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Background and Objectives In gerontological research and practice, an increasing amount of attention is being paid to lesbian, gay, bisexual, transgender, and queer (LGBTQ) older people and how their experiences differ from their heterosexual and cisgender counterparts. However, LGBTQ older adults themselves are not a homogenous group. Moreover, as the immigrant populations in industrialized nations age, the number of LGBTQ older adults from ethnic minority backgrounds will only grow. This systematic review hence investigates the experiences of LGBTQ ethnic minority older adults. Research Design and Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we conducted a systematic search in 5 databases for English peer-reviewed studies. The retrieved articles were coded and analyzed inductively using an intersectional framework to tease out the varying influences of ethnicity, age, gender, and sexual identity on the LGBTQ ethnic minority older adults’ experiences. Results A total of 30 articles across 21 studies (13 qualitative, 7 quantitative, and 1 mixed-methods) were identified. Six key themes emerged from the studies: stigma and discrimination; isolation, support and belonging; interactions with services and institutions; self-acceptance, resilience, and agency; mental health and well-being; and uncertain futures. Discussion and Implications The experiences of LGBTQ ethnic minority older adults echo those of LGBTQ ethnic majority older adults when they are shaped by gender and sexual identity factors. Nevertheless, significant differences in experiences—both positive and negative—emerge when cultural and ethnicity-related factors come to the fore. These findings emphasize the need for intersectional aging policies and services that go beyond catering for LGBTQ older adults to include the diversity within this subpopulation.

Background The US Food and Drug Administration (FDA) has granted Emergency Use Authorization (EUA) for multiple PCR-based tests to aid in the diagnosis and containment of COVID-19. A vast majority of these tests detect only SARS-CoV-2 which causes symptoms similar to those caused by other respiratory pathogens. Hence, other etiologies or co-infections requiring a different therapy may be missed. The prototype BioFire® Respiratory Panel 2.1 (RP2.1) continues the syndromic approach of the FDA-cleared BioFire® Respiratory Panel 2 (RP2), to provide the ability to simultaneously detect 22 common respiratory pathogens, including SARS-CoV-2, from nasopharyngeal swab (NPS) specimens. The goal of this study was to rapidly develop a RP2.1 prototype that contains high-performing SARS-CoV-2 assays and maintains the performance of assays retained from RP2. Methods Twelve assays designed for four SARS-CoV-2 genes were tested for compatibility with the RP2 assays and conditions. All retained RP2 assays were evaluated to verify established RP2 performance. The sensitivity of novel SARS-CoV-2 assays was estimated with nucleic acids at BioFire and contrived live virus NPS samples at MRIGlobal. Primer homology of SARS-CoV-2 assays to > 15,000 SARS-CoV-2 genomes from accessible databases was assessed for in silico inclusivity Results A prototype multiplexed PCR panel containing assays for 22 pathogens was developed in a 5-week period. Of the 12 SARS-CoV-2 assays, 7 were compatible with the RP2 conditions; 2 were selected for the prototype. No false positive results due to cross-reactivity with unintended analytes or non-specific amplification in negative samples were observed for any assays. All retained RP2 assays were detected at or near their established LoD. The SARS-CoV-2 LoD was estimated at 103 -102 genomes/mL with both nucleic acid and live virus spiked into NPS. Together, the assays are 100% inclusive for all 15,370 complete SARS-CoV-2 genomes assessed in silico for reactivity. Conclusion The results of this study indicate a strong potential for RP2.1 to serve as a sensitive comprehensive syndromic option to aid in the diagnosis of COVID-19 as well as respiratory syndromes caused by other pathogens, including co-infections. This study was performed with a test not cleared for diagnostic use. Disclosures All Authors: No reported disclosures

