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Background Molecular characterisation of hepatocellular carcinoma (HCC) is central to the development of novel therapeutic strategies for the disease. We have previously demonstrated mutagenic consequences of Long-Interspersed Nuclear Element-1 (LINE1s/L1) retrotransposition. However, the role of L1 in HCC, besides somatic mutagenesis, is not well understood. Methods We analysed L1 expression in the TCGA-HCC RNAseq dataset (n = 372) and explored potential relationships between L1 expression and clinical features. The findings were confirmed by immunohistochemical (IHC) analysis of an independent human HCC cohort (n = 48) and functional mechanisms explored using in vitro and in vivo model systems. Results We observed positive associations between L1 and activated TGFβ-signalling, TP53 mutation, alpha-fetoprotein and tumour invasion. IHC confirmed a positive association between pSMAD3, a surrogate for TGFβ-signalling status, and L1 ORF1p (P n = 32). Experimental modulation of L1 ORF1p levels revealed an influence of L1 ORF1p on key hepatocarcinogenesis-related pathways. Reduction in cell migration and invasive capacity was observed upon L1 ORF1 knockdown, both in vitro and in vivo. In particular, L1 ORF1p increased PIN1 cytoplasmic localisation. Blocking PIN1 activity abrogated L1 ORF1p-induced NF-κB-mediated inflammatory response genes while further activated TGFβ-signalling confirming differential alteration of PIN1 activity in cellular compartments by L1 ORF1p. Discussion Our data demonstrate a causal link between L1 ORF1p and key oncogenic pathways mediated by PIN1, presenting a novel therapeutic avenue.

Simple Summary The incidence of hepatocellular carcinoma (HCC) in patients with non-alcoholic fatty liver disease (NAFLD) has increased in recent years. Compared to HCC caused by other chronic liver diseases, NAFLD-related HCC is often detected later, because it more commonly arises before cirrhosis has occurred. Because of this late diagnosis, NAFLD-related HCC is often more advanced at time of diagnosis, resulting in fewer curative treatment options. Most research in the pathogenesis of HCC has focused on the disease processes in hepatocytes, the most abundant type of liver cells. However, other cell types, such as cells of the immune system and cells that regulate connective tissue formation, also play an important role in the development of NAFLD-related HCC, both by contributing to the development of HCC itself and by interfering with the immune system's ability to attack cancer cells. In this paper, we review the role of different cell types in the development of NAFLD-related HCC. Hepatocellular carcinoma (HCC) in the setting of non-alcoholic fatty liver disease (NAFLD)-related cirrhosis and even in the pre-cirrhotic state is increasing in incidence. NAFLD-related HCC has a poor clinical outcome as it is often advanced at diagnosis due to late diagnosis and systemic treatment response is poor due to reduced immune surveillance. Much of the focus of molecular research has been on the pathological changes in hepatocytes; however, immune cells, hepatic stellate cells, liver sinusoidal endothelial cells and the extracellular matrix may play important roles in the pathogenesis of NAFLD-related HCC as well. Here, we review the role of non-parenchymal cells in the liver in the pathogenesis of HCC in the context of NAFLD-NASH, with a particular focus on the innate and the adaptive immune system, fibrogenesis and angiogenesis. We review the key roles of macrophages, hepatic stellate cells (HSCs), T cells, natural killer (NK) cells, NKT cells and liver sinusoidal endothelial cells (LSECs) and the role of the extracellular matrix in hepatocarcinogenesis within the steatotic milieu.

