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Background People living with multiple long-term conditions represent a significant concern for National Health Service policy and practice, and their care is a major theme in the 2019 National Health Service Long Term Plan. The Birmingham RAND and Cambridge Rapid Evaluation Centre team has undertaken a thematic synthesis of the 10 evaluations it has conducted from 2018 to 2023, exploring the needs, priorities and implications for people with multiple long-term conditions. Objectives The aims for this overarching study were to: (1) build a body of learning about service innovations in primary and community settings for people of all ages with multiple long-term conditions, focused on questions that matter most to people with multimorbidity; and (2) develop methodological insights about how rapid evaluation can be used to inform the scoping, testing and implementation of service innovations for people with multiple long-term conditions. Design The focus on multiple long-term conditions came from a Birmingham RAND and Cambridge Rapid Evaluation Centre prioritisation process undertaken in 2018 using James Lind Alliance methods. Cross-analysis of the findings from the 10 individual rapid evaluations was supplemented by (1) building aspects of multimorbidity into the design of later evaluations; (2) interviewing national and regional stakeholders (n=19) working in or alongside integrated care systems; (3) undertaking a rapid review of evidence on remote monitoring for people with multiple long-term conditions (19 papers included); and (4) testing overall insights with organisations representing patients and carers through a patient, public and professional engagement workshop with 10 participants plus members of the research team. Results While living with multiple long-term conditions is common and is the norm for people over the age of 50 using health and care services, it is not often a focus of health service provision or innovation, nor of research and evaluation activity. We discuss six themes emerging from the totality of the study: (1) our health system is mainly organised around single conditions and not multiple long-term conditions; (2) research calls and studies usually focus on single conditions and associated services; (3) building opportunities for engaged, informed individuals and carers and improved self-management; (4) the importance of measures that matter for patients and carers; (5) barriers to developing and implementing service innovations for people with multiple long-term conditions; and (6) what is needed to make patients with multiple long-term conditions a priority in healthcare planning and delivery. Limitations Care of people with multiple long-term conditions was not the principal focus of several of the rapid evaluations. While this was a finding in itself, it limited our learning about designing and implementing, as well as methodological approaches to evaluating, service innovations for people with multiple long-term conditions. Conclusions Through a thematic analysis of the portfolio of evaluations, we have deduced a set of suggested implications for how the needs of people with multiple long-term conditions can be better embedded in policy, research and practice. Future work Areas of uncertainty related to the care of people with multiple long-term conditions should be further explored, including developing and testing measures of patient experience of (un)co-ordinated care across settings, and interrogating the experience of health and care staff when working with people with multiple long-term conditions, to understand what works. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR134284) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 15. See the NIHR Funding and Awards website for further award information. Plain language summary Many people in England live with two or more physical and/or mental health conditions that are expected to last for years. Estimates vary, but it is likely that a majority of National Health Service services are serving people living with two or more long-term conditions. We wanted to find out how well the needs of this group are taken into account when new types of health care are introduced, or existing services are reorganised. To do this, we went back to all 10 of the health service innovations that had been studied by our Birmingham RAND and Cambridge Evaluation Centre from 2018 to 2023. We did some extra research, including discussions with patient representatives and interviews with National Health Service policy-makers and managers at national and regional levels. We also looked at what new research had been published about one example of a new healthcare technology that is intended to help people who have several long-term health conditions: monitors that can be used by health service staff to measure patients’ symptoms when they are in their own home. Our main finding was that most National Health Service attention is given to organising care for single conditions, often treating them in isolation. Patients’ many treatments and needs are not routinely considered all at the same time by healthcare staff, nor by researchers. Care for one condition is too often not co-ordinated with care for other health problems that a patient may have. Although the situation of people living with several long-term health conditions is in principle understood by healthcare staff, managers and researchers, relatively little is done in practice to meet their needs. We conclude by suggesting ways that policy-makers, healthcare staff and researchers could improve how they help people living with multiple long-term conditions.

