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With their increasing popularity, there is a need for more research clarifying the potential strengths and weaknesses of the comic format for education. The panelled comic format may be particularly effective for educating adults on the scientific aspects of processes (sequences of events, occurring over time, in a series of discrete steps). We tested change in performance in adults (n = 879) in correctly ordering the stages in four processes before and after being exposed to educational material about these processes. The material was presented in a random selection of one of seven experimentally manipulated formats based on characteristics of comic books. Overall, participant performance improved after seeing the educational material. There were significant differences in learning between the processes, suggesting that the benefits, or detriments, of the comic format may be subject-specific. Performance was significantly better when images were subdivided into panels, and worse when an explanatory agent (character) was included, though these differences in performance did not survive adjustment for multiple comparisons. This study presents some evidence that the panelled nature of the comic format supports learning about scientific processes in adults. Given results differed notably between the specific topics to be learned, there is substantial scope for further investigation.

Purpose: Every year several thousand female cadets participate in the Combined Cadet Force (CCF) in the UK, but little is known about the impact that this experience has on the subsequent employability of the female cadets. This study aimed to understand the perceptions of academic teenage girls from one all-female unit of their participation in CCF and the personal benefit or otherwise in relation to their ultimate employability. Design/methodology/approach: This qualitative study used semi-structured interviews to explore the experiences of 10 young women who had participated in CCF for at least three years. Data were analysed using a thematic analysis. Findings: Participants were effusive about the transformative effects of CCF in relation to personal confidence, recognising transferable skills and raising personal aspiration, all key elements to employability, particularly for women. They also considered they had gained future workplace advantage having had opportunity to trial leadership strategies in mixed gender teams, an experience unavailable elsewhere to them. Loyalty to the contingent pervaded every discussion and the importance of team goals, although this level of selfless commitment may be detrimental to employability, subsuming their personal interests to the greater good. Originality/value: Research into the benefit or otherwise of teenage girls' extra-curricular activities is scarce, and this is the first study, to the authors' knowledge, that explores the perceptions of the impact their time in CCF had on their graduate employability skills.

Career development learning has a demonstrable positive impact on the graduate employability of higher education learners. This is particularly the case if it is integrated into the curriculum rather than experienced as an add-on or included in finite curriculum elements. However, integration of career development learning into curriculum is a significant and challenging undertaking in course design, and also in facilitation of learning experiences. Academics manage crowded curricula in their disciplinary areas, and many also have external course accreditation requirements to deal with that may not include career development elements. In many institutions there is mixed understanding of what career development learning entails, no clear top-level strategic support, and unprecedented numbers of enrolled students across digital and on-campus provision. This article explores challenges and opportunities in integrating career development learning into curriculum in higher education, and identifies effective strategies for doing so at institutional, school, and program levels. It draws upon case studies comprising more than 30 interviews across nine universities in Australia and internationally, exploring how cross-disciplinary collaboration between career development practitioners, learning and curriculum designers, and academic units can be effective in enacting curricular career development learning at scale. The article suggests strategies for institutional leaders, academics, and careers practitioners in higher education insitutions at different stages in the curricular career development learning journey.

An understanding of the prevalence and risk factors of parental mental health problems is important for early intervention and prevention measures and shaping services for parents and their children. However, large representative surveys of parental mental health problems and associated risk factors are lacking. The aim of this study was to estimate prevalence rates of parental mental health problems using a standardised measure of psychiatric morbidity (General Health Questionnaire; GHQ‐12), in a representative sample of parents and caregivers of children and young people (2–19 years) in Northern Ireland. Further, this study explored associated risk factors of parental mental health problems. A random household survey of parents and children was conducted between June 2019 and March 2020. Parental responses on demographic, economic, familial and psychological measures were collected (N = 2815) and 22% of parents and caregivers screened positive for mental health problems. The STROBE checklist for observational research was adhered to. Multivariate logistic regression indicated that being in receipt of benefits, having poor family support, a history of adverse childhood experiences, a history of exposure to politically motivated violence (the Troubles), and a child with conduct problems and poor health were all independent risk factors of increased parental mental health problems. Findings will help to inform future commissioning and development of services and broaden understanding of the correlates of parental mental health problems. [ABSTRACT FROM AUTHOR]

A belief in teleology is often suggested to be a barrier in children's science education. Many studies have catalogued children's use of teleological explanations, but fewer have developed approaches to tackle children's use in scientific contexts. This paper reports two studies that utilised dialogic interventions alongside Concept Cartoons to do just that. Study 1 (5- to 7-year-olds, n = 54) addressed teleological explanations for natural phenomena (e.g. snow or rainbows) and Study 2, (9- to 10-year-olds, n = 24) explored organisms' traits (e.g. giraffes' necks or zebras' stripes). Both studies found that after only short discussions about styles of explanation in science, children's acceptance of teleological explanations was significantly reduced and they were more likely to endorse appropriate scientific explanations. These results suggest that teleology need not be a major barrier to teaching and learning about causality as it can quickly and effectively be addressed.

Physiology is a key element of "bioscience" education within pre-registration nursing programs, but there is a lack of clarity on what is included. Physiology and bioscience content and delivery are highly varied across both higher education institutions and the related programs in the United Kingdom (UK). Despite evidence highlighting concerns over nurses' lack of bioscience knowledge and unsafe practice, there is no universally agreed on curriculum with detailed outcomes of minimum levels of knowledge to support nurses in practice and patient care. This study aimed to inform the construction of discipline-specific physiology learning outcomes to clarify relevant physiological topics required in pre-registration nursing. Initially, 360 learning outcomes were identified from various sources. Using a modified Delphi approach, an expert panel from the Bioscience in Nurse Education group reviewed and modified the list to 195 proposed outcomes. These were circulated to universities in the UK who teach nursing (n = 65). Outcomes that had 80% consensus were automatically included in the next round, with others recommended with modification (response rate 22%). The panel reviewed the modifications, and 182 outcomes were circulated in the second questionnaire (response rate 23%), and further panel review resulting in 177 outcomes agreed. These learning outcomes do not suggest how they should be delivered, but gives the basic level required for qualification as a nurse commensurate with the Nursing and Midwifery Council new standards for the "future nurse."

