Investigating the microbiological risks associated with urban flooding in the UK

Over the last 30 years, the frequency and occurrence of intense rainfall, and thus extreme hydrological events –flooding- has steadily increased. Drainage infrastructure in the UK was not designed for a changing climate, and many sewer systems in densely populated urban areas, are unable to cope. Sewage overflow and surface run off in urban areas can act as vectors for the dissemination of pathogens, known to cause disease among human populations. Most of the previous studies in this field have focused on using faecal indicators such as E.coli when assessing the public health risk of floodwater [1]. However, traditional indicators do not accurately reflect the true risk that urban flooding poses [2]. Little is understood in regards to the survivability and behaviour of pathogens in different urban settings, which are fundamental to determine potential risks to public health.

Previous investigations in UK waterlogged soils have shown a clear response of microbial communities to water table variation, temperature, and nutrient availability in soil profiles [3]. This research aims to investigate, using advanced molecular methods, the dynamics of pathogens (i.e. movement through soil and survival rates), and microbial interactions at the soil/water interface- collecting information from field work studies and laboratory-controlled experiments.

The outcomes from this research will inform future management strategies of flooded sites that will aid to protect public health.

References

[1] Yard et al., 2014. J. Environ. Sci. Health 49, 1236-1243.

[2] Hussain, 2019. Freshwater Microbiology 10, 393-420.

[3] Douterelo et al., 2009. Int. Biodeterior. Biodegradation 63, 6, 795-805.

Using Normalization Process Theory as a Practical Tool Across the Life Course of a Qualitative Research Project

Drawing on work that aimed to understand factors influencing experience of and engagement with the National Health Service (NHS) Health Check Program, this article discusses how Normalization Process Theory was used throughout the life course of a research project. As a relatively new theory, Normalization Process Theory is still being refined and much work undertaken to develop interactive tools and "test" the utility of it. Although there is little published critique of the theory, two main issues have arisen in the literature: (a) difficulties ensuring interpretation of constructs are congruent to the original theory and (b) the intensity of translation work to contextualize the theory to individual settings. These issues are explored in this article by examining the processes undertaken to translate Normalization Process Theory so that it was usable to shape a qualitative research project from design to analysis and interpretation.

Recent insights on uncertainties present in integrated catchment water quality modelling

This paper aims to stimulate discussion based on the experiences derived from the QUICS project (Quantifying Uncertainty in Integrated Catchment Studies). First it briefly discusses the current state of knowledge on uncertainties in sub-models of integrated catchment models and the existing frameworks for analysing uncertainty. Furthermore, it compares the relative approaches of both building and calibrating fully integrated models or linking separate sub-models. It also discusses the implications of model linkage on overall uncertainty and how to define an acceptable level of model complexity. This discussion includes, whether we should shift our attention from uncertainties due to linkage, when using linked models, to uncertainties in model structure by necessary simplification or by using more parameters. This discussion attempts to address the question as to whether there is an increase in uncertainty by linking these models or if a compensation effect could take place and that overall uncertainty in key water quality parameters actually decreases. Finally, challenges in the application of uncertainty analysis in integrated catchment water quality modelling, as encountered in this project, are discussed and recommendations for future research areas are highlighted.

Using Normalisation Process Theory to investigate the implementation of school-based oral health promotion

Despite the considerable improvement in oral health of children in the UK over the last forty years, a significant burden of dental caries remains prevalent in some groups of children, indicating the need for more effective oral health promotion intervention (OHPI) strategies in this population.

OBJECTIVE

To explore the implementation process of a community-based OHPI, in the North East of England, using Normalisation Process Theory (NPT) to provide insights on how effectiveness could be maximised.

METHODS

Utilising a generic qualitative research approach, 19 participants were recruited into the study. In-depth interviews were conducted with relevant National Health Service (NHS) staff and primary school teachers while focus group discussions were conducted with reception teachers and teaching assistants. Analyses were conducted using thematic analysis with emergent themes mapped onto NPT constructs.

RESULTS

Participants highlighted the benefits of OHPI and the need for evidence in practice. However, implementation of 'best evidence' was hampered by lack of adequate synthesis of evidence from available clinical studies on effectiveness of OHPI as these generally have insufficient information on the dynamics of implementation and how effectiveness obtained in clinical studies could be achieved in 'real life'. This impacted on the decision-making process, levels of commitment, collaboration among OHP teams, resource allocation and evaluation of OHPI.

CONCLUSIONS

A large gap exists between available research evidence and translation of evidence in OHPI in community settings. Effectiveness of OHPI requires not only an awareness of evidence of clinical effectiveness but also synthesised information about change mechanisms and implementation protocols.

