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Summary: After more than 120 hand‐upper extremity and 37 face transplant procedures performed worldwide, vascularized composite allotransplantation (VCA) now falls under the scope of organ transplant legislation in Europe and the United States. While in the USA, VCA has been considered as standard care since 2014, VCA in Europe is still performed through clinical research trials, except in United Kingdom. However, after two decades of favourable experience with upper extremity transplantation (UET), professionals in Europe are proposing hand allotransplantation as "controlled standard" care, as opposed to face transplantation (FT), which is still a challenging activity. The European Committee on Organ Transplantation (CD‐P‐TO) has elaborated a position paper to provide recommendations concerning regulatory aspects for UET and FT. It is aimed at Health Authorities in charge of the oversight – and coordination – of organ donation and transplantation, and at professional groups to help them manage such complex and costly programs dedicated to properly selected patients. [ABSTRACT FROM AUTHOR]

Stamp collectors frequently donate their stamps to cultural heritage institutions. As digitization becomes more prevalent for other kinds of materials, it is worth exploring how cultural heritage institutions are digitizing their philatelic materials. This paper begins with a review of the literature about the purpose of metadata, current metadata standards, and metadata that are relevant to philatelists. The paper then examines the digital philatelic collections of four large cultural heritage institutions, discussing the metadata standards and elements employed by these institutions. The paper concludes with a recommendation to create international standards that describe metadata management explicitly for philatelic materials. [ABSTRACT FROM AUTHOR]

Objective: Although medication abortion has become more common in high-income countries, the procedure has not yet met early expectations for widening access to abortion. High-quality evidence can serve as a catalyst for changes in policy and practice. To direct research priorities, it is important to understand where quality evidence is concentrated and where gaps remain. High-income countries have developed a body of evidence that may have implications for the future of medication abortion. This literature review assesses the characteristics and quality of published studies on medication abortion conducted in the last 10 years in high-income countries and indicates future areas for research to advance policy and practice, and broaden access. Study design: A structured search for literature resulted in 207 included studies. A framework based upon the World Health Organization definition of sub-tasks for medication abortion was developed to categorize research by recognized stages of the medication abortion process. Using an iterative and inductive approach, additional sub-themes were created under each of these categories. Established quality assessment frameworks were drawn upon to gauge the internal and external validity of the included research. Results: Studies in the US and the UK have dominated research on MA in high-income countries. The political and social contexts of these countries will have shaped of this body of research. The past decade of research has focused largely on clinical aspects of medication abortion. Conclusion: Researchers should consider refocusing energies toward testing service delivery approaches demonstrating promise and prioritizing research that has broader generalizability and relevance outside of narrow clinical contexts. Plain English summary: Although medication abortion is more commonly available worldwide, it is not being used as often as people thought it would be, particularly in high income countries. In order to encourage changes in policy and practice that would allow greater use, we need good quality evidence. If we can understand where we do not have enough research and where we have good amounts of research, we can determine where to invest energies in further studies. Many high-income countries have produced research on medication abortion that could influence policy and practice in similarly resourced contexts. I conducted a literature review to be able to understand the type and quality of research on medication abortion conducted in high-income countries in the past 10 years. I conducted the review in an organized way to make sure that the papers reviewed discussed studies that I thought would be important for answering this question. The literature review found 207 papers. Each of these papers were reviewed and organized them by theme. I also used existing methods to determinine the quality of each study. Most of the research came from the US and the UK. Furthermore, most of the research conducted in the past 10 years was focused on clinical studies of medication abortion. In future studies, researchers should focus more on new ways of providing medication abortion to women that offers greater access. Also, the studies should be designed so that the results have meaning for a broader group of people or situations beyond where the study was done. [ABSTRACT FROM AUTHOR]