Welcome to the third virtual HSRPP conference in this 28th anniversary of the conference. We hope to provide you with an enjoyable and interesting conference. Little did we know when we were invited to host this conference that we would be unable to welcome you in-person to the lovely city of Bath. After much deliberation in Summer 2021, with too many unknowns due to the COVID-19 pandemic, we had to make the call to run the conference online. By October 2021 we doubted ourselves. As we write this in January 2022, with the Omicron wave upon us, it feels like it was probably the right decision. We do all of course hope that HSRPP 2023 can bring us all together again in-person, but until then, we hope you enjoy our online event. HSRPP 2022 continues to provide an environment for researchers and practitioners, both new and experienced, to come together to share research and exchange ideas. Our conference theme is ‘Delivering impact for patients and other stakeholders’. We chose this theme because we believe it is central to why most of us do health services and pharmacy practice research. The days are long gone when research could remain within the pages of academic journals. We need to be able to demonstrate to our patients, our funders and the public how we will turn our findings into something that improves care. We need to work with patients and the public to make sure our research is relevant to them and efficient in its spend of what is, very often, public money. In short, it is what gets us up in the morning and through the tough times of research, of which there are many! The COVID-19 pandemic has shown just how valuable pharmacists are, whether that be delivering vaccinations, caring for critically ill hospitalised patients or coping with the huge pressure that community colleagues have faced from the worried public. These contributions to the pandemic cause are of course on top of the ‘day job’. There is much learned and to be learned about how we move forward to deliver healthcare that is sustainable, patient-centred and fit for purpose. Research is the tool from which this learning comes. We are going to hear real world evidence under our conference theme from our three keynote speakers: Dr Barbara Farrell, a pharmacist with the Bruyère Continuing Care Geriatric Day Hospital, and Senior Investigator with the Bruyère Research Institute in Ottawa, Ontario, Canada, will discuss her research experience with engaging stakeholders and users to promote the uptake and impact of deprescribing guidelines. She will highlight how her research has influenced and contributed to change in how people approach deprescribing and what difference this has made. Professor Mahendra Patel, University of Bradford, is the national Pharmacy and Ethnic Minority Communities Research Lead with the PRINCIPLE trial, University of Oxford, the world’s largest randomized clinical trial investigating COVID-19 treatment in the community. He will talk to us about promoting inclusion and diversity in clinical trials, which is critical if trial results are to be meaningful and successful when implemented to bring about change. Mr Ade Williams, lead pharmacist and independent prescriber at the multi-award-winning Bedminster Pharmacy in Bristol will discuss how researchers can work with practising pharmacists to co-develop “real-life’’ impact programmes. He will also highlight how transformations in the NHS governance structure, Long Term Plan ambitions and COVID-19 legacy work are unique opportunities for community pharmacy to play a vital role. Mahendra and Ade were both recognised in the New Year Honours List 2022 for their outstanding contributions to Pharmacy. We would like to thank all those who have contributed to making HSRPP 2022 a success. They include those who have submitted abstracts, the conference steering committee, Pharmacy Research UK, our keynotes speakers, workshop leaders, session chairs and prize judges, our sponsor Day Lewis, our colleagues at University of Bath, and you – research presenters and conference delegates. We would like to offer our special thanks to our Vice Chancellor, Professor Ian White for welcoming delegates to our University. We sincerely hope you enjoy the conference, make the most of the chance to meet researchers from the UK and elsewhere, and leave feeling inspired and excited for new research possibilities that lie ahead. Jenny Scott and Matthew Jones, HSRPP 2022 Conference hosts

