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Objectives Long-term sickness absence from employment has negative consequences for the economy and can lead to widened health inequalities. Sick notes (also called ‘fit notes’) are issued by general practitioners when a person cannot work for health reasons for more than 7 days. We quantified the sick note rate in people with evidence of COVID-19 in 2020, 2021 and 2022, as an indication of the burden for people recovering from COVID-19.Design Cohort study.Setting With National Health Service (NHS) England approval, we used routine clinical data (primary care, hospital and COVID-19 testing records) within the OpenSAFELY-TPP database.Participants People 18–64 years with a recorded positive test or diagnosis of COVID-19 in 2020 (n=365 421), 2021 (n=1 206 555) or 2022 (n=1 321 313); general population matched in age, sex and region in 2019 (n=3 140 326), 2020 (n=3 439 534), 2021 (n=4 571 469) and 2022 (n=4 818 870); people hospitalised with pneumonia in 2019 (n=29 673).Primary outcome measure Receipt of a sick note in primary care.Results Among people with a positive SARS-CoV-2 test or COVID-19 diagnosis, the sick note rate was 4.88 per 100 person-months (95% CI 4.83 to 4.93) in 2020, 2.66 (95% CI 2.64 to 2.67) in 2021 and 1.73 (95% CI 1.72 to 1.73) in 2022. Compared with the age, sex and region-matched general population, the adjusted HR for receipt of a sick note over the entire follow-up period (up to 10 months) was 4.07 (95% CI 4.02 to 4.12) in 2020 decreasing to 1.57 (95% CI 1.56 to 1.58) in 2022. The HR was highest in the first 30 days postdiagnosis in all years. Among people hospitalised with COVID-19, after adjustment, the sick note rate was lower than in people hospitalised with pneumonia.Conclusions Given the under-recording of postacute COVID-19-related symptoms, these findings contribute a valuable perspective on the long-term effects of COVID-19. Despite likely underestimation of the sick note rate, sick notes were issued more frequently to people with COVID-19 compared with those without, even in an era when most people are vaccinated. Most sick notes occurred in the first 30 days postdiagnosis, but the increased risk several months postdiagnosis may provide further evidence of the long-term impact.

Summary: Background: The COVID-19 pandemic disrupted healthcare and may have impacted ethnic inequalities in healthcare. We aimed to describe the impact of pandemic-related disruption on ethnic differences in clinical monitoring and hospital admissions for non-COVID conditions in England. Methods: In this population-based, observational cohort study we used primary care electronic health record data with linkage to hospital episode statistics data and mortality data within OpenSAFELY, a data analytics platform created, with approval of NHS England, to address urgent COVID-19 research questions. We included adults aged 18 years and over registered with a TPP practice between March 1, 2018, and April 30, 2022. We excluded those with missing age, sex, geographic region, or Index of Multiple Deprivation. We grouped ethnicity (exposure), into five categories: White, Asian, Black, Other, and Mixed. We used interrupted time-series regression to estimate ethnic differences in clinical monitoring frequency (blood pressure and Hba1c measurements, chronic obstructive pulmonary disease and asthma annual reviews) before and after March 23, 2020. We used multivariable Cox regression to quantify ethnic differences in hospitalisations related to diabetes, cardiovascular disease, respiratory disease, and mental health before and after March 23, 2020. Findings: Of 33,510,937 registered with a GP as of 1st January 2020, 19,064,019 were adults, alive and registered for at least 3 months, 3,010,751 met the exclusion criteria and 1,122,912 were missing ethnicity. This resulted in 14,930,356 adults with known ethnicity (92% of sample): 86.6% were White, 7.3% Asian, 2.6% Black, 1.4% Mixed ethnicity, and 2.2% Other ethnicities. Clinical monitoring did not return to pre-pandemic levels for any ethnic group. Ethnic differences were apparent pre-pandemic, except for diabetes monitoring, and remained unchanged, except for blood pressure monitoring in those with mental health conditions where differences narrowed during the pandemic. For those of Black ethnicity, there were seven additional admissions for diabetic ketoacidosis per month during the pandemic, and relative ethnic differences narrowed during the pandemic compared to the White ethnic group (Pre-pandemic hazard ratio (HR): 0.50, 95% confidence interval (CI) 0.41, 0.60, Pandemic HR: 0.75, 95% CI: 0.65, 0.87). There was increased admissions for heart failure during the pandemic for all ethnic groups, though highest in those of White ethnicity (heart failure risk difference: 5.4). Relatively, ethnic differences narrowed for heart failure admission in those of Asian (Pre-pandemic HR 1.56, 95% CI 1.49, 1.64, Pandemic HR 1.24, 95% CI 1.19, 1.29) and Black ethnicity (Pre-pandemic HR 1.41, 95% CI: 1.30, 1.53, Pandemic HR: 1.16, 95% CI 1.09, 1.25) compared with White ethnicity. For other outcomes the pandemic had minimal impact on ethnic differences. Interpretation: Our study suggests that ethnic differences in clinical monitoring and hospitalisations remained largely unchanged during the pandemic for most conditions. Key exceptions were hospitalisations for diabetic ketoacidosis and heart failure, which warrant further investigation to understand the causes. Funding: LSHTM COVID-19 Response Grant (DONAT15912).

