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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]

Identification of genomic variability in population plays an important role in the clinical diagnostics of human genetic diseases. Thanks to rapid technological development in the field of massive parallel sequencing technologies, also known as next-generation sequencing (NGS), complex genomic analyses are now easier and cheaper than ever before, which consequently leads to more effective utilization of these techniques in clinical practice. However, interpretation of data from NGS is still challenging due to several issues caused by natural variability of DNA sequences in human populations. Therefore, development and realization of projects focused on description of genetic variability of local population (often called "national or digital genome") with a NGS technique is one of the best approaches to address this problem. The next step of the process is to share such data via publicly available databases. Such databases are important for the interpretation of variants with unknown significance or (likely) pathogenic variants in rare diseases or cancer or generally for identification of pathological variants in a patient's genome. In this paper, we have compiled an overview of published results of local genome sequencing projects from United Kingdom and Europe together with future plans and perspectives for newly announced ones. [ABSTRACT FROM AUTHOR]

Rationale, aims and objective: Substituting outpatient hospital care with primary care is seen as a solution to decrease unnecessary referrals to outpatient hospital care and decrease rising healthcare costs. This systematic review aimed to evaluate the effects on quality of care, health and costs outcomes of substituting outpatient hospital care with primary care-based interventions, which are performed by medical specialists in face-to-face consultations in a primary care setting. Method: The systematic review was performed using the PICO framework. Original papers in which the premise of the intervention was to substitute outpatient hospital care with primary care through the involvement of a medical specialist in a primary care setting were eligible. Results: A total of 14 papers were included. A substitution intervention in general practitioner (GP) practices was described in 11 papers, three described a joint consultation intervention in which GPs see patients together with a medical specialist. This study showed that substitution initiatives result mostly in favourable outcomes compared to outpatient hospital care. The initiatives resulted mostly in shorter waiting lists, shorter clinic waiting times and higher patient satisfaction. Costs for treating one extra patient seemed to be higher in the intervention settings. This was mainly caused by inefficient planning of consultation hours and lower patient numbers. Conclusions: Despite the fact that internationally a lot has been written about the importance of performing substitution interventions in which preventing unnecessary referrals to outpatient hospital care was the aim, only 14 papers were included. Future systematic reviews should focus on the effects on the Triple Aim of substitution initiatives in which other healthcare professions than medical specialists are involved along with new technologies, such as e-consults. Additionally, to gain more insight into the effects of substitution initiatives operating in a dynamic healthcare context, it is important to keep evaluating the interventions in a longitudinal study design. [ABSTRACT FROM AUTHOR]

Biscuits are a major product category in the global confectionary sector. Despite this, their environmental impacts are poorly characterised. Therefore, this paper sets out to evaluate the life cycle environmental sustainability of the following widely-consumed types of biscuit, both at the product and sectoral levels: crackers, low fat/sugar, semi-sweet, chocolate-coated and sandwich biscuits with chocolate or vanilla cream. The results obtained through life cycle assessment demonstrate that, in addition to being healthier, low fat/sugar biscuits have the lowest impacts across most of the 18 categories considered. Chocolate-coated biscuits are environmentally the least sustainable. The most significant life cycle stage for all types is the raw materials production, causing 41%–61% of the total impacts, with flour, sugar and palm oil being the key hotspots. Replacing palm with rapeseed oil would improve five impacts but worsen another five, including a 34% increase in agricultural land occupation and marine eutrophication. Therefore, the cultivation and production of palm oil, rather than its replacement, should be targeted for improvements. The second most crucial stage is manufacturing, contributing up to 54% of the impacts, followed by transport with up to 35%. Reducing energy consumption by 25% in manufacturing would reduce primary energy demand by 8%–12%, fossil fuel depletion by 9%–12% and global warming potential by 6%–9%. The latter would increase by 55% if land use change related to cocoa was involved, despite a very small amount of cocoa in the biscuits (∼1%). The analysis at a sectoral level in the UK, the leading consumer of biscuits in Europe, reveals that biscuits contribute 7.4% of primary energy demand and 0.5% of greenhouse gas emissions of the whole UK food sector. These results can help guide manufacturers in mitigating the hotspots in the supply chain and consumers in selecting environmentally more sustainable biscuits. • The environmental sustainability of six types of biscuit is evaluated for the first time. • Low fat/sugar biscuits have the lowest impacts and chocolate-coated the highest. • Global warming potential of chocolate biscuits is 55% higher with land use change. • Flour, sugar and palm oil are the key hotpots, followed by biscuits manufacturing. • Biscuits contribute 7.4% of energy demand and 0.5% of GWP of the UK food sector. [ABSTRACT FROM AUTHOR]

