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The economic costs of pollution are large, but uncertain. This book, from some of the leading analysts in the field, provides a much-needed accessible description of the methods for calculating externalities, the results and their policy implications. The authors clearly address the relevant uncertainties and ethical underpinnings, bringing a balanced approach to complex issues that are so often distorted by vested interests.-- Source other than Library of Congress.

Local air quality co-benefits can provide complementary support for ambitious climate action and can enable progress on related Sustainable Development Goals. Here we show that the transformation of the energy system implied by the emission reduction pledges brought forward in the context of the Paris Agreement on climate change (Nationally Determined Contributions or NDCs) substantially reduces local air pollution across the globe. The NDCs could avoid between 71 and 99 thousand premature deaths annually in 2030 compared to a reference case, depending on the stringency of direct air pollution controls. A more ambitious 2 °C-compatible pathway raises the number of avoided premature deaths from air pollution to 178–346 thousand annually in 2030, and up to 0.7–1.5 million in the year 2050. Air quality co-benefits on morbidity, mortality, and agriculture could globally offset the costs of climate policy. An integrated policy perspective is needed to maximise benefits for climate and health. Local air quality co-benefits can provide convincing support for climate action. Here the authors revisited air quality co-benefits of climate action in the context of NDCs and found that 71–99 thousand premature deaths can be avoided each year by 2030, offsetting the climate mitigation costs on a global level.

Currently, many cities in Europe are affected by concentrations of PM2.5 and NO2 above the WHO guidelines on the protection of human health. This is a global problem in which the growth of road transport constitutes a major factor. Looking to the future, electric vehicles (EVs) are considered to be the choice technology for reducing road transport greenhouse gas emissions, but their impact on air quality needs to be considered. Taking the UK as a case study, this paper begins by understanding the trajectory of a future scenario without the introduction of EVs, reflecting on the latest emission control improvements in internal combustion engine vehicles (ICEVs). This is then compared to a 2050 scenario in which the introduction of EVs, based on the UK government’s Transport Decarbonisation Plan, is reviewed. This plan includes a ban on the sale of ICEV cars and LGVs, beginning in 2030, with the subsequent electrification of heavier vehicles. By 2030, population exposure to NOx was found to be significantly reduced in the ICEV scenario, with a marginal further reduction found for the EV scenario. The EV scenario further reduced NOx exposure by 2050, with most of the benefits being realized before 2040. For the ICEV and EV scenario, PM2.5 emissions were largely unchanged due to the primary contribution of non-exhaust emissions, suggesting that EVs are likely to yield relatively smaller changes in exposure to PM2.5 than for NOx.

IntroductionGene therapy has the potential to change the life experience of people with haemophilia and their families. A growing number of studies have examined the experience for those who have had gene therapy. A few studies have examined the process with other gene therapy among a wider cross-section of the haemophilia community.Exigency is a nested group of studies investigating the experience and understanding of the haemophilia community to identify what place gene therapy is likely to have in haemophilia care.Five groups have been identified: those who have already undergone gene therapy, those who do not want it, those who wanted to have it but withdrew or were withdrawn before dosing, those who have not yet been offered it and parents of children with haemophilia.MethodsA qualitative, mixed-methods process will identify what each group understands about gene therapy and what it might mean for the haemophilia community in the future.AnalysisAll of the transcripts will be analysed by the lead and coinvestigator using a grounded theory approach. The texts will be coded into themes for further analysis. The data will be summarised and synthesised, and the views expressed will be represented descriptively.Ethics and disseminationWritten consent will be required, and participants will be anonymised. All elements of the study will be reviewed by UK statutory bodies.The study findings will be submitted for publication in peer-reviewed journals, and at haemophilia conferences and symposia.The study results will also be disseminated directly to study participants. Each participant will receive a copy of any publication and a summary report at the end of the study.Trial registration numberNCT04723680