Purpose: This monograph reports on the strategic and operational roles of learning and development (L&D) professionals in Irish, UK European and US organisations including multinational corporations, small to medium enterprises, the public sector and not for profit organisations. This paper aims to investigate the contextual factors influencing L&D roles in organisations, the strategic and operational roles that L&D professionals play in organisations, the competencies and career trajectories of L&D professionals, the perceptions of multiple internal stakeholders of the effectiveness of L&D roles and the relationships between context, L&D roles, competencies/expertise and perceived organisational effectiveness. Design/methodology/approach: The study findings are based on the use of multiple methods. The authors gathered data from executives, senior managers, line managers, employee and L&D professionals using multiple methods: a survey (n = 440), Delphi study (n = 125) and semi-structured interviews (n = 30). Findings: The analysis revealed that L&D professionals increasingly respond to a multiplicity of external and internal contextual influences and internal stakeholders perceived the effectiveness of L&D professionals differently with significant gaps in perceptions of what L&D contributes to organisational effectiveness. L&D professionals perform both strategic and operational roles in organisations and they progress through four career levels. Each L&D role and career level requires a distinct and unique set of foundational competencies and L&D expertise. The authors found that different contextual predictors were important in explaining the perceived effectiveness of L&D roles and the importance attached to different foundational competencies and areas of L&D expertise. Originality/value: This is one of the few studies to have investigated the L&D professional role in organisations from the perspective of multiple stakeholders using multiple research methods.

Background: Paroxysmal Nocturnal Haemoglobinuria (PNH) is an ultra-rare, acquired disorder that is challenging to diagnose due to varied symptoms, heterogeneous patient presentations, and lack of awareness among healthcare professionals. This leads to frequent misdiagnosis and delays in diagnosis. This study evaluated the feasibility of a machine learning model to identify undiagnosed PNH patients using structured electronic health records. Methods: The study used data from the Optimum Patient Care Research Database, which contains electronic health records from general practitioner (GP) practices across the United Kingdom. PNH patients were identified by the presence, and control patients by the absence of a PNH diagnosis code in their records. Clinical features (symptoms, diagnoses, healthcare utilisation) from 131 patients in the PNH group and 593,838 patients in the control group, were inputted to a tree-based XGBoost machine learning model to classify patients as either "positive" or "negative" for PNH suspicion. The algorithm was finalised after additional exclusions and inclusions applied. Performance was assessed using positive predictive value (PPV), recall and specificity. As the sample used to develop the algorithm was not representative of the true population prevalence, PPV was additionally adjusted to reflect performance in the wider population. Results: Of all the patients in the PNH group, 27% were classified as positive (recall). 99.99% of the control group were classified as negative (specificity). Of all the patients classified as positive, 60.4% had a diagnosis of PNH in their record (PPV). The PPV adjusted for the population prevalence of PNH was 19.59 suggesting nearly 1 in 5 patients flagged may warrant further PNH investigation. The key clinical features in the model were aplastic anaemia, pancytopenia, haemolytic anaemia, myelodysplastic syndrome, and Budd-Chiari syndrome. Conclusion: This is the first study to combine clinical understanding of PNH with machine learning, demonstrating the ability to discriminate between PNH and control patients in retrospective electronic health records. With further investigation and validation, this algorithm could be deployed on live health data, potentially leading to earlier diagnosis for patients who currently experience long diagnostic delays or remain undiagnosed. [ABSTRACT FROM AUTHOR]

Purpose: Resistance training is often performed in a traditional training style using deliberate relatively longer repetition durations or in an explosive training style using maximal intended velocities and relatively shorter repetition durations. Both improve strength, "power" (impulsivity), and speed. This study compared explosive and traditional training over a 6-week intervention in 30 healthy young adult male recreational soccer players. Method: Full body supervised resistance training was performed 2 times a week using 3 sets of each exercise at 80% of one repetition maximum to momentary failure. Outcomes were Smith machine squat 1 repetition maximum, 10 meter sprint time, and countermovement jump. Results: Both groups significantly improved all outcomes based on 95% confidence intervals not crossing zero. There were no between-group differences for squat 1 RM (TRAD = 6.3[5.1 to 7.6] kg, EXP = 5.2[3.9 to 6.4] kg) or 10 meter sprint (TRAD = -0.05[-0.07 to -0.04] s, EXP = -0.05[-0.06 to -0.03] s). Explosive group had a significantly greater increase in countermovement jump compared to the traditional group (TRAD = 0.7[0.3 to 1.1] cm, EXP = 1.3[0.9 to 1.7] cm). Conclusion: Both the traditional training and explosive training performed to momentary failure produced significant improvements in strength, speed, and jump performance. Strength gains are similar independent of intended movement speed. However, speed and jump performance changes are marginal with resistance training.

This article explores a universal issue in higher education: how in practice can we secure the most productive relationships between the research universities pursue and the education they provide? It opens by drawing from three recent international literature reviews summarising research on research-teaching links, sometimes termed a 'nexus'. It then proceeds inductively to analyse grounded empirical data from practitioners in an English post-1992 University. This data describes "what" participants think should change and "where," to increase its amount and quality. To illuminate "how" things might change, the same data is then re-analysed deductively against six 'lessons learnt' from a 2012 review of literature examining the diffusion of innovative teaching and learning in higher education. Lessons are confirmed or lacunae pointed out, before the concluding discussion offers recommendations and observations for universities pursuing research-rich education.

This article offers a systematic review of the evolution of research impact assessment in Australia and the UK. We consider its inception and detail the development of relevant policy and procedures in each country. The article sets out the results of a comparative analysis of public policy documents, newspaper commentary, and academic literature in both countries. We examined the differences and commonalities between the two nations, revealing evaluation criteria and uncovering justifications for the adoption of impact assessment. The article highlights the convergence and divergence of the two countries' policy and procedures, as well as the political and bureaucratic contexts that have shaped their design and implementation. The article shows that the synergistic, intermittent, and iterative development of relevant policy and procedures in the two nations has been mutually beneficial for the evolution of retrospective impact assessment.

Background: Urinary incontinence (UI) negatively affects the well-being of women globally. Pelvic Floor Muscle Training (PFMT) is a complex intervention that aims to decrease UI symptoms. Information about how the multiple complex components involved in PFMT achieve and maintain the desired effect are rarely studied as a whole. The evidence base lacks data about how women experience PFMT over time and in the longer-term. This study explored women's experiences of biofeedback-assisted PFMT and PFMT alone, to identify and understand what influenced self-reported adherence to PFMT, and UI outcomes over time. Methods: This rigorous longitudinal qualitative case study, nested within a randomised controlled trial, recruited forty cases (women with stress or mixed UI; 20 in biofeedback-assisted and 20 in PFMT alone group). A case included up to four semi-structured interviews with each woman (prior to starting PFMT, end of treatment [6 months], 12 months, 24 months). Analysis followed case study analytic traditions, resulting in a Programme Theory about PFMT from the perspectives of women with UI. Findings: The theory demonstrates factors that motivated women to seek UI treatment, and how these influenced long-term adherence. Therapists who delivered PFMT played a crucial role in supporting women to know how to undertake PFMT (to have capability). Some, but not all, women developed self-efficacy for PFMT. Where women did not have PFMT self-efficacy, adherence tended to be poor. When women had PFMT self-efficacy, the conditions to support adherence were present, but contextual factors could still intercede to inhibit adherence. The intercession of contextual factors was individual to a woman and her life, meaning any particular contextual factor had inconsistent influences on PFMT adherence over time for individual women and exerted varying influences across different women. Conclusion: Long term adherence to PFMT is a complex interaction between many different factors. Enquiring about an individual woman's motivation to seek treatment and understanding the contextual factors that affect an individual woman will enable a practitioner to support longer-term adherence. [ABSTRACT FROM AUTHOR]

