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Abstract Background Breaking Free Online (BFO), a computer-assisted therapy (CAT) program for substance use disorders (SUD), has been available across UK treatment services for the past decade and has demonstrated efficacy. The Covid-19 pandemic has contributed to digital and ‘telehealth’ approaches to healthcare delivery becoming more common and accepted, and has in parallel, increased numbers of referrals to SUD services because of the impact pandemic-related stress has had on substance using habits in the general population. Digital and telehealth approaches, such as BFO, have the potential to support the treatment system to meet this increased demand for SUD services. Methods Parallel-group randomized controlled trial of eight-week BFO as an adjunct to standard treatment for SUD, in comparison to standard treatment only, at a National Health Service (NHS) Mental Health Trust in North-West England. Participants will be service users aged 18 years and over with demonstrable SUD for at least 12-months. Interventional and control groups will be compared on multiple measures from baseline to post-treatment assessment at eight-weeks, and then three and six-months follow-up. Primary outcome will be self-reported substance use, with secondary outcomes being standardized assessments of substance dependence, mental health, biopsychosocial functioning and quality of life. Discussion This study will examine whether BFO and telehealth support, when delivered as an adjunct to standard SUD interventions, improves outcomes for services users receiving NHS SUD treatment. Findings from the study will be used to inform both developments to the BFO program and guidance around augmenting the delivery of CAT programs via telehealth. Trial registration registered with ISRCTN on 25th May 2021—registration number: 13694016. Protocol version: 3.0 05th April 2022. Trial status: This trial is currently open to recruitment—estimated to be completed in May 2023.

Abstract Background Methamphetamine use can be associated with involvement with correctional services and incarceration. Traditionally, treatments for methamphetamine use have been delivered in-person – however, lockdowns initiated during the COVID-19 pandemic significantly reduced access to such in-person support in prisons. Therefore, in May 2020 a digital cognitive-behavioral therapy (CBT) program for substance use disorders - 'Breaking Free from Substance Abuse' - was made available across prisons in Ohio in order to meet this treatment gap. This represents the first time this digital CBT intervention has been made widely available to incarcerated people residing in prisons or jails in the United States (US). This was a within-subjects study using data from 2187 Ohio prison residents who engaged with this digital CBT program to address their methamphetamine use. Results Participants reported multiple psychosocial risk factors, including moderate to severe substance dependence, depression and anxiety; interpersonal conflict; aggressive behavior; paranoia; and difficulties with work, education and accommodation. Significant reductions in substance dependence, depression/anxiety and biopsychosocial impairment, and improvements in quality of life, were identified in the sample. Risk factors were associated with less positive outcomes, specifically interpersonal conflict and poor mental health. Completion of specific components of the program were associated with more positive outcomes – a dose response was also identified. Conclusions Digital CBT can be delivered in secure US correctional settings and may help to fill unmet needs for in-person treatment. Specifically, this digital CBT program may support incarcerated individuals to address methamphetamine use, with outcomes being associated with psychosocial risk factors and program engagement.

Background: Data for bronchodilator deposition via nebulizers and dry powder inhalers (DPIs) in the respiratory tract of patients with chronic obstructive pulmonary disease (COPD) are limited. We used functional respiratory imaging (FRI) to determine deposition patterns for revefenacin solution via a PARI LC ® Sprint ® nebulizer and tiotropium powder via HandiHaler ® DPI. Methods: Ten patients with COPD, of whom 9 had severe airflow obstruction, were selected from FLUIDDA’s database. The study did not enroll patients. Drug deposition in the extrathoracic and intrathoracic regions, including the central and peripheral airways was simulated by FRI. The percentage of delivered dose and central-to-peripheral (C/P) deposition ratio for nebulizer and DPI were evaluated. Results: Mean ± standard deviation (SD) age was 64.7 ± 7.1 years, height was 168.8 ± 8.5 cm, and percent predicted forced expiratory volume in 1 s was 40.8 ± 12.3%; 50% of patients were men. At optimal inhalation flow, intrathoracic and peripheral deposition was three-fold higher for revefenacin via nebulizer than tiotropium via HandiHaler (mean ± SD 34.6 ± 8.53% versus 10.9 ± 5.67% and 18.2 ± 4.30% versus 5.8 ± 2.73% of delivered dose, respectively). Similar results were observed for suboptimal flow (mean ± SD percentage of revefenacin versus tiotropium: intrathoracic, 32.1 ± 8.3% versus 15.1 ± 5.9%; peripheral; 16.6 ± 4.1% versus 8.4 ± 2.9%). The C/P deposition ratio for nebulizer was similar to DPI (mean ± SD 0.915 ± 0.241 versus 0.812 ± 0.249 at optimal; 0.947 ± 0.253 versus 0.784 ± 0.219 at suboptimal flow), even though the mass median aerodynamic diameter of revefenacin was higher than tiotropium. C/P deposition ratio for revefenacin decreased after bronchodilation (0.915 ± 0.241 pre-bronchodilation versus 0.799 ± 0.192 post-bronchodilation), suggesting progressively better deposition in the peripheral region, assuming bronchodilation occurred during the nebulization process. Conclusions: These results demonstrate more efficient intrathoracic and peripheral deposition for revefenacin via standard jet nebulizer than tiotropium via HandiHaler, with similar C/P deposition ratio in patients with COPD. Nebulizers are an efficient alternative to DPIs for bronchodilator administration in patients with COPD.

