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Abstract Background De-escalation is often advocated to reduce harm associated with violence and use of restrictive interventions, but there is insufficient understanding of factors that influence de-escalation behaviour in practice. For the first time, using behaviour change and implementation science methodology, this paper aims to identify the drivers that will enhance de-escalation in acute inpatient and psychiatric intensive care mental health settings. Methods Secondary analysis of 46 qualitative interviews with ward staff (n = 20) and patients (n = 26) informed by the Theoretical Domains Framework. Results Capabilities for de-escalation included knowledge (impact of trauma on memory and self-regulation and the aetiology and experience of voice hearing) and skills (emotional self-regulation, distress validation, reducing social distance, confirming autonomy, setting limits and problem-solving). Opportunities for de-escalation were limited by dysfunctional risk management cultures/ relationships between ward staff and clinical leadership, and a lack of patient involvement in safety maintenance. Motivation to engage in de-escalation was limited by negative emotion associated with moral formulations of patients and internal attributions for behaviour. Conclusion In addition to training that enhances knowledge and skills, interventions to enhance de-escalation should target ward and organisational cultures, as well as making fundamental changes to the social and physical structure of inpatient mental health wards. Psychological interventions targeting negative emotion in staff are needed to increase motivation. This paper provides a new evidence-based framework of indicative changes that will enhance de-escalation in adult acute mental health inpatient and PICU settings.

Care, management, and statute each mandate restraint-reporting in psychiatric settings in England. PROD-ALERT in this journal (“PA1”) correlated log incidence of restraint, log institutional size, and log detention. The period was September 2020 to August 2021. It showed a clear trend among reporters. Restraint correlated with institutional size and use of legal detention. Some large detaining providers reported no restraints per month despite that trend. Inference from size suggested that non-complete reporters restrained 1,774 people per month. This paper “PA2” develops analysis repeating it for September 2021 to August 2022. PA2 shows how to count L-information, i.e., questionable information, added by null reports, by applying an L-test to data sets. PA2 uses illustrative vignettes about human height to ground L-information scores from English restraint reporting. In PA2, reported restraint again correlates with size and detention as in PA1. PA2 shows evolving data. Providers still follow a trend in restraint by size and detention. Providers which newly report restraint are on trend. Inference suggests that non-complete reporters restrained 1,305 people per month (536–3233), 95% CI, a large but reduced number since PA1. English restraint data have an L-test L-information score of increase in information by a factor of L = 145. This is as surprising as claiming that an average English man of 1.72 m is 2.64 m tall. Persons restrained per month is a robust measure continuing to log-correlate with size and legal compulsion. Providers over a certain size who report null restraint probably have some. Restraint remains underreported in England. Imputation of incomplete reporters shows a large shrinking cohort of patients detained by incomplete reporters. Knowledge of this may promote reporting. Improved reporting, and the infrastructure and integrity it demands, may help providers measure and reduce restraint. PA1 remains unrefuted. L-test can measure L-information in intuitively representable ways. The informational effect of nulls on the reliable data set is similar to a claim that an average-heighted man is as tall as people with clinical gigantism.

Abstract The global health burden from wildfire smoke is expected to worsen under climate change, yet we lack quantitative estimates of the economic costs of increased mortality and hospital admissions for cardiovascular and respiratory conditions. Using a quantitative wildfire risk assessment framework and a 12-member climate model ensemble, we find a median increase in wildfire smoke health costs of 1–16% by 2070 across diverse landscapes in south-eastern Australia. Ensemble maximum cost increases (5–38%) often exceed abatements from fuel treatment, while costs decline moderately (0–7%) for the ensemble minimum. Unmitigated climate change will increase the health burden of wildfire smoke and undermine prescribed burning effectiveness.