Underground coal gasification is of great strategic significance to the effective and clean development of coal resources and scale up production of natural gas worldwide. Selection evaluation is the foundation of the exploration and development of underground coal gasification. In this paper, the differences between mid-deep (500–2200 m) and shallow layer (

To prevent unpredictable hazards caused by stress corrosion cracking (SCC) of bolts, a new rapid evaluation methodology was developed to assess their susceptibility under real condition. This innovative approach involved conducting fast and slow sweep electrochemical experiments and slow strain rate test (SSRT) methods to determine the potential range and correlation constant associated with SCC. To confirm solution composition in the crevice, we design a device to extract the test solution. Additionally, we investigated the correlation between SCC behaviors and applied cathodic potential by analyzing the fracture morphology of tensile specimen and employing analytical techniques such as Raman spectroscopy, X-ray diffraction (XRD), and X-ray photoelectron spectroscopy (XPS).The experimental findings demonstrated that the dynamic potential scanning method effectively identifies the critical potential value or sensitive potential range for SCC in crevice environment. Moreover, the stable and unstable currents obtained at a specific cathodic potential can be used to quickly assess SCC susceptibility.

Background Improved access to healthcare in low- and middle-income countries (LMICs) has not equated to improved health outcomes. Absence or unsustained quality of care is partly to blame. Improving outcomes in intensive care units (ICUs) requires delivery of complex interventions by multiple specialties working in concert, and the simultaneous prevention of avoidable harms associated with the illness and the treatment interventions. Therefore, successful design and implementation of improvement interventions requires understanding of the behavioural, organisational, and external factors that determine care delivery and the likelihood of achieving sustained improvement. We aim to identify care processes that contribute to suboptimal clinical outcomes in ICUs located in LMICs and to establish barriers and enablers for improving the care processes. Methods Using rapid evaluation methods, we will use four data collection methods: 1) registry embedded indicators to assess quality of care processes and their associated outcomes; 2) process mapping to provide a preliminary framework to understand gaps between current and desired care practices; 3) structured observations of processes of interest identified from the process mapping and; 4) focus group discussions with stakeholders to identify barriers and enablers influencing the gap between current and desired care practices. We will also collect self-assessments of readiness for quality improvement. Data collection and analysis will be led by local stakeholders, performed in parallel and through an iterative process across eight countries: Kenya, India, Malaysia, Nepal, Pakistan, South Africa, Uganda and Vietnam. Conclusions The results of our study will provide essential information on where and how care processes can be improved to facilitate better quality of care to critically ill patients in LMICs; thus, reduce preventable mortality and morbidity in ICUs. Furthermore, understanding the rapid evaluation methods that will be used for this study will allow other researchers and healthcare professionals to carry out similar research in ICUs and other health services.

Background Vertical integration means merging organisations that operate at different stages along the patient pathway. We focus on acute hospitals running primary care medical practices. Evidence is scarce concerning the impact on use of health-care services and patient experience. Objectives To assess the impact of vertical integration on use of hospital services, service delivery and patient experience and whether patients with multiple long-term conditions are affected differently from others. Design Rapid, mixed methods evaluation with four work packages: (1) review of NHS trust annual reports and other sources to understand the scale of vertical integration across England; (2) development of the statistical analysis; (3) analysis of national survey data on patient experience, and national data on use of hospital services over the 2 years preceding and following vertical integration, comparing vertically integrated practices with a variety of control practices; and (4) focus groups and interviews with staff and patients across three case study sites to explore the impact of vertical integration on patient experience of care. Results At 31 March 2021, 26 NHS trusts were in vertically integrated organisations, running 85 general practices across 116 practice sites. The earliest vertical integration between trusts and general practices was in 2015; a mean of 3.3 practices run by each trust (range 1–12). On average, integrated practices have fewer patients, are slightly more likely to be in the most deprived decile of areas, are more likely to hold an alternative provider medical services contract and have worse Quality and Outcomes Framework scores compared with non-integrated practices. Vertical integration is associated with statistically significant, modest reductions in rates of accident and emergency department attendances: 2% reduction (incidence rate ratio 0.98, 95% confidence interval 0.96 to 0.99; p

