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Background Self-harm in young people is a growing concern and reducing rates a global priority. Rates of self-harm documented in general practice have been increasing for young people in the UK in the last two decades, especially in 13–16-year-olds. General practitioners (GPs) can intervene early after self-harm but there are no effective treatments presently available. We developed the GP-led COPING intervention, in partnership with young people with lived experience and GPs, to be delivered to young people 16–25 years across two consultations. This study aims to examine the feasibility and acceptability of conducting a fully powered effectiveness trial of the COPING intervention in NHS general practice. Methods This will be a mixed-methods external non-randomised before-after single arm feasibility study in NHS general practices in the West Midlands, England. Patients aged 16–25 years who have self-harmed in the last 12 months will be eligible to receive COPING. Feasibility outcomes will be recruitment rates, intervention delivery, retention rates, and completion of follow-up outcome measures. All participants will receive COPING with a target sample of 31 with final follow-up data collection at six months from baseline. Clinical data such as self-harm repetition will be collected. A nested qualitative study and national survey of GPs will explore COPING acceptability, deliverability, implementation, and likelihood of contamination. Discussion Brief GP-led interventions for young people after self-harm are needed to address national guideline and policy recommendations. This study of the COPING intervention will assess whether a main trial is feasible. Registration ISRCTN (ISRCTN16572400; 28.11.2023).

Background Good quality shared decision-making (SDM) conversations involve people with, or at risk of osteoporosis and clinicians collaborating to decide, where appropriate, which evidence-based medicines best fit the person’s life, beliefs, and values. We developed the improving uptake of Fracture Prevention drug treatments (iFraP) intervention comprising a computerised Decision Support Tool (DST), clinician training package and information resources, for use in UK Fracture Liaison Service consultations. Two primary objectives to determine (1) the effect of the iFraP intervention on patient-reported ease in decision-making about osteoporosis medicines, and (2) cost-effectiveness of iFraP intervention compared to usual NHS care. Secondary objectives are to determine the iFraP intervention effect on patient reported outcome and experience measures, clinical effectiveness (osteoporosis medicine adherence), and to explore intervention acceptability, mechanisms, and processes underlying observed effects, and intervention implementation. Methods The iFraP trial is a pragmatic, parallel-group, individual randomised controlled trial in patients referred to a Fracture Liaison Service, with nested mixed methods process evaluation and health economic analysis. Participants aged ≥50 years (n=380) are randomised (1:1 ratio) to one of two arms: (1) iFraP intervention (iFraP-i) or (2) comparator usual NHS care (iFraP-u) and are followed up at 2-weeks and 3-months. The primary outcome is ease of decision-making assessed 2 weeks after the consultation using the Decisional Conflict Scale (DCS). The primary objectives will be addressed by comparing the mean DCS score in each trial arm (using analysis of covariance) for patients given an osteoporosis medicine recommendation, alongside a within-trial cost-effectiveness and value of information (VoI) analysis. Process evaluation data collection includes consultation recordings, semi-structured interviews, and DST analytics. Discussion The iFraP trial will answer important questions about the effectiveness of the new ‘iFraP’ osteoporosis DST, coupled with clinician training, on SDM and informed initiation of osteoporosis medicines. Trial registration ISRCTN 10606407, 21/11/2022 https://doi.org/10.1186/ISRCTN10606407

Objective and Approach They are growing concerns that self-harm and mental health conditions are increasing in university students. This may reflect widening access to higher education, existing population trends or stressors associated with this setting. We linked real-world data from the Higher Education Statistics Agency between 2012-2018 with primary and secondary healthcare records. Students were undergraduates aged 18 to 24 years at university entry. Non-students were pseudo-randomly selected based on an equivalent age distribution. We used regression approach to examine characteristics of students and non-students and their risks of self-harm and mental health conditions before and during university. Results This e-cohort study included 96,760 students and 151,795 non-students. Being male, self-harm and mental-health conditions recorded before university entry, and higher deprivation levels resulted in lower odds of entering university and higher odds of dropout. Risks of self-harm, Autistic Spectrum Disorder (ASD), depression, anxiety, drug misuse, and schizophrenia were lower for students. Risks of self-harm, ASD, ADHD, depression, alcohol misuse and schizophrenia were increasing more in students over time. Older students experienced higher risk of self-harm and mental-health conditions. Younger students were more at risk of alcohol misuse than non-students. Conclusions Mental health conditions in students are common, diverse and they influence their academic outcomes. University students have mental health needs and trajectories that differ from those of the general population. Implications The diversity and complexity of students’ needs require integrated person-centred stepped care approach within universities including triage, access to well-being support, counselling, and referral pathways to mental health services.

Abstract Background Healthcare system data (HSD) are increasingly used in clinical trials, augmenting or replacing traditional methods of collecting outcome data. This study, PRIMORANT, set out to identify, in the UK context, issues to be considered before the decision to use HSD for outcome data in a clinical trial is finalised, a methodological question prioritised by the clinical trials community. Methods The PRIMORANT study had three phases. First, an initial workshop was held to scope the issues faced by trialists when considering whether to use HSDs for trial outcomes. Second, a consultation exercise was undertaken with clinical trials unit (CTU) staff, trialists, methodologists, clinicians, funding panels and data providers. Third, a final discussion workshop was held, at which the results of the consultation were fed back, case studies presented, and issues considered in small breakout groups. Results Key topics included in the consultation process were the validity of outcome data, timeliness of data capture, internal pilots, data-sharing, practical issues, and decision-making. A majority of consultation respondents (n = 78, 95%) considered the development of guidance for trialists to be feasible. Guidance was developed following the discussion workshop, for the five broad areas of terminology, feasibility, internal pilots, onward data sharing, and data archiving. Conclusions We provide guidance to inform decisions about whether or not to use HSDs for outcomes, and if so, to assist trialists in working with registries and other HSD providers to improve the design and delivery of trials.