Background Containment (e.g. physical restraint and seclusion) is used frequently in mental health inpatient settings. Containment is associated with serious psychological and physical harms. De-escalation (psychosocial techniques to manage distress without containment) is recommended to manage aggression and other unsafe behaviours, for example self-harm. All National Health Service staff are trained in de-escalation but there is little to no evidence supporting training’s effectiveness. Objectives Objectives were to: (1) qualitatively investigate de-escalation and identify barriers and facilitators to use across the range of adult acute and forensic mental health inpatient settings; (2) co-produce with relevant stakeholders an intervention to enhance de-escalation across these settings; (3) evaluate the intervention’s preliminary effect on rates of conflict (e.g. violence, self-harm) and containment (e.g. seclusion and physical restraint) and understand barriers and facilitators to intervention effects. Design Intervention development informed by Experience-based Co-design and uncontrolled pre and post feasibility evaluation. Systematic reviews and qualitative interviews investigated contextual variation in use and effects of de-escalation. Synthesis of this evidence informed co-design of an intervention to enhance de-escalation. An uncontrolled feasibility trial of the intervention followed. Clinical outcome data were collected over 24 weeks including an 8-week pre-intervention phase, an 8-week embedding and an 8-week post-intervention phase. Setting Ten inpatient wards (including acute, psychiatric intensive care, low, medium and high secure forensic) in two United Kingdom mental health trusts. Participants In-patients, clinical staff, managers, carers/relatives and training staff in the target settings. Interventions Enhancing de-escalation techniques in adult acute and forensic units: Development and evaluation of an evidence-based training intervention (EDITION) interventions included de-escalation training, two novel models of reflective practice, post-incident debriefing and feedback on clinical practice, collaborative prescribing and ward rounds, practice changes around admission, shift handovers and the social and physical environment, and sensory modulation and support planning to reduce patient distress. Main outcome measures Outcomes measured related to feasibility (recruitment and retention, completion of outcome measures), training outcomes and clinical and safety outcomes. Conflict and containment rates were measured via the Patient–Staff Conflict Checklist. Clinical outcomes were measured using the Attitudes to Containment Measures Questionnaire, Attitudes to Personality Disorder Questionnaire, Violence Prevention Climate Scale, Capabilities, Opportunities, and Motivation Scale, Coercion Experience Scale and Perceived Expressed Emotion in Staff Scale. Results Completion rates of the proposed primary outcome were very good at 68% overall (excluding remote data collection), which increased to 76% (excluding remote data collection) in the post-intervention period. Secondary outcomes had high completion rates for both staff and patient respondents. Regression analyses indicated that reductions in conflict and containment were both predicted by study phase (pre, embedding, post intervention). There were no adverse events or serious adverse events related to the intervention. Conclusions Intervention and data-collection procedures were feasible, and there was a signal of an effect on the proposed primary outcome. Limitations Uncontrolled design and self-selecting sample. Future work Definitive trial determining intervention effects. Trial registration This trial is registered as ISRCTN12826685 (closed to recruitment). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 16/101/02) and is published in full in Health Technology Assessment; Vol. 28, No. 3. See the NIHR Funding and Awards website for further award information. Context Conflict (a term used to describe a range of potentially unsafe events including violence, self-harm, rule-breaking, medication refusal, illicit drug and alcohol use and absconding) in mental health settings causes serious physical and psychological harm. Containment interventions which are intended to minimise harm from violence (and other conflict behaviours) such as restraint, seclusion and rapid tranquilisation can result in serious injuries to patients and, occasionally, death. Involvement in physical restraint is the most common cause of serious physical injury to National Health Service mental health staff in the United Kingdom. Violence to staff results in substantial costs to the health service in sickness and litigation payments. Containment interventions are also expensive (e.g. physical restraint costs mental health services £6.1 million and enhanced observations £88 million per annum). Despite these harms, recent findings indicate containment interventions such as seclusion and physical restraint continue to be used frequently in mental health settings. Clinical trials have demonstrated that interventions can reduce containment without increasing violence and other conflict behaviours (e.g. verbal aggression, self-harm). Substantial cost-savings result from reducing containment use. De-escalation, as an intervention to manage aggression and potential violence without restrictive practices, is a core intervention. ‘De-escalation’ is a collective term for a range of psychosocial techniques designed to reduce distress and anger without the need to use ‘containment’ interventions (measures to prevent harm through restricting a person’s ability to act independently, such as physical restraint and seclusion). Evidence indicates that de-escalation involves ensuring conditions for safe intervention and effective communication are established, clarifying and attempting to resolve the patient’s concern, conveyance of respect and empathy and regulating unhelpful emotions such as anxiety and anger. Despite featuring prominently in clinical guidelines and training policy domestically and internationally and being a component of mandatory National Health Service training, there is no evidence-based model on which to base training. A systematic review of de-escalation training effectiveness and acceptability conducted in 2015 concluded: (1) no model of training has demonstrated effectiveness in a sufficiently rigorous evaluation, (2) the theoretical underpinning of evaluated models was often unclear and (3) there has been inadequate investigation of the characteristics of training likely to enhance acceptability and uptake. Despite all National Health Service staff being trained in de-escalation there have been no high-quality trials evaluating the effectiveness and cost-effectiveness of training. Feasibility studies are needed to establish whether it is possible to conduct a definitive trial that can determine the clinical, safety and cost-effectiveness of this intervention. Plain language summary Mental health hospitals are stressful places for patients and staff. Patients are often detained against their will, in places that are noisy, unfamiliar and frightening. Violence and self-injury happen quite frequently. Sometimes staff physically restrain patients or isolate patients in locked rooms (called seclusion). While these measures might sometimes be necessary to maintain safety, they are psychologically and physically harmful. To help reduce the use of these unsafe measures, staff are trained in communication skills designed to reduce anger and distress without using physical force. Professionals call these skills ‘de-escalation’. Although training in de-escalation is mandatory, there is no good evidence to say whether it works or not, or what specific techniques staff should be trained in. The Enhancing de-escalation techniques in adult acute and forensic units: Development and evaluation of an evidence-based training intervention (EDITION) project aimed to develop and evaluate a de-escalation training programme informed by research evidence. We interviewed over one hundred people who either worked in or received treatment in a mental health hospital. These people were clear that the training should target key sources of interpersonal and environmental stress that prevent de-escalation from working. We also reviewed all the scientific studies on de-escalation and training, aiming to identify the elements of training that are most likely to increase use of de-escalation. Then, in partnership with current mental health service users and clinical staff, we developed the training programme. Training was delivered to more than 270 staff working in 10 different wards in mental health hospitals. We measured rates of violence, self-injury and use of physical restraint and seclusion 8 weeks before staff received training and 16 weeks after they received training (24 weeks of data collection in total). Analysis of these data showed that these unsafe events were occurring significantly less frequently after training than they were before training, which raised the possibility that the training was helping to reduce harm. Scientific summary Background De-escalation techniques are recommended for averting potential violence in mental health settings without resorting to ‘containment’ interventions (e.g. physical restraint and seclusion) and are part of mandatory National Health Service (NHS) training. But existing training is non-evidence-based and containment interventions are used too often/too soon when conflict occurs. Containment interventions have low acceptability to patients, are potentially harmful and have limited evidence supporting their safety and effectiveness. Objectives EDITION’s overall aim was to develop a feasible, acceptable, evidence-based de-escalation staff training intervention to reduce rates of conflict (e.g. physical aggression, self-harm) and containment in adult mental health inpatient settings. We had the following objectives: Understand the factors that enhance and inhibit de-escalation behaviours in adult acute mental health inpatient settings, psychiatric intensive care units (PICUs) and adult forensic, low-, medium- and high-security inpatient mental health settings. Develop with stakeholders an effective, acceptable and context-sensitive de-escalation training intervention for mental health staff. Establish the feasibility of embedding our intervention into secondary care mental health services by monitoring training uptake and engagement rates, and exploring, from multiple stakeholder perspectives, potential barriers and enablers to its implementation. Establish the feasibility of conducting a randomised controlled trial (RCT) to determine the clinical and cost-effectiveness of our intervention, by quantifying participant recruitment and retention, and identifying the optimal strategies to overcome any difficulties experienced. Examine the applicability (content validity) and acceptability (full and partial completion rates, sensitivity-to-change) of proposed trial outcome measures. Collect outcome data to help inform the parameters of a fully powered trial, including identification and standard deviation of the proposed primary outcome measure for sample size. Methods Three work packages (WPs) were completed to develop, deliver and evaluate an evidence-based staff de-escalation training intervention adaptable for use in different settings and patient populations. WP1 consisted of two systematic reviews and a large-scale (128 participants) qualitative inquiry in adult acute and adult forensic inpatient settings. The systematic reviews consisted of an update of the authors’ previous review of de-escalation training effectiveness and acceptability in 2015 and a Theoretical Domains Framework (TDF)-informed qualitative evidence synthesis of barriers and enablers to the de-escalation of conflict in adult acute and forensic inpatient settings. Work package 2 involved the development of the EDITION training intervention, which was guided by the Behaviour Change Wheel and followed the principles of Experience-based Co-design. The process consisted of five phases: (1) charting and synthesis of behaviour change targets; (2) stakeholder events to prioritise and organise behaviour change targets and generate intervention ideas; (3) intensive working with smaller co-design teams to map the stakeholder-generated ideas to formal behaviour change techniques (using the Behaviour Change Techniques Taxonomy, v1) and develop an intervention draft; (4) stakeholder event to refine and finalise the intervention; and (5) reporting of the final intervention according to the Template for Intervention Description and Replication (TIDieR) guidelines for intervention description and replication. Work package 3 involved a feasibility trial and process evaluation of the EDITION intervention which evaluated the impact, acceptability and feasibility in 10 purposively selected wards. The intervention was evaluated using an uncontrolled pre and post design (this was to ensure maximum variation in our understanding of contextual acceptability, feasibility and impact). Data were collected over 24 weeks: 8 weeks pre training, an 8-week period to embed the intervention and 8 weeks post implementation. Staff-reported outcomes were capability, motivation and opportunity to use de-escalation (COM-B model); rates of conflict and containment [Patient and Staff Conflict Checklist (PCC-SR)]; attitudes to containment [Attitudes to Containment Measures Questionnaire (ACMQ)]; attitudes to personality disorder [Attitudes to Personality Disorder