This essay explores the emerging field of rapid evaluation in health and social care, drawing out the ways in which it is distinctive from or similar to other forms of applied research. It draws closely on the experience of two National Institute for Health and Care Research rapid service evaluation teams established in 2018, of which all authors of this essay are members. Reflection on the rapid evaluation teams’ body of work is used to highlight methodological and operational considerations for researchers, practitioners and policy-makers interested in the commissioning, conduct and application of rapid evaluations in health and social care. The essay is organised according to the ‘evaluation pathway’, from project selection and scoping, stakeholder involvement, research methods and activity, through skills and team working to feedback and dissemination. Its conceptual framing draws on Riley et al.’s rapidity, responsiveness and relevance framework, proposing a fourth dimension of rigour.1 Novel insights include: the primacy of scoping thoroughly a rapid evaluation; the trade-offs to be made in respect of patient and community engagement and rapid working; the opportunities presented by virtual and mixed research methods; the particular challenges of supervising and leading multiple studies undertaken simultaneously; and the need for flexible and dynamic approaches to disseminating emerging findings in as close to real time. The essay concludes by setting out key lessons about how to conduct rapid evaluations. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (RSET: 16/138/17; BRACE: 16/138/31). Scientific summary Rapid evaluation is increasingly used in health and social care to provide evidence about the design, implementation, experience and early outcomes of service innovations in a complex and typically fast-moving context. The methods used in rapid evaluation are often those of applied health and care research, adapted to enable or mitigate the rapid approach. This essay reports on the work over five years of two National Institute for Health and Care Research (NIHR)-funded rapid service evaluation teams [Birmingham RAND and Cambridge Rapid Evaluation (BRACE) team and Rapid Service Evaluation Team (RSET) from University College London and the Nuffield Trust)] using the combined experience of undertaking 19 studies to assert the importance of responsiveness, relevance and rigour in the practice of rapid evaluation (the ‘4 Rs’, drawing on the work of Riley et al.).1 Rapid evaluation is a field of research that is subject to debate in relation to its definition, design and implementation. Within the overall conceptualisation of the 4 Rs, ‘rapid evaluation’ can be defined as: early evaluation of an intervention, an evaluation with a short timescale, a study that is mobilised more quickly or one that provides early and rapid cycles of feedback. In addition to this timescale-based typology, the experience of the two NIHR-funded teams is that rapid evaluation can helpfully be conceptualised within a relational-based approach where it may be the precursor to a longer study, the follow-up to a longer study, a nested project within a longer-term evaluation or a stand-alone research project. A methodology-based typology may also be applied when planning, designing and undertaking rapid evaluation. Hence researchers may: use a methodology designed specifically for rapid evaluation, increase rapidity of the evaluation by doing less, use alternative technologies and/or data to increase the speed of an existing evaluation method, or adapt methods from a non-rapid evaluation. These typologies are not exhaustive but are offered as an illustration of the wider and sometimes contested debate about different ways to define, plan and undertake rapid evaluation research. An analysis is made of the methodological challenges specific to rapid evaluation with a particular focus on the selection, scoping and co-design of such studies. It is asserted that the process of scoping evaluations must be thorough and inclusive, being critical to determining when a rapid approach is required and if so, the questions to be examined and methods to adopt. Despite this process of scoping in close partnership with stakeholders, trade-offs will be inevitable in rapid evaluation studies and may lead to more uncertain or ambiguous findings. Researchers must therefore be clear and open about the limitations of their findings and ensure a clear focus on using a flexible and proportionate approach. A larger multi-skilled and experienced team will be required for rapid evaluation and especially where multiple projects are being undertaken in parallel. This in turn calls for senior academic and robust project management expertise and capacity to support effective team-working, complex and sometimes politicised stakeholder engagement, and the assurance of high-quality research delivery. The skills required of these teams extend beyond those usually taught in health and care research development programmes and encompass rapid uses of qualitative, quantitative and mixed methods, and proficiency in interpersonal skills for effective engagement, communication and dissemination. The importance of ensuring rapidity across all stages of the evaluation approach is emphasised, including: how to speed up data collection and analysis while preserving rigour; planning dissemination, uptake and impact from the earliest stages of scoping; and working in close partnership with patient, public and professional stakeholders to co-design the aims, approach and outputs. Outcomes of rapid evaluation may include assertion that intended benefits are likely to accrue, proposals for modifying or even halting a service innovation, planning a longer term study, or offering advice to local stakeholders about next steps. In all cases, the need for rapidity, responsiveness and relevance identified by Riley et al. will underpin the approach along with the additional dimension of rigour devised from the experience of the BRACE and RSET teams.1 The essay concludes with methodological and operational lessons for the conduction of rapid evaluation. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (RSET: 16/138/17; BRACE: 16/138/31).

Space launch vehicles are usually loaded with a large amount of propellant, and the destructive power caused by their explosion is significant. The altitude of an accidental explosion will lead to differences in the destructive power, because the environmental parameters of different altitudes are different, and the explosion shock wave parameters are closely related to the environmental parameters. Therefore, it was necessary to establish a set of analytical methods to rapidly analyze the relationship between altitude and the explosion shock wave parameters. A large number of simulation conditions were tested at 0~10 km altitude using the nonlinear dynamics software AUTODYN. The relationship between the explosion shock wave pressure P, the proportional distance z, and the altitude h was obtained, which could be used to rapidly characterize the explosion shock wave pressures at different altitudes. A comparative analysis was conducted with the experimental results to verify the scientificity of the fitting formula. The results indicate that the error between the experimental and calculated values is less than 5.80%, indicating that the rapid evaluation formula established in this paper is reasonable. These findings not only enrich the theory related to explosion shock waves, but also provide a rapid analysis basis for the accidental explosion of space launch vehicles.

