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Presents a study determining the influence of shift working patterns on Senior House Officers (SHO) surgery experience in Europe. Focus on the performance of inguinal herniorrhaphy and appendectomy; Maintenance of emergency clinical and operative experience; Reduction of SHO's elective operative experience.

Present-day people from England and Wales have more ancestry derived from early European farmers (EEF) than did people of the Early Bronze Age 1 . To understand this, here we generated genome-wide data from 793 individuals, increasing data from the Middle to the Late Bronze Age and Iron Age in Britain by 12-fold, and western and central Europe by 3.5-fold. Between 1000 and 875 BC, EEF ancestry increased in southern Britain (England and Wales) but not northern Britain (Scotland) due to incorporation of migrants who arrived at this time and over previous centuries, and who were genetically most similar to ancient individuals from France. These migrants contributed about half the ancestry of people of England and Wales from the Iron Age, thereby creating a plausible vector for the spread of early Celtic languages into Britain. These patterns are part of a broader trend of EEF ancestry becoming more similar across central and western Europe in the Middle to the Late Bronze Age, coincident with archaeological evidence of intensified cultural exchange 2-6 . There was comparatively less gene flow from continental Europe during the Iron Age, and the independent genetic trajectory in Britain is also reflected in the rise of the allele conferring lactase persistence to approximately 50% by this time compared to approximately 7% in central Europe where it rose rapidly in frequency only a millennium later. This suggests that dairy products were used in qualitatively different ways in Britain and in central Europe over this period., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: The patient hotel model was developed in Northern Europe as a response to increased demand for health and wellbeing services. According to current literature the patient hotel model is a concept of care provision which combines non-acute hospital care with hospitality to afford patients/guests increased satisfaction and security whilst benefitting from evidenced based care., Objective(s): This paper evaluates the concept of the patient hotel model. It presents the findings of a systematic review of existing literature evaluating the benefits such a model can bring to healthcare services and reports on the efficacy in terms of cost to health service providers, and health outcomes to patients/guests. The authors' aimed to complete a meta-analysis of the data, but were unable to, due to the diversity in the descriptions, service provisions, and client group., Design: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used to conduct and report this systematic review. In order to focus the research question, the PICO (Population; Intervention; Comparison and Outcome) framework was used to develop a strategy in literature searching, to ensure systematic rigor., Data Sources/review Methods: Cochrane Database of Systematic Reviews, OVID MEDLINE, CINAHL, Embase, ScienceDirect, Web of Science, and Scopus databases were used to search for randomized controlled trials, quasi experimental studies, quantitative and qualitative studies conducted between January 1st 2008 and August 9th, 2018, published in a peer reviewed journal in English or which provided an abstract in English. Citation searches and hand searches were also conducted., Results: 8,693 papers were retrieved and from abstract screening 68 full-text articles were assessed for eligibility by applying an inclusion and exclusion criteria. Seven articles were retained for quality assessment. Methodological rigor was appraised using accepted criteria for the evaluation of research. On appraisal, one systematic review, one Randomized Clinical Trial, two qualitative studies, one quantitative survey, one retrospective analysis of services, and one comparative analysis paper were included for data synthesis. The functionality of the patient hotel model differed across the six countries that reported on them in the included studies, from oncology care, medical care, post-acute rehabilitation and perioperative care. The studies included in this review broadly focused on the themes of patient experience and/or cost, with the intention of informing future service provision. Studies relating to cost efficacy looked at the potential financial savings which could be realized through adopting the patient hotel model. The appraised studies found positive benefits of adopting the patient hotel model, both in terms of cost and patient satisfaction. One study explored the role of nurses in a patient hotel., Conclusions: The lack of consistent definition, diversity in the descriptions, service provisions, and client groups meant that the results could only be systematically reviewed and not synthesized into a meta-analysis. The inconsistencies in labeling and description also have implications for the review process, as studies adopting more abstract classification of the patient hotel model may not have been included in the review. On balance, the appraised evidence appears to suggest that there are positive benefits to patients, nurses and healthcare providers. However further research of greater rigor is needed to provide a better understanding of these outcome measures. Implications for rehabilitation Patient hotels have particular relevance to the field of rehabilitation as they have a strong ethos of promoting self-care and independence, facilitated through greater freedom and family involvement. The patient hotel model has the potential to impact healthcare provision on the global stage, but there is no universal definition, making evidence evaluation difficult. The patient hotel model combines the concepts of health and hospitality and could potentially provide a cost-effective alternative to healthcare, with positive outcomes for patient experience as well as patient health. There is a need to explore new systems of care delivery which provide increased patient satisfaction, and a seamless continuum of care at the acute and primary care interface. This paper examines the patient hotel model of care, and its merits in terms of care provision, patient satisfaction and service efficiency, contributing to the embryonic literature in this field.