The potential for biogas provision through household-scale anaerobic digestion in rural sub-Saharan Africa is limited due to perceived water shortages. The most common substrate is animal dung diluted 1:1 with water. Two experimental methods tested the potential of reducing water demand. The first experiment compared the chemical oxygen demand (COD) and volatile solid removal of four cow dung dilutions ranging from 3.5-10.6% total solids. In the second experiment, bioslurry filtrate was recirculated back into the fresh substrate at different concentrations. The highest COD removal rate of 28.3% was obtained from mixing equal volumes of dung with filtrate (mean total solids 7.4%) while the highest methane production rate of 0.40 g/L/day, calculated from COD balance, was obtained from undiluted cow dung (total solids 10.6%). Results suggest the potential for a 75-100% reduction in water demand.

Background Good quality shared decision-making (SDM) conversations involve people with, or at risk of osteoporosis and clinicians collaborating to decide, where appropriate, which evidence-based medicines best fit the person’s life, beliefs, and values. We developed the improving uptake of Fracture Prevention drug treatments (iFraP) intervention comprising a computerised Decision Support Tool (DST), clinician training package and information resources, for use in UK Fracture Liaison Service consultations. Two primary objectives to determine (1) the effect of the iFraP intervention on patient-reported ease in decision-making about osteoporosis medicines, and (2) cost-effectiveness of iFraP intervention compared to usual NHS care. Secondary objectives are to determine the iFraP intervention effect on patient reported outcome and experience measures, clinical effectiveness (osteoporosis medicine adherence), and to explore intervention acceptability, mechanisms, and processes underlying observed effects, and intervention implementation. Methods The iFraP trial is a pragmatic, parallel-group, individual randomised controlled trial in patients referred to a Fracture Liaison Service, with nested mixed methods process evaluation and health economic analysis. Participants aged ≥50 years (n=380) are randomised (1:1 ratio) to one of two arms: (1) iFraP intervention (iFraP-i) or (2) comparator usual NHS care (iFraP-u) and are followed up at 2-weeks and 3-months. The primary outcome is ease of decision-making assessed 2 weeks after the consultation using the Decisional Conflict Scale (DCS). The primary objectives will be addressed by comparing the mean DCS score in each trial arm (using analysis of covariance) for patients given an osteoporosis medicine recommendation, alongside a within-trial cost-effectiveness and value of information (VoI) analysis. Process evaluation data collection includes consultation recordings, semi-structured interviews, and DST analytics. Discussion The iFraP trial will answer important questions about the effectiveness of the new ‘iFraP’ osteoporosis DST, coupled with clinician training, on SDM and informed initiation of osteoporosis medicines. Trial registration: ISRCTN 10606407, 21/11/2022 https://doi.org/10.1186/ISRCTN10606407

People with severe mental illness engage in considerably less physical activity than those without. They also experience premature mortality of around 10-25 years. A large proportion of these premature deaths are attributed to modifiable behaviours, including physical activity. The inpatient environment provides an opportunity to support people to become more physically active; however, there is limited evidence on which interventions are most successful and what contextual factors affect their delivery. A scoping review was conducted to help understand the extent and type of evidence in this area and identify research gaps. We included studies of physical activity correlates and interventions in adult inpatient mental health services published in peer-reviewed journals. Reviews, meta-analyses, and papers focusing on eating disorder populations were excluded. We searched the MEDLINE, CINAHL, PsycINFO, ASSIA and Web of Science databases for relevant studies published in English. We extracted data on study design, participant characteristics, intervention and control conditions, key findings, and research recommendations. We used a descriptive analytical approach and results are presented in tables and figures. Of 27,286 unique records screened, 210 reports from 182 studies were included. Sixty-one studies reported on correlates of physical activity, and 139 studies reported on physical activity interventions. Most intervention studies used a single-group, pre-post design (40%) and included fewer than 100 participants (86%). Ninety percent of interventions delivered physical activity directly to participants, and 50% included group-based sessions. The duration, type, frequency and intensity of sessions varied. Mental health was the most commonly reported outcome (64%), whereas physical activity was rarely an outcome (13%). Overall, there is a modest but growing body of research on physical activity in adult users of inpatient mental health services. More high-quality trials are needed to advance the field, and future research should target neglected intervention types, outcomes, populations and settings.

AbstractPeatlands are a globally important carbon store, but peatland ecosystems from high latitudes to the tropics are highly degraded due to increasingly intensive anthropogenic activity, making them significant greenhouse gas (GHG) sources. Peatland restoration and conservation have been proposed as a nature-based solution to climate change, by restoring the function of peatlands as a net carbon sink, but this may have implications for many local communities who rely on income from activities associated with transformed peatlands, particularly those drained for agriculture. However, without changing the way that humans interact with and exploit peatlands in most regions, peatlands will continue to degrade and be lost. We propose that there are ultimately three potential trajectories for peatland management: business as usual, whereby peatland carbon sink capacity continues to be eroded, responsible agricultural management (with the potential to mitigate emissions, but unlikely to restore peatlands as a net carbon sink), and restoration and conservation. We term this the three-peat challenge, and propose it as a means to view the benefits of restoring peatlands for the environment, as well as the implications of such transitions for communities who rely on ecosystem services (particularly provisioning) from degraded peatlands, and the consequences arising from a lack of action. Ultimately, decisions regarding which trajectories peatlands in given localities will follow torequire principles of equitable decision-making, and support to ensure just transitions, particularly for communities who rely on peatland ecosystems to support their livelihoods.

