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Background: Women with learning disabilities are less likely to access cervical and breast cancer screening when compared to the general population. The Social Ecological Model (SEM) was used to examine the inequalities faced by women with learning disabilities in accessing cervical and breast cancer screening in England, UK. Methods: The findings from a qualitative systematic review and a Q methodology study were triangulated. Framework analysis, in line with the SEM, was used to develop an integrated set of findings. Findings: Women with learning disabilities may lack knowledge of cancer symptoms, and cancer screening, as well as being scared about the process and getting the results. The attitudes of family and paid carers towards screening may influence women with learning disabilities' decisions as to whether screening is seen as favourable; support and training may ensure unbiased perspectives. Barriers were also associated with how cancer screening programmes are designed, such as postal invitations which assumes an ability to read. In addition, screening staff need to be aware of the general needs of people with learning disabilities, such as the benefits of easy-to-read documents. Lastly, multidisciplinary working is required so reasonable adjustments can be embedded into cancer screening pathways. Conclusion: This article highlights multiple methods to reduce the inequalities faced by women with learning disabilities, which can be achieved through reasonable adjustments. Embedding reasonable adjustments can support women with learning disabilities in making an informed decision and accessing screening if they choose to. This may result in women with learning disabilities getting a timely cancer diagnosis.

Human activities can elevate coastal levels of dissolved inorganic nitrogen (DIN). As macroalgae readily absorb and accumulate DIN, the elemental (total N and C:N ratio) composition of their tissues is less affected by temporal fluctuations compared to more direct measures of DIN concentration. Additionally, their isotopic (δ15N) composition can reflect that of the source, which could potentially be used to identify between multiple effluent sources. To investigate whether macroalgal ‘bioindicators’ could map and distinguish between multiple effluents, 2 species of macroalgae (Chondrus crispus and Palmaria palmata) were deployed in a bay containing a salmon farm and sewage treatment facility. Both species exhibited high total N and low C:N ratio near the salmon farm and sewage facility. However, the elemental composition of C. crispus was influenced over a greater distance than that of P. palmata. Differences were also observed between their isotopic composition, as C. crispus indicated that the salmon farm and sewage facility had distinct δ15N signatures, whereas values of δ15N in P. palmata had not changed after 10 d incubation in the field. Interestingly, the distinct isotopic signals observed in C. crispus were likely a result of higher DIN concentrations at the salmon farm, which likely caused macroalgae to fractionate and form biomass lighter in δ15N. Overall, this study suggests that macroalgal bioindicators can monitor and identify between multiple effluent sources, which could provide a useful tool for coastal management. However, some species of macroalgae may make more effective bioindicators than others, and the mechanisms underlying their fractionation require further investigation.

The eutrophication of sediments underlying marine fish farms is one of the major environmental concerns of the industry and regulatory agencies. In this study, a mechanistic model of sediment geochemistry was developed to: (1) determine maximum organic loads that can be degraded without leading to eutrophicated conditions, (2) predict the transition to suboxic conditions as a result of organic enrichment, and (3) predict sulfide levels in surface sediments, a key regulatory variable in Canada. A new definition is proposed for sediment assimilative capacity (AC) of marine fish farms, as the gross deposition rate of organic wastes that maximizes total organic carbon (Corg) degradation rates while preventing sediment sulfide accumulations in surface sediments (upper 2 cm) above regulatory limits (AC-H2S). Model results were consistent with empirical observations and highlight the influence that organic loading history, hydrodynamics, and microbial activity have on assimilative capacity. AC-H2S varied between 0.6 to 22.1 g Corg m-2 d-1 in poorly flushed environments, with no upper limit defined in environments exposed to mean tidal currents >9.5 cm s-1 (dispersion scenarios), where most fish farm organic wastes are dispersed to the far-field or resuspended after deposition below fish cages. The combination of diagenetic modelling and geochemical indicators may contribute significantly to the development of more effective tools for site selection and environmental management of marine fish farms. At this stage, the model should be considered as a proof of concept, developed with the purpose of verifying the utility of assimilative capacity for real-world application. Further validation is still required.

