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Summary: Surgical decision‐making after SARS‐CoV‐2 infection is influenced by the presence of comorbidity, infection severity and whether the surgical problem is time‐sensitive. Contemporary surgical policy to delay surgery is informed by highly heterogeneous country‐specific guidance. We evaluated surgical provision in England during the COVID‐19 pandemic to assess real‐world practice and whether deferral remains necessary. Using the OpenSAFELY platform, we adapted the COVIDSurg protocol for a service evaluation of surgical procedures that took place within the English NHS from 17 March 2018 to 17 March 2022. We assessed whether hospitals adhered to guidance not to operate on patients within 7 weeks of an indication of SARS‐CoV‐2 infection. Additional outcomes were postoperative all‐cause mortality (30 days, 6 months) and complications (pulmonary, cardiac, cerebrovascular). The exposure was the interval between the most recent indication of SARS‐CoV‐2 infection and subsequent surgery. In any 6‐month window, < 3% of surgical procedures were conducted within 7 weeks of an indication of SARS‐CoV‐2 infection. Mortality for surgery conducted within 2 weeks of a positive test in the era since widespread SARS‐CoV‐2 vaccine availability was 1.1%, declining to 0.3% by 4 weeks. Compared with the COVIDSurg study cohort, outcomes for patients in the English NHS cohort were better during the COVIDSurg data collection period and the pandemic era before vaccines became available. Clinicians within the English NHS followed national guidance by operating on very few patients within 7 weeks of a positive indication of SARS‐CoV‐2 infection. In England, surgical patients' overall risk following an indication of SARS‐CoV‐2 infection is lower than previously thought. [ABSTRACT FROM AUTHOR]

As a well-adapted plant to dry soil and short growing seasons, common millet holds great potential as a drought-resistant crop. Here, we performed a comparative RNA-Seq analysis of two common millet genotypes, Huangmizi (tolerant) and Zhenyuandamizi (sensitive) grown under stress conditions (20% Polyethylene Glycol 6000 with an average molecular weight of ~5,400-7,000 solution). Leaves of seedling plants were harvested from a control and also after 1 and 3 h stress treatment and pooled for RNA isolation. Using Illumina paired-end sequencing, approximately 46.5 million clean reads were generated. Following a de novo assembly, a total of 42,240 Unigenes were obtained. A total of 2,301 SSRs and 1,447,148 SNPs were also identified and 75% of Unigenes were annotated. A total of 21,556 and 8,304 Unigenes aligned to the GO and COG databases, respectively. The GO classification showed that the Unigenes were distributed into three categories with 74.30% having biological functions, 76.51% having molecular functions and 79.30% having cellular-level functions. By cross-referencing against KEGGs, 5,535 Unigenes were assigned to 63 metabolic pathways. Additionally, 701 DEGs including 187 up-regulated and 514 down-regulated genes were detected. Transcripts identified in this study will accelerate our understanding of the molecular mechanisms of drought tolerance in common millet. [ABSTRACT FROM AUTHOR]

The relationship between pre-operative isolation and patient outcomes is confounded by (or in the context of) societal isolation guidance, which was not explicitly modelled (i.e. it is an unmeasured confounder). The recent publication by the GlobalSurg and COVIDSurg collaboratives is likely to influence care for millions of surgical patients [1]. The study's finding that pre-operative isolation is associated with poor outcomes is confounded by the fact that, in accordance with societal guidance, patients who were older and had more comorbidities were generally expected to isolate more than young and relatively fit patients. [Extracted from the article]

Reliable population DNA molecular markers are difficult to develop for molluscs, the reasons for which are largely unknown. Identical protocols for microsatellite marker development were implemented in three gastropods. Success rates were lower for Gibbula cineraria compared to Littorina littorea and L. saxatilis. Comparative genomic analysis of 47.2 kb of microsatellite containing sequences (MCS) revealed a high incidence of cryptic repetitive DNA in their flanking regions. The majority of these were novel, and could be grouped into DNA families based upon sequence similarities. Significant inter-specific variation in abundance of cryptic repetitive DNA and DNA families was observed. Repbase scans show that a large proportion of cryptic repetitive DNA was identified as transposable elements (TEs). We argue that a large number of TEs and their transpositional activity may be linked to differential rates of DNA multiplication and recombination. This is likely to be an important factor explaining inter-specific variation in genome stability and hence microsatellite marker development success rates. Gastropods also differed significantly in the type of TEs classes (autonomous vs non-autonomous) observed. We propose that dissimilar transpositional mechanisms differentiate the TE classes in terms of their propensity for transposition, fixation and/or silencing. Consequently, the phylogenetic conservation of non-autonomous TEs, such as CvA, suggests that dispersal of these elements may have behaved as microsatellite-inducing elements. Results seem to indicate that, compared to autonomous, non-autonomous TEs maybe have a more active role in genome rearrangement processes. The implications of the findings for genomic rearrangement, stability and marker development are discussed. [ABSTRACT FROM AUTHOR]