Abstract Background Land-use is a major driver of changes in biodiversity worldwide, but studies have overwhelmingly focused on above-ground taxa: the effects on soil biodiversity are less well known, despite the importance of soil organisms in ecosystem functioning. We modelled data from a global biodiversity database to compare how the abundance of soil-dwelling and above-ground organisms responded to land use and soil properties. Results We found that land use affects overall abundance differently in soil and above-ground assemblages. The abundance of soil organisms was markedly lower in cropland and plantation habitats than in primary vegetation and pasture. Soil properties influenced the abundance of soil biota in ways that differed among land uses, suggesting they shape both abundance and its response to land use. Conclusions Our results caution against assuming models or indicators derived from above-ground data can apply to soil assemblages and highlight the potential value of incorporating soil properties into biodiversity models.

When digestates from anaerobic digestion of crop residues are added to soil, a considerable body of information indicates that soil organic carbon (SOC) levels are comparable to those when crop residues are left in the field. This occurs although the amount of digestate added to soil is diminished by digestion and implies that digestion increases the proportion of carbon inputs stabilized as SOC. Here we examine the likelihood and implications of these features being manifested for soil application of high lignin-fermentation byproduct (HLFB) from liquid biofuel production. We show that steady-state SOC levels are much less sensitive to crop residue removal with HLFB return than without it, and provide an example supporting the feasibility of foregoing process energy and coproduct revenue when HLFB is returned to the soil. Informed by this review and analysis, we expect with moderate confidence that long-term SOC levels for soils amended with HLFB from some liquid cellulosic biofuel processes will not be substantially lower than those occurring when crop residues are left in the field. We have high confidence that the economically optimum rate of fertilizer nitrogen (N) application and N _2 O emissions will be lower at most sites for HLFB return to the soil than if crop residues were left in the field. We estimate that the per hectare N demand for processing crop residues to liquid biofuels is about a third of the per hectare demand for crop production, giving rise to an opportunity to use N twice and thereby realize cost savings and environmental benefits. These observations support but do not prove the hypothesis that a ‘win-win’ is possible wherein large amounts of liquid biofuel feedstock can be obtained from crop residues while improving the economics and sustainability of food and feed production. A research agenda aimed at exploring and testing this hypothesis is offered.

The volume of municipal solid waste produced in many cities in low to middle income countries exceeds the capacity of handling facilities causing environmental and health risks. This study provides the most comprehensive analysis to date of municipal solid waste to energy options for Abuja, Nigeria. We use most recently available data on waste generation from Abuja municipal authorities, integrated with secondary data from the literature. This is combined with standard relationships between waste composition and energy production to compare the potential for thermochemical conversion and anaerobic digestion to meet the energy requirement of Abuja. In addition, we use assumptions about digestate production and nitrogen release to estimate the potential production of organic fertilizer from digestate. The organic fraction of municipal solid waste from Abuja [7.1 × 107 (±4 × 106) kg y−1] has potential to produce 3.6 × 106 (±2 × 105) m3 y−1 biogas. This could provide 7.8 × 103 (±4 × 102) MWh y−1 electricity, equivalent to 8% of annual electricity requirement in Abuja, 4.0 × 107 (±2 × 106) MJ y−1 heat, and 5.3 × 105 (±3 × 104) kg y−1 digestate use as bio-fertilizer from organic fraction only. Potential power generation by thermochemical conversion for combined heat and electricity is much greater, 7.73 × 104 (±4 × 103) MWh y−1, equivalent to 83% of power requirement in Abuja, but does not produce bio-fertilizer. Using the organic fraction for anaerobic digestion and the remaining waste for thermochemical conversion provides combined heat and energy that is 91.5% of Abuja power requirements, while also producing digestate. Barriers to implementation include informal waste recyclers with poor collection and handling procedures, absence of public education, weak environmental policies and lack of funding. There is a need for periodic review of policies and waste legislation to create a circular economy in Abuja.

Anaerobic digestate is proposed as an alternative to inorganic fertilisers, but a better understanding of how anaerobic digestates impact the soil and how plant growth is influenced is needed for wider acceptance. In this study, a series of pot experiments were conducted growing spring barley (Hordeum vulgare L.) in a range of soils with the application of digestate or synthetic fertiliser. Two application rates corresponding to total nitrogen at 120 and 480 kg ha−1 were used together with unfertilised soil as a control. Growth characteristics were measured as plant height, number of tillers, straw biomass, grain biomass and total biomass. Most growth characteristics (tillering, and straw and grain yield) increased with increasing application rates of nitrogen. An increase of 7–20% in plant height was observed with anaerobic digestate compared to synthetic fertilisers. However, results differed depending on the source of digestate and soil type. The nitrogen balance index (the ratio of the chlorophyll to polyphenolic compounds, which is linked to the nitrogen status of the crop) showed an increase of 40–50% for digestate applied at a nitrogen rate of 480 kg ha−1 compared to the control. By measuring nitrogen as ammonium, nitrate and nitrite in the different soils over 35 days, differential nitrogen release was also demonstrated, with soil water concentrations of ammonium decreasing rapidly after an early peak in all the treatments, and nitrate peaking after days 3–4. Results suggest that digestate may be used to replace synthetic fertilisers when applied in a range of soils.