Introduction: The COVID-19 pandemic has caused severe disruption of healthcare services worldwide and interrupted patients’ access to essential services. During the first lockdown, many healthcare services were shut to all but emergencies. In this study, we aimed to determine the immediate and long-term indirect impact of COVID-19 health services utilisation on hepatocellular cancer (HCC) outcomes. Methods A prospective cohort study was conducted from March 1, 2020, until June 30, 2020 correlating to the first wave of the COVID-19 pandemic. Patients were enrolled from tertiary hospitals in the UK and Germany with dedicated HCC management services. All patients with current or past HCC who were discussed at a multidisciplinary meeting (MDM) were identified. Any delay to treatment (DTT) and the effect on survival at 1 year were reported. Results The median time to receipt of therapy following MDM discussion was 49 days. Patients with Barcelona Clinic Liver Cancer (BCLC) stages-A/B disease were more likely to experience DTT. Significant delays across all treatments for HCC were observed but delay was most marked for those undergoing curative therapies. Even though severe delays were observed in curative HCC treatments, this did not translate in reduced survival in patients. Conclusion Interruption of routine healthcare services because of the COVID-19 pandemic caused severe delays in HCC treatment. However, DTT did not translate to reduced survival. Longer follow is important given the delay to therapy in those receiving curative therapy.

Dementia is a far-reaching disease and it is estimated that approximately 850,000 people are living with dementia in the UK; this is estimated to increase to over 1 million by the year 2025 (Prince, Knapp, Guerchet, et al., 2014). Caring for people with dementia is demanding and this care is often provided by unpaid carers in the home (National Institute for Health Research, 2016). So often people are uncertain about what the future could hold following diagnosis and how to support a person with dementia. Due to this in 2017, St Giles Hospice in collaboration with Green Square Accord launched a four-week carers’ course which was designed to support unpaid carers in the community who support people living with dementia. The course covers a range of topics, including looking after yourself and activities for people with dementia, eating and drinking and infections in dementia, dementia related behaviours and planning for the future including end-of-life. Prior to 2020 this four-week course was face-to-face and was group based. When the COVID-19 pandemic hit the service had to act quickly to ensure the much-needed support for these carers did not disappear. The carers’ course was adapted to provide support via a one-to-one basis either via video consultation or through a telephone call. This ensured that carers were not isolated and had access to specialist support and signposting to other services. Data captured showed that 100% of participants found that the topics covered were relevant to their situations, 92% of participants found that sessions fulfilled their expectations and that 100% were given opportunity to ask questions. Over 80 carers have been supported through the adaptation of the service so far.

Improving end-of-life care is a strategic priority for commissioners and has been for some years. The mean number of hospital admissions in the last 12 months of life averaged in England is 2.28 occupying 30.05 bed days (Bardsley, Georghiou, Spence, et al., 2019). A Carers UK (2016) survey identified that carer breakdown led to unnecessary, distressing and expensive admissions to hospital of the person being cared for, and suggested that if the carer had greater and higher quality support, it could have a significant impact on the number of emergency admissions. St Giles Hospice recognised that there was still more needed to enable families and patients to feel supported at home. After speaking to families, patients and community healthcare professionals, the organisation identified a gap in service provision for respite care. Consequently, in March 2021 St Giles launched a new respite service which was funded by the generosity of a local business. The aim of that service was to provide support to patients and carers in the last 12 months of life by providing respite care and education within the home setting. This will be achieved through: Building resilience and wellbeing within the carer. Increasing knowledge and skills for informal carers to support them in the provision of care to those they are caring for. Offering respite care in the home causing minimal disturbance to the patient and provide the carer with a much-needed break. Supporting patients and carers to maximise the scope for self-care and to combine formal and informal support. Acting as a flexible, responsive service. Supporting the wider shift from hospital to primary care by avoiding hospital admissions. Ensuring staff are trained as ‘train the trainers’ with additional skills in dementia care as it is acknowledged that dementia is not only a primary but a secondary diagnosis and the number of people of dementia is increasing as people live longer.

The article analyses the material culture of music performance on Manihiki, northern Cook Islands, and provides a framework within which the material culture may be interpreted in its cultural context. The focus of the paper is the built environment associated with music and dance performance, and the rich and varied types of musical styles heard on Manihiki. According to the argument in the paper, the type of music performance is directly related to the type of place at which the performance is held.