Questionnaire (APDQ)] and the Violence Prevention Climate (VPC). Patient-reported outcomes were: Perceived Expressed Emotion in Staff (PEES) and coercion experience [Coercion Experience Scale (CES)]. The observer-rated de-escalation performance English-Modified De-escalating Aggressive Behaviour Scale (EM-DABS) was used to assess trainee performance pre and post training. Training acceptability was evaluated via the Training Acceptability Rating Scale (TARS) distributed to trainees at the end of each session. The economic component of the feasibility study explored using the EuroQol-5 Dimensions, five-level version (EQ-5D-5L) to assess health status and quality-adjusted life-years (QALYs) and estimates of (1) the additional costs of providing and implementing the new training package, (2) costs of managing conflict and (3) the average costs of inpatient stay. The feasibility and acceptability of the EDITION intervention were also assessed through participant observation and semi-structured interviews with multidisciplinary team professionals, staff and patients in the implementation settings. Critical parameters for a future trial such as the feasibility and acceptability of recruitment strategies and the appropriate primary outcome were also assessed. Results The updated systematic review of de-escalation training effectiveness and acceptability identified 10 eligible studies published since the last search (August 2014). Synthesising these new data with the findings of our original review did not change its conclusions. The methodological quality of prior evaluations is weak and there is stronger indication of effects on training outcomes (e.g. knowledge and skills demonstration) than improvements in clinical or safety outcomes. The TDF-informed qualitative evidence synthesis of barriers and facilitators to the de-escalation of conflict identified and synthesised the findings of 62 eligible qualitative studies. WP1 qualitative data from adult acute and adult forensic mental health inpatients were composed of 60 individual interviews and 11 focus groups with 46 patient participants, 54 ward staff participants, 10 carer participants and 18 multidisciplinary professional participants (128 participants in total). These data revealed de-escalation was conceptualised by participants as an intersubjective process occurring in the context of intense, social encounters between (generally) a lone patient and either a single member of staff or a group of staff. Both staff and patients described paying vigilant attention to the behaviour of the ‘other’ during these encounters and making efforts to both regulate their own internal state (cognition, affect, arousal) as well as making efforts to regulate the internal state of the other party (e.g. by distraction or re-framing perceptions). These regulatory actions were by no means unidirectional (staff de-escalates patient). Indeed, patients provided many examples of de-escalating dysregulated staff behaviour. As such, de-escalation was characterised as a collaborative ‘process’ rather than the application of a discrete set of staff skills. Both staff and patient accounts agreed that their capacity to engage in the regulatory processes involved in de-escalation is often influenced by factors that are extraneous to the immediate situation. Moreover, they agreed that if staff or patient ability to appreciate context (consider alternative interpretations, weigh the costs and benefits of courses of action) is overwhelmed by their internal state, an impulsively violent action occurs (e.g. an assault, a physical restraint). Patient and staff accounts were consistent in the sense that they both indicated that any intervention aiming to enhance de-escalation must first address the key sources of interpersonal and environmental stress that limit patient and staff capacity for self-regulation when encounters requiring de-escalation occur. For staff, capacity for self-regulation was influenced by their individual skill levels, their knowledge of the patient/s involved in the encounter, cultures of contempt for vulnerability within staff teams, common, ideological representations of mental health problems (especially personality disorder) constructed in teams and organisations, and punitive organisational cultures where blame and sanction deter staff willingness to take positive risks. For patients, capacity for self-regulation was influenced by illiberal ward regimes (myriad rules, enforced inflexibly), environmental signifiers of threat and disrespect (visible evidence of coercion, organisational messaging demanding unconditional patient respect for staff), disempowering and dehumanising conduct of key clinical and ward processes (ward rounds, handovers, prescribing, waiting times, medication rounds, mealtimes, admission) and patient community conflict (lack of staff in communal areas to influence/intervene, lack of opportunity to escape distressing behaviour). Synthesis of WP1 learning identified 44 discrete behaviour change targets for consideration by the expert stakeholder groups (RRPI specialists, academics working in the field of violence reduction, clinicians, service users and carers). The process of organising and prioritising behaviour change targets revealed that the intervention should aim to meet its outcomes via the following five mechanisms: (1) enhancing de-escalation skills and modifying staff attitudes, knowledge and understanding of patients; (2) changing power dynamics (service user involvement, increased democratisation of inpatient services); (3) changing the environment (sensory modulation, reducing visible evidence of coercion); (4) changing clinical systems and organisational context (systems to ensure a culture of de-escalation, that is reducing blame, increasing accountability); (5) changing attitudes to vulnerability within staff teams. The expert stakeholder groups generated 16 distinct intervention components that they felt would enhance de-escalation. These were reduced to 11 final components once the voting process according to the APPEASE criteria (affordability, practicability, effectiveness and cost-effectiveness, acceptability, side effects/safety and equity) had been concluded. The final EDITION intervention included 11 behaviour change components, including de-escalation training; two novel models of reflective practice (‘Negotiated Boundaries’ and ‘Conflict Formulation’); post-incident debriefing and ‘Symmetrical Feedback’ (an intervention designed to enhance the quality of staff and patient feedback on clinical practice); collaborative prescribing and ward rounds (interventions to involve patients in prescribing decisions and reduce patient distress in ward rounds); three interventions to improve practice around admission, shift handovers and the social and physical environment; and, finally an intervention to enhance support planning and the availability of sensory modulation to patients. Work package 3 trialled the intervention in 10 adult acute and forensic inpatient wards. All wards except one completed the full 24 weeks of data collection (one ward withdrew at 13 weeks due to COVID-19 impacts on staffing). Two hundred and seventy-six mental health staff in total were trained in the EDITION intervention (214 ward staff, 62 multidisciplinary professionals). For patient clinical outcomes, 81% (283/350) of the recruitment target was met across the seven time points [excluding remote data collection due to COVID-19, this rose to 88% (283/320)]. For staff-reported clinical outcomes, 68% of the total recruitment target was achieved [excluding remote data collection due to COVID-19, this increased to 75% (135/180)] across the four time points. The proposed primary outcome for a full trial (the PCC-SR) had a completion rate of 62% (2360/3780). However, when wards that required remote data collection (due to COVID) were excluded, the completion rate increased to 68% (2343/3444). Importantly, the completion rate increased in the post-intervention period. Excluding the wards where remote data collection was required, completions increased from 65% (876/1344) in the pre-intervention period to 76% (855/1120) in the post-intervention period, strongly indicating that the strategies to increase completion that the research team tested throughout data collection were becoming optimised in the follow-up data-collection period. The staff-reported clinical outcome measures had good full completion rates between 80% (ACMQ) and 100% (COM-B). The patient-reported clinical outcome measures also had good full completion rates except the CES, which was just 53%. The other patient measures [Violence Prevention Climate (VPC) and perceived expressed emotion in staff scale (PEESS)] had full completion rates of > 80%. The TARS outcomes (n = 214) indicate that the de-escalation training was acceptable, with most participating ‘strongly agreeing’ that the training was generally acceptable. In terms of preliminary evidence of effect, the embedding and follow-up phases of the study were associated with a reduction in conflict incidents: the embedding phase had a 45% reduction in incidents and the follow-up phase saw a 55% reduction in incidents compared with baseline. Compared with baseline, the follow-up phase also saw a 20% reduction in number of containments. No effects on the secondary outcome measures for either staff or patients were detected. Most of the intervention components were in consistent use in the post-intervention follow-up periods. However, there were important exceptions. The collaborative prescribing intervention was only used by 2/10 participating wards’ psychiatrists and only 2/10 wards had the sensory modulation and support-planning intervention implemented. While the lack of engagement with the latter intervention was, partially, explained by concerns over infection risk in the context of COVID-19, our process evaluation revealed that the lack of engagement with the prescribing intervention was centred on more fundamental value clashes between the psychiatrists and the proposed intervention. The costs of the training intervention were estimated from two sources. Firstly, ward-level data reported the number of staff attending training, by agenda for change (AfC) band, at the start of the embedding period. Secondly, intervention diaries were completed by champions leading the components of the intervention during the embedding period. Overall, the average (mean) number of staff and cost per day for the initial training were similar in the two trusts, with training attended by staff across AfC bands 2–7 in each trust. The overall number and costs of staff on the ward and conflict/containment episodes per shift were estimated from the PCC-SR measure. Published unit costs of conflict/containment episodes from a single source were used to estimate the costs of these events. Exploratory regression analyses suggest that shift, ward and follow-up period may be important factors to consider in the design of an integrated clinical and economic effectiveness trial, in terms of data collection and analysis methods. Data about discharges and inpatient length of stay were limited to patients discharged and were collected from the trusts for the pre- and post-intervention periods. The data indicate that it is feasible to collect information about inpatient stay from trusts. The EQ-5D-5L indicates that it is feasible to collect the data from staff and from patients. Conclusions The EDITION study developed an evidence-based and co-designed training intervention to enhance de-escalation in adult acute and adult forensic mental health inpatient settings. The intervention was informed by evidence synthesis of 108 primary research studies and qualitative inquiry with 128 participants. Co-design of the intervention resulted in a complex intervention with 11 behaviour change components delivered by Reducing Restrictive Practices Instructors, ward staff and patients, psychiatrists, clinical psychologists, nursing leadership and occupational therapists. The training was very well engaged with, with 275 professionals and paraprofessionals from 10 participating wards completing training. Conducting a RCT of the EDITION intervention is likely to be feasible. The strategies to enhance completion rates of the PCC-SR (proposed primary outcome) were successful (rising from 65% in the pre-intervention to 76% in the post-intervention phase). Recruitment rates for secondary outcomes were also good: 81% of the target for patients was met and 68% for staff. The secondary outcome measures had excellent full completion rates except for the CES (patient-reported), which may need to be removed in a full trial. It was feasible to collect resource use and health status data to inform an economic analysis of the intervention in a full trial. Trial registration This trial is registered as ISRCTN12826685. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 16/101/02) and is published in full in Health Technology Assessment; Vol. 28, No. 3. See the NIHR Funding and Awards website for further award information. Research objectives Confirm the key components and mechanisms of effective de-escalation and explore variations across different service settings. Develop with stakeholders an effective, acceptable and context-sensitive de-escalation training package for mental health staff. Evaluate training package effects on use and effectiveness of de-escalation and rates of conflict and containment. Explore the processes underpinning training implementation and impact and understand the individual and organisational factors inhibiting or enabling routine use.