Maximizing the mitigation potential of open-water finfish-shellfish integrated multi-trophic aquaculture (IMTA) farms is complex in terms of co-locating the trophic components. Both the dispersal of finfish aquaculture wastes and biological processes are highly influenced by water circulation. Consequently, the evaluation of shellfish-finfish synergy requires a combined study of biological and physical processes, which can be achieved by the implementation and coupling of mathematical models. A highly configurable mathematical model was developed that can be applied at the apparent spatial scale of IMTA sites. The model tracks different components of the seston, including feed wastes, fish faeces, shellfish faeces, natural detritus and phytoplankton. Based on the characterization of these fluxes, a hypothetical IMTA site was used to explore different spatial arrangements for evaluating finfish-shellfish farm mitigation efficiency. The site was modelled following a factorial design, which tested 2 levels of background seston concentrations, 3 farm designs, 2 hydrodynamic conditions and 2 levels of aquaculture intensity. The model predicts that mitigation efficiency is highly dependent on the background environmental conditions, obtaining maximum mitigation under oligotrophic conditions that stimulate shellfish filtration activity. The dominance of vertical fluxes of particulate matter triggered by the high settling velocity of finfish aquaculture wastes suggests that suspended shellfish aquaculture cannot significantly reduce organic loading of the seabed. Consequently, this suggests that waste mitigation at IMTA sites should be best achieved by placing organic extractive species (e.g. deposit feeders) on the seabed directly beneath finfish cages rather than in suspension in the water column.

Abstract In this study, we explore the utilization of penalized likelihood estimation for the analysis of sparse photon counting data obtained from distributed target lidar systems. Specifically, we adapt the Poisson Total Variation processing technique to cater to this application. By assuming a Poisson noise model for the photon count observations, our approach yields denoised estimates of backscatter photon flux and related parameters. This facilitates the processing of raw photon counting signals with exceptionally high temporal and range resolutions (demonstrated here to 50 Hz and 75 cm resolutions), including data acquired through time-correlated single photon counting, without significant sacrifice of resolution. Through examination involving both simulated and real-world 2D atmospheric data, our method consistently demonstrates superior accuracy in signal recovery compared to the conventional histogram-based approach commonly employed in distributed target lidar applications.

The perioperative maintenance of a patient’s core temperature is a challenge during burn care. While patient warming devices are sometimes used to prevent intraoperative hypothermia, raising the ambient temperature of the theatre is the most common practice. Theatre temperature can impact on the performance and comfort of surgery staff but standards for theatre temperatures in burn care are poorly defined. Therefore, in this study we investigated the current, global, clinical practices in burn care with respect to the ambient temperature of theatres that are used to treat severe burn injuries. An internet-based, descriptive, QualtricsXM survey was distributed electronically to 81 burn professionals to identify the temperatures at which the surgical teams operate on severe burn injuries. The survey was completed by 33 participants from 15 countries and revealed that there is a wide range of temperatures (24–45°C) at which burn injuries are treated. The prevention of hypothermia was the clinical justification most reported for those theatre temperatures. Temperatures between 26 and 30°C appear to be most comfortable for the staff. One respondent mentioned that surgeries are often limited to 5 h to avoid hypothermia in patients, however, others noted surgery durations of up to 8–12 h in raised temperatures, which may impact the physiology and performance of the team, potentially impacting the safety of the patients. The adoption of an optimal theatre temperature to address the surgical team’s comfort levels, their performance, and patient hypothermia, may improve outcomes in cases of severe burn injury.

Background: Anthropogenic climate change is causing a rise in global temperatures, with this trend projected to increase into the future. Heatwaves are associated with a rise in preventable deaths, however this association is less well understood in regions experiencing cooler climates. Methods: We used a space-time-stratified conditional Poisson (-quasi) regression analysis to assess if heatwaves were associated with all-cause mortality in Tasmania, Australia, for the period 2010–2018. Results: We found that across Tasmania, low-intensity heatwaves were relatively common, with less occurrence of severe and extreme heatwaves. We found that for all heatwave types combined, there was a rise in mortality of 8 % (RR=1.08, 95 %CI 1.01–1.16). For low-intensity heatwaves, we found mortality increased by 9 % (RR=1.09, 95 %CI 1.02–1.17). Conclusion: These results have health promotion and health protection policy and practice implications for Tasmanian healthcare services, and potentially other cooler climate regions around the world.