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Abstract BackgroundGeneral medical practitioners and other staff at primary care medical practices have an important role in facilitating patient access to online services in the National Health Service in England. These services range from online ordering of repeat prescriptions to conducting online consultations with health care professionals. We have defined “digital facilitation” as that range of processes, procedures, and personnel that seeks to support patients in their uptake and use of online services. ObjectiveWe report how we have synthesized the evidence from a mixed methods study of digital facilitation in primary care in England. The study’s objectives were to identify, characterize, and explore the benefits and challenges of different models of digital facilitation in general medical practices in England and to design a framework for evaluation of the effectiveness and costs of digital facilitation interventions. MethodsOur study comprised scoping review of literature, survey of staff in general practices, survey of patients, and ethnography at case study practices plus stakeholder interviews. We compiled a triangulation matrix of the findings from individual work packages through an iterative process whereby each work package’s results were first analyzed separately and were then cumulatively combined across work packages in 3 successive workshops. From the resulting matrix, we developed a program theory and an implementation theory and constructed a framework for evaluations of digital facilitation in primary care. The final step of the synthesis process was to discuss the results with national and regional National Health Service stakeholders. ResultsTriangulation yielded a combined set of findings summarized within 11 thematic groupings: 3 setting the scene within which digital facilitation takes place, and 8 related to different types of digital facilitation, their implementation, and effectiveness. Some thematic groupings were evident in the findings of all 4 of the research work packages; others were not addressed in all the work packages but were evident from those where they were addressed. Throughout the synthesis, there were no instances where findings from one work package contradicted the findings of another. Findings either reinforced each other or offered complementary or additional insights. The discussion at the stakeholder meeting held at the end of the study resulted in the research team clarifying some findings but not changing any of them. ConclusionsDigital facilitation can take many forms, though much of what is currently done in primary care practices in England is reactive and passive. Clear lines of responsibility, digital tools and platforms that work well for patients and practice staff, and investment in staff time and training are all needed if digital facilitation is to deliver on its promise. We propose a framework for future evaluations of the effectiveness and costs of digital facilitation interventions.

Background General practice is facing an unprecedented challenge in managing the consequences of the pandemic. In the midst of a policy drive to balance remote and in-person service provision, substantial workload pressures remain, together with increasing prevalence of long-term conditions, and declining staff numbers and morale. To address these challenges, some practices in the UK have been delivering video and hybrid group consultations (VHGCs) providing clinical care to multiple patients at the same time. Despite positive initial findings and enthusiasm, there are still gaps in our understanding of the influence VHGCs have on patient experience, healthcare utilisation, quality, safety, equity and affordability. Objectives To generate an in-depth understanding of VHGCs for chronic conditions in general practice, surface assumptions and sociotechnical dynamics, inform practice and extend theorisation. Methods Mixed-methods, multi-site research study using co-design and participatory methods, from qualitative, quantitative and cost-related perspectives. WP1 includes a national, cross-sectional survey on VHGC provision across the UK. In WP2 we will engage patients and general practice staff in co-design workshops to develop VHGC models with emphasis on digital inclusion and equity. In WP3 we will carry out a mixed-methods process evaluation in up to 10 GP practices across England (5 sites already running VHGCs and 5 comparison sites). Qualitative methods will include interviews, focus groups and ethnographic observation to examine the experiences of patients, carers, clinical and non-clinical NHS staff, commissioners and policy-makers. Quantitative methods will examine the impact of VHGCs on healthcare utilisation in primary and secondary care, patient satisfaction, engagement and activation. We will also assess value for money of group and individual care models from a health economics perspective. Conclusions We aim to develop transferable learning on sociotechnical change in healthcare delivery, using VHGCs as an exemplar of technology-supported innovation. Findings will also inform the design of a future study.

