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BackgroundPatients who have knee instability that is associated with neuromuscular disease (NMD) and central nervous system (CNS) conditions can be treated using orthoses, such as knee–ankle–foot orthoses (KAFOs).ObjectivesTo assess existing evidence on the effectiveness of orthoses; patient perspectives; types of orthotic devices prescribed in the UK NHS; and associated costs.MethodsQualitative study of views of orthoses users – a qualitative in-depth interview study was undertaken. Data were analysed for thematic content. A coding scheme was developed and an inductive approach was used to identify themes. Systematic review – 18 databases were searched up to November 2014: MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cumulative Index to Nursing and Allied Health, EMBASE, PASCAL, Scopus, Science Citation Index, BIOSIS Previews, Physiotherapy Evidence Database, Recal Legacy, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment database, Cochrane Central Register of Controlled Trials, Conference Proceedings Citation Index: Science, Health Management Consortium, ClinicalTrials.gov, International Clinical Trials Registry Platform and National Technical Information Service. Studies of adults using an orthosis for instability of the knee related to NMD or a CNS disorder were included. Data were extracted and quality was assessed by two researchers. Narrative synthesis was undertaken. Survey and costing analysis – a web survey of orthotists, physiotherapists and rehabilitation medicine physicians was undertaken. Telephone interviews with orthotists informed a costing analysis.ResultsQualitative study – a total of 24 people participated. Potential for engagement in daily activities was of vital importance to patients; the extent to which their device enabled this was the yardstick by which it was measured. Patients’ prime desired outcome was a reduction in pain, falls or trips, with improved balance and stability. Effectiveness, reliability, comfort and durability were the most valued features of orthoses. Many expressed frustration with perceived deficiencies in service provision relating to appointment and administrative systems and referral pathways. Systematic review – a total of 21 studies (478 participants) were included of people who had post-polio syndrome, inclusion body myositis, were post stroke or had spinal cord injury. The studies evaluated KAFOs (mainly carbon fibre), stance control KAFO and hip KAFOs. All of the studies were at risk of bias and, in general, were poorly reported. Survey and costing analysis – in total, 238 health-care professionals responded. A range of orthoses is prescribed for knee instability that is related to NMD or CNS conditions, approximately half being custom-made. At least 50% of respondents thought that comfort and confidence in mobility were extremely important treatment outcomes. The cost of individual KAFOs was highly variable, ranging from £73 to £3553.ConclusionsVarious types of orthoses are used in the NHS to manage patients with NMD/CNS conditions and knee instability, both custom-made and prefabricated, of variable cost. Evidence on the effectiveness of the orthoses is limited, especially in relation to the outcomes that are important to orthoses users.LimitationsThe population included was broad, limiting any in-depth consideration of specific conditions. The response rate to the survey was low, and the costing analysis was based on some assumptions that may not reflect the true costs of providing KAFOs.Future workFuture work should include high-quality research on the effectiveness and cost-effectiveness of orthoses; development of a core set of outcome measures; further exploration of the views and experiences of patients; and the best models of service delivery.Study registrationThis study is registered as PROSPERO CRD42014010180. The qualitative study is registered as Current Controlled Trials ISRCTN65240228.FundingThe National Institute for Health Research Health Technology Assessment programme.

Aim. The purpose of this study was to develop and evaluate a computer-based, dietary, and physical activity self-management program for people recently diagnosed with type 2 diabetes.Methods. The computer-based program was developed in conjunction with the target group and evaluated in a 12-week randomised controlled trial (RCT). Participants were randomised to the intervention (computer-program) or control group (usual care). Primary outcomes were diabetes knowledge and goal setting (ADKnowl questionnaire, Diabetes Obstacles Questionnaire (DOQ)) measured at baseline and week 12. User feedback on the program was obtained via a questionnaire and focus groups.Results. Seventy participants completed the 12-week RCT (32 intervention, 38 control, mean age 59 (SD) years). After completion there was a significant between-group difference in the “knowledge and beliefs scale” of the DOQ. Two-thirds of the intervention group rated the program as either good or very good, 92% would recommend the program to others, and 96% agreed that the information within the program was clear and easy to understand.Conclusions. The computer-program resulted in a small but statistically significant improvement in diet-related knowledge and user satisfaction was high. With some further development, this computer-based educational tool may be a useful adjunct to diabetes self-management. This trial is registered with clinicaltrials.gov NCT numberNCT00877851.

Alison Booth enriches the volume’s exploration of literary geographies with an examination of ‘author country’ publications by Helen Archibald Clarke and the example of her partnership with Charlotte Endymion Porter as co-editors of the longstanding journal Poet-Lore. Booth’s essay demonstrates how turn-of-the-twentieth-century Anglophilia and biographical criticism, aided by literary tourism, were critical instruments in forming the canon of English literature on both sides of the Atlantic. Ultimately, this essay challenges latter-day academic disregard for forms of affective and material reader response, recalling an earlier moment when the ‘professional–amateur’ divide was far less stable. Along the way, it also injects important considerations of regional and domestic setting as well as gender into the story of transatlantic claims to literary authority and culture.

