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Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) is a chronic, relapsing-remitting condition associated with increased morbidity. Previous research has shown patients with AAV report high levels of fatigue, pain, depression and anxiety. Over recent years successful work has been carried out to improve clinical outcomes, resulting in reduced mortality and end stage kidney disease (ESKD). Despite this, little work has been done to better understand the role of the patient within this condition. The prevalence of AAV is increasing and to date, there is a shortage of specific tools that assess and measure key features relating to patient reported outcomes (PROs). This protocol details how we can better understand the lived experiences of those with AAV through the development of a disease specific, patient reported outcome measure (PROM), to be used in clinic practice. This will allow us to recognise and validate PROs and the impact the disease and its treatment has on patients' health related quality of life (HRQoL). In addition, we aim to identify potential differences in PRO's between demographics, organ involvement and treatment subgroups in AAV as well as outcomes relating to the patient experience. Patients from a single centre in the UK will be recruited to take part in the exploratory qualitative study which will include focus groups and semi-structured interviews. The inclusion criteria comprise anyone with a diagnosis of AAV and willing to participate, including those who have active or relapsing disease, those are economically active, unemployed, retired and patients receiving renal replacement therapy. The aim of the project is to identify key issues patients experience in relation to their disease and its management and how these can be better assessed in a new PROM developed for use in the clinic setting. This will enable better delivery of individualised care and inform shared decision making, while also serving as a platform for future research looking at PROs in other glomerulonephritides. [ABSTRACT FROM AUTHOR]

This article considers how undocumented youth in the UK survive and construct their everyday lives in precarious circumstances. Drawing on multiple in-depth narrative interviews with (n = 7) undocumented youth, I illustrate how these young people focus on the future and engage in purposeful activities as a way of enduring the everyday challenges of living with no papers. I reflect on the relationships, which young people draw on to enable them to endure adversity and rebuild their everyday lives. I conclude that the presence of love and community is critical for young people's survival, safety and wellbeing, and I suggest how practitioners and researchers might make use of these findings. [ABSTRACT FROM AUTHOR]

To improve the storage and transport of clinical specimens for the diagnosis of Neisseria meningitidis (Nm) infections in resource-limited settings, we have evaluated the performance of dried blood spot (DBS) and dried cerebrospinal fluid spot (DCS) assays. DBS and DCS were prepared on filter paper from liquid specimens previously tested for Nm in the United Kingdom. Nm was detected and genogrouped by real-time PCR performed on crude genomic DNA extracted from the DBS (n = 226) and DCS (n = 226) specimens. Targeted whole-genome sequencing was performed on a subset of specimens, DBS (n = 4) and DCS (n = 6). The overall agreement between the analysis of liquid and dried specimens was (94.2%; 95% CI 90.8–96.7) for blood and (96.4%; 95% CI 93.5–98.0) for cerebrospinal fluid. Relative to liquid specimens as the reference, the DBS and DCS assays had sensitivities of (89.1%; 95% CI 82.7–93.8) and (94.2%; 95% CI 88.9–97.5), respectively, and both assays had specificities above 98%. A genogroup was identified by dried specimen analysis for 81.9% of the confirmed meningococcal infections. Near full-length Nm genome sequences (>86%) were obtained for all ten specimens tested which allowed determination of the sequence type, clonal complex, presence of antimicrobial resistance and other meningococcal genotyping. Dried blood and CSF filter spot assays offer a practical alternative to liquid specimens for the molecular and genomic characterisation of invasive meningococcal diseases in low-resource settings. [ABSTRACT FROM AUTHOR]

Background: Novel survey methods are needed to tackle declining response rates. The 2020 National Maternity Survey included a randomised controlled trial (RCT) and social media survey to compare different combinations of sampling and data collection methods with respect to: response rate, respondent representativeness, prevalence estimates of maternity indicators and cost. Methods: A two-armed parallel RCT and concurrent social media survey were conducted. Women in the RCT were sampled from ONS birth registrations and randomised to either a paper or push-to-web survey. Women in the social media survey self-selected through online adverts. The primary outcome was response rate in the paper and push-to-web surveys. In all surveys, respondent representativeness was assessed by comparing distributions of sociodemographic characteristics in respondents with those of the target population. External validity of prevalence estimates of maternity indicators was assessed by comparing weighted survey estimates with estimates from national routine data. Cost was also compared across surveys. Results: The response rate was higher in the paper survey (n = 2,446) compared to the push-to-web survey (n = 2,165)(30.6% versus 27.1%, difference = 3.5%, 95%CI = 2.1–4.9, p < 0.0001). Compared to the target population, respondents in all surveys were less likely to be aged < 25 years, of Black or Minority ethnicity, born outside the UK, living in disadvantaged areas, living without a partner and primiparous. Women in the social media survey (n = 1,316) were less representative of the target population compared to women in the paper and push-to-web surveys. For some maternity indicators, weighted survey estimates were close to estimates from routine data, for other indicators there were discrepancies; no survey demonstrated consistently higher external validity than the other two surveys. Compared to the paper survey, the cost saving per respondent was £5.45 for the push-to-web survey and £22.42 for the social media survey. Conclusions: Push-to-web surveys may cost less than paper surveys but do not necessarily result in higher response rates. Social media surveys cost significantly less than paper and push-to-web surveys, but sample size may be limited by eligibility criteria and recruitment window and respondents may be less representative of the target population. However, reduced representativeness does not necessarily introduce more bias in weighted survey estimates. [ABSTRACT FROM AUTHOR]

The coronavirus (COVID-19) pandemic disrupted all surgical specialties significantly and exerted additional pressures on the overburdened United Kingdom (UK) National Health Service. Healthcare professionals in the UK have had to adapt their practice. In particular, surgeons have faced organisational and technical challenges treating patients who carried higher risks, were more urgent and could not wait for prehabilitation or optimisation before their intervention. Furthermore, there were implications for blood transfusion with uncertain patterns of demand, reductions in donations and loss of crucial staff because of sickness and public health restrictions. Previous guidelines have attempted to address the control of bleeding and its consequences after cardiothoracic surgery, but there have been no targeted recommendations in light of the recent COVID-19 challenges. In this context, and with a focus on the perioperative period, an expert multidisciplinary Task Force reviewed the impact of bleeding in cardiothoracic surgery, explored different aspects of patient blood management with a focus on the use of haemostats as adjuncts to conventional surgical techniques and proposed best practice recommendations in the UK. [ABSTRACT FROM AUTHOR]

Background The Medical Certificate of Stillbirth (MCS) records data about a baby's death after 24 weeks of gestation but before birth. Major errors that could alter interpretation of the MCS were widespread in two UK-based regional studies. Methods A multicentre evaluation was conducted, examining MCS issued 1 January 2018 to 31 December 2018 in 76 UK obstetric units. A systematic case-note review of stillbirths was conducted by Obstetric and Gynaecology trainees, generating individual 'ideal MCSs' and comparing these to the actual MCS issued. Anonymized central data analysis described rates and types of error, agreement and factors associated with major errors. Results There were 1120 MCSs suitable for assessment, with 126 additional submitted data sets unsuitable for accuracy analysis (total 1246 cases). Gestational age demonstrated 'substantial' agreement [K = 0.73 (95% CI 0.70–0.76)]. Primary cause of death (COD) showed 'fair' agreement [K = 0.26 (95% CI 0.24–0.29)]. Major errors [696/1120; 62.1% (95% CI 59.3–64.9%)] included certificates issued for fetal demise at <24 weeks' gestation [23/696; 3.3% (95% CI 2.2–4.9%)] or neonatal death [2/696; 0.3% (95% CI 0.1–1.1%)] or incorrect primary COD [667/696; 95.8% (95% CI 94.1–97.1%)]. Of 540/1246 [43.3% (95% CI 40.6–46.1%)] 'unexplained' stillbirths, only 119/540 [22.0% (95% CI 18.8–25.7%)] remained unexplained; the majority were redesignated as either fetal growth restriction [FGR: 195/540; 36.1% (95% CI 32.2–40.3%)] or placental insufficiency [184/540; 34.1% (95% CI 30.2–38.2)]. Overall, FGR [306/1246; 24.6% (95% CI 22.3–27.0%)] was the leading primary COD after review, yet only 53/306 [17.3% (95% CI 13.5–22.1%)] FGR cases were originally attributed correctly. Conclusion This study demonstrates widespread major errors in MCS completion across the UK. MCS should only be completed following structured case-note review, with particular attention on the fetal growth trajectory. [ABSTRACT FROM AUTHOR]