The paper describes the establishment of the British Geological Survey (BGS)’s field-based ‘Coastal Landslide Observatory’, designed for the study of coastal ‘soft cliff’ recession on the east coast of England at Aldbrough, East Riding of Yorkshire. The cliffed site is part of the 50 km long Holderness coast which is one of the most rapidly eroding coastlines in Europe. The site features a 16–17 m high sea-cliff formed by Late Devensian (18–13 ka) glacial deposits dominated by tills. The aim of the research is to investigate the role of landslides and their pre-conditioning factors, including geology, geotechnics and topography, in cliff recession with a view to developing coastal landslide forecasting capability. Two research approaches are encompassed in the observatory: firstly, terrestrial LiDAR surveying, from 2001 to present, to create digital elevation models of the cliff and, secondly, installation of instrumented boreholes from 2012. The design, methods, conceptual ground model, implementation of the observatory and geotechnical laboratory test results are described in this article. The interpretation of results and the final ground model are presented in a related article in this volume.

Urban infrastructure assets (e.g. roads, water pipes) perform critical functions to the health and well-being of society. Although it has been widely recognised that different infrastructure assets are highly interconnected, infrastructure management in practice such as planning, installation and maintenance are often undertaken by different stakeholders without considering these dependencies due to the lack of relevant data and cross-domain knowledge, which may cause unexpected cascading social, economic and environmental effects. In this paper, we present a knowledge based decision support system for urban infrastructure inter-asset management. By considering various infrastructure assets (e.g. road, ground, cable), triggers (e.g. pipe leaking) and potential consequences (e.g. traffic disruption) as a holistic system, we model each sub-domain using a modular ontology and encapsulate the interdependence between them using a set of rules. Moreover, qualitative likelihood is assigned to each rule by domain experts (e.g. civil engineers) to encode the uncertainty of knowledge, and an inference engine is applied to predict the potential consequences of a given trigger with location specific data and the encoded rules. A web-based prototype system has been developed based on the above concept and demonstrated to a wide range of stakeholders. The system can assist in the process of decision making by aiding data collation and integration, as well as presenting potential consequences of possible triggers, advising on whether additional information is needed or suggesting ways of obtaining such information. The work shows an intelligent approach to integrate and process multi-source data to pioneer a novel way to aid a complex decision process with a high social impact.

Landslide domains are a useful tool for characterising and subdividing a region into homogenous units reflecting the style of landsliding, which is controlled by the environmental characteristics (e.g. geology, relief). Landslide domains can provide a framework for the application of landslide knowledge obtained from a data-rich area across areas within the domain that are less data rich but have similar environmental characteristics. We have constructed landslide domains for East Sikkim using a landslide inventory, geology, relief and expert-based knowledge of landslide processes in the region. First, we catalogued landslide processes in East Sikkim using peer-reviewed literature, supplementing this with the mapping of over 450 translational landslides and debris flows in Google Earth through visual analysis utilising process knowledge from the catalogue. Several dozens of old landslides were mapped with stereographic analysis of four Cartosat-1 stereo pairs (90 km2) captured in March and December of 2011. Morphometric maps were constructed from Aster GDEM. Finally, the driving environmental characteristics for each process have been determined via statistical analyses to inform expert-driven construction of the landslide domains. We find that landslide domains explain landslide processes in East Sikkim well, but they may be limited by the amount of data that is available. The construction of landslide domains is flexible and can be applied to many different areas. Future work includes the testing of large-scale regions and inclusion into susceptibility models, where we hope that they will facilitate the construction of more accurate and representative susceptibility maps.

The Ripley Landslide is a small (0.04 km2), slow-moving landslide in the Thompson River Valley, British Columbia, that is threatening the serviceability of two national railway lines. Slope failures in this area are having negative impacts on railway infrastructure, terrestrial and aquatic ecosystems, public safety, communities, local heritage and the economy. This is driving the need for monitoring at the site, and in recent years there has been a shift from traditional geotechnical surveys and visual inspections for monitoring infrastructure assets toward less invasive, lower cost, and less time-intensive methods, including geophysics. We describe the application of a novel electrical resistivity tomography system for monitoring the landslide. The system provides near-real time geoelectrical imaging, with results delivered remotely via a modem, avoiding the need for costly repeat field visits, and enabling near-real time interpretation of the four-dimensional electrical resistivity tomography data. Here, we present the results of the electrical resistivity tomography monitoring alongside field sensor-derived relationships between suction, resistivity, moisture content and continuous monitoring single-frequency Global Navigation Satellite System stations. Four-dimensional electrical resistivity tomography data allows us to monitor spatial and temporal changes in resistivity, and by extension, in moisture content and soil suction. The models reveal complex hydrogeological pathways, as well as considerable seasonal variation in the response of the subsurface to changing weather conditions, which cannot be predicted through interrogation of weather and sensor data alone, providing new insight into the subsurface processes active at the site of the Ripley Landslide. © 2020 The Authors. Near Surface Geophysics published by John Wiley & Sons Ltd on behalf of European Association of Geoscientists and Engineers.