UNLABELLED Aim To explore the views of individuals recently diagnosed with type 2 diabetes in relation to self-management of dietary intake and physical activity, and to compare these with the views of health professionals (HPs). BACKGROUND Diabetes education has become a priority area in primary and secondary care, and many education programmes are now embedded within a patient's care package. There are few contemporaneous explorations of patients' views about lifestyle self-management. Such research is vital in order to identify areas that require further support, refinement or enhancement in terms of patient education. METHODS Focus groups were held with patients recently diagnosed with type 2 diabetes (n = 16, 38% female, aged 45-73 years). In-depth semi-structured interviews were conducted with HPs (n = 7). Discussions focussed on self-management specifically in relation to making dietary and physical activity changes. All discussions were tape recorded, transcribed and analysed by emergent themes analysis using NVivo to manage the coded data. Findings Barriers were divided into six main categories: difficulty changing well-established habits, negative perception of the 'new' or recommended regimen, barriers relating to social circumstances, lack of knowledge and understanding, lack of motivation and barriers relating to the practicalities of making lifestyle changes. HPs generally echoed the views of patients. In conclusion, even against a background of diabetes education, recently diagnosed patients with type 2 diabetes discussed a wide range of barriers to self-management of diet and physical activity. The findings could help to provide HPs with a deeper understanding of the needs of recently diagnosed patients and may help refine current diabetes education activities and inform the development of educational resources.

Objectives: Treatment options for patients with AML/MDS who are ineligible for intensive chemotherapy are limited. Due to rapid progression of the condition it is difficult to capture what is most important to patients when making treatment decisions. Social media data is a rich source of information, and the FDA recently encouraged stakeholders to explore the use of social media to capture the patient perspective.[i] This study aimed to capture factors most important to patients ineligible for intensive chemotherapy through using disease-specific social media posts by patients and/or their caregivers. Identifying these factors will give clinicians a better understanding of what is important to their patients when considering their treatment. Methods: AML and MDS patient/caregiver posts were extracted from publicly available discussions on three large AML/MDS-specific sites. Posts were manually reviewed to only include the experience of patients ineligible for intensive chemotherapy. 1,443 posts from 220 AML patients/caregivers and 2,733 posts from 127 MDS patients/caregivers were included. A targeted search for terms relating to end of life treatment decisions was conducted within the included posts, yielding 83 posts from 40 AML users and 70 posts from 39 MDS users. These posts were manually reviewed, and relevant text segments (discussing why patients wish to live longer and reasons/motives for treatment decisions) were highlighted using a qualitative analysis approach. Results: Of the reviewed data, 40 posts from 27 AML users and 20 posts from 18 MDS users contained relevant information. A theme important to patients and caregivers was spending time with family and making memories (in 20% of relevant posts). Often reported was the desire to reach family occasions including birthdays, Christmas, anniversaries, and weddings. Quality of life was also an important consideration (in 33% of relevant posts). Many patients expressed a wish to have better quality of life over quantity of life, and did not want the risk of suffering from side effects. Tied into this was the clear preference to be at home rather than in a hospital or care home (in over 22% of relevant posts). To some patients, it was important to try all possible treatment options, and some reported their doctors were supportive of this. However a lack of available treatments was also perceived by some patients as if their doctors give up on treating them too soon. Discussion: Treatment decisions in patients with AML/MDS are complex and unique to each patient. From this analysis, it is clear being home and spending time with family was associated with a perceived higher level of quality of life for patients and caregivers. Patients and caregivers place high importance on treatment options that provide better perceived QoL over treatments that provide a moderate extension to life expectancy and require hospitalisation. This study highlights the need to consider patient perceptions of QoL and the importance of understanding patient and caregiver goals and opinions to best determine personalised treatment options. [i] United States Food and Drug Administration (FDA). June 2018. Patient-Focused Drug Development: Collecting Comprehensive and Representative Input Guidance for Industry, Food and Drug Administration Staff, and Other Stakeholders. Available from: https://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM610442.pdf [accessed July 24, 2018]. Disclosures Booth: Evidera: Employment. Bell:Pfizer: Employment, Equity Ownership. Halhol:Evidera: Employment. Pan:Evidera: Employment. Welch:Pfizer: Employment, Equity Ownership. Merinopoulou:Evidera: Employment. Lambrelli:Evidera: Employment. Cox:Evidera: Employment.

