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Within the system of national accounts the electricity sector is typically reported as a single entry representing generation, transmission, distribution and trade. The ways in which these components interact with the economy differ greatly, a feature lost within the standard accounting framework. In this paper we propose an Electricity Satellite Account (ELSA) approach to better understand the linkages between the electricity sector and economy, with a particular focus on generation technologies. In developing this framework, we draw parallels with Tourism Satellite Accounts (TSAs). To illustrate the practical steps in constructing ELSAs, we develop an ELSA for Scotland for 2012, and show how the ELSA framework gives an improved understanding of the economic contribution of the electricity sector, which is critical in improving the usefulness of such accounts for climate, energy, and economic policy. [ABSTRACT FROM AUTHOR]

• We decompose changes in industrial water demand in Scotland between 2012 and 2016. • Changes in sectoral water intensity a key factor explaining fall in water demand. • Role of electricity generation policies aimed at encouraging renewables important. • Future changes in water availability, demand and technologies important to examine. Future climate scenarios predict significant changes in the availability of water resources at global and regional scales. Knowledge of the possible economic consequences of this are limited by a shortage of data linking economic activity with physical water use. Matching a unique premise-level dataset to economic indicators at industrial/sector level, this paper undertakes a decomposition of changes in industrial water demand for Scotland between 2012 and 2016. Results highlight the importance of taking a sectoral approach, as changes in sectoral water intensity are significant. Furthermore, changes in the structure of the economy, i.e. a move away from water-intensive industries, highlight further reductions in overall water consumption. By considering future scenarios for Scottish water resources, this paper identifies key multi-disciplinary research challenges to address the major obstacles in developing a climate-ready water policy, which also captures the potential economic opportunities for Scotland from an awareness of the role of water in the economy. [ABSTRACT FROM AUTHOR]

What is known and objectives Obstetrics services are a high-throughput and high-risk environment poised for pharmacist involvement, but determining how to ideally allocate services is difficult. There is recent interest in the development of tools for service prioritization, but none are specifically targeted to obstetrics. Therefore, the aim of this study was (i) to conduct a practice audit surveying the demographics of patients attending obstetrics wards at a high-capacity maternity hospital; and (ii) to evaluate a triage tool developed to prioritize pharmacy services. Methods A retrospective case review of women discharged after birth admissions was undertaken at a hospital in National Health Service ( NHS) Scotland during June 2014. Demographic and admission data were collected, as well as pharmacist interventions and missed opportunities in patient care on post-natal wards. A pharmacy triage tool was developed and retrospectively applied to each case to ascertain a risk category that would trigger and target pharmacist review. Interventions/opportunities were classified as either clinical (medication related) or administrative (potential for error development). Results and discussion One hundred and seventy-five cases were reviewed with a median age of 29 years old. Eighty-six patients (49·1%) were retrospectively classified with elevated risk using the triage tool. A total of 117 charts (66·9%) were identified with missed opportunities for pharmacist intervention, which was significantly greater among patients classified as higher risk (75·6 vs. 58·4%, P = 0·017). Compared to low-risk patients, patients with a higher-risk classification had lower rates of administrative missed opportunities (55·4 vs. 80·8%, P = 0·015), but numerically higher rates of clinical (26·2 vs. 9·6%, p= NS) and mixed clinical/administrative (18·5 vs. 9·6%, p= NS) missed opportunities, although this failed to reach statistical significance. What is new and conclusion Evaluation of a triage tool for obstetric services demonstrated potential for prioritizing higher-risk patients for pharmacist review and addressing opportunities for clinical improvements. [ABSTRACT FROM AUTHOR]