Research studies have described the morbidity associated with inherited bleeding disorders such as hemophilia and von Willebrand disease in women, but their effect on daily living has long been underrecognized. This systematic review sought to document the lived experience of women with a bleeding disorder by assessing research findings on quality of health care, socioeconomic factors, and mental health. A systematic search was carried out in Web of Science, the Cumulative Index to Nursing and Allied Health Literature, and PubMed on July 31, 2020. References were hand searched. Abstracts of the 2019 and 2020 congresses on bleeding disorders were hand searched. Key journals were screened for relevant studies published after the search date until the analysis was completed on December 7, 2020. Of 635 potentially eligible publications, 27 published since 1998 were selected for review. Most studies were of moderate to high quality but meta‐analysis of quantitative studies was not possible due to difference in outcomes and assessment. Women with a bleeding disorder experience obstacles to accessing care, difficulties living with their disorder, interference with schooling and work, and poor mental health. Diagnostic delay and lack of recognition of symptoms mean treatment and support may not be available. Where comparisons with controls were made, women’s negative experiences were greater than those of men. Women with bleeding disorders experience major negative impacts of their disorders on daily life and mental well‐being. Many of the challenges identified in earlier research are evident in more recent studies.

Integrated assessment modelling (IAM) has been successfully used in the development of international agreements to reduce transboundary pollution in Europe, based on the GAINS model of IIASA. At a national level in the UK, a similar approach has been taken with the UK Integrated Assessment Model, UKIAM, superimposing pollution abatement measures and behavioural change on energy projections designed to meet targets set for the reduction of greenhouse gas emissions and allowing for natural and imported contributions from other countries and shipping. This paper describes how the UKIAM was used in the development of proposed targets for the reduction of fine particulate PM2.5 in the UK Environment Act, exploring scenarios encompassing different levels of ambition in reducing the emissions of air pollutants up to 2050, with associated health and other environmental benefits. There are two PM2.5 targets, an annual mean concentration target setting a maximum concentration to be reached by a future year, and a population exposure reduction target with benefits for health across the whole population. The work goes further, also demonstrating links to social deprivation. There is a strong connection between climate measures aimed at reducing net GHG emissions to zero by 2050 and future air quality, which may be positive or negative, as illustrated by sectoral studies for road transport where electrification of the fleet needs to match the evolution of energy production, and for domestic heating, where the use of wood for heating is an air quality issue. The UKIAM has been validated against air pollution measurements and other types of modelling, but there are many uncertainties, including future energy projections.

Many young men with hemophilia engage in physical activity and sport but face challenges to participation because of their hemophilia. Project GYM aimed to investigate the feasibility of a hemophilia‐specific fitness program led by a personal trainer (PT) and its impact on gym activity, motivation, and adherence to exercise. This was a nonblinded, randomized feasibility study, recruiting participants aged 18 to 25 years with hemophilia A or B (all severities, ± inhibitor) from three London hemophilia centers. All participants were given an activity tracker and free gym membership. Participants were randomized to a “gym only” or “gym and PT” arm. Participants completed questionnaires evaluating motivation to exercise, quality of life, physical activity levels, self‐efficacy, and self‐esteem at study start and study end. Of 142 eligible individuals, 19 agreed to participate. Participants were healthy, with mean body mass index and adiposity slightly lower than the UK average. They reported low bleed numbers and had good joint health (median Hemophilia Joint Health Score [HJHS], 0; range, 0‐13). The gym and PT group had more gym attendance than the gym‐only group. Seven participants increased their activity levels and nine stayed the same, with no statistical difference between groups. HJHS scores improved in 3 participants and were unchanged in 12. There was no bleeding associated with gym activity. Project GYM has demonstrated the safety and feasibility of a tailored physical training program in young men with hemophilia. Increased gym attendance, with and without support from a PT, is associated with increased physical activity.