Objectives: For patients with AML/MDS who are ineligible for intensive chemotherapy, prognosis is poor and effective treatment options are limited, often leading to unmet medical needs in this population. A deeper understanding of the patient perspective in this population is valuable to inform decision making and better address patients' needs. The FDA encourages the use of social media to shed light on patients' perspectives regarding the symptoms and impacts of their disease, stressing the opportunity to inform medical product development and enhance regulatory decision making.[i] This study aimed to use social media data to identify self-reported barriers to treatment, and capture the patient/caregiver understanding of the condition and prognosis in AML/MDS patients ineligible for intensive chemotherapy. Methods: AML and MDS patient/caregiver posts were extracted from publicly available discussions on three large AML/MDS specific forum sites. User posts were manually reviewed to only include the experience of patients ineligible for intensive chemotherapy. A total of 1,443 posts from 220 AML patients/caregivers and 2,733 posts from 127 MDS patients/caregivers were included. A manual qualitative review of a sample of 80 AML patients/caregivers and 5 MDS patients/caregivers' posts was conducted. Hypothesis coding was used to develop a coding dictionary based on key themes and open coding was used to incorporate additional themes, codes, and sub-codes inductively. Relevant content was coded, grouped into categories and overall themes. Results: Of the 85 user posting histories reviewed, 73 (86%) contained relevant information about the stated key objectives: 41 (56%) of users discussed factors relating to treatment decisions and 37 (51%) discussed unmet needs. The most common reasons for why the patient received no treatment were: the patient could not cope with chemotherapy due to co-morbidities or poor heath (31%), old age (26%), lack of effective available treatment options (18%) and the risk of side effects (15%). Other reasons included wanting to travel and adverse events. The most commonly reported unmet needs were: lack of/no treatment options (23%), lack of information about prognosis and deterioration (18%), lack of information about treatment (13%), lack of understanding about the condition (8%) and a lack of support and information from doctors (8%). Other unmet needs discussed included delayed diagnosis, treatment effectiveness, and lack of family support. Discussion: The need for more effective treatments in this population is known. However, this analysis shows patients/caregivers also face additional challenges. The discussion surrounding lack of information about prognosis, deterioration and treatment suggest there is a communication barrier between patients/caregivers and clinicians. Patients/caregivers expressed that they did not receive adequate information about these topics. It is not possible to determine whether the information was not given or whether patients/care givers failed to understand information that was given. Clinicians need ensure these topics are discussed, and delivered in a manner comprehensible for patients/caregivers to help patients make more effective treatment decisions. Furthermore, a greater understanding of AML and its symptoms is required to potentially allow for earlier diagnosis. [i] United States Food and Drug Administration (FDA). June 2018. Patient-Focused Drug Development: Collecting Comprehensive and Representative Input Guidance for Industry, Food and Drug Administration Staff, and Other Stakeholders. Available from: https://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM610442.pdf [accessed July 24, 2018]. Disclosures Booth: Evidera: Employment. Bell:Pfizer: Employment, Equity Ownership. Halhol:Evidera: Employment. Pan:Evidera: Employment. Welch:Pfizer: Employment, Equity Ownership. Merinopoulou:Evidera: Employment. Lambrelli:Evidera: Employment. Cox:Evidera: Employment.

The effect of weight loss on psychological stress is unknown. The study aimed to investigate the effect of diet-induced weight loss in overweight and obese adults on psychological measures of stress through a meta-analysis of randomized controlled trials (RCTs). Databases including Medline Complete, Embase and PsycINFO were searched up to February 2018 for diet-induced weight loss RCTs, which included self-reported assessment of psychological stress. The mean difference between the intervention and control group of changes in stress (intervention—baseline) was used. Ten RCTs were included with 615 participants (502 women, age range 20–80 years). Overall, there was no change in stress (mean difference −0.06, 95% CI: −0.17, 0.06, p = 0.33) and no change in the five studies with a significant reduction in weight in the intervention group compared to a control group that lost no weight (mean difference in weight −3.9 Kg, 95% CI: −5.51, −2.29, p < 0.0001; mean difference in stress 0.04, 95% CI: −0.17, 0.25, p = 0.71). For all analyses, there was low heterogeneity. The benefits of weight loss for those who are overweight and obese do not appear to either increase or reduce psychological stress at the end of the weight loss period.

This study was conducted to assess the psychometric properties of 2 assessment instruments, the Behavior Problems Inventory-01 (BPI-01; Rojahn, Matson, Lott, Esbensen, & Smalls, 2001) and the Nisonger Child Behavior Rating Form (NCBRF; Aman, Tasse, Rojahn, & Hammer, 1996). The sample consisted of 237 ethnically diverse children and adolescents with intellectual disabilities who ranged in age from 4 to 22 years. Reliability parameters included internal consistency, interteacher agreement, teacher-parent agreement, and test-retest reliability. Factorial validity was assessed first by bivariate Spearman rank (ρ) correlations and then by examining the factor structure fit via confirmatory factor analysis (CFA). Convergent and discriminant validity was assessed by multiple regression analyses across the 2 instruments. Reliability coefficients (internal consistency, interteacher agreement, and test-retest reliability) of the BPI-01 and of the NCBRF subscales ranged from fair to excellent and from poor to excell...

