The eClinical Care Pathway Framework: A novel structure for creation of online complex clinical care pathways and its application in the management of sexually transmitted infections.

Despite considerable international eHealth impetus, there is no guidance on the development of online clinical care pathways. Advances in diagnostics now enable self-testing with home diagnosis, to which comprehensive online clinical care could be linked, facilitating completely self-directed, remote care. We describe a new framework for developing complex online clinical care pathways and its application to clinical management of people with genital chlamydia infection, the commonest sexually transmitted infection (STI) in England.Using the existing evidence-base, guidelines and examples from contemporary clinical practice, we developed the eClinical Care Pathway Framework, a nine-step iterative process. Step 1: define the aims of the online pathway; Step 2: define the functional units; Step 3: draft the clinical consultation; Step 4: expert review; Step 5: cognitive testing; Step 6: user-centred interface testing; Step 7: specification development; Step 8: software testing, usability testing and further comprehension testing; Step 9: piloting. We then applied the Framework to create a chlamydia online clinical care pathway (Online Chlamydia Pathway).Use of the Framework elucidated content and structure of the care pathway and identified the need for significant changes in sequences of care (Traditional: history, diagnosis, information versus Online: diagnosis, information, history) and prescribing safety assessment. The Framework met the needs of complex STI management and enabled development of a multi-faceted, fully-automated consultation.The Framework provides a comprehensive structure on which complex online care pathways such as those needed for STI management, which involve clinical services, public health surveillance functions and third party (sexual partner) management, can be developed to meet national clinical and public health standards. The Online Chlamydia Pathway's standardised method of collecting data on demographics and sexual behaviour, with potential for interoperability with surveillance systems, could be a powerful tool for public health and clinical management.UKCRC Translational Infection Research (TIR) Initiative supported by the Medical Research Council, eSTI2 Consortium (Grant Number G0901608)

Strategies for sustainable and circular management of phosphorus in the baltic sea region: The holistic approach of the inPhos project

Despite the significant reduction of phosphorus (P) discharge in the Baltic Sea in the last decades, obtained through the implementation of some approaches within the Helsinki Convention, eutrophication is still considered the biggest problem for the Baltic Sea environment. Consequently, the reduction of P load is an urgent need to solve, but the complexity of both the environmental and legislative context of the area makes this process difficult (more than in the past). Eutrophication is an intricate issue requiring a proper framework of governance that is not easy to determine in the Baltic Sea Region where the needs of several different countries converge. To identify the most suitable strategy to reduce the eutrophication in the Baltic Sea, the InPhos project (no. 17022, 2018-2019, funded by the European Institute of Innovation & Technology (EIT) Raw Materials) adopted a holistic approach considering technical, political, economic, environmental and social aspects of P management. With the aims to raise awareness about the P challenge, foster the dialogue among all the stakeholders, and find solutions already developed in other countries (such as Germany and Switzerland) to be transferred in the Baltic Sea Region, the InPhos project consortium applied the methodology proposed in this paper, consisting of three main phases: (i) analysis of the available technologies to remove P from waste streams that contribute to eutrophication; (ii) analysis of the main streams involving P in Baltic Sea countries to highlight the potential of more sustainable and circular P management; (iii) study of the current context (e.g., already-existing initiatives and issues). This approach allowed us to identify four categories of recommendations and practical actions proposed to improve P management in the Baltic Sea region. During the project, the consortium mainly addressed social aspects. Following steps beyond the project will be more quantitative to determine the techno-economic feasibility of circular P management in selected demo cases in the region

Psychosocial Factors That Shape Patient and Carer Experiences of Dementia Diagnosis and Treatment : A Systematic Review of Qualitative Studies

Funding: This article presents independent research commissioned by the UK National Institute for Health Research (NIHR) under Research for Patient Benefit (Grant Reference Number PB-PG-0808-16024). The views expressed in this paper are those of the authors and not necessarily those of the NHS, the NIHR, nor the Department of Health. The sponsor of the study had no role in study design, data analysis, data interpretation or writing of the reportEarly diagnosis and intervention for people with dementia is increasingly considered a priority, but practitioners are concerned with the effects of earlier diagnosis and interventions on patients and caregivers. This systematic review evaluates the qualitative evidence about how people accommodate and adapt to the diagnosis of dementia and its immediate consequences, to guide practice. Methods and Findings: We systematically reviewed qualitative studies exploring experiences of community-dwelling individuals with dementia, and their carers, around diagnosis and the transition to becoming a person with dementia. We searched PubMed, PsychINFO, Embase, CINAHL, and the British Nursing Index (all searched in May 2010 with no date restrictions; PubMed search updated in February 2012), checked reference lists, and undertook citation searches in PubMed and Google Scholar (ongoing to September 2011). We used thematic synthesis to identify key themes, commonalities, barriers to earlier diagnosis, and support identified as helpful. We identified 126 papers reporting 102 studies including a total of 3,095 participants. Three overarching themes emerged from our analysis: (1) pathways through diagnosis, including its impact on identity, roles, and relationships; (2) resolving conflicts to accommodate a diagnosis, including the acceptability of support, focusing on the present or the future, and the use or avoidance of knowledge; and (3) strategies and support to minimise the impact of dementia. Consistent barriers to diagnosis include stigma, normalisation of symptoms, and lack of knowledge. Studies report a lack of specialist support particularly post-diagnosis. Conclusions: There is an extensive body of qualitative literature on the experiences of community-dwelling individuals with dementia on receiving and adapting to a diagnosis of dementia. We present a thematic analysis that could be useful to professionals working with people with dementia. We suggest that research emphasis should shift towards the development and evaluation of interventions, particularly those providing support after diagnosis.Peer reviewedFinal Published versio

Device Performance of APFO-3/PCBM Solar Cells with Controlled Morphology

Polymer/fullerene solar cells with three different device structures: A) diffuse bilayer, B) spontaneously formed multilayer and C) vertically homogeneous thin films, are fabricated. The photocurrent/voltage performance is compared and it is found that the self-stratified structure (B) yields the highest energy conversion efficiency