Simulating flexibility, variability and decentralisation with an integrated energy system model for Great Britain.

Energy system models allow the development and assessment of ambitious transition pathways towards a sustainable energy system. However, current models lack adequate spatial and temporal resolution to capture the implications of a shift to decentralised energy supply and storage across multiple local energy vectors to meet spatially variable energy demand. There is also a lack of representation of interactions with the transport sector as well as national and local energy system operation. Here, we bridge these gaps with a high-resolution system-of-systems modelling framework which is applied to Great Britain to simulate differences between the performance of decarbonised energy systems in 2050 through two distinct strategies, an electric strategy and a multi-vector strategy prioritising a mix of fuels, including hydrogen. Within these strategies, we simulated the impacts of decentralised operation of the energy system given the variability of wind and across flexibility options including demand side management, battery storage and vehicle to grid services. Decentralised operation was shown to improve operational flexibility and maximise utilisation of renewables, whose electricity supplies can be cost-effectively converted to hydrogen or stored in batteries to meet peak electricity demands, therefore reducing carbon-intensive generation and the requirement for investment in expanding the electricity transmission network capacity.

Dementia education in a primary school classroom: A pedagogical perspective.

The World Health Organisation recognises the importance of dementia education across all sectors of the population, including children. Previous research has shown that dementia education in schools has positively changed students' knowledge about and attitudes to dementia, however little is known about the process of learning about a complex condition, such as dementia. This paper explores how pupils learn about dementia through a pre-planned educational session in the primary classroom to improve our understanding of the pedagogical approaches required for effective dementia education. Using a participatory video approach, 23 primary 6 pupils (aged 10-11) used iPads to film their experiences of a dementia education session using a resource called Understanding Dementia: Class in a Bag. These videos, along with researcher field notes were combined to create analytical vignettes to illustrate the learning processes and interactions that happened within the classroom. Two weeks later, the pupils were invited to a focus group to view footage of the session and reflect on their experiences and explore the understanding of dementia. The findings highlight the importance of embodied learning within the session, particularly in understanding the experience of living with dementia. By understanding the session from the pupil's perspective, the findings show how pupils developed an empathetic understanding of dementia through play and felt more confident about engaging with and helping people living with dementia in future. This paper provides a new understanding of the process of learning about dementia for primary children, as well as demonstrating the viability of including dementia education within school curriculums internationally.

Spatial and temporal data to study residential heat decarbonisation pathways in England and Wales.

The decarbonisation of residential heating is crucial if the net-zero target in the United Kingdom is going to be achieved. This paper describes methods to produce data to quantify the impacts of residential heat decarbonisation on the energy supply infrastructure across England and Wales. For the year 2018, annual heat demand for a range of dwellings was estimated for almost 35,000 local areas (known as Lower Layer Super Output Areas: LSOAs). Energy savings through implementing the potential energy efficiency measures and the indicative costs of the energy efficiency measures were quantified. Profiles were synthesised for heat production and energy demand of selected heating technologies using average daily temperature and data from trial projects. These profiles were created to study the impacts of different types of heating technology in each LSOA under user-defined heat decarbonisation pathways. Data describing the dwelling stock, heating technologies, annual heat demand for each LSOA, indicative costs of energy efficiency improvements for each local authority and the profiles for each technology were created.

Eligibility to drive and neurology: the how and the why.

Driving is an integral part of adult life and losing a driving licence is potentially a major problem. Many neurological conditions may impact on driving, either by increasing the risk of a sudden disabling event or by affecting cognition, vision, reaction speed, motor coordination, peripheral sensation or visuospatial processing. In the UK, the Drivers Medical Group of the Driver and Vehicle Licensing Agency (DVLA) decides whether an individual's medical condition meets the appropriate standards for driving. The licensing decision rests with the DVLA and is not at the clinician's discretion. However, clinicians must inform patients of their legal obligations towards the DVLA and how their neurological symptoms may restrict their driving. We discuss risk assessment, how chronic disabling neurological disease may impact on driving and the general principles of applying medical standards for fitness to drive. We also highlight how legal driving eligibility varies around the world. Finally, we discuss the practical applications relating to a specific case.

Exposing the mechanisms underlying successful animal-assisted interventions for people with dementia: A realistic evaluation of the Dementia Dog Project.

There is increasing recognition of animal-assisted interventions as a promising area of practice within health and social care for people living with dementia. However, much of the research focuses on benefits for those living in care homes and not in their own homes. The Dementia Dog Project is an innovative project that aims to support people with dementia to engage with dogs and to promote the use of dogs in dementia care in the community. The pilot project introduced a dementia assistance dog to four couples where one person had a diagnosis of dementia. The aim of this paper is to explore the mechanisms that can successfully expose the benefits of integrating dogs into dementia care by drawing on the findings of a realistic evaluation of the pilot phase of the Dementia Dog Project (2013-2015). A realistic evaluation, with its focus on context, mechanisms and outcomes illuminates why an approach may work in some situations but not in others. This makes it especially appropriate to the unique, complex experience of living with dementia and the early development stage of the programme. The analysis triangulated data from a range of primary and secondary sources including interviews with the project team, case reports, team meeting notes and transcripts of interviews with participants. The findings identified three mechanisms that help to unlock the most positive outcomes for both the participants and the dogs. These were (1) the human-animal bond, (2) relationship dynamics and (3) responsibility of caring. The findings presented within this paper provide essential information to inform and advance the planning for the use of assistance dogs for people with dementia.