This article examines the role of social/poverty impact assessment in contributing to the shaping of policy at a local level in Ireland. In doing so, it briefly describes the broader impact assessment landscape internationally, presenting key definitions and identifying underlying principles. From this the article highlights the key elements of social impact assessment, proposing a three-phase process to guide consideration of impact assessment, namely a pre-assessment phase, an assessment phase and a post-assessment phase. An analysis of these different phases then allows for a range of technical and more ‘theological’ assessment complexities to be presented. With this background in place, the article moves on to examine the local-level experience in Ireland. It acknowledges the highly innovative nature of poverty proofing as originally introduced in 1998 and retitled poverty impact assessment following a 2006 review by the Office for Social Inclusion. However, it points to the low level of engagement with poverty impact assessment processes at local level and suggests that poverty impact assessments have become largely subservient to other forms of impact assessment, particularly strategic environmental assessment. The article concludes that the local level does offer an important space for the practice of poverty impact assessment, but is unlikely to do so without the provision of appropriate capacity and resources, or without it being hardwired as a legislative obligation, albeit accompanied by mechanisms to sensitise and incentivise policymakers towards its usage.

Financing of mental health care has changed radically, especially with managed care. Shrinking revenues have forced providers to look for creative ways in which to provide quality services at less expense. Delivery of quality services depends largely on the productive use of the provider's prime resource--the clinicians. Productivity was the focus of the PC-based decision support system developed for mental health providers in New York State. It enables administrators to track key indicators of productivity such as face-to-face time and non-face-to-face time against goals. Unmet goals can be pinpointed quickly, and clinicians' caseloads can be reviewed to determine the underlying causes. A key feature of the system is the conversion of raw data into actionable information to help in problem finding and problem solving. The system has been implemented in Ulster County, the pilot site for the project. The software can be customized easily to suit the data of other providers. [ABSTRACT FROM AUTHOR]

Abstract Background The assessment of those presenting to prison in-reach and court diversion services and those referred for admission to mental health services is a triage decision, allocating the patient to the appropriate level of therapeutic security. This is a critical clinical decision. We set out to improve on unstructured clinical judgement. We collated qualitative information and devised an 11 item structured professional judgment instrument for this purpose then tested for validity. Methods All those assessed following screening over a three month period at a busy remand committals prison (n = 246) were rated in a retrospective cohort design blind to outcome. Similarly, all those admitted to a mental health service from the same prison in-reach service over an overlapping two year period were rated blind to outcome (n = 100). Results The 11 item scale had good internal consistency (Cronbach's alpha = 0.95) and inter-rater reliability. The scale score did not correlate with the HCR-20 'historical' score. For the three month sample, the receiver operating characteristic area under the curve (AUC) for those admitted to hospital was 0.893 (95% confidence interval 0.843 to 0.943). For the two year sample, AUC distinguished at each level between those admitted to open wards, low secure units or a medium/high secure service. Open wards v low secure units AUC = 0.805 (95% CI 0.680 to 0.930); low secure v medium/high secure AUC = 0.866, (95% CI 0.784 to 0.949). Item to outcome correlations were significant for all 11 items. Conclusions The DUNDRUM-1 triage security scale and its items performed to criterion levels when tested against the real world outcome. This instrument can be used to ensure consistency in decision making when deciding who to admit to secure forensic hospitals. It can also be used to benchmark admission thresholds between services and jurisdictions. In this study we found some divergence between assessed need and actual placement. This provides fertile ground for future research as well as practical assistance in assessing unmet need, auditing case mix and planning care pathways.