Background: Harmful Alcohol use is frequent among opioid dependents patients undergoing agonist maintenance treatment. The objective assessment of harmful alcohol use can be done using laboratory measures of serum biomarkers. For community-based patients, there is often a requirement of an alternative method due to lack of onsite laboratory services. The aim of the study was to examine filter paper as a matrix to measure serum biomarkers of harmful alcohol use. Methods: The initial phase involved standardization of the filter-paper-based assay. Conditions were optimised for extraction and estimation of alcohol biomarkers (Aspartate Aminotransferase; AST, Alanine Aminotransferase; ALT, Gamma Glutamyl transferase; GGT and Carbohydrate Deficient Transferrin; CDT) from the filter paper. For clinical validation, serum samples were collected from community clinics. Biomarker levels obtained from both the methods were correlated using linear regression analysis. Limits of agreement between the two methods was estimated using the Intraclass Correlation Coefficient (ICC). Results: The extraction of enzymes (AST, ALT and GGT) from filter paper was carried out using the substrate buffer available with the reagent kit (Randox, UK). CDT was readily extracted from filter paper using deionised water. Serum biomarker levels measured from samples collected from community clinics correlated well with filter paper extracted levels (ICC 0.97-0.99). More than 90% of alcohol biomarker levels were recovered from the filter paper matrix using this method. Conclusion: Filter paper has the potential to be used as a matrix to objectively measure alcohol biomarkers among opioid-dependent patients from community settings lacking onsite laboratory facilities. [ABSTRACT FROM AUTHOR]

Objective: The Patient Information Leaflet (PIL) is an authoritative document that all people with epilepsy in the EU receive when prescribed antiseizure medication (ASM). We undertook the first independent, comprehensive assessment to determine how understandable they are. Regulators state that when patients are asked comprehension questions about them, ≥80% should answer correctly. Also, recommended is that PILs have a maximum reading requirement of US grade 8. Methods: Study 1: We obtained 140 current ASM PILs written in English. "Readability" was assessed using four tests, with and without adjustment for influence of familiar, polysyllabic words. A total of 179 online materials on epilepsy were also assessed. Study 2: Two PILs from Study 1 were randomly selected (Pregabalin Focus; Inovelon) and shown to 35 people from the UK epilepsy population. Their comprehension was assessed. Study 3: To understand whether the student population provides an accessible alternative population for future examination of ASM PILs, Study 3 was completed, using the same methods as Study 2, except that participants were 262 UK university students. Results: Study 1: No PIL had a reading level of grade 8. Median was grade 11. Adjusting for context, the PILs were still at grade 10.5. PILs for branded ASMs were most readable. PILs were no more readable than (unregulated) online materials. Study 2: Users struggled to comprehend the PILs' key messages. The eight questions asked about pregabalin were typically answered correctly by 54%. For Inovelon, it was 62%. Study 3: Most student participants comprehended the PILs' key messages. The questions about Inovelon were answered correctly by 90%; for pregabalin it was 86%. Significance: This is the first independent and comprehensive examination of ASM PILs. It found that PILs being used fail to meet recommendations and regulatory requirements and risk not being understandable to a substantial proportion of users. In finding that people from the epilepsy population differ markedly in comprehension of PILs compared to students, this study highlights the importance of completing user testing with the target population. [ABSTRACT FROM AUTHOR]

ChatGPT could allow students to plagiarize the content of their coursework with little risk of detection. Little is known about undergraduate willingness to use AI tools. In this study, psychology undergraduates (N = 160) from the United Kingdom, indicated their willingness to use, and history of using, ChatGPT to write university assignments. Almost a third (32%) indicated that they would use such tools; 15% indicated that they had used them already. Neither personality (conscientiousness, agreeableness, Machiavellianism, narcissism), academic performance, nor study skills self-efficacy could predict future use of AI tools. A novel Degree Apathy Scale was the only significant predictor. Willingness to use AI tools was greater when the risk of getting caught was low, and punishment was light, particularly for those high in degree apathy. Findings suggest that degree apathy is a key risk factor in academic misconduct. Wider research and pedagogical applications of degree apathy are discussed. • Thirty-two percent of students surveyed reported that they would use ChatGPT on future academic assignments. • Future use of AI tools was significantly predicted by a new Degree Apathy Scale. • Big Five and Dark Triad scores were not significant predictors, nor was previous academic performance. • Likelihood of cheating using ChatGPT was reduced with increasing risk of detection or severity of punishment. [ABSTRACT FROM AUTHOR]

This paper provides empirical evidence that individuals substantially revise their stated wealth redistribution preferences after fiscal scandals. The 2016 Panama Papers scandal revealed top-income tax evasion behaviour simultaneously worldwide. The empirical investigation exploits this event as a quasi-natural experiment. I rely on two original datasets, a UK household longitudinal dataset and a survey conducted in 22 European countries. I use a difference-in-differences strategy and find that pro-redistribution statements increased between 2% and 3.3% after the scandal. Responses are heterogeneous and larger for right-wing individuals and low-income individuals. This change in wealth redistribution preferences is likely to have been translated into a slight change in votes. The results suggest an increase in stated voting intentions for the left and a decrease for the right. Complementary estimations reveal that more media coverage and more individuals involved by country increase the magnitude of the response. [ABSTRACT FROM AUTHOR]

Staphylococcus argenteus and Staphylococcus schweitzeri, previously known as divergent Staphylococcus aureus clonal lineages, have been recently established as novel, difficult-to-delimit, coagulase-positive species within the S. aureus complex. Methicillin-resistant strains of S. argenteus are known from Australia and the UK. Knowledge of their epidemiology, medical significance and transmission risk is limited and partly contradictory, hampering definitive recommendations. There is mounting evidence that the pathogenicity of S. argenteus is similar to that of 'classical' S. aureus , while as yet no S. schweitzeri infections have been reported. To provide decision support on whether and how to distinguish and report both species. PubMed, searched for S. argenteus and S. schweitzeri. This position paper reviews the main characteristics of both species and draws conclusions for microbiological diagnostics and surveillance as well as infection prevention and control measures. We propose not distinguishing within the S. aureus complex for routine reporting purposes until there is evidence that pathogenicity or clinical outcome differ markedly between the different species. Primarily for research purposes, suitably equipped laboratories are encouraged to differentiate between S. argenteus and S. schweitzeri. Caution is urged if these novel species are explicitly reported. In such cases, a specific comment should be added (i.e. 'member of the S.aureus complex') to prevent confusion with less- or non-pathogenic staphylococci. Prioritizing aspects of patient safety, methicillin-resistant isolates should be handled as recommended for methicillin-resistant Staphylococcus aureus (MRSA). In these cases, the clinician responsible should be directly contacted and informed by the diagnosing microbiological laboratory, as they would be for MRSA. Research is warranted to clarify the epidemiology, clinical impact and implications for infection control of such isolates. [ABSTRACT FROM AUTHOR]

Background: Universal health visiting has been a cornerstone of preventative healthcare for children in the United Kingdom (UK) for over 100 years. In 2016, Scotland introduced a new Universal Health Visiting Pathway (UHVP), involving a greater number of contacts with a particular emphasis on the first year, visits within the home setting, and rigorous developmental assessment conducted by a qualified Health Visitor. To evaluate the UHVP, an outcome indicator framework was developed using routine administrative data. This paper sets out the development of these indicators. Methods: A logic model was produced with stakeholders to define the group of outcomes, before further refining and aligning of the measures through discussions with stakeholders and inspection of data. Power calculations were carried out and initial data described for the chosen indicators. Results: Eighteen indicators were selected across eight outcome areas: parental smoking, breastfeeding, immunisations, dental health, developmental concerns, obesity, accidents and injuries, and child protection interventions. Data quality was mixed. Coverage of reviews was high; over 90% of children received key reviews. Individual item completion was more variable: 92.2% had breastfeeding data at 6–8 weeks, whilst 63.2% had BMI recorded at 27–30 months. Prevalence also varied greatly, from 1.3% of children's names being on the Child Protection register for over six months by age three, to 93.6% having received all immunisations by age two. Conclusions: Home visiting services play a key role in ensuring children and families have the right support to enable the best start in life. As these programmes evolve, it is crucial to understand whether changes lead to improvements in child outcomes. This paper describes a set of indicators using routinely-collected data, lessening additional burden on participants, and reducing response bias which may be apparent in other forms of evaluation. Further research is needed to explore the transferability of this indicator framework to other settings. [ABSTRACT FROM AUTHOR]

