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Up to 50% of autistic people experience co-occurring anxiety, which significantly impacts their quality of life. Consequently, developing new interventions (and/ or adapting existing ones) that improve anxiety has been indicated as a priority for clinical research and practice by the autistic community. Despite this, there are very few effective, evidence-based therapies available to autistic people that target anxiety; and those that are available (e.g., autism adapted Cognitive Behavioural Therapy; CBT) can be challenging to access. Thus, the current study will provide an early-stage proof of concept for the feasibility and acceptability of a novel app-based therapeutic approach that has been developed with, and adapted for, autistic people to support them in managing anxiety using UK National Institute for Health and Care Excellence (NICE) recommended adapted CBT approaches. This paper describes the design and methodology of an ethically approved (22/LO/0291) ongoing non-randomised pilot trial that aims to enrol approximately 100 participants aged >=16-years with an existing autism diagnosis and mild-to-severe self-reported anxiety symptoms (trial registration NCT05302167). Participants will be invited to engage with a self-guided app-based intervention—‘Molehill Mountain’. Primary (Generalised Anxiety Disorder Assessment, Hospital Anxiety and Depression Scale) and secondary outcomes (medication/ service use and Goal Attainment Scaling) will be assessed at baseline (Week 2 +/- 2), endpoint (Week 15 +/- 2) and three follow-ups (Weeks 24, 32 and 41 +/- 4). Participants will also be invited to complete an app acceptability survey/ interview at the study endpoint. Analyses will address: 1) app acceptability/ useability and feasibility (via survey/ interview and app usage data); and 2) target population, performance of outcome measures and ideal timing/ duration of intervention (via primary/ secondary outcome measures and survey/ interview)–with both objectives further informed by a dedicated stakeholder advisory group. The evidence from this study will inform the future optimisation and implementation of Molehill Mountain in a randomised-controlled trial, to provide a novel tool that can be accessed easily by autistic adults and may improve mental health outcomes., This study received funding from the MRC Confidence in Concept award 2019 (1118148) - awarded to BO, ES. DM, ES, BO report grants during the conduct of (but unrelated to) this study from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 777394 for the project AIMS-2-TRIALS. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation programme and EFPIA and SFARI, Autistica, Autism Speaks. The views expressed are those of the author(s) and not necessarily those of the NHS, MRC, nor IHI-JU2. The funders had no role in the conceptualisation of this study, nor the development of this publication.

The marine environment is a complex system, and with growing human demand, the sustainable use of multiple marine resources is continually challenged. The increasing complexity of overlapping marine activities causes pressures on the environment. Here, we review the fundamental aspects for effective marine management, particularly the role of science and scientific evidence to inform marine policy and decision making. The outcomes of internal expert workshops were used to analyse currently applied marine management practices in the UK using four marine sectors in English waters based on the expertise: environmental impact assessments; dredge and disposal operations; marine protected areas; and offshore renewable energy. Strengths, weaknesses, and commonalities between these sectors were assessed in terms of their effectiveness for marine management. Finally, we make recommendations based on the outputs to better inform effective yet sustainable marine management. The importance of increasing accessibility to data, hypothesis-driven environmental monitoring, streamlining funding opportunities and ensuring effective dissemination of data to ensure scientific outcomes and achieve increased robustness of assessments is emphasised. We also recommend that assessment drivers align with the outputs and approaches should be holistic and engage with the public to ensure a shared understanding and vision.