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Summary Background. The aim of this study was to evaluate the process of an innovative `presentation with discussion' approach to the Director of Public Health's (DPH) annual report for North Derbyshire Health Authority. Study design. Mixed methods-survey and interviews. Methods. Survey methods were used to obtain qualitative and quantitative data. Key stakeholders were sent a postal questionnaire, individuals attending presentations could respond via a printed slip or Letter, structured group discussions following presentations were recorded manually, and presenters and producers were interviewed. Results. Thirty-five of 41 (85.4%) key stakeholders returned questionnaires, 18 people responded individually, discussions following 26/30 (86.7%) presentations were documented, and all eight presenters and 11 producers were interviewed. The general response was extremely positive with 25 of 35 (71 %) key stakehotders, 100% of presenters and 80% of producers preferring the new format to the previous year's report. People felt that it conveyed the public health message effectively, and appreciated the opportunity to contribute to the recommendations for improving health in North Derbyshire. Many were concerned that the circulation should be wide, and key stakeholders were keen to have a printed reference document to support their work. Presenters enjoyed the process although tailoring the presentations to unfamiliar audiences proved difficult. The production team found the process more efficient and focused, although direct production costs were increased. Presenters and producers were concerned that the process for implementing recommendations for action was not fully considered. Conclusions. Most people preferred this innovative approach to the traditional annual report, and it is therefore recommended that this format should be used for future DPH annual reports. Key stakeholders still require a reference document, and presenters' briefing notes could be adapted for this purpose. Circulation of the report should be wide, and further consideration of how participants' recommendations for action are implemented is needed. [ABSTRACT FROM AUTHOR]

Abstract Background Previous studies have shown influenza vaccine uptake in UK nursing home residents to be low. Very little information exists regarding the uptake of pneumococcal vaccine in this population. The formulation of policies relating to the vaccination of residents has been proposed as a simple step that may help improve vaccine uptake in care homes. Methods A postal questionnaire was sent to matrons of all care homes with nursing within the Greater Nottingham area in January 2006. Non respondents were followed up with up to 3 phone calls. Results 30% (16/53) of respondents reported having a policy addressing influenza vaccination and 15% (8/53) had a policy addressing pneumococcal vaccination. Seasonal influenza vaccine coverage in care homes with a vaccination policy was 87% compared with 84% in care homes without a policy (p = 0.47). The uptake of pneumococcal vaccination was found to be low, particularly in care homes with no vaccination policy. Coverage was 60% and 32% in care homes with and without a vaccination policy respectively (p = 0.06). This result was found to be statistically significant on multivariate analysis (p = 0.03, R = 0.46) Conclusion The uptake of influenza vaccine among care home residents in the Nottingham region is relatively high, although pneumococcal vaccine uptake is low. This study shows that there is an association between pneumococcal vaccine uptake and the existence of a vaccination policy in care homes, and highlights that few care homes have vaccination policies in place.

