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Many scholars have argued that social programs are marked by a logic of 'increasing returns' that makes change difficult. Yet over the past decades, reformers across industrialized countries have introduced substantial administrative reforms in these services, even as entitlement reform remains politically difficult. This paper explains these shifts by breaking apart the logic of 'increasing returns' into three distinct 'costs to change': technical, political, and expectations. Decreases in a particular type of costs produce different logics of institutional change-back end, informal, and front end-that privilege the state, professionals or private, or political actors in distinct ways. I support these claims by reexamining three cases that were considered exemplars of stability but that ultimately had major entitlement reform: health care in the United Kingdom and United States and welfare programs in the United States. I show that even before radical reforms occurred, reformers introduced distinct logics of administrative change that underpinned later changes. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to provide an overview, including methodology and preliminary findings, of a current and ongoing doctoral research study of the impact of national library associations. The study uses the impact assessment framework provided by IS016439:2014 Methods and procedures for assessing the impact of libraries. Design/methodology/approach -- If the professional associations supporting the profession are to become sustainable we need to understand the difference they make to the individual members of the profession, to the employers of those individuals and to the profession of librarianship. This study applies the framework provided by ISO 16439:2014 to the national library association environment to explore and gather evidence of impact. To align with the ISO model, impact is differentiated into impact on individuals; social impact -- institution (library or employing organization); and social impact -- community (the profession). Preliminary findings show evidence of impact in all categories. Findings -- Data were gathered through semi-structured interviews that were conducted with members of national library associations in Australia, New Zealand, the UK and the USA during the third quarter of 2013. Originality/value -- This study contributes to research methodologies by testing the use of a qualitative assessment tool in a way that could be transferable to other associations both within and external to the library environment and to enable it to be adapted more broadly for other purposes within the library and information environment. [ABSTRACT FROM AUTHOR]

The article discusses a meeting organized by the Food and Health Forum of the Royal Society of Medicine that was held in Great Britain on March 27, 2014. At the meeting various papers on dietary guidelines are presented by several professors including Jayne Woodside, Tom Sanders and Peter Aggett. It also informs that attendees at the conference are welcomed by Anthony Mander, President of the Food and Health Forum.

This paper explores differences in how primary care doctors process the clinical presentation of depression by African American and African-Caribbean patients compared with white patients in the US and the UK. The aim is to gain a better understanding of possible pathways by which racial disparities arise in depression care. One hundred and eight doctors described their thought processes after viewing video recorded simulated patients presenting with identical symptoms strongly suggestive of depression. These descriptions were analysed using the CliniClass system, which captures information about micro-components of clinical decision making and permits a systematic, structured and detailed analysis of how doctors arrive at diagnostic, intervention and management decisions. Video recordings of actors portraying black (both African American and African-Caribbean) and white (both White American and White British) male and female patients (aged 55 years and 75 years) were presented to doctors randomly selected from the Massachusetts Medical Society list and from Surrey/South West London and West Midlands National Health Service lists, stratified by country (US v.UK), gender, and years of clinical experience (less v. very experienced). Findings demonstrated little evidence of bias affecting doctors' decision making processes, with the exception of less attention being paid to the potential outcomes associated with different treatment options for African American compared with White American patients in the US. Instead, findings suggest greater clinical uncertainty in diagnosing depression amongst black compared with white patients, particularly in the UK. This was evident in more potential diagnoses. There was also a tendency for doctors in both countries to focus more on black patients' physical rather than psychological symptoms and to identify endocrine problems, most often diabetes, as a presenting complaint for them. This suggests that doctors in both countries have a less well developed mental model of depression for black compared with white patients. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to explore what is known about food literacy programmes targeting adolescents, including identification of the constituents of food literacy addressed, assessment of programme effectiveness, and description of programme design or delivery specific to adolescents. Methods A review of the peer-reviewed literature surrounding adolescent food literacy was conducted using scholarly electronic databases. Programme reports were identified in the grey literature using online searching and cross-referencing to support the research aim. Programmes from 2000 to 2012 targeting adolescents aged 13-17 years were included. Results A total of 19 peer-reviewed papers and four grey literature programmes met the search criteria. Interventions focused on practical cooking and/or food preparation skills and targeted younger adolescent age groups. Programmes were most commonly held in schools and community settings. The majority of programmes (n = 16/23) did not use a theoretical basis for their development. Programme evaluation encompassed the use of pre- and post-intervention questionnaires and focus groups. Only nine studies included a dietary behaviour-based outcome measure. Although 19 of the 23 studies reviewed reported positive changes related to the intervention, these did not include significant changes in diet quality or cooking frequency at home. Conclusions Few existing adolescent food literacy programmes have demonstrated a positive impact on dietary behaviours to date. Adolescent target groups present unique challenges in programme development and delivery. However, the physical, social and emotional health needs of this age group and potential to influence lifelong behaviours highlight the need to design effective and age-appropriate adolescent food literacy programmes. [ABSTRACT FROM AUTHOR]

