People, places and the climate emergency – the Scottish Place Standard Tool with a climate lens

Since the launch of the Place Standard tool (PST) in Scotland in 2015 awareness has increased of the critical impact of the climate emergency on health and equity. A 2019 review of the PST, informed by emerging evidence and community and stakeholder feedback, confirmed the need to strengthen its contribution towards place-based climate action. This was partly achieved by integrating enhanced prompts within the PST itself, however with the increased focus of policy and action around climate adaptation and mitigation a knowledge and resource gap remained. So in 2020 PST partners* began work with experts from environmental organisations (Sniffer, Sustainable Scotland Network) and other partners to develop a “Place Standard with a climate lens” (PST CL). The PST CL toolkit was created through an iterative process integrating feedback from 10 pilot projects chosen to represent the varied communities, scales, landscapes and placemaking projects being undertaken across Scotland. It provides a suite of materials to use alongside existing PST resources to help placemaking conversations consider how climate change might play out in a local area. This ensures that local responses to climate change are designed holistically, delivered collaboratively, and helps achieve on other local priorities such as health, wellbeing and equity. This presentation will provide a brief overview of the project background, describe the Scottish PST with a climate lens, share case study examples from the piloting phases, and enable exploration of the learning from Scotland around the value of integrating health and climate in place-based approaches. While the Place Standard tool was not originally designed as a climate change tool, it is an effective method to support the design of local responses to the climate emergency. A “climate lens” can help us to plan the future of our places to maximise the health benefits and minimise the negative consequences of a changing climate.

Creating healthy places with the Place Standard Tool – An introduction

This presentation will give an overview of the evidence around 'place' - the social AND physical environment - and how it impacts on lifelong health and wellbeing and health inequalities.

It will provide a comprehensive introduction to the innovative Place Standard tool (PST) developed in partnership in Scotland - and how it translates complex health and place-making relationships into a simple set of questions. The resulting tool allows participants to identify strengths and weaknesses and begin to develop a shared understanding of place from which to take collaborative action to improve places and the lives of the people that use them.

It will give a practical guide to how, when and where the PST can be deployed to support the delivery of healthy and equitable places, illustrated by real-life examples of use in a range of scales and contexts by the public sector and by communities across Scotland (and beyond) since its launch in 2015.

It will also draw out the lessons learned during the first phase deployment and showcase the resultant versions that have been developed by the Scottish team to address identified gaps in a changing climate. These new versions, which will be launched in 2020, are: improvements to the main PST intended amongst other things to better enable place-based conversations to address health impacts of climate change; versions for children to support children's rights and participation; and a Design version aimed at architects and planners to support the design process to deliver healthier places.

Key messages

The Place Standard tool is adaptable, easy-to-use and distils complex health evidence into simple questions relevant to a range of scales and types of real-life 'place'. As a practical, accessible framework for place-based conversations to support communities and agencies to together identify priorities for action to deliver high quality, sustainable places, it has proved highly transferable to a variety of contexts and countries.

Ein einfacher Test für die Bestimmung der Funktion des Von-Willebrand-Faktors: die Kollagenbindungsaktivität

Die Bindung des Von-Willebrand-Faktors (vWF) an immobilisiertes Kollagen ist die Grundlage eines ELISAs, mit dem die Kollagenbindungsaktivität (vWF:CBA), ein funktioneller Parameter des vWF, bestimmt wird. Dieser Test ist so aufgebaut, daß dieselben Probenverdünnungen, Puffer und Instrumente wie bei dem ELISA für das vWF-Antigen (vWF:Ag) benutzt werden können. Damit ist es möglich, Patienten mit einem Morbus von Willebrand-Jürgens (MWJ) in die Typen I und II zu unterteilen. Der ELISA für die vWF : CBA ist sensitiv, schnell und einfach und kann mit standardisierter ELISA-Ausrüstung und minimaler Plasmamenge ausgeführt werden.

Leg Ulcer Patients: No Decreased Fibrinolytic Response but White Cell Trapping after Venous Occlusion of the Upper Limb

Objective:

To study changes in indicators of fibrinolytic activity and white cell trapping in response to raised venous pressure in the upper limbs of patients with chronic venous insufficiency.

Design:

Comparison of disease group versus control group study.

Setting:

Departments of Dermatology and Medicine, University of Freiburg.

Patient:

Thirty patients with chronic venous insufficiency and thirty control subjects of similar age with unrelated conditions.

Interventions:

The venous pressure was raised in one upper limb by application of a sphygmomanometer cuff around the upper arm for a period of 10 minutes.

Main outcome measures:

Red cell count, white cell count, plasminogen activator inhibitor, tissue plasminogen activator were measured in blood drawn from the arm subjected to raised venous pressure.

Results:

No significant changes were observed in the parameters of fibrinolytic activity. After 10 minutes of venous hypertension the white cell trapping in the disease group was 17.7% (interquartile range, 10.7–22), compared with 12.8% (interquartile range 4.9–16.1%) in the control group.