Aim: To assess the effectiveness of specific advice for increasing fruit, vegetable and dairy intake in free-living men participating in a weight loss study. Methods: Subjects were randomised to one of two 12-week weight loss diets, either the WELL with daily targets of four serves of fruit, four serves of vegetables and three serves of dairy or a low fat diet (LF) with general advice to increase fruit and vegetable intake. Three-day food group diaries and a food frequency questionnaire assessed intake. Results: Fifty-four overweight/obese male adults completed the study (WELL, n = 27; LF, n = 27; body mass index (mean ± standard deviation), 30.4 ± 2.5 kg/m 2 ; age, 47.7 ± 9.5 years). There was no difference in mean weight change between groups (WELL, −4.8 ± 3.3 kg; LF, −4.6 ± 3.1 kg). Subjects on the WELL diet had greater (mean difference ± standard error) fruit (0.7 ± 0.2 serves/day), vegetable (1.2 ± 0.2 serves/day) and dairy (1.1 ± 0.1 serves/day) intakes than the LF group (measured by the food group diaries) (all P Conclusions: Providing specific dietary targets to men for weight loss appears to promote greater consumption of fruit, vegetable and dairy foods than providing general dietary advice. Meeting dietary targets appears to require different adjustment periods depending on the food type.

One of the central sites of feminist literary history, A Room of One’s Own, begins by dismissing the idea of representing a group of famous authors: “a few remarks about Fanny Burney; a few more ab...

Background: Low iron intake can lead to iron deficiency, which can result in impaired health and iron-deficiency anemia. A mobile phone app, combining successful dietary strategies to increase bioavailable iron with strategies for behavior change, such as goal setting, monitoring, feedback, and resources for knowledge acquisition, was developed with the aim to increase bioavailable iron intake in premenopausal women. Objective: To evaluate the content, usability, and acceptability of a mobile phone app designed to improve intake of bioavailable dietary iron. Methods: Women aged 18-50 years with an Android mobile phone were invited to participate. Over a 2-week period women were asked to interact with the app. Following this period, semistructured focus groups with participants were conducted. Focus groups were audio recorded and analyzed via an inductive open-coding method using the qualitative analysis software NVivo 10. Themes were identified and frequency of code occurrence was calculated. Results: Four focus groups (n=26) were conducted (age range 19-36 years, mean 24.7, SD 5.2). Two themes about the app’s functionality were identified (frequency of occurrence in brackets): interface and design (134) and usability (86). Four themes about the app’s components were identified: goal tracker (121), facts (78), photo diary (40), and games (46). A number of suggestions to improve the interface and design of the app were provided and will inform the ongoing development of the app. Conclusions: This research indicates that participants are interested in iron and their health and are willing to use an app utilizing behavior change strategies to increase intake of bioavailable iron. The inclusion of information about the link between diet and health, monitoring and tracking of the achievement of dietary goals, and weekly reviews of goals were also seen as valuable components of the app and should be considered in mobile health apps aimed at adult women. [JMIR Mhealth Uhealth 2015;3(3):e92]

Protocols of systematic reviews and meta-analyses allow for planning and documentation of review methods, act as a guard against arbitrary decision making during review conduct, enable readers to assess for the presence of selective reporting against completed reviews, and, when made publicly available, reduce duplication of efforts and potentially prompt collaboration. Evidence documenting the existence of selective reporting and excessive duplication of reviews on the same or similar topics is accumulating and many calls have been made in support of the documentation and public availability of review protocols. Several efforts have emerged in recent years to rectify these problems, including development of an international register for prospective reviews (PROSPERO) and launch of the first open access journal dedicated to the exclusive publication of systematic review products, including protocols (BioMed Central’s Systematic Reviews). Furthering these efforts and building on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, an international group of experts has created a guideline to improve the transparency, accuracy, completeness, and frequency of documented systematic review and meta-analysis protocols—PRISMA-P (for protocols) 2015. The PRISMA-P checklist contains 17 items considered to be essential and minimum components of a systematic review or meta-analysis protocol.This PRISMA-P 2015 Explanation and Elaboration paper provides readers with a full understanding of and evidence about the necessity of each item as well as a model example from an existing published protocol. This paper should be read together with the PRISMA-P 2015 statement. Systematic review authors and assessors are strongly encouraged to make use of PRISMA-P when drafting and appraising review protocols