Background: Liver disease is an increasing cause of morbidity and mortality in the United Kingdom and can be challenging to live with in the advanced stages. There has been little research exploring the healthcare experiences of UK individuals with decompensated disease when the liver cannot carry out its functions properly. A PhD research project was developed with people who have liver disease to explore care experiences in decompensated advanced liver disease. Public involvement (PI) is an essential aspect of meaningful health research, and this paper reports on the progression of our PI approach in this ongoing study. Objective: To embed PI throughout the research project to ensure that the study is meaningful to individuals with liver disease and the people who support them. Methods: The research adopts a Constructivist Grounded Theory methodology to develop a theory of care experience. Various PI approaches were considered in developing the PI strategy for this qualitative study. Initially, Embedded consultation was the preferred model, which has evolved to include aspects of collaboration and coproduction. A PI group was set up to oversee the project through the national public engagement website VOICE, and reflections on PI from three members of the group are included in this paper to illuminate the PI process. Results: Six individuals with liver disease and three carers from across the United Kingdom are part of an ongoing PI group. Their role includes commenting on the findings of the systematic literature review for this project and contributing to decisions about recruitment, data collection and data analysis. Additionally, they had a direct impact on changing the focus of the research. The PI group will continue involvement until the completion of the project. Conclusion: Successfully embedding PI into doctoral research, as demonstrated in this project, requires commitment, planning and dedication to reciprocal working for the benefit of PI contributors as well as the research. This approach could be adopted by other postgraduate researchers. Patient or Public Contribution: This project is overseen by the PI group, whose contribution is described throughout, including reflections from three PI group members. [ABSTRACT FROM AUTHOR]

This paper explores the development of a smart Structural Health Monitoring (SHM) platform tailored for long-span bridge monitoring, using the Forth Road Bridge (FRB) as a case study. It discusses the selection of smart sensors available for real-time monitoring, the formulation of an effective data strategy encompassing the collection, processing, management, analysis, and visualization of monitoring data sets to support decision-making, and the establishment of a cost-effective and intelligent sensor network aligned with the objectives set through comprehensive communication with asset owners. Due to the high data rates and dense sensor installations, conventional processing techniques are inadequate for fulfilling monitoring functionalities and ensuring security. Cloud-computing emerges as a widely adopted solution for processing and storing vast monitoring data sets. Drawing from the authors' experience in implementing long-span bridge monitoring systems in the UK and China, this paper compares the advantages and limitations of employing cloud- computing for long-span bridge monitoring. Furthermore, it explores strategies for developing a robust data strategy and leveraging artificial intelligence (AI) and digital twin (DT) technologies to extract relevant information or patterns regarding asset health conditions. This information is then visualized through the interaction between physical and virtual worlds, facilitating timely and informed decision-making in managing critical road transport infrastructure. [ABSTRACT FROM AUTHOR]

Summary: After more than 120 hand‐upper extremity and 37 face transplant procedures performed worldwide, vascularized composite allotransplantation (VCA) now falls under the scope of organ transplant legislation in Europe and the United States. While in the USA, VCA has been considered as standard care since 2014, VCA in Europe is still performed through clinical research trials, except in United Kingdom. However, after two decades of favourable experience with upper extremity transplantation (UET), professionals in Europe are proposing hand allotransplantation as "controlled standard" care, as opposed to face transplantation (FT), which is still a challenging activity. The European Committee on Organ Transplantation (CD‐P‐TO) has elaborated a position paper to provide recommendations concerning regulatory aspects for UET and FT. It is aimed at Health Authorities in charge of the oversight – and coordination – of organ donation and transplantation, and at professional groups to help them manage such complex and costly programs dedicated to properly selected patients. [ABSTRACT FROM AUTHOR]

Background: Referral letters sent from primary to secondary or tertiary care are a crucial element in the continuity of patient information transfer. Internationally, the need for improvement in this area has been recognised. This aim of this study is to review the current literature pertaining to interventions that are designed to improve referral letter quality. Methods: A search strategy designed following a Problem, Intervention, Comparator, Outcome model was used to explore the PubMed and EMBASE databases for relevant literature. Inclusion and exclusion criteria were established and bibliographies were screened for relevant resources. Results: A total of 18 publications were included in this study. Four types of interventions were described: electronic referrals were shown to have several advantages over paper referrals but were also found to impose new barriers; peer feedback increases letter quality and can decrease ‘inappropriate referrals’ by up to 50%; templates increase documentation and awareness of risk factors; mixed interventions combining different intervention types provide tangible improvements in content and appropriateness. Conclusion: Several methodological considerations were identified in the studies reviewed but our analysis demonstrates that a combination of interventions, introduced as part of a joint package and involving peer feedback can improve. [ABSTRACT FROM AUTHOR]

Global warming, pollution, and increasing energy demand have compelled electrification of the transport sector. Electric vehicles are not only an attractive and cleaner mode of transport, but they also possess the capacity to offer flexible storage alternative based on bidirectional vehicle-to-grid schemes. Vehicle-to-grid or V2G technology permits electric vehicles' batteries to store energy and discharge it back to the power grid during peak-load periods. However, the feasibility and economic viability of V2G is still a matter of concern and needs investigation. In this paper, the authors delved into the feasibility of V2G technology by analysing the real time-charging data of a V2G demonstration project named EV-elocity, located at the University of Nottingham campus in the UK. The authors analysed the charging data and trip-status data of two charging sites and put forward some insights regarding the feasibility of V2G and the behavioural traits of the vehicles. This paper will enlighten the research community regarding the feasibility and benefits of V2G in a real-world environment by analysing the charging/discharging and vehicle behaviour and reporting the opportunities and benefits of vehicle-to-grid technology. [ABSTRACT FROM AUTHOR]

A unifying setup for opinion models originating in statistical physics and stochastic opinion dynamics are developed and used to analyze election data. The results are interpreted in the light of political theory. We investigate the connection between Potts (Curie–Weiss) models and stochastic opinion models in the view of the Boltzmann distribution and stochastic Glauber dynamics. We particularly find that the q-voter model can be considered as a natural extension of the Zealot model, which is adapted by Lagrangian parameters. We also discuss weak and strong effects (also called extensive and nonextensive) continuum limits for the models. The results are used to compare the Curie–Weiss model, two q-voter models (weak and strong effects), and a reinforcement model (weak effects) in explaining electoral outcomes in four western democracies (United States, Great Britain, France, and Germany). We find that particularly the weak effects models are able to fit the data (Kolmogorov–Smirnov test) where the weak effects reinforcement model performs best (AIC). Additionally, we show how the institutional structure shapes the process of opinion formation. By focusing on the dynamics of opinion formation preceding the act of voting, the models discussed in this paper give insights both into the empirical explanation of elections as such, as well as important aspects of the theory of democracy. Therefore, this paper shows the usefulness of an interdisciplinary approach in studying real world political outcomes by using mathematical models. [ABSTRACT FROM AUTHOR]

Brexit will have implications on financial stability and the implementation of macroprudential policies. The United Kingdom (UK) will no longer be subject to the jurisdiction of the European Systemic Risk Board. This paper studies the welfare implications of this change of regime. By means of a dynamic stochastic general equilibrium model, I compare the pre‐Brexit scenario with the new one, in which the UK sets macroprudential policy independently. I find that, after Brexit, the UK is better off by setting its own macroprudential policy without taking into account Europe's welfare as a whole. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has had enormous implications for the world of work. However, there has been relatively little focus on the employment and workforce challenges of the virus in relation to workforce health, beyond the immediate management of the spread of the disease. There is an important gap in understanding the ongoing workforce issues created by the significant incidence of Long COVID in the population. Aim: This paper examines the effects of Long COVID on employment and workers' mental health to contribute to understanding of work-limiting health conditions and to offer policy implications for COVID-19 and similar health conditions on employment and the workforce. Methods: A large national panel study for the UK is used to estimate the likelihood of exiting employment as well as on changes in working hours and general mental health and happiness of those who remain in work. The sample includes individuals 16 years and older who were in employment in January/February 2020 and followed during the pandemic 2020–2021. Long COVID is self-reported in the data. Informed by conceptual consideration of employment protection in the UK, two groups of individuals with Long COVID are defined based on the duration of symptoms. Group 1 has Long COVID 5–28 weeks after an infection with COVID-19, which is up to the maximum length of Statutory Sick Pay in the UK. Group 2 has symptoms for 29+ weeks, which is beyond the statutory entitlement to sickness pay. Panel regression models are fitted both with fixed-effects and random-effects. Individual and job characteristics are used as controls Those with no COVID-19 symptoms are the reference group. Results: In between-person comparison, Group 2 is at higher risk of exiting employment compared to those with no COVID-19 symptoms. Between-person estimates of mental health and well-being show negative effects of Long COVID for both groups but these are greatest in Group 2. Within-person estimates suggest that factors associated with earnings mediate the negative Long COVID effects on mental health in Group 1 and that Group 2 adapts to working with Long COVID. Group 1 is at risk of working zero hours (i.e. being on sick leave) but neither Group 1 nor Group 2 have a higher probability of working fewer hours compared to those with no COVID-19 symptoms. The negative impact of Long COVID on working hours stems primarily from working zero hours (sickness leave) rather than working fewer hours, suggesting a lack of accommodation by employers of Long COVID at work. Policy implications: The extension of Statutory Sickness Pay and greater flexibility to manage partial (returns to) work would help preserve employment and mental health. Those with Long COVID for 12 months are likely to meet the definition of disability and so have a right to receive reasonable workplace adjustments. [ABSTRACT FROM AUTHOR]

