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Objectives The National Health Service in England funds 12 months of weekly s.c. tocilizumab (qwTCZ) for patients with relapsing or refractory GCA. During the coronavirus disease 2019 (COVID-19) pandemic, some patients were allowed longer treatment. We sought to describe what happened to patients after cessation of qwTCZ. Methods Multicentre service evaluation of relapse after stopping qwTCZ for GCA. The log-rank test was used to identify significant differences in time to relapse. Results A total of 336 GCA patients were analysed from 40 centres, treated with qwTCZ for a median [interquartile range (IQR)] of 12 (12–17) months. At time of stopping qwTCZ, median (IQR) prednisolone dose was 2 (0–5) mg/day. By 6, 12 and 24 months after stopping qwTCZ, 21.4%, 35.4% and 48.6%, respectively, had relapsed, requiring an increase in prednisolone dose to a median (IQR) of 20 (10–40) mg/day. 33.6% relapsers had a major relapse as defined by EULAR. Time to relapse was shorter in those that had previously also relapsed during qwTCZ treatment (P  = 0.0017), in those not in remission at qwTCZ cessation (P  = 0.0036) and in those with large vessel involvement on imaging (P  = 0.0296). Age ≥65 years, gender, GCA-related sight loss, qwTCZ treatment duration, TCZ taper, prednisolone dosing and conventional synthetic DMARD use were not associated with time to relapse. Conclusion Up to half our patients with GCA relapsed after stopping qwTCZ, often requiring a substantial increase in prednisolone dose. One-third of relapsers had a major relapse. Extended use of TCZ or repeat treatment for relapse should be considered for these patients. [ABSTRACT FROM AUTHOR]

Objectives: Recovery from sexual trauma can be complex and multi‐faceted. Most current psychological treatment protocols for trauma use a cognitive model of post‐traumatic stress disorder (PTSD). However, sexual trauma may include specific complexities beyond that of a cognitive model of PTSD, such as relational factors. The distress experienced after sexual abuse may involve variables not exclusive to a PTSD model. Compassion focused therapy (CFT) is an approach that incorporates evolutionary, relational and social perspectives. This study explored the relationships between variables associated with CFT, PTSD and distress in survivors of sexual abuse to determine the role of CFT‐related variables. Methods: 155 adults who had experienced sexual abuse or any unwanted sexual experience at any point in their lives completed online questionnaires pertaining to various CFT variables (self‐compassion, receiving compassion from others, having a fear of compassion from others, having a fear of compassion from the self, shame and self‐criticism) and questionnaires measuring global distress as the outcome of sexual abuse and PTSD symptoms. Results: An exploratory model involving CFT‐related variables explained significantly more of the variance (4.4%) in global distress than PTSD symptomology alone. Self‐criticism was found to be the variable with significant contribution. Conclusions: That CFT treatments, targeting self‐criticism, should be developed alongside the standard cognitive model of PTSD based treatments for survivors of sexual abuse was supported. Future research may explore experimental designs utilizing CFT in this population, as well as further investigations on the roles of these specific CFT variables. [ABSTRACT FROM AUTHOR]

Vaccines against COVID-19 and influenza can reduce the adverse outcomes caused by infections during pregnancy, but vaccine uptake among pregnant women has been suboptimal. We examined the COVID-19 and influenza vaccine uptake and disparities in pregnant women during the COVID-19 pandemic to inform vaccination interventions. We used data from the Oxford-Royal College of General Practitioners Research and Surveillance Centre database in England and the Secure Anonymised Information Linkage Databank in Wales. The uptake of at least one dose of vaccine was 40.2% for COVID-19 and 41.8% for influenza among eligible pregnant women. We observed disparities in COVID-19 and influenza vaccine uptake, with socioeconomically deprived and ethnic minority groups showing lower vaccination rates. The suboptimal uptake of COVID-19 and influenza vaccines, especially in those from socioeconomically deprived backgrounds and Black, mixed or other ethnic groups, underscores the necessity for interventions to reduce vaccine hesitancy and enhance acceptance in pregnant women. [ABSTRACT FROM AUTHOR]

Transition of young people with chronic kidney disease (CKD) from paediatric to adult healthcare has been associated with poor outcomes, but few population-level studies examine trends in subgroups. We aimed to assess sociodemographic inequalities in changes in unplanned secondary care utilisation occurring across transfer to adult care for people with CKD in England. A cohort was constructed from routine healthcare administrative data in England of young people with childhood-diagnosed CKD who transitioned to adult care. The primary outcome was the number of emergency inpatient admissions and accident and emergency department (A&E) attendances per person year, compared before and after transfer. Injury-related and maternity admissions were excluded. Outcomes were compared via sociodemographic data using negative binomial regression with random effects. The cohort included 4505 individuals. Controlling for age, birth year, age at transfer, region and sociodemographic factors, transfer was associated with a significant decrease in emergency admissions (IRR 0.75, 95% CI 0.64–0.88) and no significant change in A&E attendances (IRR 1.10, 95% CI 0.95–1.27). Female sex was associated with static admissions and increased A&E attendances with transfer, with higher admissions and A&E attendances compared to males pre-transfer. Non-white ethnicities and higher deprivation were associated with higher unplanned secondary care use. Conclusion: Sociodemographic inequalities in emergency secondary care usage were evident in this cohort across the transition period, independent of age, with some variation between admissions and A&E use, and evidence of effect modification by transfer. Such inequalities likely have multifactorial origin, but importantly, could represent differential meetings of care needs. What is Known: • In chronic kidney disease (CKD), transfer from paediatric to adult healthcare is associated with declining health outcomes. • Known differences in CKD outcomes by sociodemographic factors have limited prior exploration in the context of transfer. What is New: • Population-level data was used to examine the impacts of transfer and sociodemographic factors on unplanned secondary care utilisation in CKD. • Healthcare utilisation trends may not reflect known CKD pathophysiology and there may be unexplored sociodemographic inequalities in the experiences of young people across transfer. [ABSTRACT FROM AUTHOR]

Background: Depression is the second most common chronic condition affecting women of reproductive age; 23.4% of women enter pregnancy with depression and use of selective serotonin reuptake inhibitors (SSRIs) in pregnancy is often necessary for maternal wellbeing. However, SSRI use during pregnancy can cause congenital malformations, postpartum haemorrhage (PPH), and persistent pulmonary hypertension of the newborn (PPHN). In UK primary care, prescribing formularies are one medium by which prescribers are provided with local medicines advice. Aim: To review all local prescribing formularies with respect to prescribing SSRIs in women of reproductive age, during pregnancy, and during breastfeeding. Design & setting: A systematic review of prescribing formularies in England and Wales. Method: A systematic keyword search of all clinical commissioning group and Integrated Care Board websites in England and Local Health Board websites in Wales was undertaken between December 2021–22 to identify prescribing formularies. Data were extracted on prescribing guidance for SSRIs. Results: Seventy-four prescribing formularies were reviewed. Of these, 14.9% (n = 11/74) provided links to the Medicines and Healthcare products Regulatory Agency guidance on congenital abnormalities associated with SSRIs, 28.4% (n = 21/74) provided links to guidance on PPH risk, and 1.4% (n = 1/74) provided links to guidance on PPHN. Specific local guidance was given on SSRI prescribing for women of reproductive age, during pregnancy, and during breastfeeding in 12.2% (n = 9/74), 23.0% (n = 17/74), and 21.6% (n = 16/74) of formularies, respectively. Conclusion: Our results suggest that prescribers may be poorly informed by local formularies about the risks of SSRI use around pregnancy. This could place babies at increased risk of unintentional SSRI exposure. [ABSTRACT FROM AUTHOR]