BackgroundOnline appointment booking is a commonly used tool in several industries. There is limited evidence about the benefits and challenges of using online appointment booking in health care settings. Potential benefits include convenience and the ability to track appointments, although some groups of patients may find it harder to engage with online appointment booking. We sought to understand how patients in England used and experienced online appointment booking. ObjectiveThis study aims to describe and compare the characteristics of patients in relation to their use of online appointment booking in general practice and investigate patients’ views regarding online appointment booking arrangements. MethodsThis was a mixed methods study set in English general practice comprising a retrospective analysis of the General Practice Patient Survey (GPPS) and semistructured interviews with patients. Data used in the retrospective analysis comprised responses to the 2018 and 2019 GPPS analyzed using mixed-effects logistic regression. Semistructured interviews with purposively sampled patients from 11 general practices in England explored experiences of and views on online appointment booking. Framework analysis was used to allow for comparison with the findings of the retrospective analysis. ResultsThe retrospective analysis included 1,327,693 GPPS responders (2018-2019 combined). We conducted 43 interviews with patients with a variety of experiences and awareness of online appointment booking; of these 43 patients, 6 (14%) were from ethnic minority groups. In the retrospective analysis, more patients were aware that online appointment booking was available (581,224/1,288,341, 45.11%) than had experience using it (203,184/1,301,694, 15.61%). There were deprivation gradients for awareness and use and a substantial decline in both awareness and use in patients aged >75 years. For interview participants, age and life stage were factors influencing experiences and perceptions, working patients valued convenience, and older patients preferred to use the telephone. Patients with long-term conditions were more aware of (odds ratio [OR] 1.43, 95% CI 1.41-1.44) and more likely to use (OR 1.65, 95% CI 1.63-1.67) online appointment booking. Interview participants with long-term conditions described online appointment booking as useful for routine nonurgent appointments. Patients in deprived areas were clustered in practices with low awareness and use of online appointment booking among GPPS respondents (OR for use 0.65, 95% CI 0.64-0.67). Other key findings included the influence of the availability of appointments online and differences in the registration process for accessing online booking. ConclusionsWhether and how patients engage with online appointment booking is influenced by the practice with which they are registered, whether they live with long-term conditions, and their deprivation status. These factors should be considered in designing and implementing online appointment booking and have implications for patient engagement with the wider range of online services offered in general practice.

This article describes the Research Apprenticeship Program (RAP), a mentored undergraduate research experience implemented in 2017 at a public land-grant institution located in the Appalachian region. The article focuses on RAP's approach to recruiting, retaining, and supporting students in faculty-mentored research and creative inquiry. To assess the impact of RAP on undergraduate retention, institutional data were collected to identify RAP participants from the years 2017 to 2022 (n = 868) to compare next-year retention rates with institutional averages across similar demographic groups. The results showed that retention rates for RAP participants were significantly higher than institutional averages, and disaggregated data also showed higher retention rates for participants from historically marginalized populations. These results provide evidence of the program's contribution to the educational development of the Appalachian region.

Abstract Background The National Health Service (NHS) and general practice are increasingly adopting digital services. These services can impact both positively and negatively upon patient experiences, and access to digital services is not equal amongst all groups. Within a wider project examining digital facilitation (the Di-Facto study) our team conducted a patient survey amongst English primary care practices aiming to investigate patient views of what supports uptake and use of web-based services. This paper reports on the analysis of the free-text responses from the patient survey. Methods The Di-Facto patient survey was distributed to practices in eight clinical commissioning groups (CCGs) in England between 2021–2022. We examined free-text responses to two questions relating to access to primary care web-based and support for web-based services. We used qualitative reflexive thematic analysis based on a six-stage process to analyse responses. Results Of the 3051 patients who responded to the Di-Facto survey, 2246 provided a free-text response. We present our findings in two major themes: systems and structures and their impact on use of web-based services, and ‘what works for me’, a description of how respondents described what worked, or did not work in terms of their interactions with web-based services. Respondents described how the technology, such as poor practice website design, confusion over multiple digital apps, data security and concerns about eConsultation offerings impacted on use of web-based services. Respondents described practice level barriers, such as a lack of or inconsistent provision, which prevented optimal use of web-based services. Respondents described personal and technical barriers that impacted on their use of digital services, and described which web-based services worked well for them. Respondents felt that web-based services were not a replacement for face-to-face interactions with a doctor. Conclusions This analysis of free-text responses from a large patient survey highlights the system, practice, and person level barriers and facilitators to use of digital services in primary care. With an increasing push towards digital solutions in NHS primary care, practices should consider the design, rollout and communication of their web-based services to support patient access.