Background: Within the European Union (EU), substantial efforts are being made to achieve economic and social cohesion, and the reduction of health inequalities between EU regions is integral to this process. This paper is the first to examine how self-reported conditions and non-communicable diseases (NCDs) vary spatially between and within countries. Methods: Using 2014 European Social Survey (ESS) data from 20 countries, this paper examines how regional inequalities in self-reported conditions and NCDs vary for men and women in 174 regions (levels 1 and 2 Nomenclature of Statistical Territorial Units, 'NUTS'). We document absolute and relative inequalities across Europe in the prevalence of eight conditions: general health, overweight/obesity, mental health, heart or circulation problems, high blood pressure, back, neck, muscular or joint pain, diabetes and cancer. Results: There is considerable inequality in self-reported conditions and NCDs between the regions of Europe, with rates highest in the regions of continental Europe, some Scandinavian regions and parts of the UK and lowest around regions bordering the Alps, in Ireland and France. However, for mental health and cancer, rates are highest in regions of Eastern European and lowest in some Nordic regions, Ireland and isolated regions in continental Europe. There are also widespread and consistent absolute and relative regional inequalities in all conditions within countries. These are largest in France, Germany and the UK, and smallest in Denmark, Sweden and Norway. There were higher inequalities amongst women. Conclusion: Using newly available harmonized morbidity data from across Europe, this paper shows that there are considerable regional inequalities within and between European countries in the distribution of self-reported conditions and NCDs. [ABSTRACT FROM AUTHOR]

Background: Patient and public involvement (PPI) is a requirement for UK health and social care research funding. Evidence for how best to implement PPI in research programmes, such as National Institute for Health Research (NIHR) Collaborations for Applied Health Research and Care (CLAHRCs), remains limited. This paper reports findings from an action research (AR) project called IMPRESS, which aims to strengthen PPI within CLAHRC East of England (EoE). IMPRESS combines AR with Normalisation Process Theory (NPT) to explore PPI within diverse case study projects, identifying actions to implement, test and refine to further embed PPI. Methods: We purposively selected CLAHRC EoE case study projects for in-depth analysis of PPI using NPT. Data were generated from project PPI documentation, semi-structured qualitative interviews with researchers and PPI contributors and focus groups. Transcripts and documents were subjected to abductive thematic analysis and triangulation within case. Systematic across case comparison of themes was undertaken with findings and implications refined through stakeholder consultation. Results: We interviewed 24 researchers and 13 PPI contributors and analysed 28 documents from 10 case studies. Three focus groups were held: two with researchers (n = 4 and n = 6) and one with PPI contributors (n = 5). Findings detail to what extent projects made sense of PPI, bought in to PPI, operationalised PPI and appraised it, thus identifying barriers and enablers to fully embedded PPI. Conclusion: Combining NPT with AR allows us to assess the embeddedness of PPI within projects and programme, to inform specific local action and report broader conceptual lessons for PPI knowledge and practice informing the development of an action framework for embedding PPI in research programmes. To embed PPI within similar programmes teams, professionals, disciplines and institutions should be recognised as variably networked into existing PPI support. Further focus and research is needed on sharing PPI learning and supporting innovation in PPI. [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]

There are a wide range of techniques that can be used for evaluating environmental impacts of agriculture, but they have not previously been used to identify the contribution individual farming activities make towards environmental outcomes or for prioritising activities to ensure maximum benefits. This paper reports a novel technique for identifying how different activities influence environmental outcomes. The methodology is based upon traditional EIA techniques. Knowledge is collated from documented evidence and structured within a database such that the causal processes by which different activities influence outcomes can be identified. Cause and effect chains are created and each link is weighted according to the strength of the relationship between the two components. The entire cause-effect chain assumes the weighting of the weakest link. This is used to identify the strengths and weakness of individual practices or groups of activities. This paper explains the process using examples from agricultural production and policy in the UK and Europe for illustration. [ABSTRACT FROM AUTHOR]

Drawing on evidence from the United Kingdom and elsewhere in Europe, this paper explores how people have responded to flood warning information and how these responses impact upon the effectiveness of a flood warning through saving lives and injuries, and reducing economic damages. Methods of flood warning that the public rely upon are discussed alongside empirical evidence of how flood victims prepare for, and respond to, flood warnings in rapid to mediumonset floods. The paper investigates why some members of the public fail to act appropriately, or most effectively, to flood warning information, touching on ideas of a lack of understanding, mistrust in authority and a lack of ownership of flood reducing actions. The paper examines the styles of public learning about flood warning response which might be most appropriate and effective, and how recent positive steps to increase the publics understanding of effective response might be further enhanced in the United Kingdom. Copyright © 2009 Royal Meteorological Society [ABSTRACT FROM AUTHOR]