Background: Cemiplimab was licensed in the United Kingdom (UK) in 2019 for the treatment of patients with locally advanced and metastatic CSCC not suitable for curative surgery or radiotherapy (advanced CSCC [aCSCC]). No UK multicenter studies have investigated the real-world experience of cemiplimab post marketing authorization in aCSCC. Methods: This non-interventional retrospective study (10 UK centers) involved data collection from medical records of patients with aCSCC who initiated cemiplimab treatment between 2 July 2019 and 30 November 2020. The study period was a minimum of 12 and a maximum of 36 months post cemiplimab initiation. The primary objective was to describe the real-world clinical effectiveness of cemiplimab (primary outcome: overall response rate [ORR]). Results: Of 105 patients, 70% (n=73/105) were male (median [range] age at index of 78.5 [55.4–93.2] years); most patients (63% [n=50/80]) had an Eastern Cooperative Oncology Group (ECOG) score of 1 and 62% (n=63/102) had metastatic disease. The ORR within 12 months was 42% (95% confidence interval [CI] 32%–51%) and the disease control rate was 62% (n=65/105). The median (95% CI) real-world progression-free survival and overall survival from index was 8.6 (6.0–18.7) and 21.0 (14.7–25.2) months, respectively. The median (range) number of cemiplimab infusions was 11.0 (1.0–44.0). Eighty-seven percent experienced no cemiplimab treatment interruptions; 13% (n=14/105) interrupted treatment due to immune-related adverse reactions (irARs) (47% [n=9/19] of treatment interruption events). Eighty-five percent (n=89/105) of patients had discontinued cemiplimab treatment by the end of the study; where reasons for discontinuation were recorded, 20% (n=17/87) discontinued due to the completion of their 2-year treatment course. Nineteen percent (n=20/105) of patients experienced irARs. Conclusion: Effectiveness and safety data in this study are broadly similar to previous real-world studies of cemiplimab and the EMPOWER-CSCC1 clinical trial; with our cohort representing a broader population (included immunocompromised and transplant patients). Results support the use of cemiplimab for the treatment of aCSCC in a real-world setting. [ABSTRACT FROM AUTHOR]

Like much of the European centre-left, Britain's Labour Party has struggled to appeal to its former core working class support base in recent years. However, this is largely a failure to connect with the 'white working class' (WWC) specifically, whereas support among ethnic minorities remains robust. We hypothesise that Labour could be experiencing a 'trade-off', whereby efforts to cater to minorities harm its perceived ability to represent WWC interests. We test this thesis by examining whether WWC voters are more likely to view minority and working class representation in zero-sum terms and shun Labour when they associate the party with minority interests. We show that the WWC are somewhat less likely to view working class and ethnic minority representation as strongly correlated, and Labour's perceived ability to represent minorities is negatively associated with WWC support. This is not (primarily) about ethnocentrism. Instead, we suggest that 'relative political deprivation' is crucial. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) with preserved or mildly reduced ejection fraction includes a heterogenous group of patients. Reclassification into distinct phenogroups to enable targeted interventions is a priority. This study aimed to identify distinct phenogroups, and compare phenogroup characteristics and outcomes, from electronic health record data. Methods: 2,187 patients admitted to five UK hospitals with a diagnosis of HF and a left ventricular ejection fraction ≥ 40% were identified from the NIHR Health Informatics Collaborative database. Partition-based, model-based, and density-based machine learning clustering techniques were applied. Cox Proportional Hazards and Fine-Gray competing risks models were used to compare outcomes (all-cause mortality and hospitalisation for HF) across phenogroups. Results: Three phenogroups were identified: (1) Younger, predominantly female patients with high prevalence of cardiometabolic and coronary disease; (2) More frail patients, with higher rates of lung disease and atrial fibrillation; (3) Patients characterised by systemic inflammation and high rates of diabetes and renal dysfunction. Survival profiles were distinct, with an increasing risk of all-cause mortality from phenogroups 1 to 3 (p < 0.001). Phenogroup membership significantly improved survival prediction compared to conventional factors. Phenogroups were not predictive of hospitalisation for HF. Conclusions: Applying unsupervised machine learning to routinely collected electronic health record data identified phenogroups with distinct clinical characteristics and unique survival profiles. [ABSTRACT FROM AUTHOR]

School psychology has heavily relied on quantitative methodology to create and sustain our knowledge of best practices regarding academic, behavioral, and mental health outcomes for students. Nevertheless, underlying assumptions of the neutrality of quantitative data have obfuscated how school psychology research has perpetuated oppressive ideologies and practices, which directly harm students from marginalized identities. This paper demonstrates the need for employing a critical lens when engaging in and consuming school psychology research that utilizes quantitative methods. One such framework is QuantCrit, developed in the United Kingdom, which intentionally integrates Critical Race Theory tenets into the development, analysis, and interpretation of quantitative data. We explore specific examples of the insidious ways that 'presumed neutral' quantitative approaches have led to the perpetuation of oppressive practices in the following key areas of school psychology research: (a) discipline disproportionality, (b) special education disproportionality, and (c) school accountability metrics. Furthermore, we provide recommendations for both utilizing and publishing quantitative research that moves school psychologists towards more equitable practices for children and families across the globe. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore how sharing stories of being a mental health professional and academic, based more broadly on serendipity and searching in life, can serve as means for bridging and developing cross-cultural understandings and collaborative work. Design/methodology/approach: This paper is a relational autoethnography based on face-to-face and written conversational dialogue between five mental health academics from the UK and Norway. Findings: The very practice of writing this paper displays and serves the purpose of bridging people, cultures and understandings, at several levels, in the facilitation of new research and writing projects. Troubling traditional boundaries between "us" and "them, and the "knower" and the "known," the writing is theoretically underpinned by Friendship as Method, situated in a New Materialist context. Originality/value: Through its conversational descriptions and explorations the paper shows how doing relational autoethnography can be purposeful in developing cross-cultural understandings and work at both professional and personal levels. It also demonstrates how autoethnography as relational practice can be useful in the sharing of this methodology between people who are more and less familiar with it.

In this content analysis, we explored how students address instructor ideology in the university classroom through the social media platform Twitter. We employed Boolean search operators through Salesforce Marketing Cloud Radian6 software to gather tweets and identified English language tweets by how students referenced their instructor's ideology. Tweets originated in the United States (U.S.), the United Kingdom (U.K.), and Australia. Using qualitative coding procedures, we identified seven themes in the data that described how students wrote about instructor ideology on Twitter: "venting regarding instructor's ideology," "sharing classroom anecdote," "affirming instructor's beliefs/actions," "expressing grade concern," "articulating an opposing view," "reporting conflict," and "indicating confusion." Across categories, Twitter was employed primarily as a back-stage means to communicate expressive dissent regarding instructor ideology and also to demonstrate students' identity. We identified differences between categories based on the perceived ideology of the students' instructors as well as differences in the number of tweets per capita originating in each country.