Abstract Measurements of W-boson production at the LHC have reached percent-level precision and impose challenging demands on theoretical predictions. Such predictions directly limit the precision of measurements of fundamental quantities such as the W-boson mass and the weak mixing angle. A dominant source of uncertainty in predictions is from higher-order QCD effects. We present a calculation of W-boson production at the level of α s 3 $$ {\alpha}_s^3 $$ at fixed order and including transverse-momentum resummation. We further show predictions for a direct comparison with low-pileup ATLAS transverse-momentum and fiducial cross-section measurements at s $$ \sqrt{s} $$ = 5.02 TeV. We discuss in detail the impact of modern PDFs. Our calculation including the matching to W+jet production at NNLO will be publicly available the upcoming CuTe-MCFM release and allows for theory-data comparison at the state-of-the-art level.

Abstract Background The NHS Talking Therapies for Anxiety and Depression programme (‘TTad’; formerly Improving Access to Psychological Therapies ‘IAPT’) delivers high-intensity cognitive behavioural therapy (CBT) to over 200,000 individuals each year for common mental health problems like depression and anxiety. More than half of these individuals experience comorbid personality difficulties, who show poorer treatment outcomes. TTad therapists report feeling unskilled to work with clients with personality difficulties, and enhancing the training of TTad therapists may lead to improved treatment outcomes for individuals presenting with secondary personality difficulties alongside depression and anxiety. Methods This is a pre-post non-randomised mixed-method feasibility study, exploring the feasibility and acceptability of a 1-day training workshop for high-intensity (HI) CBT therapists. The workshop is focused on understanding and assessing personality difficulties and adapting HICBT treatments for anxiety and depression to accommodate client needs. The feasibility and acceptability of the workshop and the evaluation procedures will be investigated. It will be examined to what extent the workshop provision leads to improvements in therapist skills and confidence and explored to what extent the training has the potential to enhance clinical outcomes for this client group. Discussion This feasibility study will provide data on the acceptability and feasibility of delivering brief therapist training to adapt usual HICBT to optimise care for individuals with secondary personality difficulties seeking treatment in TTad services for a primary problem of depression and/or anxiety. The study will also evaluate proof of concept that such an approach has the potential to improve clinical outcomes for those with secondary personality difficulties and report any possible harms identified. The study will inform the design of a future randomised controlled trial designed to test the effectiveness and cost-effectiveness of the training. Trial registration ISRCTN81104604 . Submitted on 6th June 2022. Registration date: 3rd January 2023.

Summary: Background: Bacille Calmette-Guérin (BCG) vaccination has off-target (non-specific) effects that are associated with protection against unrelated infections and decreased all-cause mortality in infants. We aimed to determine whether BCG vaccination prevents febrile and respiratory infections in adults. Methods: This randomised controlled phase 3 trial was done in 36 healthcare centres in Australia, Brazil, the Netherlands, Spain, and the United Kingdom. Healthcare workers were randomised to receive BCG-Denmark (single 0.1 ml intradermal injection) or no BCG in a 1:1 ratio using a web-based procedure, stratified by stage, site, age, and presence of co-morbidity. The difference in occurrence of febrile or respiratory illness were measured over 12 months (prespecified secondary outcome) using the intention-to-treat (ITT) population. This trial is registered with ClinicalTrials.gov, NCT04327206. Findings: Between March 30, 2020, and April 1, 2021, 6828 healthcare workers were randomised to BCG-Denmark (n = 3417) or control (n = 3411; no intervention or placebo) groups. The 12-month adjusted estimated risk of ≥1 episode of febrile or respiratory illness was 66.8% in the BCG group (95% CI 65.3%–68.2%), compared with 63.4% in the control group (95% CI 61.8%–65.0%), a difference of +3.4 percentage points (95% CI +1.3% to +5.5%; p 0.002). The adjusted estimated risk of a severe episode (defined as being incapacitated for ≥3 consecutive days or hospitalised) was 19.4% in the BCG group (95% CI 18.0%–20.7%), compared with 18.8% in the control group (95% CI 17.4%–20.2%) a difference of +0.6 percentage points (95% CI −1.3% to +2.5%; p 0.6). Both groups had a similar number of episodes of illness, pneumonia, and hospitalisation. There were three deaths, all in the control group. There were no safety concerns following BCG vaccination. Interpretation: In contrast to the beneficial off-target effects reported following neonatal BCG in infants, a small increased risk of symptomatic febrile or respiratory illness was observed in the 12 months following BCG vaccination in adults. There was no evidence of a difference in the risk of severe disease. Funding: Bill & Melinda Gates Foundation, Minderoo Foundation, Sarah and Lachlan Murdoch, the Royal Children's Hospital Foundation, Health Services Union NSW, the Peter Sowerby Foundation, SA Health, the Insurance Advisernet Foundation, the NAB Foundation, the Calvert-Jones Foundation, the Modara Pines Charitable Foundation, the UHG Foundation Pty Ltd, Epworth Healthcare, the National Health and Medical Research Council, the Swiss National Science Foundation and individual donors.