In both the United Kingdom and United States of America legislation has been proposed or enacted which claims to provide patients with a 'right' of access to experimental drugs and treatments where there is no other hope. In this paper we will explore this narrative and consider the steps taken in the United States to shift to a more rights driven legal framework. The paper will critically assess the United States model and the similarly framed 'Saatchi' model in the United Kingdom; demonstrating that, despite the rights-based narrative, these laws do not represent a significant change in access to treatment for patients. Rather, the reality is that this 'right to try' paradigm represents a patient advocate narrative that is deeply flawed. It fails to implement any meaningful change, exposes vulnerable patients to risk of harm and, potentially, delays safe development of potentially life-saving treatment regimes. [ABSTRACT FROM AUTHOR]

Traditional citation analysis has been greatly criticized because the process of citation accumulation requires considerable time after publication. So, the term "altmetrics" was proposed in 2010 to measure the scientific and social impact of a paper. According to the deficiencies of traditional citation analysis, we performed a comprehensive search for medical ethics publications using the altmetrics approach from the beginning until 2019. In this descriptive-analytical study, we retrieved the articles discussing any topics relating to medical ethics that published in the Scopus database from the beginning till 2019 using related medical ethics keywords. A total number of 455 articles with altmetrics scores and citations, included in this study. Altmetrics data were extracted via an altmetrics bookmarklet. Dimensions, Mendeley, and Twitter, had prominent sources of attention on social media platforms. The most number of tweets, and Mendeley's attentions, in the medical ethics fields, originated from the United States (US) and the United Kingdom (UK). Moreover, master students have the largest share in the citation of articles in Mendeley. Journal of Medical Ethics and History of Medicine has the most proportion of altmetrics score among Iranian papers in medical ethics. The correlation between the altmetrics score and citation index was significant (p <0.05). The medical ethics researchers have to pay more attention to social activities (such as creating and updating their profiles on social media) on the web for wide dissemination and proper evaluation of their scientific publications. [ABSTRACT FROM AUTHOR]

Introduction: The prescribing of opioids has increased internationally in developed countries in recent decades within primary and secondary care. The majority of patients with chronic non-malignant pain (CNMP) are managed by their general practitioner (GP). Recent qualitative studies have examined the issue of opioid prescribing for CNMP from a GP viewpoint. The aim of this study is to identify and synthesise the qualitative literature describing the factors influencing the nature and extent of opioid prescribing by GPs for patients with CNMP in primary care. Methods: MEDLINE, Embase, PsycINFO, Cochrane Database, International Pharmaceutical Abstracts, Database of Abstracts of Reviews of Effects, CINAHL and Web of Science were systematically searched from January 1986 to February 2018. The full text of included articles was reviewed using the Critical Appraisal Skills Programme (CASP) tool for qualitative research. The papers were coded by two researchers and themes organised using Thematic Network Analysis. Themes were constructed in a hierarchical manner, basic themes informed organising themes which informed global themes. A theoretical model was derived using global themes to explain the interplay between factors influencing opioid prescribing decisions. Results: From 7020 records, 21 full text papers were assessed, and 13 studies included in the synthesis; 9 were from the United States, 3 from the United Kingdom and 1 from Canada. Four global themes emerged: suspicion, risk, agreement and encompassing systems level factors. These global themes are inter-related and capture the complex decision-making processes underlying opioid prescribing whereby the physician both consciously and unconsciously quantifies the risk–benefit relationship associated with initiating or continuing an opioid prescription. Conclusion: Recognising the inherent complexity of opioid prescribing and the limitations of healthcare systems is crucial to developing opioid stewardship strategies to combat the rise in opioid prescription morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Global health research partnerships, which promote the exchange of ideas, knowledge and expertise across countries, are considered key to addressing complex challenges facing health systems. Yet, many studies report inequalities in these partnerships, particularly in those between high and low-and-middle-income countries (LMICs). Objective: This paper examines global research collaborations on community health worker (CHW) programmes, specifically analysing the structures of authorship teams and networks in publications reporting research on CHW programmes in low-income countries (LICs). Methods: A sub-set of 206 indexed journal articles reporting on CHW programmes in LICs was purposefully selected from a prior review of research authorship on CHW programmes in all LMICs over a five year period (2012–2016). Data on country and primary organisational affiliation and number of publications for all individual authors, programme area (e.g. maternal child health) and total citations per paper were extracted and coded in excel spreadsheets. Data were then exported and analysed in Stata/ICV.14 and Gephi. Results: The 206 papers were authored by 1045 authors from 299 institutions, based in 43 countries. Half (50.1%) the authors came from LIC-based institutions, 43.8% from high-income country (HIC) institutions, 2.9% from middle-income country (MIC) institutions and 3.2% had different first affiliations in different publications. Authors based in the USA (302) and UK (68) accounted for just over a third (35.4%) of all authors. Partnership patterns revealed a primary mode of North–South collaboration with authors from the US, and to a lesser extent the UK, playing central bridging roles between institutions. Strong network clusters of multiple-affiliated authors were evident in research on MCH and HIV/TB aspects of CHW programmes. Conclusion: Knowledge production on CHW programmes in LICs flows predominantly through a pool of connected HIC authors and North–South collaborations. There is a need for strategies harnessing more diverse, including South–South, forms of partnership. [ABSTRACT FROM AUTHOR]