In many species a fundamental feature of genetic diversity is that genetic similarity decays with geographic distance; however, this relationship is often complex, and may vary across space and time. Methods to uncover and visualize such relationships have widespread use for analyses in molecular ecology, conservation genetics, evolutionary genetics, and human genetics. While several frameworks exist, a promising approach is to infer maps of how migration rates vary across geographic space. Such maps could, in principle, be estimated across time to reveal the full complexity of population histories. Here, we take a step in this direction: we present a method to infer maps of population sizes and migration rates associated with different time periods from a matrix of genetic similarity between every pair of individuals. Specifically, genetic similarity is measured by counting the number of long segments of haplotype sharing (also known as identity-by-descent tracts). By varying the length of these segments we obtain parameter estimates associated with different time periods. Using simulations, we show that the method can reveal time-varying migration rates and population sizes, including changes that are not detectable when using a similar method that ignores haplotypic structure. We apply the method to a dataset of contemporary European individuals (POPRES), and provide an integrated analysis of recent population structure and growth over the last ∼3,000 years in Europe., Competing Interests: The authors have declared that no competing interests exist.

Background: A scientifically sound validated foot and ankle specific score validated ab initio for different languages is missing. The aim of a project of the European Foot and Ankle Society (EFAS) was to develop, validate, and publish a new score(the EFAS-Score) for different European languages., Methods: The EFAS Score was developed and validated in three stages: (1) item (question) identification, (2) item reduction and scale exploration, (3) confirmatory analyses and responsiveness. The following score specifications were chosen: scale/subscale (Likert 0-4), questionnaire based, outcome measure, patient related outcome measurement. For stage 3, data were collected pre-operatively and at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, confirmatory analyses and responsiveness were executed using analyses from classical test theory and item response theory., Results: Stage 1 resulted in 31 general and 7 sports related questions. In stage 2, a 6-item general EFAS Score was constructed using English, German, French and Swedish language data. In stage 3, internal consistency of the scale was confirmed in seven languages: the original four languages, plus Dutch, Italian and Polish (Cronbach's Alpha >0.86 in all language versions). Responsiveness was good, with moderate to large effect sizes in all languages, and significant positive association between the EFAS Score and patient-reported improvement. No sound EFAS Sports Score could be constructed., Conclusions: The multi-language EFAS Score was successfully validated in the orthopaedic ankle and foot surgery patient population, including a wide variety of foot and ankle pathologies. All score versions are freely available at www.efas.co., (Copyright © 2018 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)

We consider the statistical analysis of population structure using genetic data. We show how the two most widely used approaches to modeling population structure, admixture-based models and principal components analysis (PCA), can be viewed within a single unifying framework of matrix factorization. Specifically, they can both be interpreted as approximating an observed genotype matrix by a product of two lower-rank matrices, but with different constraints or prior distributions on these lower-rank matrices. This opens the door to a large range of possible approaches to analyzing population structure, by considering other constraints or priors. In this paper, we introduce one such novel approach, based on sparse factor analysis (SFA). We investigate the effects of the different types of constraint in several real and simulated data sets. We find that SFA produces similar results to admixture-based models when the samples are descended from a few well-differentiated ancestral populations and can recapitulate the results of PCA when the population structure is more "continuous," as in isolation-by-distance models., Competing Interests: The authors have declared that no competing interests exist.

Understanding the genetic structure of human populations is of fundamental interest to medical, forensic and anthropological sciences. Advances in high-throughput genotyping technology have markedly improved our understanding of global patterns of human genetic variation and suggest the potential to use large samples to uncover variation among closely spaced populations. Here we characterize genetic variation in a sample of 3,000 European individuals genotyped at over half a million variable DNA sites in the human genome. Despite low average levels of genetic differentiation among Europeans, we find a close correspondence between genetic and geographic distances; indeed, a geographical map of Europe arises naturally as an efficient two-dimensional summary of genetic variation in Europeans. The results emphasize that when mapping the genetic basis of a disease phenotype, spurious associations can arise if genetic structure is not properly accounted for. In addition, the results are relevant to the prospects of genetic ancestry testing; an individual's DNA can be used to infer their geographic origin with surprising accuracy-often to within a few hundred kilometres.

Official frameworks for soil monitoring exist in most member states of the European Union. However, the uniformity of methodologies and the scope of actual monitoring are variable between national systems. This review identifies the differences between existing systems, and describes options for harmonising soil monitoring in the Member States and some neighbouring countries of the European Union. The present geographical coverage is uneven between and within countries. In general, national and regional networks are much denser in northern and eastern regions than in southern Europe. The median coverage in the 50 km x 50 km EMEP cells applied all over the European Union, is 300 km(2) for one monitoring site. Achieving such minimum density for the European Union would require 4100 new sites, mainly located in southern countries (Italy, Spain, Greece), parts of Poland, Germany, the Baltic countries, Norway, Finland and France. Options are discussed for harmonisation of site density, considering various risk area and soil quality indicator requirements.

Helicobacter pylori, a chronic gastric pathogen of human beings, can be divided into seven populations and subpopulations with distinct geographical distributions. These modern populations derive their gene pools from ancestral populations that arose in Africa, Central Asia, and East Asia. Subsequent spread can be attributed to human migratory fluxes such as the prehistoric colonization of Polynesia and the Americas, the neolithic introduction of farming to Europe, the Bantu expansion within Africa, and the slave trade.