Background: Hospital 'command centres' use digital technologies to collect, analyse and present real-time information that may improve patient flow and patient safety. Bradford Royal Infirmary has trialled this approach and presents an opportunity to evaluate effectiveness to inform future adoption in the United Kingdom., Objective: To evaluate the impact of the Bradford Command Centre on patient care and organisational processes., Design: A comparative mixed-methods study. Operational data from a study and control site were collected and analysed. The intervention was observed, and staff at both sites were interviewed. Analysis was grounded in a literature review and the results were synthesised to form conclusions about the intervention., Setting: The study site was Bradford Royal Infirmary, a large teaching hospital in the city of Bradford, United Kingdom. The control site was Huddersfield Royal Infirmary in the nearby city of Huddersfield., Participants: Thirty-six staff members were interviewed and/or observed., Intervention: The implementation of a digitally enabled hospital command centre., Main Outcome Measures: Qualitative perspectives on hospital management. Quantitative metrics on patient flow, patient safety, data quality., Data Sources: Anonymised electronic health record data. Ethnographic observations including interviews with hospital staff. Cross-industry review including relevant literature and expert panel interviews., Results: The Command Centre was implemented successfully and has improved staff confidence of better operational control. Unintended consequences included tensions between localised and centralised decision-making and variable confidence in the quality of data available. The Command Centre supported the hospital through the COVID-19 pandemic, but the direct impact of the Command Centre was difficult to measure as the pandemic forced all hospitals, including the study and control sites, to innovate rapidly. Late in the study we learnt that the control site had visited the study site and replicated some aspects of the command centre themselves; we were unable to explore this in detail. There was no significant difference between pre- and post-intervention periods for the quantitative outcome measures and no conclusive impact on patient flow and data quality. Staff and patients supported the command-centre approaches but patients expressed concern that individual needs might get lost to 'the system'., Conclusions: Qualitative evidence suggests the Command Centre implementation was successful, but it proved challenging to link quantitative evidence to specific technology interventions. Staff were positive about the benefits and emphasised that these came from the way they adapted to and used the new technology rather than the technology per se., Limitations: The COVID-19 pandemic disrupted care patterns and forced rapid innovation which reduced our ability to compare study and control sites and data before, during and after the intervention., Future Work: We plan to follow developments at Bradford and in command centres in the National Health Service in order to share learning. Our mixed-methods approach should be of interest to future studies attempting similar evaluation of complex digitally enabled whole-system changes., Study Registration: The study is registered as IRAS No.: 285933., Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129483) and is published in full in Health and Social Care Delivery Research ; Vol. 12, No. 41. See the NIHR Funding and Awards website for further award information.

Background: Gestational trophoblastic disease (GTD) is an uncommon but highly treatable condition. There is limited local evidence to guide therapy., Aims: To report the experience of a statewide registry in the treatment of low-risk gestational trophoblastic neoplasia (GTN) over a 20-year period., Materials and Methods: A retrospective review of the prospectively maintained GTD registry database was conducted. There were 144 patients identified with low-risk GTN, of which 115 were analysed. Patient demographics, treatment details and outcomes, including development of resistance, toxicity or relapse were reviewed., Results: The incidence of GTD was 2.6/1000 live births. There was 100% survival. The mean time from diagnosis to commencing treatment was 1.9 days (range 0-29 days). Seventy-seven percent of patients treated with methotrexate achieved complete response. Thirteen patients (11.3%) required multi-agent chemotherapy, for the treatment of resistant or relapsed disease. There was a higher rate of treatment resistance in those with World Health Organization (WHO) risk scores 5-6 (odds ratio (OR) 6.56, 95% CI 1.73-24.27, P = 0.005) and those with pre-treatment human chorionic gonadotropin >10 000 (OR 4.00 95% CI 1.73-24.27 P = 0.007). Four patients (3.5%) were diagnosed with choriocarcinoma after commencing treatment. Nine patients (7.8%) had successful surgical treatment for GTN, both alone and in combination with chemotherapy. The relapse rate was 4.3%; all were treated successfully with a combination of chemotherapy and surgery, and 93.9% of patients completed follow up through the registry., Conclusions: Methotrexate is a highly effective treatment for low-risk GTN, especially with WHO risk score ≤4. The optimal treatment for those with risk scores of 5-6 requires further investigation., (© 2023 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Introduction: Pelvic girdle pain is a common problem experienced during pregnancy, with high incidence rates and significant impacts on quality of life. Remedial massage might be able to provide some reduction in pain., Aim: This study aimed to investigate the feasibility of conducting a randomised controlled trial on the effectiveness of massage in treating pregnant women with pelvic girdle pain to determine its merits and viability for use in a large-scale study., Methods: A two-arm pilot randomised feasibility crossover-controlled trial. The two treatment phases were a) remedial pregnancy massage, and b) exercise., Results: Twenty-four women started the study and 19 women completed the study. Data were collected on recruitment and retention rates, crossover study design methodology, participant sub-characteristics, and acceptability of the outcome measures (pain, quality of life, and disability)., Conclusion: Recruiting participants for a pregnancy-related pelvic girdle pain study is indeed feasible; however, a crossover study design is not appropriate and future studies should consider a mixed methods study design., Competing Interests: CONFLICT OF INTEREST NOTIFICATION SF is a practicing massage therapist and business owner. KV is a practising physiotherapist and a business owner. CM is the owner of Pregnancy Massage Australia who funded the study. CM was not involved in the study design, implementation of the study nor the data analysis. The other authors declare no conflict of interest., (Copyright© The Author(s) 2023. Published by the Massage Therapy Foundation.)