Abstract Background A national pre-registration pharmacist training recruitment scheme, which replaces local recruitment models, was introduced in England and Wales in 2017. The national recruitment system allows pharmacy students to apply for the 52 weeks training programmes (mandatory requirement for registration as a pharmacist), through a single application system prior to undertaking a nationally administered assessment. This study aimed to explore experiences of pharmacy students on the national recruitment scheme, particularly their views on the selection methodology, application process, and offer outcomes. Methods This mixed method study involved a) an online survey of all (approximate n = 2800) year 4 (final year of MPharm degree) pharmacy students in England and Wales and b) a qualitative focus group with four students. The study population was eligible to participate in the 2017/18 national recruitment scheme. Survey respondents were invited to participate in a focus group. Quantitative data were analysed using descriptive and inferential analysis. Qualitative data were analysed using the framework technique. Participation was voluntary. Ethical approval from University of Birmingham was obtained. Results A total of 307 completed surveys were returned (approximate response rate 11%). Respondents were generally satisfied with the application process and commended the fairness of the selection methodology and convenience in allowing them to apply to multiple training providers. Most survey respondents (n = 181, 72.9%) were either satisfied or highly satisfied with the training programme they were offered based on their assessment performances. Three themes and eight sub-themes obtained from the analysis of over 200 open comments data from the survey and transcript of a focus group with four participants. Results suggested the need to widen the timeframe available for applicants to shortlist their preferred employers, improve the method of programme listing in the application system, and consideration of prior achievements including academic performances and placement experiences to be included in the selection methodology. Conclusions Experiences of pharmacy students on the national recruitment scheme suggest that respondents considered the selection methodology to be fair. Student engagement and satisfaction with the recruitment system can be maximised through improved listing of employers and widening the timescales for students to shortlist their preferred employers during application process. Inclusion of University achievements in the selection methodology will require consideration of evidence based approaches. Low response rate limits generalisation of findings.

Abstract Background Substance misuse, including problematic drug and alcohol use, are significant issues in society that can have multiple detrimental effects. Many people access support for their substance misuse during prison sentences, due to the associations between substance misuse and offending, and the high proportion of the prison population who have drug and alcohol issues. Breaking Free Online Health and Justice is a computer-assisted therapy program that has been developed to support substance-involved offenders to address their substance misuse and associated offending within prison settings. Methods This will be a parallel-group randomized controlled trial of 4-week Breaking Free Online Health and Justice program as an adjunct to standard treatment for substance misuse, in comparison to standard treatment only, in a male Category D open prison. Interventional and control groups will be compared in terms of the changes in their scores on multiple measures from baseline to post-treatment assessment at 4-weeks, and then 3- and 6-months follow-up. Participants will be adult male offenders serving sentences in prison in England who have demonstrable difficulties with drugs and/or alcohol for at least the past 12-months. The primary outcome measure will be self-reported substance misuse, with secondary outcomes being standardized psychometric assessments of substance dependence, mental health, biopsychosocial functioning, quality of life and post-release offending. Other secondary measures will include frequency of completion of specific intervention strategies in the program. Discussion This study will examine whether Breaking Free Online Health and Justice as an adjunct to standard substance misuse interventions in prisons, improves outcomes for substance-involved offenders receiving interventions in custodial settings. Findings from the study will be used to inform further developments of the program and potential improvements to custodial treatment. Trials registration ISRCTN09846981.