IntroductionCOVID-19 challenges are well documented. Academic Health Science Networks (AHSNs) are a key partner to NHS and care organizations. In response to managing COVID-19 challenges, Wessex AHSN offered rapid insight generation and rapid evaluation to local NHS and care systems to capture learning during this period. This novel “Rapid Insight” approach involved one-off online deliberative events with stakeholders to generate insights linked to specific, priority areas of interest, followed by rapid analysis and dissemination of the findings.ContextKey objectives were to enable system leaders to build their adaptive leadership capability and learn from the experience of COVID-19 to inform recovery planning and system support. Rapid Insight (RI) gathered together health and care professionals into a tightly managed, virtual forum to share system intelligence.ApproachFocused questions asked about the systems' response to the pandemic, what changes to continue and sustain, or discontinue. Participants responded simultaneously to each question using the virtual chat function. Immediate thematic analysis of the chat conducted in 48–72 h by paired analysts for each question strengthened analytical integrity. Mind maps, the key output, provided easily assimilated information and showed linkages between themes. Telephone or virtual interviews of key informants (health and care professionals and patients) and routinely collected data were synthesized into short reports alongside several RI events. However, insufficient time limited the opportunities to engage diverse participants (e.g., mental health users). Data from RI can scope the problem and immediate system needs, to stimulate questions for future evaluative work.ImpactRI facilitated a shared endeavor to discover “clues in the system” by including diverse opinions and experience across NHS and care organizations. Although these rapid virtual events saved on travel time, digital exclusion might constrain participation for some stakeholders which needs other ways to ensure inclusion. Successful rapid engagement required Wessex AHSN's existing system relationships to champion RI and facilitate participant recruitment. RI events “opened the door” to conversations between up to 150 multi-professional clinicians to share their collective response to COVID-19. This paper focuses on the RI approach with a case example and its further development.

IntroductionRapid evaluations can offer evidence on innovations in health and social care that can be used to inform fast-moving policy and practise, and support their scale-up according to previous research. However, there are few comprehensive accounts of how to plan and conduct large-scale rapid evaluations, ensure scientific rigour, and achieve stakeholder engagement within compressed timeframes.MethodsUsing a case study of a national mixed-methods rapid evaluation of COVID-19 remote home monitoring services in England, conducted during the COVID-19 pandemic, this manuscript examines the process of conducting a large-scale rapid evaluation from design to dissemination and impact, and reflects on the key lessons for conducting future large-scale rapid evaluations. In this manuscript, we describe each stage of the rapid evaluation: convening the team (study team and external collaborators), design and planning (scoping, designing protocols, study set up), data collection and analysis, and dissemination.ResultsWe reflect on why certain decisions were made and highlight facilitators and challenges. The manuscript concludes with 12 key lessons for conducting large-scale mixed-methods rapid evaluations of healthcare services. We propose that rapid study teams need to: (1) find ways of quickly building trust with external stakeholders, including evidence-users; (2) consider the needs of the rapid evaluation and resources needed; (3) use scoping to ensure the study is highly focused; (4) carefully consider what cannot be completed within a designated timeframe; (5) use structured processes to ensure consistency and rigour; (6) be flexible and responsive to changing needs and circumstances; (7) consider the risks associated with new data collection approaches of quantitative data (and their usability); (8) consider whether it is possible to use aggregated quantitative data, and what that would mean when presenting results, (9) consider using structured processes & layered analysis approaches to rapidly synthesise qualitative findings, (10) consider the balance between speed and the size and skills of the team, (11) ensure all team members know roles and responsibilities and can communicate quickly and clearly; and (12) consider how best to share findings, in discussion with evidence-users, for rapid understanding and use.ConclusionThese 12 lessons can be used to inform the development and conduct of future rapid evaluations in a range of contexts and settings.

