An ageing population has placed strains on health and social care systems. Innovative solutions have been sought to inject capacity and capability in order to deliver services to older people more efficiently and effectively. Over the last two decades, governments have actively encouraged third sector organisations to deliver public services on the assumption that they exhibit higher levels of innovation, efficiency and responsiveness. The evidence base, particularly for whether they provide better value for money, remains poor. We present the results of a systematic literature review on the costs and outcomes of services for older people delivered by third sector organisations. We combine this evidence with a framework for analysing the benefits and costs of third sector-led initiatives, and test this out empirically with a group of initiatives delivered for older people in an urban context. We find that our method may hold considerable promise for the evaluation of third sector initiatives.

This article analyses Aftenlandet (Evening Land), a film made for the Danish Film Institute in 1976 by Peter Watkins, one of the world’s most politically radical directors and a pioneer of docudrama. The aim is to provide a detailed historical account of the life cycle of a key but hitherto critically neglected film in the director’s career: his last to be professionally funded for nearly 25 years and one that saw Watkins working within the very particular milieu of Denmark, investigating, often controversially, the perceived political fault lines of Danish society during the 1970s. The article traces how this English-born filmmaker came to be working in Scandinavia, details the production of Evening Land and provides a close critical reading of the film’s various themes and techniques as well as considering its reception and aftermath. Correspondence and production files from Watkins’ own personal archive reveal the difficulties the filmmaker clearly experienced as something of ‘an Englishman abroad’ attempting to find a place for himself within Scandinavian film culture of the period. The article asserts that this experience eventually contributed to Watkins’ decision to quit Scandinavia altogether following the completion of Evening Land, a decision that would inadvertently propel Watkins out of the world of professional filmmaking for nearly a quarter century. The article argues, however, that Evening Land, a film long obscure and critically neglected, still has cultural resonance and applicability to our own times in the twenty-first century.

BackgroundThere is limited empirical work assessing the effectiveness of treatment as prevention (TasP) in reducing HCV prevalence among people who inject drugs (PWID). Here, we used survey data from the UK during 2010–2020, to evaluate the impact of direct-acting antiviral agent (DAA) treatment scale-up, which started in 2015, on HCV prevalence among PWID. Methods. We fitted a logistic regression to time/location specific data on prevalence from the Needle Exchange Surveillance Initiative in Scotland and Unlinked Anonymous Monitoring programme in England. For each post-intervention year and location, we quantified the effect of TasP as the difference between estimated prevalence and its counterfactual (prevalence in the absence of scale-up). Progress to elimination was assessed by comparing most recent prevalence against one in 2015. ResultsIn 2015, prevalence ranged from 0.44 to 0.71 across the 23 locations (3 Scottish, 20 English). Compared to counterfactuals, there was an absolute reduction of 46% (95% credible interval [32%,59%]) in Tayside in 2020, 35% ([24%,44%]) in Glasgow in 2019, and 25% ([10%,39%]) in the Rest of Scotland in 2020. The English sites with highest estimated absolute reductions in 2021 were South Yorkshire (45%, [29%,58%]), Thames Valley (49%, [34%,59%]) and West London (41%, [14%,59%]). Compared to 2015, there was 80% probability that prevalence had fallen by 65% in Tayside, 53% in Glasgow and 36% in the Rest of Scotland. The English sites with highest % prevalence decrease compared to 2015, achieved with probability 80%, were Chesire & Merseyside (70%), South Yorkshire (65%) and Thames Valley (71%). Higher treatment intensity was associated with higher reductions in prevalence. ConclusionConclusion. Real-world evidence showing substantial reductions in chronic HCV associated with increase of HCV treatment scale-up in the community thus supporting the effectiveness of HCV treatmen as prevention in people who inject drugs.