Background: In a post-pandemic landscape, Generation Z (Gen Z) nursing students are increasingly facing mental health challenges, notably anxiety. This study investigated these challenges among first-year nursing students. Aims: The primary objective was to assess self-reported anxiety levels in first-year undergraduate nursing students, focusing on Gen Z, before or at the onset of their initial clinical placement post-pandemic. Methods: Employing a cross-sectional design, this study used the Generalized Anxiety Disorder-7 (GAD-7) questionnaire to evaluate anxiety levels. It encompassed first-year nursing students from various fields at a university in North East England, considering generational differences, field of nursing, and demographic variables. Findings: Results indicated anxiety levels among generational groups, with Gen Z students exhibiting extreme variations. Notably, students in Mental Health Nursing reported less anxiety than their counterparts in other nursing fields. The study also sheds light on the ramifications of the COVID-19 pandemic on student mental health. Conclusions: The study underscores the necessity for bespoke support systems in educational and clinical environments, particularly for Gen Z students. It advocates for comprehensive strategies in universities and clinical settings to nurture nursing students' emotional health, thereby enhancing their resilience and long-term career prospects [ABSTRACT FROM AUTHOR]

Background: In response to the adverse impacts of the COVID-19 lockdown measures Move Well, Feel Good (MWFG) was developed as a school intervention using improvement of motor competence as a mechanism for promoting positive mental health. Study objectives were to evaluate the feasibility and acceptability of MWFG and to describe changes in child-level outcomes. Methods: Five northwest England primary schools were recruited. MWFG was delivered over 10-weeks through physical education (PE) lessons, which were supplemented by optional class-time, break-time, and home activities. The intervention focused on development of 9–10 year-old children's motor competence in locomotor, object control, and stability skills, and psychosocial skills. Feasibility was evaluated against nine pre-defined criteria using surveys, interviews (teachers), and focus groups (children). Pre- and post-intervention assessments of motor competence, mental health, prosocial behaviour, wellbeing, and 24-hour movement behaviours were also completed. Results: The five recruited schools represented 83% of the target number, 108 children consented (54% of target) with teachers recruited in all schools (100% of target). Intervention dose was reflected by 76% of the 45 scheduled PE lessons being delivered, and adherence was strong (>85% of children attending ≥75% of lessons). Positive indicators of acceptability were provided by 86% of children, 83% of PE teachers, and 90% of class teachers. Data collection methods were deemed acceptable by 91% of children and 80% of class teachers, and children spoke positively about participating in the data collection. Child-level outcome data collection was completed by 65%-97% of children, with a 3%-35% attrition rate at post-intervention, depending on measure. Favourable changes in motor competence (+13.7%), mental health difficulties (-8.8%), and prosocial behaviour (+7.6%) were observed. Conclusions: MWFG is an acceptable and feasible motor competence intervention to promote positive mental health. Content and delivery modifications could inform progression to a pilot trial with a more robust design. [ABSTRACT FROM AUTHOR]

This article considers the difficulties faced by social workers and others who have concerns about the reliability of information provided by people they are assessing in England under the Mental Health Act 1983. The article is in two parts, the first part includes descriptions of case studies which highlight difficulties in assessments when assessors need to note what they are told and yet sometimes also fear that the truth of this information might be knowingly or unknowingly masked. The second part of the article argues that a understanding of Shakespeare and other creative writers can enhance and expand empathy and thereby promote more sensitive and aware social work practice. Advantages of allowing as much time as possible for conflicting realities to emerge throughout assessments are advocated along with acknowledgement of the essentially unseeable complexities of attempting to assess people at any one point in time. [ABSTRACT FROM AUTHOR]

Background: Psychological therapies can be effective in reducing symptoms of depression and anxiety in people living with dementia (PLWD). However, factors associated with better therapy outcomes in PLWD are currently unknown. Aims: To investigate whether dementia-specific and non-dementia-specific factors are associated with therapy outcomes in PLWD. Method: National linked healthcare records were used to identify 1522 PLWD who attended psychological therapy services across England. Associations between various factors and therapy outcomes were explored. Results: People with frontotemporal dementia were more likely to experience reliable deterioration in depression/anxiety symptoms compared with people with vascular dementia (odds ratio 2.98, 95% CI 1.08–8.22; P = 0.03) or Alzheimer's disease (odds ratio 2.95, 95% CI 1.15–7.55; P = 0.03). Greater depression severity (reliable recovery: odds ratio 0.95, 95% CI 0.92–0.98, P < 0.001; reliable deterioration: odds ratio 1.73, 95% CI 1.04–2.90, P = 0.04), lower work and social functioning (recovery: odds ratio 0.98, 95% CI 0.96–0.99, P = 0.002), psychotropic medication use (recovery: odds ratio 0.67, 95% CI 0.51–0.90, P = 0.01), being of working age (recovery: odds ratio 2.03, 95% CI 1.10–3.73, P = 0.02) and fewer therapy sessions (recovery: odds ratio 1.12, 95% CI 1.09–1.16, P < 0.001) were associated with worse therapy outcomes in PLWD. Conclusions: Dementia type was generally not associated with outcomes, whereas clinical factors were consistent with those identified for the general population. Additional support and adaptations may be required to improve therapy outcomes in PLWD, particularly in those who are younger and have more severe depression. [ABSTRACT FROM AUTHOR]

Background Recent evidence suggests that the first consultation with a general practitioner (GP) for symptoms of depression may be more than just a vehicle for assessment and management planning (as current guidelines imply). Objectives To identify what patients find helpful, or otherwise, in their first consultation for low mood with a GP. Methods A cross-sectional questionnaire and interview study of patients with low mood who had recently consulted their GP, in the North of England. Patients were asked to complete a questionnaire regarding the consultation, and a Patient Health Questionnaire-9 (PHQ-9), within 2 weeks. They were also invited to take part in a face–face interview with a researcher. Both sources of data were subjected to qualitative thematic analysis. Results Thirty-seven questionnaires were returned; 5 interviews took place. The majority of participants felt better after consulting a GP for the first time for low mood. The factors most commonly cited as helpful were "being listened to" and "understanding or empathy from the GP." Others included "admitting the problem," "being reassured of normality," and "being provided with optimism or hope for change." The most commonly reported difficulty was the patients' struggle to express themselves. Patients often felt that GP follow-up was inadequate. Conclusions These results suggest that the therapeutic benefit of the GP consultation is under-recognized in current guidelines. The results of our study will provide crucial information as to how such consultations can be tailored to improve patient satisfaction. [ABSTRACT FROM AUTHOR]