Objective The increase in reliance on online services for general practice has the potential to increase inequalities within some populations. Patients with a mental health condition are one such group. Digital facilitation is defined as a range of processes, procedures, and people, which seek to support NHS patients in using online services. This study aimed to examine the views and experiences of digital facilitation in primary care amongst patients living with a mental health condition. Methods Semi-structured interviews were conducted with patients living with a mental health condition, recruited from general practices across England participating in the Di-Facto study. Thematic analysis was conducted on interview transcripts. Results Interviews were conducted with ten participants with a mental health condition, recruited from five general practices. Three themes were identified: (1) familiarity with online services; (2) experiences of those using online services; (3) the need for digital facilitation. The need for digital facilitation was identified in the registration for online services, and in trusting online services. Conclusions Online services offer convenience for patients, but registration for the use of such services remains a potential area of difficulty. Participants had difficulties with registering for online services and had concerns about trust in using them. Support offered by general practices in using online services needs to be varied and adaptable to meet the needs of individual patients.

Summary: Background: The COVID-19 pandemic led to the rapid development and deployment of several highly effective vaccines against SARS-CoV-2. Recent studies suggest that these vaccines may also have off-target effects on the immune system. We sought to determine and compare the off-target effects of the adenovirus vector ChAdOx1-S (Oxford-AstraZeneca) and modified mRNA BNT162b2 (Pfizer-BioNTech) vaccines on immune responses to unrelated pathogens. Methods: Prospective sub-study within the BRACE trial. Blood samples were collected from 284 healthcare workers before and 28 days after ChAdOx1-S or BNT162b2 vaccination. SARS-CoV-2-specific antibodies were measured using ELISA, and whole blood cytokine responses to specific (SARS-CoV-2) and unrelated pathogen stimulation were measured by multiplex bead array. Findings: Both vaccines induced robust SARS-CoV-2 specific antibody and cytokine responses. ChAdOx1-S vaccination increased cytokine responses to heat-killed (HK) Candida albicans and HK Staphylococcus aureus and decreased cytokine responses to HK Escherichia coli and BCG. BNT162b2 vaccination decreased cytokine response to HK E. coli and had variable effects on cytokine responses to BCG and resiquimod (R848). After the second vaccine dose, BNT162b2 recipients had greater specific and off-target cytokine responses than ChAdOx1-S recipients. Interpretation: ChAdOx1-S and BNT162b2 vaccines alter cytokine responses to unrelated pathogens, indicative of potential off-target effects. The specific and off-target effects of these vaccines differ in their magnitude and breadth. The clinical relevance of these findings is uncertain and needs further study. Funding: Bill & Melinda Gates Foundation, National Health and Medical Research Council, Swiss National Science Foundation and the Melbourne Children’s. BRACE trial funding is detailed in acknowledgements.