Introduction Due to propellants, metered dose inhalers (pMDIs) have a higher carbon footprint than low carbon footprint inhalers (LCFIs), such as dry powder or soft mist inhalers (1). Consequently, pMDIs contribute 3.5% of the NHS’s CO2 equivalent emissions (2). Local and national guidelines (NICE, British Thoracic Society) have attempted to increase use of LCFIs, but their effects and factors influencing success are unknown. Aim To investigate temporal and geographical variation in LCFI dispensing in England over five years. Methods Clinical commissioning group (CCG) dispensed items (March 2016-February 2021) were obtained from openprescribing.net for five classes of inhaler where a choice between pMDIs and LCFIs is available: short-acting beta-agonists (SABAs), long-acting beta-agonists (LABAs), inhaled corticosteroids (ICS), ICS plus LABA inhalers (ICS/LABA) and ICS/LABA plus long-acting muscarinic antagonist inhalers (ICS/LABA/LAMA). CCG population age profiles were obtained from the Office for National Statistics. CCG emergency hospital admission and mortality rates were obtained from Public Health England. CCG formularies and guidelines were reviewed to identify where guidance is available to prescribers. To control for total inhaler dispensing, the key measure used is the %LCFI: the number of LCFI items dispensed relative to the total number of pMDI and LCFI items. Multivariate regression models were used to investigate geographical variation. Results The total annual %LCFI increased from 19.5% to 26.3% over the study period. This was driven by the introduction of ICS/LABA/LAMA inhalers in 2018, as %LCFI decreased for SABA, ICS and ICS/LABA inhalers. %LCFI varied between classes. In the final year, it ranged from 6% for both SABA and ICS inhalers, to 41.2% and 43.9% for ICS/LABA and ICS/LABA/LAMA inhalers, respectively. Interestingly, the cost per item for ICS/LABA and ICS/LABA/LAMA inhalers was similar for both pMDIs and LCFIs, but for SABA and ICS inhalers LCFIs were more expensive. %LCFI in the final year varied between CCGs (10.7% to 30.9%). The North West, and Birmingham and London areas had consistently higher %LCFI for all classes. For SABA and ICS inhalers, both the presence of advice on climate change in CCG guidelines or formularies, and greater CCG asthma prevalence, were significantly associated with higher %LCFI (p Conclusion Current initiatives have not been successful in increasing the use of LCFIs, indicating limited implementation of guidelines for unknown reasons. Further action is required to reduce the carbon footprint of inhaler prescribing. Actions to address the financial disincentives to LCFI prescribing, CCG leadership (e.g. guidelines) and the appropriate use of LCFI in young people should be considered. Research into facilitators and barriers to LCFI use would support this. An important limitation is the use of dispensed items data rather than the number of inhalers, although there is no evidence that the number of inhalers per item varies between pMDIs and LCFIs. In addition, the Covid-19 pandemic disrupted prescribing patterns and long-term NHS projects. References (1) Wilkinson AJK, Braggins R, Steinbach I, Smith K. Costs of switching to low global warming potential inhalers. An economic and carbon footprint analysis of NHS prescription data in England. BMJ Open. 2019; 9:e028763. (2) Environmental Audit Committee. UK progress on reducing F-Gas emissions inquiry: Fifth report of session 2017-19. London (UK): House of Commons Environmental Audit Committee; 25 April 2018. Available from https://publications.parliament.uk/pa/cm201719/cmselect/cmenvaud/469/469.pdf: [Accessed 27 September 2021].

Background Human immunodeficiency virus (HIV)-infected individuals have a higher risk of developing active tuberculosis (TB) than HIV-uninfected individuals, but the mechanisms underpinning this are unclear. We hypothesized that depletion of specific components of Mycobacterium tuberculosis (Mtb)-specific CD4+ and CD8+ T-cell responses contributed to this increased risk. Methods Mtb-specific T-cell responses in 147 HIV-infected and 44 HIV-uninfected control subjects in a TB-endemic setting in Bloemfontein, South Africa, were evaluated. Using a whole-blood flow cytometry assay, we measured expression of interferon gamma, tumor necrosis factor alpha, interleukin 2, and interleukin 17 in CD4+ and CD8+ T cells in response to Mtb antigens (PPD, ESAT-6/CFP-10 [EC], and DosR regulon-encoded α-crystallin [Rv2031c]). Results Fewer HIV-infected individuals had detectable CD4+ and CD8+ T-cell responses to PPD and Rv2031c than HIV-uninfected subjects. Mtb-specific T cells showed distinct patterns of cytokine expression comprising both Th1 (CD4 and CD8) and Th17 (CD4) cytokines, the latter at highest frequency for Rv2031c. Th17 antigen-specific responses to all antigens tested were specifically impaired in HIV-infected individuals. Conclusions HIV-associated impairment of CD4+ and CD8+Mtb-specific T-cell responses is antigen specific, particularly impacting responses to PPD and Rv2031c. Preferential depletion of Th17 cytokine-expressing CD4+ T cells suggests this T-cell subset may be key to TB susceptibility in HIV-infected individuals.