The aim of this paper is to quantify the impact of incorporating biochar into soils on net nitrogen waste from farming systems in India. It assumes only crop residues that are currently burnt in the fields are used to produce biochar. It accounts for losses of nitrogen occuring during pyrolysis, and the potential savings due to capture of reactive nitrogen from other parts of the farming system and from industry and energy sectors. In 2020, this could have been used to capture up to 67% of the nitrogen lost as nitrogen oxides and ammonia from the energy, industry and farming sectors. This is equivalent to 31% of the nitrogen that was applied as fertilisers and so could be an important tool in efforts to meet the United Nations target to reduce nitrogen waste by 50% by 2030. However, if the rate of nitrogen capture is low, alternative uses for crop residues are developed, or wasted nitrogen is successfully captured by other methods, the benefits of nitrogen capture on biochar could be much lower. Nevertheless, using biochar as a method to deliver wasted nitrogen to crops is likely to sequester more carbon than alternatives because pyrolyzed carbon is highly recalcitrant. It is also likely to be a more reliable method of capturing nitrogen emissions and delivering nitrogen to crops because emissions of ammonia during storage and spreading of compost or bioslurry can be high. Therefore, even if alternative uses of crop residues are favoured by farmers, it is recommended that nitrogen sorption on biochar should be part of the process, whether it is by direct capture of nitrogen from urine and industrial nitrogen oxide emissions, or by mixing of biochar with compost or the ammonium rich bioslurry produced by anaerobic digestion.

Over the last few decades, both New Zealand and the intergovernmental organisation of UNESCO have widely spread the rhetoric of safety through a broad range of educational issues. This notion, in vogue since the neoliberal turn, has raised little opposition in educational debates. In this article, we use a Foucauldian lens to analyse the assumptions that underlie the discourses of safety of UNESCO and the New Zealand's education policy, and to what extent they align or differ. The findings show a general alignment between the safety discourses of UNESCO and the New Zealand Ministry of Education, and three main assumptions were identified that frame the problem, the solution and those responsible for solving safety issues in education. In the texts analysed, safety operates as a neoliberal mechanism to manage student behaviour and individualise social risk in the guise of altruism.

Abstract Background The presence of condensed tannins (CT) in tree fodders entails a series of productive, health and ecological benefits for ruminant nutrition. Current wet analytical methods employed for full CT characterisation are time and resource-consuming, thus limiting its applicability for silvopastoral systems. The development of quick, safe and robust analytical techniques to monitor CT’s full profile is crucial to suitably understand CT variability and biological activity, which would help to develop efficient evidence-based decision-making to maximise CT-derived benefits. The present study investigates the suitability of Fourier-transformed mid-infrared spectroscopy (MIR: 4000–550 cm−1) combined with multivariate analysis to determine CT concentration and structure (mean degree of polymerization—mDP, procyanidins:prodelphidins ratio—PC:PD and cis:trans ratio) in oak, field maple and goat willow foliage, using HCl:Butanol:Acetone:Iron (HBAI) and thiolysis-HPLC as reference methods. Results The MIR spectra obtained were explored firstly using Principal Component Analysis, whereas multivariate calibration models were developed based on partial least-squares regression. MIR showed an excellent prediction capacity for the determination of PC:PD [coefficient of determination for prediction (R2P) = 0.96; ratio of prediction to deviation (RPD) = 5.26, range error ratio (RER) = 14.1] and cis:trans ratio (R2P = 0.95; RPD = 4.24; RER = 13.3); modest for CT quantification (HBAI: R2P = 0.92; RPD = 3.71; RER = 13.1; Thiolysis: R2P = 0.88; RPD = 2.80; RER = 11.5); and weak for mDP (R2P = 0.66; RPD = 1.86; RER = 7.16). Conclusions MIR combined with chemometrics allowed to characterize the full CT profile of tree foliage rapidly, which would help to assess better plant ecology variability and to improve the nutritional management of ruminant livestock.

Abstract Background Despite the potential of digital health interventions to improve the delivery of psychoeducation to people with mental health problems and their relatives, and substantial investment in their development, there is little evidence of successful implementation into clinical practice. We report the first implementation study of a digital health intervention: Relatives Education And Coping Toolkit (REACT), into routine mental healthcare. Our main aim was to identify critical factors affecting staff uptake and use of this online self-management tool for relatives of people with psychosis or bipolar. Methods A mixed-methods, theory-driven (Normalisation Process Theory), iterative multiple case study approach using qualitative analysis of interviews with staff and quantitative reporting of uptake. Carer researchers were part of the research team. Results In all, 281 staff and 159 relatives from Early Intervention teams across six catchment areas (cases) in England registered on REACT; 129 staff took part in qualitative interviews. Staff were positive about REACT helping services improve support and meet clinical targets. Implementation was hindered by: high staff caseloads and difficulties prioritising carers; perception of REACT implementation as research; technical difficulties using REACT; poor interoperability with trust computer systems and care pathways; lack of access to mobile technology and training; restricted forum populations; staff fears of risk, online trolling, and replacement by technology; and uncertainty around REACT’s long-term availability. Conclusions Digital health interventions, such as REACT, should be iteratively developed, evaluated, adapted and implemented, in partnership with the services they aim to support, and as part of a long term national strategy to co-develop integrated technology-enabled mental healthcare. Implementation strategies must instil a sense of ownership for staff and ensure they have adequate IT training, appropriate governance protocols for online working, and adequate mobile technologies. Wider contextual factors including adequate funding for mental health services and prioritisation of carer support, also need to be addressed for successful implementation of carer focussed digital interventions. Trial registration Study registration: ISCTRN 16267685 .

Salt-affected soil reclamation provides opportunities for crop production and carbon sequestration. In arid regions such as Pakistan, limited studies have been reported involving soil reclamation and crop production under wheat–maize rotation, but no study has reported predictions on long-term carbon sequestration in reclaimed soils for the treatments used in this study. Thus, a field-scale fallow period and crop production experiment was conducted for wheat–maize rotation on salt-affected soils in Pakistan for 3 years to check the effectiveness of organic amendments for reclamation of the salt-affected soils, carbon sequestration and food grain production. Treatments used were the control (with no additional amendments to reduce salinity), gypsum alone and gypsum in combination with different organic amendments (poultry manure, green manure, and farmyard manure). The treatment with gypsum in combination with farmyard manure was most effective at increasing soil carbon (+169% over the three-year period of the trial). The maximum wheat yield was also recorded in year 3 with gypsum in combination with farmyard manure (51%), while the effect of green manure combined with gypsum also showed a significant increase in maize yield in year 3 (49%). Long-term simulations suggested that the treatments would all have a significant impact on carbon sequestration, with soil C increasing at a steady rate from 0.53% in the control to 0.86% with gypsum alone, 1.25% with added poultry manure, 1.69% with green manure and 2.29% with farmyard manure. It is concluded that food crops can be produced from freshly reclaimed salt-affected soils, and this can have added long-term benefits of carbon sequestration and climate change mitigation.