Coastal sediment grain size is an important factor in determining coastal morphodynamics. In this study, we explore a novel approach for retrieving the median sediment grain size (D50) of gravel-dominated beaches using Synthetic Aperture Radar (SAR) spaceborne imagery. We assessed this by using thirty-six Sentinel-1 (C-band SAR) satellite images acquired in May and June 2022 and 2023, and three NovaSAR (S-band SAR) satellite images acquired in May and June 2022, for three different training sites and one test site across England (the UK). The results from the Sentinel-1 C-band data show strong positive correlations (R2 ≥ 0.75 ) between the D50 and the backscatter coefficients for 15/18 of the resultant models. The models were subsequently used to derive predictions of D50 for the test site, with the models which exhibited the strongest correlations resulting in Mean Absolute Errors (MAEs) in the range 2.26–5.47 mm. No correlation (R2 = 0.04) was found between the backscatter coefficients from the S-band NovaSAR data and D50. These results highlight the potential to derive near-real time estimates of coastal sediment grain size for gravel beaches to better inform coastal erosion and monitoring programs. [ABSTRACT FROM AUTHOR]

Background/Aims: Autism is a neurodevelopmental disability affecting interpersonal communication and interaction, and has a prevalence of more than 1% of the population. This review aimed to identify what midwives in England can learn from studies exploring the experiences of autistic women in the antenatal, intrapartum and early postnatal periods. Methods: A systematic literature search was conducted using seven electronic databases. Thematic analysis was performed, based on Braun and Clarke. Results: Three themes were found: autism diagnosis and disclosure, communication and interaction with healthcare professionals, babies and groups, and sensory difficulties. Conclusions: Autistic women experience many challenges during the antenatal, intrapartum and early postnatal periods, and it is clear that midwives in England should treat all women as an individual, asking about their specific needs and any adjustments that can be made to provide inclusive care. [ABSTRACT FROM AUTHOR]

Walking-creating was adopted to probe orientations towards communities, while early career teachers were on clinical placement in the remote South West Peninsular of England. The aim of carrying out walking-creating events was to elicit whether and if so, the extent to which, early career teachers were sensitive to the communities where they had been placed and hence had begun to question deficit discourses tending to adhere to peripheral landscapes. We explored whether they were replacing these negative discourses with hopeful ones. We present a study of one early career teacher who during our creative activity disclosed how place awareness had been developing through interactions within the community. The novel walking-creating methodology is informed by a generative theorising of peripherality so as to contextualise the complexities of the multiple drivers likely to be coalescing in teachers' peripheral placement communities. [ABSTRACT FROM AUTHOR]

Many migratory bird species have undergone recent population declines, but there is considerable variation in trends between species and between populations employing different migratory routes. Understanding species‐specific migratory behaviours is therefore of critical importance for their conservation. The Common Sandpiper Actitis hypoleucos is an Afro‐Palaearctic migratory bird species whose European populations are in decline. We fitted geolocators to individuals breeding in England or wintering in Senegal to determine their migration routes and breeding or non‐breeding locations. We used these geolocator data in combination with previously published data from Scottish breeding birds to determine the distributions and migratory connectivity of breeding (English and Scottish) and wintering (Senegalese) populations of the Common Sandpiper, and used simulated random migrations to investigate wind assistance during autumn and spring migration. We revealed that the Common Sandpipers tagged in England spent the winter in West Africa, and that at least some birds wintering in Senegal bred in Scandinavia; this provides insights into the links between European breeding populations and their wintering grounds. Furthermore, birds tagged in England, Scotland and Senegal overlapped considerably in their migration routes and wintering locations, meaning that local breeding populations could be buffered against habitat change, but susceptible to large‐scale environmental changes. These findings also suggest that contrasting population trends in England and Scotland are unlikely to be the result of population‐specific migration routes and wintering regions. Finally, we found that birds used wind to facilitate their migration in autumn, but less so in spring, when the wind costs associated with their migrations were higher than expected at random. This was despite the wind costs of simulated migrations being significantly lower in spring than in autumn. Indeed, theory suggests that individuals are under greater time pressures in spring than in autumn because of the time constraints associated with reproduction. [ABSTRACT FROM AUTHOR]

During COVID‐19 lockdowns in England, 'key workers' including factory workers, carers and cleaners had to continue to travel to workplaces. Those in key worker jobs were often from more marginalised communities, including migrant workers in precarious employment. Recognising space as materially and socially produced, this qualitative study explores migrant workers' experiences of navigating COVID‐19 risks at work and its impacts on their home spaces. Migrant workers in precarious employment often described workplace COVID‐19 protection measures as inadequate. They experienced work space COVID‐19 risks as extending far beyond physical work boundaries. They developed their own protection measures to try to avoid infection and to keep the virus away from family members. Their protection measures included disinfecting uniforms, restricting leisure activities and physically separating themselves from their families. Inadequate workplace COVID‐19 protection measures limited workers' ability to reduce risks. In future outbreaks, support for workers in precarious jobs should include free testing, paid sick leave and accommodation to allow for self‐isolation to help reduce risks to workers' families. Work environments should not be viewed as discrete risk spaces when planning response measures; responses and risk reduction approaches must also take into account impacts on workers' lives beyond the workplace. [ABSTRACT FROM AUTHOR]

There is growing recognition, in the UK and internationally, of the huge costs of recurrent appearances of parents in local authority care proceedings. This paper contributes to pressing policy and practice concerns to reduce recurrence. It presents qualitative longitudinal data from the first study of fathers' experiences of recurrent care proceedings in England. Demonstrating the emotional impact of repeat proceedings and successive loss of children on fathers, in terms of grief, loss and shame, we highlight the trauma and abuse in their developmental histories. We consider complex connections between anger and shame for these fathers, including within the arena of family justice. With the use of literature on complex trauma, shame and parental disengagement, we explore ideas for re‐framing fathers', and professionals', resistance to engagement and for better understanding fathers' intense emotions. We suggest that the link between shame and complex trauma and the value of shame reducing, dignity promoting practice in response provide a valuable way forward for working with fathers. As is recognized to be the case for mothers, without holistic, empathic interventions to address the vulnerabilities of such fathers, the risks for children, mothers and fathers are unlikely to reduce. [ABSTRACT FROM AUTHOR]