Cow-calf surveillance data provide critical information about changing herd demographics, productivity, health, and management as well as the opportunity to investigate the impact of differing management practices. A national cow-calf network was established to collect baseline information on herd health, production performance measures, and management. Questionnaires were used to collect information on herd attributes as well as data for the calving season, breeding, pregnancy testing, and weaning for herds from across Canada. From 2018 to 2022, a total of 565 calving record questionnaires, representing 110,658 calving female records from 171 herds were returned, along with 543 herd breeding to weaning questionnaires. Suggested benchmark values based on the 25th percentiles from Western and Eastern Canada were determined to be

Background: Recent policy initiatives seeking to address the workforce crisis in general practice have promoted greater multidisciplinarity. Evidence is lacking on how changes in staffing and the relational climate in practice teams affect the experiences of staff and patients. Aim: To synthesise evidence on how the composition of the practice workforce and team climate affect staff job satisfaction and burnout, and the processes and quality of care for patients. Design & setting: A systematic literature review of international evidence. Method: Four different searches were carried out using MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, and Web of Science. Evidence from English language articles from 2012–2022 was identified, with no restriction on study design. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed and data were synthesised thematically. Results: In total, 11 studies in primary healthcare settings were included, 10 from US integrated healthcare systems, one from Canada. Findings indicated that when teams are understaffed and work environments are stressful, patient care and staff wellbeing suffer. However, a good relational climate can buffer against burnout and protect patient care quality in situations of high workload. Good team dynamics and stable team membership are important for patient care coordination and job satisfaction. Female physicians are at greater risk of burnout. Conclusion: Evidence regarding team composition and team climate in relation to staff and patient outcomes in general practice remains limited. Challenges exist when drawing conclusions across different team compositions and definitions of team climate. Further research is needed to explore the conditions that generate a ‘good’ climate.

Disease prevention is a cornerstone of herd management for minimizing preweaning calf mortality. However, scientific evidence about the usefulness of practices in herds is scarce. The first objective was for a group of veterinarians to determine which practices are most useful considering their effectiveness, ease of implementation, and economic feasibility. A second objective was for them to define which practices should be included in a tool to facilitate discussions between producers and veterinarians. Expert opinions and consensus were determined using a modified Delphi approach. During two questionnaire rounds, participants scored the effectiveness, ease of implementation, and economic feasibility of each practice. Overall scores for each practice were calculated, and feedback reports were sent to participants between rounds showing the groups’ median responses. Consensus on which practices should be included in the tool was targeted during the workshops. Twelve veterinary experts participated. Administering clostridial vaccines and providing calves with colostrum in case they had not nursed were considered practices that were ‘always useful for all herds’. However, most practices had intermediate levels of usefulness, and among these, antibiotics were considered the least useful. Nevertheless, all practices discussed during the workshops attained a consensus about being included in the future tool to facilitate on-farm discussions.

ObjectivesThe objectives of this study were to (i) evaluate the prevalence of pre-iridal monocellular and fibrovascular membranes in canine globes affected with congenital glaucoma associated with anterior segment dysgenesis (ASD), primary glaucoma associated with goniodysgenesis (GD), and secondary glaucoma, and (ii) examine the associations between monocellular and fibrovascular membranes by breed, gender, age and histopathologic ocular changes on light microscopic examination.MethodsRecords of dogs who had eyes enucleated due to blindness and uncontrolled glaucoma were reviewed. Glaucoma was categorized clinically and histologically into three groups: congenital/ASD, primary/GD, and secondary glaucoma. The presence or absence and type of pre-iridal membrane (monocellular or fibrovascular) and other intraocular histologic findings were reviewed and compared statistically for each group.ResultsIn total, 108 canine globes (101 dogs) were included. Pre-iridal monocellular membranes were identified with light microscopy in 10 out of 19 congenital/ASD, 29 out of 40 primary, and 23 out of 49 secondary glaucoma globes. Fibrovascular membranes were observed in 3 out of 19 congenital/ASD, 9 out of 40 in primary, and 24 out of 49 secondary glaucoma globes. There were no associations between the type of membrane and breed, gender, or age. Peripheral anterior synechiae were more common in globes with fibrovascular membranes, and uveal atrophy was more common in globes with monocellular membranes.ConclusionPre-iridal monocellular membranes are common in all types of canine glaucoma. They are identified with light microscopy most easily in cases of primary glaucoma, and they are masked by pre-iridal fibrovascular membranes in other forms of glaucoma.