One compelling vision of the future of materials discovery and design involves the use of machine learning (ML) models to predict materials properties and then rapidly find materials tailored for specific applications. However, realizing this vision requires both providing detailed uncertainty quantification (model prediction errors and domain of applicability) and making models readily usable. At present, it is common practice in the community to assess ML model performance only in terms of prediction accuracy (e.g. mean absolute error), while neglecting detailed uncertainty quantification and robust model accessibility and usability. Here, we demonstrate a practical method for realizing both uncertainty and accessibility features with a large set of models. We develop random forest ML models for 33 materials properties spanning an array of data sources (computational and experimental) and property types (electrical, mechanical, thermodynamic, etc). All models have calibrated ensemble error bars to quantify prediction uncertainty and domain of applicability guidance enabled by kernel-density-estimate-based feature distance measures. All data and models are publicly hosted on the Garden-AI infrastructure, which provides an easy-to-use, persistent interface for model dissemination that permits models to be invoked with only a few lines of Python code. We demonstrate the power of this approach by using our models to conduct a fully ML-based materials discovery exercise to search for new stable, highly active perovskite oxide catalyst materials.

Abstract There is an imperative for fire agencies to quantify the potential for prescribed burning to mitigate risk to life, property and environmental values while facing changing climates. The 2019–2020 Black Summer fires in eastern Australia raised questions about the effectiveness of prescribed burning in mitigating risk under unprecedented fire conditions. We performed a simulation experiment to test the effects of different rates of prescribed burning treatment on risks posed by wildfire to life, property and infrastructure. In four forested case study landscapes, we found that the risks posed by wildfire were substantially higher under the fire weather conditions of the 2019–2020 season, compared to the full range of long-term historic weather conditions. For area burnt and house loss, the 2019–2020 conditions resulted in more than a doubling of residual risk across the four landscapes, regardless of treatment rate (mean increase of 230%, range 164–360%). Fire managers must prepare for a higher level of residual risk as climate change increases the likelihood of similar or even more dangerous fire seasons.