This article attempts to highlight quantitatively the growth and development of world literature on hemophilia in terms of publications output as per SCOPUS database (2003-2017). During 2003-2017 a total of 13503 papers were published by the scientists in the field of hemophilia. The average number of publications published per year was 900. The highest number of publications 1095 was published in 2012. Out of 13503 contributions, only 18.48% (2495 papers) of single authored and rest of 11008 papers (81.52%) were multi authored. The study identifies active institutions and country-wise distributions of hemophilia research output. The yearly analysis of data shows that there is a rapid growth of literature from 2011 onwards. There were 126 countries involved in the research in this field. USA is the top producing country with 3986 authorships (29.52%) followed by United Kingdom with 1438 authorships (10.65%). Still, in an international sense, relative productivity of India is low and requires more focused research and development. [ABSTRACT FROM AUTHOR]

Objectives: To describe and summarize evidence on economic evaluations (EEs) of primary caries prevention in preschool children aged 2 to 5 years and to evaluate the reporting quality of full EE studies using a quality assessment tool.Methods: A systematic literature search was conducted in several databases. Full and partial EEs were included. The reporting quality of full EE studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.Results: A total of 808 studies were identified, and 39 were included in the review. Most papers were published between 2000 and 2017 and originated in the United States and the United Kingdom. The most common type of intervention investigated was a complex multicomponent intervention, followed by water fluoridation. Cost analysis and cost-effectiveness analysis were the most frequently used types of EE. One study employed cost-utility analysis. The proportion of full EEs increased over time. The parameters not reported well included study perspective, baseline year, sensitivity analysis, and discount rate. The CHEERS items that were most often unmet were characterizing uncertainty, study perspective, study parameters, and estimating resources and costs.Conclusions: Within the past 2 decades, there has been an increase in the number of EEs of caries prevention interventions in preschool children. There was inconsistency in how EEs were conducted and reported. Lack of preference-based health-related quality-of-life measure utilization in the field was identified. The use of appropriate study methodologies and greater attention to recommended EE design are required to further improve quality. [ABSTRACT FROM AUTHOR]

Objectives. The bibliometric analysis uses the citation count of an article to measure its impact in the scientific community, yet there is still no comprehensive summary of gastric disease researches via bibliometric analysis. We aimed to evaluate the situations and trends of the most cited articles in gastric disease via bibliometric analysis and to provide physicians a practical guide in assessing the most influential articles written on this subject. Methods. The 100 top-cited articles in gastric disease were compiled using Web of Science. The articles selected were evaluated for their number of citations, year of publication, country of origin, type of study, and others. Results. The database had 484,281 articles published between 1965 and 2019. The most cited article received 4,017 citations and the least received 604, with a mean of 1,149 citations. We classified the articles into seven categories: gastric cancer (n = 53), Helicobacter pylori (n = 17), ulcer (n = 7), gastrointestinal stromal tumors (n = 6), gastritis (n = 5), gastric bypass surgery (n = 2), and others (n = 10). Altogether, 69 of the articles were from the USA (n = 41), the UK (n = 17), and Japan (n = 11). Among all the institutions, Royal Perth Hospital led the list with 5 articles. One-quarter of authors owned three or more of these top-cited articles. The 100 papers were published in 33 journals, and most of them were clinical researches (n = 47). Conclusions. Our study provides a historical perspective for the scientific progress of gastric disease, and the articles of significant findings that contributed great impact on the prevention and treatment of gastric disease had been identified. [ABSTRACT FROM AUTHOR]