This paper considers the influence of ecofeminism on policy concerning gender (in)equality and the environment during the past 20 years. It reviews the broad contours of the ecofeminist debate before focusing on the social construction interpretation of women's relationship with the environment. It will argue that there have been substantial policy shifts in Europe and the UK in both the environmental and equalities fields, and that this is in part a result of lobbying at a range of scales by groups informed by ecofeminist debates. Nevertheless, the paper cautions that these shifts are largely incremental and operate within existing structures, which inevitably limit their capacity to create change. As policy addresses some of the concerns highlighted by ecofeminism, academic discourse and grass roots activity have been moving on to address other issues, and the paper concludes with a brief consideration of contemporary trajectories of ecofeminism and campaigning on issues that link women's, feminist and environment concerns. [ABSTRACT FROM AUTHOR]

This paper explores questions of citizenship and the role of universities in the context of the policy changes in the UK and in Europe over the last two decades. Twenty fi ve years after the political transitions in Eastern Europe, and 70 years since the end of the Second World War, Europe is more united than ever before. New political, social and economic configurations across the continent are bringing expectations and pressures to its citizens and institutions, with universities at the front of many economic and social projects. What do these new conditions mean for citizenship in the context of European universities, and how do member states respond to this changing context? The article will use England as a national case study within the EU to illustrate the tensions between the humanistic visions still carried out by many universities, although interpreted differently across the sector, and the pressures for the creation of the 'knowledge economy' that are shared at the national and transnational levels. [ABSTRACT FROM AUTHOR]

Abstract: Jack arch masonry slab, developed in the post-industrial revolution Britain has been used extensively to floor and roof industrial and residential buildings in many parts of the world. It is still in use in parts of Europe, the Middle East and Indian subcontinent. Collapse of a large number of these composite slabs during past earthquakes, including those belonging to some buildings of historic importance, has pointed out the weakness of this type of flooring to seismic loading. It has also highlighted the need for developing appropriate retrofitting schemes. Two different retrofitting methods are currently in use. One method uses a thin reinforced concrete layer over the slab to provide integrity and the necessary strength. Another method utilizes transverse beams to form a steel grid with the main beams to achieve the same objectives. In this paper, out-of-plane pushover tests are first conducted on a number of full-scale ordinary and retrofitted jack arch slabs. Results of the tests are then used to compare the strength capacity and other seismic performance parameters of the slabs including; ductility and the behaviour factor. Numerical analyses are also carried out in support of the experimental investigation. It is concluded that the steel grid method of retrofitting, in addition to being easier and faster to perform and much less costly, addresses all the strength and performance requirements of the slab, whereas, the concrete layer method, though effective in increasing the strength, considerably increases the weight of the slab, which, in turn, may increase strength demand on other structural elements. The benefits of using the concrete layer in improving the seismic performance are also less than those of the steel grid method. [Copyright &y& Elsevier]

Satellite-derived high-resolution precipitation products (HRPP) have been developed to address the needs of the user community and are now available with 0.25° × 0.25° (or less) subdaily resolutions. This paper evaluates a number of commonly available satellite-derived HRPPs covering northwest Europe over a 6-yr period. Precipitation products include the Tropical Rainfall Measuring Mission (TRMM) Multisatellite Precipitation Analysis (TMPA), the Climate Prediction Center (CPC) morphing (CMORPH) technique, the CPC merged microwave technique, the Naval Research Laboratory (NRL) blended technique, and the Precipitation Estimation from Remotely Sensed Information using Artificial Neural Networks (PERSIANN) technique. In addition, the Geosynchronous Operational Environmental Satellite (GOES) precipitation index (GPI) and the European Centre for Medium-Range Weather Forecasting (ECMWF) operational forecast model products are included for comparison. Surface reference data from the European radar network is used as ground truth, supported by the Global Precipitation Climatology Centre (GPCC) precipitation gauge analysis and gauge data over the United Kingdom. Measures of correlation, bias ratio, probability of detection, and false alarm ratio are used to evaluate the products. Results show that satellite products generally exhibit a seasonal cycle in correlation, bias ratio, probability of detection, and false alarm ratio, with poorer statistics during the winter. The ECMWF model also shows a seasonal cycle in the correlation, although the results are poorer during the summer, while the bias ratio, probability of detection, and false alarm ratio are consistent through all seasons. Importantly, all the satellite HRPPs underestimate precipitation over northwest Europe in all seasons. [ABSTRACT FROM AUTHOR]