Background: Previous studies have shown influenza vaccine uptake in UK nursing home residents to be low. Very little information exists regarding the uptake of pneumococcal vaccine in this population. The formulation of policies relating to the vaccination of residents has been proposed as a simple step that may help improve vaccine uptake in care homes.Methods: A postal questionnaire was sent to matrons of all care homes with nursing within the Greater Nottingham area in January 2006. Non respondents were followed up with up to 3 phone calls.Results: 30% (16/53) of respondents reported having a policy addressing influenza vaccination and 15% (8/53) had a policy addressing pneumococcal vaccination. Seasonal influenza vaccine coverage in care homes with a vaccination policy was 87% compared with 84% in care homes without a policy (p = 0.47). The uptake of pneumococcal vaccination was found to be low, particularly in care homes with no vaccination policy. Coverage was 60% and 32% in care homes with and without a vaccination policy respectively (p = 0.06). This result was found to be statistically significant on multivariate analysis (p = 0.03, R = 0.46)Conclusion: The uptake of influenza vaccine among care home residents in the Nottingham region is relatively high, although pneumococcal vaccine uptake is low. This study shows that there is an association between pneumococcal vaccine uptake and the existence of a vaccination policy in care homes, and highlights that few care homes have vaccination policies in place. [ABSTRACT FROM AUTHOR]

Objectives: Expanding delivery of oral pre-exposure prophylaxis (PrEP) to community pharmacies could improve access, aligning well with the UK government's goals to eliminate new HIV acquisitions by 2030. Using the Capability, Opportunity, Motivation, Behaviour (COM-B) model for behaviour change, the aim of this research was to explore the barriers and facilitators of community pharmacy PrEP delivery, for pharmacists and community members., Methods: Community members at elevated risk of acquiring HIV and community pharmacists were recruited to participate in semi-structured interviews. Interviews were recorded, transcribed, and thematically analysed within the framework of the COM-B model., Results: 17 interviews with pharmacists (pharmacy owners n=7; employed pharmacists n=6; locums n=4) and 24 with community members (black African women n=6; other women n=2; young adults aged 18-25 years n=6; transgender people n=6; female sex workers n=4) were carried out. Capability barriers included suboptimal awareness and knowledge of PrEP, pharmacy facilities and pharmacist roles in delivering public health services. Opportunity barriers included a lack of staff capacity, privacy and pharmacy screening and monitoring facilities. Motivational barriers included a concern that increased access could increase sexually transmitted infections and involve a financial cost. Capability facilitators included awareness raising, HIV and PrEP training and education. Opportunity facilitators included PrEP appointments and the accessibility of pharmacies. Motivational facilitators included a preference for pharmacy delivery over other models (eg, sexual health, General Practitioner (GP)), and a belief that it would be discrete and less stigmatising., Conclusion: Pharmacy PrEP delivery is acceptable but for it to be feasible, results point to the need for the development of a behaviour change intervention focusing on education, training and awareness raising, targeting pharmacists and community members to stimulate patient activation and de-stigmatise HIV. This intervention would need to be facilitated by system and environmental changes (eg, commissioning service)., Competing Interests: Competing interests: RH-S is an employee of Gilead Sciences., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Tripartite ATP-independent periplasmic (TRAP) transporters are analogous to ABC transporters in that they use a substrate-binding protein to scavenge metabolites (e.g., N-acetylneuraminate) and deliver them to the membrane components for import. TRAP substrate-binding proteins are thought to bind the substrate using a two-state (open and closed) induced-fit mechanism. We solved the structure of the TRAP N-acetylneuraminate substrate-binding protein from Aggregatibacter actinomycetemcomitans (AaSiaP) in both the open ligand-free and closed liganded conformations. Surprisingly, we also observed an intermediate conformation, where AaSiaP is mostly closed and is bound to a non-cognate ligand, acetate, which hints at how N-acetylneuraminate binding stabilizes a fully closed state. AaSiaP preferentially binds N-acetylneuraminate (K D  = 0.4 μM) compared to N-glycolylneuraminate (K D  = 4.4 μM), which is explained by the closed-N-acetylneuraminate bound structure. Small-angle X-ray scattering data alongside molecular dynamics simulations suggest the AaSiaP adopts a more open state in solution than in a crystal. However, the open unliganded conformation can also sample closed conformations. Molecular dynamics simulations also demonstrate the importance of water molecules for stabilizing the closed conformation. Although our data is consistent with an induced fit model of binding, we suggest that the open unliganded conformation may sample multiple states capable of binding substrate. The mechanism by which the ligand is released for import remains to be determined., Competing Interests: Conflict of interest The authors declare that they have no conflicts of interest with the contents of this article., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Health and care staff have limited opportunities to design, deliver and lead critical enquiry activities., Aims: To explore barriers and enablers of building capacity, capability and confidence of these practitioners who wish to undertake critical enquiry activity., Methods: A realist conceptual framework including the development of middle range theory allowed analysis of the scholarship process and outcomes. Data were collected through snap surveys, interviews (face to face and online) and project output (posters)., Results: Nine scholars completed the programme and all participated in the study. They all experienced an increase in capacity, capability and confidence in critical enquiry activity. Six overarching themes arose from analysis of the interviews and snap survey data: value; expertise; attitudes; meaningful, responsive support; brain space; and skill and knowledge acquisition., Discussion: A combined focus on people and project while staff remained embedded in their work area was key for the growth of skills and knowledge and creating impact from projects. Guilt at having dedicated time to take part in the programme was a self-imposed barrier to building capacity and capability. Social capital (gained from bringing together individuals from different groups with shared values) facilitated bonding, which increased psychological safety and helped enable capability and confidence., Conclusion: The combination of theory and practice embedded in a real-world context led to positive outcomes for staff, patients, carers and the facilitation team as real-life changes were made in clinical environments.