Tactical positioning is essential for success in short-track speed skating as the race format (direct, head-to-head competition over multiple laps) prioritises finishing position over finishing time. Despite this, current research into tactical positioning treats the race's laps as discrete, independent events. Accordingly, the aggregate metrics used to summarise each lap's tactical positioning behaviour do not allow us to explore the sequential nature of the data, e.g., Lap 2 occurs after Lap 1 and before Lap 3. Here, we capture the sequential relationships between laps to investigate tactical positioning behaviours in short-track speed skating. Using intermediate and final rankings from 500 m, 1,000 m, and 1,500 m elite short-track races, we analyse whole-race and sub-race race sequences of group and winner tactical positioning behaviours. This approach, combined with a large dataset of races collected over eight seasons of competition ( n  = 4,135), provides the most rigorous and comprehensive description of tactical positioning behaviours in short-track speed skating to date. Our results quantify the time-evolving complexity of tactical positioning, offer new thoughts on race strategy, and can help practitioners design more representative learning tasks to enhance skill transfer.

In short-track speed skating, tactical positioning is essential for success as the race format (head-to-head) prioritises finishing position over finishing time. At present, our understanding of this phenomenon is based on measuring the similarity between athletes' intermediate and final rankings. However, as this approach groups athlete performances across races, each lap's estimate of tactical importance ignores the athlete-opponent interactions specific to each race. Here, we examine the utility of race-specific athlete-opponent interactions for investigating tactical positioning. Using intermediate and final rankings of elite 1,000 m short-track speed skating competitors collected from 2010/11-2017/18 (n = 6,196, races = 1,549), we compared the current method to a novel approach that accounted for race-specific athlete-opponent interactions. This approach first applied the current method to each race independently before using these values to form (1) discrete, empirical distributions of each lap's tactical importance and (2) race-specific tactical positioning sequences. Our results showed that accounting for race-specific athlete-opponent interactions provided a higher measurement granularity (i.e. level of detail) for investigating tactical positioning in short-track speed skating, which better captured the complexity of the phenomenon. We observed 61 different tactical positioning behaviours and 1,269 unique tactical positioning sequences compared to the current approach's nine-point estimates of tactical positioning importance. For this reason, we recommend that researchers and practitioners account for race-specific athlete-opponent interactions in the future as it offers a deeper understanding of tactical positioning that will enhance both strategic and tactical decisions. Highlights We compare the current approach for investigating tactical positioning to a novel approach that accounts for race-specific athlete-opponent interactions.We show that accounting for race-specific athlete-opponent interactions provides a higher measurement granularity (i.e. level of detail) for investigating tactical positioning in short-track speed skating.We demonstrate that this increased measurement granularity can facilitate a deeper understanding of tactical positioning by (1) producing theoretically-more-correct point estimates of tactical positioning importance, (2) enabling more rigorous statistical analyses into the effect of athlete-environment interactions on tactical positioning behaviour, and (3) allowing sequential analyses that capture the progressive relationships between laps.We recommend that researchers and practitioners account for race-specific athlete-opponent interactions in future investigations, as the findings will enhance analyst, coach, and athlete preparation for the strategic and tactical decision-making process essential for success in short-track.

Objective: To prospectively compare long-term lower gastrointestinal function before and after laparoscopic surgery for deep endometriosis (DE)., Methods: In this prospective observational study we followed 149 patients with confirmed DE who were treated surgically. Patients completed the International Consultation on Incontinence Questionnaire Anal Incontinence Symptoms and Quality of Life Module (ICIQ-B) before surgery, and 6 weeks, 6 months, and 12 months after surgery. Bowel pattern, bowel control, and bowel impact on quality of life summary scores were compared before and after surgery., Results: Bowel pattern score showed an increasing improvement at all time points after surgery, from a mean pre-operation score of 4.8 ± 2.0 to 4.4 ± 1.8 at 6 weeks, 4.2 ± 1.8 at 6 months, and 4.2 ± 1.2 at 12 months. Bowel impact on quality of life significantly improved from pre-surgery mean score of 5.5 ± 6.0 to 4.2 ± 5.5 at 6 weeks and 4.4 ± 5.4 at 6 months. Direct lower gastrointestinal endometriosis involvement and worse initial function were associated with larger improvements in scores following surgery., Conclusions: Lower gastrointestinal function significantly improved after surgical treatment of DE. Further research is needed to confirm our findings and to better characterize the sub-groups of patients for whom surgery will have a beneficial effect on their bowel function., (© 2022 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