Abstract Background There is good evidence that psychological interventions improve patient well-being and independent living, but patients on acute mental health wards often do not have access to evidence-based psychological therapies which are strongly advised by NICE guidance for severe mental health problems. The overall aim of this programme of work is to increase patient access to psychological therapies on acute mental health inpatient wards. Stage one of the programme (which is complete) aimed to identify barriers and facilitators to delivering therapy in these settings through a large qualitative study. The key output of stage one was an intervention protocol that is designed to be delivered on acute wards to increase patient access to psychologically-informed care and therapy. Stage two of the programme aims to test the effects of the intervention on patient wellbeing and serious incidents on the ward (primary outcomes), patient social functioning and symptoms, staff burnout, ward atmosphere from staff and patient perspectives and cost effectiveness of the intervention (secondary outcomes). Methods The study is a single blind, pragmatic, cluster randomised controlled trial and will recruit thirty-four wards across England that will be randomised to receive the new intervention plus treatment as usual, or treatment as usual only. Primary and secondary outcomes will be assessed at baseline and 6-month and 9-month follow-ups, with serious incidents on the ward collected at an additional 3-month follow-up. Discussion The key output will be a potentially effective and cost-effective ward-based psychological intervention that increases patient access to psychological therapy in inpatient settings, is feasible to deliver in inpatient settings and is acceptable to patients. Trial Registration number ClinicalTrials.gov Identifier: NCT03950388. Registered 15th May 2019. https://clinicaltrials.gov/ct2/show/NCT03950388

Abstract Background Violence and other harms that result from conflict in forensic inpatient mental health settings are an international problem. De-escalation approaches for reducing conflict are recommended, yet the evidence-base for their use is limited. For the first time, the present study uses implementation science and behaviour change approaches to identify the specific organisational and individual behaviour change targets for enhanced de-escalation in low and medium secure forensic inpatient settings. The primary objective of this study was to identify and describe individual professional, cultural and system-level barriers and enablers to the implementation of de-escalation in forensic mental health inpatient settings. The secondary objective was to identify the changes in capabilities, opportunities and motivations required to enhance de-escalation behaviours in these settings. Methods Qualitative design with data collection and analysis informed by the Theoretical Domains Framework (TDF). Two medium secure forensic mental health inpatient wards and one low secure mental health inpatient ward participated. 12 inpatients and 18 staff participated across five focus groups and one individual interview (at participant preference) guided by a semi-structured interview schedule informed by the TDF domains. Data were analysed via Framework Analysis, organised into the 14 TDF domains then coded inductively within each domain. Results The capabilities required to enhance de-escalation comprised relationship-building, emotional regulation and improved understanding of patients. Staff opportunities for de-escalation are limited by shared beliefs within nursing teams stigmatising therapeutic intimacy in nurse-patient relationships and emotional vulnerability in staff. These beliefs may be modified by ward manager role-modelling. Increased opportunity for de-escalation may be created by increasing service user involvement in antipsychotic prescribing and modifications to the physical environment (sensory rooms and limiting restrictions on patient access to ward spaces). Staff motivation to engage in de-escalation may be increased through reducing perceptions of patient dangerousness via post-incident debriefing and advanced de-escalation planning. Conclusions Interventions to enhance de-escalation in forensic mental health settings should enhance ward staff’s understanding of patients and modify beliefs about therapeutic boundaries which limit the quality of staff-patient relationships. The complex interactions within the capabilities-opportunities-motivation configuration our novel analysis generated, indicates that de-escalation behaviour is unlikely to be changed through knowledge and skills-based training alone. De-escalation training should be implemented with adjunct interventions targeting: collaborative antipsychotic prescribing; debriefing and de-escalation planning; modifications to the physical environment; and ward manager role-modelling of emotional vulnerability and therapeutic intimacy in nurse-patient relationships.

Aims and MethodsRestraint reporting varies, which undermines regulation, obfuscates analyses, and incentivises minimisation. The English Mental Health Units Use of Force Act 2018, “Seni's Law” mandates reporting. This paper analysed open data from all psychiatric and learning disability institutions in England from September 2020 to August 2021. We correlated logarithms of “people restrained per month”, against “bed days” per month and “people under legal mental health detention” per month, per institution. We designated institutions reporting some restraint for at least 11 of 12 months as reporting “completely” and used their trend to infer rates from non-“complete” institutions. Allowance was made for size. Our a priori manual can be shared on request.ResultsLogarithms of people restrained per month and bed-days per month correlated among complete reporters: R2 0.90 (2.s.f). Persons detained per month also correlated with restraint: R2 0.78. “Partial” institutions reported intermittently. “Joiner” institutions reported firstly null, then substantive reporting. “Null” institutions (including the largest) reported no restraint. Precisely-reporting institutions with high inverse variance between months reported similar restraint-rates but less-precise reported lower rates. In institutions reporting no restraint, two independent “true rate” estimations, by bed-days or people detained, correlated across institutions: R2 0.95. Inference from size suggested non-complete reporters restrained 1,774 people in England per month 95% CI (1,449–2,174).Clinical implicationsRestraint remains under-reported. Institutional size explains most restraint variation among complete reporting institutions, 90% of R2. Institutional restraint reports can be compared per-bed per-month. Rates of people detained are a useful independent “checking” comparator in England.

Abstract Background Violent and aggressive incidents are common within mental health settings and are often managed using high-risk physical interventions such as restraint and seclusion. De-escalation is a first-line technique to manage conflict behaviours and prevent violence and aggression. There is limited research into the use of de-escalation in high-secure settings. This study investigated staff, patient and carer perspectives on the barriers and facilitators to using de-escalation for conflict behaviours. Methods Semi-structured individual interviews (n = 12) and focus groups (n = 3) were conducted with eight patients, four carers and 25 staff members in a high-secure hospital in England. Interviews and focus groups were informed by the theoretical domains framework and were digitally recorded, transcribed verbatim and analysed using framework analysis and the COM-B behaviour change model. Results Four themes and 15 sub-themes (barriers and facilitators) were identified. Themes related to capabilities (building relationships: knowing the patient and knowing yourself), opportunities (filling the void: challenges within the high-security environment; dynamic relationships) and motivation (keeping everyone safe). Strong staff–patient therapeutic relationships underpinned by trust, fairness, consistency and an awareness of the trauma-aggression link were considered key to successful de-escalation. Specific psychological and interpersonal skills including empathy, respect, reassurance, sincerity, genuine concern and validation of the patient perspective are needed to achieve this. Barriers related to the physical environment; organisational resources, practices and systems; staff traumatisation; hierarchical and punitive attitudes towards patient care, and an insufficient understanding of psychiatric diagnoses, especially personality disorder. It was apparent across themes that fear, which was experienced by both staff and patients, was a driver for many behaviours. Conclusions This work has identified organizational and behaviour change targets for interventions seeking to reduce violence and restrictive practices through the use of de-escalation in high-secure hospitals. The potential for, and occurrence of, violence in such settings is high and leads to fear in patients and staff. The factors which promote fear in each group should be addressed in de-escalation training.