Novel types of optical hybrid metasurfaces consist of metallic and dielectric elements are designed and proposed for controlling the interference between magnetic and electric modes of the system, in a reversible manner. By employing the thermo-optical effect of silicon and gold nanoantennas we demonstrate an active control on the excitation and interference between electric and magnetic modes, and subsequently, the Kerker condition, as a directive radiation pattern with zero backscattering, via temperature control as a versatile tool. This control allows precise tuning optical properties of the system and stimulating switchable sharp spectral Fano-like resonance. Furthermore, it is shown that by adjusting the intermediate distance between metallic and dielectric elements, opposite scattering directionalities are achievable in an arbitrary wavelength. Interestingly, this effect is shown to have a direct influence on nonlinear properties, too, where 10-fold enhancement in the intensity of third harmonic light can be obtained for this system, via heating. This hybrid metasurface can find a wide range of applications in slow light, nonlinear optics and bio-chemical sensing.

This paper will critically assess the utility of conventional and novel data sources for building fine-scale spatio-temporal estimates of the ambient population. It begins with a review of data sources employed in existing studies of the ambient population, followed by preliminary analysis to further explore the utility of each dataset. The identification and critiquing of data sources which may be useful for building estimates of the ambient population are novel contributions to the literature. This paper will provide a framework of reference for researchers within urban analytics and other areas where an accurate measurement of the ambient population is required. This work has implications for national and international applications where accurate small area estimates of the ambient population are crucial in the planning and management of urban areas, the development of realistic models and informing policy. This research highlights workday population estimates, in conjunction with footfall camera and Wi-Fi sensors data as potentially valuable for building estimates of the ambient population.

Alongside recent trends in the purchasing of illicit substances online, there has been a growth in the availability of online resources dedicated to treatment and recovery from substance misuse, including online interventions, mutual-aid groups and forums. Currently however, there is a lack of research on the utilisation of these online resources. Therefore, the aim of this study was to examine the use of these online resources by employing online data collection techniques. A quantitative online survey was used to investigate the range of online recovery resources used, and to compare the types of resources used at different stages of the substance misuse recovery journey. Qualitative online interviews were also conducted to investigate how individuals use these online resources alongside traditional offline recovery resources. Analyses revealed that forums were the most widely accessed online resource, however participants who were currently working towards abstinence were more likely to use therapeutic resources that explore the underlying causes behind substance misuse and help to manage these difficulties. Qualitative findings suggested an interaction between online and offline recovery resources. For example, participants reported that online resources may provide initial contact information for offline recovery meetings, or that offline support with developing digital skills may facilitate access to online resources. Despite these apparent benefits, there is limited signposting advice to direct people to appropriate online treatment and recovery resources for their substance misuse, so it is hoped that the findings from this study will help to inform future research around the production of such signposting advice.

Objectives: Community pharmacists’ roles in the UK are evolving; pharmacists currently deliver a wider range of clinical services with more patient-focused care. The objectives of this study were (i) to investigate UK community pharmacists’ views on their current communication skills in pharmacist-patient facing consultations, and (ii) to explore the perceptions of UK community pharmacists towards the application of motivational interviewing (MI) in a pharmacy consultation. In-depth qualitative face-to-face, semi-structured interviews with ten practicing community pharmacists were carried out, ranging from 30−60 min in length. The interviews were audio recorded, transcribed verbatim and thematic analysis was employed. Four themes emerged from the data: (1) the fight for time; (2) wrestling with consultation styles; (3) a personal communication evolution; and (4) unfamiliar but engaging motivational interviewing. These themes demonstrated the juxtaposition between the desire for patient-centred care and the pressures of managing broader dispensing work. Participants were critical of academic and continuous professional learning (CPD) training in communication skills and there was a strong recognition of the potential role of MI in promoting patient autonomy and outcomes. Participants recognized a few elements of MI techniques in their current consultations, but welcomed further training on behavioral change for effective consultations, expressing a desire for practical MI-specific training. Face-to-face CPD of consultation skills is needed to avoid the feeling of isolation among UK practicing pharmacists and rigidity in consultation delivery. Support for community pharmacists from other pharmacy staff could relieve current pressures and allow pharmacists time to develop and acquire effective skills for patient facing roles. Behavioural change consultation skills training for pharmacists could be an effective strategy to address these current challenges.

There has been great interest in bone marrow aspirate concentrate (BMAC) as a cost effective method in delivering mesenchymal stem cells (MSCs) to aid in the repair and regeneration of cartilage defects. Alongside MSCs, BMAC contains a range of growth factors and cytokines to support cell growth following injury. However, there is paucity of information relating to the basic science underlying BMAC and its exact biological role in supporting the growth and regeneration of chondrocytes. The focus of this review is the basic science underlying BMAC in relation to chondral damage and regeneration.