Background: There are over 15,000 care homes in England, with a total of approximately 450,000 beds. Most residents are older adults, some with dementia, and other residents are people of any age with physical or learning disabilities. Using pulse oximetry in care homes can help the monitoring and care of residents with COVID-19 and other conditions. Objectives: To explore the views of care home staff, and the NHS staff they interact with, with regard to using pulse oximetry with residents, as well as the NHS support provided for using pulse oximetry. Design: We carried out a rapid mixed-methods evaluation of care homes in England, comprising (1) scoping interviews with NHS leaders, care association directors and care home managers, engaging with relevant literature and co-designing the evaluation with a User Involvement Group; (2) an online survey of care homes; (3) interviews with care home managers and staff, and with NHS staff who support care homes, at six purposively selected sites; and (4) synthesis, reporting and dissemination. The study team undertook online meetings and a workshop to thematically synthesise findings, guided by a theoretical framework. Results: We obtained 232 survey responses from 15,362 care homes. Although this was a low (1.5%) response rate, it was expected given exceptional pressures on care home managers and staff at the time of the survey. We conducted 31 interviews at six case study sites. Pulse oximeters were used in many responding care homes before the pandemic and use of pulse oximeters widened during the pandemic. Pulse oximeters are reported by care home managers and staff to provide reassurance to residents and their families, as well as to staff. Using pulse oximeters was usually not challenging for staff and did not add to staff workload or stress levels. Additional support provided through the NHS COVID Oximetry @home programme was welcomed at the care homes receiving it; however, over half of survey respondents were unaware of the programme. In some cases, support from the NHS, including training, was sought but was not always available. Limitations: The survey response rate was low (1.5%) and so findings must be treated with caution. Fewer than the intended number of interviews were completed because of participant unavailability. Throughout the COVID-19 pandemic, care homes may have been asked to complete numerous other surveys etc., which may have contributed to these limitations. Owing to anonymity, the research team was unable to determine the range of survey respondents across location, financial budget or quality of care. Conclusions: Using pulse oximeters in care homes is considered by managers and staff to have been beneficial to care home residents. Ongoing training opportunities for care home staff in use of pulse oximeters would be beneficial. Escalation processes to and responses from NHS services could be more consistent, alongside promoting the NHS COVID Oximetry @home programme to care homes. Future research: Further research should include the experiences of care home residents and their families, as well as finding out more from an NHS perspective about interactions with care home staff. Research to investigate the cost-effectiveness of pulse oximetry in care homes, and of the NHS COVID Oximetry @home programme of support, would be desirable. Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 35. See the NIHR Journals Library website for further project information.

The COVID-19 pandemic created an urgent need for high-quality rapid research. One clinical challenge was how to minimise the risk of transmission in the hospital setting. The CLEAN study conducted a rapid evaluation of the potential utility of a spray-based disinfectant in a hospital setting. The study was undertaken between December 2020 and March 2021 and involved the implementation of the spray in 10 different clinical areas in one UK teaching hospital. A mixed-methods approach was adopted (including observations, surveys, and qualitative interviews) informed by the theories for understanding the implementation of new healthcare technologies. The evaluation found that while the spray had a number of perceived benefits when added to existing disinfection processes, other factors limited its potential utility. These findings informed a number of recommendations for future adoption within hospital settings. This paper describes and reflects on the rapid methodology that allowed us to undertake the study and deliver results in a short space of time. We experienced a number of pressures during set-up and fieldwork due to the challenging conditions caused by the pandemic, and the methodological approach had to evolve throughout the study because of the changing clinical context. The involvement of clinicians from the research setting as full members of the research team was key to the rapid delivery of the research. They provided an essential link to the implementation environment, and their experiential knowledge of the setting added an important perspective to the analysis. Balancing their involvement with their clinical roles was challenging, however, as was coordinating a large and diverse team of interviewers in such a short space of time. Overall, the study highlighted the value of rapid research to inform urgent healthcare decisions in a pandemic. Although our experience suggests that conducting such research requires some practical and methodological trade-offs, we found that there were also numerous benefits of using rapid methods and identified various opportunities to ensure their robustness.