Conclusion:

The differences in white cell trapping parameters between healthy control subjects and patients with chronic venous insufficiency is probably attributable to systemic activation of white cells associated with their venous disease.

[85-year-old woman with acute backache]

Eine 85-jährige Patientin wurde wegen akuten thorakovertebralen Schmerzen bei vorbestehenden Rückenschmerzen notfallmässig in unserer rheumatologischen Abteilung hospitalisiert. Die differenzialdiagnostischen Überlegungen bei Rückenschmerzen im Alter werden diskutiert. Als Ursache der Beschwerden zeigte sich ein grosses, teilweise thrombosiertes Aneurysma der unteren Aorta thoracica mit Perforation ins hintere Mediastinum. Bei Inoperabilität des ausgedehnten Befundes verstarb die Patientin am vierten Hospitalisationstag.

["Lupus anticoagulant" in immune hyperthyroidism]

A 56-year-old woman with autoimmune hyperthyroidism (Basedow) whose blood coagulation had at first been normal developed prolonged partial thromboplastin time (PTT) of 48 s and a fall in prothrombin time (Quick value) to 52%. At the same time, total activity of factor VIII was reduced to 18% and factor IX to 16%. These values not having changed after the addition of normal plasma, it is assumed that an acquired inhibitor of plasmatic coagulation was responsible. Such inhibitors were first described in lupus erythematodes and therefore called lupus anticoagulant, but later also demonstrated in other autoimmune diseases.

Antithrombin-III-Aktivitätsabfall im Plasma unter intravenöser kontinuierlicher Heparintherapie

30 Patienten im Alter von 20-67 Jahren mit einer phlebographisch gesicherten tiefen Bein-Bekken-Venenthrombose wurden 8 Tage lang intravenös kontinuierlich mit Heparin-Natrium von Hoffmann-La Roche bzw. Ratiopharm behandelt. Bei diesen Patienten wurde eine Vollantikoagulierung mit einer Verlängerung der partiellen Thromboplastinzeit >60 bis 90 s angestrebt. Die Heparindosis variierte zwischen 25000-60000 IE/ 24 Std. In beiden Behandlungsgruppen hatte das Körpergewicht der Patienten einen hochsignifikanten Einfluß auf die Heparindosis, bei der eine Verlängerung der partiellen Thromboplastinzeit >60 s erreicht wurde. Bei allen Patienten fiel unter der kontinuierlichen Heparintherapie das Antithrombin III (AT III) um durchschnittlich 3,3 IU/ml ab. Das Ausmaß des AT-III-Abfalls variierte individuell, korrelierte nicht mit der Heparindosis.

[Disseminated intravascular coagulation disorder in the 2d trimester of pregnancy. Case report from the 16th week of pregnancy with spontaneous parturition at term]

After exercising on a trampoline, a 29-year-old primigravidae in the 16th week of gestation was admitted to our hospital with the clinical signs of premature ablatio placentae and acute coagulation disturbances with disseminated intravascular coagulation and uncontrolled secondary hyperfibrinolysis. The coagulation disturbance was stabilized by conservative therapy (Substitution with fresh-frozen-plasma (ffp), whole blood and low-dose heparin treatment without having to terminate the pregnancy by evacuation of the uterus. An appropriate antifibrinolytic treatment was not performed in this case. The continuous controls of fibrinmonomeres and reptilase time indicate the possibility of a persisting latent coagulation disturbance after the acute phase. Thus, the necessity of a low-dose heparin therapy after an acute coagulation disturbance becomes evident.

Long-term results of percutaneous transluminal angioplasty: a study of 4750 dilatations and local lyses

During a period of 8 years 4750 percutaneous transluminal angioplasties and local lyses have been performed in the Department of Radiology of the University of Freiburg and the Hochrheinklinik Bad Sackingen. From 1984 to 1987 all patients have been assessed clinically and in 320 cases angiographically. Lesions were localised mainly to the pelvic and the femoro-popliteal regions. The short and long term results have been compared, i.e. 2-8 years after PTA. Patients with occlusive disease from stage IIa to stage IV were treated. Long-term success of PTA (2-8 years after the intervention) reached 85% in stage IIa, 73% in stage IIb, 68% in stage III and 36% in stage IV, when all treated lesions were included.

[Local fibrinolytic therapy in thrombotic complications of peritoneovenous shunt]

Since 1981 in the University Hospital of Freiburg 41 patients with ascites have been treated by installation of a peritoneo-venous shunt system. In 9 patients thrombotic complications occurred. Two patients had to undergo a second surgical treatment. Seven patients have been treated by local fibrinolysis. In 6 patients local fibrinolytic therapy was partly or completely successful, in one patient local fibrinolysis was of no therapeutic effect.