This article makes a contribution to contemporary debates of police education and training by reporting the findings of a small-scale qualitative study that examined the impact of part-time higher education on a cohort of police officers in the north of England. Differentiating between police training and higher education study, the article explore the views of officers who have voluntarily completed a social science informed Policing Studies programme in their own time, funded by a unique collaboration between their local constabulary, the Higher Education Funding Council England, and the host university. The article discusses the motivations of officers to engage with such a programme; identifies what officers liked about the programme of study; and explores the perceived impact of the programme on their professional police practice.

© The Author 2017. Published by Oxford University Press. All rights reserved. Organisational settings such as schools, workplaces and hospitals are well recognised as key environments for health promotion. Whilst there is extensive literature on specific types of settings, little empirical research has investigated the transfer of frameworks between sectors. This study analyses Food for Life, an England-wide healthy and sustainable food programme that evolved in schools and is being adapted for children's centres, universities, care homes, and hospital settings. Following a case study design, we interviewed 85 stakeholders in nine settings. Food for Life's systemic framework of 'food education, skills and experience' 'food and catering quality', 'community and partnerships' and 'leadership' carried salience in all types of settings. These were perceived to act both as principles and operational priorities for driving systemic change. However, each setting type differed in terms of the mix of facilitating factors and appropriate indicators for change. Barriers in common included the level of culture-shift required, cost perceptions and organisational complexity. For settings based health promotion practice, this study points to the importance of 'frame-working' (the systematic activity of scoping and categorising the field of change) alongside the development and application of benchmarks to stimulate change. These processes are critical in the transfer of learning from between sectors in a form that balances commonality with sufficient flexibility to adapt to specific settings. Synergy between types of settings is an under-recognised, but critical, part of action to address complex issues such as those emerging from the intersection between food, health and sustainability.

Fractures of the trapezium are rare and easily missed. As these injuries are often imperceptible on plain radiographs, diagnosis in the ED setting is challenging. We report a case of an isolated fracture of the trapezium which was picked up as a non-union 5 months after the injury following persistence of symptoms.

This article highlights the intersection of sexualities with contemporary police diversity debates. It showcases the findings of a national survey of LGB police officers in England and Wales, representing one of the largest datasets of its kind (n = 836). Presenting the main findings from the survey, the article identifies that the workplace experiences of these once stigmatized and rejected officers have been transformed post-Macpherson, but that some resistances and anxieties persist. Throughout, the complexity of managing LGB identities in professional policing contexts’ are demonstrated. The article calls on police constabularies not to see diversity reform as complete, but rather to further invest and address issues raised in this research by LGB officers themselves so that their career experiences can be further improved and contributions maximized.