Introduction: Traditionally, wards in acute care hospitals consist predominately of multioccupancy bays with some single rooms. There is an increasing global trend towards a higher proportion of single rooms in hospitals, with the UK National Health Service (NHS) advocating for single-room provision in all new hospital builds. There is limited evidence on the impact of a ward environment incorporating mostly single and some multioccupancy bays on patient care and organisational outcomes., Methods and Analyses: This study will assess the impact of a newly designed 28-bedded ward environment, with 20 single rooms and two four-bedded bays, on patient and staff experiences and outcomes in an acute NHS Trust in East England. The study is divided into two work packages (WP)-WP1 is a quantitative data extraction of routinely collected patient and staff data while WP2 is a mixed-methods process evaluation consisting of one-to-one, in-depth, semistructured interviews with staff, qualitative observations of work processes on the ward and a quantitative data evaluation of routinely collected process evaluation data from patients and staff., Ethics and Dissemination: Ethical approval was obtained from the UK Health Research Authority (IRAS ID: 334395). Study findings will be shared with key stakeholders, published in peer-reviewed high-impact journals and presented at relevant conferences., Competing Interests: Competing interests: This study is funded by James Paget University Hospitals NHS Foundation Trust and some members of the research team namely ES, HA, HH, JC and PM are Trust employees with whom Staffordshire University team collaborated to facilitate data collection and access. The authors declare that they have no other competing interests., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To report the development, implementation, acceptability and feasibility of vending machines offering HIV and sexually transmitted infection (STI) testing kits., Design: A qualitative study using the Person-Based Approach with patient and public involvement workshops and stakeholder involvement and interviews with machine users, sexual health service (SHS) staff, venue staff and local authority sexual health commissioners. Transcripts were analysed thematically., Setting: Bristol, North Somerset and South Gloucestershire (BNSSG)., Participants: 15 machine users, 5 SHS staff, 3 venue staff and 3 local authority commissioners., Intervention: Four vending machines dispensing free HIV self-testing and STI self-sampling kits in publicly accessible venues across BNSSG were introduced to increase access to testing for groups at higher risk of HIV and STI infection who are less likely to access SHS clinic testing services (young people, people from black communities, and gay, bisexual and other men who have sex with men)., Results: Machine users reported the service was convenient, easy to use and accessible; however, concerns regarding privacy related to machine placement within the venues and issues of maintenance were raised. Promotional material was inclusive and informative; however, awareness of the service through the promotional campaign was limited. Vending machines were acceptable to venue staff once clear processes for their management were agreed with the SHS. SHS staff identified challenges with the implementation of the service related to the limited involvement of the whole SHS team in the planning and development., Conclusions: The codeveloped vending machine service was acceptable, addressing some barriers to testing. Resources and protected staff time are needed to support greater involvement of the whole SHS team and service providers in venues. Adopting a similarly robust coproduction approach to the implementation of the machines could avoid the challenges reported. The placement of the machines to assure users privacy and repeated, targeted promotion could encourage service use among target groups., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Pre-exposure prophylaxis (PrEP) is an effective medication to reduce the risk of acquiring HIV. PrEP is available free of charge in the UK from sexual health clinics. Expanding PrEP delivery to community pharmacies holds promise and aligns with UK government goals to eliminate new cases of HIV by 2030. The aim of this scoping review was to describe the existing evidence about the barriers to and facilitators of community pharmacy oral PrEP delivery, for pharmacists and pharmacy clients, as aligned with the Capacity Opportunity, Motivation Behaviour (COM-B) Model., Methods: Five bibliographic and five review databases were searched from inception to August 2023. Literature of any study design was included if it