Background: Stroke survivors with aphasia want to improve their everyday talking (discourse). In current UK practice, 90% of speech and language therapists believe discourse assessment and treatment is part of their role but are hampered by barriers in resources, time and expertise. There is a clinical need for well-articulated discourse assessment and treatments. LUNA is a multi-level treatment targeting words, sentences and discourse macrostructure in personal stories that addresses this clinical need. Objectives: This study aimed to assess the feasibility and acceptability of LUNA trial procedures in a randomised waitlist-controlled trial; and to evaluate preliminary efficacy. Methods: This paper reports a phase II, waitlist-controlled, proof-of-concept feasibility trial. Participants with chronic aphasia (n = 28) were recruited from the community and randomised to an Immediate (n = 14) or Delayed (n = 14) group. LUNA treatment was delivered twice weekly for 10 weeks via the videoconferencing technology, Zoom. Feasibility was assessed in terms of participant recruitment and retention, adherence, missing data, and treatment fidelity. Preliminary treatment efficacy was assessed in terms of between group differences in outcome measures relating to discourse, language, and psychosocial state. Results: The remote LUNA trial was feasible: 85% of those eligible consented to the trial; trial retention was 86%; 87% of treatment sessions were delivered as scheduled, and 79% of participants completed 80%+ of the treatment programme; data was missing only for participants who withdrew; treatment fidelity was high at 92% adherence; and only one clinical outcome measure demonstrated ceiling effects. ANCOVA analysis of the clinical outcome measures revealed group differences with medium and large effect sizes, indicating, improvements in the production of words, sentences, discourse macrostructure, overall language functioning (WAB-R), and psychosocial state (VAMS) following LUNA treatment. For most outcomes measured, similar treatment benefits were suggested in a secondary, non-parametric analysis. Conclusions: Large-scale evaluation of the clinical efficacy and cost-effectiveness of LUNA is warranted and supported by these findings. Trial registration: Clinical trials registration: NCT05847023 (clinical trials.gov). [ABSTRACT FROM AUTHOR]

Post-partum haemorrhage is among the main causes of (preventable) mortality for women in low-resource settings (LRSs), where, in 2017, the mortality ratio was 462 out of every 100 000 live births, over 10 times higher than for high-resource settings. There are different treatments available for post-partum haemorrhage. The intrauterine balloon tamponade is a medical device that proved to be a simple and cost-effective approach. Currently, there are several balloon tamponades available, with different design and working principles. However, all these devices were designed for high-resource settings, presenting several aspects that could be inappropriate for many lower-income countries. This paper presents the results of a preclinical study aiming at informing the design, prototyping and validation of a 3D-printed intrauterine balloon tamponade concept, contributing towards the United Nation's Sustainable Development Goal 3: Good health and Well-being. Frugal engineering concepts and contextualised design techniques were applied throughout, to define the design requirements and specifications. The performance of the final prototype was validated against the requirements of the UK National Health System (NHS) technical guidelines and relevant literature, measuring the water leak and pressure drop over time, both open air and in a approximate uterus model. The resulting prototype is made up of six components, some of which are easy to retrieve, namely a water bottle, a silicone tube and an ordinary condom, while others can be manufactured locally using 3D printers, namely a modified bottle cap, a flow stopper and a valve for holding the condom in place. Validation testing bore promising results with no water or pressure leak open air, and minimal leaks in the approximate uterus model. This demonstrates that the 3D printed condom-based intrauterine balloon tamponade is performing well against the requirements and, when compared to the state of the art, it could be a more appropriate and more resilient solution to low-resource settings, as it bypasses the challenges in the supply of consumables and presents a greener option based on circular economy. [ABSTRACT FROM AUTHOR]

International students' mental health has become an increasing concern in recent years, as more students leave their country for better education. They experience a wide range of challenges while studying abroad that have an impact on their psychological well-being. These challenges can include language obstacles, cultural differences, homesickness, financial issues and other elements that could severely impact the mental health of international students. Given the limited research on the demographic, cultural, and psychosocial variables that influence international students' mental health, and the scarcity of studies on the use of machine learning algorithms in this area, this study aimed to analyse data to understand the demographic, cultural factors, and psychosocial factors that impact mental health of international students. Additionally, this paper aimed to build a machine learning-based model for predicting depression among international students in the United Kingdom. This study utilized both primary data gathered through an online survey questionnaire targeted at international students and secondary data was sourced from the 'A Dataset of Students' Mental Health and Help-Seeking Behaviors in a Multicultural Environment,' focusing exclusively on international student data within this dataset. We conducted data analysis on the primary data and constructed models using the secondary data for predicting depression among international students. The secondary dataset is divided into training (70%) and testing (30%) sets for analysis, employing four machine learning models: Logistic Regression, Decision Tree, Random Forest, and K Nearest Neighbor. To assess each algorithm's performance, we considered metrics such as Accuracy, Sensitivity, Specificity, Precision and AU-ROC curve. This study identifies significant demographic variables (e.g., loan status, gender, age, marital status) and psychosocial factors (financial difficulties, academic stress, homesickness, loneliness) contributing to international students' mental health. Among the machine learning models, the Random Forest model demonstrated the highest accuracy, achieving an 80% accuracy rate in predicting depression. [ABSTRACT FROM AUTHOR]

Internationally, research comparing education systems across countries and jurisdictions is valuable and can elicit nuanced insights into how particular systems operate. This paper's interest lies in considering the scope and content of research comparing education systems across the four UK nations (England, Northern Ireland, Scotland and Wales). This study sought to determine the coverage of UK cross-national comparative education research ('home international' research) between 2000 and 2022. We chose this time period as 1999 marks the devolution of education policy to each UK nation. We aimed to investigate what educational issues had been discussed in the literature and identify any gaps in the content covered by the research. An exploratory, high-level review of 'home international' education research was conducted, based on the review of abstracts. We searched several research databases using a variety of keyword combinations to identify relevant literature published since 2000. Our search identified 53 studies that met our selection criteria. Using a meta-synthesis approach, we coded the content of each abstract to build a picture of the range and thematic coverage of research involving comparisons between at least two of the four UK nations. The analysis of abstracts identified that, over the last two decades, UK 'home international' research has tended to include comparisons of all four nations, coverage of multiple educational phases and a focus on national education policy reviews. Furthermore, we pinpointed a number of gaps in coverage that might not have been anticipated (e.g. relatively little cross-national research focusing on assessment). This high-level review uncovers the landscape of recent 'home international' research, allowing us to view issues that are driving the cross-national research agenda in the UK and recognise implications relevant to education systems that may resonate with jurisdictions beyond these four UK nations. [ABSTRACT FROM AUTHOR]

A variant of membrane computing models called Spiking Neural P systems (SNP systems) closely mimics the structure and behavior of biological neurons. As third-generation neural networks, SNP systems have flexible architectures allowing the design of bio-inspired machine learning algorithms. This paper proposes Modular Spiking Neural P (MSNP) systems to solve image classification problems, a novel SNP system to be applied in scenarios where hundreds or even thousands of different classes are considered. A main issue to face in such situations is related to the structural complexity of the network. MSNP systems devised in this work allow to approach the general classification problem by dividing it in smaller parts, that are then faced by single entities of the network. As a benchmark dataset, the Oxford Flowers 102 dataset is considered, consisting of more than 8000 pictures of flowers belonging to the 102 species commonly found in the UK. These classes sometimes present large variations within them, may be also very similar to one another, and different images of the same subject may differ a lot. The work describes the architecture of the MSNP system, based on modules focusing on a specific class, their training phase, and the evaluation of the model both concerning result accuracy as well as energy consumption. Experimental results on image classification problems show that the model achieves good results, but is strongly connected to image quality, mainly depending on the frequency of images, remarkable changes of pose, images not centered, and subject mostly not shown. [ABSTRACT FROM AUTHOR]