Hybrid energy storage system (HESS) based on Li-ion and supercapacitor (SC) can play a potential role to stabilize the grid by providing the fast frequency ancillary services. The SC helps to reduce the battery charge/discharge stress and, hence, assists to extend the battery lifespan. The power sharing method (PSM) is the heart in control part to improve the HESS performance and reduce the battery stress. This paper proposes a hybrid PSM and investigates its impact on battery life extension along with its relation to the system design and regulation signal. The performance of hybrid PSM is compared with three other PSMs (low-pass filter, first and second rule based) in a 10 MW/10 MWh full-active parallel HESS for frequency regulation service in two networks: U.K. (national grid) and USA (PJM). Considering maximum possible battery lifetime upto 25 years, result shows that the hybrid PSM approach allows a degree of the better performance for both grid while the sharing of SC is kept maximum 2.0% and 2.5% (for U.S. and U.K. grid, respectively) of the HESS capacity. This study also analyses the impact of PSM on shared capacity and design of HESS for different grid regulation signals. [ABSTRACT FROM AUTHOR]

Extensive research has been conducted on the concept of jobless recoveries and their potential causes, primarily focused on the United States from the 1990s. This paper finds that the prolonged employment downturn following the brief 1980–1981 recession in Britain qualifies as a jobless recovery and then investigates possible contributing factors: labor reallocation across industries, regional employment changes, and job polarization. The United States, which did not have a jobless recovery from the early 1980s recession, is taken as a comparison case. I find that the leading candidate explanation for this jobless recovery is the reallocation of labor across industries. This suggests an important role for structural change in the early 1980s recession and in jobless recoveries more generally. [ABSTRACT FROM AUTHOR]

The student accommodation sector in now the best-performing asset in the UK and US property markets and this is projected to further accelerate, with building refurbishment of existing student accommodations being the preferred method to satisfy growing demand. However, there are no published research studies on refurbishment projects within the student accommodation sector. Refurbishment is an emergent trend to upgrade existing stock to ensure that buildings meet rising energy efficiency demands. Moreover, it is widely affirmed that greenhouse gases contribute to climate change and notably the built environment is a significant contributor, both through its construction and during its operation and use. This paper demonstrates through a comparative case study approach, how greenhouse gases levels can be effectively measured during refurbishment works. There are multiple metrics used for quantification/assessment of greenhouse gases performance and this paper aims to make well-argued recommendations for their best use. Four student accommodation refurbishment projects are presented to compare and contrast differing emission datasets. The results dictate that project cost and duration cannot alone be used to gauge greenhouse gases emissions; more too, in the instance of student accommodation refurbishment, gross internal floor area and the number of rooms offers a more predictable indicator. It is recommended that refurbishment developers reflect on these recommendations when reporting the primary energy and GHG performance of their refurbishment works. Best practice from this research may be adopted into domestic buildings refurbishment projects. [ABSTRACT FROM AUTHOR]

The United Nations Decade of Education for Sustainable Development steered by The United Nations Organization for Education, Science and Culture (UNESCO) since 2005 ended in 2014. It looked into the integration principles, values and practices of sustainable development in all aspects of education and learning, with the intention of addressing the global social, economic, cultural and environmental issues in the 21st century. It has become an essential issue in architectural education to create awareness among future generations of architects to be more sensitive towards the environmental impact of architecture on human behavior. This encouraged every school of architecture to incorporate sustainability knowledge into its curriculum and promote ‘sustainable architectural education’, leading to the questions of: what type of structural model of integration approach being applied in promoting architectural sustainable education? The objectives of this paper are to investigate the type of structural models that have been applied in architectural curriculum in selected schools of architecture in both countries and evaluate the level of emphasis in incorporating sustainability knowledge in the curriculum. Therefore, this paper reviewed the approach of integration principles, values and practices of sustainable development at 10 conveniently sampled architecture schools in the United Kingdom (UK) and the United States of America (USA). Data was collected from their respective web sites and their concepts of integration were reviewed and the distribution of credit hours revealed to determine the level of emphasis considered. Findings showed various paths taken by the different institutions in integrating the knowledge of sustainability into their architectural curriculum. This paper concludes with recommendations for further research into gauging the effectiveness of architectural curricula with integrated sustainability knowledge. [ABSTRACT FROM AUTHOR]