Background The majority of older people (> 65 years) in hospital have frailty and are at increased risk of readmission or death following discharge home. In the UK, following acute hospitalisation, around one third of older people with frailty are referred on for rehabilitation, termed ‘intermediate care’ services. Although this rehabilitation can reduce early readmission to hospital (< 30 days), recipients often do not feel ready to leave the service on discharge, suggesting possible incomplete recovery. Limited evidence suggests extended rehabilitation is of benefit in several conditions and there is preliminary evidence that progressive physical exercise can improve mobility and function for older people with frailty, and slow progression to disability. Our aim is to evaluate the effectiveness of the Home-based Older People’s Exercise (HOPE) programme as extended rehabilitation for older people with frailty discharged home from hospital or intermediate care services after acute illness or injury. Methods A multi-centre individually randomised controlled trial, to evaluate the clinical and cost-effectiveness of the HOPE programme. This individualised, graded and progressive 24-week exercise programme is delivered by NHS physiotherapy teams to people aged 65 and older with frailty, identified using the Clinical Frailty Scale, following discharge from acute hospitalisation and linked intermediate care rehabilitation pathways. The primary outcome is physical health-related quality of life, measured using the physical component summary score of the modified Short Form 36- item health questionnaire (SF36) at 12 months. Secondary outcomes include self-reported physical and mental health, functional independence, death, hospitalisations, care home admissions. Plans include health economic analyses and an embedded process evaluation. Discussion This trial seeks to determine if extended rehabilitation, via the HOPE programme, can improve physical health-related quality of life for older people with frailty following acute hospitalisation. Results will improve awareness of the rehabilitation needs of older people with frailty, and provide evidence on the clinical and cost-effectiveness of the targeted exercise intervention. There is potential for considerable benefit for health and social care services through widespread implementation of trial findings if clinical and cost-effectiveness is demonstrated. Trial registration ISRCTN 13927531 . Registered on April 19, 2017.

Contemporary hemophilia care supports physical activity, its benefits being well recognized. Despite recognition of the psychological challenges encountered by people with hemophilia, little is known about the psychological impact of physical fitness in this population. To identify changes in psychological well‐being in young men with hemophilia through participation in a gym program. This observational feasibility study of a 6‐month gym participation program used validated questionnaires pre‐ and poststudy to evaluate motivation to exercise, physical activity levels, self‐efficacy, self‐esteem, and quality of life. Individual audio‐recorded interviews about study participation and impact were transcribed verbatim and analyzed for recurring themes using thematic analysis. Nineteen participants aged 18–25 years with hemophilia A or B (all severities ± inhibitor) consented to the study; two were lost to follow‐up. There was a shift in motivation to exercise as shown by the Stages of Change grouping moving from contemplation to action and maintenance phases (p= 0.03). Self‐efficacy overall scores showed a trend (p< 0.06) towards improvement. Median self‐esteem scores improved from 22 (range 12–30, n = 19) to 25 (range 13–30, n = 17), a statistically significant change (p= 0.02). Three participants recorded scores below the accepted normal range before study, of whom two improved at study end. The key themes identified from the interviews were: fear, self‐confidence, “being normal,” pain, weight loss, ability, getting fitter. The psychological wellbeing of young men with hemophilia improved during this study. This may have been related to participating in a gym‐based, physical exercise program.

The ubiquity of mobile technology offers the potential for instantaneous and two-way transfer of information, as well as the potential for improving medical care delivery and extending it to those in countries and regions with a less developed medical infrastructure. This review considers the role of mobile health (mHealth) technology in managing hemophilia. This is a disease area in which good record-keeping is an essential component of home-based hemophilia care. Health care professionals contribute patients' data to national registries and databases and frequently interrogate those data for commercial and academic purposes. Only rarely are the data used to directly improve the care of the individual patient. Patient-focused apps designed to respond to an individual's personal data may offer the potential to empower patients to live healthier lifestyles, reinforcing the care provided by health care professionals and offering a mechanism for peer-support and promoting adherence to an individualized management plan. Keywords: mHealth, hemophilia, peer-support, adherence