Background: This paper provides a one-page visual summary of the previously published relative survival estimates for 42 types of cancers in 23 countries in Europe.Methods: The cancer patients in these analyses were 15 years or older at the time of their diagnosis in the period 1995-1999. Follow-up was to the end of 2003 and relative survival estimates were computed by the cohort method.Results: The analysis of 1-year survival had good discriminatory power and visibly separated a group of countries with consistently high survival estimates (Switzerland, France, Sweden, Belgium and Italy) and another group of countries with lower estimates (Poland, Czech Republic, Ireland, Denmark and United Kingdom-Northern Ireland). After the first year, there was less variation between the countries.Conclusion: To more fully understand the UK situation, a rational comparison would select countries with data-quality, prosperity and healthcare systems that are similar to the United Kingdom. In otherwise comparable populations, a pronounced difference in 1-year survival is most likely to be due to variation in a strong prognostic factor, which exerts its effect in the short term. A likely explanation for the short-term survival deficit in the United Kingdom compared with the Nordic countries is a less favourable stage distribution in the United Kingdom. However, the present superficial analysis does not exclude possible functions for other factors relating to the organisation and quality of cancer care services. [ABSTRACT FROM AUTHOR]

The European natural gas market is characterized by declining indigenous resources, particularly in the UK and the Netherlands, and a growing dependence on a small number of large exporters who, as a consequence, see their market power increasing. In this paper we analyze long-run scenarios for the European natural gas markets in a model, NATGAS, that explicitly includes both factors, resource constraints and producers' market power. Finite resources lead to interdependencies of current production decisions and future opportunities. These decisions in turn depend on the potential for large producers to set market prices above marginal costs. We analyze the impact of conditions on the global LNG market on market shares of pipeline gas suppliers, as well as on the speed of depletion of indigenous European resources. We focus on how shadow prices of resource constraints affect substitution patterns in the various scenarios. [ABSTRACT FROM AUTHOR]

Objective: To systematically review and critically appraise the economic evaluations of one to one interventions to reduce sexually transmitted infections (STIs) and teenage conceptions. Design: Systematic review. Data Sources: Search of four electronic bibliographic databases from 1990 to January 2006. Search keywords included teenage, pregnancy, adolescent, unplanned, unwanted, cost benefit, cost utility, economic evaluation, cost effectiveness and all terms for STIs, including specific diseases. Review Methods: We included studies that evaluated a broad range of one to one interventions to reduce STIs. Outcomes included major outcomes averted, life years and quality adjusted life years (QALY). All studies were assessed against quality criteria. Results: Of 3,190 identified papers, 55 were included. The majority of studies found one to one interventions to be either cost saving or cost effective, although one highlighted the need to target the population to receive post-exposure prophylaxis to reduce transmission of HIV. Most studies used a static approach that ignores the potential re-infection of treated patients. Conclusion: One to one interventions have been shown to be cost saving or cost effective but there are some limitations in applying this evidence to the UK policy context. More UK research using dynamic modelling approaches and QALYs would provide improved evidence, enabling more robust policy recommendations to be made about which one to one interventions are cost effective in reducing STIs in the UK setting. The results of this review can be used by policy makers, health economists and researchers considering further research in this area. [ABSTRACT FROM AUTHOR]

Many countries have introduced evaluations of university research, reflecting global demands for greater accountability. This paper compares methods of evaluation used across twelve countries in Europe and the Asia-Pacific region. On the basis of this comparison, and focusing in particular on Britain, we examine the advantages and disadvantages of performance-based funding in comparison with other approaches to funding. Our analysis suggests that, while initial benefits may outweigh the costs, over time such a system seems to produce diminishing returns. This raises important questions about its continued use. [ABSTRACT FROM AUTHOR]

The understanding and interpretation of the presumed "secularization" of Britain and other European nations is clouded by a lack of adequate information regarding the substance and timing of religious change. This paper represents the first systematic effort to collect and analyze existing survey data on religious belief in Britain from the late 1930s to the present. Overall, the results show an increase in general scepticism about the existence of God, the related erosion of dominant, traditional Christian beliefs, and the persistence of nontraditional beliefs. A theoretical perspective is needed that recognizes the often corrosive effects of modern life on the transmission of religious beliefs and the continued popularity of worldviews which presume a transcendent referent, however broadly defined.