For the sake of inquiry, imagine a woman, Frances Milton Trollope (1779–1863), as a person in a network of the short biographies of women that circulated in books printed in Britain and North America in the nineteenth century. This persona is supposed to represent a historical individual with many documented relationships and activities. Most of the reasons for noting Frances Trollope today have to do with her role as a novelist, as the mother of writers, and as a travel writer. She gained international renown with her satiric documentary about the new republic, Domestic Manners of the Americans (1832), and subsequently published novels and travel narratives at an alarming rate that salvaged the family finances.1 Yet the woman known as “Mrs. Trollope” has not become the epitome of a Victorian woman writer.2 Her daughter-in-law Frances Eleanor Trollope’s two-volume biography, published in 1895, begins: “Forty years ago, any list of Englishwomen of Letters would have been held to be strangely incomplete without the name of Frances Trollope. Fashions change; reputations fade; books are forgotten.”3 Quite so, but there are also successive reconstructions of cultural periods and the careers of the once renowned.

Systematic reviews should build on a protocol that describes the rationale, hypothesis, and planned methods of the review; few reviews report whether a protocol exists. Detailed, well-described protocols can facilitate the understanding and appraisal of the review methods, as well as the detection of modifications to methods and selective reporting in completed reviews. We describe the development of a reporting guideline, the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015). PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. Similarly, peer reviewers and editors can use the guidance to gauge the completeness and transparency of a systematic review protocol submitted for publication in a journal or other medium.

Purpose The practice of radiographers performing double contrast barium enemas (DCBE) is now widespread and in many centres the radiographer's opinion is, at least, contributing to a dual reporting system [Bewell J, Chapman AH. Radiographer performed barium enemas – results of a survey to assess progress. Radiography 1996; 2 :199–205; Leslie A, Virjee JP. Detection of colorectal carcinoma on double contrast barium enema when double reporting is routinely performed: an audit of current practice. Clin Radiol 2001; 57 :184–7; Culpan DG, Mitchell AJ, Hughes S, Nutman M, Chapman AH. Double contrast barium enema sensitivity: a comparison of studies by radiographers and radiologists. Clin Radiol 2002; 57 :604–7]. To ensure this change in practice does not lead to an increase in reporting errors, this study aimed to compare the perception abilities of radiographers with those of radiologists. Methods Three gastro-intestinal (GI) radiographers and three consultant radiologists independently reported on a selection of 50 DCBE examinations, including the level of certainty in their comments for each examination. A blinded comparison of the results with an independent ‘standard report' was recorded. Results The results demonstrate there was no significant difference in perception error for any of the levels of certainty, for single reporting, for double reading by a radiographer/radiologist or by two radiologists. Conclusions The study shows that radiographers can perceive abnormalities on DCBE at similar sensitivities and specificities as radiologists. While the participants in the study may be typical of a district general hospital, the nature of the study gives it limited external validity. As a pilot, the results demonstrate that, with slight modification, the methodology could be used for a larger study.

Background: Weight loss reduces blood pressure, and the Dietary Approaches to Stop Hypertension (DASH) diet has also been shown to lower blood pressure. Objective: Our goal was to assess the effect on blood pressure of 2 weight-reduction diets: a low-fat diet (LF diet) and a moderate-sodium, high-potassium, high-calcium, low-fat DASH diet (WELL diet). Design: After baseline measurements, 63 men were randomly assigned to either the WELL or the LF diet for 12 wk, and both diet groups undertook 0.5 h of moderate physical activity on most days of the week. Results: Fifty-four men completed the study. Their mean (± SD) age was 47.9 ± 9.3 y (WELL diet, n = 27; LF diet, n = 27), and their mean baseline home systolic and diastolic blood pressures were 129.4 ± 11.3 and 80.6 ± 8.6 mm Hg, respectively. Body weight decreased by 4.9 ± 0.6 kg (±SEM) in the WELL group and by 4.6 ± 0.6 kg in the LF group (P < 0.001 for both). There was a greater decrease in blood pressure in the WELL group than in the LF group [between-group difference (week 12 -baseline) in both SBP (5.5 ± 1.9 mm Hg; P = 0.006) and DBP (4.4 ± 1.2 mm Hg; P = 0.001)]. Conclusions: For a comparable 5-kg weight loss, a diet high in low-fat dairy products, vegetables, and fruit (the WELL diet) resulted in a greater decrease in blood pressure than did the LF diet. This dietary approach to achieving weight reduction may confer an additional benefit in reducing blood pressure in those who are overweight. Am J Clin Nutr 2005-81:983-9.

This essay places Henry James's stories, "The Birthplace," "The Real Right Thing," and "The Death of the Lion," in relation to his travel writing (English Hours and American Notes) and his own home, Lamb House in Rye, Sussex, as aspects of his response to a tradition of literary homes and haunts. Washington Irving's Sketchbook and his home, Sunnyside, provide precedents for later American literary pilgrimages to Stratford on Avon such as that by the popular collector of homes of the great, Elbert Hubbard. Despising commercial intrusion into authors' lives, James revisited Sunnyside as a refuge for the American literary past while safeguarding his own literary shrine.