This paper reports on a multi-institutional project using reflection and collaboration to enable one-to-one music teachers to improve their professional skills and foster deep learning in music students. The benefits of reflection and collaboration in student learning and teacher development are reported on in depth within higher education. Less researched is their relevance to the one-to-one tertiary music context. This project comprised several initiatives around professional development activities for teachers and reflective exercises for students. The outcomes indicate the potential for the transformative approaches of reflection and collaboration to improve student learning outcomes in one-to-one tertiary music settings. This would appear to be dependent on two factors: students receiving support and guidance to reflect in such a way that enhances their learning outcomes; and teachers receiving support and guidance on how to foster students' reflective capabilities. One recommendation from the study is that greater professional development opportunities in these areas are made available to one-to-one music teachers.

Background: Autistic people are more likely to experience stigma, communication barriers and anxiety during healthcare. Autism Health Passports (AHPs) are a communication tool that aim to provide information about healthcare needs in a standardised way. They are recommended in research and policy to improve healthcare quality. Aim: To explore views and experiences of AHPs among Autistic people from the UK who have been pregnant. Methods: We developed an online survey using a combination of open and closed questions focused on healthcare impairments and views and experiences of AHPs. Data were anlaysed using descriptive statistics, Kruskal-Wallis tests, and content analysis. Findings: Of 193 Autistic respondents (54% diagnosed, 22% undergoing diagnosis and 24% self-identifying), over 80% reported anxiety and masking during healthcare always or most of the time. Some significant differences were identified in healthcare (in)accessibility by diagnostic status. Only 4% of participants knew a lot about AHPs, with 1.5% of participants using one at least half of the time. Almost three quarters of respondents had not previously seen an AHP. Open text responses indicated that the biggest barrier to using an AHP was a belief that health professionals would discriminate against Autistic patients. Additional barriers included staff lack of familiarity with AHPs and respondents expecting a negative response to producing an AHP. Conclusions: Our findings suggest that AHPs are not reducing health inequalities for Autistic adults who have been pregnant. Alternative solutions are needed to reduce health inequalities for Autistic people. [ABSTRACT FROM AUTHOR]

Identifying factors linked to autism traits in the general population may improve our understanding of the mechanisms underlying divergent neurodevelopment. In this study we assess whether factors increasing the likelihood of childhood autism are related to early autistic trait emergence, or if other exposures are more important. We used data from 536 toddlers from London (UK), collected at birth (gestational age at birth, sex, maternal body mass index, age, parental education, parental language, parental history of neurodevelopmental conditions) and at 18 months (parents cohabiting, measures of socio-economic deprivation, measures of maternal parenting style, and a measure of maternal depression). Autism traits were assessed using the Quantitative Checklist for Autism in Toddlers (Q-CHAT) at 18 months. A multivariable model explained 20% of Q-CHAT variance, with four individually significant variables (two measures of parenting style and two measures of socio-economic deprivation). In order to address variable collinearity we used principal component analysis, finding that a component which was positively correlated with Q-CHAT was also correlated to measures of parenting style and socio-economic deprivation. Our results show that parenting style and socio-economic deprivation correlate with the emergence of autism traits at age 18 months as measured with the Q-CHAT in a community sample. [ABSTRACT FROM AUTHOR]

We investigate the use of atmospheric oxygen (O 2) and carbon dioxide (CO 2) measurements for the estimation of the fossil fuel component of atmospheric CO 2 in the UK. Atmospheric potential oxygen (APO) – a tracer that combines O 2 and CO 2 , minimizing the influence of terrestrial biosphere fluxes – is simulated at three sites in the UK, two of which make APO measurements. We present a set of model experiments that estimate the sensitivity of APO simulations to key inputs: fluxes from the ocean, fossil fuel flux magnitude and distribution, the APO baseline, and the exchange ratio of O 2 to CO 2 fluxes from fossil fuel combustion and the terrestrial biosphere. To estimate the influence of uncertainties in ocean fluxes, we compare three ocean O 2 flux estimates from the NEMO–ERSEM, the ECCO–Darwin ocean model, and the Jena CarboScope (JC) APO inversion. The sensitivity of APO to fossil fuel emission magnitudes and to terrestrial biosphere and fossil fuel exchange ratios is investigated through Monte Carlo sampling within literature uncertainty ranges and by comparing different inventory estimates. We focus our model–data analysis on the year 2015 as ocean fluxes are not available for later years. As APO measurements are only available for one UK site at this time, our analysis focuses on the Weybourne station. Model–data comparisons for two additional UK sites (Heathfield and Ridge Hill) in 2021, using ocean flux climatologies, are presented in the Supplement. Of the factors that could potentially compromise simulated APO-derived fossil fuel CO 2 (ffCO 2) estimates, we find that the ocean O 2 flux estimate has the largest overall influence at the three sites in the UK. At times, this influence is comparable in magnitude to the contribution of simulated fossil fuel CO 2 to simulated APO. We find that simulations using different ocean fluxes differ from each other substantially. No single model estimate, or a model estimate that assumed zero ocean flux, provided a significantly closer fit than any other. Furthermore, the uncertainty in the ocean contribution to APO could lead to uncertainty in defining an appropriate regional background from the data. Our findings suggest that the contribution of non-terrestrial sources needs to be better accounted for in model simulations of APO in the UK to reduce the potential influence on inferred fossil fuel CO 2 using APO. [ABSTRACT FROM AUTHOR]

Protective antigen (PA) is a protein produced by Bacillus anthracis. It forms part of the anthrax toxin and is a key immunogen in US and UK anthrax vaccines. In this study, we have conducted experiments to quantify PA in the supernatants of cultures of B. anthracis Sterne strain, which is the strain used in the manufacture of the UK anthrax vaccine. Then, for the first time, we quantify PA production and degradation via mathematical modelling and Bayesian statistical techniques, making use of this new experimental data as well as two other independent published data sets. We propose a single mathematical model, in terms of delay differential equations (DDEs), which can explain the in vitro dynamics of all three data sets. Since we did not heat activate the B. anthracis spores prior to inoculation, germination occurred much slower in our experiments, allowing us to calibrate two additional parameters with respect to the other data sets. Our model is able to distinguish between natural PA decay and that triggered by bacteria via proteases. There is promising consistency between the different independent data sets for most of the parameter estimates. The quantitative characterisation of B. anthracis PA production and degradation obtained here will contribute towards the ambition to include a realistic description of toxin dynamics, the host immune response, and anti-toxin treatments in future mechanistic models of anthrax infection. [ABSTRACT FROM AUTHOR]