The civil war in Somalia forced many Somalis to migrate to other countries where they had to adapt to new cultures and learn new languages. At the same time, they retained the identity and culture that were important to them throughout the process of migration. These first-generation Somali immigrants may feel strong allegiance to their country of origin along with a “sense of belonging” to their clan/kinship. They may also hope that one day they will be able to return “home”. But do second-generation Somalis feel the same way? This paper is based on 23 interviews with Somali immigrants in Australia, the UK and the USA. Out of the 23 participants, two were first-generation and the rest were second-generation. I seek to understand the participants' identity and their sense of belonging to their ethnicity and host country in the wake of pertinent moments of local, national and international anxiety. [ABSTRACT FROM PUBLISHER]

National exergy efficiency analysis relates the quality of primary energy inputs to an economy with end useful work in sectoral energy uses such as transport, heat and electrical devices. This approach has been used by a range of authors to explore insights to macroscale energy systems and linkages with economic growth. However, these analyses use a variety of calculation methods with sometimes coarse assumptions, inhibiting comparisons. Therefore, building on previous studies, this paper first contributes toward a common useful work accounting framework, by developing more refined methodological techniques for electricity end use and transport exergy efficiencies. Second, to test this more consistent and granular approach, these advances are applied to the US and UK for 1960 to 2010. The results reveal divergent aggregate exergy efficiencies: US efficiency remains stable at around 11%, while UK efficiency rises from 9% to 15%. The US efficiency stagnation is due to "efficiency dilution", where structural shifts to lower efficiency consumption (e.g., air-conditioning) outweigh device-level efficiency gains. The results demonstrate this is an important area of research, with consequent implications for national energy efficiency policies. [ABSTRACT FROM AUTHOR]

In this paper we develop models for multivariate financial bubbles and antibubbles based on statistical physics. In particular, we extend a rich set of univariate models to higher dimensions. Changes in market regime can be explicitly shown to represent a phase transition from random to deterministic behaviour in prices. Moreover, our multivariate models are able to capture some of the contagious effects that occur during such episodes. We are able to show that declining lending quality helped fuel a bubble in the US stock market prior to 2008. Further, our approach offers interesting insights into the spatial development of UK house prices. [ABSTRACT FROM AUTHOR]

Abstract: Given the increasing number of interactions between police and people with mental illnesses (PMI), there has been widespread interest in the development of education for police about how best to interact with PMI. This paper reflects the review of current practice in a variety of jurisdictions across Canada as well as in the United States (U.S.), the United Kingdom (U.K.) and Australia; it proposes a comprehensive model of learning based on the literature that addresses not only the content in the narrow sense but also the importance of broader contextual knowledge and understanding in developing effective education and training. Embedded in the principles articulated in the Mental Health Strategy for Canada, the TEMPO (Training and Education about Mental illness for Police Organizations) model is a multilevel learning strategy for Canadian police personnel. Learning objectives and key principles are articulated in order to ensure the model is applicable to a wide range of police agencies and individual jurisdictional needs. In addition to providing a firm basis of factual knowledge for police personnel, the resultant model embraces a human rights/anti-stigma philosophy, provides for a range of education appropriate to diverse police audiences, emphasizes a systems approach to police/mental health liaison activities and addresses issues related to the delivery and implementation of police education and training. [Copyright &y& Elsevier]