Acute esophageal necrosis (AEN) or black esophagus is a rare cause of mortality in patients with gastrointestinal bleeding. We present a case of a 54-year-old female who presented with diabetic ketoacidosis (DKA) and developed melena eventually attributed to AEN. The esophagogastroduodenoscopy (EGD) identified severe inflammation with black discoloration consistent with acute esophageal necrosis in the middle and lower esophagus. The patient was managed with intravenous pantoprazole and total parenteral nutrition (TPN) until she was able to tolerate an adequate diet. Black esophagus should be added to the differential diagnosis of patients with DKA who develop gastrointestinal bleeding. This need is stressed by the fact that early treatment is essential to reducing complications and mortality associated with the condition.

In 2010, Kh. Hessami Pilehrood and T. Hessami Pilehrood introduced generating function identities used to obtain series accelerations for values of Dirichlet's $\beta$ function, via the Markov--Wilf--Zeilberger method. Inspired by these past results, together with related results introduced by Chu et al., we introduce a variety of hypergeometric recurrences. We prove these recurrences using the WZ method, and we apply these recurrences to obtain series acceleration identities. We introduce a family of summations generalizing a Ramanujan-type series for $\frac{1}{\pi^2}$ due to Guillera, and a family of summations generalizing an accelerated series for Catalan's constant due to Lupa\c{s}, and many related results.

In the secondary metals refining processes, vacuum arc remelting (VAR) and electroslag remelting (ESR), the consumable electrode is commonly produced by vacuum induction melting (VIM) which employs the regrettably primitive casting technique of simply pouring into the open top of the mold. Despite the vacuum, the resulting oxidizing conditions and the immensely powerful turbulence accompanying the top-pouring of the electrode is now known to create a substantial density of serious cracks. The cracks in the cast electrode are bifilms (double oxide films), which in turn are proposed to be responsible for the major faults of the VAR ingot, including undetectable, horizontal macroscopic cracks, white spots (clean and dirty varieties) and in-fallen crown. The remedial action to solve all these issues at a stroke is the provision of a counter-gravity cast electrode, cast in air or vacuum, or provision of any similar electrode substantially free from bifilm defects. The ESR process is also described, explaining the reasons for its significantly reduced sensitivity to the top-poured VIM electrode, but indicating that with an improved electrode, this already nearly reliable process has the potential for perfect reliability. The target of this critical overview is an assessment of the potential of these secondary refining processes to produce, for the first time, effectively defect-free metals, metals we can trust.

Objectives: We aimed to evaluate the quality of currently available health apps for prevention of type 2 diabetes among Asian Indians using validated rating scales. Materials and Methods: Using the keywords, “diabetes prevention,” “healthy lifestyle,” and “fitness,” a total of 1486 apps available in India via Google Play were assessed for eligibility by two independent reviewers. After initial screening using specific inclusion and exclusion criteria, 50 apps underwent a pre-specified rating based on user reviews, number of downloads, and app size. Sixteen apps that scored ≥ 9 were shortlisted for further review using the Mobile App Rating Scale (MARS). The mean MARS scores (for categories I and II) were used to identify the top ranked apps. Results: The mean score for Category I of MARS rating was highest for “Google Fit: Health and Activity Tracking” (4.55/5). This was followed by “Healthifyme—Diet Plan, Health, and Weight Loss” (4.45/5). For Category II of MARS, “Diabetes M,” “Google Fit: Health and Activity Tracking,” “Calorie Counter—My Fitness Pal,” and “Healthifyme—Diet Plan, Health, and Weight Loss” all scored equally well. On comparing the advantages and disadvantages of each of these applications, “Google Fit: Health and Activity Tracking” and “Healthifyme—Diet Plan, Health, and Weight Loss” again ranked the best. Conclusion: Our review identifies two commercially available apps “Google Fit: Health and Activity Tracking” and “Healthifyme—Diet Plan, Health, and Weight Loss” as being user friendly and good quality. Although encouraging, further research is needed to evaluate the efficacy of these apps for the prevention of diabetes.

