Abstracts A1-A2

Diabetes foot disease is a major cause of morbidity and mortality, with foot ulceration leading to an amputation rate of 40%. Foot ulceration and amputation are the leading cause of hospital admission related to diabetes. In Scotland it is estimated over £60million is spent on foot ulcers and amputations every year. Up to 80% of amputations may be preventable. Patients in rural settings face unique challenges due to distance from health resources and transport limitations. We aimed to pilot a care pathway system with early triage and review of diabetes related foot problems remotely through innovative use of technology.

Patients were referred to RAPID via a generic email account that also allowed image-sharing. Community podiatrists used an Omni-Hub™ portable device for prioritising networks to (a) to share still or video images and (b) to connect live to the Multi-Disciplinary Team as required.

The project was evaluated through four stages comprising practitioner experience; patient experience; technology usability; triangulation of data from all stages.

32 patients with 17 neuroischaemic and 15 neuropathic ulcers were referred to the RAPID project resulting in 95 patient contacts by community podiatrists over two large health divisions, average return distance to Raigmore 90 miles. Of the 95 contacts, a live link was attempted 15 times of which 7 were successful. Compared with standard practice there was evidence of earlier intervention of pressure relief and orthotics referrals. One hospital admission was expedited and one unnecessary admission avoided. Patient evaluation indicated that they would recommend the service to others.

This feasibility study has demonstrated the potential for establishing a new care pathway in the management of diabetic foot ulceration in the community. Further refinement of the technology approach is required. A further study is planned to explore integration of the pathway to routine practice and assess health economic outcomes.

Online Health Information Seeking (OHIS) has become an area of increasing interest over the last decade. The Internet has enabled the democratisation of health information as knowledge which was previously exclusive to health professionals has now become open access for all. The activity of OHIS has also revealed a digital divide in terms of those who access the Internet for health information.

The prevalence of OHIS and the impact it has on patient outcomes and the relationship between health professional and patient is the focus of an on-going body of research outlined in this presentation..

Lyme Borreliosis, also known as Lyme disease, is the most common tick-borne disease in Northern Europe. Communities typically affected include forestry workers, gamekeepers, land and estate managers, and their employees. People can also be exposed to ticks, and therefore Lyme disease, through more ‘everyday’ and leisure-based activities, such as dog walking or gardening.

The research presented aimed to test ways of gathering local knowledge on outdoor behaviours, as well as exploring the awareness of ticks and Lyme disease in the Scottish Highlands. In was anticipated that this information could be used to co-design risk mitigation strategies. A mixed methods approach was designed and implemented to include community engagement workshops, questionnaires and interviews.

This presentation reports on the methods used, the engagement levels achieved, and insight into how a community-based approach was successful in facilitating the development of locally appropriate risk mitigation strategy for rural communities.

Harmful algal blooms (HABs) can impact coastal aquaculture through mortalities of farmed fish or the production of potent biotoxins that accumulate in the flesh of filter feeding shellfish and hence pose a threat to human consumers. Early warning of the timing, location and magnitude of HABs is therefore potentially of great value to coastal zone managers and the aquaculture industry, informing business planning and ensuring the protection of human health. Achieving this goal is, however, far from straightforward as key HAB genera or species exhibit different life cycles and potentially variable toxicity. Variability in local or regional oceanography or hydrography is also critical to bloom location and timing.

As part of the EU project Asimuth (ww.asimuth.eu) we developed a prototype HAB and biotoxin early warning weekly bulletin system for Scottish waters. This was a map based graphical synthesis of official control regulatory monitoring data with some expert interpretation of the current and expected future HAB conditions.

In many European locations HABs are natural rather than anthropogenically generated events. These HABs may be composed of a number of different species/genera that are both spatially and temporally variable in their occurrence, bloom magnitude and toxicity.

Increased availability of official control monitoring data in combination with operational oceanographic products, remote sensing and mathematical modelling offers tools suitable to reduce the HAB risk to aquaculture operations. Expert synthesis of these products can provide HAB risk.

Burnt mounds or ‘fulacht fiadh’ are a common feature in the Irish and British archaeological record, dating from the Neolithic to the medieval period (Ó Néill, 2009) and were widely used during the second millennium BC. They occur in various shapes and sizes. Crescent- or horseshoe- shaped burnt mounds are typical in Ireland but they can also be circular, oval and d-shaped varying in height and diameter (O’Sullivan and Downey, 2004). Despite being ubiquitous, we know little about their function, with hypotheses varying from cooking, brewing, bathing, dyeing and textile processing together with butchery, sweat lodges and funerary and ritual practices.

This paper provides a summary of the palaeoenvironmental evidence from a complex of 23 burnt mounds with a chronology of activity from the Neolithic to the medieval period at Ballygawley, Co. Tyrone. A range of palaeoenvironmental methods were employed to accompany the archaeological investigations including pollen, non-pollen palynomorphs, micro- and macroscopic charcoal, waterlogged worked wood analysis, insects and waterlogged and charred plant remains analysis. The focus of this paper will be on those methods directed at investigating possible woodland management to provide fuel for the burnt mound activity and wood for trough construction. Pollen analysis provides both regional and local evidence for landscape change, including a ‘seesaw’ pattern of tree and shrub pollen immediately after and preceding a period of burnt mound use. This together with the macroscopic charcoal data and worked wood analysis, indicate possible species selection and management of the local woodland resource for fuelwood.

Human activities can impact biophysical ecosystem features, reducing resilience and potentially impacting ecosystem services, which can affect the environmental, socio-economic and cultural benefits derived by coastal communities. Marine spatial planning (MSP) is increasingly being used as a mechanism to manage the marine environment. All though there has been considerable research into MSP there are relatively few examples worldwide of MSP in practice.

Shetland is one of the few areas with a statutory regional marine plan, through a monitoring programme we consider whether there is evidence for improved marine management, how the Plan will change and adapt to meet changing expectations and legislative frameworks and the impact MSP can have on coastal communities.