Priorities for future intensive care research in the UK: results of a James Lind Alliance Priority Setting Partnership.

This James Lind Alliance (JLA) Priority Setting Partnership aimed to identify and prioritise unanswered questions about adult intensive care that are important to people who have been critically ill, their families, and the health professionals who care for them. Consensus techniques (modified Delphi and Nominal Group) were used to generate suggestions using online and postal surveys. Following verification and iterative editorial review, research topics were constructed from these suggestions. These topics were presented in a second online and postal survey for rating. A Nominal Group of 21 clinicians, patients and family representatives subsequently met to rank the most important research topics and produce a prioritised list. The project was coordinated by a representative Steering Group and independently overseen by the JLA. The initial survey and review of the literature generated over 1,300 suggestions. Preliminary editing and verification permitted us to encapsulate these suggestions within 151 research topics. Iterative review by members of the Steering Group produced 37 topic statements, subsequently rated by participants. Using the mode to determine importance, 19 topics were presented to the group from which a ‘top three’ intensive care research priorities were identified and a further nine topics were prioritised. By applying and adapting the JLA methodology to focus on an area of care rather than to a single disease, we have provided a means to ensure that patients, their families and professionals materially contribute to the prioritisation of intensive care research in the UK.

Managing the Brisbane River and Moreton Bay: an integrated research/management program to reduce impacts on an Australian estuary

The Brisbane River and Moreton Bay Study, an interdisciplinary study of Moreton Bay and its major tributaries, was initiated to address water quality issues which link sewage and diffuse loading with environmental degradation. Runoff and deposition of fine-grained sediments into Moreton Bay, followed by resuspension, have been linked with increased turbidity and significant loss of seagrass habitat. Sewage-derived nutrient enrichment, particularly nitrogen (N), has been linked to algal blooms by sewage plume maps. Blooms of a marine cyanobacterium, Lyngbya majuscula, in Moreton Bay have resulted in significant impacts on human health (e.g., contact dermatitis) and ecological health (e.g., seagrass loss), and the availability of dissolved iron from acid sulfate soil runoff has been hypothesised. The impacts of catchment activities resulting in runoff of sediments, nutrients and dissolved iron on the health of the Moreton Bay waterways are addressed. The Study, established by 6 local councils in association with two state departments in 1994, forms a regional component of a national and state program to achieve ecologically sustainable use of the waterways by protecting and enhancing their health, while maintaining economic and social development. The Study framework illustrates a unique integrated approach to water quality management whereby scientific research, community participation and the strategy development were done in parallel with each other. This collaborative effort resulted in a water quality management strategy which focuses on the integration of socioeconomic and ecological values of the waterways. This work has led to significant cost savings in infrastructure by providing a clear focus on initiatives towards achieving healthy waterways. The Study's Stage 2 initiatives form the basis for this paper.

Epidemiologic transition in northern Angola: discussion of cumulative results from CISA (Health Research Centre of Angola)

The 41 years of armed conflict (1961 to 2002) resulted in a poor development of the health care and education infrastructures, and forced the relocation of people to safer places, namely major urban cities like Luanda. This phase was characterized by typical demographic, nutritional and epidemiological profiles. With the end of this period Angola has been repeatedly ranked as one of the three fastest growing economies in the world, and along with the social stabilization and globalization, the country is facing the introduction of new medical technologies, improvement of health sys-tems and services, better access to them, and overall better quality of life. These changes could also be translating into socio-cultural, demographic and nutritional changes which in turn may leading to changes in the epidemiological profile of the country. Thus, the emergence of non-communicable diseases are likely to become an increasingly im-portant public health problem in Angola. Also, considering that several infectious diseases persist, our weakened health system will have to face a double burden. Thus, disease surveillance data on non-communicable diseases to determine their prevalence and impact, along with the major behavioural risk factors like consumption of tobacco, alcohol, diets and physical inactivity are urgently needed.