Background: Primary care networks are groups of general practices brought together in July 2019 to hold shared budgets and develop new services in response to NHS England (now NHS England and Improvement) policy. This study examined the early implementation of primary care networks, especially what has helped or hindered progress, how they operate in relation to pre-existing collaborations and issues for rural networks. Objective: To produce early evidence about the development of primary care networks to inform policy for their future development. Our research questions were to investigate (1) the contextual background of primary care networks; (2) the rationale for general practices to enter into collaborations; (3) the early learning from establishing primary care networks; (4) barriers to and facilitators of effective collaboration across general practices; and (5) the likely future progress of primary care networks in the English NHS, including in the light of COVID-19. Design: A qualitative cross-comparative case study evaluation comprised four work packages: (1) a rapid evidence assessment; (2) a workshop with academics, policy experts and patient/public representatives; (3) interviews with stakeholders, observations of meetings, a survey and documentary analysis across four case study sites; and (4) analysis and synthesis of findings to develop recommendations for the next stage of the development of primary care networks. Results: Primary care networks have been implemented in a timely manner and have established a range of new local health services. Previous general practice collaborations provide much-needed support in terms of management, leadership and infrastructure, although they can be a source of tension within networks where interests, goals and ways of working do not align. Reasons for collaborative working typically focus on the sustainability of primary care and a desire for better-integrated services, although those cited as the basis for joining primary care networks were mostly related to policy and financial incentives. Early evidence reveals operational success in establishing organisational structures, recruiting to new roles and providing services as required by the national specification. Effective management and leadership, particularly with respect to having a committed clinical director, and constructive relationships between primary care networks and clinical commissioning groups, are important in ensuring success. In rural areas there was some perceived lack of fit with aspects of the primary care network specification, alongside existing challenges of providing primary care to rural populations. Limitations: Arranging and carrying out interviews proved difficult given the workload associated with implementing networks and wider time pressures. Following the onset of the COVID-19 pandemic, the team was unable to undertake planned face-to-face workshops to explore findings. Given that primary care networks were in their first year of operation at the time of this evaluation, we were cautious in drawing definitive conclusions. Conclusions: Key lessons focus on increasing the engagement of general practices and wider primary care teams with networks; building leadership and management capacity to support networks in fulfilling their contractual obligations and meeting local health needs; and clarifying how primary care networks will operate in the post-COVID-19 health and social care system. Future work: Future work could involve evaluating the impact and effectiveness of primary care networks using quantitative and qualitative measures; undertaking research in both rural and urban areas, exploring the extent to which this context is significant; examining the cost and effectiveness of sustaining and extending leadership and management support within primary care networks; and understanding the relationships between primary care networks and the wider health and care system. Study registration: This study is registered as PROSPERO CRD42018110790. Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care and Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 27. See the NIHR Journals Library website for further project information.

Background: Vertical integration refers to merging organisations that operate at different stages along the patient pathway. An organisation running an acute hospital and also operating primary care medical practices (i.e. general medical practitioner practices, also known as ‘general practices’) is an example of vertical integration. Evidence is limited concerning the advantages and disadvantages of different arrangements for implementing vertical integration, their rationale and their impact. Objectives: Our aim was to (1) understand the rationale for, and early impact of, vertical integration in the NHS in England and Wales and (2) develop a theory of change for vertical integration. Design: We carried out a rapid qualitative cross-comparative case study evaluation at three sites in England (n = 2) and Wales (n = 1), which comprised three work packages: (1) a rapid review of literature, telephone scoping interviews and a stakeholder workshop; (2) interviews with stakeholders across case study sites, alongside observations of strategic meetings and analysis of key documents from the sites; and (3) development of a theory of change for each site and for vertical integration overall. Results: We interviewed 52 stakeholders across the three case study sites; however, gaining access to and arranging and completing non-participant observations proved difficult. The single most important driver of vertical integration proved to be the maintenance of primary care local to where patients live. Vertical integration of general practices with organisations running acute hospitals has been adopted in some locations in England and Wales to address the staffing, workload and financial difficulties faced by some general practices. The opportunities created by vertical integration’s successful continuation of primary care, namely to develop patient services in primary care settings and better integrate them with secondary care, were exploited to differing degrees across the three sites. There were notable differences between the sites in organisational and clinical integration. Closer organisational integration was attributed to previous good relationships between primary and secondary care locally, and to historical planning and preparation towards integrated working across the local health economy. The net impact of vertical integration on health system costs is argued by local stakeholders to be beneficial. Limitations: Across all three case study sites, the study team was unable to complete the desired number of non-participant observations. The pace of data collection during early interviews and documentary analysis varied. Owing to the circumstances of the COVID-19 pandemic during project write-up, the team was unable to undertake site-specific workshops during data analysis and an overall workshop with policy experts. Conclusions: The main impact of vertical integration was to sustain primary medical care delivery to local populations in the face of difficulties with recruiting and retaining staff, and in the context of rising demand for care. This was reported to enable continued patient access to local primary care and associated improvements in the management of patient demand. Future work: The patient experience of vertical integration, effectiveness of vertical integration in terms of impact on secondary care service utilisation (e.g. accident and emergency attendances, emergency admissions and length of stay) and patient access (e.g. general practitioner and practice nurse appointments) to primary care requires further evaluation. Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 17. See the NIHR Journals Library website for further project information.

