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Purpose: The purpose of this paper is to evaluate career impact of entrepreneurship education (EE) considering evidence drawn from a quantitative study of alumni within two UK higher education institutions (HEIs) from a retrospective perspective. The findings inform the value of the EE experience and its impact on both self-employability and wider employability career choices. This study will be of relevance to both enterprise support agencies and government policy makers. Design/methodology/approach: This research study considers evidence drawn from an online quantitative survey of EE within two UK HEIs. The survey evaluated a range of issues including course design, programme satisfaction, impact, career outcomes and respondents demographics. Over 80 respondents completed the survey in full which was analysed using a range of bivariate techniques. Findings: The evidence suggested here indicates that EE programmes provide value both in terms of helping to enable business start-ups and also in supporting other career paths, through the enterprising knowledge and skill sets graduates acquire during their specialised studies. This study contributes to the literature by recognising and measuring these contributions. For example, this study enables discernment between different EE course components and their value for different career outcomes. Research limitations/implications The study recognises the limitations of this survey data in terms of the size of the sample, number of HEIs evaluated and its point in time design. Practical implications The HEI sector must evaluate its practices and measure the effectiveness of its graduates in terms of achieving sustainable business start-up. In course design, the evidence suggested that students value both the enterprising and entrepreneurial skills and knowledge components and discern value between them in their later careers. The findings suggest that EE graduates typically experience portfolio careers with multiple occupations in different sectors and roles within both employment and self-employment. Thus it is important that EE programme design includes both enterprising and entrepreneurial components to meet the future requirements of their graduates postgraduation. Originality/value This study contributes new evidence regarding the value of EE in UK HEIs. This evidence should inform course design and policy makers regarding the value of EE in creating self-employment and creating enterprising employees.

Atmospheric methane (CH 4) is the second-most-important anthropogenic greenhouse gas and has a 20-year global warming potential 82 times greater than carbon dioxide (CO 2). Anthropogenic sources account for ∼ 60 % of global CH 4 emissions, of which 20 % come from oil and gas exploration, production and distribution. High-resolution satellite-based imaging spectrometers are becoming important tools for detecting and monitoring CH 4 point source emissions, aiding mitigation. However, validation of these satellite measurements, such as those from the commercial GHGSat satellite constellation, has so far not been documented for active leaks. Here we present the monitoring and quantification, by GHGSat's satellites, of the CH 4 emissions from an active gas leak from a downstream natural gas distribution pipeline near Cheltenham, UK, in the spring and summer of 2023 and provide the first validation of the satellite-derived emission estimates using surface-based mobile greenhouse gas surveys. We also use a Lagrangian transport model, the UK Met Office's Numerical Atmospheric-dispersion Modelling Environment (NAME), to estimate the flux from both satellite- and ground-based observation methods and assess the leak's contribution to observed concentrations at a local tall tower site (30 km away). We find GHGSat's emission estimates to be in broad agreement with those made from the in situ measurements. During the study period (March–June 2023) GHGSat's emission estimates are 236–1357 kg CH 4 h -1 , whereas the mobile surface measurements are 634–846 kg CH 4 h -1. The large variability is likely down to variations in flow through the pipe and engineering works across the 11-week period. Modelled flux estimates in NAME are 181–1243 kg CH 4 h -1 , which are lower than the satellite- and mobile-survey-derived fluxes but are within the uncertainty. After detecting the leak in March 2023, the local utility company was contacted, and the leak was fixed by mid-June 2023. Our results demonstrate that GHGSat's observations can produce flux estimates that broadly agree with surface-based mobile measurements. Validating the accuracy of the information provided by targeted, high-resolution satellite monitoring shows how it can play an important role in identifying emission sources, including unplanned fugitive releases that are inherently challenging to identify, track, and estimate their impact and duration. Rapid, widespread access to such data to inform local action to address fugitive emission sources across the oil and gas supply chain could play a significant role in reducing anthropogenic contributions to climate change. [ABSTRACT FROM AUTHOR]