A comparative analysis of sustainable tourism, planning and development between Sligo and Donegal County Councils

Sustainable Development requires appropriate and continuous planning and management of economic, socio cultural and environmental resources. Tourism planning calls for continuous collaboration among tourism agencies, local authorities and local communities for success of the industry. While evidence suggests that tourism planning has been extensively documented, it is apparent that Donegal and Sligo County Councils have, in some cases failed to adequately address the significance of planning of the tourism industry for the North West of Ireland. This was investigated through interviews with chief planners of Donegal and Sligo county councils and was conducted in conjunction with the analysis of county development plans; which were formulated by both organisations involved in this study. Evidence suggests that although tourism is extensively documented by Donegal and Sligo county councils, neither of the two local authorities have developed implementation strategies to facilitate the promotion of sustainable tourism development. This research compares and analyses Donegal and Sligo county councils and how they plan for sustainable tourism development. It outlines the role of the county councils in relation to tourism planning and how Donegal and Sligo compare in how they plan for such a significant industry in the North West o f Ireland. It highlights the importance of implementation tools and methods and offers future directions that can assist in the development of sustainable tourism.

A computable general equilibrium analysis of the relative price sensitivity required to induce rebound effects in response to an improvement in energy efficiency in the UK economy

In recent years there has been extensive debate in the energy economics and policy literature on the likely impacts of improvements in energy efficiency. This debate has focussed on the notion of rebound effects. Rebound effects occur when improvements in energy efficiency actually stimulate the direct and indirect demand for energy in production and/or consumption. This phenomenon occurs through the impact of the increased efficiency on the effective, or implicit, price of energy. If demand is stimulated in this way, the anticipated reduction in energy use, and the consequent environmental benefits, will be partially or possibly even more than wholly (in the case of ‘backfire’ effects) offset. A recent report published by the UK House of Lords identifies rebound effects as a plausible explanation as to why recent improvements in energy efficiency in the UK have not translated to reductions in energy demand at the macroeconomic level, but calls for empirical investigation of the factors that govern the extent of such effects. Undoubtedly the single most important conclusion of recent analysis in the UK, led by the UK Energy Research Centre (UKERC) is that the extent of rebound and backfire effects is always and everywhere an empirical issue. It is simply not possible to determine the degree of rebound and backfire from theoretical considerations alone, notwithstanding the claims of some contributors to the debate. In particular, theoretical analysis cannot rule out backfire. Nor, strictly, can theoretical considerations alone rule out the other limiting case, of zero rebound, that a narrow engineering approach would imply. In this paper we use a computable general equilibrium (CGE) framework to investigate the conditions under which rebound effects may occur in the Scottish regional and UK national economies. Previous work has suggested that rebound effects will occur even where key elasticities of substitution in production are set close to zero. Here, we carry out a systematic sensitivity analysis, where we gradually introduce relative price sensitivity into the system, focusing in particular on elasticities of substitution in production and trade parameters, in order to determine conditions under which rebound effects become a likely outcome. We find that, while there is positive pressure for rebound effects even where (direct and indirect) demand for energy is very price inelastic, this may be partially or wholly offset by negative income and disinvestment effects, which also occur in response to falling energy prices.

Negative rebound and disinvestment effects in response to an improvement in energy efficiency in the UK economy

This paper uses a computable general equilibrium (CGE) framework to investigate the conditions under which rebound effects may occur in response to increases in energy efficiency in the UK national economy. Previous work for the UK has suggested that rebound effects will occur even where key elasticities of substitution in production are set close to zero. The research reported in this paper involves carrying out a systematic sensitivity analysis, where relative price sensitivity is gradually introduced into the system, focusing specifically on elasticities of substitution in production and trade parameters, in order to determine conditions under which rebound effects become a likely outcome. The main result is that, while there is positive pressure for rebound effects even where (direct and indirect) demands for energy are very price inelastic, this may be partially or wholly offset by negative income, competitiveness and disinvestment effects, which also occur in response to falling energy prices. The occurrence of disinvestment effects is of particular interest. These occur where falling energy prices reduce profitability in domestic energy supply sectors, leading to a contraction in capital stock in these sectors, which may in turn lead to rebound effects that are smaller in the long run than in the short run, a result that runs contrary to the predictions of previous theoretical work in this area.

How do improvements in labour productivity in the Scottish economy affect the UK position on the Environmental Kuznets Curve?

The research reported here is an output of Karen Turner’s ESRC Climate Change Leadership Fellow project (Grant reference RES-066-27-0029). However, this research builds on previous work funded by the ESRC on modelling the economic and environmental impacts of technological improvement (Grant reference: RES-061-25-0010) and by the EPSRC through the SuperGen Marine Energy Research Consortium on accounting for and modeling environmental indicators (Grant reference: EP/E040136/1).