Background: The onset of disability in bathing is particularly important for older adults as it can be rapidly followed by disability in other daily activities; this may represent a judicious time point for intervention in order to improve health, well-being and associated quality of life. An important environmental and preventative intervention is housing adaptation, but there are often lengthy waiting times for statutory provision. In this randomised controlled trial (RCT), we aim to evaluate the effectiveness and cost-effectiveness of bathing adaptations compared to no adaptations and to explore the factors associated with routine and expedited implementation of bathing adaptations. Methods: BATH-OUT-2 is a multicentre, two-arm, parallel-group RCT. Adults aged 60 and over who are referred to their local authority for an accessible level access shower will be randomised, using pairwise randomisation, 1:1, to receive either an expedited provision of an accessible shower via the local authority or a usual care control waiting list. Participants will be followed up for a maximum of 12 months and will receive up to four follow-ups in this duration. The primary outcome will be the participant's physical well-being, assessed by the Physical Component Summary score of the Short Form-36 (SF-36), 4 weeks after the intervention group receives the accessible shower. The secondary outcomes include the Mental Component Summary score of the SF-36, self-reported falls, health and social care resource use, health-related quality of life (EQ-5D-5L), social care-related quality of life (Adult Social Care Outcomes Toolkit (ASCOT)), fear of falling (Short Falls Efficacy Scale), independence in bathing (Barthel Index bathing question), independence in daily activities (Barthel Index) and perceived difficulty in bathing (0–100 scale). A mixed-methods process evaluation will comprise interviews with stakeholders and a survey of local authorities with social care responsibilities in England. Discussion: The BATH-OUT-2 trial is designed so that the findings will inform future decisions regarding the provision of bathing adaptations for older adults. This trial has the potential to highlight, and then reduce, health inequalities associated with waiting times for bathing adaptations and to influence policies for older adults. Trial registration: ISRCTN Registry ISRCTN48563324. Prospectively registered on 09/04/2021. [ABSTRACT FROM AUTHOR]

In this paper, we deploy data collected through a Q study with educators in south-west England. The mixed methodology involved the two stages of forced choice statement sorting by educator participants and subsequent factor analysis. Through abductive analyses, four views regarding aspirations and young people in peripheral communities are identified. Of these, only one viewpoint, named 'acknowledge the barriers to finding employment', aligns with taken for granted narratives on encouraging school students to pursue careers in the knowledge economy, with transition to higher education being the acknowledged pathway to flourishing futures. Three further viewpoints are identified and discussed. The paper contributes new insights to understanding educational landscapes in peripheral places through employing a novel approach, that of Q method, to illuminate educators' lived experiences in such communities. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of increased availability of healthier options on purchasing of different types of vending snack products sold in English leisure (sports) centres. Design: An evaluation of an intervention using pre-post methods and interrupted time series analysis. Products within the vending machines were altered over three phases to increase the availability of healthier options, using agreed nutrition criteria – Government Buying Standards for Food and Catering Services (GBSF) for England – as a guide, as well as product availability. The primary outcome was the change in mean weekly purchased energy between the first and third phase. Secondary outcomes included changes by phase and by week in weekly number of purchases, fats, sugars and salt for all products combined and by individual product categories. Setting: Fifteen sports centres in the city of Leeds, West Yorkshire, UK. Participants: Snack products sold in eighteen vending machines. Results: Energy purchased reduced from baseline to phase 2, for all product categories combined, by 47·25 MJ (95 % CI (−61·22, −33·27)) per machine and by 279 kJ, (95 % CI (−325, −266)) per product unit. There were reductions in most nutrients purchased in all individual product categories except chocolate confectionery. Nutrients per product unit decreased for all product categories except saturated fat in chocolate confectionery. Minimal underlying trends in the baseline phase were identified, indicating changes in outcomes were likely to be due to the intervention. Conclusions: Introducing standards to increase availability of healthier snack products in vending machines is feasible without substantially affecting sales. [ABSTRACT FROM AUTHOR]

Hepatitis C virus infection (HCV) is prevalent in prisons. Therefore, effective prison HCV services are critical for HCV elimination programmes. We aimed to evaluate the efficacy of a regional HCV prison testing and treatment programme. Between July 2017 and June 2022, data were collected prospectively on HCV test offer and uptake rates, HCV Antibody (HCV‐Ab) and HCV‐RNA positivity, treatment starts and outcomes for new inmates incarcerated in three prisons. Rates of HCV‐Ab and RNA positivity at reception, incidence of new HCV infections and reinfection following treatment were determined. From a total of 39,652 receptions, 33,028 (83.3%) were offered HCV testing and 20,394 (61.7%) completed testing. Including all receptions, 24.5% of tests (n = 4995) were HCV‐Ab positive and 8.4% of tests (n = 1713) were HCV‐RNA positive. When considering the first test for each individual (median age 34 years; 88.1% male), 14.8% (n = 1869) and 7.2% (n = 905) were HCV‐Ab and HCV‐RNA positive, respectively. The incidence of new HCV‐Ab and RNA positivity was 5.1 and 3.3 per 100 person‐years, respectively. Of 1145 HCV viraemic individuals, 18 died within 6 months and 150 were rapidly transferred out of area, leaving 977 individuals with outcomes. Of these, 835 (85.5%) received antivirals and 47 spontaneously cleared the infection, leaving 95 (9.7%) untreated. 607 (72.7%) achieved SVR. 95 patients had reinfection post‐treatment (rate 10.1 cases per 100 person‐years). Testing for HCV has increased in our prisons and the majority with viraemia are initiated on antiviral treatment. Reassuringly, a significant fall in frequency of HCV‐RNA positivity at prison reception was observed suggesting progress towards HCV elimination. [ABSTRACT FROM AUTHOR]

Most long-term care systems (social care) for older people rely on some means testing, copayment system, private insurance, or other non-governmental funding to supplement state provision. In England, an estimated quarter of homecare delivery is funded privately. For many older people, the absence of state funding for their care is only part of the problem: they are also expected to search for care in a market characterised by complexity, plurality, and imperfect information. Surprisingly, there are few services available to support private funders to navigate the system. This paper examines willingness to pay for care navigation and seeks to classify heterogeneity of preferences for navigation support. A discrete choice experiment (DCE) survey was completed by 182 participants across England in 2020-21. The results of the random parameter logit model used to analyse preferences showed that people valued information about care options (quality, information, and finances), but they also wanted help to "think things through," as processing information could be challenging. Generally, participants valued what the navigation service provided, more than how the services were organised and delivered. The study also used latent class analysis to identify four groups with similar preferences, with almost half of participants (48%) expressing high willingness to pay for a comprehensive navigation service. The other three classes represented those with preferences focused on a narrower set of attributes: fast access to information (20%), affordable help to "think things through" (18%), and information provided by their local council (14%). The study demonstrates the potential demand and likely take-up of navigation support if made available to people who pay privately for care. Future research needs to examine the barriers to market development for social care navigation services. [ABSTRACT FROM AUTHOR]