The fourth industrial revolution is based on cyber-physical systems and the connectivity of devices. It is currently unclear what the consequences are for patient safety as existing digital health technologies become ubiquitous with increasing pace and interact in unforeseen ways. In this paper, we describe the output from a workshop focused on identifying the patient safety challenges associated with emerging digital health technologies. We discuss six challenges identified in the workshop and present recommendations to address the patient safety concerns posed by them. A key implication of considering the challenges and opportunities for Patient Safety Informatics is the interdisciplinary contribution required to study digital health technologies within their embedded context. The principles underlying our recommendations are those of proactive and systems approaches that relate the social, technical and regulatory facets underpinning patient safety informatics theory and practice.

Introduction: More people are living with and beyond a cancer diagnosis. There is limited understanding of the long-term effects of cancer and cancer treatment on quality of life and personal and household finances when compared to people without cancer. In a separate protocol we have proposed to link de-identified data from electronic primary care and hospital records for a large population of cancer survivors and matched controls. In this current protocol, we propose the linkage of Patient Reported Outcomes Measures data to the above data for a subset of this population. The aim of this study is to investigate the full impact of living with and beyond a cancer diagnosis compared to age and gender matched controls. A secondary aim is to test the feasibility of the collection of Patient Reported Outcomes Measures (PROMS) data and the linkage procedures of the PROMs data to electronic health records data., Materials and Methods: This is a cross-sectional study, aiming to recruit participants treated at the Leeds Teaching Hospitals National Health Service Trust. Eligible patients will be cancer survivors at around 5 years post-diagnosis (breast, colorectal and ovarian cancer) and non-cancer patient matched controls attending dermatology out-patient clinics. They will be identified by running a query on the Leeds Teaching Hospitals Trust patient records system. Approximately 6000 patients (2000 cases and 4000 controls) will be invited to participate via post. Participants will be invited to complete PROMs assessing factors such as quality of life and finances, which can be completed on paper or online (surveys includes established instruments, and bespoke instruments (demographics, financial costs). This PROMs data will then be linked to routinely collected de-identified data from patient's electronic primary care and hospital records., Discussion: This innovative work aims to create a truly 'comprehensive patient record' to provide a broad picture of what happens to cancer patients across their cancer pathway, and the long-term impact of cancer treatment. Comparisons can be made between the cases and controls, to identify the aspects of life that has had the greatest impact following a cancer diagnosis. The feasibility of linking PROMs data to electronic health records can also be assessed. This work can inform future support offered to people living with and beyond a cancer diagnosis, clinical practice, and future research methodologies., Competing Interests: The authors have declared that no competing interests exist.

Introduction: This paper presents a mixed-methods study protocol that will be used to evaluate a recent implementation of a real-time, centralised hospital command centre in the UK. The command centre represents a complex intervention within a complex adaptive system. It could support better operational decision-making and facilitate identification and mitigation of threats to patient safety. There is, however, limited research on the impact of such complex health information technology on patient safety, reliability and operational efficiency of healthcare delivery and this study aims to help address that gap., Methods and Analysis: We will conduct a longitudinal mixed-method evaluation that will be informed by public-and-patient involvement and engagement. Interviews and ethnographic observations will inform iterations with quantitative analysis that will sensitise further qualitative work. Quantitative work will take an iterative approach to identify relevant outcome measures from both the literature and pragmatically from datasets of routinely collected electronic health records., Ethics and Dissemination: This protocol has been approved by the University of Leeds Engineering and Physical Sciences Research Ethics Committee (#MEEC 20-016) and the National Health Service Health Research Authority (IRAS No.: 285933). Our results will be communicated through peer-reviewed publications in international journals and conferences. We will provide ongoing feedback as part of our engagement work with local trust stakeholders., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