Trends in economic research: an international perspective

Given the recent efforts in several countries to reorganize the research institutional setting to improve research productivity, our analysis addresses the following questions: To which extent has the recent awareness over international quality standards in economics around the world been reflected in research performance? How have individual countries fared? Do research quantity and quality indicators tell us the same story? We concentrate on trends taking place since the beginning of the 1990s and rely on a very comprehensive database of scientific journals, to provide a cross-country comparison of the evolution of research in economics. Our findings indicate that Europe is catching-up with the US but, in terms of influential research, the US maintains a dominant position. The main continental European countries, Germany, France, Italy and Spain, experienced some of the largest growth rates in economic scientific output. Other European countries, namely the UK, Norway, the Netherlands, Denmark, and Sweden, have shown remarkable progress in per capita output. Collaborative research seems to be a key factor explaining the relative success of some European countries, in particular when it comes to publishing in top journals, attained predominantly through international collaborations.

The Irish alcohol misuser in England: Ill served by research and policy? Some suggestions for future research opportunities.

Inequalities in the physical and psychological health of the first- and second-generation Irish subjects have been well documented. Despite the fact that the Irish alcohol misuser is subject to a number of unhelpful stereotypes, the research concerning alcohol misuse in the Irish is surprisingly sparse. What little exists indicates that Irish alcohol misusers tend to fit the profile of the "chronic alcoholic." Specifically, they tend to be older (45 years +) and to have impaired physical and psychological health. Not surprisingly this is accompanied by poor longitudinal outcomes. Furthermore, alcohol problems worsen as a result of migration (this phenomenon is not restricted to the UK). Alcohol and drug services are now frequently merged, and policy is directed towards the visible young illicit drug user. This paper argues that inadvertently Irish alcohol misusers are discriminated against as a result. Future avenues of research are outlined to provide services and policy makers with data to plan services taking full account of the needs of Irish alcohol misusers.This resource was contributed by The National Documentation Centre on Drug Use.

Whole-person care: from rhetoric to reality. Achieving parity between mental and physical health.

The report presents evidence on a range of factors affecting disparity between mental and physical health, and includes case studies and examples of good practice to illustrate some of the key issues and solutions. It should be seen as the first stage of an on-going process over the next 5"10 years that will deliver parity for mental health and make whole-person care a reality. It builds on the Implementation Framework for the Mental Health Strategy in providing further analysis of why parity does not currently exist, and the actions required to bring it about. A parity approach should enable NHS and local authority health and social care services to provide a holistic, whole person response to each individual, whatever their needs, and should ensure that all publicly funded services, including those provided by private organisations, give people's mental health equal status to their physical health needs. Central to this approach is the fact that there is a strong relationship between mental health and physical health, and that this influence works in both directions. Poor mental health is associated with a greater risk of physical health problems, and poor physical health is associated with a greater risk of mental health problems. Mental health affects physical health and vice versa. The report makes a series of key recommendations for the UK government, policy-makers and health professionals. Recommendations include: The government and the NHS Commissioning Board should work together to give people equivalent levels of access to treatment for mental health problems as for physical health problems, agreed standards for waiting times, and agreed standards for emergency/crisis mental healthcare. Action to promote good mental health and to address mental health problems needs to start at the earliest stage of a person's life and continue throughout the life course. Preventing premature mortality " there must be a major focus on improving the physical health of people with mental health problems. Public health programmes must include a focus on the mental health dimension of issues commonly considered as physical health concerns, such as smoking, obesity and substance misuse. Commissioners need to regard liaison doctors (who work across physical and mental healthcare) as an absolute necessity rather than an optional luxury. NHS and social care commissioners should commission liaison psychiatry and liaison physician services to drive a whole-person, integrated approach to healthcare in acute, secure, primary care and community settings, for all ages. Mental health services and mental health research must receive funding that reflects the prevalence of mental health problems and their cost to society. Mental illness is responsible for the largest proportion of the disease burden in the UK (22.8%), larger than that of cardiovascular disease (16.2%) or cancer (15.9%). However, only 11% of the NHS budget was spent on NHS services to treat mental health problems for all ages during 2010/11. Culture, attitudes and stigma " zero-tolerance policies in relation to discriminatory attitudes or behaviours should be introduced in all health settings to help combat the stigma that is still attached to mental illness within medicine. Political and managerial leadership is required at all levels. There should be a mechanism at national level for driving a parity approach to relevant policy areas across government; all local councils should have a lead councillor for mental health; all providers of specialist mental health services should have a board-level lead for physical health and all providers of physical healthcare services should have a board-level lead for mental health. The General Medical Council (GMC) and Nursing and Midwifery Council (NMC) should consider how medical and nursing study and training could give greater emphasis to mental health. Mental and physical health should be integrated within undergraduate medical education.This resource was contributed by The National Documentation Centre on Drug Use.

