How do we evaluate the cost of nosocomial infection? The ECONI protocol: an incidence study with nested case-control evaluating cost and quality of life

Introduction Healthcare-associated or nosocomial infection (HAI) is distressing to patients and costly for the National Health Service (NHS). With increasing pressure to demonstrate cost-effectiveness of interventions to control HAI and notwithstanding the risk from antimicrobial-resistant infections, there is a need to understand the incidence rates of HAI and costs incurred by the health system and for patients themselves. Methods and analysis The Evaluation of Cost of Nosocomial Infection study (ECONI) is an observational incidence survey with record linkage and a nested case-control study that will include postdischarge longitudinal follow-up and qualitative interviews. ECONI will be conducted in one large teaching hospital and one district general hospital in NHS Scotland. The case mix of these hospitals reflects the majority of overnight admissions within Scotland. An incidence survey will record all HAI cases using standard case definitions. Subsequent linkage to routine data sets will provide information on an admission cohort which will be grouped into HAI and non-HAI cases. The case-control study will recruit eligible patients who develop HAI and twice that number without HAI as controls. Patients will be asked to complete five questionnaires: the first during their stay, and four others during the year following discharge from their recruitment admission (1, 3, 6 and 12 months). Multiple data collection methods will include clinical case note review; patient-reported outcome; linkage to electronic health records and qualitative interviews. Outcomes collected encompass infection types; morbidity and mortality; length of stay; quality of life; healthcare utilisation; repeat admissions and postdischarge prescribing. Ethics and dissemination The study has received a favourable ethical opinion from the Scotland A Research Ethics Committee (reference 16/SS/0199). All publications arising from this study will be published in open-access peer-reviewed journal. Lay-person summaries will be published on the ECONI website. Trial registration number NCT03253640; Pre-results

A systematic review of adaption to climate change impacts in the aviation sector

The incremental changes and greater extremes of a changing climate will have operational, infrastructure and economic impacts for aviation. Given the criticality of aviation for global connectivity and mobility, it is vital that the sector understands and adequately adapts to these risks. This article presents a systematic review of the growing but somewhat dispersed academic literature on climate change impacts and adaptation in the aviation sector. Information was synthesised from 131 studies (published between January 2000 and November 2022) on eleven climate change effects and the associated impacts and potential adaptation measures. Six areas for action to address knowledge, awareness and implementation gaps were identified: (i) to broaden geographical coverage, particularly to address the current lack of studies addressing climate risks and responses in Central and South America, Africa and the Middle East; (ii) to extend knowledge of physical impacts; (iii) to address known-unknowns such as the risks associated with unprecedented or compound extreme events; (iv) to extend knowledge of adaptation including cost–benefit analysis and consideration of integrated mitigation and adaptation; (v) to identify and apply other relevant research; and (vi) for sector bodies to support and facilitate collaboration between researchers and practitioners to co-develop accessible user-oriented climate adaptation services

Recovery and utilisation of municipal solid waste incineration bottom ash: implications for European waste management strategy

Over the last two decades, the stated intent of European waste management strategy has evolved from a specific focus on landfill diversion to enabling the transition to a circular economy. Widespread introduction of source-segregation alongside deploy-ment of material recovery technologies have improved MSW management practices across Europe. However, with diminishing returns it has become more difficult to achieve further landfill diversion through increased recycling alone, and incineration rates (across the EU-27 as a whole) have continued to increase. The advantages of incineration include the ability to harness the energy content of the waste alongside a sizeable reduction in mass and volume. However, the remaining solid residues, the most substantial being incinerator bottom ash, present a management issue. Exploring the role of incineration and the utilisation of incineration bottom ash, this paper highlights the potential risks of lock-in in the context of evolving waste poli-cy. A simple thought experiment suggests that while increased use of incineration may help member states achieve 2035 landfill diversion targets, it would also carry a substantive risk of placing the 2035 recycling target out of reach. To address this, a long-term vision concerning the future of incineration is required, where it is recom-mended that policy which focuses on landfill diversion and the recycling of residual wastes should be strengthened through mechanisms that gradually phase out incineration and distinguish between open and closed-loop recycling

Not all brownfields are equal: a typological assessment reveals hidden green space in the city