RNA-sequencing (RNA-seq) is a relatively new technology that lacks standardisation. RNA-seq can be used for Differential Gene Expression (DGE) analysis, however, no consensus exists as to which methodology ensures robust and reproducible results. Indeed, it is broadly acknowledged that DGE methods provide disparate results. Despite obstacles, RNA-seq assays are in advanced development for clinical use but further optimisation will be needed. Herein, five DGE models (DESeq2, voom + limma, edgeR, EBSeq, NOISeq) for gene-level detection were investigated for robustness to sequencing alterations using a controlled analysis of fixed count matrices. Two breast cancer datasets were analysed with full and reduced sample sizes. DGE model robustness was compared between filtering regimes and for different expression levels (high, low) using unbiased metrics. Test sensitivity estimated as relative False Discovery Rate (FDR), concordance between model outputs and comparisons of a 'population' of slopes of relative FDRs across different library sizes, generated using linear regressions, were examined. Patterns of relative DGE model robustness proved dataset-agnostic and reliable for drawing conclusions when sample sizes were sufficiently large. Overall, the non-parametric method NOISeq was the most robust followed by edgeR, voom, EBSeq and DESeq2. Our rigorous appraisal provides information for method selection for molecular diagnostics. Metrics may prove useful towards improving the standardisation of RNA-seq for precision medicine., Competing Interests: Professor Richard Kennedy receives payment as the medical director for Almac Diagnostic Services, M.S.T has recently received honoraria for advisory work in relation to the following companies: Incyte, MindPeak, QuanPathDerivatives and MSD. He is part of academia-industry consortia supported by the UK government (Innovate UK). These are all unrelated to this work. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors.)

The area of process change over time is a particular concern in healthcare, where patterns of care emerge and evolve in response to individual patient needs. We propose a structured approach to analyse process change over time that is suitable for the complex domain of healthcare. Our approach applies a qualitative process comparison at three levels of abstraction: a holistic perspective (process model), a middle-level perspective (trace), and a fine-grained detail (activity). Our aim was to detect change points, localise and characterise the change, and unravel/understand the process evolution. We illustrate the approach using a case study of cancer pathways in Leeds where we found evidence of change points identified at multiple levels. In this paper, we extend our study by analysing the miners used in process discovery and providing a deeper analysis of the activity of investigation in trace and activity levels. In the experiment, we show that this qualitative approach provides a useful understanding of process change over time. Examining change at three levels provides confirmatory evidence of process change where perspectives agree, while contradictory evidence can lead to focused discussions with domain experts. This approach should be of interest to others dealing with processes that undergo complex change over time.

Background: Pregnancy-related pelvic girdle pain (PPGP) significantly impacts women's lives both physically and psychologically. Given the severity and impact of PPGP on pregnancy, the authors anticipated that pregnant women with PPGP might respond differently to massage than pregnant women without PPGP., Purpose: The aim of the study was to further analyze a published 2017 study to assess the response of pregnancy massage in participants with and without PPGP., Setting: Two massage clinics, one in Sydney and one in Melbourne, recruited participants from December 2016 to December 2017., Participants: Nineteen women with PPGP and 78 without PPGP., Research Design: PPGP and non-PPGP women receiving at least one massage, with outcome measures assessed immediately prior to and after massage, and again one week postmassage., Main Outcome Measures: Visual analog scales for pain, stress, range of movement, sleep, and self-reported side effects of massage., Results: Both groups changed significantly and similarly over time for measures of pain, stress, range of motion, and sleep (all p < .05). Post hoc analysis found significant reduction in all outcome measures immediately following massage, but returned to baseline at one week postmassage for all measures except pain, which remained reduced for the PPGP group (49.79±25.68 to 34.75±34.75, p = .03, effect size 0.593), and stress remained reduced in the non-PPGP group (33.36±21.54 to 24.90±19.18, p = .002, effect size 0.373). The PPGP group entered the study with higher baseline levels of pain ( p = .01) and a greater restriction in range of motion ( p = .006) than the non-PPGP group. There was no difference in the number of side effects experienced between the two groups ( p = .130)., Conclusions: Although PPGP clients report greater pain and restriction in range of motion at baseline than non-PPGP clients, the response to pregnancy massage was similar. Results support a role of pregnancy massage in the management of PPGP. More research on massage for PPGP is needed to confirm a lasting effect of pain reduction from massage., Competing Interests: CONFLICT OF INTEREST NOTIFICATION Catherine McInerney is the owner of Pregnancy Massage Australia; she was not involved in the analysis of the data. Phillipa Hay receives sessional fees and lecture fees from the Australian Medical Council, Therapeutic Guidelines publication, and New South Wales Institute of Psychiatry, and receives support from Shire Pharmaceuticals for speaking engagements., (Copyright© The Author(s) 2020. Published by the Massage Therapy Foundation.)