The relationship between supply chain performance and renewable energies has been widely identified as a critical research topic by practitioners, international organizations, and academics. It is essential to explore the articles that have been published by scholars regarding their main concerns, the methodologies used, the renewable energies that have been focused on, and the performance indicators that have been used in the optimization of renewable energies supply chains. This paper delivers a comprehensive bibliometric analysis that provides a better understanding not previously fully evaluated by earlier studies in the field of supply chain performance and renewable energies. The goal of this research is: 1) to recognize the scholarly production; 2) the most productive authors; 3) the most productive journals; 4) the most cited articles; and 5) the most productive countries. The analysis begins by identifying studies published during the period between 2005 and the middle of 2018, which are then reduced in number to those authored by influential investigators. Also discussed are the gaps in knowledge about literature and bibliometric analysis. The findings provide a potential roadmap for researchers who intend to undertake research in this field. • The number of publications in supply chain performance and renewable energies has been increasing, in the last few years. • The topic of supply chain performance and renewable energies has been explored most deeply in the USA, Italy, and the UK. • The most-cited articles are related to the spatial distribution of bioenergy production units and process network. • The renewable energies most focused are bioethanol, biofuels, biomass, bio-oil gasifier. • The Biomass and Bioenergy journal is the most-cited journal in the field. [ABSTRACT FROM AUTHOR]

Older adults often experience functional decline following acute medical care. This functional decline may lead to permanent disability, which will increase the burden on the medical and long-term care systems, families, and society as a whole. Post-acute care aims to promote the functional recovery of older adults, prevent unnecessary hospital readmission, and avoid premature admission to a long-term care facility. Research has shown that post-acute care is a cost-effective service model, with both the hospital-athome and community hospital post-acute care models being highly effective. This paper describes the post-acute care models of the United States and the United Kingdom and uses the example of Taiwan's highly effective post-acute care system to explain the benefits and importance of post-acute care. In the face of rapid demographic aging and smaller household size, a post-acute care system can lower medical costs and improve the health of older adults after hospitalization. [ABSTRACT FROM AUTHOR]

Background: Non‐motor symptoms (NMS) are integral to Parkinson's disease (PD) and have a detrimental effect on patients and their caregivers. Clinical quantification has been aided by the development of comprehensive assessments such as the Non‐Motor Symptoms Questionnaire (NMSQuest) and Scale (NMSS). The NMSS has been widely used in clinical studies and trials; however, since its validation in 2007, our understanding of NMS has changed substantially. With the support of the International Parkinson and Movement Disorder Society (IPMDS), after a detailed peer review an initiative to develop an updated version of NMSS, the MDS‐NMS was launched in 2015. Objective: This paper encapsulates the data from the pre‐validation phases carried out under the auspices of the IPMDS Non‐Motor PD Study Group. Methods: Item selection and wording (formatted as a rater‐based tool) were based on the NMSS, literature review, and expert consensus. Neurologists, PD patients, and healthy controls were included in the cognitive pretesting and administration of the preliminary version of the MDS‐NMS. Primary data on acceptability and reliability were obtained. Results: The pilot study, carried out in English in the United Kingdom and the United States, demonstrated that the preliminary version of the MDS‐NMS was comprehensive, understandable, and appropriate. Data quality was excellent; moderate floor effect was present in patients for most MDS‐MNS domains, with some components showing weak internal consistency. The results led to additional instrument modifications. Conclusion: Qualitative and quantitative research results have led to an updated NMSS, the definitive version of the MDS‐NMS, which is currently being validated. [ABSTRACT FROM AUTHOR]