In recent years, a number of high profile landslide events have caused disruption, derailments or damage to railway infrastructure in Great Britain. A landslide susceptibility model of the entire railway network was created, designed to give a national overview of potential landslide hazard originating from Outside Party Slopes. The current assessment was compiled using Geographic Information System (GIS) techniques and desktop modelling to apply a structured analysis of each buffered Earthwork Inspection 5 Chain (c. 100 m; EI5C). Data analysed along the network included the BGS GeoSure instability model and newly updated national models for debris flow, earth flow and rock fall, supported by historical landslide data. In order to further focus the Outside Party Slope zone, a buffer of External Natural Geological Influence (BENGI) was created using a 5 m Digital Terrain Model. Landslide susceptibility for each EI5C was categorized using a ‘Classification of Hazards on Outside Party Slopes’ (CHOPS) score; representing the modelled potential for landslide hazard. The outputs were combined as a series of matrices to present the CHOPS and Network Rail Derailment Criticality Band interactions. This research will allow further focused analysis of the network, in order to prioritize and direct future investigation and policy decisions.

Background and aims The aim of this project was to introduce an innovative leadership programme aimed at hospice nurses within the community palliative care team to help enhance their leadership skills and build resilience to reduce the risk of burnout. The programme aimed to develop nursing leadership skills, to enhance patient care and to improve practitioner self-management. To ensure the programme reflects the needs of the individuals and the group as a whole, a range of teaching and learning methods were employed. The programme included Myers Briggs Type Indicator (MBTI), FIERCE training, training on self-management techniques and change, group coaching and a workbook which supported the programme with self-reflection exercises. The programme was underpinned by the Clinical Leadership Competency Framework (NHS Leadership Academy, 2011) to ensure optimisation of leadership potential. Method Focus groups were used to gather information from the participants regarding their understanding of leadership and how they felt about themselves as leaders. Results Prior to the programme participants felt that the traits of a leader and the relationship between leader and follower were of paramount importance. There was also an acknowledgement from the participants that they did not self-identify as leaders in their role. Following the leadership programme further focus groups were used to evaluate the programme. Participants felt they had increased their confidence around their leadership skills and the programme had helped them to understand themselves and others more which they felt led to better team working which consequently increased resilience. Questionnaires were also used to demonstrate change in individuals with most showing an improvement in their confidence, self-management and team working. Conclusion Overall, the evaluation of the leadership programme was extremely positive with the only suggested improvement to shorten the one-year programme to intensify the experience.

Background The national picture: the NSF for Older People emphasised the need to provide the right care in the right place at the right time. Hospital is not necessarily the best place for older people, unless they are in need of acute medical or surgical intervention (Department of Health, 2001). Admissions are expensive (Department of Health, 2004) and often a frightening experience, particularly to those who are frail and vulnerable; people with advanced dementia are particularly vulnerable and frequently admitted to hospital, often unnecessarily (Department of Health, 2009). In view of this, St Giles Hospice and Douglas Macmillan Hospice are working with South East Staffordshire + Seisdon Peninsula Clinical Commissioning Group to support care homes in providing end of life care to their residents by providing expert support and implementation of key tools to help identify residents in their last 12 months of life. St Giles and Douglas Macmillan Hospice are supporting care homes throughout their localities by providing a specialist palliative care nurse to help support the home in identifying patients who may be in the last 12 months of life. Aims and objectives of the service: Development of a ‘Planning Ahead’ register of frail patients at risk of admission or likely to be in the last 12 months of life, using recognised and evidence based prognostic indicator(s); To ensure residents on this register have a care plan and advance care plan where appropriate; To ensure resuscitation status is reviewed for patients and that support is provided for these discussions; To deliver reduction in the number of avoidable emergency admissions to hospital. Outcomes and the future Currently St Giles Hospice and Douglas Macmillan Hospice are working with 46 homes providing weekly support sessions and review of the planning ahead register. Data is collated quarterly, with results due the beginning of July 2019.

