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Background: Sciatica is a common condition reported to affect > 3% of the UK population at any time and is most often caused by a prolapsed intervertebral disc. Currently, there is no uniformly adopted treatment strategy. Invasive treatments, such as surgery (i.e. microdiscectomy) and transforaminal epidural steroid injection, are often reserved for failed conservative treatment. Objective: To compare the clinical effectiveness and cost-effectiveness of microdiscectomy with transforaminal epidural steroid injection for the management of radicular pain secondary to lumbar prolapsed intervertebral disc for non-emergency presentation of sciatica of

Bluetooth monitoring systems (BTMS) have opened a new era in traffic sensing, providing a reliable, economical, and easy-to-deploy solution to uniquely identify vehicles. Raw data from BTMS have traditionally been used to calculate travel time and origin–destination matrices. However, we could extend this to include other information like the number of vehicles or their residence times. This information, together with their temporal components, can be applied to the complex task of forecasting traffic. Level of service (LOS) prediction has opened a novel research line that fulfills the need to anticipate future traffic states, based on a standard link-based variable, accepted for both researchers and practitioners. In this paper, we incorporate BTMS’s extended variables and temporal information to an LOS classifier based on a Random Undersampling Boost algorithm, which is proven to efficiently respond to the data unbalance intrinsic to this problem. By using this approach, we achieve an overall recall of 87.2% for up to 15-min prediction horizons, reaching 96.6% predicting congestion, and improving the results for the intermediate traffic states, especially complex given their intrinsic instability. Additionally, we provide detailed analyses on the impact of temporal information on the LOS predictor’s performance, observing improvements up to a separation of 50 min between last features and prediction horizons. Furthermore, we study the predictor importance resulting from the classifiers to highlight those features contributing the most to the final achievements.

Abstract 1. To be effective, the next generation of conservation practitioners and managers need to be critical thinkers with a deep understanding of how to make evidence‐based decisions and of the value of evidence synthesis. 2. If, as educators, we do not make these priorities a core part of what we teach, we are failing to prepare our students to make an effective contribution to conservation practice. 3. To help overcome this problem we have created open access online teaching materials in multiple languages that are stored in Applied Ecology Resources. So far, 117 educators from 23 countries have acknowledged the importance of this and are already teaching or about to teach skills in appraising or using evidence in conservation decision‐making. This includes 145 undergraduate, postgraduate or professional development courses. 4. We call for wider teaching of the tools and skills that facilitate evidence‐based conservation and also suggest that providing online teaching materials in multiple languages could be beneficial for improving global understanding of other subject areas.

Objectives The global distribution of health professionals and associated training programmes is wide but prior study has demonstrated reported scholarship of teaching and learning arises from predominantly Western perspectives.Design We conducted a document analysis to examine authorship of recent publications to explore current international representation.Data sources The table of contents of seven high-impact English-language health professional education journals between 2008 and 2018 was extracted from Embase.Eligibility criteria The journals were selected according to highest aggregate ranking across specific scientific impact indices and stating health professional education in scope; only original research and review articles from these publications were included for analysis.Data extraction and synthesis The table of contents was extracted and eligible publications screened by independent reviewers who further characterised the geographic affiliations of the publishing research teams and study settings (if applicable).Results A total 12 018 titles were screened and 7793 (64.8%) articles included. Most were collaborations (7048, 90.4%) conducted by authors from single geographic regions (5851, 86%). Single-region teams were most often formed from countries in North America (56%), Northern Europe (14%) or Western Europe (10%). Overall lead authorship from Asian, African or South American regions was less than 15%, 5% and 1%, respectively. Geographic representation varied somewhat by journal, but not across time.Conclusions Diversity in health professional education scholarship, as marked by nation of authors’ professional affiliations, remains low. Under-representation of published research outside Global North regions limits dissemination of novel ideas resulting in unidirectional flow of experiences and a concentrated worldview of teaching and learning.

Background: Targeted recruitment of students with disabilities is a novel area in pharmacy education and may help to attract qualified students in light of decreasing applicant numbers. The aim of this study was to explore the visibility of disabilities within online recruitment material for pharmacy programs and to determine the location of targeted information available to prospective students with disabilities. Methods: The top 50 ranked programs offering a professional pharmacy degree under the Pharmacy and Pharmacology QS subject rankings were identified and included if recruitment material was published in English. Online recruitment material was reviewed for presence of persons with disabilities in photos, presence or description of persons with disabilities in videos, information specific to disabilities on the program website (e.g. technical standards), and information specific to disabilities on the university website (if not located on the program website). Results: A total of 41 international program websites met the inclusion criteria. No programs included pictures or videos featuring persons with disabilities. A total of 18 (44%) of programs had disability information on the program website and an additional 18 (44%) of programs included information on the university website. There were 5 (12%) of programs that did not include any information about disabilities on the program or university website. Conclusion: Recruitment material for pharmacy degree programs should be current, inclusive, and reflective of student populations eligible to be admitted. This study found a distinct underrepresentation of students with disabilities and information pertaining to disabilities within recruitment material for a sample of international pharmacy programs. Article Type: Original Research

Abstract Sea level rise (SLR) and subsidence are expected to increase the risk of flooding and reliance on flood defenses for cities built on deltas. Here, we combine reliability analysis with hydrodynamic modeling to quantify the effect of projected relative SLR on dike failures and flood hazards for Shanghai, one of the most exposed delta cities. We find that flood inundation is likely to occur in low‐lying and poorly protected periurban/rural areas of the city even under the present‐day sea level. However, without adaptation measures, the risk increases by a factor of 3–160 across the densely populated floodplain under projected SLR to 2100. Impacts of frequent flood events are predicted to be more affected by SLR than those with longer return periods. Our results imply that including reliability‐based dike failures in flood simulations enables more credible flood risk assessment for global delta cities where conventional methods have assumed either overtopping only or complete failure.