While the role of urban green space in mitigating environmental hazards and enhancing urban resilience is widely recognised, the current or potential contribution of brownfield land to urban green infrastructure and ecosystem services has been largely overlooked by planning legislation. The perception of brownfield as low value spaces has instead driven a focus on brownfield-first redevelopment, and thus, this dynamic resource is quickly being lost. This research, based on GIS and remote sensing data, develops a novel hierarchical brownfield classification methodology to understand the nature and distribution of brownfield, using k-means clustering of several physical attributes, which can be used for a range of objectives and is widely applicable to post-industrial cities. Application of the methodology to the case study, Greater Manchester, UK, produced a typology of twenty-six brownfield types with distinct characteristics and differing spatial patterns across the city. Land cover analysis reveals that over half (51%) of brownfield land is vegetated (comprising 27% trees and shrubs, 24% grass and herbaceous vegetation), highlighting the significant ‘hidden’ green space present on brownfield. Brownfield sites traditionally perceived as difficult to develop (e.g. those with uneven topography, irregular shapes, or a water body), are particularly highly vegetated. Predominantly pervious types are widely distributed across the conurbation, including in built-up areas, which are a principal target for redevelopment, and thus highly vegetated brownfields are likely being lost undetected. Brownfield land is evidently a valuable dynamic resource in post-industrial cities and redevelopment should be planned at the city-scale to ensure careful strategic selection of sites for redevelopment, greening, or interim use based upon their characteristics and location

Low carbon futures: assessing the status of decarbonisation efforts at universities within a 2050 perspective

https://v2.sherpa.ac.uk/id/publication/21924 © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.Background The implementation of sustainability at universities means that they can also play a key role in the transition to a low carbon economy, and in assisting global efforts towards decarbonisation. Yet, not all of them have so far fully engaged in this area. This paper reviews the state of the art on trends in decarbonisation, and outlines the need for decarbonisation efforts at universities. It also reports on a survey aimed at ascertaining the extent to which universities in a sample of 40 countries across the various geographical regions are engaged in carbon reduction efforts, identifying the challenges faced. Results The study has shown that the literature on the topic has been evolving over time and that increasing a given university’s energy supply from renewable energy sources has been the cornerstone of university-based climate action plans. The study also indicates that even though several universities are concerned with their carbon footprint and actively seeking ways to reduce it, there are some institutional obstacles that need to be overcome. Conclusions A first conclusion which can be drawn is that efforts on decarbonisation are becoming more popular, with a special focus being placed on the use of renewable energy. Also, the study has shown that, from the range of efforts being made towards decarbonisation, many universities are setting up a team with carbon management responsibilities, have Carbon Management Policy Statements, and review them. The paper points towards some measures which may be deployed, so as to allow universities to take better advantage of the many opportunities an engagement in decarbonisation initiatives offers to them.info:eu-repo/semantics/publishedVersio

Rapid carbon accumulation at a saltmarsh restored by managed realignment exceeded carbon emitted in direct site construction

Increasing attention is being paid to the carbon sequestration and storage services provided by coastal blue carbon ecosystems such as saltmarshes. Sites restored by managed realignment, where existing sea walls are breached to reinstate tidal inundation to the land behind, have considerable potential to accumulate carbon through deposition of sediment brought in by the tide and burial of vegetation in the site. While this potential has been recognised, it is not yet a common motivating factor for saltmarsh restoration, partly due to uncertainties about the rate of carbon accumulation and how this balances against the greenhouse gases emitted during site construction. We use a combination of field measurements over four years and remote sensing to quantify carbon accumulation at a large managed realignment site, Steart Marshes, UK. Sediment accumulated rapidly at Steart Marshes (mean of 75 mm yr-1) and had a high carbon content (4.4% total carbon, 2.2% total organic carbon), resulting in carbon accumulation of 36.6 t ha-1 yr-1 total carbon (19.4 t ha-1 yr-1 total organic carbon). This rate of carbon accumulation is an order of magnitude higher than reported in many other restored saltmarshes, and is somewhat higher than values previously reported from another hypertidal system (Bay of Fundy, Canada). The estimated carbon emissions associated with the construction of the site were ~2–4% of the observed carbon accumulation during the study period, supporting the view that managed realignment projects in such settings may have significant carbon accumulation benefits. However, uncertainties such as the origin of carbon (allochthonous or autochthonous) and changes in gas fluxes need to be resolved to move towards a full carbon budget for saltmarsh restoration

Correction : Low carbon futures: assessing the status of decarbonisation efforts at universities within a 2050 perspective (Energy, Sustainability and Society, (2023), 13, 1, (5), 10.1186/s13705-023-00384-6)