Abstract Background Adolescent-onset psychosis is associated with more severe symptoms and poorer outcomes than adult-onset psychosis. The National Institute for Clinical Excellence (NICE) recommend that adolescents with first episode psychosis (FEP) should be offered a combination of antipsychotic medication (APs), cognitive behavioural therapy (CBT) and family intervention (FI). The evidence for APs in treating psychosis is limited in adolescents compared to adults. Nevertheless, it indicates that APs can reduce overall symptoms in adolescents but may cause more severe side effects, including cardiovascular and metabolic effects, than in adults. CBT and FI can improve outcomes in adults, but there are no studies of psychological interventions (PI) in patients under 18 years old. Given this limited evidence base, NICE made a specific research recommendation for determining the clinical and cost effectiveness of APs versus PI versus both treatments for adolescent FEP. Methods/design The current study aimed to establish the feasibility and acceptability of conducting such a trial by recruiting 14–18-year-olds with a first episode of psychosis into a feasibility prospective randomised open blinded evaluation (PROBE) design, three-arm, randomised controlled trial of APs alone versus PI alone versus a combination of both treatments. We aimed to recruit 90 participants from Early Intervention and Child and Adolescent Mental Health Teams in seven UK sites. APs were prescribed by participants’ usual psychiatrists. PI comprised standardised cognitive behavioural therapy and family intervention sessions. Discussion This is the first study to compare APs to PI in an adolescent population with FEP. Recruitment finished on 31 October 2018. The study faced difficulties with recruitment across most sites due to factors including clinician and service-user treatment preferences. Trial registration Current controlled trial with ISRCTN, ISRCTN80567433. Registered on 27 February 2017.

Abstract Background Understanding stakeholders’ perceptions is crucial to the development and implementation of any intervention. However, a structured approach to eliciting stakeholder insights into complex, multisector issues of food security, household environment and health is lacking in many low and middle-income countries. This qualitative, workshop-based participatory study explores stakeholders’ experiences of developing and implementing multisector interventions to provide transdisciplinary lessons for future developments in low and middle-income countries. Methods Participants were purposely selected based on their involvement in, or exposure to, the multisector intervention. Participants with interests in agriculture, nutrition, household air-quality, drinking water-quality and health from academic institutes, government and developmental organisations were brought together at a one-day workshop to participate in a series of discussions on issues relating to food security, nutrition, household environment and health in Nepal. All group discussions were audio-recorded and transcribed, and a thematic qualitative analysis performed to identify relevant themes. Results The government’s ongoing Multisector Nutrition Plan, stakeholders’ willingness to work together, availability of local infrastructure for cross-institutional inputs and increasing global movement towards transdisciplinary approaches were identified by the 33 workshop participants, representing 23 organisations as key factors determining success of transdisciplinary work. Fragmentation, lack of research-based and practice-based evidence, limited transdisciplinary knowledge amongst sectoral stakeholders, short-term funding and lack of knowledge-sharing mechanisms were identified as barriers, often creating systematic problems for successful implementation. Stakeholders suggested methods to bring about success included: improved knowledge, both amongst policy-makers and implementers, of food security and its linkage with nutrition, household environments, health and hygiene; investment in collaborative practice-based research and evidence-based practice; and strengthened transdisciplinary collaboration between multi-stakeholders, such as researchers, implementers and beneficiaries, throughout the intervention development and implementation process. Conclusions This study suggests that multisector approach needs to adapt to take into account the experiences and views of the stakeholders concerned. The paper offers recommendations for successful development and implementation of future multisector interventions in Nepal that can be extrapolated to other low and middle-income countries, and lays foundations for future transdisciplinary working to support realisation of the recommendations.

Background: Mental disorders and their symptoms are highly prevalent in the university student population, and the transition from secondary to tertiary education is associated with a rise in mental health problems. Existing web-based interventions for the prevention of common mental disorders in student populations often focus on just one disorder and have not been designed specifically for students. There is thus a need for transdiagnostic, student-specific preventative interventions that can be widely disseminated. This two-arm, parallel group randomised controlled trial aims to evaluate the effectiveness and cost-effectiveness of a web-based transdiagnostic mental health problem prevention programme (PLUS) across several universities in four countries. Method: Students (N = 5550) will be recruited through a variety of channels and asked to complete a personality assessment to determine whether they are at high risk for developing common mental disorders. Students at high risk will be randomly allocated to either PLUS or a control intervention, which provides practical support around issues commonly experienced at university. Students at low risk will be allocated to the control intervention. Both intervention groups will be assessed at baseline, 4 weeks, 3 months, 6 months and 12 months after randomisation. Depression and generalised anxiety, assessed using the Patient Health Questionnaire and the Generalised Anxiety Disorder scales, will form the primary outcomes in this study. Secondary outcome measures include alcohol and drug use, eating behaviour, self-esteem, and quality of life. The cost-effectiveness of the intervention will also be evaluated. Conclusions: This study will contribute to understanding the role of transdiagnostic indicated web-based interventions for the prevention of common mental disorders in university students. It will also be one of the first studies to investigate the cost-effectiveness of such interventions. Trial Registration: This trial was registered in the ISRCTN register (ISRCTN15570935) on 12th February 2016. Keywords: Students, Internet, Mental health, Depression, Anxiety, Prevention, CBT