To identify the patient classification systems used to classify nursing intensity in the assessment of nursing staffing resources currently used in home health care, with a special emphasis on validity, reliability and staff allocation. Scoping review of internationally published and grey literature, based on a methodological framework by Arksey and O'Malley. Searches of the electronic databases Cinahl, Medline, Embase and SweMed, the websites Google and Google Scholar and hand searches of reference lists occurred. Eligibility criteria included (A) a focus on patient classification systems measuring nursing intensity and workload in home health care and (B) published in English between January 2007 and March 2019. In level one testing two team members screened titles and abstracts, in level two testing two team members determined which papers should undergo a full text review. Data were extracted using structured extraction by one team member and verified by two other members. Thirteen peer-reviewed articles and grey literature documents were identified, from Canada, Ireland, the UK, the USA, Scotland, Turkey and the Netherlands. Four patient classification systems had been tested for both validity and reliability. Validity was tested through face validity, predictive validity, concurrent validity or content validity index. Reliability was tested through stability, internal consistency, observer agreement or inter rater reliability. One patient classification system had been tested only for reliability, through interrater reliability and observer agreement. Two patient classification systems had been evaluated through summative evaluation; one qualitatively through focus group interviews and one through semi-structured interviews. Only one patient classification system had been validity and reliability tested and evaluated. Overall, the patient classification systems in the included papers (13) were considered to have benefits and to be appropriate for the measurement of patients' needs, workload and allocation of staff, although specific information was not always given. Little has been published on validity or reliability tested patient classification systems linked to staffing allocation in home health care in the past decade. Limited research was seen where a patient classification system was considered to be fully operational in home health care. [ABSTRACT FROM AUTHOR]

Many influential theorists of nationalism see war as a social conflict that to a great extent homogenizes and unifies the nation. Nowhere is that unity more clearly expressed than in war memorials and cemeteries. This article considers the examples of Britain and the USA during the aftermath of World War I in order to examine how the state legitimized its ownership of the bodies of its dead soldiers. It argues first that in an internal dispute, when all sides share a normative ideology, nationalism cannot offer an effective basis for legitimacy. Second, it shows that during the aftermath of World War I, the bodies of dead soldiers were not symbols. This article concludes that in order to transform a dead body into a symbol, the body first has to be "de-individualized." [ABSTRACT FROM AUTHOR]

• Temporal characterization of marine energy resources, at varying time scales. • Characterized wave, tidal, and ocean currents, and compared to wind and solar. • Data based exposition of grid benefits for wave power at high renewable scenarios. • Data based exposition of higher capacity adequacy and stability for wave power. • Detailed discussion on market implications of grid integration of marine energy. In this paper, the applicability of marine renewable energy (MRE) for potential grid applications is presented. We show that many of the unique value streams from marine-based electricity generation resources stem from their inherent temporal characteristics, especially when compared to wind and solar. Specifically, in this work, we evaluate the timing value for three types of MRE resources: (a) tidal, (b) wave, and (c) ocean currents. First, through a suite of novel metrics, such as resource availability, persistence, and versatility, we evaluate the temporal value characteristics of these resources. Second, through a more grid-oriented numerical study, we comment on the potential ramifications of those temporal characteristics in context of energy balancing and effective load carrying capability for one marine-based resource i.e., wave. Finally, we further our understanding of the relative advantages that may be leveraged by operating wave-based generation in tandem with more established renewable resources, such as wind and solar. Our results indicate that compared to wind and solar, MRE resources are consistently more available and persistent on an hourly level throughout an entire year of operation. In addition, wave resources are also seen to reduce the balancing requirements within the power system. Our work focuses on sites specific to the United States (US) and a parallel study for a location in Great Britain (GB). Results are found to be consistent for sites in both the US and GB, implying that the grid benefits discussed in this work could apply to a number of locations globally. [ABSTRACT FROM AUTHOR]