Introduction BCG vaccination modulates immune responses to unrelated pathogens. This off-target effect could reduce the impact of emerging pathogens. As a readily available, inexpensive intervention that has a well-established safety profile, BCG is a good candidate for protecting healthcare workers (HCWs) and other vulnerable groups against COVID-19.Methods and analysis This international multicentre phase III randomised controlled trial aims to determine if BCG vaccination reduces the incidence of symptomatic and severe COVID-19 at 6 months (co-primary outcomes) compared with no BCG vaccination. We plan to randomise 10 078 HCWs from Australia, The Netherlands, Spain, the UK and Brazil in a 1:1 ratio to BCG vaccination or no BCG (control group). The participants will be followed for 1 year with questionnaires and collection of blood samples. For any episode of illness, clinical details will be collected daily, and the participant will be tested for SARS-CoV-2 infection. The secondary objectives are to determine if BCG vaccination reduces the rate, incidence, and severity of any febrile or respiratory illness (including SARS-CoV-2), as well as work absenteeism. The safety of BCG vaccination in HCWs will also be evaluated. Immunological analyses will assess changes in the immune system following vaccination, and identify factors associated with susceptibility to or protection against SARS-CoV-2 and other infections.Ethics and dissemination Ethical and governance approval will be obtained from participating sites. Results will be published in peer-reviewed open-access journals. The final cleaned and locked database will be deposited in a data sharing repository archiving system.Trial registration ClinicalTrials.gov NCT04327206

Riparian taxa are subject to dynamic, intense, flood‐related stressors, and have evolved traits to persist in this environment. Climate change‐induced intensification of flood regimes pose a threat to these ecosystems, and little is understood about their resilience to this intensification. Following two consecutive major floods (the first flood record‐breaking) along the subtropical coast of eastern Australia in March 2022, we used methods based on persistence (resprouting, seedling recruitment), and floristic structure (height, DBH) and assemblage, to assess the resilience of an old growth riparian rainforest to severe flooding in the 12‐month post‐flooding window. Smallerwoody plants (stems <10 m tall, <30 cm DBH) were the most impacted and were significantly impacted by flooding. Native species richness and plant density (plants/m−2) significantly decreased between before and 3 months post‐flooding, after which they continued to significantly increase to surpass pre‐flood values. Overall, ~35% of taxa exhibited resprouting, ~28% of taxa exhibited seedling recruitment, and ~11% exhibited both resprouting and recruitment. An additional ~21% native taxa were introduced to the site via seedling recruitment, along with 65 invasive species. Model‐based multivariate analysis showed flooding significantly altered community floristics (p = 0.026) at 3 months. At 12 months post‐flooding the community was recovering, becoming more floristically similar to its pre‐flood composition. The riparian rainforest exhibited high resilience to intense flooding. Impact, persistence, and resilience varied amongplots, and the community took 12 months to move into recovery. We found that persistence, and floristic structure and composition weighted against impact were effective measures of ecosystem resilience. In the absence of further consecutive events, mature‐phase riparian rainforests are likely to be structurally and floristically resilient to climate change‐induced amplification of flood regimes. Further studies should build on this framework to include invasive weed species impacts, for a more accurate assessment of impacts. [ABSTRACT FROM AUTHOR]

Abstract Without proper control of numerical and methodological errors in theoretical predictions at the per mille level it is not possible to study the effect of input parameters in current hadron-collider measurements at the required precision. We present the new version of the parton-level code MCFM-9.0 that achieves this requirement through its highly-parallelized nature, significant performance improvements and new features. An automatic differential jettiness slicing cutoff extrapolation is introduced to assess the cutoff dependence of all results, thus ensuring their reliability and potentially improving fixed- cutoff results by an order of magnitude. The efficient differential study of PDF uncertainties and PDF set differences at NNLO, for multiple PDF sets simultaneously, is achieved by exploiting correlations. We use these improvements to study uncertainties and PDF sensitivity at NNLO, using 371 PDF set members. The work described here permits NNLO studies that were previously prohibitively expensive, and lays the groundwork necessary for a future implementation of NNLO calculations with a jet at Born level in MCFM.

