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Cardiovascular disease is the commonest chronic illness in both developed and developing countries, causing the most deaths and the greatest impact on morbidity. The superiority of disease prevention over treatment was appreciated at least 5,000 years ago in China. The link between the existence of disease in society and the political and social circumstances of a country was emphasised by Virchow in the nineteenth century. The scientific basis and methods for prevention of cardiovascular disease are known. What are lacking are the will and the means to implement change. The well-intentioned often have a dominant sense of entitlement in the pursuit of the common goal of disease prevention. There is a failure of many organisations to acknowledge the importance of other groups within society in achieving the common goal. Doctors, particularly cardiovascular physicians and cardiologists, must play a much greater role in linking with the public, other health workers, epidemiologists, media, industry, academia and politicians. Too many vested interests obstruct progress in the prevention of cardiovascular disease.

In Scotland, the Children's Hearing system determines the placement of maltreated children. A locally tailored version of the New Orleans Intervention for such children is about to be introduced in Glasgow. As part of an evaluation of its impact, an exploration was conducted of decision-making by children's panel members, their possible role in the new intervention and their attitudes towards the changes. Interviews were held with focus groups and with members of the Children's Hearing system using vignettes and a topic guide to focus the discussions. Thematic analysis identified key themes about the decision-making process and how the new service might impact on this. It was found that making decisions about a child's eventual permanent placement is complex, but discussions generally focused on the parent rather than the child. Panel members highlighted how decision-making could be facilitated by a solid evidence base and knowing that a future care plan for the child is in place. Many of them were positive about the new intervention. Good, clear communication will be essential if they are to accept recommendations from a new service. Also, training will be crucial if they are to appreciate the validity of the reports that emerge.

In recent years, retailers have come to the fore in the development
of distribution systems in the UK. With this move has come the greatly
accelerated use of "distribution service companies" to
provide tailored, dedicated, contractual solutions to the distribution
needs of retailers. This article reviews the development of this trend,
identifies the major causes of it, considers the advantages and
drawbacks of contract solutions, examines a number of specific cases and
speculates as to what further penetration dedicated contracts may
achieve in both retailing and other distribution areas.

Organizational initiatives and researchers have argued for the importance of the natural outdoor environment (NOE) for promoting wellbeing. The main aim of this meta-analysis was to synthesize the existing literature to examine the effects of physical activity (PA) in the NOE on wellbeing in adults. The secondary aim was to explore whether wellbeing reported by adults differs as a function of PA context. Electronic databases (PubMed, ProQuest Nursing and Allied Health, PsycINFO, SPORTDiscus and Embase) were searched for English peer-reviewed articles published before January 2019. Inclusion criteria were: (1) healthy adults; (2) PA in the NOE; (3) the measurement of wellbeing; and (4) randomized control trials, quasi-experimental designs, matched group designs. To address the secondary aim, PA in the NOE was compared with that performed indoors. Risk of bias was assessed through the Effective Public Health Practice Project (EHPP) Quality Assessment Tool for Quantitative Studies. Primary studies meeting inclusion criteria for the main (nstudies = 19) and secondary (nstudies = 5) aims were analyzed and interpreted. The overall effect size for the main analysis was moderate (d = 0.49, p < 0.001; 95% CI = 0.33, 0.66), with the magnitude of effect varying depending on wellbeing dimension. Wellbeing was greater in PA in the NOE subgroup (d = 0.53) when compared with the indoor subgroup (d = 0.28), albeit not statistically significant (p = 0.15). Although physical activity in the NOE was associated with higher wellbeing, there is limited evidence to support that it confers superior benefits to that engaged indoors. Researchers are encouraged to include study designs that measure markers of wellbeing at multiple time points, greater consideration to diverse wellbeing dimensions and justify decisions linked to PA and NOE types.

Healthcare systems across the world generate large volumes of data about patients including information about their age, sex, and medical history. It also captures information on how patients interact across multiple points of care (e.g., hospitals, dentists and general practice). Advances in data availability and computational power now means that much of this data can be leveraged for social good. This ranges from the use of behavioural analytics to better predict service demand through to understanding the impact of behaviour change interventions. In this project, we used patient data to explore the causes of low engagement in healthcare and the impact this has on patients and services. This also involved linking data sets from different organisations (e.g., health, death and education). We observed that serially missing general practice (GP) appointments provided a risk marker for vulnerability and poorer health outcomes. While the project was administratively and methodologically challenging, the interdisciplinary background of the team ensured that the project was ultimately successful. This was particularly important when navigating a variety of different systems used to manage and distribute sensitive patient data. Our results have already started to inform debates concerning how best to reduce non-attendance and increase patient engagement within healthcare systems. Following a series of high-profile publications and associated impact events, non-academic beneficiaries have included governments, policymakers and medical practitioners.

High-Speed planing Craft (HSC) expose their crew to levels of vibration that regularly exceed the daily exposure limit set out by European directive 2002/44/EU. The human exposure to vibration can cause many effects, from chronic and acute, to physiological and psychological. Many reduction methods are currently being researched, such as suspension seats, but Coats et al. (2003) and Coe et al. (2013) concluded that a combination of methods will be required to reduce the level sufficiently to meet the legislation. The highest levels of acceleration occur during the slamming of HSC. This paper describes an experimental investigation to determine whether hydroelasticity can affect the slamming characteristics and Whole Body Vibration (WBV) of a HSC using quasi-2D and full-scale drop tests. The quasi-2D drop tests revealed that hydroelasticity can affect the peak acceleration and Vibration Dosage Value (VDV), and that a wooden hull generated higher magnitude WBV than fabric hulls. The full-scale drop tests were performed on a RNLI D-class inflatable lifeboat. Hydroelasticity was controlled using the internal pressures of the sponson and keel. The full-scale results show that the peak acceleration and VDV can be reduced by decreasing the internal pressures and structural stiffness at the transom and crew locations; however, this lead to an increase at the bow. This indicates that the WBV experienced by the crew can be reduced by considering hydroelasticity. Incorporating an element of hydroelasticity shows great potential, alongside other reduction strategies, to alleviate the human exposure to vibration on board HSC.

Iacobucci points out that missed GP appointments have been the subject of intense political interest, much of it misleading and designed to blame "feckless" patients.1 In a recent article in BMC Medicine, we described an extremely strong association between repeatedly missing appointments and a greatly increased risk of mortality independent of the presence of known long term conditions.2 These findings persist after correcting for the number of appointments made. Around 5% of patients who missed more than two appointments a year over a three year period had died within a year of follow-up. The increased risk of all cause mortality shows a dose based response with increasing number of missed appointments. Patients with long term mental health conditions who missed more than two appointments a year were over eight times more likely to die (all cause mortality) than were those who missed no appointments. These patients died prematurely, commonly from non-natural external factors such as suicide. Missed appointments are a major risk marker for all cause mortality, particularly in patients with mental health conditions. For these patients, existing primary healthcare appointment systems may be ineffective. Clinicians (and politicians) should carefully consider the causes of repeated missed appointments rather than ascribing blame.

Procedures used to train an adult with severe disabilities to perform a variety of food service tasks in a restaurant are described. Dependent measures included (a) the rate of prompts delivered per 5-min interval and (b) the percentage of steps of the task analyses performed correctly. A multielement feature was embedded within a multiple baseline design, which allowed experimenters to determine when fading of instructional stimuli should occur. Maintenance and long-term follow-up data are presented. Following 20 months of employment, the owners continue to express their satisfaction with the participant's work performance.