Anthony Cond is Managing Director of Liverpool University Press, the UK’s third oldest university press. With the current resurgence of interest and activities around university presses, Insights managed to catch up with Anthony to find out exactly what it takes to run a successful university press.

Dr Paul Feldman was appointed as the new chief executive of Jisc in late 2015, taking the reins from Martyn Harrow. Paul has extensive experience of working at a senior level in large, complex organizations and has a strong commercial background. In the Jisc press release announcing his appointment, he is quoted as saying, ‘Now, more than ever, universities and colleges need this kind of body and advice to help them take advantage of the opportunities digital technology offers to transform research, teaching, learning and organizational culture’. With this thought in mind, Insights took the opportunity to chat to Paul about his role and his vision for Jisc.

Kristiina, who is currently Director of Library Network Services at the National Library of Finland was appointed as LIBER’s 11th President at their 2014 Annual Conference. This followed her significant contributions to the development of LIBER during four years as Vice President. She has also been very active in other international networks such as IFLA, ICOLC (International Coalition of Library Consortia), IGeLU (ExLibris User Group), and Europeana. Her appointment saw her become the first female President in LIBER’s history, so Insights was keen to chat to her about her fascinating career and her new role.

From graduate trainee at Durham University Library to Librarian at one of the UK’s most prestigious libraries, the Bodleian at the University of Oxford, Richard Ovenden has had a fascinating career. 'Insights' took the opportunity to invite him to fill in the gaps and to share his experiences at ‘Bodley’.

The thermal conditions in lecture theatres directly affect the well-being and overall learning experience of the users but also offer a testbed for understanding the degree to which people’s thermal perceptions are affected by their climate background. This study included surveys completed online by users in situ and environmental measurements conducted on four different days in three different lecture theatres at the University of Liverpool. The 340 participants who took part in the study were divided into three groups—from climates warmer or cooler than that of the UK and similar to that of the UK. Based on statistical analysis, it was observed that the climatic backgrounds affected participants’ thermal sensations and preferences. The results showed that the thermal sensation and preferences of people from warmer backgrounds and similar backgrounds were different and statistically significant. Most users from a warmer background preferred the environment to be warmer while most users with a similar background preferred it to be cooler. These findings have energy and comfort implications for how heating and cooling set-point temperatures in lecture theatres should be determined.