Briefing: Negotiating value at the research–practice interface in the water sector

Lessons from experiences of managing an engineering doctorate programme are delineated in this paper, with particular emphasis on the relationship between research and practice. The paper reports on applied, practice-oriented research at the UK's industrial doctoral centre for the water sector. A descriptive account of the negotiating value at the research–practice interface is presented based on decades of collective practice, during which the engineering doctorate model has matured and grown. Conclusions focus on recommendations pertaining to project management, knowledge transfer and the effective and consistent translation of academic and practitioner project details.

Reasons for (non)compliance with intervention following identification of 'high-risk' status in the NHS Health Check programme

Background

The Department of Health introduced a risk assessment, management and reduction programme, NHS Health Checks, which aimed to reduce premature morbidity and mortality from cardiovascular diseases for those aged 40–74. Those identified as at increased risk of CVD are offered prophylactic medication and lifestyle advice to reduce their risk. Health gains will only be achieved if patients are compliant with advice/intervention however. This study sought to understand factors that influenced adherence to medication and advice in ‘high-risk’ patients.

Methods

Qualitative data were collected through 29 semi-structured interviews with a purposive sample of individuals who had been identified as at high-risk of CVD. Participants had been offered lifestyle advice, lipid lowering medications and attended at least one annual review.

Results

Findings explore the challenges and experiences confronting ‘high-risk’ individuals when making decisions about engaging with intervention. Key findings explore: statin adherence, as well as adherence to advice about diet, physical activity, alcohol consumption and smoking cessation.

Conclusions

Attention needs to be paid to the way prophylactic medications are prescribed and explained to high-risk patients. Consistent provision of tailored lifestyle advice and access to appropriate services could facilitate sustained changes to factors that increase CVD risk.

Predicting combined sewer overflows chamber depth using artificial neural networks with rainfall radar data

Combined sewer overflows (CSOs) represent a common feature in combined urban drainage systems and are used to discharge excess water to the environment during heavy storms. To better understand the performance of CSOs, the UK water industry has installed a large number of monitoring systems that provide data for these assets. This paper presents research into the prediction of the hydraulic performance of CSOs using artificial neural networks (ANN) as an alternative to hydraulic models. Previous work has explored using an ANN model for the prediction of chamber depth using time series for depth and rain gauge data. Rainfall intensity data that can be provided by rainfall radar devices can be used to improve on this approach. Results are presented using real data from a CSO for a catchment in the North of England, UK. An ANN model trained with the pseudo-inverse rule was shown to be capable of predicting CSO depth with less than 5% error for predictions more than 1 hour ahead for unseen data. Such predictive approaches are important to the future management of combined sewer systems.

Comparison between InfoWorks hydraulic results and a physical model of an urban drainage system

Urban drainage systems are frequently analysed using hydraulic modelling software packages such as InfoWorks CS or MIKE-Urban. The use of such modelling tools allows the evaluation of sewer capacity and the likelihood and impact of pluvial flood events. Models can also be used to plan major investments such as increasing storage capacity or the implementation of sustainable urban drainage systems. In spite of their widespread use, when applied to flooding the results of hydraulic models are rarely compared with field or laboratory (i.e. physical modelling) data. This is largely due to the time and expense required to collect reliable empirical data sets. This paper describes a laboratory facility which will enable an urban flood model to be verified and generic approaches to be built. Results are presented from the first phase of testing, which compares the sub-surface hydraulic performance of a physical scale model of a sewer network in Yorkshire, UK, with downscaled results from a calibrated 1D InfoWorks hydraulic model of the site. A variety of real rainfall events measured in the catchment over a period of 15 months (April 2008-June 2009) have been both hydraulically modelled and reproduced in the physical model. In most cases a comparison of flow hydrographs generated in both hydraulic and physical models shows good agreement in terms of velocities which pass through the system.

Adolescent drinking behaviour and the role of family life: a Scottish perspective

Family socialisation processes have been shown to have a significant influence on a variety of health-related behaviours. In this study two aspects of family life--the family's social position, and patterns of support and control by parents of their adolescent offspring--are examined in relation to young peoples self-reports of levels of drinking by a representative randomly selected sample of more than 600 Scottish young people. The analysis is based on data drawn from a longitudinal study of adolescent socialisation and life-styles. The results initially support the usual negative relationship reported in other studies between family structure and young people's alcohol use, with adolescents from non-intact families tending to drink more. However, adolescent drinking behaviour is found to be largely unrelated to the socio-economic circumstances of the family. In addition, a supportive family environment is associated with lowered prevalences of alcohol use. The work also points to the fact that, from the young person's perspective, an unsupportive family environment where there are also extremes of parental control (irrespective of whether these are high or low levels of control) is associated with raised levels of alcohol use later in adolescence. The results of a multiple linear regression show that these socialisation factors, related to parental support and control, continue to be of significance even when the family's social position is taken into account, and that such family socialisation factors would appear to be of more direct importance to adolescent drinking behaviour than family structure.