Previous laboratory-based studies have demonstrated pressure stimulated currents and electromagnetic emissions in rock and cement mortar can be used to assess damage. There is some debate whether the current and electromagnetic emission measurement technologies used thus far are viable for field application. The results presented here provide evidence that electric potential sensors are a viable new technology for field monitoring of electrical emissions. Cylindrical specimens of rock were loaded at constant stress or strain rates until failure occurred; strain gauges, piezoelectric transducers and electric potential sensors were used to monitor the strain, acoustic emissions and pressure stimulated voltages. Pressure stimulated voltages were observed in the linear elastic and inelastic deformation regions of loading, suggesting that pressure stimulated voltages are associated with microcracking and macrocracking events. Electric potential sensors are potentially a cost effective and more advanced alternative to piezo transducers and geophones for structural health monitoring of rocks.

After the first successful pregnancy in a liver transplant recipient in 1978, much evidence has accumulated on the course, outcomes and management strategies of pregnancy following liver transplantation. Generally, liver transplantation restores sexual function and fertility as early as a few months after transplant. Considering that one third of all liver transplant recipients are women, that approximately one-third of them are of reproductive age (18–49 years), and that 15% of female liver transplant recipients are paediatric patients who have a >70% probability of reaching reproductive age, the issue of pregnancy after liver transplantation is rather relevant, and obstetricians, paediatricians, and transplant hepatologists ever more frequently encounter such patients. Pregnancy outcomes for both the mother and infant in liver transplant recipients are generally good, but there is an increased incidence of preterm delivery, hypertension/preeclampsia, foetal growth restriction, and gestational diabetes, which, by definition, render pregnancy in liver transplant recipients a high-risk one. In contrast, the risk of congenital anomalies and the live birth rate are comparable to those of the general population. Currently there are still no robust guidelines on the management of pregnancies after liver transplantation. The aim of this position paper is to review the available evidence on pregnancy in liver transplant recipients and to provide national Italian recommendations for clinicians caring for these patients.

There have been a number of high profile reports of landslides on the national rail network of Great Britain (comprising England, Scotland and Wales) over recent years. Events range in size from small wash out failures (St. Bees, Cumbria) to well publicised large failures causing major longer term disruption (Hatfield Colliery, South Yorkshire). In conjunction with negative media attention, derailment and damage to railway infrastructure, failures along the rail network have the potential to cause injury and loss of life. The national rail network comprises ten strategic routes that cover a variety of terrains and geologies. The British Geological Survey (BGS) have produced, for Network Rail, a high level susceptibility model of landslide hazard from Outside Party Slopes adjacent to the strategic rail network. This assessment was compiled based on Geographic Information System (GIS) techniques and historical landslide records (landslide inventory). The model was designed to give a high level overview of potential landslide hazard to Network Rail senior management and individual Route Asset Managers. The national study adopted a fixed buffer style analysis of each 5 chain section (∼100 m length) of the entire railway network. It included event data from the BGS National Landslide Database superimposed on mapped data from the BGS GeoSure land instability susceptibility model and geologically mapped landslide polygons. The National Landslide Database is the most comprehensive inventory of landslide events in Great Britain. The BGS GeoSure slope instability layer provides a scientifically based 1:50 000 scale assessment of national susceptibility to natural slope failure. The results of this study have been provided as a spatially attributed dataset with total hazard susceptibility scores A (low)–E (high). Maximum hazard scores are attributed for both up and down- track and 5 chain length for the full network. A high score indicates where conditions imply a significant potential for future landslide hazard. Further refinement of the hazard layers are being developed by BGS to include specific landslide processes such as Rockfall, Earthflow and Debris Flow hazards.

