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Introduction: Normalisation Process Theory (NPT) is widely used to explore how new healthcare practices are understood, enacted, reflected upon and embedded in usual practice, typically focussing on professionals’ behaviours. NPT is less commonly used to explore patients’ experiences during implementation of new interventions. The RETurn to work After stroKE (RETAKE) trial used NPT’s four constructs (coherence, cognitive participation, collective action, reflexive monitoring) in comparing experi-ences of stroke survivors who received Early Stroke Specialist Vocational Rehabilitation (ESSVR) with recipients of usual care (UC) only.Method: Semi-structured interviews with 44 stroke survivors (23 who received ESSVR and 21 UC participants). NPT underpinned data collec-tion and analysis.Results: RETAKE OTs helped participants in the ESSVR arm make sense of stroke, accept stroke-related limitations, and develop intervention understanding (coherence) more easily than most UC participants. RETAKE OTs typically involved all stakeholders in return-to-work (RTW) plans, facilitating co-operation and engagement (cognitive participation), whereas UC participants described poor co-ordination between services and limited or no focus on RTW. ESSVR participants completed individu-ally tailored work-related tasks, with RETAKE OTs mediating workplace adjustments and monitoring employment progress (collective action). In contrast, OT involvement in work preparation and employer negotiations for UC participants was rare. RETAKE OTs supported ESSVR participants to reflect on the appropriateness of RTW post-stroke or explore alterna-tives (reflexive monitoring). However, few UC recipients were supported to consider the suitability of their current work roles; consequently, some reported feeling ‘abandoned’ by health services.Conclusion: NPT was useful in exploring participants’ perspectives of a complex intervention in the RETAKE trial.

Study Objectives: Obstructive sleep apnea (OSA) is a well-established cause of impaired daytime functioning. However, there is a complex interindividual variability in neurobehavioral performance in OSA patients. We previously reported compromised brain bioenergetics during apneic sleep in severe OSA. In this study, we investigate whether brain bioenergetics during resting wakefulness are related to neurobehavioral performance. Methods: Patients attended the sleep laboratory in the evening and were kept awake over-night. Repeated testing on the 10-minute psychomotor vigilance task (PVT, at 9 pm, 11 pm, 1 am, 3 am, 5 am) and 30-minute AusEd driving simulator task (9 pm and 5 am) was performed. Brain bioenergetics (inorganic phosphate/adenosine triphosphate ratio, Pi/ATP) were measured in the temporal lobe during resting wakefulness at 7 am in a 1.5T MRI scanner using phosphorus magnetic resonance spectroscopy (31P MRS). Results: Fifteen males with severe OSA (age 47.7 ± 10.4 years, body mass index [BMI] 34 ± 6.6 kg/m2, apnea hypopnea index [AHI] 79.7 ± 21.8/ hour) were investigated. A higher Pi/ATP ratio in the brain (lower phosphorylation potential) was correlated with worse PVT and driving simulator performance across the testing period (PVT lapses: r = 0.632, r2 = 0.399, p = 0.012; and AusEd braking reaction time: r = 0.609, p = 0.016). In contrast, the conventional AHI measure of disease severity was not significantly correlated with performance (PVT lapses: r = -0.084, p = 0.8; and AusEd braking reaction time: r = -0.326, p = 0.2). Conclusions: Lower phosphorylation potential was associated with worse performance. Compromised brain bioenergetics may in part underlie the neurobehavioral deficits in untreated OSA. We speculate that better brain bioenergetics may explain why some OSA patients are relatively asymptomatic compared with others.

Background: The importance of economic evaluation in decision making is growing with increasing budgetary pressures on health systems. Diverse economic evidence is available for a range of interventions across national contexts within Europe, but little attention has been given to identifying evidence gaps that, if filled, could contribute to more efficient allocation of resources. One objective of the Research Agenda for Health Economic Evaluation project is to determine the most important methodological evidence gaps for the ten highest burden conditions in the European Union (EU), and to suggest ways of filling these gaps. Methods: The highest burden conditions in the EU by Disability Adjusted Life Years were determined using the Global Burden of Disease study. Clinical interventions were identified for each condition based on published guidelines, and economic evaluations indexed in MEDLINE were mapped to each intervention. A panel of public health and health economics experts discussed the evidence during a workshop and identified evidence gaps. Results: The literature analysis contributed to identifying cross-cutting methodological and technical issues, which were considered by the expert panel to derive methodological research priorities. Conclusions: The panel suggests a research agenda for health economics which incorporates the use of real-world evidence in the assessment of new and existing interventions; increased understanding of cost-effectiveness according to patient characteristics beyond the “-omics” approach to inform both investment and disinvestment decisions; methods for assessment of complex interventions; improved cross-talk between economic evaluations from health and other sectors; early health technology assessment; and standardized, transferable approaches to economic modeling.

Variable renewable energies will be an important building block of future power systems and are already being successfully integrated into the Polish power system. Several trends and developments are likely to lead to a further increase of the share of variable renewables in the Polish power system: declining costs of variable renewables, an aging coal power plant fleet, an aim to lower emissions and the changing regulatory environment in Europe.

This article is a report of the fourth meeting of the Harmonising Outcome Measures for Eczema (HOME) initiative held in Malmö, Sweden on 23–24 April 2015 (HOME IV). The aim of the meeting was to achieve consensus over the preferred outcome instruments for measuring patient-reported symptoms and quality of life for the HOME core outcome set for atopic eczema (AE). Following presentations, which included data from systematic reviews, consensus discussions were held in a mixture of whole group and small group discussions. Small groups were allocated a priori to ensure representation of different stakeholders and countries. Decisions were voted on using electronic keypads. For the patient-reported symptoms, the group agreed by vote that itch, sleep loss, dryness, redness/inflamed skin and irritated skin were all considered essential aspects of AE symptoms. Many instruments for capturing patient-reported symptoms were discussed [including the Patient-Oriented SCOring Atopic Dermatitis index, Patient-Oriented Eczema Measure (POEM), Self-Administered Eczema Area and Severity Index, Itch Severity Scale, Atopic Dermatitis Quickscore and the Nottingham Eczema Severity Score] and, by consensus, POEM was selected as the preferred instrument to measure patient-reported symptoms. Further work is needed to determine the reliability and measurement error of POEM. Further work is also required to establish the importance of pain/soreness and the importance of collecting information regarding the intensity of symptoms in addition to their frequency. Much of the discussion on quality of life concerned the Dermatology Life Quality Index and Quality of Life Index for Atopic Dermatitis; however, consensus on a preferred instrument for measuring this domain could not be reached. In summary, POEM is recommended as the HOME core outcome instrument for measuring AE symptoms.