Summary: The failure to mount an antibody response following viral infection or seroconversion failure is a largely underappreciated and poorly understood phenomenon. Here, we identified immunologic markers associated with robust antibody responses after influenza virus infection in two independent human cohorts, SHIVERS and FLU09, based in Auckland, New Zealand and Memphis, Tennessee, USA, respectively. In the SHIVERS cohort, seroconversion significantly associates with (1) hospitalization, (2) greater numbers of proliferating, activated CD4+ T cells, but not CD8+ T cells, in the periphery during the acute phase of illness, and (3) fewer inflammatory monocytes (CD14hiCD16+) by convalescence. In the FLU09 cohort, fewer CD14hiCD16+ monocytes during early illness in the nasal mucosa were also associated with the generation of influenza-specific mucosal immunoglobulin A (IgA) and IgG antibodies. Our study demonstrates that seroconversion failure after infection is a definable immunological phenomenon, associated with quantifiable cellular markers that can be used to improve diagnostics, vaccine efficacy, and epidemiologic efforts.

In the last six decades, the consumption of reactive nitrogen (Nr) in the form of fertilizer in India has been growing rapidly, whilst the nitrogen use efficiency (NUE) of cropping systems has been decreasing. These trends have led to increasing environmental losses of Nr, threatening the quality of air, soils, and fresh waters, and thereby endangering climate-stability, ecosystems, and human-health. Since it has been suggested that the fertilizer consumption of India may double by 2050, there is an urgent need for scientific research to support better nitrogen management in Indian agriculture. In order to share knowledge and to develop a joint vision, experts from the UK and India came together for a conference and workshop on “Challenges and Opportunities for Agricultural Nitrogen Science in India.” The meeting concluded with three core messages: (1) Soil stewardship is essential and legumes need to be planted in rotation with cereals to increase nitrogen fixation in areas of limited Nr availability. Synthetic symbioses and plastidic nitrogen fixation are possibly disruptive technologies, but their potential and implications must be considered. (2) Genetic diversity of crops and new technologies need to be shared and exploited to reduce N losses and support productive, sustainable agriculture livelihoods. (3) The use of leaf color sensing shows great potential to reduce nitrogen fertilizer use (by 10–15%). This, together with the usage of urease inhibitors in neem-coated urea, and better management of manure, urine, and crop residues, could result in a 20–25% improvement in NUE of India by 2030.

Background: When psychosis emerges in young people there is a risk of poorer outcomes, and access to evidence-based treatments is paramount. The current evidence base is limited. Antipsychotic medications show only a small benefit over placebo, but young people experience more side effects than adults. There is sparse evidence for psychological intervention. Research is needed to determine the clinical effectiveness and cost-effectiveness of psychological intervention versus antipsychotic medication versus a combined treatment for adolescents with psychosis. Objectives: The objective of Managing Adolescent first-episode Psychosis: a feasibility Study (MAPS) was to determine the feasibility of conducting a definitive trial to answer the question of clinical effectiveness and cost-effectiveness of these three treatment options. Design: This was a prospective, randomised, open-blinded, evaluation feasibility trial with a single blind. Participants were allocated 1 : 1 : 1 to receive antipsychotic medication, psychological intervention or a combination of both. A thematic qualitative study explored the acceptability and feasibility of the trial. Setting: Early intervention in psychosis services and child and adolescent mental health services in Manchester, Oxford, Lancashire, Sussex, Birmingham, Norfolk and Suffolk, and Northumberland, Tyne and Wear. Participants: People aged 14–18 years experiencing a first episode of psychosis either with an International Classification of Diseases, Tenth Revision, schizophrenia spectrum diagnosis or meeting the entry criteria for early intervention in psychosis who had not received antipsychotic medication or psychological intervention within the last 3 months. Interventions: Psychological intervention involved up to 26 hours of cognitive–behavioural therapy and six family intervention sessions over 6 months, with up to four booster sessions. Antipsychotic medication was prescribed by the participant’s psychiatrist in line with usual practice. Combined treatment was a combination of psychological intervention and antipsychotic medication. Main outcome measures: The primary outcome was feasibility (recruitment, treatment adherence and retention). We used a three-stage progression criterion to determine feasibility. Secondary outcomes were psychosis symptoms, recovery, anxiety and depression, social and educational/occupational functioning, drug and alcohol use, health economics, adverse/metabolic side effects and adverse/serious adverse events. Results: We recruited 61 out of 90 (67.8%; amber zone) potential participants (psychological intervention, n = 18; antipsychotic medication, n = 22; combined treatment, n = 21). Retention to follow-up was 51 out of 61 participants (83.6%; green zone). In the psychological intervention arm and the combined treatment arm, 32 out of 39 (82.1%) participants received six or more sessions of cognitive–behavioural therapy (green zone). In the combined treatment arm and the antipsychotic medication arm, 28 out of 43 (65.1%) participants received antipsychotic medication for 6 consecutive weeks (amber zone). There were no serious adverse events related to the trial and one related adverse event. Overall, the number of completed secondary outcome measures, including health economics, was small. Limitations: Medication adherence was determined by clinician report, which can be biased. The response to secondary outcomes was low, including health economics. The small sample size obtained means that the study lacked statistical power and there will be considerable uncertainty regarding estimates of treatment effects. Conclusions: It is feasible to conduct a trial comparing psychological intervention with antipsychotic medication and a combination treatment in young people with psychosis with some adaptations to the design, including adaptations to collection of health economic data to determine cost-effectiveness. Future work: An adequately powered definitive trial is required to provide robust evidence. Trial registration: Current Controlled Trials ISRCTN80567433. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 4. See the NIHR Journals Library website for further project information.