The Portable Antiquities Scheme (PAS) is a partnership project, funded by the Department for Culture, Media and Sport and Welsh Government, run by the British Museum in England and Amgueddfa Cymru-Museum Wales in Wales, with over 40 archaeologists – Finds Liaison Officers (FLOs) – based at partner institutions throughout these two countries. It exists to record small finds made by members of the public, for the advancement of knowledge and to preserve the archaeological record. Since its inception as a pilot project covering six counties in 1997, it has recorded more than 1.6 million objects on its online database at https:// finds.org.uk, the vast majority of these voluntarily submitted (the exception being finds meeting the definition of Treasure, which must be reported by law). The data amassed by the PAS has been used in hundreds of research projects and feeds into local Historic Environment Records. This round-up of finds recorded with the PAS covers the period between 1 January and 31 December 2021, for everything classed as ‘Post-Medieval’ (c.1500–c.1900) or ‘Modern’ (c.1901–present) on its database. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic saw unprecedented resources and funds driven into research for the development, and subsequent rapid distribution, of vaccines, diagnostics and directly acting antivirals (DAAs). DAAs have undeniably prevented progression and life-threatening conditions in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, there are concerns of antimicrobial resistance (AMR), antiviral resistance specifically, for DAAs. To preserve activity of DAAs for COVID-19 therapy, as well as detect possible mutations conferring resistance, antimicrobial stewardship and surveillance were rapidly implemented in England. This paper expands on the ubiquitous ongoing public health activities carried out in England, including epidemiologic, virologic and genomic surveillance, to support the stewardship of DAAs and assess the deployment, safety, effectiveness and resistance potential of these novel and repurposed therapeutics. [ABSTRACT FROM AUTHOR]

Aim: The aim was to determine whether specialist‐led habit training using Habit Training with Biofeedback (HTBF) is more effective than specialist‐led habit training alone (HT) for chronic constipation and whether outcomes of interventions are improved by stratification to HTBF or HT based on diagnosis (functional defaecation disorder vs. no functional defaecation disorder) by radio‐physiological investigations (INVEST). Method: This was a parallel three‐arm randomized single‐blinded controlled trial, permitting two randomized comparisons: HTBF versus HT alone; INVEST‐ versus no‐INVEST‐guided intervention. The inclusion criteria were age 18–70 years; attending specialist hospitals in England; self‐reported constipation for >6 months; refractory to basic treatment. The main exclusions were secondary constipation and previous experience of the trial interventions. The primary outcome was the mean change in Patient Assessment of Constipation Quality of Life score at 6 months on intention to treat. The secondary outcomes were validated disease‐specific and psychological questionnaires and cost‐effectiveness (based on EQ‐5D‐5L). Results: In all, 182 patients were randomized 3:3:2 (target 384): HT n = 68; HTBF n = 68; INVEST‐guided treatment n = 46. All interventions had similar reductions (improvement) in the primary outcome at 6 months (approximately −0.8 points of a 4‐point scale) with no statistically significant difference between HT and HTBF (−0.03 points; 95% CI −0.33 to 0.27; P = 0.85) or INVEST versus no‐INVEST (0.22; −0.11 to 0.55; P = 0.19). Secondary outcomes showed a benefit for all interventions with no evidence of greater cost‐effectiveness of HTBF or INVEST compared with HT. Conclusion: The results of the study at 6 months were inconclusive. However, with the caveat of under‐recruitment and further attrition at 6 months, a simple, cheaper approach to intervention may be as clinically effective and more cost‐effective than more complex and invasive approaches. [ABSTRACT FROM AUTHOR]

Background: Mental health acute and crisis care consumes a large share of mental health budgets internationally but is often experienced as unsatisfactory and difficult to access. As a result, there is an increasing move towards developing innovative community crisis services, to improve patient experience and relieve pressure on inpatient and emergency services. This study aims to understand what helps and hinders the implementation of innovative mental health crisis care projects in England. Methods: Using a qualitative approach, 18 interviews were conducted with crisis care service managers exploring their experiences and views of the development and implementation of their service developed with support from an English national capital funding programme. A framework analysis was conducted informed by implementation science. Results: Key facilitators to implementation of innovative crisis services included bottom-up development, service user involvement, strong collaborative working, and leadership and management buy-in. Key barriers that affected the projects implementation included the complexities of crisis care, workforce challenges and resourcing issues. Conclusion: There is a recognised need to improve, update, and innovate current crisis care offers. Results from this study suggest that a range of models can help address the heterogenous needs of local populations and that new approaches can be implemented where they utilise a whole-systems approach, involving service users and relevant professional stakeholders beyond mental health services in planning and developing the service. [ABSTRACT FROM AUTHOR]

In England, Pupil Premium Plus is additional funding to help address the educational attainment gap experienced by looked after children. This paper explores the experiences of virtual school heads and designated teachers (n = 140) as they access Pupil Premium Plus-related information, guidance and training to support their practice; navigate the complexities of the Personal Education Plan (PEP) process; and measure the impact of Pupil Premium Plus-funded interventions. We explain professionals' experiences using insights from social practice theories, and argue that the process of supporting the educational outcomes of looked after children via Pupil Premium Plus is made up of context- and audience-dependent 'social practices'. When the social practices are aligned, virtual school heads and designated teachers may be effectively able to support looked after children, whereas barriers may emerge when social practices become disjointed. We conclude this paper by arguing that for Pupil Premium Plus to support educational outcomes of looked after children effectively, professionals need to reflect on their own cultures and practices. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity is a major challenge to health and social care systems around the world. There is limited research exploring the wider contextual determinants that are important to improving care for this cohort. In this study, we aimed to elicit and prioritise determinants of improved care in people with multiple conditions. Methods: A three-round online Delphi study was conducted in England with health and social care professionals, data scientists, researchers, people living with multimorbidity and their carers. Results: Our findings suggest a care system which is still predominantly single condition focused. 'Person-centred and holistic care' and 'coordinated and joined up care', were highly rated determinants in relation to improved care for multimorbidity. We further identified a range of non-medical determinants that are important to providing holistic care for this cohort. Conclusions: Further progress towards a holistic and patient-centred model is needed to ensure that care more effectively addresses the complex range of medical and non-medical needs of people living with multimorbidity. This requires a move from a single condition focused biomedical model to a person-based biopsychosocial approach, which has yet to be achieved. [ABSTRACT FROM AUTHOR]

The Arden Sandstone Formation of central and western England is a thin but conspicuous arenaceous unit within the Late Triassic Mercia Mudstone Group. Sedimentological and palaeontological data point to lacustrine depositional conditions, in contrast to the red desert mudstones above and below which were deposited as continental dryland desert floodplains. The Arden Sandstone records deposits of the lake margins and may be the high stand lateral equivalent of the halite and gypsum deposits which formed in the lake centre. The Carnian age of the Arden Sandstone potentially links it to the Carnian Pluvial Episode, marking the coalescence, spread and freshening of the formerly saline desert lakes, and deposition of sandy, fluvial and lacustrine deposits, during the wetter climate that prevailed for at least a million years. [ABSTRACT FROM AUTHOR]