The promotion of diversity formed a major plank of police reform during the late 1990s and into the 2000s. A plethora of policy statements, training programmes, recruitment drives, organizational investment, and community engagement activity followed a series of authoritative reports, culminating in the 1999 Macpherson Report. However, perhaps the nature of public debate and the cyclical nature of policy reform contributed to a subsequent sense that the ‘diversity agenda’ was complete, that the police service had ‘done diversity’, and that other priorities required attention. A key proponent of the immediate post-Macpherson reform, Jack Straw had moved from the Home Office and was Justice Secretary when, in 2009, he stated that the Metropolitan Police was no longer institutionally racist. Since then policing in the UK, and elsewhere, has faced huge challenges in terms of spending cuts that have both impacted on police budgets as well as those of other agencies dealing with marginalized and vulnerable communities. In that context, it has been understood that the promotion of diversity has become an unaffordable liberal preoccupation that has to be swept aside by the cold winds of austerity. In that—rather bleak—context the publication of a special edition devoted to issues in police diversity might seem incongruous. Contrary to some prevailing opinion, however, we argue that there are a number of reasons why the importance of diversity within policing needs to be re-stated. First, as the papers gathered here indicate, there continues to be a wide range of investment in programmes to promote diversity in the UK, in Europe, and in the USA. Incomplete, partial, and with varying degrees of success, but the promotion of more inclusive, more effective, and more legitimate police services that better reflect the diversity of contemporary global societies, continues. Secondly, as the contributions in this collection reaffirm, the development of a more diverse policing can secure a range of operational and institutional advantages to police services. In an era in which financial austerity and changing demand on police services have increased focus on the development of evidence-based policing, the research represented here (and the much wider body of literature available in general) can be used to help generate policy relating to diversity that will enhance the delivery of contemporary policing. Thirdly, diversity within policing is of continuing importance in terms of the promotion of professionalism, ethics and integrity, and public legitimacy. Although none of these related factors were

Background Rapid identification of causative agents from positive blood culture (PBC) can aid earlier targeted therapy, as well as reduce mortality, length of stay, and costs associated with systemic infections. The BioFire® Blood Culture Identification 2 (BCID2) Panel being developed by BioFire Diagnostics, LLC, aims to maintain or improve the performance of the BioFire® FilmArray® Blood Culture Identification (BCID) Panel with updated and novel assays (15 new analytes: six antimicrobial resistance (AMR), six bacterial, and three fungal analytes). The performance of an RUO BioFire BCID2 Panel during a prospective pilot study is compared with standard of care (SoC), as well as independent PCR comparator assay (compPCR) results. Methods Two pilot sites enrolled de-identified PBC (99% specificity, and >97% sensitivity, the BioFire BCID2 Panel is expected to provide rapid and accurate results for key pathogens associated with systemic infections, as well as important AMR markers. RUO products used in this study have not been evaluated by the FDA or other regulatory agencies for In Vitro Diagnostic use. Disclosures U. Spaulding, BioFire Diagnostics, LLC: Employee, Salary. J. Stone, BioFire Diagnostics, LLC: Employee, Salary. K. Koch, BioFire Diagnostics, LLC: Employee, Salary. J. Antosch, BioFire Diagnostics, LLC: Employee, Salary. M. Jones, BioFire Diagnostics, LLC: Employee, Salary. Z. Lu, BioFire Diagnostics, LLC: Employee, Salary. T. Todorov, BioFire Diagnostics, LLC: Employee, Salary. S. Kerr, BioFire Diagnostics, LLC: Employee, Salary. K. Holmberg, BioFire Diagnostics, LLC: Employee, Salary. M. Rogatcheva, BioFire: Employee, Salary.

The Food for Life Partnership (FFLP) is an initiative led by the Soil Association (SA), a non governmental organisation in the UK which aims to encourage a healthy, sustainable food culture in communities. The SA also runs a Catering Mark scheme that provides an independent endorsement that food providers are taking steps to improve the food they serve, using fresh ingredients which are free from undesirable additives and trans fats, are better for animal welfare, and comply with national nutrition standards. FFLP work in schools has already been shown a significant impact and FFLP has now been extended to hospitals, care homes, universities and early years settings.