Wider networks of people are affected by a suicide death than originally thought, including those whose job-role brings them into contact with a death by suicide of another person. The impact of student suicide within United Kingdom (UK) Higher Education Institutions (HEIs) is unexplored and the experiences of staff members remain unknown. It is not known whether staff members have specific postvention needs following a student death by suicide. Any postvention support currently offered to staff members within UK HEIs lacks a context-specific evidence base. This study asked 'How is a student suicide experienced by staff members within a UK HEI and what are the features of that experience?' Staff members from diverse job-roles in two UK HEIs responded to a qualitative survey (n = 19) and participated in semi-structured interviews (n = 10). Data were transcribed and subjected to a constructivist grounded theory analysis. Participants' experiences informed the development of a core category: 'Bearing witness', which encompassed six further categories: 'Responding to a student suicide'; 'Experiencing a student suicide'; 'Needs and fears'; 'Experiences of support'; 'Human stories'; and 'Cultural stories'. The resulting grounded theory demonstrates how participants' perceptions of impact are informed by their experiences of undertaking tasks following a student suicide within the community of their HEI. Processes of constructing perceptions of closeness to the student who died are evident amongst participants who did not know the student prior to their death. Tailored postvention support is required to respond to the range and complexity of HEI staff needs following a student death by suicide.

Biogas digester programmes have been rolled out across many countries in sub-Saharan Africa over the past decade with varying levels of success. In Ethiopia, reported success rates have been low, despite high levels of interaction between non-governmental organisations and various levels of government, plus the establishment of practical eligibility criteria. In Halaba, Ethiopia, we investigated physical and social factors affecting feedstock and water availability using a face-to-face questionnaire-based survey (n = 112) in four kebeles (local administration areas). We found that practices of fuel use and water collection were markedly different between seasons. Fuel use was almost entirely dependent on season, with wood being burned in the wet season and crop residues and cow dung being used instead in the dry season. A matched pair t-test found a significant difference between seasons in terms of water collection times (p = 7.4 × 10−16), with households spending more time and money obtaining clean drinking water in the dry season. Results indicate that seasonal differences in resource availability may reduce the proportion of households that meet the physical characteristics for maintaining a biogas digester by approximately 62% from wet season to dry season. Conversely, the greatest benefits of digester use would be gained in the dry season, when dung could be returned to the soil as a nutrient-rich bioslurry, instead of being combusted as a dirty and inefficient fuel. Seasonality is rarely considered in feasibility studies, so we recommend that these factors should be built into future analyses.

Previous research in patients with schizophrenia in European and USA population groups has demonstrated a high prevalence of metabolic syndrome and disease progression (~35%–40%) and increased risk for cardiovascular disease and long-term mortality. Limited research has determined the prevalence of existing cardiometabolic risk factors at onset of a first episode psychosis. This cross-sectional study presents a clinical overview of the cardiometabolic risk profile in young people with first episode psychosis in the UK. Forty-six participants (72% male) clinically diagnosed with first episode psychosis (n = 25), schizophrenia (n = 13), bipolar disorder (n = 4), unspecified non-organic psychosis (n = 2) or acute psychotic episode (n = 2) with < 6 months Duration of Untreated Psychosis (DUP; mean 33.4 ± 37.2 days) were assessed for anthropometric, health risk behaviors and clinical measurements including resting heart rate, blood pressure, blood lipids, glycated hemoglobin, and prolactin. Overall, participants (aged 18–37 years) had a high prevalence of cardiometabolic risk factors due to: elevated values for BMI (73%) and abdominal adiposity (50%), blood pressure (47% prehypertensive; 23% hypertensive), resting heart rate (43%); hypercholesterolemia (32%); suboptimal HDL-C levels (36%); and hypertriglyceridemia (40%). Participants also self-reported poor health risk habits including smoking (55%), alcohol use (39%), substance use (18%), poor diet (52%), and sedentary behavior (29%). Young people with psychosis are at increased risk for cardiometabolic disorders due to elevated clinical markers and health risk behaviors. Physical health interventions (including health behavior advice) are needed early in the treatment process to address this increased risk for cardiometabolic disorders in individuals recently diagnosed with psychosis.

AimYoung people with psychosis have higher rates of obesity, premature cardiovascular disease, and death compared to non-psychotic peers in the general population due to changes in metabolic regulation linked to antipsychotic medication and adverse health risk behaviors. The aim of this paper is to outline the development, implementation, and evaluation of a combined 12-week exercise and health behavior intervention delivered as part of an Early Intervention in Psychosis (EIP) routine service, within the UK.MethodsParticipants (n = 27) completed a 12-week combined intervention program, engaging in weekly, 90-min sessions comprising a healthy behavior education session (45 min), followed by a facilitated exercise session (45 min). Anthropometric data from participants (n = 26) were collected at baseline, 12 weeks, and 12 months post-intervention. Health behaviors and clinical measurements were assessed at baseline and 12 months.ResultsMean baseline data suggests participants were at an increased health risk on entry to the program, with elevated values in mean body mass index (BMI; 70% overweight/obese), waist circumference, resting heart rate, and triglycerides. Fifty percent reported smoking daily, 64% ate < 5 fruits/vegetables per day, and 52% of participants were prescribed highly obesogenic antipsychotic medications (i.e., Olanzapine). At 12 weeks and 12 months, no changes were observed in mean BMI, waist circumference or any other clinical variable (p > 0.05). At 12 months, participants reported a positive impact on health behaviors including improved diet, increased physical activity levels, and cessation of substance use (n = 2), alcohol use (n = 2), and smoking (n = 4). Focus groups captured participant experiences, engagement with and satisfaction with the program, including challenges/barriers to program adherence.ConclusionsThe 12-week exercise and health behaviors program supported participants to attenuate their physical health risk which was sustained at 12-month follow-up. Self-reported positive health behavior changes are likely to have contributed to the prevention of excessive weight gain in this high-risk period. The evaluation was designed to have validity for a “real world EIP setting” and reflect the complexity of delivery to this participant group. Evaluation findings influenced subsequent commissioning of the physical health intervention as an ongoing element of routine EIP care within the participant site.

