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Introduction: Co‐production is gaining increasing recognition as a good way of facilitating collaboration among different stakeholders, including members of the public. However, it remains an ambiguous concept as there is no definitive or universal model of co‐production or clarity on what constitutes a good co‐production approach. This paper draws on the reflections of the academic researchers, practitioners and public advisors involved in co‐producing a priority‐setting exercise. The exercise was conducted by the Primary and Community Health Services (PCHS) Theme of the National Institute for Health and Care Research Applied Research Collaboration for Kent, Surrey and Sussex (NIHR ARC KSS). Methods: We collected data through written and verbal reflections from seven collaborators involved in the PCHS priority‐setting exercise. We used Gibbs' model of reflection to guide the data collection. We then analysed the data through an inductive, reflexive thematic analysis. Results: A common thread through our reflections was the concept of 'sharing'. Although co‐production is inherently shared, we used the virtuous cycle to illustrate a sequence of sharing concepts during the research cycle, which provides the underpinnings of positive co‐production outcomes. We identified six themes to denote the iterative process of a shared approach within the virtuous cycle: shared values, shared understanding, shared power, shared responsibilities, shared ownership and positive outcomes. Conclusion: Our results present a virtuous cycle of co‐production, which furthers the conceptual underpinnings of co‐production. Through our reflections, we propose that positive co‐production outcomes require foundations of shared values and a shared understanding of co‐production as a concept. These foundations facilitate a process of shared power, shared responsibilities and shared ownership. We argue that when these elements are present in a co‐production exercise, there is a greater potential for implementable outcomes in the communities in which the research serves and the empowerment of collaborators involved in the co‐production process. Public Members' Contributions: Three members of the public who are public advisors in the NIHR ARC KSS were involved in the priority‐setting exercise that informed this paper. The public advisors were involved in the design of the priority‐setting exercise and supported participants' recruitment. They also co‐facilitated the focus groups during data collection and were involved in the data analysis, interpretation and preparation of the priority‐setting report. For this current manuscript, two of them are co‐authors. They provided reflections and contributed to the writing and reviewing of this manuscript. [ABSTRACT FROM AUTHOR]

Background: Migrant and ethnic inequalities in maternal and perinatal mortality persist across high‐income countries. Addressing social adversity and inequities across the childbirth trajectory cannot be left to chance and the good intentions of practitioners. Robust, evidence‐based tools designed to address inequity by enhancing both the quality of provision and the experience of care are needed. Methods: An inductive modelling approach was used to develop a new evidence‐based conceptual model of woman–midwife relationships, drawing on data from an ethnographic study of relationships between migrant Pakistani women and midwives, conducted between 2013 and 2016 in South Wales, UK. Key analytic themes from early data were translated into social–ecological concepts, and a model was developed to represent how these key themes interacted to influence the woman–midwife relationship. Results: Three key concepts influencing the woman–midwife relationship were developed from the three major themes of the underpinning research: (1) Healthcare System; (2) Culture and Religion; and (3) Family Relationships. Two additional weaving concepts appeared to act as a link between these three key concepts: (1) Authoritative Knowledge and (2) Communication of Information. Social and political factors were also considered as contextual factors within the model. A visual representation of this model was developed and presented. Conclusions: The model presented in this paper, along with future work to further test and refine it in other contexts, has the potential to impact on inequalities by facilitating future discussion on cultural issues, encouraging collaborative learning and knowledge production and providing a framework for future global midwifery practice, education and research. Patient or Public Contribution: At the outset of the underpinning research, a project involvement group was created to contribute to study design and conduct. This group consisted of the three authors, an Advocacy Officer at Race Equality First and an NHS Consultant Midwife. This group met regularly throughout the research process, and members were involved in discussions regarding ethical/cultural/social issues, recruitment methods, the creation of participant information materials, interpretation of data and the dissemination strategy. Ideas for the underpinning research were also discussed with members of the Pakistani community during community events and at meetings with staff from minority ethnic and migrant support charities (BAWSO, Race Equality First, The Mentor Ring). Local midwives contributed to study design through conversations during informal observations of antenatal appointments for asylum seekers and refugees. [ABSTRACT FROM AUTHOR]

The reduced inertia levels in low-carbon power grids necessitate explicit constraints to limit frequency’s nadir and rate of change during scheduling. This can result in significant curtailment of renewable energy due to the minimum generation of thermal plants that are needed to provide frequency response (FR) and inertia. Additional consideration of fast FR, a dynamically reduced largest loss and under frequency load shedding (UFLS) allows frequency security to be achieved more cost effectively. This paper derives a novel constraint from the swing equation to contain the frequency nadir using all of these services. The expected cost of UFLS is found probabilistically to facilitate its comparison to the other frequency services. We demonstrate that this constraint can be accurately and conservatively approximated for moderate UFLS levels with a second order cone (SOC), resulting in highly tractable convex problems. Case studies performed on a Great Britain 2030 system demonstrate that UFLS as an option to contain single plant outages can reduce annual operational costs by up to $\pounds $ 559 m, 52% of frequency security costs. The sensitivity of this value to wind penetration, abundance of alternative frequency services, UFLS amount and cost is explored. [ABSTRACT FROM AUTHOR]