This cross-sectional study examines ophthalmic data, including imaging results, for 101 416 patients from the AlzEye study to determine the association between retinal biomarkers and schizophrenia. Key Points: Question: Do individuals with schizophrenia have measurable differences in retinal morphology? Findings: In this cross-sectional analysis of a cohort of data for 101 416 patients (485 with schizophrenia), those with schizophrenia had significantly thinner ganglion cell–inner plexiform layers. Retinovascular differences were mostly attributable to higher medical comorbidity among patients with schizophrenia. Meaning: In this study, individuals with schizophrenia had reduced thickness of the inner retina, which may indicate heightened neurodegeneration. Importance: The potential association of schizophrenia with distinct retinal changes is of clinical interest but has been challenging to investigate because of a lack of sufficiently large and detailed cohorts. Objective: To investigate the association between retinal biomarkers from multimodal imaging (oculomics) and schizophrenia in a large real-world population. Design, Setting, and Participants: This cross-sectional analysis used data from a retrospective cohort of 154 830 patients 40 years and older from the AlzEye study, which linked ophthalmic data with hospital admission data across England. Patients attended Moorfields Eye Hospital, a secondary care ophthalmic hospital with a principal central site, 4 district hubs, and 5 satellite clinics in and around London, United Kingdom, and had retinal imaging during the study period (January 2008 and April 2018). Data were analyzed from January 2022 to July 2022. Main Outcomes and Measures: Retinovascular and optic nerve indices were computed from color fundus photography. Macular retinal nerve fiber layer (RNFL) and ganglion cell–inner plexiform layer (mGC-IPL) thicknesses were extracted from optical coherence tomography. Linear mixed-effects models were used to examine the association between schizophrenia and retinal biomarkers. Results: A total of 485 individuals (747 eyes) with schizophrenia (mean [SD] age, 64.9 years [12.2]; 258 [53.2%] female) and 100 931 individuals (165 400 eyes) without schizophrenia (mean age, 65.9 years [13.7]; 53 253 [52.8%] female) were included after images underwent quality control and potentially confounding conditions were excluded. Individuals with schizophrenia were more likely to have hypertension (407 [83.9%] vs 49 971 [48.0%]) and diabetes (364 [75.1%] vs 28 762 [27.6%]). The schizophrenia group had thinner mGC-IPL (−4.05 μm, 95% CI, −5.40 to −2.69; P = 5.4 × 10−9), which persisted when investigating only patients without diabetes (−3.99 μm; 95% CI, −6.67 to −1.30; P =.004) or just those 55 years and younger (−2.90 μm; 95% CI, −5.55 to −0.24; P =.03). On adjusted analysis, retinal fractal dimension among vascular variables was reduced in individuals with schizophrenia (−0.14 units; 95% CI, −0.22 to −0.05; P =.001), although this was not present when excluding patients with diabetes. Conclusions and Relevance: In this study, patients with schizophrenia had measurable differences in neural and vascular integrity of the retina. Differences in retinal vasculature were mostly secondary to the higher prevalence of diabetes and hypertension in patients with schizophrenia. The role of retinal features as adjunct outcomes in patients with schizophrenia warrants further investigation. [ABSTRACT FROM AUTHOR]

Background: Sapropterin has been approved as a treatment option for individuals with Phenylketonuria in the United Kingdom. Individuals are assessed as responsive to Sapropterin by a ≥30% reduction in Phenylalanine (Phe) concentrations using dried blood spot (DBS) specimens. DBS quality is critical for accurate and precise measurement of Phe. Currently, UK national guidelines for DBS specimen acceptance do not exist for patient-collected DBS specimens. We adopted evidence-based guidelines for specimen acceptance criteria and retrospectively assessed the impact of introducing these guidelines on specimen rejection rates. Methods: Laboratories were invited to audit the quality of DBS specimens routinely received for Phe monitoring using: (1) existing acceptance/rejection criteria and (2) proposed national guidelines. Results: Ten laboratories audited 2111 specimens from 1094 individuals. Using existing local guidelines, the median rejection rate was 4.0% (IQR 1.5–7.2%). This increased to 21.9% (IQR 10.0–33.0%) using the proposed guidelines. Where reason(s) for rejection were provided (n = 299); 211/299 (70.6%) of DBS specimens were too small or multi-spotted. 380 individuals had more than one sample evaluated; 231/380 (60.8%) provided specimens of acceptable quality, 37/380 (9.7%) consistently provided poor-quality DBS specimens. Conclusions: There is significant variability in the quality of patient-collected DBS specimens. If unacceptable specimens are not rejected, imprecise/inaccurate results will be used in clinical decision making. Using annual workload data for England, this equates to 12,410 incorrect results. Individuals and parents/carers should receive ongoing training in blood collection technique to ensure use of evidence-based acceptability criteria does not cause undue distress from increased sample rejection rates. [ABSTRACT FROM AUTHOR]

Background Concerns have been raised that angiotensin-converting enzyme-inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) might facilitate transmission of severe acute respiratory syndrome coronavirus 2 leading to more severe coronavirus disease (COVID-19) disease and an increased risk of mortality. We aimed to investigate the association between ACE-I/ARB treatment and risk of death amongst people with COVID-19 in the first 6 months of the pandemic. Methods We identified a cohort of adults diagnosed with either confirmed or probable COVID-19 (from 1 January to 21 June 2020) using computerized medical records from the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) primary care database. This comprised 465 general practices in England, United Kingdom with a nationally representative population of 3.7 million people. We constructed mixed-effects logistic regression models to quantify the association between ACE-I/ARBs and all-cause mortality among people with COVID-19, adjusted for sociodemographic factors, comorbidities, concurrent medication, smoking status, practice clustering, and household number. Results There were 9,586 COVID-19 cases in the sample and 1,463 (15.3%) died during the study period between 1 January 2020 and 21 June 2020. In adjusted analysis ACE-I and ARBs were not associated with all-cause mortality (adjusted odds ratio [OR] 1.02, 95% confidence interval [CI] 0.85–1.21 and OR 0.84, 95% CI 0.67–1.07, respectively). Conclusion Use of ACE-I/ARB, which are commonly used drugs, did not alter the odds of all-cause mortality amongst people diagnosed with COVID-19. Our findings should inform patient and prescriber decisions concerning continued use of these medications during the pandemic. [ABSTRACT FROM AUTHOR]

Background: Over the last decade use of raw acceleration metrics to assess physical activity has increased. Metrics such as Euclidean Norm Minus One (ENMO), and Mean Amplitude Deviation (MAD) can be used to generate metrics which describe physical activity volume (average acceleration), intensity distribution (intensity gradient), and intensity of the most active periods (MX metrics) of the day. Presently, relatively little comparative data for these metrics exists in youth. To address this need, this study presents age- and sex-specific reference percentile values in England youth and compares physical activity volume and intensity profiles by age and sex. Methods: Wrist-worn accelerometer data from 10 studies involving youth aged 5 to 15 y were pooled. Weekday and weekend waking hours were first calculated for youth in school Years (Y) 1&2, Y4&5, Y6&7, and Y8&9 to determine waking hours durations by age-groups and day types. A valid waking hours day was defined as accelerometer wear for ≥ 600 min·d−1 and participants with ≥ 3 valid weekdays and ≥ 1 valid weekend day were included. Mean ENMO- and MAD-generated average acceleration, intensity gradient, and MX metrics were calculated and summarised as weighted week averages. Sex-specific smoothed percentile curves were generated for each metric using Generalized Additive Models for Location Scale and Shape. Linear mixed models examined age and sex differences. Results: The analytical sample included 1250 participants. Physical activity peaked between ages 6.5–10.5 y, depending on metric. For all metrics the highest activity levels occurred in less active participants (3rd-50th percentile) and girls, 0.5 to 1.5 y earlier than more active peers, and boys, respectively. Irrespective of metric, boys were more active than girls (p <.001) and physical activity was lowest in the Y8&9 group, particularly when compared to the Y1&2 group (p <.001). Conclusions: Percentile reference values for average acceleration, intensity gradient, and MX metrics have utility in describing age- and sex-specific values for physical activity volume and intensity in youth. There is a need to generate nationally-representative wrist-acceleration population-referenced norms for these metrics to further facilitate health-related physical activity research and promotion. [ABSTRACT FROM AUTHOR]