Atmospheric methane (CH 4) concentrations have more than doubled since the beginning of the industrial age, making CH 4 the second most important anthropogenic greenhouse gas after carbon dioxide (CO 2). The oil and gas sector represents one of the major anthropogenic CH 4 emitters as it is estimated to account for 22 % of global anthropogenic CH 4 emissions. An airborne field campaign was conducted in April–May 2019 to study CH 4 emissions from offshore gas facilities in the southern North Sea with the aim of deriving emission estimates using a top-down (measurement-led) approach. We present CH 4 fluxes for six UK and five Dutch offshore platforms or platform complexes using the well-established mass balance flux method. We identify specific gas production emissions and emission processes (venting and fugitive or flaring and combustion) using observations of co-emitted ethane (C 2 H 6) and CO 2. We compare our top-down estimated fluxes with a ship-based top-down study in the Dutch sector and with bottom-up estimates from a globally gridded annual inventory, UK national annual point-source inventories, and operator-based reporting for individual Dutch facilities. In this study, we find that all the inventories, except for the operator-based facility-level reporting, underestimate measured emissions, with the largest discrepancy observed with the globally gridded inventory. Individual facility reporting, as available for Dutch sites for the specific survey date, shows better agreement with our measurement-based estimates. For all the sampled Dutch installations together, we find that our estimated flux of (122.9 ± 36.8) kg h -1 deviates by a factor of 0.64 (0.33–12) from reported values (192.8 kg h -1). Comparisons with aircraft observations in two other offshore regions (the Norwegian Sea and the Gulf of Mexico) show that measured, absolute facility-level emission rates agree with the general distribution found in other offshore basins despite different production types (oil, gas) and gas production rates, which vary by 2 orders of magnitude. Therefore, mitigation is warranted equally across geographies. [ABSTRACT FROM AUTHOR]

Isotopic measurements of atmospheric methane are valuable for the verification of bottom‐up atmospheric emissions inventories. The balance of sources in emissions inventories must be consistent with the δ13C‐CH4 isotopic record in the air. Long‐term records of both methane mole fraction and δ13C from five sites across the UK are presented, showing post‐2007 growth in CH4 and negative trend in δ13C, consistent with global background sites. Miller‐Tans analyses of atmospheric measurements identified that the δ13C signature of the methane source mix varied between −50.1 and −56.1‰, with less depleted δ13C signatures at sites receiving air from urban areas, consistent with an increased proportion of thermogenic sources. Isotopic signatures calculated for all sites are more enriched than those expected from the bottom‐up emissions inventory, suggesting that inventories for the UK either underestimate contributions of thermogenic/pyrogenic emissions or overestimate biogenic sources. Plain Language Summary: Methane is a powerful greenhouse gas. The UK has committed to net zero carbon emissions by 2050 and has signed the Global Methane Pledge, which aims to reduce methane emissions by 30% by 2030, compared to 2020 levels. This study analyses long‐term measurements of methane and its carbon isotope ratio (δ13C) collected by Royal Holloway, University of London, across five UK sites. The δ13C source signature value acts as a fingerprint, distinguishing between different sources of methane. Bulk regional isotopic source signatures for each site were calculated, showing that urban sites are dominated by thermogenic emissions (e.g., gas leaks) and rural sites by agricultural emissions (e.g., cattle). The data presented in this study are compared with data from the UK National Atmospheric Emissions Inventory (NAEI). According to the data that were collected by Royal Holloway, University of London, the NAEI underestimates the relative contribution of fossil fuel sources in the UK, such as gas from pipelines in domestic and industrial settings, or overestimates biogenic sources. This has important implications for the design of UK greenhouse gas reduction strategies. Key Points: Long‐term records of CH4 mole fraction and δ13C‐CH4 from five UK sites show an increase in CH4 and a decrease in δ13CThe Miller‐Tans method can be used to calculate bulk regional δ13C‐CH4 source signaturesThe relative contribution of thermogenic/pyrogenic emissions across the UK may be underestimated in inventories [ABSTRACT FROM AUTHOR]