Alpha-2-adrenoreceptor density on intact platelets and adrenaline-induced platelet aggregation in endurance- and nonendurance-trained subjects

Alpha-2-adrenoreceptor density on intact platelets was evaluated in 17 sportsmen, 8 of whom were endurance-trained athletes. Receptor density was determined as being equivalent to 3H-Yohimbine, specifically bound on intact platelets. Adrenaline-induced aggregation of platelets in vitro was additionally ascertained. Bmax (maximal binding) and KD (dissociation constant) were significantly lower in endurance-trained athletes (148 fmol per 10(9) platelets, KD = 0.92 nmol) than in the nine nonendurance-trained individuals (284 fmol, KD = 1.79 nmol, P less than 0.01), amounting to 89 receptors per cell (endurance-trained subjects) and 171 (nonendurance-trained subjects). No significant change of receptor density or affinity was observed subsequent to exhaustive exercise in the group of eight endurance-trained individuals. Bmax values and oxygen uptake capacity correlated negatively (r = -0.78, P less than 0.001) and Bmax values and induced platelet aggregation in vitro positively (r = 0.79, P less than 0.001). Data may indicate a reduced sensitivity of platelets in endurance-trained subjects.

[Spectrum of von Willebrand-Jürgens syndrome. A study on 53 patients]

Von Willebrand-Jürgens syndrome was diagnosed in 53 patients on the basis of bleeding symptoms and blood clotting analytical findings. It was possible to classify the patients into four types using the recommendations of the European Thrombosis Research Organization. Type I, 56%, was most common, 15% belonged to type II, 13% to type III and 16% to type IV. Whereas type I corresponds to the so-called classical von Willebrand-Jürgens syndrome, types II-IV demonstrate the heterogeneity of the disease.

[A variant of the von Willebrand-Jürgens-syndrome with abnormalities of the factor VIII/von Willebrand factor protein (author's transl)]

A family is reported with a variant of von Willebrand's disease. The members of this family showed a qualitative defect of the factor VII/von Willebrand factor protein. The qualitative defect was characterized by an abnormal electrophoretical mobility of factor VIII-related antigen and an abnormal elution pattern as demonstrated by gelfiltration on Sepharose 4 B. Factor VIII-subunits in these patients were found to be normal by polyacrylamidgelelektrophoresis.

Hereditary Hypodysfibrinogenemia with Defective Release of Fibrinogenopeptide A (Fibrinogen Freiburg)

A new autoaomally inherited hypodysfibrinogenemia was recognized in four members in three different generations of a family. Only one patient had a major bleeding episode after trauma, the other affected members had no history of excessive bleeding or thromboembolic disease.

The thrombin time and Reptilase time of plasma were greatly prolonged and partially corrected by the addition of calcium. Patient plasma prolonged the thrombin time of normal plasma. Fibrinogen levels ranged between 10 to 20 mg/100ml when measured as thrombin-clottable protein, whereas immunologically the fibrinogen levels were only slightly reduced.

Functionally the major defect was impaired release of fibrinogenopeptide A upon incubation of the purified abnormal fibrinogen (94% clottable protein) with thrombin and Reptilase. The abnormal fibrinogen showed a delayed polymerisation of its purified fibrin monomers. The described abnormal fibrinogen was indistinguishable from normal fibrinogen by polyacrylamide gel electrophoresis with and without sodium dodecyl sulfate.

[Diagnosis of von Willebrand's disease]

31 patients with the diagnosis or presumed diagnosis of von Willebrand's disease were reinvestigated by means of Ristocetin cofactor-activity and factor VIII-associated antigen. In addition a family with a variant of von Willebrand's disease is described. Ristocetin cofactor-activity was found the most reliable test, its value for the diagnosis of mild forms and of variants of von Willebrand's disease is further established by these results.

[Von Willebrand-Jürgens syndrome with a variant of factor VIII-associated antigen]

A family is described in which 5 out of 8 children had a marked bleeding disorder. The children showed prolonged bleeding times, abnormal platelet retention upon passage of blood through a glass bead column, the Willebrand factor activity as measured by ristocetin in a washed platelet system was low. Factor VIII/von Willebrand factor protein levels were normal even so the factor VIII-procoagulant activity. Even the parents and one child without any bleeding tendency and normal bleeding times had a reduced Willebrand factor activity. In all these patients evidence of an abnormal protein was observed on crossed antigen-antibody electrophoresis indicating a qualitative defect of the factor VIII/von Willebrand factor protein.

Pathogenetic aspects of bromocarbamide intoxication

In bromocarbamide intoxication in humans, as in rabbits, the predominant feature is the endothelial damage characterized by desquamation and vacuolisation, followed by interstitial oedema. Consumption coagulopathy, as observed in some cases of human bromocarbamide intoxication and also in our experimental model, can be prevented by anti-coagulant therapy with heparin and also, as could be shown in rabbits, with aggregation-inhibiting agents. These findings strongly suggest that consumption coagulopathy is only a secondary phenomenon which develops in the course of primary endothelial damage. Similarities in the histological findings of endothelial damage between bromocarbamide intoxication in humans and in rabbits and the so-called "Adalin purpura", which can be observed after chronic use of bromocarbamide, are discussed.