Contralateral pneumothorax following repositioning of an atrial lead.

A right-sided pneumothorax developed several hours after atrial lead repositioning following otherwise straightforward implantation of a biventricular defibrillator from a left subclavian approach. Right atrial lead perforation was presumed, though this could not be demonstrated on computed tomography. The patient was managed conservatively and made a full recovery.

Patients' experiences and views of cascade screening for familial hypercholesterolemia (FH): a qualitative study.

Familial DNA cascade screening for familial hypercholesterolemia (FH) has recently been introduced in Scotland. This study investigated index patients' experiences of DNA testing and mediating cascade screening. Thirty-eight patients with a clinical diagnosis of definite or possible FH who had undergone DNA testing in the lipid clinic took part in semi-structured qualitative interviews. All patients were positive about DNA screening being undertaken by familiar and trusted clinicians within the lipid clinic. Most patients had already cascaded close relatives for serum cholesterol testing following their attendance at the lipid clinic. Identified mutation carriers who had attended the genetics clinic (n = 15) for a cascading appointment described finding this consultation helpful because it identified other at-risk family members and provided them with tailored information for their relatives. Participants who expressed a preference said they favoured indirect (patient-mediated) methods of cascading as they considered indirect approaches to be less threatening to family members than direct clinical contact. We conclude that DNA screening and indirect familial cascading is perceived as highly acceptable to index patients with FH. However, while indirect cascading methods may be more acceptable to patients, they do not yield the same numbers as more direct methods. There is, therefore, a need for further systematic research to investigate patients', family members' and staff views of the acceptability of direct versus indirect methods of cascade screening.

'Effectiveness of Continuing Professional Development' project: a summary of findings.

This article reports on a study examining continuing professional development (CPD) for consultant doctors. The aim of the study was to identify what promotes or inhibits the effectiveness of CPD and met the following objectives: comparing and contrasting the experiences of CPD across the range of specialties; identifying and describing the range of different models of CPD employed across the different specialties and clinical contexts; considering the educational potential of reflective practice in CPD and its impact on professional practice and exploring how different professionals judge the effectiveness of current CPD practices. Using a mixture of qualitative (interviews, letters, observation) and quantitative (online questionnaire) methods, the views of CPD providers and users were surveyed. Findings suggested that the effectiveness of CPD, as inferred from the comments made by interviewees and questionnaire respondents, relates to the impact on knowledge, skills, values, attitudes, behaviours and changes in practice in the work place. The quality of CPD was seen as inextricably linked to any improvements in the quality of the professional practices required for service delivery. There was widespread consensus as to the value of learning in professional settings. There was recognition that there needs to be a move away from tick boxes to the in-depth identification of learning needs and how these can be met both within and external to the work place, with learning being adequately enabled and assessed in all locations. In conclusion, it can be said that CPD is valued and is seen as effective when it addresses the needs of individual clinicians, the populations they serve and the organisations within which they work. However, the challenge for CPD may lie in the dynamic interaction between educational opportunities and service delivery requirements, as there may be occasions where they vie with each other for resources.

Combining carotid intima-media thickness with carotid plaque on screening for coronary heart disease.

BACKGROUND: Ultrasound-detected carotid artery intima-media thickness (IMT) and carotid plaque are possible screening tests for coronary heart disease (CHD) among asymptomatic individuals. OBJECTIVE: To assess the increase in screening performance of combining carotid IMT and plaque compared with each measurement alone in the identification of individuals with CHD. METHODS: Ultrasound examination of left and right carotid arteries was performed on 100 individuals (median age 57), 55 with a history of CHD (unstable angina or myocardial infarction) and 45 without. IMT measurements were taken from the common carotid artery and plaque was identified above, at and below the carotid bifurcation. Associations between IMT and plaque were determined using logistic regression, and screening performance was assessed from the distributions of IMT and plaque among cases and controls. RESULTS: At a false-positive rate of 5%, IMT (cut-off >0.75 mm) identified 30% (95% CI 14-58) of affected individuals. There was an increase in the detection rate of 8 percentage points (1-33%) using IMT and plaque combined compared with IMT alone. As the false-positive increased, the difference in the detection rate increased, up to a maximum of 20 percentage points (5-38%) at a false-positive rate of 20%. The comparison of IMT and plaque combined with plaque alone could only be estimated for the false-positive rate observed using plaque alone (18%); at this point the detection rate was 72% for plaque and 75% for plaque and IMT combined, an increase of 3 percentage points (0-4%). CONCLUSION: In screening for CHD, combining carotid IMT measurement with plaque assessment is better than using either measurement alone, but the improvement in discrimination is not sufficient to make carotid ultrasound screening for CHD worthwhile.