Background: Healthcare workers (HCWs) in the United Kingdom (UK) have faced many challenges during the COVID-19 pandemic, some of these arising out of their social positions. Existing literature explicating these challenges (e.g., lack of appropriate PPE, redeployment, understaffing) have highlighted inequities in how these have been experienced by HCWs based on ethnicity, gender or, job role. In this paper, we move a step ahead and examine how the intersection of these social positions have impacted HCWs' experiences of challenges during the pandemic. Methods: We collected qualitative data, using interviews and focus groups, from 164 HCWs from different ethnicities, gender, job roles, migration statuses, and regions in the United Kingdom (UK) between December 2020 and July 2021. Interviews and focus groups were conducted online or by telephone, and recorded with participants' permission. Recordings were transcribed and a hybrid thematic analytical approach integrating inductive data-driven codes with deductive ones informed by an intersectional framework was adopted to analyse the transcripts. Results: Thematic analysis of transcripts identified disempowerment, disadvantage and, discrimination as the three main themes around which HCWs' experiences of challenges were centred, based on their intersecting identities (e.g., ethnicity gender, and/or migration status). Our analysis also acknowledges that disadvantages faced by HCWs were linked to systemic and structural factors at the micro, meso and macro ecosystemic levels. This merging of analysis which is grounded in intersectionality and considers the ecosystemic levels has been termed as 'intrasectionalism'. Discussion: Our research demonstrates how an intrasectional lens can help better understand how different forms of mutually reinforcing inequities exist at all levels within the healthcare workforce and how these impact HCWs from certain backgrounds who face greater disadvantage, discrimination and disempowerment, particularly during times of crisis like the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Research into canine health and welfare is supported by Government, charitable and private UK funding organisations. However, there is no current overall visibility or coordination of these funding activities, potentially compromising optimal distribution of limited resources. This study aimed to survey UK canine health and welfare funding by not-for-profit funders between 2012 and 2022, providing a novel baseline analysis to inform future sector stakeholder priorities. Results: Funding data were collected from 10 wide-scope funders (UK Government funding councils and medical charities), 18 animal-directed funders (organisations specifically concerned with animal health and welfare) and 81 breed community groups. These 109 UK funders together provided traceable canine-relevant funding of £57.8 million during the surveyed period, comprising 684 individual grant awards supporting over 500 separate research projects. Wide-scope funders contributed £41.2 million (71.2% of total funding); animal-directed organisations, £16.3 million (28.1% of total funding); and breed-specific groups, £370K (0.6% of total funding). Individual grants ranged from £2.3 million to £300. Funding patterns varied between sectors. Animal-directed funders provided £14.7 million of canine-relevant research funding that foregrounded the dog, 73% of all such funding; wide-scope funders provided £17.5 million of canine-relevant One Health research funding, 97% of all such funding. Customised metrics developed for this study assessed the 'benefit to the dog' and 'pathway to impact' of individual research projects. Overall, studies supported by animal-directed funders achieved significantly higher 'benefit to the dog' scores (Mann-Whitney U = 45235, p<0.001) and 'pathway to impact' scores (Mann-Whitney U = 43506.5, p<0.001) than those supported by wide-scope funders. Conclusion: The landscape of UK not-for-profit funding of canine health and welfare research is complex, with considerable variation between providers. Although wide-scope funders provide the majority of overall canine-relevant research funding, animal-directed funders provide the majority of canine-focused funding and support research with greater direct impact on canine welfare. Visibility of past funding patterns will enable stakeholders in this sector to make more informed decisions about future research. Definitions: To increase clarity, certain words and phrases are used in specific ways within the context of this paper. Animal-directed funders—Charities and other funding organisations whose remit primarily concerns animals or veterinary work Canine-focused research—Investigations where the primary purpose is to advance understandings of canine health and/or welfare Canine-relevant research—All research that is framed as advancing understandings of canine health and/or welfare as a primary or subsidiary purpose Institution—Refers to universities and other centres where research is carried out Organisation—Refers to funding bodies, including research councils, charities and other groups Research grant—A single funding event originating from one or more funders Research project—A cohesive piece of research concerning a particular topic; may involve multiple researchers and/or multiple research grants, in series or in parallel Wide-scope funders—Large organisations whose remit does not primarily concern animals, i.e. (in this dataset) UKRI councils and the Wellcome Trust [ABSTRACT FROM AUTHOR]

Background: The small Atlantic island of St Helena is a United Kingdom Overseas Territory (UKOT) with a high prevalence of childhood obesity (over a quarter of 4–5 and 10–11 year olds) and, anecdotally, adulthood obesity and its associated health detriments. St Helena have taken a whole systems approach to obesity (WSAO) to address the issue. A WSAO recognises the factors that impact obesity as a complex system and requires a 'health in all policies' approach. UK academic and public health technical support was provided to the local St Helena delivery team. This process evaluation sought to explore the early stages of the WSAO implementation and implications for the transferability of the approach to other small island developing states and UKOT. Methods: Data was collected via eight semi-structured interviews, paper based and online surveys, and document analysis. Thematic analysis was used to analyse the data. Results: The analysis identified three factors which aided the first phase of WSAO implementation: (1) senior leaders support for the approach; (2) the academic support provided to establish and develop the approach; and (3) effective adaptation of UK Government resources to suit the local context. Key challenges of early implementation included: maintaining and broadening stakeholder engagement; limited local workforce capacity and baseline knowledge related to obesity and systems thinking; and limited capacity for support from the UK-based academic team due to contract terms and COVID-19 restrictions. Conclusions: Early stages of implementation of a WSAO in a UKOT can be successful when using UK's resources as a guide and adapting them to a small island context. All participants recommended other small islands adopt this approach. Continued senior support, dedicated leadership, and comprehensive community engagement is needed to progress implementation and provide the foundation for long-term impact. Small island developing states considering adopting a WSAO should consider political will, senior level buy-in and support, funding, and local workforce knowledge and capacity to enable the best chances of successful and sustainable implementation. [ABSTRACT FROM AUTHOR]

Solar energy is one type of clean energy resource, and currently the IMO, EU and UK are targeting net zero carbon emissions by 2050. This paper delves into the integration of photovoltaic (PV) systems into hybrid vessels in order to meet their strategies and targets. The technical challenges that come with designing such systems as well as their economic and environmental impacts are examined. By optimizing the usage of harnessed solar energy, we discover the operational strategy that provides maximal benefits through day-to-day savings as well as over the 25 year lifespan of solar panels. It demonstrates impressive economic viability, with cost savings of up to GBP 4.55 per day and a payoff period as short as 9 years. It also displays a modest emission reduction of up to 8.002 kg of CO2, which serves as proof for a pathway to greener practices in the maritime industry. This report highlights the operational flexibility that a hybrid vessel possesses once paired with a PV system through the ability to withstand regulatory and market changes. Also, when looking ahead, further adoption of PV technology creates opportunities for innovation in adopting renewable energy solutions in maritime transportation. [ABSTRACT FROM AUTHOR]

This paper introduces three new scales to measure left- and right-wing radical as well as general extremist attitudes that can be applied across Western European countries. We therefore propose a thorough conceptualization of extremist attitudes that consists of two dimensions: general extremism, by which we understand attitudes that oppose the constitutional democratic state, and another dimension that differentiates between right- and left-wing radicalism by which we understand people who take far-reaching but often one-sided positions on political issues (e.g., on nationalism or anti-imperialism) by advocating fundamental socio-political change. Based on data from Germany, Great Britain, and the Netherlands (n = 6,201) we created short indices for general extremism and left- and right-wing radicalism. We check for convergence validity by assessing the psychometric properties of the extracted indices, i.e. their internal coherence and the degree to which a scale is able to distinguish strongly extremist and non-extremist individuals. Finally, we correlate the scales with various constructs that are likely related to extremist attitudes in order to assure external or construct validity. The results indicate that the three scales are highly valid and applicable across three Western European countries. Overall, we find that about two to four percent of citizens in each country hold left-wing or right-wing extremist attitudes. [ABSTRACT FROM AUTHOR]

Joint analysis of multiple correlated phenotypes for genome-wide association studies (GWAS) can identify and interpret pleiotropic loci which are essential to understand pleiotropy in diseases and complex traits. Meanwhile, constructing a network based on associations between phenotypes and genotypes provides a new insight to analyze multiple phenotypes, which can explore whether phenotypes and genotypes might be related to each other at a higher level of cellular and organismal organization. In this paper, we first develop a bipartite signed network by linking phenotypes and genotypes into a Genotype and Phenotype Network (GPN). The GPN can be constructed by a mixture of quantitative and qualitative phenotypes and is applicable to binary phenotypes with extremely unbalanced case-control ratios in large-scale biobank datasets. We then apply a powerful community detection method to partition phenotypes into disjoint network modules based on GPN. Finally, we jointly test the association between multiple phenotypes in a network module and a single nucleotide polymorphism (SNP). Simulations and analyses of 72 complex traits in the UK Biobank show that multiple phenotype association tests based on network modules detected by GPN are much more powerful than those without considering network modules. The newly proposed GPN provides a new insight to investigate the genetic architecture among different types of phenotypes. Multiple phenotypes association studies based on GPN are improved by incorporating the genetic information into the phenotype clustering. Notably, it might broaden the understanding of genetic architecture that exists between diagnoses, genes, and pleiotropy. Author summary: Biological pleiotropy refers to a SNP or gene that has a direct biological influence on more than one phenotypic trait, which can offer significant insights in understanding the complex genotype-phenotype relationships. Network analyses provide an integrative approach to characterize complex genomic associations by linking phenotypes and genotypes into a Genotype and Phenotype Network (GPN). Jointly analyzing multiple phenotypes and incorporating the genetic information into the phenotype clustering may increase the statistical power to discover the cross-phenotype association and pleiotropy. We evaluate our proposed multiple phenotype association tests based on network modules detected by GPN for 72 EHR-derived phenotypes in the diseases of the musculoskeletal system and connective tissue in the UK Biobank. From the post-GWAS analyses, we observe that the test based on GPN can identify more significantly enriched biological pathways than that without considering the network modules. Meanwhile, some of the uniquely identified SNPs by the test based on GPN are also colocalized in the eQTL study of the gene expression in the Muscle Skeletal tissue. [ABSTRACT FROM AUTHOR]