The distribution of Atlantic salmon redds was recorded during two spawning seasons (2005 and 2006) along a 4 km braided reach of the river Feshie in the Cairngorm mountains, Scotland. Within this complex reach, four main channels types were differentiated on the basis of geographical water sources, channel morphology and hydrochemistry: (1) the main braided channels of the river Feshie; (2) groundwater channels fed by seepage at the edge of the floodplain; (3) hillslope tributary channels and (4) mixed channels downstream of confluences of two or more of types 1-3. The 2005 season was characterised by high and variable flows. In total, 223 redds were observed which were mainly (64%) located in groundwater channels, with relatively few (9%) in the more extensive sections of main channel. The second year had much lower and more stable flows. Here, a total of 337 redds were observed. The largest number were again located in the groundwater channels (44%), though spawning was more evenly distributed in the other channel types, including the main river (19%). It is hypothesised that the apparently more suitable characteristics of groundwater-fed channels relate to a more stable, richer environment for embryo development and juvenile growth, whilst hydraulic conditions and sediment stability in the main channel may create more adverse conditions for successful recruitment. [ABSTRACT FROM AUTHOR]

This article analyses the economic size and resilience of five established definitions of the Blue Economy across two geographical locations: Scotland (UK) and Michigan (USA). The article analyses sector-level employment, labor productivity and Gross Value Added (GVA) data, and uses graphical representations to highlight the differences in conceptualizing the Blue Economy in ways that affect its weight and contribution to regional economies. Further, it analyses how each definition has fared in the post-2007/2011 crisis, assessing their resilience. This novel work tackles the emerging discourse around the Blue Economy by highlighting its regional character, and by problematizing the divergent definitions of the concept. • No operational definition of Blue Economy currently exists. • Regional and sectoral differences lead to conflicts and conundrums. • Analysis show varying economic sizes of 5 accepted definitions. • Definitions change in terms of job quality and contribution to the economy. • New data and regional methods can support operationalizing B.E. and reducing. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess the predictive power of three different Sepsis Scoring Systems (SSSs), namely maternity Systematic Inflammatory Response Syndrome (mSIRS), quick Sepsis-related Organ Failure Assessment (qSOFA) and Modified Early Warning System (MEWS) in identifying sepsis by comparing them with positive culture. This study also sought to evaluate compliance with using the Sepsis Six Care Bundle (SSCB) operated in an individual health board., Methods: A retrospective cohort study was conducted in 3 maternity hospitals of a single Scottish health board that admitted 2690 pregnancies in a 12 weeks period in 2016. Data for study was obtained from medical notes, handheld and electronic health records for women who were prescribed antibiotics with a confirmed or suspected diagnosis of sepsis. Data on clinical parameters was used to classify women according to mSIRS, qSOFA and MEWS as having sepsis or not and this was compared to results of positive culture to obtain sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under Receiver Operating Characteristic curve (AUROC) along with their 95% confidence intervals. Data was also obtained on SSCB compliance., Results: A total of 89 women were diagnosed with sepsis, of which 14 had missing data, leaving 75 for final analysis. Sensitivity, specificity, PPV, NPV and AUROC of mSIRS and MEWS were almost similar with AUROC of both being around 50%. Only 33 (37.1%) had identifiable sepsis six sticker displayed on medical notes and only 2 (2.2%) had all elements of SSCB delivered within the recommended one-hour post-diagnosis period. Blood culture and full blood count with other lab tests had been performed for most women (97%) followed by intravenous antibiotics and fluids (93.9%)., Conclusions: mSIRS and MEWS were quite similar in detecting sepsis when compared to positive culture, with their ability to detect sepsis being close to chance. This underlines the need for creating a valid SSS with high sensitivity and specificity for clinical use in obstetric settings. Clinical use of SSCB was limited despite it being a health board policy, although there is considerable possibility of improvement following detailed audits and removal of barriers for implementing SSCB., (© 2021. The Author(s).)

