British Red Cross

Measurement is essential for effective adaptation management and operation, and indicators and metrics (I&M) have a pivotal role. Surprisingly, systematic efforts to assess advances in the provision of adaptation I&M are scarce, and those that do exist often lack in-depth analysis of the types, characteristics, and applicability of the collected information. Here, we analyse 137 publications and 901 I&M sourced in the scientific literature (2007–2022) to measure adaptation to climate change in urban areas where governments are increasingly placing efforts to prepare populations and infrastructures. A lack of common terminology, standardisation, and guidelines has resulted in a field that is complex to track and understand. This complexity has led to a fragmented methodological landscape, marked by diverse, context-dependent, and occasionally conflicting approaches to the development of I&M. We argue that conventional approaches to I&M are largely inadequate and must better emphasise quantifiability, long-term assessment, and alignment with policy objectives.

Background: The transformation of the National Health Service (NHS), outlined in the 10 Year Health Plan for England, must take account of the inexorable rise in the prevalence of multiple long-term conditions (MLTC). However, most evidence on MLTC is based on primary care data preceding the COVID-19 pandemic and, data from hospitals are scarce. We aimed to analyse routinely-collected electronic health records to estimate the prevalence of MLTC among adults accessing hospital care in North East England before and after the COVID-19 pandemic, and to test associations between sociodemographic characteristics and MLTC within these populations. Methods and Findings: All adults with at least one admission to Newcastle upon Tyne Hospitals NHS Foundation Trust (NuTH) between July 2018 and June 2019 (N= 88,117, 51% women) or between July 2021 and June 2022 (N=83,036, 51% women) were included in analyses. MLTC was defined as the presence of two or more long-term conditions from an established list of 60 conditions. Poisson regression models were used to test associations of age, sex, ethnicity and index of multiple deprivation with MLTC. Among people admitted to NuTH at least once between July 2018 and June 2019, overall prevalence of MLTC was 49.6% and between July 2021 and June 2022 it was 61.0%. Older age and neighbourhood deprivation were associated with increased risk of MLTC; people living in the most deprived neighbourhoods had a prevalence of MLTC equivalent to people from the least deprived neighbourhoods a decade older. Associations between neighbourhood deprivation and MLTC were stronger in younger adults; those aged 30-39y living in the most deprived neighbourhoods had 1.74 (95% confidence interval: 1.49-2.02) times higher risk of MLTC than those living in the least deprived neighbourhoods. Conclusions: Among adults accessing inpatient hospital care in North East England, the prevalence of MLTC is high, has increased since the COVID-19 pandemic and has a greater impact on younger adults from the most deprived neighbourhoods. This highlights the sheer scale of the challenge that MLTC present in hospitals which must be addressed when redesigning services fit for the future.

The United Nations’ Education 2030 Framework (2015) clearly stated that initial teacher-training should be enhanced to support education for sustainable development (ESD) practice. Instrumental to the acquisition of ESD learning objectives and key competencies is the advancement of trainee-teachers as agents of change (Mundy et al, 2008). Holding knowledge of the sustainable development goals (SDGs) and transformative pedagogies for ESD enables educators to positively contribute to their communities. Trainee-teachers of English as a Foreign Language (TEFL) and Teaching English to Speakers of Other Languages (TESOL) are preparing to teach in a diversity of countries yet the inclusion of ESD in their training is not visible. This case study reports on the utilisation of the CoDesignS ESD Toolkit Planner (‘Toolkit’) for the learning design of a 15-credit module titled Introduction to embedding sustainability in TEFL and TESOL. The module aims to enable trainee-teachers to develop an understanding of the implications of local, national, regional, and global learning contexts upon their teaching practice. Micro-teaching was developed as part of the module to provide trainee-teachers with opportunities to tailor their pedagogical practice to the needs of their learners. The intended outcome of the learning design was to enable the trainee-teachers to feel better equipped to incorporate localised sustainability issues into their classes without detracting from delivering authentic English language learning. This case study report reflects upon the effectiveness of the design in achieving its goals at the completion of a first term of delivery to final year TEFL undergraduates and first term TESOL and Applied Linguistics postgraduates at the University of Essex, UK.