Following publication of the original article [1], the authors identified an error since Ayyoob Sharifi was missing from the author group. The missing author name is: Ayyoob Sharifi12 (E-mail: [email protected]) The authors’ affiliation is: 12Graduate School of Humanities and Social Sciences, and Network for Education and Research on Peace and Sustainability, Hiroshima University, Higashi-Hiroshima 739-8530, Japan. The Author contributions section should instead read: Author contributions WLF was responsible for the article’s concept and contribute with the whole manuscript; RMD, IRA and PM-H wrote the literature review of the manuscript; DGV, AS and CRPV wrote the method section; MAPD, WL, ALS, AS and CRPV wrote the results and discussion. All authors read and approved the final manuscript. The author group has been updated above and the original article [1] has been corrected

Assistive technology and telecare to maintain independent living at home for people with dementia:the ATTILA RCT

BACKGROUND: Assistive technology and telecare have been promoted to manage the risks associated with independent living for people with dementia, but there is limited evidence of their effectiveness.OBJECTIVES: This trial aimed to establish whether or not assistive technology and telecare assessments and interventions extend the time that people with dementia can continue to live independently at home and whether or not they are cost-effective. Caregiver burden, the quality of life of caregivers and of people with dementia and whether or not assistive technology and telecare reduce safety risks were also investigated.DESIGN: This was a pragmatic, randomised controlled trial. Blinding was not undertaken as it was not feasible to do so. All consenting participants were included in an intention-to-treat analysis.SETTING: This trial was set in 12 councils in England with adult social services responsibilities.PARTICIPANTS: Participants were people with dementia living in the community who had an identified need that might benefit from assistive technology and telecare.INTERVENTIONS: Participants were randomly assigned to receive either assistive technology and telecare recommended by a health or social care professional to meet their assessed needs (a full assistive technology and telecare package) or a pendant alarm, non-monitored smoke and carbon monoxide detectors and a key safe (a basic assistive technology and telecare package).MAIN OUTCOME MEASURES: The primary outcomes were time to admission to care and cost-effectiveness. Secondary outcomes assessed caregivers using the 10-item Center for Epidemiological Studies Depression Scale, the State-Trait Anxiety Inventory 6-item scale and the Zarit Burden Interview.RESULTS: Of 495 participants, 248 were randomised to receive full assistive technology and telecare and 247 received the limited control. Comparing the assistive technology and telecare group with the control group, the hazard ratio for institutionalisation was 0.76 (95% confidence interval 0.58 to 1.01; p = 0.054). After adjusting for an imbalance in the baseline activities of daily living score between trial arms, the hazard ratio was 0.84 (95% confidence interval 0.63 to 1.12; p = 0.20). At 104 weeks, there were no significant differences between groups in health and social care resource use costs (intervention group - control group difference: mean -£909, 95% confidence interval -£5336 to £3345) or in societal costs (intervention group - control group difference: mean -£3545; 95% confidence interval -£13,914 to £6581). At 104 weeks, based on quality-adjusted life-years derived from the participant-rated EuroQol-5 Dimensions questionnaire, the intervention group had 0.105 (95% confidence interval -0.204 to -0.007) fewer quality-adjusted life-years than the control group. The number of quality-adjusted life-years derived from the proxy-rated EuroQol-5 Dimensions questionnaire did not differ between groups. Caregiver outcomes did not differ between groups over 24 weeks.LIMITATIONS: Compliance with the assigned trial arm was variable, as was the quality of assistive technology and telecare needs assessments. Attrition from assessments led to data loss additional to that attributable to care home admission and censoring events.CONCLUSIONS: A full package of assistive technology and telecare did not increase the length of time that participants with dementia remained in the community, and nor did it decrease caregiver burden, depression or anxiety, relative to a basic package of assistive technology and telecare. Use of the full assistive technology and telecare package did not increase participants' health and social care or societal costs. Quality-adjusted life-years based on participants' EuroQol-5 Dimensions questionnaire responses were reduced in the intervention group compared with the control group; groups did not differ in the number of quality-adjusted life-years based on the proxy-rated EuroQol-5 Dimensions questionnaire.FUTURE WORK: Future work could examine whether or not improved assessment that is more personalised to an individual is beneficial.TRIAL REGISTRATION: Current Controlled Trials ISRCTN86537017.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. 25, No. 19. See the NIHR Journals Library website for further project information.</p