BackgroundPartner notification (PN) is key to the control of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). Digital interventions have been used to facilitate PN. A scoping review was conducted to describe the interventions used, user preferences and acceptability of digital PN interventions from patient and partner perspectives.MethodsA systematic literature search was conducted of eight databases for articles published in English, available online with digital PN outcome data. Articles were assessed using the Mixed Methods Appraisal Tool. Quantitative and qualitative data were synthesised and analysed using thematic analysis.ResultsTwenty-six articles met the eligibility criteria. Articles were heterogeneous in quality and design, with the majority using quantitative methods. Nine articles focused solely on bacterial STIs (five on syphilis; four on chlamydia), one on HIV, two on syphilis and HIV, and 14 included multiple STIs, of which 13 included HIV. There has been a shift over time from digital PN interventions solely focusing on notifying partners, to interventions including elements of partner management, such as facilitation of partner testing and treatment, or sharing of STI test results (between index patients and tested sex partners). Main outcomes measured were number of partners notified (13 articles), partner testing/consultation (eight articles) and treatment (five articles). Relationship type and STI type appeared to affect digital PN preferences for index patients with digital methods preferred for casual rather than established partner types. Generally, partners preferred face-to-face PN.ConclusionDigital PN to date mainly focuses on notifying partners rather than comprehensive partner management. Despite an overall preference for face-to-face PN with partners, digital PN could play a useful role in improving outcomes for certain partner types and infections. Further research needs to understand the impact of digital PN interventions on specific PN outcomes, their effectiveness for different infections and include health economic evaluations.

To quantitatively characterize retinal changes across different quantiles of refractive error in 34,414 normal eyes of 23,064 healthy adults in the UK Biobank. Twelve optic disc (OD), foveal and vascular parameters were derived from color fundus photographs, correcting for ocular magnification as appropriate. Quantile regression was used to test the independent associations between these parameters and spherical equivalent refraction (SER) across 34 refractive quantiles (high hyperopia to high myopia)-controlling for age, sex and corneal radius. More negative SER was nonlinearly associated with greater Euclidian (largely horizontal) OD-fovea distance, larger OD, less circular OD, more obliquely orientated OD (superior pole tilted towards the fovea), brighter fovea, lower vascular complexity, less tortuous vessels, more concave (straightened out towards the fovea) papillomacular arterial/venous arcade and wider central retinal arterioles/venules. In myopia, these parameters varied more strongly with SER as myopia increased. For example, while every standard deviation (SD) decrease in vascular complexity was associated with 0.63D (right eye: 95% confidence interval [CI], 0.58-0.68) to 0.68D (left eye: 95% CI, 0.63-0.73) higher myopia in the quantile corresponding to -0.60 D, it was associated with 1.61D (right eye: 95% CI, 1.40-1.82) to 1.70D (left eye: 95% CI, 1.56-1.84) higher myopia in the most myopic quantile. OD-fovea angle (degree of vertical separation between OD and fovea) was found to vary linearly with SER, but the magnitude was of little practical importance (less than 0.10D variation per SD change in angle in almost all refractive quantiles) compared with the changes in OD-fovea distance. Several interrelated retinal changes indicative of an increasing (nonconstant) rate of mechanical stretching are evident at the posterior pole as myopia increases. These changes also suggest that the posterior pole stretches predominantly in the temporal horizontal direction.

Water constitutes an indispensable resource crucial for the sustenance of humanity, as it plays an integral role in various sectors such as agriculture, industrial processes, and domestic consumption. Even though water covers 71% of the global land surface, governments have been grappling with the challenge of ensuring the provision of safe water for domestic use. A contributing factor to this situation is the persistent contamination of available water sources rendering them unfit for human consumption. A common contaminant, pesticides are not frequently tested for despite their serious effects on biodiversity. Pesticide determination in water quality assessment is a challenging task because the procedures involved in the extraction and detection are complex. This reduces their popularity in many monitoring campaigns despite their harmful effects. If the existing methods of pesticide analysis are adapted by leveraging new technologies, then information concerning their presence in water ecosystems can be exposed. Furthermore, beyond the advantages conferred by the integration of wireless sensor networks (WSNs), the Internet of Things (IoT), Machine Learning (ML), and big data analytics, a notable outcome is the attainment of a heightened degree of granularity in the information of water ecosystems. This paper discusses methods of pesticide detection in water, emphasizing the possible use of electrochemical sensors, biosensors, and paper-based sensors in wireless sensing. It also explores the application of WSNs in water, the IoT, computing models, ML, and big data analytics, and their potential for integration as technologies useful for pesticide monitoring in water.