Recent research relating to energy use and carbon emissions by buildings has started to move from operational energy carbon impacts to the embodied energy/carbon impacts of buildings, and the methods and approaches used in architectural design to reduce embodied carbon have become more prominent. From a practitioner’s perspective, working with an ‘in-house’ Life Cycle Assessment (LCA) tool has become a growing trend for architects, and one perceived way of improving the LCA outcomes of a proposed building is to consider prefabrication of the construction process. Initiatives such as the Low Energy Transformation Initiative (LETI) and government bodies such as Greater London Authorities (GLA) provide guidance on LCA and upfront carbon emission targets for transitioning to net zero by 2050. The aim of this study was to establish (i) the LCA impacts from prefabricated residential buildings against current benchmarks; (ii) boundaries and opportunities in architectural practice in the UK when conducting an LCA; (iii) the effectiveness of an in-house LCA tool. This study shows that, although the life-cycle emissions of this prefabricated building achieved a low band in the LETI labelling system, with 1076 kgCO2e/m², it still performs better than the business-as-usual model value of 1200 kgCO2e/m². The results also reveal that the construction industry is not ready to provide realistic data on the prefabrication process to test its advantages compared to conventional constructional methods. However, having an in-house LCA tool provides a faster and more comprehensive LCA due to the commitment to carbon assessment in the office and saves time compared to manual calculations.

This study uses numerical thermal simulation to investigate the potential use of building geometry to eliminate or reduce current and future thermal discomfort overheating risk in UK Passivhaus dwellings. The study focused on the optimum inclination of a south façade to make use of the building shape to self-protect itself. Dynamic simulation modelling software was used to test a range of different inclined façades with regards to their effectiveness in reducing overheating risk. The research found that implementing a tilted façade could completely eliminate the risk of overheating for current UK climates, but with some consequences for natural ventilation and daylighting. Future overheating was significantly reduced by the tilted façade. However, geometric considerations could not eradicate completely the risk of thermal discomfort overheating, particularly by the 2080s.

Additive manufacturing (AM) is a production technology where material is accumulated to create a structure, often through added shaped layers. The major advantage of additive manufacturing is in creating unique and complex parts for use in areas where conventional manufacturing reaches its limitations. However, the current class of AM systems produce parts that contain structural defects (e.g., cracks and pores) which is not compatible with certification in high value industries. The probable complexity of an AM design increases the difficulty of using many non-destructive evaluation (NDE) techniques to inspect AM parts—however, a unique opportunity exists to interrogate a part during production using a rapid surface based technique. Spatially resolved acoustic spectroscopy (SRAS) is a laser ultrasound inspection technique used to image material microstructure of metals and alloys. SRAS generates and detects `controlled’ surface acoustic waves (SAWs) using lasers, which makes it a non-contact and non-destructive technique. The technique is also sensitive to surface and subsurface voids. Work until now has been on imaging the texture information of selective laser melted (SLM) parts once prepared (i.e., polished with R a < 0 . 1 μ m)—the challenge for performing laser ultrasonics in-process is measuring waves on the rough surfaces present on as-deposited parts. This paper presents the results of a prototype SRAS system, developed using the rough surface ultrasound detector known as speckle knife edge detector (SKED)—texture images using this setup of an as-deposited Ti64 SLM sample, with a surface roughness of S a ≈ 6 μ m, were obtained.

NHS England commissioned the project described in this article to explore how patients and carers can, acting as leaders, make a real difference in improving experience of care. The work was carried out on a collaborative basis, co-designing the scope of the research with patient leaders and commissioners. We gathered case examples across England that had involved patient leaders in using patient and carer feedback to improve experience of care. A Patient Leaders Expert Advisory Group selected four case examples that were visited to undertake a more detailed study and subsequently discussed and agreed the key learning points and conclusions. The Advisory Group chair provided a patient leader view on the project. The main learning points were that in order for patient leadership to have a significant impact on improving experience of care, health organisations should invest in patient leaders, put robust feedback mechanisms in place and develop the culture and systems to act on feedback. Our findings identified ten building blocks that provide a basis for success, including a set of key roles across systems. Our conclusion is that patient and carer leaders can raise the profile of improving experience of care and have a real impact on action being taken in response to patient and carer feedback.