Background: The COronaVIrus Disease 2019 (COVID-19) pandemic has led to significant re-organisation of general practice in the United Kingdom and around the world. The general practice workforce has led changes to their services, often dealing with high levels of uncertainty. The way in which many practitioners consult has shifted significantly, and there has been an increase in the number of phone and online consultations. We know very little about how those working in general practice experienced the service reorganisation introduced in the first year of the COVID-19 pandemic. Aim: The aim of this project was to describe the changes in the delivery of general practice in the United Kingdom in the first year of the COVID-19 pandemic. Furthermore, to explore primary care practitioners' and managers' experiences of change within general practice during this time and investigate shifts in perceptions of professional identities. Method: We conducted a longitudinal qualitative study that captured narrative accounts from 17 primary care practitioners and managers across England and Scotland. Each participant submitted narrative accounts in the first year of the COVID-19 pandemic using self-recorded or written contributions, or via an interview if preferred. These were analysed using a grounded theory approach, with thematic coding used to construct common themes. Findings: Participants' narratives describe the challenges COVID-19 presented to general practice. Responses mirror the shifts in the pandemic and its management – from an initial sense of autonomy but uncertainty, to a period of stability and patients' increasing frustration. The re-organisation of general practice has affected practitioners' views of their work and their role as clinicians. Participants' narratives were framed profoundly by the importance of their relationships with patients. This analysis of practitioners' and managers' narratives highlights the need for further exploration of how to support the general practice workforce's well-being longer term in a context of increased demand and significant change. [ABSTRACT FROM AUTHOR]

Emissions of methane (CH 4) from offshore oil and gas installations are poorly ground-truthed, and quantification relies heavily on the use of emission factors and activity data. As part of the United Nations Climate & Clean Air Coalition (UN CCAC) objective to study and reduce short-lived climate pollutants (SLCPs), a Twin Otter aircraft was used to survey CH 4 emissions from UK and Dutch offshore oil and gas installations. The aims of the surveys were to (i) identify installations that are significant CH 4 emitters, (ii) separate installation emissions from other emissions using carbon-isotopic fingerprinting and other chemical proxies, (iii) estimate CH 4 emission rates, and (iv) improve flux estimation (and sampling) methodologies for rapid quantification of major gas leaks. In this paper, we detail the instrument and aircraft set-up for two campaigns flown in the springs of 2018 and 2019 over the southern North Sea and describe the developments made in both the planning and sampling methodology to maximise the quality and value of the data collected. We present example data collected from both campaigns to demonstrate the challenges encountered during offshore surveys, focussing on the complex meteorology of the marine boundary layer and sampling discrete plumes from an airborne platform. The uncertainties of CH 4 flux calculations from measurements under varying boundary layer conditions are considered, as well as recommendations for attribution of sources through either spot sampling for volatile organic compounds (VOCs) / δ13 C CH4 or using in situ instrumental data to determine C 2 H 6 –CH 4 ratios. A series of recommendations for both planning and measurement techniques for future offshore work within marine boundary layers is provided. [ABSTRACT FROM AUTHOR]

We report measurements of methane (CH4) mixing ratios and emission fluxes derived from sampling at a monitoring station at an exploratory shale gas extraction facility in Lancashire, England. Elevated ambient CH4 mixing ratios were recorded in January 2019 during a period of cold-venting associated with a nitrogen lift process at the facility. These processes are used to clear the well to stimulate flow of natural gas from the target shale. Estimates of CH4 flux during the emission event were made using three independent modeling approaches: Gaussian plume dispersion (following both a simple Gaussian plume inversion and the US EPA OTM 33-A method), and a Lagrangian stochastic transport model (WindTrax). The three methods yielded an estimated peak CH4 flux during January 2019 of approximately 70 g s−1. The total mass of CH4 emitted during the six-day venting period was calculated to be 2.9, 4.2 ± 1.4(1σ) and 7.1 ± 2.1(1σ) tonnes CH4 using the simple Gaussian plume model, WindTrax, and OTM-33A methods, respectively. Whilst the flux approaches all agreed within 1σ uncertainty, an estimate of 4.2 (± 1.4) tonnes CH4 represents the most confident assessment due to the explicit modeling of advection and meteorological stability permitted using the WindTrax model. This mass is consistent with fluxes calculated by the Environment Agency (in the range 2.7 to 6.8 tonnes CH4), using emission data provided by the shale site operator to the regulator. This study provides the first CH4 emission estimate for a nitrogen lift process and the first-reported flux monitoring of a UK shale gas site, and contributes to the evaluation of the environmental impacts of shale gas operations worldwide. This study also provides forward guidance on future monitoring applications and flux calculation in transient emission events. Implications: This manuscript discusses atmospheric measurements near to the UK's first hydraulic fracturing facility, which has very high UK public, media, and policy interest. The focus of this manuscript is on a single week of data in which a large venting event at the shale gas site saw emissions of ~4 tonnes of methane to atmosphere, in breach of environmental permits. These results are likely to beresults are likely to be reported by the media and may influence future policy decisions concerning the UK hydraulic fracturing industry. [ABSTRACT FROM AUTHOR]