discussed barriers and facilitators of community pharmacy PrEP delivery. Trial registrations, protocols and news articles were excluded., Results: A total of 649 records were identified, 73 full texts were reviewed and 56 met the inclusion criteria, predominantly from high-income/westernized settings. Most of the included literature was original research (55%), from the United States (77%) conducted during or after the year 2020 (63%). Barriers to PrEP delivery for pharmacists included lack of knowledge, training and skills (capability), not having the necessary facilities (opportunity), concern about the costs of PrEP and believing that PrEP use could lead to risk behaviours and sexually transmitted infections (motivation). Facilitators included staff training (capability), time, the right facilities (opportunity), believing PrEP could be a source of profit and could reduce new HIV acquisitions (motivation). For clients, barriers included a lack of PrEP awareness (capability), pharmacy facilities (opportunity) and not considering pharmacists as healthcare providers (motivation). Facilitators included awareness of PrEP and pharmacist's training to deliver it (capability), the accessibility of pharmacies (opportunity) and having an interest in PrEP (motivation)., Discussion: To effectively enhance oral PrEP delivery in UK community pharmacies, the identified barriers and facilitators should be explored for UK relevance, addressed and leveraged at the pharmacy team, client and care pathway level., Conclusions: By comprehensively considering all aspects of the COM-B framework, community pharmacies could become crucial providers in expanding PrEP accessibility, contributing significantly to HIV prevention efforts., (© 2024 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.)

Objectives: Prompt HIV and STI diagnosis and treatment is a public health priority and relies on accessible testing. Technology-based approaches to distribute test kits have the potential to increase access to testing. We evaluated the acceptability and uptake of vending machines in publicly available settings in Brighton and Hove (BH) and Bristol, North Somerset and South Gloucestershire (BNSSG), to distribute HIV rapid self-test and STI self-sample kits., Methods: Seven machines were installed in BH and four in BNSSG. User characteristics, proportion of kits returned and test results, taken from the machine database and clinic records, combined with online questionnaires completed by self-recruited users and analysed using Stata and SPSS., Results: 2536 kits were dispensed over 12 months (April 2022 to March 2023). The STI self-sample kits were most popular (74% of vends). 78% of kits dispensed were among users aged 16-35 years and 56% identified as male. 68% and 59% of users had either not tested in the last 12 months or never tested for HIV and STIs, respectively. 51% of STI kits were returned via post, lower than the local online service (65%). 208 users completed questionnaires. Convenience, desire for instant access and increased confidentiality were the most common reasons for using machines. 92% of respondents thought the machines were user-friendly and 97% would recommend the service. Concerns about safety and privacy while using the machine were reported by 42% and 66% of respondents., Conclusions: This study demonstrates that vending machines are an acceptable and effective means of accessing infrequent or never testers in the general population and can act as a horizontal intervention to tackle HIV and STIs. Research is needed to understand optimal machine locations to assure privacy and safety along with the long-term impact on sexual health services., Competing Interests: Competing interests: JK and JH are partly funded by NIHR ARC West and NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation. SDenford's time is supported by the NIHR HPRU in Behavioural Science and Evaluation., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Previous embedded researcher models have focused predominantly on an individual being a temporary team member and embedded for a project-limited short-term placement., Aim: To develop an innovative research capacity building model to address the challenges of developing, embedding and sustaining, research led by Nurses, Midwives, and Allied Health Professionals (NMAHPs) in complex clinical environments. This healthcare and academic research partnership model offers an opportunity to support the 'how' of enabling NMAHP research capacity building from within the researchers' clinical area of expertise., Method: Collaboration between three healthcare and academic organisations and the iterative process of cocreation, development and refinement