The extrathoracic oral airway is not only a major mechanical barrier for pharmaceutical aerosols to reach the lung but also a major source of variability in lung deposition. Using computational fluid dynamics, deposition of 1–30 µm particles was predicted in 11 CT-based models of the oral airways of adults. Simulations were performed for mouth breathing during both inspiration and expiration at two steady-state flow rates representative of resting/nebulizer use (18 L/min) and of dry powder inhaler (DPI) use (45 L/min). Consistent with previous in vitro studies, there was a large intersubject variability in oral deposition. For an optimal size distribution of 1–5 µm for pharmaceutical aerosols, our data suggest that >75% of the inhaled aerosol is delivered to the intrathoracic lungs in most subjects when using a nebulizer but only in about half the subjects when using a DPI. There was no significant difference in oral deposition efficiency between inspiration and expiration, unlike subregional deposition, which shows significantly different patterns between the two breathing phases. These results highlight the need for incorporating a morphological variation of the upper airway in predictive models of aerosol deposition for accurate predictions of particle dosimetry in the intrathoracic region of the lung.

While evidence exists supporting the potential for aerosol transmission of SARS-CoV-2, the infectious dose by inhalation remains unknown. In the present study, the probability of infection following inhalation of SARS-CoV-2 was dose-dependent in a nonhuman primate model of inhalational COVID-19. The median infectious dose, assessed by seroconversion, was 52 TCID50 (95% CI: 23-363 TCID50), and was significantly lower than the median dose for fever (256 TCID50, 95% CI: 102-603 TCID50), resulting in a group of animals that developed an immune response post-exposure but did not develop fever or other clinical signs of infection. In a subset of these animals, virus was detected in nasopharyngeal and/or oropharyngeal swabs, suggesting that infected animals without signs of disease are able to shed virus and may be infectious, which is consistent with reports of asymptomatic spread in human cases of COVID-19. These results suggest that differences in exposure dose may be a factor influencing disease presentation in humans, and reinforce the importance of public health measures that limit exposure dose, such as social distancing, masking, and increased ventilation. The dose-response data provided by this study are important to inform disease transmission and hazard modeling, and, ultimately, mitigation strategies. Additionally, these data will be useful to inform dose selection in future studies examining the efficacy of therapeutics and vaccines against inhalational COVID-19, and as a baseline in healthy, young adult animals for assessment of the importance of other factors, such as age, comorbidities, and viral variant, on the infectious dose and disease presentation.

From the beginning of the COVID-19 pandemic, researchers assessed the impact of the disease in terms of loss of life, medical load, economic damage, and other key metrics of resiliency and consequence mitigation; these studies sought to parametrize the critical components of a disease transmission model and the resulting analyses were informative but often lacked critical parameters or a discussion of parameter sensitivities. Using SARS-CoV-2 as a case study, we present a robust modeling framework that considers disease transmissibility from the source through transport and dispersion and infectivity. The framework is designed to work across a range of particle sizes and estimate the generation rate, environmental fate, deposited dose, and infection, allowing for end-to-end analysis that can be transitioned to individual and population health models. In this paper, we perform sensitivity analysis on the model framework to demonstrate how it can be used to advance and prioritize research efforts by highlighting critical parameters for further analyses.

Variations in global patterns of burning and fire regimes are relatively well measured, however, the degree of influence of the complex suite of biophysical and human drivers of fire remains controversial and incompletely understood. Such an understanding is required in order to support current fire management and to predict the future trajectory of global fire patterns in response to changes in these determinants. In this study we explore and compare the effects of four fundamental controls on fire, namely the production of biomass, its drying, the influence of weather on the spread of fire and sources of ignition. Our study area is southern Australia, where fire is currently limited by either fuel production or fuel dryness. As in most fire-prone environments, the majority of annual burned area is due to a relatively small number of large fires. We train and test an Artificial Neural Network’s ability to predict spatial patterns in the probability of large fires (>1,250 ha) in forests and grasslands as a function of proxies of the four major controls on fire activity. Fuel load is represented by predicted forested biomass and remotely sensed grass biomass, drying is represented by fraction of the time monthly potential evapotranspiration exceeds precipitation, weather is represented by the frequency of severe fire weather conditions and ignitions are represented by the average annual density of reported ignitions. The response of fire to these drivers is often non-linear. Our results suggest that fuel management will have limited capacity to alter future fire occurrence unless it yields landscape-scale changes in fuel amount, and that shifts between, rather than within, vegetation community types may be more important. We also find that increased frequency of severe fire weather could increase the likelihood of large fires in forests but decrease it in grasslands. These results have the potential to support long-term strategic planning and risk assessment by fire management agencies.

Air pollution with PM2.5 (particulate matter smaller than 2.5 micro-metres in diameter) is a major health hazard in many cities worldwide, but since measuring instruments have traditionally been expensive, monitoring sites are rare and generally show only background concentrations. With the advent of low-cost, wirelessly connected sensors, air quality measurements are increasingly being made in places where many people spend time and pollution is much worse: on streets near traffic. In the interests of enabling members of the public to measure the air that they breathe, we took an open-source approach to designing a device for measuring PM2.5. Parts are relatively cheap, but of good quality and can be easily found in electronics or hardware stores, or on-line. Software is open source and the free LoRaWAN-based "The Things Network" the platform. A number of low-cost sensors we tested had problems, but those selected performed well when co-located with reference-quality instruments. A network of the devices was deployed in an urban centre, yielding valuable data for an extended time. Concentrations of PM2.5 at street level were often ten times worse than at air quality stations. The devices and network offer the opportunity for measurements in locations that concern the public.

Fire management agencies around the world use suppression firing for fire control. Yet, we know little about the extent of its use (e.g., prevalence and spatial coverage) and its impact on containment. We examine the prevalence and practice of suppression firing in Victoria, Australia. We used operational data from five years (2010–2015) to identify and map the incidence of suppression firing on 74 large fires (500+ ha). Suppression firing occurred on half (34) of these fires, 26 of which had data to map firing locations. The area burnt by suppression firing ranged from

During the last decades, climate and land use changes led to an increased prevalence of megafires in Mediterranean-type climate regions (MCRs). Here, we argue that current wildfire management policies in MCRs are destined to fail. Focused on fire suppression, these policies largely ignore ongoing climate warming and landscape-scale buildup of fuels. The result is a ‘firefighting trap’ that contributes to ongoing fuel accumulation precluding suppression under extreme fire weather, and resulting in more severe and larger fires. We believe that a ‘business as usual’ approach to wildfire in MCRs will not solve the fire problem, and recommend that policy and expenditures be rebalanced between suppression and mitigation of the negative impacts of fire. This requires a paradigm shift: policy effectiveness should not be primarily measured as a function of area burned (as it usually is), but rather as a function of avoided socio-ecological damage and loss.