Background: The 2022/23 influenza season in the United Kingdom saw the return of influenza to prepandemic levels following two seasons with low influenza activity. The early season was dominated by A(H3N2), with cocirculation of A(H1N1), reaching a peak late December 2022, while influenza B circulated at low levels during the latter part of the season. From September to March 2022/23, influenza vaccines were offered, free of charge, to all aged 2–13 (and 14–15 in Scotland and Wales), adults up to 49 years of age with clinical risk conditions and adults aged 50 and above across the mainland United Kingdom. Methods: End‐of‐season adjusted vaccine effectiveness (VE) estimates against sentinel primary‐care attendance for influenza‐like illness, where influenza infection was laboratory confirmed, were calculated using the test negative design, adjusting for potential confounders. Methods: Results In the mainland United Kingdom, end‐of‐season VE against all laboratory‐confirmed influenza for all those > 65 years of age, most of whom received adjuvanted quadrivalent vaccines, was 30% (95% CI: −6% to 54%). VE for those aged 18–64, who largely received cell‐based vaccines, was 47% (95% CI: 37%–56%). Overall VE for 2–17 year olds, predominantly receiving live attenuated vaccines, was 66% (95% CI: 53%–76%). Conclusion: The paper provides evidence of moderate influenza VE in 2022/23. [ABSTRACT FROM AUTHOR]

Background: Severe and enduring anorexia nervosa (SE-AN), is a serious and persistent illness, despite 'state of the art' treatment. Criteria have been theoretically proposed, but not tested, and may not adequately capture illness complexity, which potentially inhibits treatment refinements. The clinical reality of death as an outcome for some people who experience SE-AN (1 in 20) and broadening access to voluntary assisted dying, further complicates the field, which is undeveloped regarding more fundamental concepts such as nosology, treatment, recovery definitions and alternative conceptualisations of SE-AN. The present paper is in response to this and aims to build upon qualitative literature to enhance phenomenological understandings of fatal SE-AN. Method: A published book, being the legacy of a 32-year-old professional artist offers a rich account of a life lived with AN, for 18 years with continuous treatment. A polysemous narrative via the interrelationship between the languages of the artist's words and visual art is translated via interpretative phenomenological analysis (IPA), offering rich insight into the SE-AN experience. Findings: The process of analysis induced three superordinate themes (1) Disappearing Self (2) Dialectical Dilemma (3) Death and Dying: Finding Meaning. Two cross cutting themes traversed these themes: (a) Colour and (b) Shifting Hope, where the former produced a visual representation via the 'SE-AN Kaleidoscope'. Collectively the themes produce a concept of SE-AN, grounded in the data and depicted visually through the artist's paintings. Conclusions: The picture of SE-AN revealed in the analysis extends upon conceptualisations of SE-AN, highlighting key processes which are thus far under explored. These factors are implicated in illness persistence eliciting opportunities for further research testing including diagnostic considerations and treatment directions. In SE-AN, distorted body image extends to a global distortion in the perception of self. Additional criteria for the severe and enduring stages of illness related to (1) self and identity processes (2) measures of 'global impoverishment' across life domains are proposed for consideration in the future testing of putative defining features of SE-AN. Plain English summary: Anorexia Nervosa (AN) is a serious and life-threatening illness. There is a need to understand more about why AN persists in becoming severe and enduring (SE-AN) for some people. One such way to build understanding of a condition is via the stories of those who experience it. This study utilizes a person's unique artistic language to do so. This has the potential to generate new ideas about a condition, especially those that may be beyond words for some people and therefore progress classifications for SE-AN for research and treatment purposes. The artist in this study contributes a unique perspective offering new areas for potential research such as understudied complex psychological processes for example shame, dissociation, 'self', emotional literacy, and anorexia as an identity. Additionally, other factors to be considered in the assessment and classifications of long-term cases of AN as well as an alternative understanding of AN persistence is proposed, beyond the concept of 'body image disturbance'. Alternative treatment approaches such as art therapy are indicated. Note: Contents of this paper may be distressing to people who have lost a loved one to an eating disorder and the following website may provide access to support if any of the content of his paper causes the reader distress: USA - NEDA https://www.nationaleatingdisorders.org/ UK BEAT https://www.beateatingdisorders.org.uk/ Australia Butterfly https://butterfly.org.au/ or Lifeline - which is an international organisation with local websites. [ABSTRACT FROM AUTHOR]

Introduction: Social Prescribing has an established recognition regarding the benefits provided to the health-related social needs of adults, but little is known about how the intervention addresses young people's needs. There is optimism regarding the central role of two core mechanisms that allows social prescribing to be effective, such as the empathetic role of Link Workers and the connection with community resources. This paper aims to describe the role played by Link Workers working a Social Prescribing intervention targeting young people. Description: This paper adopts a case study methodology to describe the role of Link Workers addressing young people's needs and implementing Social Prescribing scheme in Sheffield (UK). Data were collected through semi-structured interviews with four of the seven link workers of one organisation based in Sheffield. Data were analysed through an inductive approach for emerging themes. Discussion: We provided a description of the profiles and background of Link Workers and described the three models of referral pathways into the intervention. The paper also shows how Link Workers identify young people's needs and how they connect with the community. Conclusion: Based on the insights and the internationally accepted definition of Social Prescribing, we provide a visual representation of the Social Prescribing model and discuss challenges. The paper highlights lessons learned and future directions regarding the role of Link Workers from the case study. [ABSTRACT FROM AUTHOR]

Psychologist resourcing across the United Kingdom (UK) spinal cord injury centres (SCICs) varies considerably, which has detrimentally impacted standardising service provision for people with spinal cord injuries/disorders (PwSCI/D) compared with other nations. This paper presents the outcome of a project involving the Spinal Cord Injury Psychology Advisory Group (SCIPAG) and NHS England Clinical Reference Group/SCI transformation groups to agree upon screening and standards and shares data from the National Spinal Injuries Centre (NSIC) and the Yorkshire and Midlands Regional SCICs. Inpatients completed the GAD-7, the PHQ-9, and the short form of the Appraisals of DisAbility: Primary and Secondary Scale (ADAPSSsf), assessing adjustment. A total of 646 participants were included, with 43% scoring above the clinical threshold on at least one of the measures on admission. A subset of 272 participants also completed discharge measures and 42% remained above the threshold on discharge, demonstrating sustained psychological need. This paper provides support for services to move to a screen-and-assessment model supplemented by referral options for those with changing needs or who present with difficulties outside the remit of screening. The findings also support the efficacy of universal screening across the system and consideration of screening and standards for psychological care by the wider psychology community. [ABSTRACT FROM AUTHOR]

Background: Maternal smoking in pregnancy is associated with several adverse maternal and infant health outcomes including increased risk of miscarriage, stillbirth, low birth weight, preterm birth, and asthma. Progress to reduce rates of smoking at time of delivery in England have been slow and over the last decade, less than half of pregnant women who accessed services went onto report having quit. This realist review was undertaken to improve the understanding of how smoking cessation services in pregnancy work and to understand the heterogeneity of outcomes observed. Methods: The initial programme theory was developed using the National Centre for Smoking Cession and Training Standard Treatment Programme for Pregnant Women and the National Institute for Health and Care Excellence guidance on treating tobacco dependency. A search strategy and inclusion criteria were developed. Four databases were searched to identify published papers and four websites were hand searched to identify any unpublished literature that could contribute to theory building. Realist logic was applied to the analysis of papers to identify the contexts in which the intended behaviour change mechanism(s) were triggered, or not, and towards what outcomes to develop context mechanism outcome configurations. Results: The review included 33 papers. The analysis produced 19 context mechanism outcome configurations structured under five closely interconnected domains (i) articulating harm, (ii) promoting support, (iii) managing cravings, (iv) maintaining commitment and (v) building self-efficacy. This review identifies two key processes involved in how services achieve their effects: how material resources are implemented and relationships. Of the two key processes identified, more existing literature was available evidencing how material resources are implemented. However, the review provides some evidence that non-judgemental and supportive relationships with healthcare workers where regular contact is provided can play an important role in interrupting the social cues and social practice of smoking, even where those around women continue to smoke. Conclusions: This review clarifies the range of interconnected and bi-directional relationships between services and the personal and social factors in women's lives. It underscores the importance of aligning efforts across the models five domains to strengthen services' ability to achieve smoking cessation. [ABSTRACT FROM AUTHOR]