This study demonstrates the use of Multi-channel Analysis of Surface Waves (MASW) to measure changes in Rayleigh wave velocity relating to both the initial trench construction and subsequent simulated failures (water leaks) of a buried water-pipe. The MASW field trials were undertaken in conjunction with a wider suite of geophysical monitoring techniques at a site in South-west England, within an area of clayey sandy SILT. The Rayleigh wave velocity through a soil approximately equals the shear wave velocity, which in turn is predominantly dependant on the shear modulus of the soil (G) and this can be inferred to give a measure of the relative strength of a soil. It is proposed that the time-lapse measurement of Rayleigh wave velocity may be used to monitor ongoing changes in soil strength and therefore the MASW technique could perform a significant role in monitoring the initiation/progression of any internal processes within a geotechnical asset, before they would otherwise be identified through visual inspection alone.

The national picture The NSF for Older People emphasised the need to provide the right care in the right place at the right time. Hospital is not necessarily the best place for older people, unless they are in need of acute medical or surgical intervention (Department of Health, 2001). Admissions are expensive (Department of Health, 2004) and often a frightening experience, particularly for those who are frail and vulnerable; people with advanced dementia are particularly vulnerable and frequently admitted to hospital, often unnecessarily (Department of Health, 2009). In view of this St Giles Hospice are working with Virgin Care and SES CCG to support care homes in providing end of life care to their residents by providing expert support and implementation of key tools to help identify residents in their last 12 months of life. Aims and objectives of the service Development of a ‘Planning Ahead’ register of frail patients at risk of admission or likely to be in the last 12 months of life using recognised and evidence based prognostic indicator(s) To ensure residents on this register have a care plan and advance care plan where appropriate To ensure valid DNACPR is in place for patients To ensure a valid RESPECT document is in place (where appropriate) To deliver reduction in the number of unplanned emergency admissions to hospital. Outcomes and the future Currently St Giles Hospice are working with 25 homes providing weekly support sessions and review of the planning ahead register. There has been an increase in people achieving preferred place of death enabling 80% to die in their care home and of all admissions to hospital during this period only one was found to be avoidable. Quarterly reports/evaluations are collated with the aim to increase this service to all care homes within our area.

The effects of cancer and its treatment can have major adverse effects on the women it has affected and their families. This service has been set up with the support of Sutton Breast Friends and St Giles Hospice and will enable patients to discuss issues which were previously unrecognised relating to the impact on their altered body image, well-being and sexuality in a comfortable and open environment with a specialist nurse who has the skills to empower these patients to live their lives well, when suffering from the adverse effects of cancer and its treatment. Focus groups were utilised at the start to ensure that the service was set up how women wanted to ensure its success. By developing this service and delivering this model of care, our aim is to: improve the wellbeing of women suffering with cancer and the adverse effects of its treatment enable women to take control and manage a range of problems impacting on their body image, sexuality and wellbeing enable wives/husbands/partners to discuss the issues and concerns relating to how cancer and its treatment may impact on their relationship prevent relationship disconnect linked to cancer and its treatments There will continue to be an unmet need and these issues will remain unresolved for patients affecting their quality of life, and their ability to reconnect with their relationships. Evidence shows increased risk of relationship breakdown when suffering from the adverse effects of cancer and its treatment. Due to this being a new service outcome measures will be collected and will be used to demonstrate the effect the intervention has had on patients self-worth, confidence and state of mind.

The deliverable report D4.2 'Procedure for landslide monitoring using remote sensing techniques', is the outcome of Task 4.2 'Developing semi-automatic remote sensing for landslide inventories'. The report is about the use of remotely sensed data and image processing for landslide recognition and mapping as input useful to validate the landslide forecasts produced by the early warning model to develop in WP7, in the two specific pilot-study areas of the project. It includes an analysis of the landslides types occurred in the past in the study areas, and a critical evaluation of the earth Observation methods proposed in literature for landslide recognition and mapping. The report comes up with a list of recommendations useful for the purposes of the Project. The report is due by month 24.

