AIS 4–6). The overall mortality was 40.5% in our series. Conclusion: Concomitant injuries are to be expected in the majority of cases of femoral fractures sustained as a result of MVCs. There should be a low threshold for involving a general surgical team in the management of these cases.