Introduction: Machine learning (ML) uses statistical techniques to give computer systems the ability to "learn" from data, without being explicitly programmed. Application of rapid advances in artificial intelligence systems, is expected to revolutionize healthcare in the near future. While cardiovascular diseases are a leading cause of death among elderly in present time, mortality is largely due to late diagnosis. Applied ML can accurately aid early prediction of cardiovascular diseases. The current work aims to review the available literature on applications of artificial intelligence or machine learning in healthcare to predict cardiovascular disease. Method: A literature searches on PubMed database in October 2018 using keywords "(Machine learning or artificial intelligence) & (Cardiovascular OR Heart OR Blood OR vessels OR Cardiac) & Prediction" revealed 1086 citations. However, most did not have machine learning and cardiovascular disease as principal focus. Using filters to allow the appearance of keywords in the title of the paper, limiting to studies including older persons (>65years) we narrowed our results to seven citations of which six which were freely available and are included in our review. Results: Among the early applications, Ong et al in 2012 generated a heart rate variability parameter from five-minute spectrogram and other vital parameters were added to generate a machine learning score which was found to be more accurate than modified early warning score. Liu et al in 2014 in Singapore reported that ML based selection of predictors of Cardiac events gave relevant and significant results. Dames et al, in 2017 found that machine learning of three dimensional right ventricular motion enable outcome prediction in pulmonary hypertension. Weng et al in 2017 in UK have compared four machine learning algorithms with an established algorithm (American college of Cardiology Guidelines) and found that machine learning significantly improves accuracy of cardiovascular risk prediction. Ambala et al in 2017 in USA used random survival forest technique to identify the top 20 predictors of each Cardiovascular Outcome. Conclusions: Our review shows that the impact of machine learning on ageing through early prediction of cardiovascular diseases can no longer be ignored and the field is just warming up. Our work highlights how artificial intelligence is rapidly transforming the way we approach cardiovascular diseases and will be a major game changer in the foreseeable future. [ABSTRACT FROM AUTHOR]

Background: Patient safety in primary care is an emerging field of research with a growing evidence base in western countries but little has been explored in the Gulf Cooperation Council Countries (GCC) including the Sultanate of Oman. This study aimed to review the literature on the safety culture and patient safety measures used globally to inform the development of safety culture among health care workers in primary care with a particular focus on the Middle East. Methods: A systematic review of the literature. Searches were undertaken using Medline, EMBASE, CINAHL and Scopus from the year 2000 to 2014. Terms defining safety culture were combined with terms identifying patient safety and primary care. Results: The database searches identified 3072 papers that were screened for inclusion in the review. After the screening and verification, data were extracted from 28 papers that described safety culture in primary care. The global distribution of the articles is as follows: the Netherlands (7), the United States (5), Germany (4), the United Kingdom (1), Australia, Canada and Brazil (two for each country), and with one each from Turkey, Iran, Saudi Arabia and Kuwait. The characteristics of the included studies were grouped under the following themes: safety culture in primary care, incident reporting, safety climate and adverse events. The most common theme from 2011 onwards was the assessment of safety culture in primary care (13 studies, 46%). The most commonly used safety culture assessment tool is the Hospital survey on patient safety culture (HSOPSC) which has been used in developing countries in the Middle East. Conclusions: This systematic review reveals that the most important first step is the assessment of safety culture in primary care which will provide a basic understanding to safety-related perceptions of health care providers. The HSOPSC has been commonly used in Kuwait, Turkey, and Iran. [ABSTRACT FROM AUTHOR]