Background: People with long term conditions (LTCs) make most of the daily decisions and carry out the activities which affect their health and quality of life. Only a fraction of each contact with a health care professional (HCP) is spent supporting this. This paper describes how care and support planning (CSP) and an implementation framework to redesign services, were developed to address this in UK general practice. Focussed on what is important to each individual, CSP brings together traditional clinical issues and the person's lived experience in a solution focussed, forward looking conversation with an emphasis on 'people not diseases'. Methods: The components of CSP were developed in three health communities using diabetes as an exemplar. This model was extended and refined for other single conditions and multimorbidity across 40 sites and two nations, over 15 years. Working with local teams and communities the authors used theoretical models of care, implementation and spread, developing and tailoring training, support and resources to embed CSP as usual care, sharing learning across a community of practice. Results: The purpose, content, process, developmental hurdles and impact of this CSP model are described, alongside an implementation strategy. There is now a robust, reproducible five step model; preparation, conversation, recording, actions and review. Uniquely, preparation, involving information sharing with time for reflection, enables an uncluttered conversation with a professional focussed on what is important to each person. The components of the Year of Care House act as a checklist for implementation, a metaphor for their interdependence and a flexible framework. Spreading CSP involved developing exemplar practices and building capacity across local health communities. These reported improved patient experience, practitioner job satisfaction, health behaviours and outcomes, teamwork, practice organisation, resource use, and links with wider community activities. Conclusions: Tested in multiple settings, CSP is a reproducible and practical model of planned care applicable to all LTCs, with the capacity to be transformative for people with LTCs and health care professionals. It recaptures relational dimensions of care with transactional elements in the background. Options for applying this model and implementation framework at scale now need to be explored. [ABSTRACT FROM AUTHOR]

In this paper, a systematic review of academic literature and policy papers since 2008 is undertaken with an aim of identifying the prevalent energy systems models and tools in the UK. A list of all referenced models is presented and the literature is analysed with regards sectoral coverage and technological inclusion, as well as mathematical structure of models. The paper compares available models using an appropriate classification schema, the introduction of which is aimed at making the model landscape more accessible and perspicuous, thereby enhancing the diversity of models within use. The distinct classification presented in this paper comprises three sections, which specify the model purpose and structure, technological detail and mathematical approach. The schema is not designed to be comprehensive, but rather to be a broad classification with pertinent level of information required to differentiate between models. As an example, the UK model landscape is considered and 22 models are classified in three tables, as per the proposed schema. [ABSTRACT FROM AUTHOR]

ABSTRACT Atkinson, J.; Esteves, L.S.; Williams, J.W.; McCann D.L., and Bell, P.S., 2018. The Application of X-Band Radar for Characterisation of Nearshore Dynamics on a Mixed Sand and Gravel Beach. In: Shim, J.-S.; Chun, I., and Lim, H.S. (eds.), Proceedings from the International Coastal Symposium (ICS) 2018 (Busan, Republic of Korea). Journal of Coastal Research, Special Issue No. 85, pp. 281–285. Coconut Creek (Florida), ISSN 0749-0208. Remote sensing using X-band radar allows the estimation of wave parameters, near surface currents and the underlying bathymetry. This paper explores the use of radar to derive nearshore bathymetry at a complex site, at Thorpeness in Suffolk, UK. The site has a history of sporadic and focused erosion events along the beach frontage and as part of the X-Com project (X-band Radar and Evidence-Based Coastal Management Decisions) a radar system was deployed with the aim of further understanding the complex nearshore sediment processes influencing erosion. Initially, the bathymetric variation at the site is quantified through analysis of current and historic multibeam surveys. These indicate depth changes approaching 3 m. Subsequently, validation of the radar data against concurrent multibeam survey data has been undertaken. Results show that the radar derived bathymetry has a precision of ±1m at the site, with the largest errors being associated with areas of more complex bathymetry and where wave data quality was less suitable for analysis by the X-band radar bathymetry algorithms. It is concluded that although the accuracy of radar-derived bathymetry is lower than traditional multibeam survey, the low cost for high temporal coverage can be utilised for long-term monitoring of coastal sites where a cost-effective means of quantifying large-scale bathymetric changes is required. [ABSTRACT FROM AUTHOR]

Background: People are increasingly living for longer with multimorbidity. Medical education and healthcare delivery must be re-orientated to meet the societal and individual patient needs that multimorbidity confers. The impact of multimorbidity on the educational needs of doctors is little understood. There has been little critique of how learning alongside healthcare provision is negotiated by patients, general practitioners and trainee doctors. This study asked ‘what is known about how and why concurrent healthcare delivery and professional experiential learning interact to generate outcomes, valued by patients, general practitioners and trainees, for patients with multimorbidity in primary care?' Methods: This realist synthesis is reported using RAMESES standards. Relationship-centred negotiation of needs-based learning and care was the primary outcome of interest. Healthcare, social science and educational literature were sought as evidence. Data extraction focused on context, mechanism and outcome configurations within studies and on data which might assist understanding and explain; i) these configurations; ii) the relationships between them and; iii) their role and place in evolving programme theories arising from data synthesis. Mind-mapping software and team meetings were used to aid interpretative analysis. Results: The final synthesis included 141 papers of which 34 contained models for workplace-based experiential learning and/or patient care. Models of experiential learning for practitioners and for patient engagement were congruent, frequently referencing theories of transformation and socio-cultural processes as mechanisms for improving clinical care. Key issues included the perceived impossibility of reconciling personalised concepts of success with measurability of clinical markers or adherence to guidelines, and the need for greater recognition of social dynamics between patients, GPs and trainees including the complexities of shared responsibilities. A model for considering the implications of concurrency for learning and healthcare delivery in the context of multimorbidity in primary care is proposed and supporting evidence is presented. Conclusions: This study is novel in considering empirical evidence from patients, GPs and trainees engaged in concurrent learning and healthcare delivery. The findings should inform future interventions designed to produce a medical workforce equipped to provide multimorbidity care. Trial registration: PROSPERO International prospective register of systematic reviews CRD42013003862 [ABSTRACT FROM AUTHOR]