Urban infrastructure assets perform critical functions to the health and well-being of the society. In this paper, we present a prototype decision support system for sustainable subsurface inter-asset management. To the best of the authors’ knowledge, this work is the first on assessing the underground space by considering the inter-asset dependencies using semantic technologies. Based on a family of interlinked city infrastructure asset ontologies describing the ground, roads and buried utilities (e.g. water pipes), various datasets are integrated and logical rules are developed to describe the intra-asset and inter-asset relationships. An inference engine is employed to exploit the knowledge and data for assessing the potential impact of an event. This system can be beneficial to a wide range of stakeholders (e.g. utility incident managers) for quickly gathering of the localised contextual data and identifying potential consequences from what may appear as an insignificant trigger. A video demonstrating the prototype is available at: http://bit.ly/2mdyIY4.

Acceso electrónico sólo desde el IGME, Landslides are one of the most widespread geohazards in Europe, producing significant social and economic impacts. Rapid population growth in urban areas throughout many countries in Europe and extreme climatic scenarios can considerably increase landslide risk in the near future. Variability exists between European countries in both the statutory treatment of landslide risk and the use of official assessment guidelines. This suggests that a European Landslides Directive that provides a common legal framework for dealing with landslides is necessary. With this long-term goal in mind, this work analyzes the landslide databases from the Geological Surveys of Europe focusing on their interoperability and completeness. The same landslide classification could be used for the 849,543 landslide records from the Geological Surveys, from which 36% are slides, 10% are falls, 20% are flows, 11% are complex slides, and 24% either remain unclassified or correspond to another typology. Most of them are mapped with the same symbol at a scale of 1:25,000 or greater, providing the necessary information to elaborate European-scale susceptibility maps for each landslide type. A landslide density map was produced for the available records from the Geological Surveys (LANDEN map) showing, for the first time, 210,544 km2 landslide-prone areas and 23,681 administrative areas where the Geological Surveys from Europe have recorded landslides. The comparison of this map with the European landslide susceptibility map (ELSUS 1000 v1) is successful for most of the territory (69.7%) showing certain variability between countries. This comparison also permitted the identification of 0.98 Mkm2 (28.9%) of landslide-susceptible areas without records from the Geological Surveys, which have been used to evaluate the landslide database completeness. The estimated completeness of the landslide databases (LDBs) from the Geological Surveys is 17%, varying between 1 and 55%. This variability is due to the different landslide strategies adopted by each country. In some of them, landslide mapping is systematic; others only record damaging landslides, whereas in others, landslide maps are only available for certain regions or local areas. Moreover, in most of the countries, LDBs from the Geological Surveys co-exist with others owned by a variety of public institutions producing LDBs at variable scales and formats. Hence, a greater coordination effort should be made by all the institutions working in landslide mapping to increase data integration and harmonization., Earth Observation and Geohazards Expert Group (EOEG), EuroGeoSurveys, the Geological Surveys of Europe, Bélgica, Geohazards InSAR Laboratory and Modeling Group, Instituto Geológico y Minero de España, España, Risk and Prevention Division, Bureau de Recherches Géologiques et Minières, Francia, Engineering Geology Department, Institute of Geology and Mineral Exploration, Grecia, GeoHazard team, Geological Institute of Romania, Rumanía, Geological Survey of Slovenia, Eslovenia, Croatian Geological Survey, Croacia, Italian Institute for Environmental Protection and Research, Geological Survey of Italy, Italia, Swiss Federal Office for the Environment, Suiza, Geological Survey of Austria, Austria, Polish Geological Institute, National Research Institute, Polonia, Geological Survey of Ireland, Irlanda, Czech Geological Survey, República Checa, Federal Institute for Geosciences and Natural Resources, Alemania, Geological Survey of Norway, Noruega, Cyprus Geological Survey, Chipre, Geological Survey of Sweden, Suecia, Institut Cartogràfic i Geològic de Catalunya, España, British Geological Survey, Reino Unido, Geological Survey of Slovakia, Eslovaquia, Geological Survey of Lithuania, Lituania, Federalni zavod za geologiju, Bosnia y Herzegovina, Geological Survey of Estonia, Estonia, Laboratório Nacional de Energia e Geologia, Portugal, Geological Survey of Hungary, Hungría, Norwegian Water and energy Directorate of Norway, Noruega