• Despite consensus on importance of relationships in RCC, theorisation is limited. • Relational practice most prominently identified as threshold in transatlantic study. • All 5 characteristics of threshold concepts were reflected across interview data. • There was an emphasis on the troublesome nature of relationship boundaries. • The relational nature of teaching and learning relational practice was identified. Despite growing international consensus around the complex and demanding nature of residential child care for children and young people, consensus is lacking around how to develop a workforce equal to the task. Similarly, there is near unanimity about the essential nature of relationships, particularly the relationship between practitioner and child, for good residential care. At the same time, theorization on how those relationships are enacted and how to support practitioners' related development of practice is underdeveloped or even absent in some contexts. This second of a two-part paper discusses stage two of a two-stage, transatlantic study aimed at identifying and exploring threshold concepts in residential child care. Threshold concepts are central concepts in a given discipline which are transformative but troublesome for many. They are important to their given discipline because they shape thinking and practice, but they are often difficult to master. In stage one, relational practice was the most prominently discussed potential threshold concept in focus groups comprised of educators and practitioners who had studied, practiced and/or taught in the UK, Canada and/or the US. In stage two, in-depth individual interviews were carried out with practitioners around their threshold experiences of relational practice. Analysis found all five characteristics of threshold concepts reflected in the data, with a particular emphasis on the troublesome nature of relationship boundaries. A further theme around the relational nature of teaching and learning relational practice was identified, raising important parallels between the relational experiences practitioners have as part of their training, and their relational practice in the field. Implications are discussed, including the misfit between the demarcation of professional boundaries as applied by cognate fields and the actual requirements of ameliorative relationships in residential child care. [ABSTRACT FROM AUTHOR]

• Threshold concepts are core concepts in a given field that are transformative. • They are important because they shape thinking and practice. • A transatlantic study was carried out to identify them in residential child care. • Relational Practice and Use of Self were prominently identified. • They have explanatory power in guiding workforce development. Despite growing international consensus around the complex and demanding nature of residential child care for children and young people, consensus is lacking around how to develop a workforce equal to the task. Threshold concept theory casts a light on related issues of training and education, and offers direction in addressing them. Threshold concepts are central concepts in a given discipline which are transformative but troublesome for many. They are important to their given discipline because they shape thinking and practice, but they are often difficult to master. This first of a two-part paper discusses the first of a two-stage, transatlantic study aimed at identifying and exploring threshold concepts in residential child care. Using focus groups and individual interviews with participants who had studied, practiced and/or taught in the UK, Canada or the US, it explored the views and experiences of educators who have contributed to knowledge production in the field, as well as front-line practitioners who have completed a dedicated course in child and youth care, residential child care or therapeutic child care. Findings included unanimous agreement about the relevance of threshold concept theory to their experiences, and strong support for its utility in considering how curricula should be taught. There was a greater degree of commonality than divergence between educator and practitioner views about what might be threshold, with relational practice the most prominently discussed. A theme around the self of the learner was identified in discussions of threshold concept theory more generally, particularly across the educator focus groups. Implications for pedagogical practice are discussed, including the concept of praxis which provides a useful counterpoint for conceptualising the relationship between threshold concept theory and the use of self in practice, especially in fields where the self is a primary instrument of the work. [ABSTRACT FROM AUTHOR]