Writing in a March 1927 editorial for the Negro World, Amy Jacques Garvey conjectured that a “guilty conscience [had] begun to torture the white race. They foresee in awakened Asia the stern hand of retribution preparing to return measure for measure all that it has received. They are in the throes of a horrid nightmare. … The cycle of civilization is shifting, and with it the battleground of the future. The age of the Atlantic has passed, the age of the Pacific is here.” With the coming of Pacific dominance, the “superior force of Asiatic arms,” aroused against Western influence, could eventually be turned against the United States. In such circumstances, Garvey asked, would fifteen million oppressed American Negroes “say that the Asiatics are wrong to demand racial equality, or will they sing, ‘My country ’tis of thee, sweet land of liberty’?” Although there was a future possibility that the United States might offer a hand of friendship to China, she was not optimistic the racial divide between the white and nonwhite worlds could be bridge...

This article seeks to explore the background to the Wilson Government's decisions of 1967‐68 to pull back British forces from South East Asia and leave the Singapore base. It challenges assumptions that this was a reluctant step on the part of several Labour ministers, who some have alleged were wedded to a sentimental and romantic attachment to a British ‘world power’ role. Instead, by analysing official thinking behind the creation of Malaysia in 1963, and tracing back to the previous Conservative administration important continuities in attitudes toward South East Asian commitments and the necessity for cut‐backs, the article argues that the most important inhibitor on early British withdrawal was the Malaysia‐Indonesia confrontation, and the related desire of the United States to see Britain retain a presence in the region. Once in office, Labour ministers were prepared to see British forces withdraw when conditions were right, and after the summer of 1966, with the end of the confrontation and American attitudes having become more resigned to British departure, the way was clear for the key decisions to be taken.

Estimates of responder cell frequency (RCF) based on limiting dilution analyses are laborious, and alternative means to quantitate cell-mediated immunity to immunogens are desirable. It was shown that levels of interleukin (IL)-2 in the supernatant of varicella-zoster virus-stimulated blood lymphocytes from immune adults peaked at 48 h of culture and correlated partially with estimates of RCF (r = .74, P = .003). Levels of gamma-interferon, IL-4, and IL-10 increased through the first 4 days of culture, and gamma-interferon levels showed some correlation with peak IL-2 levels (r = .48, P = .03). Nevertheless, correlations between levels of these cytokines and RCF did not reach statistically significant levels.

The role of 'inter-agency' co-operation in the sphere of crime prevention has been promoted increasingly by central and local government policy initiatives in recent years. In this paper we consider a number of theoretical issues raised by the examination of power relations in inter organizational contexts and the definitional processes through which local crime 'problems' are identified and translated into policies and practice. The work of Geoffrey Pearson and colleagues represents the pre-eminent contribution to criminological understanding in the field. In this paper we develop a sympathetic critique of their work. In doing so we draw on our own two-year research study of the social dynamics of inter-agency co-operation in a number of metropolitan and shire county community-based crime prevention initiatives. In the past decade a growing body of opinion has developed in academic and government circles that the most effective delivery of crime prevention emphasizes the co-operation of state agencies together with the public at the local level.1 The importance of 'multi-agency' or 'partnership' work has been repeatedly stressed in recent years. The Home Office circulars 8/84 and 44/90, and the 'good practice' booklet which accompanied the latter circular (Home Office 1990), have acted as important catalysts in this process. In addition to repeated policy statements, multi agency work has been promoted through financial incentives at both the national and local levels, to the extent that some forms of funding are now only available through a commitment to partnership work.2 The 'multi-agency' approach has increasingly come to be seen as a panacea for recurring crises within criminal justice. Yet, aside from the plethora of'outcome' evaluation studies (see for example Forrester et al. 1988, 1990) there remains little serious criminological attention given to the broader implications of the multi-agency approach for the processes of policy formation and implementation and the emergence of new corporatist administrative arrangements for local gover nance. While wary of the dangers of reifying 'multi-agency' to the level of a pseudo-science,3 we wish to argue that there is a need to address and understand the complex social processes involved in inter-agency collaboration and their relation to the ongoing restructuring of the system of crime control and prevention.