Emissions of methane (CH4) from offshore oil and gas installations are poorly ground-truthed and quantification relies heavily on the use of emission factors and activity data. As part of the United Nations Climate and Clean Air Coalition (UN CCAC) objective to study and reduce short-lived climate pollutants (SLCP) a Twin Otter aircraft was used to survey CH4 emissions from UK and Dutch offshore oil and gas installations. The aims of the surveys were to i) identify installations that are significant CH4 emitters, ii) separate installation emissions from other emissions using carbon-isotopic fingerprinting and other chemical proxies, iii) estimate CH4 emission rates, and iv) improve flux estimation (and sampling) methodologies for rapid quantification of major gas leaks. In this paper, we detail the instrument and aircraft set up for two campaigns flown in the springs of 2018 and 2019 over the southern North Sea and describe the developments made in both planning and sampling methodology in order to maximise the quality and value of the data collected. We present example data collected from both campaigns to demonstrate the challenges encountered during offshore surveys, focussing on the complex meteorology of the marine boundary layer, and sampling discrete plumes from an airborne platform. The uncertainties of CH4 flux calculations from measurements under varying boundary layer conditions are considered, as well as recommendations for attribution of sources through either spot sampling for VOCs / Î'13CCH4 or using in-situ instrumental data to determine C2H6-CH4 ratios. A series of recommendations for both planning and measurement techniques for future offshore work within the marine boundary layers are provided. [ABSTRACT FROM AUTHOR]

The article highlights the results of survey of Great Britain breast surgery trainees related to Axillary lymph node dissection (ALND) training. It mentions the results of this survey suggest that a significant number of breast surgery trainees in the Britain feel that they are not getting adequate exposure to ALNDs during their training and addresses such training gaps to ensure satisfactory skills acquisition prior to completion of training.

Background: In 2016, one in three older people in the UK were living alone. These patients often have complex health needs and require additional clinical and non-clinical support. This study aimed to analyse the association between living alone and health care utilisation in older patients.Methods: We conducted a retrospective cohort study of 1447 patients over the age of 64, living in 1275 households who were registered at a large general practice in South East London. The utilisation of four different types of health care provision were examined in order to explore the impact of older patients living alone on health care utilisation.Results: After adjusting for patient demographics and clinical characteristics, living alone was significantly associated with a higher probability of utilising emergency department and general practitioner services, with odds ratios of 1.50 (95% confidence interval [CI] 1.16 to 1.93) and 1.40 (95% CI 1.04 to 1.88) respectively.Conclusions: Living alone has an impact on health care service utilisation for older patients. We show that general practice data can be used to identify older patients who are living alone, and general practitioners are in a unique position to identify those who could benefit from additional clinical and non-clinical support. Further research is needed to understand the mechanism driving higher utilisation for those patients who live alone. [ABSTRACT FROM AUTHOR]

The article discusses the 2023 National Clinical Guideline for Stroke accredited by the British National Institute for Health and Care Excellence (NICE). Topics explored include the development of this guideline overseen by the Intercollegiate Stroke Working Party (ICSWP), the recommended delivery of acute treatments for stroke by pre-hospital emergency services, and the clinical management of patients with intracerebral haemorrhage.

The article presents a qualitative study on the experiences of patients and their carers during Early Supported Discharge services after stroke. It notes that the study was carried out at the community stroke services in Nottinghamshire, Great Britain. It mentions the use of a thematic analysis process and intensive multidisciplinary specialist rehabilitation.