Background Device-assisted enteroscopy (DAE) has become a well-established diagnostic and therapeutic tool for the management of small-bowel pathology. We aimed to evaluate the performance measures for DAE across the UK against the quality benchmarks proposed by the European Society of Gastrointestinal Endoscopy (ESGE). Methods We retrospectively collected data on patient demographics and DAE performance measures from electronic endoscopy records of consecutive patients who underwent DAE for diagnostic and therapeutic purposes across 12 enteroscopy centers in the UK between January 2017 and December 2022. Results A total of 2005 DAE procedures were performed in 1663 patients (median age 60 years; 53% men). Almost all procedures (98.1%) were performed for appropriate indications. Double-balloon enteroscopy was used for most procedures (82.0%), followed by single-balloon enteroscopy (17.2%) and spiral enteroscopy (0.7%). The estimated depth of insertion was documented in 73.4% of procedures. The overall diagnostic yield was 70.0%. Therapeutic interventions were performed in 42.6% of procedures, with a success rate of 96.6%. Overall, 78.0% of detected lesions were marked with a tattoo. Patient comfort was significantly better with the use of deep sedation compared with conscious sedation (99.7% vs. 68.5%; P <0.001). Major adverse events occurred in only 0.6% of procedures. Conclusions Performance measures for DAE in the UK meet the ESGE quality benchmarks, with high diagnostic and therapeutic yields, and a low incidence of major adverse events. However, there is room for improvement in optimizing sedation practices, standardizing the depth of insertion documentation, and adopting marking techniques to aid in the follow-up of detected lesions. [ABSTRACT FROM AUTHOR]

This study explored the influence social capital had over parental sports volunteers who are considered to be of paramount importance in the delivery of UK sports initiatives. A review of the relevant literature identifies and discusses the complexities within the debate to define social capital while human and cultural capital emerge as an essential element in the production of parental volunteers' ability to access opportunities through a process of bonding or bridging social networks. This study used a grounded research focused on the use of semi-structured interviews and research diaries with (n = 8) study participants. The results from this study, which were analysed through a Bourdieuan perspective, suggested the process that recruits parental volunteers is exclusive; furthermore, the results show the insidious presences of the dark side of social capital, which affected the respondents by reinforcing exclusive ties and identities, which was found to exclude outsiders while reproducing a dominant social hierarchy. The paper concludes by considering the implications of the study for future practical and academic applications of social capital production within sports volunteerism.

The aim of this study was to explore perceptions of members of the public and key stakeholders of a localised campaign to increase engagement with cervical cancer screening. Whilst numerous interventions have been trialled to increase engagement with cancer screening, the evidence for their effectiveness is somewhat mixed. In addition, few studies have explored the perceptions of members of the public targeted by such campaigns nor the perceptions of healthcare professionals who may be involved in delivering such campaigns in the United Kingdom. Members of the public who had potentially been exposed to the campaign in the North-East of England were approached to take part in individual interviews whilst stakeholders were invited to take part in a focus group. A total of 25 participants (13 members of the public, 12 stakeholders) took part. All interviews were audio recorded, transcribed verbatim and analysed using applied thematic analysis. Four themes were identified, two of which were cross-cutting (barriers to screening and factors promoting screening), with one theme identified as specific to the public interviews (knowledge of and attitudes toward awareness campaigns) and one theme specific to the focus group (keeping campaigns relevant. Awareness of the localised campaign was limited; however, when made aware, participants were mostly positive towards the approach, although mixed responses were noted in relation to financial incentives. Members of the public and stakeholders identified some common barriers to screening although differed in their perceptions of promotional factors. This study highlights the importance of multiple strategies to promote cervical screening as one size fits all approach may limit engagement. [ABSTRACT FROM AUTHOR]

Participatory research approaches hold potential to better understand society through valuing lived experience. Formula feeding babies is routinely stigmatised in the UK, despite inadequate support to facilitate breastfeeding. Our community science project investigated the safety of powdered infant formula preparation in the home through the completion of an at-home experiment and a research diary with closed and open questions (n = 151). To add validity to the interpretation of open text data in research diaries, a community analysis group of five formula-feeding mothers was established. The community analysts undertook inductive thematic analysis through a series of analysis group meetings focused around data extracts, contributed to the study's empirical outputs and this methodological output, meeting 23 times over a nine-month period. Detailed notes were taken during meetings and the methodological elements of these were thematically analysed with the community analysts to produce this article, with extracts from the academic researchers' field notes added where relevant. The overarching themes, presenting both positive experiences and areas for improvement, focused on: (i) clarity of expectations and the impact this had on community analysts' confidence, (ii) the stigmatising topic area and how this was managed by the facilitators, and (iii) feeling valued, in relation to honoraria, inclusion in outputs and community analysts coming to recognise their own expertise. Furthermore, the community analysts co-produced recommendations for including community analysts in future research. It provides guidance on how this can be appropriately costed for and supported by funding bodies and research teams, as well as providing guidance on recruitment and chairing meetings. We hope that this article can provide valuable input into how to involve the community more inclusively as research partners in qualitative analysis related to stigmatised topics. [ABSTRACT FROM AUTHOR]

Around 3% of people are Autistic. Autistic people communicate differently from non‐Autistic people and experience the sensory world differently. There is limited evidence that Autistic people can face additional barriers to breastfeeding. We are an Autistic‐led research team that developed an online survey following consultation with the Autistic community. Autistic people from the UK who had been pregnant were eligible to take part in the survey, which focused on the entire maternity journey. A total of 193 people participated, of whom 152 had experiences of infant feeding (137 breastfeeding, 82 formula feeding). Participants were highly motivated to breastfeed, and almost half of those who breastfed found it positive always or most of the time. However, breastfeeding—and in particular the milk let‐down reflex—could result in pain and sensory difficulties, including 'feeling odd'. Expressing breastmilk always or most of the time was reported by 10% of breastfeeding participants. The intensity and unpredictability of both breast and formula feeding were challenging to manage. Parents reported that it was easy to understand how to prepare infant formula, but that it could also be a negative and anxiety‐inducing experience. Support for breast and formula feeding was often considered inadequate. When parents did access breastfeeding support, this significantly improved a range of breastfeeding experiences. However, participants recommended more tailored support and continuity of carer. To meet the needs of Autistic birthing parents, those providing infant feeding support should receive training on Autism through a neurodiversity‐affirming lens, which should be delivered by Autistic people. Key messages: Many Autistic people are highly motivated to breastfeed, regardless of challenges.Autistic people may experience sensory discomfort when breastfeeding, including from the intensity of touch between themselves and their baby. Distraction and reducing sensory burdens can help.Expressing always or most of the time was relatively common (10%), and a route to maintaining exclusive breastfeeding when directly breastfeeding was too uncomfortable.Receiving breastfeeding support was significantly associated with improvements in a range of breastfeeding experiences.Breastfeeding support for Autistic people should be offered on a one‐to‐one basis with continuity of carer. [ABSTRACT FROM AUTHOR]