Objectives: (i) To determine the current state of online grocery shopping, including individuals' motivations for shopping for groceries online and types of foods purchased; and (ii) to identify the potential promise and pitfalls that online grocery shopping may offer in relation to food and beverage purchases. Design: PubMed, ABI/INFORM and Google Scholar were searched to identify published research. Setting: To be included, studies must have been published between 2007 and 2017 in English, based in the USA or Europe (including the UK), and focused on: (i) motivations for online grocery shopping; (ii) the cognitive/psychosocial domain; and (iii) the community or neighbourhood food environment domain. Subjects: Our search yielded twenty-four relevant papers. Results: Findings indicate that online grocery shopping can be a double-edged sword. While it has the potential to increase healthy choices via reduced unhealthy impulse purchases, nutrition labelling strategies, and as a method to overcome food access limitations among individuals with limited access to a brick-and-mortar store, it also has the potential to increase unhealthy choices due to reasons such as consumers' hesitance to purchase fresh produce online. Conclusions: Additional research is needed to determine the most effective ways to positively engage customers to use online grocery shopping to make healthier choices. [ABSTRACT FROM AUTHOR]

Probabilistic flood mapping offers flood managers, decision makers, insurance agencies, and humanitarian relief organizations a useful characterization of uncertainty in flood mapping delineation. Probabilistic flood maps are also of high interest for data assimilation into numerical models. The direct assimilation of probabilistic flood maps into hydrodynamic models would be beneficial because it would eliminate the intermediate step of having to extract water levels first. This paper introduces a probabilistic flood mapping procedure based on synthetic aperture radar (SAR) data. Given a SAR image of backscatter values, we construct a total histogram of backscatter values and decompose this histogram into probability distribution functions of backscatter values associated with flooded (open water) and non-flooded pixels, respectively. These distributions are then used to estimate, for each pixel, its probability of being flooded. The new approach improves on binary SAR-based flood mapping procedures, which do not inform on the uncertainty in the pixel state. The proposed approach is tested using four SAR images from two floodplains, i.e., the Severn River (U.K.) and the Red River (U.S.). In all four test cases, reliability diagrams, with error values ranging from 0.04 to 0.23, indicate a good agreement between the SAR-derived probabilistic flood map and an independently available validation map, which is obtained from aerial photography. [ABSTRACT FROM PUBLISHER]

ABSTRACT A huge change has occurred in the way people obtain weather information in the last few years and a large percentage of the population now get weather forecasts on their mobile phones. There is currently a wide range of smartphone weather apps available: in 2014, iTunes App Store alone offered 5043 active applications in the weather category. The rapid penetration of new broadcasting technologies strongly affects the way weather forecasts are communicated to, and used by, people. Portability, permanent connectivity and geolocalization allow location-specific and time-sensitive weather forecasts to be provided. This paper explores the main features emerging in the 39 most popular weather apps in the United States, United Kingdom and Italy, and focuses on the implications in the communication of uncertainty. The results show that even if the advances in mobile communication technologies could, in principle, improve the effectiveness of weather communication enormously, the expectations created around weather forecasts appear to be inconsistent with current forecasting capabilities, particularly with their inherent uncertainties in space and time, as well as in the nature of the predicted weather events. [ABSTRACT FROM AUTHOR]

This paper uses a structural time series methodology to test the notion of interconnectedness between the UK and the US credit markets. The empirical tests utilise data on premium for the Banking sector credit default swaps (CDS) and covers the recent period of financial turmoil. The methodology based on Kalman filter is robust in the presence of limited convergence. The long-term steady state convergence in CDS premium is clearly noticeable between these two markets from the results. This observation lends support for the coordinated regulatory policy initiatives to deal with the crisis and offer suggestions for sound operations of the international financial systems. [ABSTRACT FROM AUTHOR]