Despite the recent advances in stroke rehabilitation research, the translation of research evidence into practice remains a challenge. The purpose of this article is to communicate practical experience and describe research methodologies used to promote change and implementation of stroke rehabilitation research in three international settings. In England, the development of an evidence-based consensus document, combined with qualitative and quantitative methods, was used to promote practice change in community-based stroke services. The Canadian research program involved synthesis of evidence, creation of user friendly information, and development of multimodal knowledge transfer strategies to promote change at an individual clinician level. Australian researchers followed a multistep process, involving audit and feedback, identification of barriers, and tailored education to improve implementation of one clinical guideline recommendation. Reducing the evidence-practice gap requires the development of active management strategies. This article highlights the importance of close collaboration between stakeholders - both in terms of the transfer of evidence into clinical practice and for optimizing future Phase IV implementation research endeavours. [ABSTRACT FROM AUTHOR]

• Closed landfill sites emissions were more enriched in δ13C CH4 than active sites. • The δ13C signature of fugitive methane did not show a seasonal trend. • An active landfill cell closure caused a significant decrease in CH 4 mole fraction. • Closed landfill sites have a higher oxidised proportion than active sites. • Oxidised proportion is highly site specific. Biological oxidation of methane in landfill cover material can be calculated from the carbon isotopic signature (δ13C CH4) of emitted CH 4. Enhanced microbial consumption of methane in the aerobic portion of the landfill cover is indicated by a shift to heavier (less depleted) isotopic values in the residual methane emitted to air. This study was conducted at four landfill sites in southwest England. Measurement of CH 4 using a mobile vehicle mounted instrument at the four sites was coupled with Flexfoil bag sampling of ambient air for high-precision isotope analysis. Gas well collection systems were sampled to estimate landfill oxidised proportion. Closed or active status, seasonal variation, cap stripping and site closure impact on landfill isotopic signature were also assessed. The δ13C CH4 values ranged from −60 to −54‰, with an average value of −57 ± 2‰. Methane emissions from active cells are more depleted in 13C than closed sites. Methane oxidation, estimated from the isotope fractionation, ranged from 2.6 to 38.2%, with mean values of 9.5% for active and 16.2% for closed landfills, indicating that oxidised proportion is highly site specific. [ABSTRACT FROM AUTHOR]

Natural gas is regarded as a cleaner alternative to other fossil fuels with respect to pollution and carbon dioxide (CO2) emissions when burned as fuel. Methane (CH4) is a potent greenhouse gas however and can escape during natural gas production and transmission. It is therefore vital to quantify fugitive CH4 emissions from natural gas production and transmission when assessing its contribution to climate change. Identifying and distinguishing emission sources is an important step in quantifying emissions, with δ13C in CH4, ethane:methane (C2H6:CH4) and CH4:CO2 ratios being well used as signatures for this. Principally, these signatures enable fugitive natural gas emissions to be distinguished from other CH4 sources in aircraft and ground sampling. Studying these signatures also has potential utility in identifying specific emission processes (e.g. flaring vs leaking gas) and further characterising specific sources (e.g. maturity or depth of gas source). As part of the United Nations Climate and Clean Air Coalition (UN CCAC) international methane studies, a five-day aircraft campaign was conducted over gas rigs in the southern North Sea in April 2018, with a further four-day campaign scheduled for April/May 2019. Flights are conducted using the British Antarctic Survey (BAS) Twin Otter aircraft. C2H6, CH4 and CO2 mole fractions are measured continuously during flights using cavity enhanced spectroscopy. Whole air samples are collected in flasks and bags when flying through emission plumes at low altitude and analysed in the laboratory for δ13C in CH4 using high precision CF-GC-IRMS. Emissions from a few rigs have been identified from the April 2018 campaign, with enriched δ13C in CH4 signatures or elevated C2H6 measured from the CH4 plumes, indicating the rigs as sources. Targeted sampling in the April/May 2019 flight campaign should enable testing of the temporal consistency of the emissions and their δ13C in CH4 and C2H6:CH4 signatures, and aid investigation of the relationship between these signatures, and infrastructure and gas source characteristics.Two ground surveys have also been conducted around each of three gas terminals on the UK's east coast. Surveys were conducted by car and on foot, again using cavity enhanced spectroscopy for continuous in situ C2H6, CH4 and CO2 mole fraction measurement, and whole air sample collection in bags for laboratory analysis of δ13C in CH4. Differences in excess CH4 from terminals have been detected. δ13C in CH4 and C2H6:CH4 signatures of gas terminal emissions have been compared with those for gas rigs sampled during the aircraft campaigns, and additionally, with signatures from UK gas distribution network leaks. [ABSTRACT FROM AUTHOR]