Formula fed infants experience gastrointestinal infections at higher rates than breastfed infants, due in part to bacteria in powdered infant formula (PIF) and bacterial contamination of infant feeding equipment. The United Kingdom National Health Service (UK NHS) has adopted the World Health Organization recommendation that water used to reconstitute PIF is ≥70°C to eliminate bacteria. We used community science methods to co‐design an at home experiment and online questionnaire ('research diary') to explore the safety of PIF preparation compared to UK NHS guidelines. 200 UK‐based parents of infants aged ≤12 months were recruited; 151 provided data on PIF preparation, and 143 were included in the analysis of water temperatures used to reconstitute PIF. Only 14.9% (n = 11) of 74 PIF preparation machines produced a water temperature of ≥70°C compared with 78.3% (n = 54) of 69 kettle users (p < 0.001). The mean temperature of water dispensed by PIF preparation machines was 9°C lower than kettles (Machine M = 65.78°C, Kettle M = 75.29°C). Many parents did not always fully follow NHS safer PIF preparation guidance, and parents did not appear to understand the potential risks of PIF bacterial contamination. Parents should be advised that the water dispensed by PIF preparation machines may be below 70°C, and could result in bacteria remaining in infant formula, potentially leading to gastrointestinal infections. PIF labelling should advise that water used to prepare PIF should be ≥70°C and highight the risks of not using sufficiently hot water, per WHO Europe advice. There is an urgent need for stronger consumer protections regarding PIF preparation devices. Key points: Only 14.9% (n = 11) of 74 PIF preparation machines produced a water temperature of ≥70°C compared with 78.3% (n = 54) of 69 kettle users (p < 0.001).The mean temperature of water dispensed by PIF preparation machines was 9°C lower than kettles (Machine M = 65.78°C, Kettle M = 75.29°C).Most parents routinely washed and sterilised bottles and teats.Many parents did not always fully follow NHS safer PIF preparation guidance, including 21.8% washing their hands half the time or less, and 14.6% regularly pre‐preparing bottles.Most parents did not appear to understand the risks of PIF bacterial contamination. [ABSTRACT FROM AUTHOR]

Purpose: The paper aims to explore "content" factors influencing consumptive and contributive use of enterprise social networking within UK higher education during the COVID-19 pandemic. Design/methodology/approach: The methodology uses genre analysis and grounded theory to analyse empirical data from posts obtained through Microsoft Yammer and a focus group. Findings: The findings reveal the motivators-outcomes-strategies and the barriers-outcomes-strategies of users. Motivators (M) include feature value, Information value, organizational requirement and adequate organizational and technical support. Barriers (B) include six factors, including resisting engagement on the online platform, emotional anxiety, loss of knowledge, the lack of organizational pressure, lack of content quality and lack of time. An Outcomes (O) framework reveals benefits and dis-benefits and strategies (S) relating to improving user engagement. Practical implications: The research method and resultant model may serve as guidelines to higher educational establishments interested in motivating their staff and scholars around the use of enterprise social network (ESN) systems, especially during face-to-face restrictions. Originality/value: This research study was conducted during the COVID-19 pandemic which provides a unique setting to examine consumptive and contributive user behaviour of ESN's. Furthermore, the study develops a greater understanding of "content" factors leading to the benefits or dis-benefits of ESN use, drawing on user motivators, barriers and strategies during the COVID-19 pandemic in UK education. [ABSTRACT FROM AUTHOR]

Psychologist resourcing across the United Kingdom (UK) spinal cord injury centres (SCICs) varies considerably, which has detrimentally impacted standardising service provision for people with spinal cord injuries/disorders (PwSCI/D) compared with other nations. This paper presents the outcome of a project involving the Spinal Cord Injury Psychology Advisory Group (SCIPAG) and NHS England Clinical Reference Group/SCI transformation groups to agree upon screening and standards and shares data from the National Spinal Injuries Centre (NSIC) and the Yorkshire and Midlands Regional SCICs. Inpatients completed the GAD-7, the PHQ-9, and the short form of the Appraisals of DisAbility: Primary and Secondary Scale (ADAPSSsf), assessing adjustment. A total of 646 participants were included, with 43% scoring above the clinical threshold on at least one of the measures on admission. A subset of 272 participants also completed discharge measures and 42% remained above the threshold on discharge, demonstrating sustained psychological need. This paper provides support for services to move to a screen-and-assessment model supplemented by referral options for those with changing needs or who present with difficulties outside the remit of screening. The findings also support the efficacy of universal screening across the system and consideration of screening and standards for psychological care by the wider psychology community. [ABSTRACT FROM AUTHOR]

Background: Endometriosis affects 1 in 9 women, yet it is poorly understood with long diagnostic delays, invasive diagnoses, and poor treatment outcomes. Characterised by the presence of endometrial-like tissue outside of the uterus, its main symptoms are pain and infertility. Endometriosis often co-occurs with other conditions, which may provide insights into the origins of endometriosis. Methods: Here a polygenic risk score phenome-wide association study of endometriosis was conducted in the UK Biobank to investigate the pleiotropic effects of a genetic liability to endometriosis. The relationship between the polygenic risk score for endometriosis and health conditions, blood and urine biomarkers and reproductive factors were investigated separately in females, males and females without an endometriosis diagnosis. The relationship between endometriosis and the blood and urine biomarkers was further investigated using genetic correlation and Mendelian randomisation approaches to identify causal relationships. Results: Multiple health conditions, blood and urine biomarkers and reproductive factors were associated with genetic liability to endometriosis in each group, indicating many endometriosis comorbidities are not dependent on the physical manifestation of endometriosis. Differences in the associated traits between males and females highlighted the importance of sex-specific pathways in the overlap of endometriosis with many other traits. Notably, an association of genetic liability to endometriosis with lower testosterone levels was identified. Follow-up analysis utilising Mendelian randomisation approaches suggested lower testosterone may be causal for both endometriosis and clear cell ovarian cancer. Conclusions: This study highlights the diversity of the pleiotropic effects of genetic risk to endometriosis irrespective of a diagnosis of endometriosis. A key finding was the identification of a causal effect of the genetic liability to lower testosterone on endometriosis using Mendelian randomisation. [ABSTRACT FROM AUTHOR]

When the Dutch West Indies Company (WIC) established the free port of Willemstad, Curaçao after 1674, they launched a model for economic competition that other European empires would emulate. Within a century, the Danish, Spanish, British, and French all established their own Caribbean free ports. Emulation, however, was not replication. This article argues that while the expansion of free ports into different Caribbean empires generated similar forms of economic dualism (prohibitive commercial systems in certain locales with more-open ones in others), they all served varying purposes. The Dutch and Danish maintained or expanded their free-port systems and utilised strategic neutrality to remain active players within an increasingly competitive economic arena. Britain wanted to extend its commercial empire by making foreign realms dependent on its trade. France sought to pacify recalcitrant planters desperate for reliable provisioning. Finally, Spain enacted free ports in Santo Domingo to supply and encourage settlement in a region threatened by French encroachments. Thus, although these empires all established free ports in strategic locales and jealously emulated each other, they did so with unique political-economic aims in mind. Meanwhile, merchants, enslaved Africans, sailors, settlers, and European intellectuals employed Caribbean free ports to accomplish their own ends as well. [ABSTRACT FROM AUTHOR]