Antioxidants remove free radicals and inhibit the oxidation of oxygen-sensitive substances, which are of great significance in disease prevention and food preservative. Therefore, it is of great significance to establish a convenient, efficient and universal method for screening and evaluating antioxidant activity. In this study, Nitrogen-doped Graphene (N-G) with high conductivity and Chitosan (CS) with good film forming and stability were used as electrode substrate materials. And a ds-DNA/N-G@CS/GCE electrochemical biosensor for rapid evaluation of antioxidant activity was constructed by assembling ds-DNA and taking advantage of the signal difference between pre- and post-damage ds-DNA loading in Ru(NH _3 ) _6 ^3+ probe solution. N-G@CS with good electro-catalysis and high capacitance significantly improved the response signal of the sensor. At the same time, Square Wave Voltammetry (SWV) was used to optimize the conditions affecting the evaluation results of biosensors. The results showed that under the Fenton solution system with pH 7.0 and the ratio of Fe ^2+ to OH ^− 1:4, the biosensor has a high oxidation ds-DNA damage within 30 min The system can inhibit the damage of ds-DNA by adding antioxidants. Under optimized experimental conditions, composite yogurt and plain yogurt with weak antioxidant activity difference were evaluated by the constructed biosensor, and compared with L -ascorbic acid, the activity order was L -ascorbic acid > composite yogurt > plain yogurt. The results were consistent with the results of hydroxyl radical scavenging and ABTS ^+ radical scavenging experiments, and there was no significant difference between the three methods. This study not only provides a convenient and efficient method for the evaluation of antioxidant activity, but also provides strategies and technical support for the development of low-cost, highly sensitive and universal portable activity evaluation techniques.

As a vitamin C–rich fruit, choosing the eating time for kiwifruit with the best quality during the shelf period is still a problem for consumers. This paper mainly focuses on the correlation between cold storage time, quality indexes, volatile flavor compounds of postharvest kiwifruit and RGB value readouts from photos taken by mobile phone. Results indicated that the R to B ratio values (Central R/B) and B to G ratio values (Central B/G) of the central site of kiwifruit were strongly associated with storage time and all quality indicators. The central R/B was negatively correlated with titratable acidity, vitamin C and 2,6-Nonadienal contents and firmness and positively correlated with storage time, weight loss, soluble solids content, total soluble sugars, total plate counts and 1,3-Cyclooctadiene. We provide a novel and smart strategy to predict the shelf life and quality parameters of kiwifruit by capturing and calculating RGB values using a smartphone.

Rapid evaluation of aerodynamic forces is a key technology in conceptual and preliminary performance assessment and design optimization for supersonic/hypersonic vehicles, which is expected to achieve a balance between accuracy and time. In this paper, the preliminary evaluation platform of aerodynamic forces is built based on the physical theories and engineering methods. This platform computes the local velocity vector by using the streamline tracing technology, and extracts the pressure and friction coefficients by calling methods in method database. Furthermore, an example based on HL-20 is brought out. A good agreement is obtained by comparing the calculated results via CFD with the experimental. Also, a good angle of attack compatibility of streamline tracing technology is concluded. This platform has a computation time less than that via CFD and an flight range greater than that via wind tunnel. Finally, the simple flight dynamics simulation is taken out and the synergetic process is verified.

RESUMO Objetivo Desenvolver e validar o conteúdo de instrumento de avaliação de linguagem pautado na Comunicação Suplementar e Alternativa (CSA). Métodos O instrumento foi elaborado a partir de revisão bibliográfica, em conjunto com a experiência clínica da pesquisadora. Em seguida, foi avaliado por juízes especialistas na área e uma nova versão foi construída, incorporando as colaborações dos juízes. Resultados O instrumento foi elaborado em 4 eixos de conteúdo, com instruções e sugestão de contextos e símbolos gráficos. A partir da avaliação dos juízes, o instrumento foi aprimorado e proposto, em sua versão final. Conclusão O instrumento denominado CSA_Linguagem se mostrou operacional, de fácil e rápida aplicação e baixo custo. Contudo, esta pesquisa tem limitações, na medida em que não há instrumentos de avaliação de linguagem padronizados, que considerem a utilização de símbolos gráficos como possibilidade de comunicação.