Go to the self-help section of the bookstore chain, and you face a welter of advice on everything you were never taught in kindergarten about your body, relationships, spiritual growth, and managing your investments and career. Similar concoctions of personality and money crowd the shelves of memoir and biography as well as fiction, in defiance of generic and disciplinary distinctions. The private is publicized, making hash of separate spheres. Whether the integration of the personal with the political and economic is a welcome or an alarming sign-and across the political spectrum it has been seen as both it is not so much a sign of these times. Self-fashioning has long been regarded as a trade secret. Victorian self-help modeled the entrepreneur, implicating the fundamentals of character in the principles of success. John Irving's The Cider House Rules (1985) revives the Victorian tradition of self-help, as though turning back the clock to a time when home and work were united and character spelled success. In The Cider House Rules, the hero's development is both accelerated and stalled by his enrollment in two hybrid institutions: an orphanage that doubles as an abortion hospital, and a cider house. Both locations, the two zones of Homer Wells's life so far, serve as home, school, workplace, death place, and Foucauldian carceral institutions, perhaps. Like factories they amass-and divide-labor (including reproductive labor) that might "naturally" have taken place in the private home: orphanage and cider house collapse the public and private spheres and simulate families in an

Objectives Social prescribing is a way of linking patients in primary care with sources of support within the community to help improve their health and well-being. Social prescribing programmes are being widely promoted and adopted in the UK National Health Service and so we conducted a systematic review to assess the evidence for their effectiveness. Setting/data sources Nine databases were searched from 2000 to January 2016 for studies conducted in the UK. Relevant reports and guidelines, websites and reference lists of retrieved articles were scanned to identify additional studies. All the searches were restricted to English language only. Participants Systematic reviews and any published evaluation of programmes where patient referral was made from a primary care setting to a link worker or facilitator of social prescribing were eligible for inclusion. Risk of bias for included studies was undertaken independently by two reviewers and a narrative synthesis was performed. Primary and secondary outcome measures Primary outcomes of interest were any measures of health and well-being and/or usage of health services. Results We included a total of 15 evaluations of social prescribing programmes. Most were small scale and limited by poor design and reporting. All were rated as a having a high risk of bias. Common design issues included a lack of comparative controls, short follow-up durations, a lack of standardised and validated measuring tools, missing data and a failure to consider potential confounding factors. Despite clear methodological shortcomings, most evaluations presented positive conclusions. Conclusions Social prescribing is being widely advocated and implemented but current evidence fails to provide sufficient detail to judge either success or value for money. If social prescribing is to realise its potential, future evaluations must be comparative by design and consider when, by whom, for whom, how well and at what cost. Trial registration number PROSPERO Registration: CRD42015023501.

BACKGROUND: Early treatment for rheumatoid arthritis (RA) is vital. However, people often delay in seeking help at symptom onset. An assessment of the reasons behind patient delay is necessary to develop interventions to promote rapid consultation. OBJECTIVE: Using a mixed methods design, we aimed to develop and test a questionnaire to assess the barriers to help seeking at RA onset. DESIGN: Questionnaire items were extracted from previous qualitative studies. Fifteen people with a lived experience of arthritis participated in focus groups to enhance the questionnaire's face validity. The questionnaire was also reviewed by groups of multidisciplinary health-care professionals. A test-retest survey of 41 patients with newly presenting RA or unclassified arthritis assessed the questionnaire items' intraclass correlations. RESULTS: During focus groups, participants rephrased questions, added questions and deleted items not relevant to the questionnaire's aims. Participants organized items into themes: early symptom experience, initial reactions to symptoms, self-management behaviours, causal beliefs, involvement of significant others, pre-diagnosis knowledge about RA, direct barriers to seeking help and relationship with GP. The test-retest survey identified seven items (out of 79) with low intraclass correlations which were removed from the final questionnaire. CONCLUSION: The involvement of people with a lived experience of arthritis and multidisciplinary health-care professionals in the preliminary validation of the DELAY (delays in evaluating arthritis early) questionnaire has enriched its development. Preliminary assessment established its reliability. The DELAY questionnaire provides a tool for researchers to evaluate individual, cultural and health service barriers to help-seeking behaviour at RA onset.

A striking feature of the past few decades has been the development of wage determination models that assume that labour markets are imperfectly competitive. This paper discusses two such models (trade unions and oligopsony), although there are many more. It also asks if imperfectly competitive models should be used whenever researchers are modelling the labour market. Some people would argue for this only in cases when the predictions and comparative statics of the imperfectly competitive model differ from those of the competitive model. Of course, to know this, one needs to know precisely what the predictions and comparative statics of the respective models are. Moreover, for policymakers to be able to determine if an intervention is required in the first place, there does need to be some analytical framework to act as a guide. In the perfectly competitive model of the labour markets, for example, typically no intervention or regulation would be justified. However, labour economics has moved far beyond this position, with the incorporation of new ideas into modeling wage determination in imperfectly competitive labour markets, and with the availability of better datasets to facilitate empirical investigation.