Effective infection prevention and control (IPC) practices among healthcare workers are crucial to prevent the spread of COVID-19 and other infections in healthcare settings. To synthesise evidence on behaviour change theories, models, or frameworks applied to understand healthcare workers' IPC practices during the COVID-19 pandemic. PubMed, EBSCOhost interface, ProQuest interface, MEDLINE (Ovid), and grey literature were searched for primary studies published between December 2019 and May 2023. The Mixed Method Appraisal Tool evaluated the methodological quality of the studies. Two reviewers independently completed study selection, data extraction, and quality assessment. The search yielded 2110 studies, of which 19 were included. Seven behaviour change theories, models, and frameworks were identified, with the Health Belief Model and Theoretical Domains Framework being the most employed. Based on these theories, models, and frameworks, the included studies identified cognitive, environmental, and social factors influencing healthcare workers' compliance with COVID-19 IPC practices. This review offers insights into the critical role of behavioural change theories, models, or frameworks in understanding the factors influencing healthcare workers' compliance with IPC practices during COVID-19. It also highlights the potential of these theories in guiding the development of evidence-based interventions to improve healthcare workers' compliance with IPC practices.

Telerehabilitation (TR) shows promise as a method of remote service delivery, yet there is little guidance to inform implementation in the context of the National Health Service (NHS) in England. This paper presents the protocol for a realist synthesis study aiming to investigate how TR can be implemented to support the provision of high-quality, equitable community-based stroke rehabilitation, and under what conditions. Using a realist approach, we will synthesise information from (1) an evidence review, (2) qualitative interviews with clinicians (n ≤ 30), and patient-family carer dyads (n ≤ 60) from three purposively selected community stroke rehabilitation services in England. Working groups including rehabilitation professionals, service-users and policy-makers will co-develop actionable recommendations. Insights from the review and the interviews will be synthesised to test and refine programme theories that explain how TR works and for whom in clinical practice, and draw key messages for service implementation. This protocol highlights the need to improve our understanding of TR implementation in the context of multidisciplinary, community-based stroke service provision. We suggest the use of a realist methodology and co-production to inform evidence-based recommendations that consider the needs and priorities of clinicians and people affected by stroke.

This paper established a numerical model of mass transport and electrochemical reaction coupling in porous media of thermally regenerative ammonia-based flow battery with foam copper electrode (TRAFB-FCE) for the first time. The effects of the structural parameters of the foam copper electrode on the power density, energy density, discharge capacity, and active species distribution of the battery were comprehensively studied based on the coupled numerical model. Special attention was paid to the selection strategy of the initial reactant concentration for the battery under different discharge conditions. The results suggest that increasing the porosity or thickness of the foam copper electrode causes the voltage and power density of the battery to first increase and then decrease, while the discharge capacity and energy density monotonically increase. Moreover, the battery should avoid discharging at current densities exceeding 720 A·m−2. When the discharge current density is less than 200 A·m−2, it is preferable to set the initial concentration of Cu2+ to 0.4 mol/L, while the discharge current density is in the range of 200–720 A·m−2, the initial concentration of Cu2+ is preferable to be 0.3 mol/L. When it discharges at about 5 % of its maximum power density, the Carnot-relative efficiency of this battery is comparable to the highest value currently reported in the field of liquid-based thermo-electric conversion achieved by the Thermal Regenerative Electrochemical Cycle (TREC) technology, and the power density of the former is 8.87 times that of the latter.

Chronic pain is a highly prevalent long-term condition, experienced unequally, impacting both the individual living with pain, and wider society. 'Acceptance' of chronic pain is relevant to improved consultations in pain care, and navigating an approach towards evidence-based, long-term management and associated improvements in health. However, the concept proves difficult to measure, and primary qualitative studies of lived experiences show complexity related to our socio-cultural-political worlds, healthcare experiences, and difficulties with language and meaning. We framed acceptance of chronic pain as socially constructed and aimed to conceptualise the lived experiences of acceptance of chronic pain in adults. We conducted a systematic search and screening process, followed by qualitative, interpretive, literature synthesis using Meta-ethnography. We included qualitative studies using chronic pain as the primary condition, where the study included an aim to research the acceptance concept. We conducted each stage of the synthesis with co-researchers of differing disciplinary backgrounds, and with lived experiences of chronic pain. We included 10 qualitative studies from Canada, Sweden, The Netherlands, Ireland, UK, Australia and New Zealand. Our 'lines of argument' include a fluid and continuous journey with fluctuating states of acceptance; language and meaning of acceptance and chronic pain, a challenge to identity in a capitalist, ableist society and the limits to individualism; a caring, supportive and coherent system. The conceptual framework of the meta-ethnography is represented by a rosebush with interconnected branches, holding both roses and thorns, such is the nature of accepting life with chronic pain. Our findings broaden conceptualisation of 'acceptance of chronic pain' beyond an individual factor, to a fluid and continuous journey, interconnected with our socio-cultural-political worlds; an ecosystem.