While the time-honoured one-to-one supervisory model of higher research degree training has its advantages, recent research suggests that the model also has significant drawbacks, including its hierarchical nature. Nevertheless, this pedagogical model remains the default for higher research pedagogy. Using the discipline of music as a case study, where growing interest in practice-based research has lately demanded considerable fluidity in supervisory practices, this research explores the benefits and challenges of one-to-one models of supervision. Drawing on semi-structured interviews, dialogue forums, survey data, the extant literature and observations of practices at selected higher music education institutions in Australia, the UK, Belgium and the Netherlands, it recommends and suggests ways to implement more "horizontal" approaches to research pedagogy. The findings of this research may improve teaching and learning experiences and outcomes in higher research degrees in music and the creative arts, and stimulate a reflection of supervisory approaches more generally across the sector.

The last decade has seen intensification in moves to professionalise the practice of university teaching, including graduate teaching assistants (GTAs). It has also seen significant growth in terms of the internationalisation of the postgraduate student body and changing expectations around doctoral training. These transformations have implications for the construction, delivery, and management of educational training for this group, yet little contemporary research exists investigating the adaptability of academic development and institutions to such change. This paper reports empirical research exploring these issues using a UK-based case study. The research investigated the international doctoral students' experience of a teaching course and subsequent academic development. GTAs reported institutional and cultural factors governing access to teaching opportunities, particularly in relation to the international cohort. We explore the possible reasons for this, and the implications for the case institution and the wider HE sector.

Background: While studies of ex-orphanage care show adverse effects on development, the longer-term impact on mid-life psychosocial functioning and physical health has not been established. Methods: Orphanage records provided baseline data on a sample of 100 Hong Kong Chinese girls who were subsequently adopted into the UK. A mid-life follow-up using standardised questionnaires and face-to-face interviews assessed current circumstances, life satisfaction and mental and physical health outcomes. Comparisons were made with age-matched UK-born adopted and nonadopted women. Results: Half the group spent between 1 and 2 years in orphanages, average age at adoptive placement was 23 months and 72% participated in the follow-up. Despite this poor early start, mid-life outcomes were commensurate with the comparison groups in terms of mental and physical health measures. Serious psychiatric and social difficulties were largely absent. Although the timing and extent of exposure to orphanage care did not influence outcome, participants' reports of poorer quality adoptive family experience and a negative view of their adoption were significantly associated with poorer mental health outcomes (difference in means = 0.76, 95% CI 1.33-0.19, p = 0.01; difference in means = 1.2, 95% CI 0.68-1.73, p = 0.01, respectively). Conclusions: Moderately depriving orphanage care did not predict enduring adverse consequences in mid-life but subsequent poor adoption experience was associated with outcome.

Background: Thoracotomy is considered one of the most painful surgical procedures and can cause debilitating chronic post-surgical pain lasting months or years postoperatively. Aggressive management of acute pain resulting from thoracotomy may reduce the likelihood of developing chronic pain. This trial compares the two most commonly used modes of acute analgesia provision at the time of thoracotomy (thoracic epidural blockade (TEB) and paravertebral blockade (PVB)) in terms of their clinical and cost-effectiveness in preventing chronic post-thoracotomy pain. Methods: TOPIC 2 is a multi-centre, open-label, parallel group, superiority, randomised controlled trial, with an internal pilot investigating the use of TEB and PVB in 1026 adult (≥ 18 years old) patients undergoing thoracotomy in up to 20 thoracic centres throughout the UK. Patients (N = 1026) will be randomised in a 1:1 ratio to receive either TEB or PVB. During the first year, the trial will include an integrated QuinteT (Qualitative Research Integrated into Trials) Recruitment Intervention (QRI) with the aim of optimising recruitment and informed consent. The primary outcome is the incidence of chronic post-surgical pain at 6 months post-randomisation defined as 'worst chest pain over the last week' equating to a visual analogue score greater than or equal to 40 mm indicating at least a moderate level of pain. Secondary outcomes include acute pain, complications of regional analgesia and surgery, health-related quality of life, mortality and a health economic analysis. Discussion: Both TEB and PVB have been demonstrated to be effective in the prevention of acute pain following thoracotomy and nationally practice is divided. Identification of which mode of analgesia is both clinically and cost-effective in preventing chronic post-thoracotomy pain could ameliorate the debilitating effects of chronic pain, improving health-related quality of life, facilitating return to work and caring responsibilities and resulting in a cost saving to the NHS. Trial registration: NCT03677856 [ClinicalTrials.gov] registered September 19, 2018. https://clinicaltrials.gov/ct2/show/NCT03677856. First patient recruited 8 January 2019. [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]

Throughout British membership of the European Union (EU), agricultural policy was largely determined by the Common Agricultural Policy (CAP). This was viewed by the UK as a dysfunctional policy and while periodic reforms meant that the EU moved slowly in the direction advocated by the UK, many of the main policy elements remained in place. The devolved administrations in Scotland, Wales and Northern Ireland have always enjoyed a measure of policy freedom in agriculture and have diverged from England in some areas. This article explores the extent of de-Europeanisation in the agricultural sectors in the UK and the patterns of divergence between them, focusing primarily on the development of policies for agricultural support that will replace those in place under the CAP. Overall, there has been substantial divergence in policy, but also areas of continuity, which means that processes of de-Europeanisation in the UK agricultural sectors has been uneven. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic and attendant lockdowns have had a substantial negative effect on alcohol consumption and physical activity globally. Pre-pandemic evidence in the adult population suggests that higher levels of physical activity were associated with higher levels of drinking, but it is unclear how the pandemic may have affected this. Therefore, this study aims to assess the association between alcohol consumption and physical activity in a UK cohort established during the COVID-19 pandemic. Methods: Analyses utilized data from the Health Behaviours during the COVID-19 pandemic (HEBECO) study involving 2,057 UK adults (≥18 years). Participants completed self-report measures of alcohol consumption [frequency, quantity, frequency of heavy episodic drinking (HED) and AUDIT-C score] and physical activity [moderate-vigorous physical activity (MVPA), frequency of muscle strengthening activity (MSA) and sedentary behaviour] between November 2020 and January 2021. Ordinal logistic regression models were conducted, adjusting for sociodemographic factors. Results: Fifteen percent of the sample reported abstinence from drinking. Overall, 23.4% of participants drank ≥4 times/week, 13.9% drank more than 6 units/single drinking occasion (HED), 7.5% reported HED daily/almost daily and 4.2% scored ≥11 on AUDIT-C. MSA 3 days/week compared with no MSA was significantly associated with higher odds of alcohol frequency [OR (95 CI%) = 1.41 (1.04–1.91)], quantity [OR (95 CI%) = 1.38 (1.02–1.87)], HED [OR (95 CI%) = 1.42 (1.05–1.94)] and possible dependence [OR (95 CI%) = 1.47 (1.05–2.06)]. The association of MVPA and sedentary behaviour with drinking measures was not significant (p>0.05). Conclusion: In contrast with previous research, MSA rather than aerobic physical activity was associated with increased alcohol consumption during the COVID-19 pandemic. It is conceivable that during lockdown while drinking was used as a coping strategy, limited opportunities for aerobic exercise made MSA a more convenient form of physical activity. To guide public health interventions, more research is required to examine the temporal relationship between different forms of physical activity and alcohol consumption. [ABSTRACT FROM AUTHOR]