Introduction: Co‐production is gaining increasing recognition as a good way of facilitating collaboration among different stakeholders, including members of the public. However, it remains an ambiguous concept as there is no definitive or universal model of co‐production or clarity on what constitutes a good co‐production approach. This paper draws on the reflections of the academic researchers, practitioners and public advisors involved in co‐producing a priority‐setting exercise. The exercise was conducted by the Primary and Community Health Services (PCHS) Theme of the National Institute for Health and Care Research Applied Research Collaboration for Kent, Surrey and Sussex (NIHR ARC KSS). Methods: We collected data through written and verbal reflections from seven collaborators involved in the PCHS priority‐setting exercise. We used Gibbs' model of reflection to guide the data collection. We then analysed the data through an inductive, reflexive thematic analysis. Results: A common thread through our reflections was the concept of 'sharing'. Although co‐production is inherently shared, we used the virtuous cycle to illustrate a sequence of sharing concepts during the research cycle, which provides the underpinnings of positive co‐production outcomes. We identified six themes to denote the iterative process of a shared approach within the virtuous cycle: shared values, shared understanding, shared power, shared responsibilities, shared ownership and positive outcomes. Conclusion: Our results present a virtuous cycle of co‐production, which furthers the conceptual underpinnings of co‐production. Through our reflections, we propose that positive co‐production outcomes require foundations of shared values and a shared understanding of co‐production as a concept. These foundations facilitate a process of shared power, shared responsibilities and shared ownership. We argue that when these elements are present in a co‐production exercise, there is a greater potential for implementable outcomes in the communities in which the research serves and the empowerment of collaborators involved in the co‐production process. Public Members' Contributions: Three members of the public who are public advisors in the NIHR ARC KSS were involved in the priority‐setting exercise that informed this paper. The public advisors were involved in the design of the priority‐setting exercise and supported participants' recruitment. They also co‐facilitated the focus groups during data collection and were involved in the data analysis, interpretation and preparation of the priority‐setting report. For this current manuscript, two of them are co‐authors. They provided reflections and contributed to the writing and reviewing of this manuscript. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to better understand how emerging artists use information to navigate the transition out of university, using their changing ideas of failure, success, information literacy (IL), and transition to frame the qualitative data. A literature review is used to frame the current understanding of emerging artists and feed into the creation of the interview questions. Four emerging artists participated to elicit qualitative accounts. Descriptive and process coding was used to analyse the interviews to form the findings. The findings present how emerging artists use information to shape their criteria for success and failure during the transitional period after leaving art school education. Three core information practices -- sharing, feeding, and balancing -- were observed within the interviews. With this framing insights into the emerging artists' past (learning from historic failings) and the future (envisioning future success) begin to be formed. Furthermore, this paper contributes to the knowledge of emerging artists' information practices, including the impact of their digital media usage and self-referencing as IL. The study uses the work of other IL scholars with the information practices of emerging artists and frames them through three key ideas: IL, transition, and success and failure. This intersection of study has not been explored previously. The results will provide direction for information professionals serving emerging artists, and for art educators preparing their students for their careers outside of university. It also deepens the understanding of the field of transition and information practices of new practitioners across fields. [ABSTRACT FROM AUTHOR]

The paper explores three periods in the UK electricity consumption-production system since World War II. The first two involved the development of an increasingly centralized, integrated system that provided electricity to meet growing post-war demand. It saw two major changes in governance, first to nationalization, then to privatization and liberalization. The third period started at the turn of the Century, driven by increasing evidence of the impact of fossil fuels on the Earth's climate. The paper focuses on the drivers of change, within the UK and externally, and how they affected governance, technology deployment, and industry structure. It draws on the multilevel perspective and the concepts of governance and technological branching points to inform the analysis of each period. It shows that there is a considerable distance to travel toward a truly sustainable electricity system. [ABSTRACT FROM AUTHOR]

Students of European integration have produced an enormous amount of literature on the intergovernmental negotiations that led to the establishment of such organizations as the OEEC, the EEC and EFTA. However, only a few have devoted substantial attention to the international contacts between companies that attempted to undermine the integration process by building private trade barriers that would replace those that governments had agreed to remove. The paper producers began to build such barriers soon after EFTA and the EEC had been set up. Although these attempts were not always successful, the industrialists did manage to create arrangements that were substantially more extensive in their geographical and product scope than those that had existed before. The British government and the EEC were reluctant to challenge these arrangements, and in some cases even actively promoted them. The interwar decades are widely considered to be the ‘golden era’ for international cartels; but for the paper cartels, the ‘golden era’ began in the 1960s, when previous bilateral links were replaced with multilateral ones. [ABSTRACT FROM PUBLISHER]

Researchers commonly perform sentiment analysis on large collections of short texts like tweets, Reddit posts or newspaper headlines that are all focused on a specific topic, theme or event. Usually, general-purpose sentiment analysis methods are used. These perform well on average but miss the variation in meaning that happens across different contexts, for example, the word "active" has a very different intention and valence in the phrase "active lifestyle" versus "active volcano". This work presents a new approach, CIDER (Context Informed Dictionary and sEmantic Reasoner), which performs context-sensitive linguistic analysis, where the valence of sentiment-laden terms is inferred from the whole corpus before being used to score the individual texts. In this paper, we detail the CIDER algorithm and demonstrate that it outperforms state-of-the-art generalist unsupervised sentiment analysis techniques on a large collection of tweets about the weather. CIDER is also applicable to alternative (non-sentiment) linguistic scales. A case study on gender in the UK is presented, with the identification of highly gendered and sentiment-laden days. We have made our implementation of CIDER available as a Python package: https://pypi.org/project/ciderpolarity/. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this paper is to investigate what factors are associated to cardiovascular disease and what differences exists between Asians living in the UK (from the English Longitudinal Study of Ageing) and the Asians living in India (from the Longitudinal Ageing Study in India). Methods: Logistic regression was used to investigate how demographic and physical performance factors were associated with cardiovascular disease using data from Wave 6 of the English Longitudinal Study of Ageing and Wave 1 of the Longitudinal Study of Ageing in India, with the main variable of interest being country of residence, Asians in England or Asians in India. Results: A total of 83,997 participants were included in the analyses. In the primary analysis, 73,396 participants from LASI were compared to 171 Asians in ELSA. After adjusting for age, blood pressure, resting heart rate, sex, waist circumference, gait, handgrip strength and standing balance, there was a statistically significant difference for the outcome of CVD between Whites ELSA (reference) and the participants of LASI (odds ratio = 0.77; 95% confidence interval = 0.60 to 0.99). There were no significant differences in CVD between the LASI participants, Asian ELSA, and the Non-White but not Asian ELSA groups. Discussion: No difference was found between Asians that live in India compared to ethnic minorities living in England, including Asians, after adjusting for confounders, but was found between Whites in ELSA compared to LASI participants. A key limitation was the massive disparity in sample sizes between the ELSA subgroups and LASI. Further work is required where comparable sample sizes and longitudinal analyses allow trends to be identified and to investigate the factors associated with the difference in CVD between two similar ethnicities living in distinct locations. Conclusion: After adjusting for risk factors, there was no difference in CVD between localised Asians and the ethnic minorities in the UK, but there was a difference between the majority ethnicities in the respective countries. [ABSTRACT FROM AUTHOR]

Objectives: To establish if Black adults and adult ethnic minorities, defined as any group except White British, were represented in UK-based COVID-19 vaccination randomised controlled trials (RCTs) when compared to corresponding UK population proportions, based on 2011 census data. Design: Systematic review of COVID-19 Randomised Controlled Vaccine Trials Setting: United Kingdom Participants: Randomised Controlled Trials of COVID-19 vaccines conducted in the UK were systematically reviewed following PRISMA guidelines. MeSH terms included "Covid-19 vaccine", "Ad26COVS1", and "BNT162 Vaccine" with keywords such as [covishield OR coronavac OR Vaxzevria OR NVX-CoV2373] also used. Studies that provided (A) participant demographics and (B) full eligibility criteria were included. The following key data was extracted for analysis: number of participants analysed, number of Black adults and number of adult minority ethnicity participants. Primary and Secondary Outcome Measures: The primary outcome is the mean percentage of Black adults randomised to COVID-19 vaccine trials deemed eligible within this review. The secondary outcome is the mean percentage of adult ethnic minorities randomised. Results: The final review included 7 papers and a total of 87 sets of data collated from trial sites across the UK. The standard mean percentage of Black adults included in the trials (0.59%, 95% CI: 0.13% - 1.05%) was significantly lower compared to the recorded Black adult population (2.67%) indicating that they were under-served in UK based COVID-19 vaccine RCTs (p < 0.001). Adult ethnic minority presence (8.94%, 95% CI: 2.07% - 15.80%) was also lower than census data (16.30%), indicating they were also under-served (p = 0.039). Conclusion: The findings show that COVID-19 vaccine trials failed to adequately randomise proportionate numbers of Black adults and adult minority ethnicities. More inclusive practices must be developed and implemented in the recruitment of underserved groups to understand the true impact of COVID-19. [ABSTRACT FROM AUTHOR]