The European Dementia Research Agenda

In light of this contemporary challenge for public policy, on the 16th November 2010 a highlevel group of experts in dementia research convened at the European Parliament, to discussthe dementia research agenda. The purpose of this report is to present the opinions, viewsand knowledge expressed at the meeting and to serve as a platform for further actions andinitiatives at the EU and Member State level. This forms the latter section of the report. The first part of the report aims to set the scene to the dementia research environment, by exploringthe scale of the challenge ahead, the current funding environment and recent EU policydevelopments in this regard.

Women and Dementia - Not forgotten ILC-UK

ILC-UK recently (31 Aug 2011)��published a report calling for a gendered approach and response to dementia at the national and international level. The report posits that women will disproportionately bear the burden of dementia in terms of numbers, but also impact in the coming years. The ‘feminization of ageing’ is a widely recognised trend and yet hitherto a comprehensive approach to the impact of dementia on women remains largely under explored.Invariably women and men as they age, share many of the same fundamental needs. Yet, as is acknowledged in many parts of the world, older women are particularly vulnerable and are subject to prolonged inequalities experienced since childhood, for example, lower levels of education and a greater risk of poverty. This report assumes a life course approach to the challenge of dementia and women, arguing from a global perspective that women face a ‘triple jeopardy’ as a result of the associated stigma attached to their age, gender and decline in cognitive functions. ILC-UK make a number of recommendations for improving outcomes and interventions for women, which include: 1. Dementia health policies and programmes should incorporate a gender dimension in their design, delivery and evaluation2. Gender should be included as a key health determinant in the promotion and disease prevention of dementia3. Dementia research at the regional, national and international level needs to be disaggregated by gender and age4. Women and men should be equally represented and involved at the micro and macro level of decision-making with regard to the development of health and social care policies and resource allocation as they pertain to dementia5. There is a need for greater interdisciplinary research incorporating the biological and social models of health for men and women to improve health interventions and outcomesDownload the full pdf report here��

Dementia Research Impact Report (1990-2012)

Impact of Alzheimer's Society's dementia research programme 1990-2012. Full details and the publication can be accessed here.

A new pathway for the regulation and governance of health research

The Academy's review, 'A new pathway for the regulation and governance of health research' was published in January 2011. The report was prepared by a working group, chaired by Professor Sir Michael Rawlins FMedSci, convened in response to an invitation from Government to review the regulation and governance of UK health research involving human participants, their tissue or their data.The report proposes four key principles that should underpin the regulation and governance framework around health research in the UK, and makes recommendations to:Create a new Health Research Agency (HRA) to rationalise the regulation and governance of all health research. Include within the HRA a new National Research Governance Service to facilitate timely approval of research studies by NHS Trusts. Improve the UK environment for clinical trials.Provide access to patient data that protects individual interests and allows approved research to proceed effectively. Embed a culture that values research within the NHS.

Clinical research: how to be involved

The Northern Ireland Clinical Research Network (NICRN) undertakes research in a range of medical fields, which have recently been expanded to include mental health. The NICRN is part of a UK-wide initiative to provide opportunities for patients and clinicians to participate in high-quality clinical research.This suite of leaflets provides both the public and clinical researchers with an introduction to the work of the NICRN. They provide an overview of the NICRN's goals and highlight what the network can offer to patients, carers and researchers. Each leaflet includes specific details on the NICRN's work in that area and reasons why clinical research plays such a vital role in improving the delivery of health and social care