For many species, there is evidence that breeding performance changes as an individual ages. In iteroparous species, breeding performance often increases through early life and is expected to level out or even decline (senesce) later in life. An individual's sex and conditions experienced in early life may also affect breeding performance and how this changes with age. Long-term monitoring of individuals from reintroduced populations can provide unique opportunities to explore age-related trends in breeding performance that might otherwise be logistically challenging. We used a unique dataset from a reintroduced population of white-tailed eagles Haliaeetus albicilla in Scotland, which has been intensively monitored since their initial reintroduction in 1975, to study age- and sex-specific trends in two measures of breeding performance. This monitoring provided data on the breeding performance of known individuals ranging in age from 3 to 26 years. We also explored changes in breeding performance in relation to early life experience (i.e., whether they were released or fledged in the wild). Breeding performance increased with age in early life in a similar manner for both sexes. We found stronger evidence for senescence in breeding performance in males than females. However, late-life female breeding success was associated with early life experience, while male senescent trends were not apparently impacted by conditions experienced during early life. Sexual differences in senescence mean that older males are less likely to breed successfully compared to older females, and this may influence females' mate changes later in life. This difference may suggest a linked sexual difference in survival rates or the possibility of proactive partner change by females in later life in this typically monogamous biparental species., (© 2018 The Authors. Journal of Animal Ecology © 2018 British Ecological Society.)

Objectives: This study aimed to describe the population of people who acquired ventilator acquired pneumonia and determine the feasibility of a larger scale study to assess the degree to which bundle compliance reduces or even eliminates, the risk of ventilator acquired pneumonia., Research Methodology/design: A retrospective matched case note review was conducted to scrutinise 10 VAP cases. Cases were matched with two controls for age, gender, APACHE score and number of ventilated days. Compliance with the VAP bundle was determined by extracting data on compliance from case notes. Binary logistic regression was used to calculate odds ratios with confidence intervals which were utilised to determine numbers needed for a larger study., Setting: A general intensive care unit within a 750 bedded district general hospital, serving a population of approximately 270,000 people in Scotland., Main Outcome Measure: The outcome variable of interest was ventilator acquired pneumonia and the independent variable was ventilator acquired pneumonia bundle compliance., Results: Binary logistic regression suggested that cases which did not receive the bundle reliably were more likely to develop ventilator acquired pneumonia (OR 1.33, confidence interval (CI) 0.28-6.30). Statistical results should be interpreted with caution due to the small sample size, which is demonstrated with the wide ranging confidence intervals (CIs)., Conclusion: Wide confidence intervals enable only a cursory impression as to numbers that would be required for a full scale trial. Nonetheless, the effect size indicated in this paper contributes towards consideration as to numbers needed for future studies., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: Competence based education is currently being introduced into higher surgical training in the UK. Valid and reliable performance assessment tools are essential to ensure competencies are achieved. No such tools have yet been reported in the UK literature., Objective: We sought to develop and pilot test an Endoscopic Sinus Surgery Competence Assessment Tool (ESSCAT). The ESSCAT was designed for in-theatre assessment of higher surgical trainees in the UK., Methods: The ESSCAT rating matrix was developed through task analysis of ESS procedures. All otolaryngology consultants and specialist registrars in Scotland were given the opportunity to contribute to its refinement. Two cycles of in-theatre testing were used to ensure utility and gather quantitative data on validity and reliability. Videos of trainees performing surgery were used in establishing inter-rater reliability., Results: National consultation, the consensus derived minimum standard of performance, Cronbach's alpha = 0.89 and demonstration of trainee learning (p = 0.027) during the in vivo application of the ESSCAT suggest a high level of validity. Inter-rater reliability was moderate for competence decisions (Cohen's Kappa = 0.5) and good for total scores (Intra-Class Correlation Co-efficient = 0.63). Intra-rater reliability was good for both competence decisions (Kappa = 0.67) and total scores (Kendall's Tau-b = 0.73)., Conclusion: The ESSCAT generates a valid and reliable assessment of trainees' in-theatre performance of endoscopic sinus surgery. In conjunction with ongoing evaluation of the instrument we recommend the use of the ESSCAT in higher specialist training in otolaryngology in the UK.