The article focuses on the challenges Labour would face in renegotiating a Brexit deal if it comes to power, highlighting three key reasons. It includes shifting public opinion in the United Kingdom towards closer European Union ties, increasing economic damage from Boris Johnson's deal, and emerging global challenges necessitating closer UK-EU cooperation.

A range of professionals and services are often involved in supporting parents with mental health needs where there are child protection concerns. However, they do not always meet the needs of this population who tend to experience inadequate support and mistrust of services. This review aimed to synthesize parent and practitioner experiences of support for parents with both mental health needs and children's social services involvement. We performed electronic searches of the following databases: PsycINFO, CINAHL, HMIC, MEDLINE, Embase, Social Policy and Practice, Social Services Abstracts, Social Science Citation Index, OpenGrey, Social Care Online, and ProQuest. Following searching and screening, 41 studies were identified including 359 parents and 1370 practitioners. We worked with a Lived Experience Advisory Group to develop the following themes: (1) a downward spiral of service intervention; (2) working with parents, not against them; (3) support wanted versus support provided; and (4) constrained by service rigidity. We found that families were often parenting amidst trauma and adversity. However, service involvement could trigger a "downward spiral" of stressful processes over which parents felt they lacked control. Instead of improving their situations, support sometimes added to families' difficulties, worsening parents' mental health and making them feel marginalised, criticised, and retraumatised. There were, however, also examples of positive practice, where practitioners and parents developed trusting, open, and mutually respectful relationships. Practitioners often felt that they were limited in their ability to offer collaborative, holistic care because services were fragmented, underfunded, crisis driven, and inflexible. Difficulties mentioned most often by parents, such as financial issues, tended not to be a focus of available interventions. We conclude that the key issues identified must be targeted to improve support. [ABSTRACT FROM AUTHOR]

Background: Autism is a normal part of cognitive diversity, resulting in communication and sensory processing differences, which can become disabling in a neurotypical world. Autistic people have an increased likelihood of physical and mental co-occurring conditions and die earlier than neurotypical peers. Inaccessible healthcare may contribute to this. Autism Health Passports (AHPs) are paper-based or digital tools which can be used to describe healthcare accessibility needs; they are recommended in UK clinical guidance. However, questions remained as to the theoretical underpinnings and effectiveness of AHPs. Methods: We undertook a systematic literature search identifying studies focused on AHPs for adults (aged over 16 years) from five databases. Included literature was subjected to realist evaluation. Data were extracted using a standardised form, developed by the research team, which considered research design, study quality for realist review and the Context, Mechanisms and Outcomes (CMOs) associated with each AHP tool. Findings: 162 unique records were identified, and 13 items were included in the review. Only one item was considered high quality. Contextual factors focused on the inaccessibility of healthcare to Autistic patients and staff lack of confidence and training in supporting Autistic needs. Interventions were heterogeneous, with most sources reporting few details as to how they had been developed. The most frequently included contents were communication preferences. Mechanisms were often not stated or were inferred by the reviewers and lacked specificity. Outcomes were included in four studies and were primarily focused on AHP uptake, rather than Outcomes which measured impact. Conclusion: There is insufficient evidence to conclude that AHPs reduce the health inequalities experienced by Autistic people. Using an AHP tool alone in a healthcare Context that does not meet Autistic needs, without the inclusion of the local Autistic community developing the tool, and a wider intervention to reduce known barriers to health inequality, may mean that AHPs do not trigger any Mechanisms, and thus cannot affect Outcomes. [ABSTRACT FROM AUTHOR]

Comorbid conditions can be driven by underlying pleiotropic and causal mechanisms that can provide insights into shared molecular and biological processes contributing to disease risk. Endometriosis is a chronic condition affecting one in nine women of reproductive age and poses many challenges including lengthy diagnostic delays and limited treatment efficacy owing to poor understanding of disease aetiology. To shed light on the underlying biological mechanisms and to identify potential risk factors, we examine the epidemiological and genomic relationship between endometriosis and its comorbidities. In the UK Biobank 292 ICD10 codes were epidemiologically correlated with endometriosis diagnosis, including gynaecological, immune, infection, pain, psychiatric, cancer, gastrointestinal, urinary, bone and cardiovascular traits. A subset of the identified comorbidities (n = 76) underwent follow-up genetic analysis. Whilst Mendelian randomisation suggested causality was not responsible for most comorbid relationships, 22 traits were genetically correlated with endometriosis, including pain, gynaecological and gastrointestinal traits, suggestive of a shared genetic background. Pleiotropic genetic variants and genes were identified using gene-based and colocalisation analysis. Shared genetic risk factors and potential target genes suggest a diverse collection of biological systems are involved in these comorbid relationships including coagulation factors, development of the female reproductive tract and cell proliferation. These findings highlight the diversity of traits with epidemiological and genomic overlap with endometriosis and implicate a key role for pleiotropy in the comorbid relationships. [ABSTRACT FROM AUTHOR]

Purpose: The paper offers clarity to the market orientation (MO) and performance relationship in real estate by examining the limited relevant literature, presenting international results and discussing the implications for market orientation researchers and real estate practitioners. Design/methodology/approach: Based on a survey of 1,251 individual renters in the USA, the United Kingdom (UK) and Canada, this study examines the relationship between residential property managers' MO and performance. It extends MO research in real estate by focusing on property management as opposed to property development. Findings: The results show that MO and performance are correlated in all three countries. Commitments to understanding and serving customers and differentiating from competitors are shown to enhance performance measures including residential tenants' loyalty toward the property manager, trust in the property manager, pride in rental accommodation and commitment to paying rent on time. Originality/value: This study is one of the largest MO studies in real estate in terms of sample size and offers a unique international perspective. The research is novel as MO is evaluated by tenants as opposed to self-assessed by firms. The paper offers a new measure of property manager performance and provides strategic directives for real estate professionals seeking to enhance competitiveness. [ABSTRACT FROM AUTHOR]