Background: When doctors have honest conversations with patients about their illness and involve them in decisions about their care, patients express greater satisfaction with care and lowered anxiety and depression. The Serious Illness Care Programme (the Programme), originally developed in the United States (U.S), promotes meaningful, realistic and focused conversations about patient's wishes, fears and worries for the future with their illness. The Serious Illness Conversation Guide (the guide) provides a framework to structure these conversations. The aim of this paper is to present findings from a study to examine the 'face validity', acceptability and relevance of the Guide for use within the United Kingdom (UK) health care setting.Methods: A multi-stage approach was undertaken, using three separate techniques: 1. Nominal Group Technique with clinician 'expert groups' to review the Serious Illness Conversation Guide: 14 'experts' in Oncology, Palliative Care and Communication Skills; 2. Cognitive Interviews with 6 patient and public representatives, using the 'think aloud technique'; to explore the cognitive processes involved in answering the questions in the guide, including appropriateness of language, question wording and format 3. Final stakeholder review and consensus.Results: Nominal Group Technique Unanimous agreement the conversation guide could provide a useful support to clinicians. Amendments are required but should be informed directly from the cognitive interviews. Training highlighted as key to underpin the use of the guide. Cognitive interviews The 'holistic' attention to the person as a whole was valued rather than a narrow focus on their disease. Some concern was raised regarding the 'formality' of some wording however and suggestions for amendments were made. Final stakeholder review Stakeholders agreed amendments to 5/13 prompts and unanimously agreed the UK guide should be implemented as a part of the pilot implementation of the Serious Illness Care Programme UK.Conclusion: Use of the guide has the potential to benefit patients, facilitating a 'person-centred' approach to these important conversations, and providing a framework to promote shared decision making and care planning. Further research is ongoing, to understand the impact of these conversations on patients, families and clinicians and on concordance of care delivery with expressed patient wishes. [ABSTRACT FROM AUTHOR]

Summary: Skin cancer is increasing in many countries, including in the UK. For example, in the USA in 2017, over 87,000 people had been diagnosed with a dangerous type of skin cancer (melanoma); of these it was expected that nearly 10,000 would die from the condition. We are a U.K based research team that conducted a review of scientific papers from across the world. Our aim was to examine and pool the existing research on whether the different approaches to helping people to examine their own skin, to detect skin cancer early, are effective or not. This review identified all the relevant published articles for available research studies up to April 2018. The identified relevant studies totalled 18 in number, which we then summarised. These approaches included education, such as teaching and reminding people (sometimes using technology, for example, using computers and mobile phones) to examine their skin and quickly report any suspicious changes to their doctor. We found that the various approaches used had a positive effect on peoples' likelihood and ability to examine their skin, especially in the short‐term. More studies targeted people at higher risk of skin cancer, such as those with a previous diagnosis of skin cancer, compared to people at no greater risk. Of the research we looked at, two thirds of the studies were poorly designed. Skin specialists should raise awareness and support people to routinely examine their skin for skin cancer, especially those at high risk. Linked Article: Ersser et al. Br J Dermatol 2019; 180:1339–1347 [ABSTRACT FROM AUTHOR]

Renewable energy sources (RES) are gradually becoming one of the key elements in the process of achieving energy efficiency worldwide. This trend can be observed in many developed Western economies—for example, in the United States, as well as in the United Kingdom. Hence, the role of innovative policies for promoting energy efficiency is becoming crucial in transition to the post-carbon economy. The shift to the carbon-free future make all actors to face forgoing commitments Nevertheless, customers and residential households are the first and the most important players in the pursuit of the energy-efficient future. Without them, carbon-free economy based on RES would never take the shape as envisaged. Our paper focuses on the innovative strategies and policies studying the effect and the scope of RES penetration into the households. We employ and empirical analysis of the effects from using RES in households using an example of the residential households in the northwest region of the United Kingdom (UK) with and without solar photovoltaic (PV) panels and electric vehicles (EV). We analyse the four scenarios that are aimed at analysing the system dynamics and providing differentiation between systems in terms of the varying values of the gross demand, tariffs, metered import, and the total revenue. Our results demonstrate that the solar PV leads to the transfer of costs and wealth regardless of the ownership of PV and EVs. Solar energy generation reduces the share of UK solar PV households per kWh costs of the distribution system which causes the augmenting of the per unit charges as well as to the changes in payments for the electricity that impoverishes less wealthy customer groups. It also becomes clear that with the increase of EV penetration, the existing energy efficiency schemes would have to be revised. [ABSTRACT FROM AUTHOR]