Background: Lone parents and their children experience higher than average levels of adverse health and social outcomes, much of which are explained by high rates of poverty. Many high income countries have attempted to address high poverty rates by introducing employment requirements for lone parents in receipt of welfare benefits. However, there is evidence that employment may not reduce poverty or improve the health of lone parents and their children.Methods: We conducted a systematic review of qualitative studies reporting lone parents' accounts of participation in welfare to work (WtW), to identify explanations and possible mechanisms for the impacts of WtW on health and wellbeing. Twenty one bibliographic databases were searched. Two reviewers independently screened references and assessed study quality. Studies from any high income country that met the criteria of focussing on lone parents, mandatory WtW interventions, and health or wellbeing were included. Thematic synthesis was used to investigate analytic themes between studies.Results: Screening of the 4703 identified papers and quality assessment resulted in the inclusion of 16 qualitative studies of WtW in five high income countries, USA, Canada, UK, Australia, and New Zealand, covering a variety of welfare regimes. Our synthesis found that WtW requirements often conflicted with child care responsibilities. Available employment was often poorly paid and precarious. Adverse health impacts, such as increased stress, fatigue, and depression were commonly reported, though employment and appropriate training was linked to increased self-worth for some. WtW appeared to influence health through the pathways of conflict and control, analytical themes which emerged during synthesis. WtW reduced control over the nature of employment and care of children. Access to social support allowed some lone parents to manage the conflict associated with employment, and to increase control over their circumstances, with potentially beneficial health impacts.Conclusion: WtW can result in increased conflict and reduced control, which may lead to negative impacts on mental health. Availability of social support may mediate the negative health impacts of WtW. [ABSTRACT FROM AUTHOR]

Older people who live in nursing homes commonly suffer from pain. Therefore, relieving suffering among older people that stems from pain demands knowledge improvement through an integration of international knowledge. This study aimed to integrate current international findings and strengthen the understanding of older people's experiences of and perspectives on pain and pain management in nursing homes. A meta-synthesis study using Noblit and Hare's interpretative meta-ethnography approach was conducted. Empirical research papers from journals were collected from various databases. The search process and appraisal determined six articles for inclusion. Two studies were conducted in the US and one each in Iceland, Norway, the UK, and Australia. The older people's experiences of pain as well as perspectives on pain management from all involved (older people, their family members, and healthcare staff) were integrated into a theoretical model using three themes of "identity of pain," "recognition of pain," and "response to pain." The metaphor of "normalizing suffering" was devised to illustrate the meaning of pain experiences and pain management in nursing homes. Society's common attitude that pain is unavoidable and therefore acceptable in old age in society--among older people themselves as well as those who are responsible for reporting, acknowledging, and relieving pain--must change. The article emphasizes that pain as a primary source of suffering can be relieved, provided that older people are encouraged to report their pain. In addition, healthcare staff require sufficient training to take a person-centered approach towards assessment and management of pain that considers all elements of pain. [ABSTRACT FROM AUTHOR]

The remit of the National Institute for Health Research Public Health Research (PHR) Programme is to evaluate public health interventions, providing new knowledge on the benefits, costs, acceptability and wider impacts of interventions, set outside of the National Health Service, intended to improve the health of the public and reduce inequalities. This paper illustrates how the PHR Programme is providing new knowledge for public health decision makers, based on the nine key areas for local authority public health action, described by the King's Fund. Many funded PHR projects are evaluating interventions, applied in a range of settings, across the identified key areas for local authority influence. For example, research has been funded on children and young people, and for some of the wider determinants of health, such as housing and travel. Other factors, such as spatial planning, or open and green spaces and leisure, are less represented in the PHR Programme. Further opportunities in research include interventions to improve the health of adolescents, adults in workplaces, and communities. Building evidence for public health interventions at local authority level is important to prioritise and implement effective changes to improve population health. [ABSTRACT FROM AUTHOR]

The article discusses details relating to the Hydrogen Epoch of Reionization Array (HERA), a collaborative project built by research bodies from the U.S., Great Britain and South Africa in the Karoo Astronomy Reserve in Carnarvon, South Africa. Topics covered include the limited scientific understanding of the Dark Ages, the highlights of the Precision Array for Probing the Epoch of Reionization (PAPER) and Murchison Widefield Array (MWA) experiments, and details relating to HERA funding.

• 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]

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]

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]