Introduction: The under-reporting of Aboriginal and Torres Strait Islander people on routinely collected health datasets has important implications for understanding the health of this population. By pooling available information on individuals' Aboriginal or Torres Strait Islander status from probabilistically linked datasets, methods have been developed to adjust for this under-reporting., Objectives: To explore different algorithms that enhance reporting of Aboriginal status in birth data to define a cohort of Aboriginal women, examine any differences between women recorded as Aboriginal and those assigned enhanced Aboriginal status, and assess the effects of using different reported populations to estimate within-group comparisons for Aboriginal people., Methods: Three algorithms, with different levels of inclusiveness, were used to establish different study populations all of which aimed to include all singleton babies born to Aboriginal or Torres Strait Islander women residing in New South Wales, Australia between 2010 and 2014 and their mothers. The demographics of the four study populations were described and compared using frequencies and percentages. In order to assess the impact on research outcomes and conclusions of using study populations derived from different algorithms, estimates of the associations between smoking during pregnancy and selected perinatal outcomes were compared using rates and relative risks., Results: Women included in the study population through enhanced reporting were older, less disadvantaged and more commonly resided in urban areas than those recorded as Aboriginal in the birth data. Although rates of smoking and some perinatal outcomes differed between the different study populations, the relative risks of each outcome comparing smoking and non-smoking Aboriginal mothers were very similar when estimated from each of the study populations., Conclusions: This work provides evidence that estimates of within-group relative risks are reliable regardless of the assumptions made for establishing the study population through the enhanced reporting of indigenous peoples., Competing Interests: Statement of Conflicts of Interest: The authors declare that they have no conflicts of interest.

Objectives: To provide evidence for targeted smoking cessation policy, the aim of this study was to compare pregnancy outcomes of Aboriginal mothers who reported not smoking during pregnancy with Aboriginal mothers who reported smoking during pregnancy., Design: Population based retrospective cohort study using linked data., Setting: New South Wales, the most populous Australian state., Population: 18 154 singleton babies born to 13 477 Aboriginal mothers between 2010 and 2014 were identified from routinely collected New South Wales datasets. Aboriginality was determined from birth records and from four linked datasets through an Enhanced Reporting of Aboriginality algorithm., Exposure: Not smoking at any time during pregnancy., Main Outcome Measures: Unadjusted and adjusted relative risks (aRR) and 95% CIs from modified Poisson regression were used to examine associations between not smoking during pregnancy and maternal and perinatal outcomes including severe morbidity, inter-hospital transfer, perinatal death, preterm birth and small-for-gestational age. Population attributable fractions (PAFs) were calculated using adjusted relative risks., Results: Compared with babies born to mothers who smoked during pregnancy, babies born to non-smoking mothers had a lower risk of all adverse perinatal outcomes including perinatal death (aRR=0.58, 95% CI 0.44 to 0.76), preterm birth (aRR=0.58, 95% CI 0.53 to 0.64) and small-for-gestational age (aRR=0.35, 95% CI 0.32 to 0.39). PAFs (%) were 27% for perinatal death, 26% for preterm birth and 48% for small-for-gestational-age. Compared with women who smoked during pregnancy (n=8919), those who did not smoke (n=9235) had a lower risk of being transferred to another hospital (aRR=0.76, 95% CI 0.66 to 0.89)., Conclusions: Babies born to women who did not smoke during pregnancy had a lower risk of adverse perinatal outcomes. Rates of adverse outcomes among Aboriginal non-smokers were similar to those among the general population. These results quantify the proportion of adverse perinatal outcomes due to smoking and highlight why effective smoking cessation programme are urgently required for this population., Competing Interests: Competing interests: CM and ST’s salaries came from a Prevention Research Support Programme grant from the NSW Ministry of Health, no other relationships or activities that could appear to have influenced the submitted work., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background/aims: The financial crisis that enveloped Europe in 2009 created financial pressure for governments and required a number of countries to obtain a financial bailout from the IMF. The purpose of this paper is to examine the effect of the financial crisis on public health expenditure in bailout countries and if bailouts shift the burden of paying for healthcare from the state onto individuals., Methods: Quantitative health expenditure data were collected from the WHO and OECD for the period 2004-2015 and evaluated using a comparison of means Welch's t test., Results: The majority of bailout countries recorded a decrease in public health expenditure as a percentage of total government expenditure, with Ireland recording the largest decrease with government health expenditure as a percentage of total government expenditure, falling by 22% (P < .01). In addition, the results also suggest that the burden of paying for healthcare shifted from the state onto individuals in three countries, namely Hungary, Ireland and Portugal, where public health expenditure declined and private expenditure increased significantly., Conclusions: The ramifications of shifting the burden of paying for healthcare from the state onto individuals at this point remain unclear with further research required to identify the long-term consequences for healthcare.