BackgroundObsessive-compulsive disorder (OCD) is prevalent and without adequate treatment usually follows a chronic course. "High-intensity" cognitive-behaviour therapy (CBT) from a specialist therapist is current "best practice." However, access is difficult because of limited numbers of therapists and because of the disabling effects of OCD symptoms. There is a potential role for "low-intensity" interventions as part of a stepped care model. Low-intensity interventions (written or web-based materials with limited therapist support) can be provided remotely, which has the potential to increase access. However, current evidence concerning low-intensity interventions is insufficient. We aimed to determine the clinical effectiveness of 2 forms of low-intensity CBT prior to high-intensity CBT, in adults meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for OCD.Methods and findingsThis study was approved by the National Research Ethics Service Committee North West-Lancaster (reference number 11/NW/0276). All participants provided informed consent to take part in the trial. We conducted a 3-arm, multicentre randomised controlled trial in primary- and secondary-care United Kingdom mental health services. All patients were on a waiting list for therapist-led CBT (treatment as usual). Four hundred and seventy-three eligible patients were recruited and randomised. Patients had a median age of 33 years, and 60% were female. The majority were experiencing severe OCD. Patients received 1 of 2 low-intensity interventions: computerised CBT (cCBT; web-based CBT materials and limited telephone support) through "OCFighter" or guided self-help (written CBT materials with limited telephone or face-to-face support). Primary comparisons concerned OCD symptoms, measured using the Yale-Brown Obsessive Compulsive Scale-Observer-Rated (Y-BOCS-OR) at 3, 6, and 12 months. Secondary outcomes included health-related quality of life, depression, anxiety, and functioning. At 3 months, guided self-help demonstrated modest benefits over the waiting list in reducing OCD symptoms (adjusted mean difference = -1.91, 95% CI -3.27 to -0.55). These effects did not reach a prespecified level of "clinically significant benefit." cCBT did not demonstrate significant benefit (adjusted mean difference = -0.71, 95% CI -2.12 to 0.70). At 12 months, neither guided self-help nor cCBT led to differences in OCD symptoms. Early access to low-intensity interventions led to significant reductions in uptake of high-intensity CBT over 12 months; 86% of the patients allocated to the waiting list for high-intensity CBT started treatment by the end of the trial, compared to 62% in supported cCBT and 57% in guided self-help. These reductions did not compromise longer-term patient outcomes. Data suggested small differences in satisfaction at 3 months, with patients more satisfied with guided self-help than supported cCBT. A significant issue in the interpretation of the results concerns the level of access to high-intensity CBT before the primary outcome assessment.ConclusionsWe have demonstrated that providing low-intensity interventions does not lead to clinically significant benefits but may reduce uptake of therapist-led CBT.Trial registrationInternational Standard Randomized Controlled Trial Number (ISRCTN) Registry ISRCTN73535163.

Background: The Obsessive–Compulsive Treatment Efficacy randomised controlled Trial emerged from a research recommendation in National Institute for Health and Care Excellence obsessive–compulsive disorder (OCD) guidelines, which specified the need to evaluate cognitive–behavioural therapy (CBT) treatment intensity formats. Objectives: To determine the clinical effectiveness and cost-effectiveness of two low-intensity CBT interventions [supported computerised cognitive–behavioural therapy (cCBT) and guided self-help]: (1) compared with waiting list for high-intensity CBT in adults with OCD at 3 months; and (2) plus high-intensity CBT compared with waiting list plus high-intensity CBT in adults with OCD at 12 months. To determine patient and professional acceptability of low-intensity CBT interventions. Design: A three-arm, multicentre, randomised controlled trial. Setting: Improving Access to Psychological Therapies services and primary/secondary care mental health services in 15 NHS trusts. Participants: Patients aged ≥ 18 years meeting Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition criteria for OCD, on a waiting list for high-intensity CBT and scoring ≥ 16 on the Yale–Brown Obsessive Compulsive Scale (indicative of at least moderate severity OCD) and able to read English. Interventions: Participants were randomised to (1) supported cCBT, (2) guided self-help or (3) a waiting list for high-intensity CBT. Main outcome measures: The primary outcome was OCD symptoms using the Yale–Brown Obsessive Compulsive Scale – Observer Rated. Results: Patients were recruited from 14 NHS trusts between February 2011 and May 2014. Follow-up data collection was complete by May 2015. There were 475 patients randomised: supported cCBT (n = 158); guided self-help (n = 158) and waiting list for high-intensity CBT (n = 159). Two patients were excluded post randomisation (one supported cCBT and one waiting list for high-intensity CBT); therefore, data were analysed for 473 patients. In the short term, prior to accessing high-intensity CBT, guided self-help demonstrated statistically significant benefits over waiting list, but these benefits did not meet the prespecified criterion for clinical significance [adjusted mean difference –1.91, 95% confidence interval (CI) –3.27 to –0.55; p = 0.006]. Supported cCBT did not demonstrate any significant benefit (adjusted mean difference –0.71, 95% CI –2.12 to 0.70). In the longer term, access to guided self-help and supported cCBT, prior to high-intensity CBT, did not lead to differences in outcomes compared with access to high-intensity CBT alone. Access to guided self-help and supported cCBT led to significant reductions in the uptake of high-intensity CBT; this did not seem to compromise patient outcomes at 12 months. Taking a decision-making approach, which focuses on which decision has a higher probability of being cost-effective, rather than the statistical significance of the results, there was little evidence that supported cCBT and guided self-help are cost-effective at the 3-month follow-up compared with a waiting list. However, by the 12-month follow-up, data suggested a greater probability of guided self-help being cost-effective than a waiting list from the health- and social-care perspective (60%) and the societal perspective (80%), and of supported cCBT being cost-effective compared with a waiting list from both perspectives (70%). Qualitative interviews found that guided self-help was more acceptable to patients than supported cCBT. Professionals acknowledged the advantages of low intensity interventions at a population level. No adverse events occurred during the trial that were deemed to be suspected or unexpected serious events. Limitations: A significant issue in the interpretation of the results concerns the high level of access to high-intensity CBT during the waiting list period. Conclusions: Although low-intensity interventions are not associated with clinically significant improvements in OCD symptoms, economic analysis over 12 months suggests that low-intensity interventions are cost-effective and may have an important role in OCD care pathways. Further research to enhance the clinical effectiveness of these interventions may be warranted, alongside research on how best to incorporate them into care pathways. Trial registration: Current Controlled Trials ISRCTN73535163. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 37. See the NIHR Journals Library website for further project information.