HAVING SURVIVED THE Y2K HYSTERIA, we may feel we have entered new corridors of one hundred and one thousand years. But it is only in 2001 that the punctilious and historical among us may at last observe a centennial, truly the final year of the past century and the hundredth anniversary of the death of Queen Victoria.1 The Jubilees in the last decades of Victoria’s life, and the ceremonies of international mourning that followed her death, might seem to have said goodbye to all that, but in many ways we are still under the sway of the great queen who lent her name to the age before “the American century.” Our own fin-de-siècle urges us to rediscover the many forms of Victoria that have “been hidden in plain view for a hundred years,” as Margaret Homans and Adrienne Munich put it in their co-edited collection of essays, Remaking Queen Victoria (1).2 While North American and British feminist studies have dwelt among Victorian ways since the 1970s — with implications that I will consider below — the queen herself has recently commanded critical attention that might seem, like so many features of Victoria’s public performance, out of proportion. Yet that excess, like our obeisance to the arbitrary power of the calendar, seems to be the very stuff of imagined community and ideological construction, and thus worth watching in action. In any case, when feminist literary critics such as Adrienne Munich, Margaret Homans, and Gail Turley Houston

Background: The Centre for Reviews and Dissemination (CRD) funded through the United Kingdom National Institute for Health Research undertakes systematic reviews evaluating the research evidence on health and public health questions of national and international importance. CRD is involved in methods research and produces internationally accepted guidelines for undertaking systematic reviews. A core product of the Centre are the CRD databases; a key resource for health professionals, policy makers, and researchers around the world. Research evidence evaluating the effects and cost-effectiveness of healthcare interventions is growing year on year, and can be difficult and time consuming to identify and appraise. The databases assist decision makers by systematically identifying and critically describing systematic reviews and economic evaluations, appraising their quality and highlighting their relative strengths and weaknesses; and providing a comprehensive listing of ongoing and published health technology assessments.Methods and Results: This article briefly outlines the processes behind each of the three databases, gives details of the records, the information they contain and the value added by CRD. An overview of the new public interface for the CRD databases to be launched later this year is given. Improvements and innovations to supplement existing functions are listed, including enhanced and new search options, the addition of quick links to relevant material from within individual records, an integrated PubMed search and the ability to select personal preferences.Conclusions: CRD's databases provide free access to an important knowledge base and are used widely to underpin evidence informed healthcare decisions in the United Kingdom and internationally.

PROSPERO is an international database of prospectively registered systematic reviews in health and social care. Between July 2012 and June 2013, 1,106 registrations were added, bringing the total since launch in February 2011 to 1,704. The value of the growing number of records is reflected in a 117% increase in page views in the first half of 2013 compared with the first half of 2012. Developments over the year included expansion of scope, improvement of the registration form and easier access to information on how to register.

Author(s): Alliston, April; Ammons, Elizabeth; Arnold, Jean; Baym, Nina; Beckett, Sandra L; Beidler, Peter G; Berger, Roger A; Bermann, Sandra; Wilson, J. J; Boone, Troy; Booth, Alison; Booth, Wayne C; Phelan, James; Borroff, Marie; Hassan, Ihab; Bowen, Zack; Weisstein, Ulrich; Campbell, Jill; Campion, Dan; Caplan, Jay; Charney, Maurice; Clark, Beverly Lyon; Colby, Robert A; Coleman, Thomas C; Cooley, Nicole; Dellamora, Richard; Dickstein, Morris; Dixon, Terrell; Elliott, Emory; Emerson, Caryl; Engar, Ann W; Engle, Lars; Hammermeister, Kai; Feltes, N. N; Ferguson, Mary Anne; Finch, Annie; Fishkin, Shelley Fisher; Flieger, Jerry Aline; Friedman, Norman; Garland-Thomson, Rosemarie; Gilbert, Sandra M; Grobman, Laurie; Guida, George; Gumpel, Liselotte; Gupta, R. K; Howe, Florence; Jrade, Cathy L; Kaye, Richard A; Winton, Calhoun; Krieger, Murray; Langbaum, Robert; Lanham, Richard A; Lindemann, Marilee; Lutzeler, Paul Michael; Lynn, Thomas J; MacCannell, Juliet Flower; Masse, Michelle A; Massey, Irving; May, Georges; Hallstein, Christian W; May, Gita; McDiarmid, Lucy; Messer-Davidow, Ellen; Mitchell, Koritha; Smiles, Robin; Albeny, Kenyatta; Monteiro, George; Myerson, Joel; Nadel, Alan; Nichols, Ashton; Nishimura, Jeffrey; Oxenhandler, Neal; Palumbo-Liu, David; Pecora, Vincent P; Porter, David; Potter, Nancy; Rosbottom, Ronald C; Rivers, Elias L; Strasser, Gerhard F; Styan, J. L; de Marco Torgovnick, Marianna; Totten, Gary; van Leer, David; Varadharajan, Asha; Wang, Orrin N. C | Abstract: In 1997 I was asked to organize humanities outreach activities at the University of California, Irvine. The result was the formation of Humanities Out There (HOT). In our workshops, faculty members and graduate students supervise teams of undergraduates in order to take the methods and materials of the university into the larger community.I believe that programs like these will become increasingly important in the next century, as economic, cultural, and educational divisions deepen in the wake of the demise of affirmative action and as the humanities fight to define their missions in a world driven by technology and its discontents. In this brave new world, what I call the new outreach may have a role to play in responding to social crises as they are visited on the life of the university. The new outreach will be driven by intellectual content, not public relations.It will take its orientation from the faculty rather than administrators. It will engage all the research disciplines rather than remain the purview of education departments. It will be integrated into the professional lives of its participants rather than rely on the spirit of volunteerism alone.