Background: In 2006, the British government launched 'Improving Access to Psychological Therapies' (IAPT), a low intensity cognitive behaviour therapy intervention (LiCBT) designed to manage people with symptoms of anxiety and depression in the community. The evidence of the effectiveness of IAPT has been demonstrated in multiple studies from the UK, USA, Australia and other countries. MindStep™ is the first adaptation of IAPT in Australia, delivered completely by telephone, targeting people with a recent history of a hospital admission for mental illnesses within the private health system. This paper reports on the outcome of the first 17 months of MindStep™ implemented across Australia from March 2016. Methods: This prospective observational study investigated the MindStep™ program in a cohort of clients with a recent hospitalisation for mental illnesses. The study used quantitative methods to compare pre-post treatment clinical measures (N = 680) using Patient Health Questionnaire (PHQ-9) and the Generalised Anxiety Disorder (GAD-7). This study also included in-depth interviews with participants (N = 14) and coaches (N = 4) to determine the feasibility and acceptability of the program. Results: Of the 867 clients referred to MindStep™, 757 had initial assessments by phone making an enrolment rate of 87.3%. Following assessment, 680 commenced treatment and of them, 427 (62.7%) completed treatment. According to 'per-protocol' analysis (N = 427), there was a large effect size for post-treatment PHQ-9 (d = 1.03) and GAD-7 (d = 0.99) scores; reliable recovery rate was 62% (95% CI: 57–68%). For intent-to-treat analysis using multiple imputation (N = 680), effect sizes were also large for pre-post treatment change: PHQ-9 (d = 0.78) and GAD-7 (d = 0.76). The reliable recovery rate was 49% (95% CI: 45–54%). Qualitative findings supported these claims where participants were positive about MindStep™ and found the telephone delivery and use of mental health coaches highly acceptable. Conclusions: MindStep™ has demonstrated encouraging outcomes that suggest LiCBT can be successfully delivered to people with a history of hospital admissions for anxiety and depressive disorders and achieve target recovery rates of > 50%. Other promising evaluation findings indicate the MindStep™ option is acceptable, feasible and safe within the stepped models of mental health care delivery in Australia. [ABSTRACT FROM AUTHOR]

Background: As research in family medicine covers varied topics, multiple methodologies such as qualitative research (QR) and mixed methods research (MMR) are crucial. However, we do not know about the difference in the proportion of QR or MMR between Japan, the UK and the US. This knowledge is needed to shape future research within countries with developing primary care such as Japan and other Asian countries. This study aims to describe the use of QR and MMR in Japanese primary care and compare this to the UK and US; then to make informed recommendations for primary care research. Methods: A repeated cross-sectional study (2012–2016) based on the abstracts submitted to the annual conferences of the Japanese Primary Care Association in Japan, the Royal College of General Practitioners in the UK, and the North American Primary Care Research Group in the US and other North American countries. The proportions of QR/MMR among all the posters and paper presentations for each of these three conferences were assessed. Also examined were trends and types of qualitative techniques for all three countries and participants/settings for Japan. Results: There were 1080 abstracts for Japan, 575 for UK and 3614 for US conferences. QR/MMR proportions were 7.5%, 15.1% and 28.1%, respectively. Japan's proportion was lower than that of UK and US (p < 0.001). The proportion was increasing over time for the UK (p = 0.02). Steps for coding and analyses was most popular for Japan, thematic analysis for the UK and grounded theory for the US. Primary care doctors and hospitals were the commonest contexts for Japan. Conclusions: QR and MMR were not as popular in primary care in Japan compared to the UK and the US, whereas their use was increasing in the UK. Approaches, participants and settings may differ among these countries. Education and promotion of QR/MMR and multi-disciplinary collaborations need to be recommended in Japan with developing primary care. [ABSTRACT FROM AUTHOR]