Purpose: To determine the effectiveness of two dissemination and implementation strategies to implement a national guideline for epilepsy management in primary care settings., Methods: Three-arm cluster-randomized controlled trial. The participants were general practitioners from 68 practices in Tayside, Scotland, and 1,133 of their patients with self-reported epilepsy treated with antiepileptic medications (AEDs). Practices were randomized blind to a control, intermediate, or intensive intervention., Control: Postal dissemination of a nationally developed clinical guideline. Intermediate intervention: Postal dissemination of the guideline supported by interactive, accredited workshops, and dedicated, structured protocol documents. Intensive intervention: Intermediate intervention plus a nurse specialist who supported and educated practices in the establishment of epilepsy review clinics. The primary outcome was the SF-36 health-related quality-of-life instrument. Secondary measures were a battery of prevalidated epilepsy-specific quality-of-life instruments. These were administered at baseline and after the intervention phase. Process of care was assessed by case-note review on number of review meetings and counseling sessions for epilepsy before and after the interventions., Results: None of the intervention groups showed any change in the primary or secondary outcome measures or process-of-care measures., Conclusions: None of the intervention strategies led to improvements in patient quality of life or quality of epilepsy care. Further research is needed to discover why the interventions failed, to identify barriers to adoption of guidelines, and to develop strategies that might improve implementation and uptake in the future.

The first year experience of an innovative experiment in undergraduate medical education is described. The study investigated the educational effectiveness of prolonged clinical attachments for medical undergraduates in community hospital-based general practice. It has also assessed the ability of students to take some responsibility for their own learning in a clinically challenging environment. A retrospective evaluation of the experience obtained during the 3 month attachments for a self-selected group of fourth year Dundee medical school undergraduates was made. These undergraduates were placed in 10 mainly rural Scottish general practices with attached community hospitals providing a wide spectrum of inpatient and outpatient medical and surgical care. Students were assessed on the satisfactory completion of a portfolio of learning experiences and a practical clinical skills list. They were also required to submit a clinical project based on some aspect of their work during the attachment. The initial results showed a high degree of student and tutor satisfaction with the attachments. The assessment of all 10 of the students' educational achievements in their attachment were regarded as satisfactory and two were assessed as outstanding. Tutor assessment confirmed the validity of the initiative. Prolonged attachments in community hospital-based general practice for medical undergraduates have proved educationally valid and popular with both students and tutors. The development and dissemination of this model on a wider scale has resource issues which require to be addressed.

A survey of wild rabbits in Tayside, Scotland revealed that 67 per cent were infected with Mycobacterium avium subspecies paratuberculosis. In general, the infected rabbits had histopathological changes within the lymph nodes and intestines which were consistent with the changes due to paratuberculosis in ruminants. The survey raises the possibility that rabbits and other wildlife may be involved in the epidemiology of paratuberculosis, a possibility which has important implications for the control of the disease.

A retrospective survey of abdominal hysterectomy in a district hospital in two separate years (1970 and 1980) was undertaken. The mortality and short-term physical morbidity of the operation was low. Evidence is presented of a change in attitude over the decade by gynaecologists towards abdominal hysterectomy, the trend being increasingly liberal, such that in 1980 nearly half the patients subjected to abdominal hysterectomy had no demonstrable pathology. In view of the reported adverse long-term psychiatric and cardiovascular effects of hysterectomy, even when the ovaries are conserved, this trend must give rise to concern.

A drug formulary comprising 249 preparations of 132 drugs and drug combinations was prepared by the partners in a three-doctor general practice serving more than 5000 patients. No attempt was made to change to generic prescribing nor were repeat prescription drugs altered. Introduction of the formulary in September 1981 was followed by an increase in the proportion of prescriptions containing drugs from the formulary from about 55% to more than 60% for both repeat and non-repeat prescriptions. The proportion of formulary drugs on non-repeat prescriptions reached a maximum of 78% within the first year with the additional influence of information feedback. Over the first year the level of formulary drugs used for both repeat and nonrepeat prescribing levelled off at about 62%. Even with these modest changes, when compared with the costs of general practice prescribing in Scotland as a whole, the introduction of the formulary resulted in savings of approximately 10% within the practice for the mean ingredient costs both per patient and per prescription.