Individual and organisational factors have been identified as influencing personal wellbeing, with an emphasis placed on the organisation and management to support their staff. Whilst various policies, interventions and campaigns are in place at national and local level, it is unclear how well individual and organisational perspectives of wellbeing are aligned. This study seeks to address this through the analysis of secondary data provided by Oscar Kilo in 2018: Blue Light Wellbeing Frameworks (organisational perspective) and Human Resources policy review survey data (individual perspective). Whilst findings indicate positive steps to enhancing police wellbeing, a disconnect between the organisation and employees was apparent. [ABSTRACT FROM AUTHOR]

Background: Every Mind Matters (EMM) is a publicly funded health campaign, launched in England in 2019, to equip adults to look after their mental health, and that of others, by offering online information about common problems: anxiety, low mood, sleep, and stress. This study is one component of an independent evaluation of EMM conducted by the NIHR Mental Health Policy Research Unit. Its aim is to explore individuals' experiences of the EMM campaign and website. Methods: Four researchers, including three with lived experience of using mental health services, conducted 20, one-off, semi-structured, online interviews with a range of adult participants, including a sample of EMM users and a purposively recruited sub-sample known to have severe or long-term mental health conditions. A codebook thematic analysis was undertaken, and four main themes were identified. Findings: There was an expectation from the name Every Mind Matters that its advice would address everyone. Almost all participants had experience of mental distress and looked to EMM for help with a current problem for themselves. All participants were complimentary about the EMM website and found it to be user-friendly (theme 1) and personalised (theme 2) especially the interactive feature Your Mind Plan quiz which responds with suggested actions to improve wellbeing and follows up with reminder emails. A few participants found the website information and/or Mind Plan suggestions to be life changing. Some participants wanted EMM to better acknowledge the contexts in which they live (theme 3) such as the limitations of health conditions and health services, and difficulties of crowded housing, social policy, and climate change. Many participants would like EMM to do more (theme 4), offer more interactivity, more choice, more information about available treatments, and more stratified advice to cover more severe mental health conditions. Conclusion: EMM is available to all, including people with common or severe mental disorders. In the context of overwhelmed mental health services, people with severe mental illness expect more from EMM than advice about common problems. EMM could build on its success by extending its remit to address a wider range of needs so that everyone is included. [ABSTRACT FROM AUTHOR]

Background: The CVD-COVID-UK consortium was formed to understand the relationship between COVID-19 and cardiovascular diseases through analyses of harmonised electronic health records (EHRs) across the four UK nations. Beyond COVID-19, data harmonisation and common approaches enable analysis within and across independent Trusted Research Environments. Here we describe the reproducible harmonisation method developed using large-scale EHRs in Wales to accommodate the fast and efficient implementation of cross-nation analysis in England and Wales as part of the CVD-COVID-UK programme. We characterise current challenges and share lessons learnt. Methods: Serving the scope and scalability of multiple study protocols, we used linked, anonymised individual-level EHR, demographic and administrative data held within the SAIL Databank for the population of Wales. The harmonisation method was implemented as a four-layer reproducible process, starting from raw data in the first layer. Then each of the layers two to four is framed by, but not limited to, the characterised challenges and lessons learnt. We achieved curated data as part of our second layer, followed by extracting phenotyped data in the third layer. We captured any project-specific requirements in the fourth layer. Results: Using the implemented four-layer harmonisation method, we retrieved approximately 100 health-related variables for the 3.2 million individuals in Wales, which are harmonised with corresponding variables for > 56 million individuals in England. We processed 13 data sources into the first layer of our harmonisation method: five of these are updated daily or weekly, and the rest at various frequencies providing sufficient data flow updates for frequent capturing of up-to-date demographic, administrative and clinical information. Conclusions: We implemented an efficient, transparent, scalable, and reproducible harmonisation method that enables multi-nation collaborative research. With a current focus on COVID-19 and its relationship with cardiovascular outcomes, the harmonised data has supported a wide range of research activities across the UK. [ABSTRACT FROM AUTHOR]

There are many pressing questions about how to deliver adult social care services. Where research evidence exists to address these questions, there is often limited use by social care commissioners, providers and the workforce. Sometimes this is attributed to the lack of perceived relevance and accessibility of the research itself, at other times it is considered to be a matter of individual and organisational capacity. As things stand, there is a gap between social care research and practice. Improving interaction between different stakeholders in the research process is a contemporary mechanism for promoting the production of research that is useful, usable and used. This paper describes one collaborative approach called research-practice partnerships (RPPs). These partnerships share the goal of benefit for all partners and are supported by a growing international evidence base. This paper summarises some of the key literature from different countries and contexts where the approach has been tried. It highlights the main features of RPPs, introduces a project setting up three new partnerships in the care home sector in England and highlights aspects of the theory of change that will guide the evaluation of the partnerships. In doing so, the paper introduces a promising collaborative approach to a social care audience and considers whether RPPs have the potential to achieve meaningful and impactful research in social care contexts. [ABSTRACT FROM AUTHOR]

Purpose: This paper intends to examine and evaluate the implementation and delivery of a discharge to assess pathway based on the UK Department of Health and Social Care Hospital Discharge Policy in relation to the quadruple aim of healthcare improvement: improving patient experience, reducing costs, benefiting the wider population and improving the work life of staff. Design/methodology/approach: Using a place based partnership in the south of England, 18 staff involved the delivery of discharge to assess and four patients who had recently been through the pathway were interviewed and the narratives analysed using a framework method. Findings: All four dimensions of the quadruple aim were felt to be positively impacted by the discharge to assess pathway in varying degrees. Staff described improvements to working lives; patients described a positive experience. There was no evidence of reduced costs and wider benefit through reduced length of stay was suggested rather than demonstrated. The study showed a need to ensure both information flows and discharge process are smooth, that there is sufficient community capacity and capability, a need for strong relationships and shared goals, for clarity of pathway and empowered staff, and for an avoidance of the over prescription of care. Originality/value: The revised discharge to assess pathway in England has been in place since 2020 and no other assessments of the pathway were found that related the changes to the quadruple aim framework. [ABSTRACT FROM AUTHOR]