It is commonly assumed that women's lives remained largely hidden from history until their systematic recuperation by second-wave feminists. A glance through the annals of European arts and letters can yield the impression that women could audition for parts only as angels or viragos: much better or no better than they should be. Anna Brownell MurphyJameson (1794-1860), pioneering a form of feminist criticism in 1832, observed, "Women are illustrious in history, not from what they have been in themselves, but generally in proportion to the mischief they have done or caused" (Characteristics xviii). Like many recent feminist scholars, this early-Victorian woman of letters sought to supplant the stereotypes with her own models

Waugh is correct1—we cannot completely prevent unscrupulous use of content with an open register. However, there is no evidence that people are using PROSPERO records to plunder others’ ideas and scoop publication. But there are examples of unnecessary duplication being avoided, including the National Institute for Health Research Health Technology Assessment programme being able to allocate resources to an alternative review. For pragmatic reasons we have to …

Background PROSPERO, an international prospective register of systematic review protocols in health and social care, was launched in February 2011. After one year of operation we describe access and use, explore user experience and identify areas for future improvement. Methods We collated administrative data and web statistics and conducted an online survey of users’ experiences. Results On 21 February 2012, there were 1,076 registered users and 359 registration records published on PROSPERO. The database usage statistics demonstrate the international interest in PROSPERO with high access around the clock and around the world. Based on 232 responses from PROSPERO users (response rate 22%), almost all respondents found joining and navigation was easy or very easy (99%); turn round time was good or excellent (96%); and supporting materials provided were helpful or very helpful (80%). The registration fields were found by 80% to be relevant to their review; 99% rated their overall experience of registering with PROSPERO as good or excellent. Most respondents (81%) had a written protocol before completing the registration form and 19% did not. The majority, 136 (79%), indicated they completed the registration form in 60 minutes or less. Of those who expressed an opinion, 167 (87%) considered the time taken to be about right. Conclusions The first year of PROSPERO has shown that registration of systematic review protocols is feasible and not overly burdensome for those registering their reviews. The evaluation has demonstrated that, on the whole, survey respondents are satisfied and the system allows registration of protocol details in a straightforward and acceptable way. The findings have prompted some changes to improve user experience and identified some issues for future consideration.

Objective To identify the main areas of uncertainty and subsequent research priorities to inform the ongoing debate around assisted dying. Design Two-round electronic modified Delphi consultation with experts and interested bodies. Setting and participants 110 groups and individuals interested in the subject of end-of-life care and/or assisted dying were approached to participate. Respondents included health and social care professionals, researchers, campaigners, patients and carers predominantly based in the UK. In the first round, the respondents were asked to propose high-priority research questions related to the topic of assisted dying. The collected research questions were then deduplicated and presented to all respondents in a second round in which they could rate each question in terms of importance. Results 24% and 26% of participants responded to the first and second rounds, respectively. Respondents suggested 85 unique research questions in the first round. These were grouped by theme and rated in terms of importance in the second round. Emergent themes were as follows: palliative care/symptom control; patient characteristics, experiences and decisions; families and carers; society and the general public; arguments for and against assisted dying; international experiences/analysis of existing national data; suicide; mental health, psychological and psychosocial considerations; comorbidities; the role of clinicians; environment and external influences; broader topics incorporating assisted dying; and moral, ethical and legal issues. 10 of the 85 proposed questions were rated as being important (≥7/10) by at least 50% of respondents. Conclusions Research questions with the highest levels of consensus were predominantly concerned with understanding how and why people make end-of-life decisions, and which factors influence those decisions. Dissemination of these findings alongside a focused examination of the existing literature may be the most effective way to add evidence to the ongoing debate around assisted dying.