Abstract Background While existing psychological treatments for depression are effective for many, a significant proportion of depressed individuals do not respond to current approaches and few remain well over the long-term. Anhedonia (a loss of interest or pleasure) is a core symptom of depression which predicts a poor prognosis but has been neglected by existing treatments. Augmented Depression Therapy (ADepT) has been co-designed with service users to better target anhedonia alongside other features of depression. This mixed methods pilot trial aims to establish proof of concept for ADepT and to examine the feasibility and acceptability of a future definitive trial evaluating the clinical and cost-effectiveness of ADepT, compared to an evidence-based mainstream therapy (Cognitive Behavioural Therapy; CBT) in the acute treatment of depression, the prevention of subsequent depressive relapse, and the enhancement of wellbeing. Methods We aim to recruit 80 depressed participants and randomise them 1:1 to receive ADepT (15 weekly acute and 5 booster sessions in following year) or CBT (20 weekly acute sessions). Clinical and health economic assessments will take place at intake and at 6-, 12-, and 18-month follow-up. Reductions in PHQ-9 depression severity and increases in WEMWBS wellbeing at 6-month assessment (when acute treatment should be completed) are the co-primary outcomes. Quantitative and qualitative process evaluation will assess mechanism of action, implementation issues, and contextual moderating factors. To evaluate proof of concept, intake-post effect sizes and the proportion of individuals showing reliable and clinically significant change on outcome measures in each arm at each follow-up will be reported. To evaluate feasibility and acceptability, we will examine recruitment, retention, treatment completion, and data completeness rates and feedback from patients and therapists about their experience of study participation and therapy. Additionally, we will establish the cost of delivery of ADepT. Discussion We will proceed to definitive trial if any concerns about the safety, acceptability, feasibility, and proof of concept of ADepT and trial procedures can be rectified, and we recruit, retain, and collect follow-up data on at least 60% of the target sample. Trial registration ISCRTN85278228, registered 27/03/2017

There is significant evidence from light metals that turbulence in casting leads to bifilm defects; enfolded, doubled-over oxide films which act like cracks in the liquid, and are inherited as cracks by the solid. This population of introduced cracks is now known to significantly influence the tensile failure behaviour of light alloys. There is evidence that analogous defects exist in steels. This paper examines the possibility that bifilms may control the hot ductility of TWIP and TRIP steels, and therefore the problems of straightening during continuous casting. Techniques for overcoming these problems are indicated.

Bee pollinators are key components of terrestrial ecosystems. Evidence is mounting that bees are globally in decline, and species with a higher degree of specialization are the most vulnerable to local extinction. However, ecological features that could explain bee specialization remain poorly tested, especially in tropical species. Here, we aim to determine the most specialized bee species and their associated ecological traits in tropical plant–bee interaction networks, answering three questions: (1) Which bees in the interaction networks are specialists? (2) Is body size related to their role as specialists in interaction networks? (3) Are there phylogenetic relationships between the bee species identified as specialists? We used fifteen quantitative plant–bee interaction networks from different Brazilian biomes covering 1,702 interactions (386 bee and 717 plant species). We used the normalized degree (standardized number of partners) as a metric to determine trophic specialization of bee species. Body size was estimated by measuring intertegular distance (ITD), i.e., the distance between the bases of the wings on the thorax. Evolutionary distinctiveness (ED) was used to quantify species uniqueness, i.e., the singularity of species in the phylogenetic tree. Relationships between dietary specialism, ITD and ED were assessed using generalized linear models. We detected 34 specialist bee species (9% of total species), distributed in 13 genera, and four families. ITD and ED were important variables explaining the specialization of tropical bee species. Specialists were larger and less phylogenetically distinct than expected by chance. Based on a large data set covering some of the main tropical biomes, our results suggest that loss of specialist bees from Brazilian plant–bee networks could have deleterious consequences for native plant species preferentially pollinated by large-bodied bees. Moreover, by affecting more evolutionarily distinct species, i.e., those with fewer extant relatives, the loss of specialist bees will likely affect few clades but can result on considerable loss of evolutionary history and phylogenetic diversity in the Brazilian bee communities. The results are important for decision-making concerning conservation measures for these species and may also encourage the development of sustainable management techniques for bees.