• 10 UK biogas plant methane emission rates were estimated. • Total methane emissions were in range of 0.1 to 58.7 kg hr -1. • The percentage of losses relative to the calculated production rate ranged from 0.02 to 8.1%. • Biogas plants may averagely account for up to 1.9% of total methane emissions in the UK. The rising number of operational biogas plants in the UK brings a new emissions category to consider for methane monitoring, quantification and reduction. Minimising methane losses from biogas plants to the atmosphere is critical not only because of their contribution of methane to global warming but also with respect to the sustainability of renewable energy production. Mobile greenhouse gas surveys were conducted to detect plumes of methane emissions from the biogas plants in southern England that varied in their size, waste feed input materials and biogas utilization. Gaussian plume modelling was used to estimate total emissions of methane from ten biogas plants based on repeat passes through the plumes. Methane emission rates ranged from 0.1 to 58.7 kg CH 4 hr-1, and the percentage of losses relative to the calculated production rate varied between 0.02 and 8.1%. The average emission rate was 15.9 kg CH 4 hr-1, and the average loss was 3.7%. In general, methane emission rates from smaller farm biogas plants were higher than from larger food waste biogas plants. We also suggest that biogas methane emissions may account for between 0.4 and 3.8%, with an average being 1.9% of the total methane emissions in the UK excluding the sewage sludge biogas plants. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the principles and objectives of academic clinical fellowships, particularly in the field of primary care in Great Britain.

This study aimed to characterize the carbon isotopic signatures (δ 13C-CH 4) of several methane waste sources, predominantly in the UK, and during field campaigns in the Netherlands and Turkey. CH 4 plumes emitted from waste sources were detected during mobile surveys using a cavity ring-down spectroscopy (CRDS) analyser. Air samples were collected in the plumes for subsequent isotope analysis by gas chromatography isotope ratio mass spectrometry (GC-IRMS) to characterize δ 13C-CH 4. The isotopic signatures were determined through a Keeling plot approach and the bivariate correlated errors and intrinsic scatter (BCES) fitting method. The δ 13C-CH 4 and δ 2H-CH 4 signatures were identified from biogas plants (−54.6 ± 5.6‰, n = 34; −314.4 ± 23‰ n = 3), landfills (−56.8 ± 2.3‰, n = 43; −268.2 ± 2.1‰, n = 2), sewage treatment plants (−51.6 ± 2.2‰, n = 15; −303.9 ± 22‰, n = 6), composting facilities (−54.7 ± 3.9‰, n = 6), a landfill leachate treatment plant (−57.1 ± 1.8‰, n = 2), one water treatment plant (−53.7 ± 0.1‰) and a waste recycling facility (−53.2 ± 0.2‰). The overall signature of 71 waste sources ranged from −64.4 to −44.3‰, with an average of −55.1 ± 4.1‰ (n = 102) for δ 13C, −341 to −267‰, with an average of −300.3 ± 25‰ (n = 11) for δ 2H, which can be distinguished from other source types in the UK such as gas leaks and ruminants. The study also demonstrates that δ 2H-CH 4 signatures, in addition to δ 13C-CH 4 , can aid in better waste source apportionment and increase the granularity of isotope data required to improve regional modelling. • Isotopic 13C signatures from 71 waste sources in UK, NL and TR determined. • Feedstock types have an impact on carbon isotopic signature of generated biogas. • Open and active landfill status has a great impact on carbon isotopic signature. • Sewage treatment is more enriched in 13C than from other waste sources. • Average δ13C isotopic signature of waste sources is −55.1 ± 4.1‰. [ABSTRACT FROM AUTHOR]