Despite urbanization's general erosion of biodiversity, towns and cities provide novel opportunities for some species. During the 20th century, gulls (Laridae) colonized urban areas around the world where they flourished. At the same time, some coastal populations declined. The reasons for this difference are not fully understood, partly because little is known about any ecological differences between urban and non‐urban gulls, such as their foraging ecology. Here we compare the movement ecology and habitat selection of Lesser Black‐backed Gulls Larus fuscus graellsii breeding at two neighbouring colonies – one urban and one coastal – in north‐west England. We used bird‐borne GPS loggers to first compare colony‐level movement behaviour and habitat selection and then investigated individual‐level habitat use. We observed clear colony‐level habitat segregation: urban breeders preferentially foraged in urban areas whereas coastal breeders foraged primarily in coastal habitats and avoided urban areas. Coastal breeders also had larger core and home‐ranges than urban breeders, possibly due to differences in colony size. However, we also found inter‐individual differences in habitat use, which may have important management implications. These findings suggest a link between nesting and foraging ecology, and thus management or environmental change altering food availability will impact gulls at the coastal and urban sites differently. [ABSTRACT FROM AUTHOR]

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel virus responsible for the coronavirus disease 2019 (COVID-19) pandemic. Although COVID-19 is a viral illness, many patients admitted to hospital are prescribed antibiotics, based on concerns that COVID-19 patients may experience secondary bacterial infections, and the assumption that they may respond well to antibiotic therapy. This has led to an increase in antibiotic use for some hospitalised patients at a time when accumulating antibiotic resistance is a major global threat to health. Procalcitonin (PCT) is an inflammatory marker measured in blood samples and widely recommended to help diagnose bacterial infections and guide antibiotic treatment. The PEACH study will compare patient outcomes from English and Welsh hospitals that used PCT testing during the first wave of the COVID-19 pandemic with those from hospitals not using PCT. It will help to determine whether, and how, PCT testing should be used in the NHS in future waves of COVID-19 to protect patients from antibiotic overuse. PEACH is a retrospective observational cohort study using patient-level clinical data from acute hospital Trusts and Health Boards in England and Wales. The primary objective is to measure the difference in antibiotic use between COVID-19 patients who did or did not have PCT testing at the time of diagnosis. Secondary objectives include measuring differences in length of stay, mortality, intensive care unit admission, and resistant bacterial infections between these groups. [ABSTRACT FROM AUTHOR]

Background: Patients with both atrial fibrillation (AF) and cardiovascular disease (CVD) may receive dual antithrombotic therapy (DAT) with both an anticoagulant and ≥1 antiplatelet agents. Avoiding prolonged duration of DAT and use of gastroprotective therapies reduces bleeding risk. Aim: To describe the extent and duration of DAT and use of gastroprotection in a primary care cohort of patients with AF. Design & setting: Observational study in 1.2 million people registered with GPs across four east London clinical commissioning groups (CCGs), covering prescribing from January 2020--June 2021. Method: In patients with AF, factors associated with DAT prescription, prolonged DAT prescription (>12 months), and gastroprotective prescription were characterised using logistic regression. Results: There were 8881 patients with AF, of whom 4.7% (n = 416) were on DAT. Of these, 65.9% (n = 274) were prescribed DAT for >12 months and 84.4% (n = 351) were prescribed concomitant gastroprotection. Independent of all other factors, females with AF were less likely to receive DAT than males (odds ratio [OR] 0.61, 95% confidence interval [CI] = 0.49 to 0.77). Similarly, older (aged ≥75 years) individuals (OR 0.79, 95% CI = 0.63 to 0.98) were less likely to receive DAT than younger patients. Among those with AF on DAT, pre-existing CVD (OR 3.33, 95% CI = 1.71 to 6.47) and South Asian ethnicity (OR 2.70, 95% CI = 1.15 to 6.32) were associated with increased gastroprotection prescriptions. Gastroprotection prescription (OR 1.80, 95% CI = 1.01 to 3.22) was associated with prolonged DAT prescription. Conclusion: Almost two-thirds of patients with AF on DAT were prescribed prolonged durations of therapy. Prescription of gastroprotection therapies was suboptimal in one in six patients. Treatment decisions varied by sex, age, ethnic group, and comorbidity. Duration of DAT and gastroprotection in patients with AF requires improvement. [ABSTRACT FROM AUTHOR]

Biomolecular analysis of historical parchment legal documents is providing new insight into their production and use. Successful interpretation of this data is dependent on understanding if the location and date written on the document accurately reflect where the animal from which the parchment was produced was raised and when it died. Our analysis reveals that the location the deed concerns, or that of the stationer through whom it was sold, typically bears no relation to the animal's origin, but that the date the agreement was signed was probably only a few months after the animal's death. [ABSTRACT FROM AUTHOR]

This study calls for the meaningful inclusion of disabled children within Physical Education (PE), by exploring the experiences of a triad of key stakeholders: (a) Disabled children and their families; (b) PE teachers; and (c) Initial Teacher Training (ITT) Providers. Semi-structured interviews were conducted between September 2017 and September 2019 with a total of 34 participants from across these three groups. Thematic analysis of the interviews revealed the following: (i) disabled children still face many barriers to participation in PE lessons in 'mainstream' schools in England; (ii) teaching professionals remain unprepared for including disabled children in PE; and, (iii) both parents and teaching professionals (teachers and ITT providers) cited recommendations to enhance the inclusion of disabled children in PE. It is concluded that disabled children are still outsiders to PE in mainstream schools in England and an intervention into PE teacher training is needed to promote strategies for inclusion. Disabled children across the world have traditionally experienced exclusion from Physical Education lessons in mainstream schools. Disabled children still face many barriers to participation in Physical Education lessons in mainstream schools in England. Teaching professionals remain unprepared for including disabled children in Physical Education settings. Both parents and teaching professionals cited recommendations to enhance the inclusion of disabled children in Physical Education. The authors suggest that changes to the structure and content of the initial teacher training for Physical Education teachers is needed to promote strategies for the meaningful inclusion of disabled children. [ABSTRACT FROM AUTHOR]

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Evidence shows that the application of problem-oriented policing can be effective in reducing a wide range of crime and public safety issues, but that the approach is challenging to implement and sustain. This article examines police perceptions and experiences regarding organisational barriers to and facilitators of the implementation and delivery of problem-oriented policing. Drawing on surveys of (n = 4141) and interviews with (n = 86) police personnel from 19 police forces in England and Wales, we identify five key barriers and facilitators to problem-oriented policing: leadership and governance, capacity, organisational structures and infrastructure, partnership working and organisational culture. These factors provide important indicators for what police organisations need to do, or need to avoid, if they are to successfully embed and deliver problem-oriented policing. The article generates critical information about the processes that drive change in police organisations and offers recommendations for police managers who may wish to implement or develop problem-oriented policing. The paper also proposes a research agenda aimed at addressing evidence gaps in our understanding of the implementation and sustenance of problem-oriented policing. [ABSTRACT FROM AUTHOR]