Introduction: Women commonly use massage therapy during pregnancy for pregnancy-related health conditions such as lower back and neck pain; however, there is little to no research related evidence on the side effects or mother or child physical harm of massage during pregnancy and the postnatal period., Objectives: This study aims to report on the side effects and mother or child physical harm of massage during pregnancy and the postnatal period., Design: An observational study methodology., Setting and Time Frame: Two massage clinics, one in Sydney and one in Melbourne recruited participants from December 2016 to December 2017., Intervention: Massage., Main Outcome Measure: Side effects and mother or child physical harm from massage., Results: One hundred and one participants were recruited to the study. Two fifths of the participants (n = 32, 40%) experienced one of more post-massage side effects. There were no mother or child physical harm events. Low back pain was the most common condition women sought massage treatment for 34 (33.7.%). A significant benefit (p < 0.001) was seen pre-massage to post-massage and pre-massage to 1-week post massage in decreasing stress, decreasing pain, increasing range of motion and improving sleep DISCUSSION: Similar to previous research, low back pain was the most common condition that women sought massage treatment for followed by hip pain, shoulder pain, neck pain and to improve mental health. Ninety-seven percent of the cohort received a full body massage including the feet leading credence that 'massage on the feet during pregnancy is harmful' is mythic in nature., Conclusion: While our findings lead credence that massage on the feet during pregnancy is a myth the study was not powered to determine the safety of pregnancy massage and further research is needed. Massage was commonly sought for low back pain with promising benefits in decreased pain and improved range of movement and further research on the effectiveness of massage for low back pain in pregnancy., (Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.)

Background: There are increasing imperatives for patients and members of the public to engage as partners in identifying health research priorities. The use of participatory methods to engage stakeholders in health care in research prioritization is not commonly reported., Objective: This article analyses the use of World Cafés as a participatory method for research prioritization with marginalized communities in Ireland and the USA., Methods: The principles of purposeful and snowball sampling were followed in both settings and a diverse range of community and health care stakeholders participated (n = 63 Ireland and n = 55 USA). The principles for a classic World Café were employed but there were novel features in each setting as well. Stewart et al.'s (Patients' and clinicians' research priorities. Health Expect 2011; 14: 439-48, conceptual framework for patient engagement was adapted and used to comparatively analyse the strengths and weaknesses of the World Cafés, focusing on agenda setting, engagement with research processes, interactional features and outputs., Results: Design principles for World Cafés were found to align with high-quality patient engagement for research prioritization in both settings. They served to facilitate meaningful collaboration among stakeholder groups in research prioritization (research agenda setting) and explored research priorities (engagement with research). The café ambience, emphasis on hospitality and self-facilitation created an environment for dialogues within and across participating groups (interactional features). There was a commitment to follow-up actions with reference to possible subsequent research (outputs)., Conclusions: The World Café is a valuable, participatory, flexible method that can be used with community and health care stakeholders for research prioritization with marginalized communities., (© The Author 2016. Published by Oxford University Press.)

Rice planthopper (RPH) populations of Nilaparvata lugens and Sogatella furcifera periodically have erupted across Asia. Predicting RPH population dynamics and identifying their source areas are crucial for the management of these migratory pests in China, but the origins of the migrants to temperate and subtropical regions in China remains unclear. In particular, their early migration to China in March and April have not yet been explored due to a lack of research data available from potential source areas, Central Vietnam and Laos. In this study, we examined the population dynamics and migratory paths of N. lugens and S. furcifera in Vietnam and South China in 2012 and 2013. Trajectory modeling showed that in March and April in 2012 and 2013, RPH emigrated from source areas in Central Vietnam where rice was maturing to the Red River Delta and South China. Early migrants originated from Southern Central Vietnam (14-16°N), but later most were from Northern Central Vietnam (16-19°N). Analysis of meteorological and light-trap data from Hepu in April (1977-2013) using generalized linear models showed that immigration increased with precipitation in Southern Central Vietnam in January, but declined with precipitation in Northern Central Vietnam in January. These results determined that the RPH originate from overwintering areas in Central Vietnam, but not from southernmost areas of Vietnam. Winter precipitation, rather than temperature was the most important factor determining the number of RPH migrants. Based on their similar population dynamics and low population densities in Central Vietnam, we further speculated that RPH migrate to track ephemeral food resources whilst simultaneously avoiding predators. Migrations do not seem to be initiated by interspecific competition, overcrowding or host deterioration. Nevertheless, S. furcifera establishes populations earlier than N. lugens South China, perhaps to compensate for interspecific competition. We provide new information that could assist with forecasting outbreaks and implementing control measures against these migratory pests.