Background: Dominant conceptualisations of access to health care are limited, framed in terms of speed and supply. The Candidacy Framework offers a more comprehensive approach, identifying diverse influences on how access is accomplished., Aim: To characterise how the Candidacy Framework can explain access to general practice - an increasingly fraught area of public debate and policy., Design and Setting: Qualitative review guided by the principles of critical interpretive synthesis., Method: We conducted a literature review using an author-led approach, involving iterative analytically guided searches. Articles were eligible for inclusion if they related to the context of general practice, without geographical or time limitations. Key themes relating to access to general practice were extracted and synthesised using the Candidacy Framework., Results: A total of 229 articles were included in the final synthesis. The seven features identified in the original Candidacy Framework are highly salient to general practice. Using the lens of candidacy demonstrates that access to general practice is subject to multiple influences that are highly dynamic, contingent, and subject to constant negotiation. These influences are socioeconomically and institutionally patterned, creating risks to access for some groups. This analysis enables understanding of the barriers to access that may exist, even though general practice in the UK is free at the point of care, but also demonstrates that a Candidacy Framework specific to this setting is needed., Conclusion: The Candidacy Framework has considerable value as a way of understanding access to general practice, offering new insights for policy and practice. The original framework would benefit from further customisation for the distinctive setting of general practice., (© The Authors.)

Objectives: In the UK, over 20% of stroke survivors leave hospital with severe disability. Limited evidence-based clinical guidance is available to support the rehabilitation of these individuals. Our previous research has focused on establishing consensus regarding the core components of home-based rehabilitation for this under investigated group. This study explores the barriers of providing rehabilitation and identifies strategies to overcome them., Design: Three focus group interviews were conducted with n=20. The context coding framework was employed to organise the transcribed data and to facilitate inductive and deductive analysis and synthesis., Setting: Online, MSTeams, UK., Participants: A purposive sample of 20 National Health Service clinical staff participants, from 3 multidisciplinary teams providing home-based stroke rehabilitation for this population (n=7, 6 and 7)., Results: High levels of need were reported across multiple domains for survivors including continence, communication and physical function. Interventions often required multiagency collaboration in order to optimise the available resources and specialist skills. There was lack of clarity regarding who was ultimately responsible for providing components of rehabilitation for stroke survivors with severe disability. Teams provide rehabilitation for this population but are insufficiently commissioned or resourced to fully meet their needs. In-complete and disjointed pathways with resultant healthcare inequalities were commonly reported. Teams used a variety of strategies to overcome these barriers and optimise rehabilitation opportunities. These included upskilling a diverse range of partners to capitalise on the skills and resources across health, social care and voluntary sector boundaries employing multiagency collaboration. Teams established and engaged networks of stakeholders in order to advocate on behalf of stroke survivors., Conclusions: Collaboration and partnership working is important in the delivery of rehabilitation for stroke survivors with severe disability. Commissioners need to be aware that cross-agency multidisciplinary expertise is required, if rehabilitation opportunities are to be realised and existing health inequalities addressed., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: Compared with adult onset psychosis, adolescent psychosis has been associated with poorer outcomes in terms of social and cognitive functioning and negative symptoms. Young people experiencing first episode psychosis have developmental needs that frequently pre-date and are compounded by psychosis onset (a previous study). There is a lack of published studies of adolescent onset psychosis and further information is needed so that developmentally appropriate interventions can be developed. We report an observational naturalistic cohort study of an adolescent specific service, the Early Psychosis Support service (EPSS)., Method: We examined baseline demographic and clinical variables, treatments outcomes and predictors of outcome for this population., Results: The mean age of our sample was 16.3 years. Median duration of untreated illness (DUI) was 88 weeks, and median duration of untreated psychosis (DUP) was 16 weeks. We found significant improvements in positive symptoms, negative symptoms, disorganization, excitement, emotional distress and depression from 0 to 12 months. We found that baseline positive symptoms and DUI significantly predicted positive symptoms at 12 months and only negative symptoms at baseline predicted 12-month negative symptoms., Conclusion: Our finding that specialist early intervention for adolescents experiencing psychosis is effective suggests that such treatment should be routinely offered in line with existing clinical guidelines. Our finding that DUI is predictive of poorer outcome at 12 months suggests that even earlier intervention from a specialist team may further improve treatment outcomes., (© 2019 John Wiley & Sons Australia, Ltd.)