The paper presents a brief and personal history of the main developments in British vascular plant taxonomy and distribution studies in a European setting since the Second World War. It assesses the importance of the 'European view', and considers recent and current work under two main heads: the factual information itself, and the presentation of the facts, especially in the form of dot distribution maps. [ABSTRACT FROM AUTHOR]

Radical changes are taking place in the United Kingdom in relation to the classification of, and access to, medicines. More and more medicines are being made available over the counter both in local pharmacies and in supermarkets. The provision of more open access to medicines may be hailed as a triumph for patient autonomy. This paper examines whether such a claim is real or illusory. It explores the ethical and legal implications of deregulating medicines. Do patients benefit? What is the impact on pharmacists? Are the true beneficiaries of change largely the pharmaceutical industries? [ABSTRACT FROM AUTHOR]

The article offers information on quality of care research in Europe. One study explored the effectiveness of computerized guidelines on patients, the behavior of clinicians and organization outcomes in an international setting. Another paper investigated whether the new pay-for-performance scheme for family practitioners in Great Britain has led to good clinical practice or has encouraged the abuse of its measures by excluding appropriate patients.

Background: Options for opioid agonist therapy (OAT) are expanding with the development of prolonged-release (also known as extended-release) 1-week, 1-month, and 6-month formulations of buprenorphine. There is an assumption that patients will welcome these new treatments and medication adherence will correspondingly increase. However, there has been little research exploring patients' views of prolonged-release buprenorphine. This paper aims to understand which durations patients prefer and why, and to consider the findings with reference to the development of future OAT products. Methods: Data were generated as part of a qualitative interview study. Fieldwork was conducted in London, UK, during 2018 (before any prolonged-release OAT formulations were licensed in Europe). Participants (n = 36) were taking daily oral OAT (methadone or buprenorphine) or using heroin daily without OAT. They included 26 men and 10 women, aged 24–63 years. All were asked for their views on weekly, monthly, and six-monthly duration buprenorphine. Responses were audio-recorded, transcribed, and analyzed by Iterative Categorization. Results: Participants generally stated that having buprenorphine of different prolonged durations was positive. They tended to believe that 'longer' prolonged-release formulations would be beneficial for patients who wanted to avoid thinking about drugs and drug-using associates, wished to evade the stigma of substance use, and desired 'normality' and 'recovery.' In contrast, participants favored 'shorter' prolonged-release formulations for patients who are new to OAT, worried about the safety and reliability/effectiveness of OAT, want a 'break' from street opioids, and need contact with services to monitor/support them. Participants indicated that transitioning between OAT medications of different duration would be a very individual process. Some also linked prolonged-release OAT duration to political, philosophical, and ethical issues, such as patient coercion and mental capability. Conclusions: Medication duration is an important but complex feature of prolonged-release buprenorphine, with patients' views and preferences likely to be influenced by a wide range of factors. We need further qualitative research to explore the experiences of people who have actually used prolonged-release OAT. Meanwhile, drug developers should continue to build flexibility and choice into OAT products to ensure that future treatment is acceptable to patients and able to accommodate their diverse individual needs. [ABSTRACT FROM AUTHOR]

A response to a study on whether terrorism is a force for urban dispersal or whether terrorism drives people together is presented. It cites the costly travel effect and the city walls effect which counter the tall targets effect. The author says that terrorism is in decline in Europe and North America, but is on the rise in the Middle East. The incidence of terrorism in large cities in the U.S. and Great Britain which is indicative of the tall targets effect is mentioned. The article elaborates on the correlation between terrorism and urban land use.

Starch is one of the most important plant products to man. It is an essential component of food providing a large proportion of the daily calorific intake and is important in non-food uses such as in adhesives. However, while much is known about the chemistry and pathways of synthesis for starch, there are major gaps in this knowledge so that it is not possible to modify the quantity or quality of starch produced by plants in a predictable way. While yield has improved markedly over the last century it is no longer improving faster than the growth in population and, at the same time, farmers' incomes in Europe have been falling, especially in the UK. Thus, production, even in Europe, is not much greater than demand. In the western world an increasing amount of the harvested crop is processed and, therefore, the quality of the raw product becomes an increasingly important issue. There is, therefore, an increasing need to combine the modern mathematical modelling tools with modern biochemical tools and the modern science of genomics. [ABSTRACT FROM AUTHOR]

Comments on Peter Rowley-Conwy's paper which suggests a reconsideration of agricultural origin in Great Britain, Ireland, and southern Scandinavia. Ideological and subsistence dynamics and the current interpretations of their correlation that have achieved axiomatic status in postprocessual views of the transition in north-western Europe; Theoretical and interpretative postulates and available data on palaeoeconomy, palaeodiet, and cultural continuum in northwestern Europe; Economy and material culture.