The discontinuation of life-sustaining therapy has been the subject of dispute for many years. Despite the guidelines, which were created to facilitate the resolution of disputes between the doctor (hospital) and the patient (family, surrogate), new cases of seriously ill patients continue to emerge and stir up controversy. One such case was the RS case. A Polish citizen living in the UK suffered severe brain damage as a result of cardiac arrest. The hospital applied to the court to withdraw ventilation, hydration, and nutrition for RS. The judge ultimately ruled that it was in RS’s best interest to withdraw ventilation and nutrition, but he left the decision on hydration to RS’s wife and the hospital. The court’s ruling has stirred up controversy among the Polish public. Some Polish doctors assessed the UK court’s decision as “legal murder” and “euthanasia”. I believe that it is worth examining the RS case for at least two reasons. Firstly, it provides a better understanding of the difference in approaches to therapy cessation in the UK and Poland. Secondly, many Poles live in the UK, and therefore similar disputes may arise in the future. In this paper, I point out several differences between the British and Polish approaches to discontinuing life-sustaining therapy. These differences are focused on the definitions of medical futility and persistent therapy, best interest and dignity, and quality of life and sanctity of life. [ABSTRACT FROM AUTHOR]

Assess whether ChatGPT 4.0 is accurate enough to perform research evaluations on journal articles to automate this time-consuming task. Test the extent to which ChatGPT-4 can assess the quality of journal articles using a case study of the published scoring guidelines of the UK Research Excellence Framework (REF) 2021 to create a research evaluation ChatGPT. This was applied to 51 of my own articles and compared against my own quality judgements. ChatGPT-4 can produce plausible document summaries and quality evaluation rationales that match the REF criteria. Its overall scores have weak correlations with my self-evaluation scores of the same documents (averaging r=0.281 over 15 iterations, with 8 being statistically significantly different from 0). In contrast, the average scores from the 15 iterations produced a statistically significant positive correlation of 0.509. Thus, averaging scores from multiple ChatGPT-4 rounds seems more effective than individual scores. The positive correlation may be due to ChatGPT being able to extract the author's significance, rigour, and originality claims from inside each paper. If my weakest articles are removed, then the correlation with average scores (r=0.200) falls below statistical significance, suggesting that ChatGPT struggles to make fine-grained evaluations. The data is self-evaluations of a convenience sample of articles from one academic in one field. Overall, ChatGPT does not yet seem to be accurate enough to be trusted for any formal or informal research quality evaluation tasks. Research evaluators, including journal editors, should therefore take steps to control its use. This is the first published attempt at post-publication expert review accuracy testing for ChatGPT. [ABSTRACT FROM AUTHOR]

Introduction: Those with severe and enduring mental ill health are at greater risk of long‐term physical health conditions and have a reduced life expectancy as a result. Multiple factors compound this health inequality, and the need for setting research priorities in this area is highlighted with physical and mental healthcare services being separate, and limited multimorbidity research. Methods: The aim of this exercise was to work in partnership with healthcare professionals and carers, family, friends and individuals with lived experience of both mental and physical health conditions, to set research priorities to help people with mental health conditions to look after their physical health. The exercise was guided by the James Lind Alliance approach. For this, a steering group was set up, two surveys were completed and a final priority workshop was conducted. Results: This priority setting exercise guided by people's needs and lived experience has produced a set of well‐defined research topics. Initially, 555 research questions were suggested in the first survey, which were refined to 54 questions for the second survey. A priority setting workshop was then conducted to get the final 10 priorities. Conclusions: Taking these topics forward to improve services and treatment for both mental and physical ill health may in turn improve physical health and lessen the reduced life expectancy of those living with mental ill health. Patient or Public Contribution: This work was completed in collaboration with people who have lived experience of mental ill health and physical health conditions, as well as carers, family and friends. Their contribution has been significant for this work from piloting surveys, amending language used and educating the researchers and contributing to this paper. The initial work was completed with a steering group and continued with surveys and workshops. [ABSTRACT FROM AUTHOR]

Background: Motor neuron disease (MND) (also known as amyotrophic lateral sclerosis) is a life‐limiting neurodegenerative condition. In up to 20% of people with MND, a pathogenic variant associated with autosomal dominant inheritance can be identified. Children of people carrying a pathogenic variant have a 50% chance of inheriting this and a higher, although harder to predict, chance of developing the disease compared to the general adult population. This paper explores the experience of living with the genetic risk of MND. Methods: We undertook a UK‐based interview study with 35 individuals, including: 7 people living with genetically‐mediated forms of MND; 24 asymptomatic relatives, the majority of whom had an increased risk of developing the disease; and 4 unrelated partners. Results: We explore how individuals make sense of genetic risk, unpacking the interplay between genetic knowledge, personal perception, experiences of the disease in the family, age and life stage and the implications that living with risk has for different aspects of their lives. We balance an emphasis on the emotional and psychological impact described by participants, with a recognition that the salience of risk fluctuates over time. Furthermore, we highlight the diverse strategies and approaches people employ to live well in the face of uncertainty and the complex ways they engage with the possibility of developing symptoms in the future. Finally, we outline the need for open‐ended, tailored support and information provision. Conclusions: Drawing on wider literature on genetic risk, we foreground how knowledge of MND risk can disrupt individuals' taken‐for‐granted assumptions on life and perceptions of the future, but also its contextuality, whereby its relevance becomes more prominent at critical junctures. This research has been used in the development of a public‐facing resource on the healthtalk.org website. Patient or Public Contribution: People with experience of living with genetic risk were involved throughout the design and conduct of the study and advised on aspects including the topic guide, sampling and recruitment and the developing analysis. Two patient and public involvement contributors joined a formal advisory panel. [ABSTRACT FROM AUTHOR]

Supply chain disruptions, a pandemic, and war in Ukraine have exposed faultlines in a globalised food system that depends on a few staple crops grown in a few exporting regions and transported to consumers around the world. In the UK, just three crops, (wheat, barley, and oilseed rape), account for 75 per cent of the UK's 4.5 million hectares of arable land whilst the country imports around half its food—nearly 40 per cent—from just four EU countries (The Netherlands, Ireland, Germany, and France). Poor diets contribute to one in seven deaths in the UK, 63 per cent of the population is overweight or obese and health inequality is increasing between the poorest and most affluent regions. The food security and health of the UK population is therefore dependent on a small number of locally grown crops, vulnerable supply chains, and an unhealthy, obesogenic diet. The UK food system must diversify if it is to become food and nutritionally secure, meet its climate and biodiversity goals and have a healthy and active population. Climate-resilient and nutritious underutilised crops can help diversify the UK agrifood system, but research and investment in them is sporadic, piecemeal, and unfocused. In this paper, we compare two approaches to identifying potentially suitable underutilised crops for the UK. The first, based on UK Department for Environment, Food and Rural Affairs (Defra) Project CH0224, was delivered through literature and database searches and the expertise of growers, advisers, breeders, seed suppliers, processors, traders, and researchers. The second used the CropBASE digital knowledge base for underutilised crops. The two approaches produced no single crop that was common to both shortlists. We propose that the analytical and predictive tools derived from CropBASE could be combined with local knowledge and expertise from the Defra project to provide a common framework for the identification of underutilised crops that are best suited to local UK circumstances now and in climates of the future. [ABSTRACT FROM AUTHOR]

Many research institutions and funders have recently stated their commitment to actively support and promote 'Equality, Diversity and Inclusion' (EDI) in various aspects of health research including Patient and Public Involvement (PPI). However, translating this commitment into specific research projects presents significant challenges that existing approaches, practical guidelines and initiatives have not adequately addressed. In this paper, we explore how the lack of clear justifications for the EDI commitment in existing guidelines inadvertently complicates the work of those involved with PPI and we stress the need for conceptual clarity for any EDI effort to yield meaningful results. Our focus centres on the first principle of the EDI discourse, 'equality', particularly in the form of 'equality of opportunity' as outlined in current guidance provided by the National Institute of Health Research in the United Kingdom. We examine challenges related to justifying and implementing a general, unspecified commitment to equality of opportunity and explain that this reflects a lack of consensus regarding the moral value of PPI in research – a profound problem that remains unaddressed. We then discuss how the presence of several opposing moral perspectives on PPI, makes determining the most appropriate way of addressing barriers to involvement complex and controversial, raising ethical implications for the work of health researchers, PPI specialists and coordinators. Finally we make suggestions on how future research can enrich the concept of 'equality of opportunity' in PPI and improve practice. While our primary focus is on the NIHR, a strong advocate of PPI in research, this analysis will point to normative and ethical considerations that may be relevant to other research institutions and funding organisations aiming to promote equality of opportunity in their public and patient involvement strategies. [ABSTRACT FROM AUTHOR]