Abstract Background Hypertension prevalence in young adults has increased and is associated with increased incidence of cerebrovascular and cardiovascular events in middle age. However, there is significant debate regards how to effectively manage young adult hypertension with recommendation to target lifestyle intervention. Surprisingly, no trials have investigated whether lifestyle advice developed for blood pressure control in older adults is effective in these younger populations. Methods/Design TEPHRA is an open label, parallel arm, randomised controlled trial in young adults with high normal and elevated blood pressure. The study will compare a supervised physical activity intervention consisting of 16 weeks structured exercise, physical activity self-monitoring and motivational coaching with a control group receiving usual care/minimal intervention. Two hundred young adults aged 18–35 years, including a subgroup of preterm born participants will be recruited through open recruitment and direct invitation. Participants will be randomised in a ratio of 1:1 to either the exercise intervention group or control group. Primary outcome will be ambulatory blood pressure monitoring at 16 weeks with measure of sustained effect at 12 months. Study measures include multimodal cardiovascular assessments; peripheral vascular measures, blood sampling, microvascular assessment, echocardiography, objective physical activity monitoring and a subgroup will complete multi-organ magnetic resonance imaging. Discussion The results of this trial will deliver a novel, randomised control trial that reports the effect of physical activity intervention on blood pressure integrated with detailed cardiovascular phenotyping in young adults. The results will support the development of future research and expand the evidence-based management of blood pressure in young adult populations. Trial Registration Clinicaltrials.gov registration number NCT02723552, registered on 30 March, 2016.

Abstract Background Sciatica is a common condition reported to affect over 3% of the UK population at any time and is often caused by a prolapsed intervertebral disc (PID). Although the duration and severity of symptoms can vary, pain persisting beyond 6 weeks is unlikely to recover spontaneously and may require investigation and treatment. Currently, there is no specific care pathway for sciatica in the National Health Service (NHS), and no direct comparison exists between surgical microdiscectomy and transforaminal epidural steroid injection (TFESI). The NERVES (NErve Root block VErsus Surgery) trial aims to address this by comparing clinical and cost-effectiveness of surgical microdiscectomy and TFESI to treat sciatica secondary to a PID. Methods/design A total of 163 patients were recruited from NHS out-patient clinics across the UK and randomised to either microdiscectomy or TFESI. Adult patients (aged 16–65 years) with sciatic pain endured for between 6 weeks and 12 months are eligible if their symptoms have not been improved by at least one form of conservative (non-operative) treatment and they are willing to provide consent. Patients will be excluded if they present with neurological deficit or have had previous surgery at the same level. The primary outcome is patient-reported disability measured using the Oswestry Disability Questionnaire (ODQ) score at 18 weeks post randomisation and secondary outcomes include disability and pain scales using numerical pain ratings, modified Roland-Morris and Core Outcome Measures Index at 12-weekly intervals, and patient satisfaction at 54 weeks. Cost-effectiveness and quality of life (QOL) will be assessed using the EQ-5D-5 L and self-report cost data at 12-weekly intervals and Hospital Episode Statistics (HES) data. Adverse event data will be collected. Analysis will follow the principle of intention-to-treat. Discussion NERVES is the first trial to evaluate the comparative clinical and cost-effectiveness of microdiscectomy to local anaesthetic and steroid administered via TFESI. The results of this research may facilitate the development of an evidence-based treatment strategy for patients with sciatica. Trial registration ISRCTN, ID: ISRCTN04820368. Registered on 5 June 2014. EudraCT EudraCT2014–002751-25. Registered on 8 October 2014.

A continuous 305-year (1711–2016) monthly rainfall series (IoI_1711) is created for the Island of Ireland. The post 1850 series draws on an existing quality assured rainfall network for Ireland, while pre-1850 values come from instrumental and documentary series compiled, but not published by the UK Met Office. The series is evaluated by comparison with independent long-term observations and reconstructions of precipitation, temperature and circulation indices from across the British–Irish Isles. Strong decadal consistency of IoI_1711 with other long-term observations is evident throughout the annual, boreal spring and autumn series. Annually, the most recent decade (2006–2015) is found to be the wettest in over 300 years. The winter series is probably too dry between the 1740s and 1780s, but strong consistency with other long-term observations strengthens confidence from 1790 onwards. The IoI_1711 series has remarkably wet winters during the 1730s, concurrent with a period of strong westerly airflow, glacial advance throughout Scandinavia and near unprecedented warmth in the Central England Temperature record – all consistent with a strongly positive phase of the North Atlantic Oscillation. Unusually wet summers occurred in the 1750s, consistent with proxy (tree-ring) reconstructions of summer precipitation in the region. Our analysis shows that inter-decadal variability of precipitation is much larger than previously thought, while relationships with key modes of climate variability are time-variant. The IoI_1711 series reveals statistically significant multi-centennial trends in winter (increasing) and summer (decreasing) seasonal precipitation. However, given uncertainties in the early winter record, the former finding should be regarded as tentative. The derived record, one of the longest continuous series in Europe, offers valuable insights for understanding multi-decadal and centennial rainfall variability in Ireland, and provides a firm basis for benchmarking other long-term records and reconstructions of past climate. Correlation of Irish rainfall with other parts of Europe increases the utility of the series for understanding historical climate in further regions.