Adolescent focal theories: age-trends in developmental transitions

Focal theory is considered as a framework for looking at psychosocial and leisure transitions in middle and later adolescence. Although these transitions are examined from a different perspective in the present study, by utilising cross-sectional survey data from a representative sample of three age groups of young Scots (13-14, 15-16 and 17-18 year-olds), the results confirm and extend the general age-trends in relational issues and leisure involvement reported in original studies. Within this overall picture, few gender differences are found in age-related relational transitions, but gender differences are apparent in shifting focuses of leisure involvement with age. Further, the findings suggest a linkage between relational issues in adolescence and leisure contexts, where psychosocial processes are seen to be associated with contextual changes in young people's lives. Focal theory has been criticised for a failure to take true account of the social circumstances, constraints and contexts affecting adolescent development, but in the present study surprisingly few differences are found with respect to the young person's social class of family background, for example, with age-trends in developmental transitions similar for all social groups. By contrast, in later adolescence aspects of the young person's own socio-economic position, rather than that of their family background, are clearly linked to both relational issues and leisure involvement, for example, creating a disrupting effect on those young people who are currently unemployed or non-employed at this age.

Lifestyle, health and social class in adolescence

The paper considers mechanisms for indirect health selection in adolescence, as part of the explanation for health inequalities between social groups. Aspects of adolescent lifestyles are identified as potentially important factors for the production of class based differences in adult health status. Survey data from a Scottish longitudinal study of adolescent socialization and lifestyles are utilized in order to locate such health lifestyle factors within the wider contexts of the individual's personal and social environment at this stage of the life cycle. Relationships and attitudes to family, school and peers in middle adolescence at 15-16 years of age are first examined, and distinctive patterns of integration within these contexts are identified. The inter-connections between these broader aspects of lifestyle, social class and individual health behaviours are then examined. Mid-adolescent patterns of social integration are found to have a clear structural basis, and most importantly, they anticipate social position in later adolescence at 17-18 years of age. It is also found that such patterns of integration into the family, peer and school contexts are linked to subsequent health related behaviours and to self assessed health in later adolescence, and that these links are independent of the young person's social class background. Thus, we conclude that behavioural--cultural lifestyle factors, when these are located within a broader social context, provide a clear and plausible mechanism for indirect health selection in adolescence.

Social class and adolescent smoking behaviour

The paper examines class based differences in smoking behaviour in middle and later adolescence. The analyses are based on questionnaire survey data drawn from a longitudinal study of adolescent socialisation, leisure and lifestyles in Scotland. Perhaps surprisingly, the social class of the family is found to have little relationship to smoking in middle and later adolescence. By contrast, marked variations in smoking are evident with respect to the current socio-economic position occupied by young people themselves in middle and later adolescence. The connections between smoking, social class background, and current social class position are examined through a consideration of inter-generational occupational mobility, and once more a clear pattern of differences is found. Thus, we conclude that there is an emergent pattern of class based differences in adolescent smoking behaviour, as young people make the transition towards adulthood. We consider the possible role that factors from the family, the peer group, and the school contexts may play in the production of these differences in smoking behaviour. We also highlight the importance that our findings may have for the health inequalities debate, and particularly for explanations which link the production of class based differences in health to processes of inter-generational mobility.

Adolescence and health inequalities: extensions to Macintyre and West

The paper investigates class based health inequalities in mid to late adolescence. Health status is assessed by means of three subjective self-report measures; evaluation of general health, psychological well-being and disability/long-standing illness. Using six measures of social class (three occupationally and three non-occupationally based) which derive from parental characteristics, no evidence for consistent class based differentials in health amongst adolescents is found. However, it is not concluded that class based health inequalities are absent at this stage of the life cycle. Instead, it is argued that the above measures of social class differentiate between young people on the basis of the socio-economic status of their parents. As such they fail to allow for the possibility that variations in the current social position of young people themselves may have important consequences for their health. Current social position is assessed in terms of economic activity status, occupation and educational attainment. Using these measures, class based health inequalities are indeed found. Extending the analysis further, the relationship between social class of origin, current social circumstances and self-assessed health status is investigated by considering inter-generational occupational mobility. Again, evidence for class based health inequalities is found.