The COVID-19 pandemic has had a profound impact on society; it changed the way we work, learn, socialise, and move throughout the world. In the United Kingdom, policies such as business closures, travel restrictions, and social distance mandates were implemented to slow the spread of COVID-19 and implemented and relaxed intermittently throughout the response period. While negative emotions and feelings such as distress and anxiety during this time of crisis were to be expected, we also see the signs of human resilience, including positive feelings like determination, pride, and strength. A longitudinal study using online survey tools was conducted to assess people's changing moods during the pandemic in the UK. The Positive and Negative Affect Schedule (PANAS) was used to measure self-reported feelings and emotions throughout six periods (phases) of the study from March 2020 to July 2021. A total of 4,222 respondents participated in the survey, while a sub-group participated in each of the six study phases (n = 167). The results were analysed using a cross-sectional study design for the full group across each study phase, while prospective cohort analysis was used to assess the subset of participants who voluntarily answered the survey in each of the six study phases (n = 167). Gender, age and employment status were found to be most significant to PANAS score, with older people, retirees, and women generally reporting more positive moods, while young people and unemployed people generally reported lower positive scores and higher negative scores, indicating more negative emotions. Additionally, it was found that people generally reported higher positive feelings in the summer of 2021, which may be related to the relaxation of COVID-19-related policies in the UK as well as the introduction of vaccines for the general population. This study is an important investigation into what allows for positivity during a crisis and gives insights into periods or groups that may be vulnerable to increased negative states of emotions and feelings.

AimSystem leadership is the requirement for a leader of a single organisation to operate on behalf of a wider system, rather than their individual organisation. The current policy landscape does not incentivise system leadership, as many national structures emphasise a focus on individual organisations. This study aims to understand how chief executives in the National Health Service (NHS) in England implement system leadership in practice when faced with decisions that benefit the system to the detriment of their own trust.MethodologySemistructured interviews were conducted with ten chief executives from various NHS trust types to understand their perceptions and decision-making process in practice. Semantic thematic analysis was used to draw out themes in relation to how chief executives approach decisions which weigh up the system and organisation.ResultsInterviewees expressed advantages (such as support in managing demand) and disadvantages (such as increased bureaucracy) of system leadership and practical considerations in operationalisation (such as the importance of interpersonal relationships). Interviewees endorsed system leadership in principle, but did not feel that current organisational incentives support the implementation of system leadership in practice. However, this was not seen as a major challenge or impediment to effective leadership.ConclusionAs a specific policy area, a direct focus on systems leadership is not necessarily helpful. Chief executives should be supported to make decisions in a complex environment, without a specific focus on healthcare systems as a unit of operation.

To determine the frequency and type of healing complications arising after the use of the caudal auricular axial pattern flap to close defects on the head in dogs and cats. Multi-centre retrospective cohort study. Centres were recruited by the Association for Veterinary Soft Tissue Surgery Research Cooperative. Medical records of 11 centres were reviewed, and data from all dogs and cats treated with a caudal auricular axial pattern flap were retrieved. The following data were recorded: signalment, reason for reconstruction, flap dimensions, anatomic landmarks used, histological diagnosis, flap healing and whether revision surgery was required. Twenty-eight cases were included: 16 dogs and 12 cats. Flap length: width ratio was approximately 3:1 and flap length extended to the scapular spine in most cases. Optimal wound healing occurred in five of 16 (31%) dogs and six of 12 (50%) cats. Wound dehiscence without flap necrosis occurred in one of 16 (6%) dogs and one of 12 (8%) cats. Wound dehiscence with flap necrosis occurred in 10 of 16 (63%) dogs and five of 12 (42%) cats. Revision surgery was performed in eight of 16 (50%) dogs and three of 12 (25%) cats. The caudal auricular axial pattern flap can provide full thickness skin coverage for large defects on the head in dogs and cats. Partial flap necrosis is a common complication, and revision surgery may be required in order to achieve final wound closure.