Abstract Background Periodic assessment is one of the recommendations for improving health-care waste management worldwide. This study aimed at translating and adapting the Health-Care Waste Management - Rapid Assessment Tool (HCWM-RAT), proposed by the World Health Organization, to a Brazilian Portuguese version, and resolving its cultural and legal issues. The work focused on the evaluation of the concepts, items and semantic equivalence between the original tool and the Brazilian Portuguese version. Methods A cross-cultural adaptation methodology was used, including: initial translation to Brazilian Portuguese; back translation to English; syntheses of these translation versions; formation of an expert committee to achieve consensus about the preliminary version; and evaluation of the target audience’s comprehension. Results Both the translated and the original versions’ concepts, items and semantic equivalence are presented. The constructs in the original instrument were considered relevant and applicable to the Brazilian context. The Brazilian version of the tool has the potential to generate indicators, develop official database, feedback and subsidize political decisions at many geographical and organizational levels strengthening the Monitoring and evaluation (M&E) mechanism. Moreover, the cross-cultural translation expands the usefulness of the instrument to Portuguese-speaking countries in developing regions. Conclusion The translated and original versions presented concept, item and semantic equivalence and can be applied to Brazil

The objective of this work is to propose a rapid methodology called Overview Case Analysis (OCA) to analyze in a synthetic and simple form, the tremendous amount of information that is created through the years in a technology transfer project. Using OCA analyst can rapidly detect the project highlights along its critical path of the technology transfer project. At the end of the evaluation process, qualification of the project performance is performed using a coarse scale to measure the technology transfer capacity of the participant organizations. To prove the methodology proposed, we explore the economic and social impact results of some technology transfer projects developed by academic groups of the National Autonomous University of Mexico (UNAM, by its Spanish acronym). The conclusion is that in order to have a successful TTP, at least three conditions are necessary: (a) the project must be handled by an efficient technology transfer team (T3); (b) the technology transferred must be mature; and (c) the technology transferred must have economic and social impacts for the final organization or other users inside the receiver country.

Acoustic rhinometry, rhinomanometry and Inspiratory Peak Nasal Flow (IPNF) are used in order to objectively assess nasal patency. These are expensive not very practical tests, except for IPNF, which is a fast, simple and low cost method. OBJECTIVE: To assess IPNF in healthy individuals complaining of nose obstruction caused by allergic rhinitis. METHOD: IPNF use in 78 individuals with and without rhinitis symptoms. STUDY DESIGN: Contemporary cross-sectional cohort. RESULTS: IPNF showed significant results for nasal obstruction, rhinorrhea, pruritus, sneezes and tearing (p < 0. 001). There was no correlation between the presence of nasal septum deviation and IPNF (p = 0. 561). We found a positive correlation between IPNF and the Visual Analogue Scale (VAS) for nasal obstruction (p = 0. 002). In the multiple linear regression model, there was a statistical significance between the values found in IPNF with allergic rhinitis and age (p = 0. 005 and p = 0. 023 respectively). CONCLUSIONS: IPNF proved to be a reliable method to detect changes in nasal patency, by obstructive causes as well as inflammatory causes, with an acceptable level of statistical significance, simple, easy to handle, inexpensive and reproducibleA rinometria acústica, rinomanometria e o peak flow nasal inspiratório (PFNI) são utilizados para a avaliação objetiva da patência nasal. Estes exames são dispendiosos e pouco práticos, exceto o PFNI, que se apresenta como um método rápido, de baixo custo e simples. OBJETIVO: Avaliar o PFNI em indivíduos saudáveis e com queixas nasais obstrutivas por rinite alérgica. MéTODO: Aplicação do PFNI em 78 sujeitos com e sem sintomas de rinite. FORMA DE ESTUDO: Estudo de coorte contemporâneo com corte transversal. RESULTADOS: O PFNI mostrou resultados significantes para obstrução nasal, rinorreia, prurido, espirros e lacrimejamento (p < 0,001). Não houve correlação entre a presença de desvio de septo nasal e PFNI (p = 0,561). Encontrou-se uma correlação positiva entre PFNI e Escala Visual Analógica - EAV- para obstrução nasal (p = 0,002). No modelo de regressão linear múltipla, houve significância estatística entre os valores encontrados no PFNI com rinite alérgica e idade (p = 0,005 e p = 0,023 respectivamente). CONCLUSÃO: O PFNI mostrou ser um método confiável para detecção das alterações da patência nasal, tanto por causas obstrutivas quanto por causas inflamatórias, com um nível de significância estatística aceitável, simples, fácil de manusear, pouco dispendioso e reprodutível