Background Palliative care teams have historically worked in isolation from other services. St Giles has revolutionised their workforce by incorporating staff nurse rotation between community and palliative care services. Aim To provide seamless patient care, St Giles Hospice has incorporated rotation of staff nurses between community and inpatient palliative care services. The aim of this is to streamline patient journeys between services, increase staff knowledge between departments, maintain clinical skills and offer career development for staff. Methods Staff nurses between departments were identified to be part of the pilot rotation, timeframes were set for rotation with evaluations at the beginning and end to evaluate the pilot and the benefits it had had. Patient feedback was also evaluated for any reference to the rotational role. Results The initial rotation timeframe was too short, feedback from the nurses was that six months in each department would be more efficient and enable embedding into practice. Clinical skills in the community have been maintained with nurses able to perform more clinical tasks (bloods, medications etc) with increased confidence and competence. In addition the handover of care to inpatient settings has been improved with patients having a familiar face when they enter an unfamiliar setting. Due to the success this has now been rolled out to all staff nurses in the community with recruitment underway for their rotational counterparts. Conclusion To date the rotation has been a success. We now have a rotation of CNS and Sister between departments and also rotation between staff nurses as well. As patients do not see barriers between services neither should staff. A greater understanding of each department enables better outcomes for patients and also staff with greater appreciation of roles.

Background Studies have found that people with dementia are often admitted to hospital unnecessarily from care homes by staff who have not received enough support to help them understand dementia and how to support them at the end of life. Aims The presentation will cover how working collaboratively has resulted in a change across the culture of Walsall healthcare resulting in improved outcomes for patients with dementia. It will provide practical solutions to commonly found problems when looking at service improvements and provide an honest account of setting up a collaborative partnership between organisations and the challenges we encountered and the ways we overcame them. Method Support is provided by a range of methods including observations, support sessions, forums and steering groups. Homes can access as much or as little as they want and have ongoing contact to ensure their needs are met. Collaboratively work with other services for more joined up working. Results As a direct result of the service we now have a community dementia steering group that brings together a range of professionals including care homes, ambulance service, hospital, hospice, community professionals, commissioners to name a few. Here we focus on how we can all work collaboratively to improve care for dementia patients. The service is now recurrently funded and this in part is due to the service having a direct impact on the decreasing the number of patients with dementia being admitted to the acute sector. Conclusion There is no quick fix to improving cross boundary and sector working, however, as proven by this service by acknowledging that we all have a part to play and that we can all positively influence patients care change does not have to cost anything other than time and the dedication of the staff involved.

Background In 2016 St Giles Hospice undertook a review of its community palliative care services to ensure the service would be fit for the future. This entailed a review of team caseloads and how and who they were managed by. Aims Community palliative care services have been historically very linear in their approach, mainly compromising of clinical nurse specialists. The aim of the review was to identify the numbers and complexities of patients on the caseloads and produce recommendations for how caseloads could be managed more efficiently ensuring patients were seen by the right professional or person at the right time. Methods We reviewed the number of patients on the caseloads (approximately 550 at any one time) and identified if their needs were stable, deteriorating or unstable. We then reviewed which nurse was allocated to patients and identified whether patients were moved through the team or whether they stayed with one nurse throughout their journey. Results After reviewing the case loads it was realised our structure needed adjusting. As a result, we now have a tiered approach to our community team. Our staff nurses will see the most stable patients or patients at the beginning of their journey with us, clinical nurse specialists will see patients whose condition is changing and our advanced CNSs will see our most complex patients. This means that patients are seen by the right person at the right time via step up or step down approach and has enabled us to see 1300 extra patients in 2016–2017. Conclusion Service review continues and as a result we will be adding lead advanced nurse practitioners to the team and community care volunteers as we continue to evolve our service to ensure we can be responsive to the needs of the communities we serve.