took place over 6 months during 2021. The collaboration relied on virtual meetings, emails, telephone calls and document review., Results: A codesigned NMAHP embedded research (ER) model is ready for trialling with the individual being an existing clinician working collaboratively within the healthcare setting and with academia to develop the skills to become the ER., Conclusion: This model supports NMAHP-led research activity in clinical organisations in a visible and manageable way. As a shared, long-term vision, the model will contribute to research capacity and capability of the wider healthcare workforce. It will lead, facilitate and support research in and across clinical organisations in collaboration with higher education institutions., Competing Interests: Competing interests: CLW and LT are National Institute for Health Research (NIHR) '70@70' senior nurse and midwife research leaders. The views expressed in this article are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Patient and public involvement (PPI) can be used in methods research, as well as applied research, in health economics. However, methods research goals may seem quite abstract when compared to the lived experiences of lay participants. This article draws on 4 years of PPI in a research project to develop methods for including family carer outcomes in economic evaluation. Key challenges in using PPI for health economics methods research relate to (1) training and preparation, (2) maintaining involvement, and (3) selecting suitable tasks. We suggest three criteria for selecting a research task for PPI input based on task importance, professional researcher skills gap, and potential PPI contribution.

Background: Business cases are used to provide a structured justification in favour of investing in new projects, services or interventions. Despite the use of business cases in determining how limited resources will be allocated within England's National Health Service (NHS), guidance concerning how to develop and evaluate business cases in the context of healthcare is inconstant and of varying relevance. This study aimed to develop a new framework of quality indicators for healthcare-related business cases by analysing the content of expert guidance documents and a sample of NHS business cases., Methods: Qualitative document analysis was conducted on guidance documents (n = 7) and existing NHS business case documents (n = 18). Documents were purposefully sampled using criteria to ensure the framework reflected a diverse spread of expert opinion, and a varied sample of example business cases from current practice. Data were analysed using thematic and content analysis, and are presented in a visualised framework., Results: Seven themes were identified within the qualitative document analysis (purpose, strategic priorities, options, benefits, costs, risks and evaluation). These themes were described and presented with a framework of quality indicators for healthcare-related business cases., Conclusion: To ou`r knowledge, this is the first framework of business case quality indicators designed specifically for use in a healthcare context. The framework presented in this study has implications for how business cases are developed and evaluated by decision makers. In the future it would be beneficial to investigate how the framework could be used in practice as a tool for critical appraisal.

Six trained men 21-38 yrs old ran 19-29 km (1.5 to 2.5 hrs) approximately 75% of their VO2 max on a level treadmill in the heat (33.5/21.5 degrees C db/wb, wind velocity 36 m/min). Every 20 min while running they (a) drank 200 ml of 10 degrees C water, (b) drank 200 ml of water at core body temperature, or (c) sponged their faces, arms, and trunks for 2 min with a towel soaked in 10 degrees C water. In another series of experiments each subject (d) hydrated 30 min before the run by drinking 1 liter of water, (e) hydrated and performed (a) above, and (f) hydrated and performed (b) above. Rectal temperature (Tre) and body weight loss (WL) were determined every 30 min and metabolism at 45 min of running. Terminal Tre after (a) through (f) averaged 39.1, 39.3, 39.9, 39.7, 39.1, and 39.3 degrees C respectively. During a control run the corresponding mean Tre was 39.9 degrees C. In a 66.7 kg man with a body weight/surface area (BW/SA) ratio of 37.5 and running at 74% of his VO2 max, Tre rose 0.4 degrees C/1% WL with increasing WL's greater than 2.0% of his initial body weight regardless of the intervention imposed. In another subject weighing 70 kg with a BW/SA ratio of 38.8 and running at 83% of his VO2 max, Tre rose 0.49 degrees C/1% WL over the entire range of WL's.(ABSTRACT TRUNCATED AT 250 WORDS)