Air quality was measured in Auburn, a western suburb of Sydney, Australia, for approximately eighteen months during 2016 and 2017. A long open-path infrared spectrometer sampled path-averaged concentrations of several gaseous species, while other pollutants such as PM 2.5 and PM 10 were sampled by a mobile air quality station. The measurement site was impacted by a number of indoor wood-heating smoke events during cold winter nights as well as some major smoke events from hazard reduction burning in the spring of 2017. In this paper we compare the atmospheric composition during these different smoke pollution events and assess the relative overall impact on air quality from domestic wood-heaters and prescribed forest fires during the campaign. No significant differences in the composition of smoke from these two sources were identified in this study. Despite the hazard reduction burning events causing worse peak pollution levels, we find that the overall exposure to air toxins was greater from domestic wood-heaters due to their higher frequency and total duration. Our results suggest that policy-makers should place a greater focus on reducing wood-smoke pollution in Sydney and on communicating the issue to the public.

Abstract The revegetation of cleared landscapes with woody plants (termed “environmental planting”) has the potential to sequester carbon (C), provide habitat, and increase biodiversity and connectivity. These environmental values are potentially offset by an increased fire hazard posed by revegetation. There is a need to understand the influence environmental planting has on landscape fire behavior and to determine how this changes as plantings age. This study examined how environmental values, regenerative capacity, fuel metrics, and potential fire behavior change with time since planting. We assessed 57 sites across the Albury‐Wodonga region (New South Wales, Australia). This included a range of environmental planting ages (4–40 yr time since planting), remnants, and pastures. Carbon storage increased with age of planting, with largest C stores found in remnants (105 tC/ha), while habitat complexity plateaued around 20 yr, with no significant difference between moderately aged plantings (14–20 yr), old plantings (>20 yr), and remnants. Modeled rate of fire spread was faster in pastures compared to environmental plantings and remnants. Flame height was slightly higher (0.5–1 m) in pastures than environmental plantings and remnants under a Very High Forest Fire Danger Index (FFDI), but this trend reversed under Extreme and Catastrophic conditions with flame heights greatest in environmental plantings and remnants albeit with slower rates of spread. This research highlights the importance of environmental plantings in the landscape in terms of C storage and environmental values and indicates the perceived hazard associated with rate of spread and flame height may not be justified at or less than Very High FFDI. However, at FFDI greater than Very High fire behavior may be significantly enhanced in environmental plantings and remnants. Further consideration needs to be given to the size and design of plantings and the type of species planted to fully develop an understanding of the complexities of fire risk. This study allows land managers to make informed decisions regarding the values and risks associated with revegetation of cleared landscapes with woody plants.

Previous investigations into the factors associated with house loss in wildfires have focused on the house construction and its immediate environment (e.g. gardens). Here, we examine how nearby native forest and other houses can influence house loss. Specifically, we used a sample of 3500 houses affected by the Victorian bushfires of February 7th 2009 to explore how the amount of forest, proportion of forest burned by crown fire and the number of nearby houses affected house loss and how far from the house this influence was exerted. These fires were the most destructive in Australian history and so represent the extreme of fire risk. Using generalized linear modeling we found that the probability of house loss increased with forest extent and the proportion burnt by crown fire and this relationship was strongest for forest measured 1 km from the houses. Houses were more likely to be destroyed if there were other houses within 50 m and if they were on a slope. A model containing these variables predicted house loss with 72% accuracy. Our findings have three important implications: i) management to change the occurrence of crown fire will be effective in reducing house loss; ii) this management may be required up to 1 km away from houses in some situations (a much larger zone than is currently used); iii) high density of houses may increase risk of loss. Given the potentially large width of this management zone and the hazard from nearby houses, it may be more sensible to concentrate on modification of buildings to reduce their vulnerability.

Each wildfire has its own “history”, burns under specific conditions and leads to unique environmental impacts. Information on where and when it has started and its duration is important to improve understanding on the dynamics of individual wildfires. This information is typically included in fire databases that are known to have: (i) multiple error sources; (ii) limited spatial coverage and/or time span, and; (iii) often unknown accuracy and uncertainty. Satellite data have a large potential to reduce such limitations. We used active fire data from the MODerate Resolution Imaging Spectroradiometer (MODIS) to estimate fire start/end dates and ignition location(s) for large wildfires that occurred in Alaska, Portugal, Greece, California and southeastern Australia. We assessed the agreement between satellite-derived estimates and data from fire databases, and determined the associated uncertainty. Fire dates and ignition location(s) were estimated for circa 76% of the total burnt area extent for the five study regions. The ability to estimate fire dates and ignitions from satellite data increased with fire size. The agreement between reported and estimated fire dates was very good for start dates (Model efficiency index, MEF = 0.91) and reasonable for end dates (MEF = 0.73). The spatio-temporal agreement between reported and satellite-derived wildfire ignitions showed temporal lags and distances within 12 h and 2 km, respectively. Uncertainties associated with ignition estimates were generally larger than the disagreements with data reported in fire databases. Our results show how satellite data can contribute to improve information regarding dates and ignitions of large wildfires. This contribution can be particularly relevant in regions with scarce fire information, while in well-documented areas it can be used to complement, potentially detect, and correct inconsistencies in existing fire databases. Using data from other existing and/or upcoming satellites should significantly contribute to reduce errors and uncertainties in satellite-derived fire dates and ignitions, as well as improve coverage of small fires.

The increased severity and frequency of bushfires accompanying human-induced global warming have dire implications for biodiversity conservation. Here we investigate the response of a cryptic, cool-climate elapid, the mustard-bellied snake Drysdalia rhodogaster, to the extensive Black Summer fires of 2019/2020 in south-eastern Australia. The species is categorized as Least Concern on the IUCN Red List (last assessed in 2017), but because a large part of its range was burnt during the Black Summer and little was known about its ecology, D. rhodogaster was identified as a priority species for post-fire impact assessment. We evaluated three lines of evidence to assess the impact of the Black Summer fires on D. rhodogaster. Habitat suitability modelling indicated that c. 46% of the predicted range of the species was affected by bushfire. Field surveys conducted 9–36 months post-fire and collation of records from public databases submitted 0–24 months post-fire indicated that D. rhodogaster persisted in burnt landscapes. Fire severity and proportion of the landscape that was burnt within a 1,000-m radius of survey sites were poor predictors of site occupancy by D. rhodogaster. Although conclusions regarding the effects of fire on D. rhodogaster are limited because of the lack of baseline data, it is evident that the species has persisted across the landscape in the wake of extensive bushfires. Our work highlights the need for baseline knowledge on cryptic species even when they are categorized as Least Concern, as otherwise assessments of the impacts of catastrophic events will be constrained.