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Maxine Cromar-Hayes,1 Carolyn Lees,1 Denis Parkinson,1 Karen Deane,2 Helen Marshall1 1School of Allied Health Professions and Nursing, University of Liverpool, Liverpool, Merseyside, UK; 2Mersey Care NHS Foundation Trust, Liverpool, Merseyside, UKCorrespondence: Helen Marshall; Maxine Cromar-Hayes, School of Allied Health and Nursing, Institute of Population Health, University of Liverpool, Whelan Building, the Quadrangle, Brownlow Hill, Liverpool, L69 3GB, UK, Email Helen.marshall@liverpool.ac.uk; Maxine.Cromar-Hayes@liverpool.ac.ukPurpose: There is a known inequality in the healthcare provision for people with a learning disability, they have a poorer experience and a higher mortality rate than the general population. All registered health and social care organisations are required to provide training for staff in learning disability and autism, including how to communicate effectively and to provide reasonable adjustments. It has been suggested that this training needs to be available to those completing their nursing degrees.Methods: Focus groups were conducted with 21 adult nursing students. The qualitative data collected was analysed using a thematic framework to identify the main factors that contributed to how adult nursing students cared for those adults with a learning disability while on a clinical placement.Results: Generally, participants felt unprepared to care for adults with a learning disability. They described how they lacked knowledge and confidence, yet increased time on clinical placement was a facilitator to improving this. Role modelling of confident healthcare staff and personal experiences of having a relative with a learning disability all positively contributed to increasing confidence. Simulated practice and learning from those with lived experience were cited as a mechanism to enhance their knowledge. Communication with patients and between healthcare staff and families was seen as integral to being able to provide patient centred care.Conclusion: In a bid to ensure that those people with a learning disability have access to adequately skilled healthcare staff, adult nursing students need to be better prepared to provide care while on clinical placements. This will involve universities, clinical practice partners and those with a learning disability working together to collaboratively focus on training and education that develops confidence, knowledge and understanding which will then translate to excellent patient care.Keywords: intellectual disabilities, practice learning, nursing education

Background: Universal well-child health nursing services in high-resource countries promote the health and well-being of children and families while preventing health inequities. The COVID-19 pandemic and technological advancements have led to the increased use of telehealth in this field. To enhance policies and practices, it's important to understand the acceptability and effectiveness of telehealth, as well as the barriers and enablers to its implementation, and to determine when its use is appropriate and safe. Objective: To explore the global evidence on the use of telehealth in well-child health settings within high-income countries. Focussing on the effectiveness and acceptability of telehealth, along with the factors affecting its implementation and the considerations for safety from the perspectives of both providers and families. Design: A mixed methods systematic review Methods: A systematic review was conducted following PRISMA guidelines. The inclusion criteria for the review included: primary research papers written in English, conducted in high-income countries, focused on telehealth in the well-child health setting, and involving children under six years of age. The search, which was completed in July 2023, systematically explored the CINAHL, ProQuest Central, PubMed, and Web of Science bibliographic databases. Studies were critically appraised for quality, and relevant data extracted. A convergent segregated approach was employed to synthesise both quantitative and qualitative data, which is presented in a narrative format. Results: A total of 4,354 records were identified and screened, and 169 full-text papers were assessed for eligibility, resulting in 20 papers for inclusion. Telehealth acceptability among families was reported in 13 of the 20 studies reviewed, with participants expressing high satisfaction regarding its use as a complement to standard care. Only three studies examined practitioners' acceptance, revealing mixed responses. Effectiveness was observed in 15 studies, with no significant differences found between the control and telehealth groups, suggesting that telehealth may achieve outcomes like those of standard care. Four studies identified both enablers and barriers to the implementation of telehealth, though none addressed concerns regarding safety and appropriateness. Conclusions: Telehealth shows promise for well-child health services, but there is limited evidence of its effectiveness and safety. The COVID-19 pandemic increased its use, yet risks need further exploration. To validate telehealth in this field, we must identify effective applications, tackle implementation barriers, and ensure client safety. Additional research is essential for developing evidence-based policies for future practices.

The COVID-19 outbreak and subsequent public health interventions have depressed demand and disrupted supply chains for many fishing businesses. This paper provides an analysis of the COVID-19 impacts on the profitability of the EU fishing fleets. Nowcasting techniques were used to estimate the impact of the COVID-19 pandemic on the economic performance for the EU fishing fleet in 2020 and 2021. Our results show that the economic impact of COVID-19 on this sector was smaller than initially expected and overall profits remained positive. This was in part due to low fuel prices that reduced operating costs of fishing, and the early response from governments to support the sector. The results vary by fishing fleet, revealing that small-scale fleets and the fleets in the Mediterranean and Black seas have been more impacted than large-scale fleets and the fleets in the Northeast Atlantic.

While empirical studies of research ethics and integrity are increasingly common, few have aimed at national scope, and even fewer at current results from Central and Eastern Europe. This article introduces the results of the first national research integrity survey in Estonia, which included all research-performing organisations in Estonia, was inclusive of all disciplines and all levels of experience. A web-based survey was developed and carried out in Estonia with a call sent to all accredited Estonian research institutions. The results indicate that the vast majority (89%) of respondents consider research ethics and integrity issues important and view falsification, fabrication, and plagiarism (FFPs) as the most severe forms of misconduct. Self-reporting of FFPs is generally comparable to levels published in other studies (6.2%). Gift authorship (41%) and hampering the work of a colleague (32%) were problematic practices most noticed among colleagues. At the same time, two of the noticed questionable research practices (QRPs) - salami-slicing and misuse of research funding -- were seen as less severe, hinting at the existence of counter-norms that career advancement rules and structural factors like funding policies may encourage. The availability of research ethics and integrity guidelines was considered good. Ethical aspects of studying potentially stigmatising data in a very small research community are discussed in the article and results are analysed through counter-norms andc normative dissonance frames.

Liquid-alkaline water electrolyzers (LAWEs) use electricity to drive the conversion of water to H2 and O2 gas. These devices benefit from the use of low-cost nickel electrodes and metal-oxide separators, but suffer from lower current densities and higher cell voltages than proton-exchange-membrane water electrolyzers. Identifying the inefficiencies that result in this poor performance is key to mitigating losses and optimizing LAWEs. Here, we report an experimentally-validated 1-D continuum model of a LAWE that elucidates the gradients within the cell, simulates H2 crossover, and projects the energy improvements made possible by modulating the properties of the electrodes and separator. The model captures the Nernstian polarization losses and the distribution of gas- and liquid-phases within the electrodes, enabling quantification of energy losses associated with kinetic, ohmic, and bubble-induced (mass-transport) resistances. Simulations demonstrate that LAWE can achieve energy intensities of 50 kWh kg−1 of H2 at 1 A cm−2 using improved electrode and separator properties.

Genetic testing has the potential to revolutionize primary care, but few health systems have developed the infrastructure to support precision population medicine applications or attempted to evaluate its impact on patient and provider outcomes. In 2018, Sanford Health, the nation’s largest rural nonprofit health care system, began offering genetic testing to its primary care patients. To date, more than 11,000 patients have participated in the Sanford Chip Program, over 90% of whom have been identified with at least one informative pharmacogenomic variant, and about 1.5% of whom have been identified with a medically actionable predisposition for disease. This manuscript describes the rationale for offering the Sanford Chip, the programs and infrastructure implemented to support it, and evolving plans for research to evaluate its real-world impact.