Background: Digital health interventions have the potential to improve the delivery of psychoeducation to people with mental health problems and their relatives. Despite substantial investment in the development of digital health interventions, successful implementation into routine clinical practice is rare. Objectives: Use the implementation of the Relatives’ Education And Coping Toolkit (REACT) for psychosis/bipolar disorder to identify critical factors affecting uptake and use, and develop an implementation plan to support the delivery of REACT. Design: This was an implementation study using a mixed-methods, theory-driven, multiple case study approach. A study-specific implementation theory for REACT based on normalisation process theory was developed and tested, and iterations of an implementation plan to address the key factors affecting implementation were developed. Setting: Early-intervention teams in six NHS mental health trusts in England (three in the north and three in the south). Participants: In total, 281 staff accounts and 159 relatives’ accounts were created, 129 staff and 23 relatives took part in qualitative interviews about their experiences, and 132 relatives provided demographic data, 56 provided baseline data, 21 provided data at 12 weeks’ follow-up and 20 provided data at 24 weeks’ follow-up. Interventions: REACT is an online supported self-management toolkit, offering 12 evidence-based psychoeducation modules and support via a forum, and a confidential direct messaging service for relatives of people with psychosis or bipolar disorder. The implementation intervention was developed with staff and iteratively adapted to address identified barriers. Adaptations included modifications to the toolkit and how it was delivered by teams. Main outcome measures: The main outcome was factors affecting implementation of REACT, assessed primarily through in-depth interviews with staff and relatives. We also assessed quantitative measures of delivery (staff accounts and relatives’ invitations), use of REACT (relatives’ logins and time spent on the website) and the impact of REACT [relatives’ distress (General Health Questionnaire-28), and carer well-being and support (Carer Well-being and Support Scale questionnaire)]. Results: Staff and relatives were generally positive about the content of REACT, seeing it as a valuable resource that could help services improve support and meet clinical targets, but only within a comprehensive service that included face-to-face support, and with some additional content. Barriers to implementation included high staff caseloads and difficulties with prioritising supporting relatives; technical difficulties of using REACT; poor interoperability with trust information technology systems and care pathways; lack of access to mobile technology and information technology training; restricted forum populations leading to low levels of use; staff fears of managing risk, online trolling, or replacement by technology; and uncertainty around REACT’s long-term availability. There was no evidence that REACT would reduce staff time supporting relatives (which was already very low), and might increase it by facilitating communication. In all, 281 staff accounts were created, but only 57 staff sent relatives invitations. In total, 355 relatives’ invitations were sent to 310 unique relatives, leading to the creation of 159 relatives’ accounts. The mean number of logins for relatives was 3.78 (standard deviation 4.43), but with wide variation from 0 to 31 (median 2, interquartile range 1–8). The mean total time spent on the website was 40.6 minutes (standard deviation 54.54 minutes), with a range of 0–298 minutes (median 20.1 minutes, interquartile range 4.9–57.5 minutes). There was a pattern of declining mean scores for distress, social dysfunction, depression, anxiety and insomnia, and increases in relatives’ well-being and eHealth literacy, but no changes were statistically significant. Conclusions: Digital health interventions, such as REACT, should be iteratively developed, evaluated, adapted and implemented, with staff and service user input, as part of a long-term strategy to develop integrated technology-enabled services. Implementation strategies must instil a sense of ownership for staff and ensure that they have adequate training, risk protocols and resources to deliver the technology. Cost-effectiveness and impact on workload and inequalities in accessing health care need further testing, along with the generalisability of our findings to other digital health interventions. Limitations: REACT was offered by the same team running the IMPlementation of A Relatives’ Toolkit (IMPART) study, and was perceived by staff and relatives as a time-limited research study rather than ongoing clinical service, which affected engagement. Access to observational data was limited. Trial registration: Current Controlled Trials ISRCTN16267685. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 37. See the NIHR Journals Library website for further project information.

Abstract Background Web-based interventions to support people to manage long-term health conditions are available and effective but rarely used in clinical services. The aim of this study is to identify critical factors impacting on the implementation of an online supported self-management intervention for relatives of people with recent onset psychosis or bipolar disorder into routine clinical care and to use this information to inform an implementation plan to facilitate widespread use and inform wider implementation of digital health interventions. Methods A multiple case study design within six early intervention in psychosis (EIP) services in England, will be used to test and refine theory-driven hypotheses about factors impacting on implementation of the Relatives’ Education And Coping Toolkit (REACT). Qualitative data including behavioural observation, document analysis, and in-depth interviews collected in the first two EIP services (wave 1) and analysed using framework analysis, combined with quantitative data describing levels of use by staff and relatives and impact on relatives’ distress and wellbeing, will be used to identify factors impacting on implementation. Consultation via stakeholder workshops with staff and relatives and co-facilitated by relatives in the research team will inform development of an implementation plan to address these factors, which will be evaluated and refined in the four subsequent EIP services in waves 2 and 3. Transferability of the implementation plan to non-participating services will be explored. Discussion Observation of implementation in a real world clinical setting, across carefully sampled services, in real time provides a unique opportunity to understand factors impacting on implementation likely to be generalizable to other web-based interventions, as well as informing further development of implementation theories. However, there are inherent challenges in investigating implementation without influencing the process under observation. We outline our strategies to ensure our design is transparent, flexible, and responsive to the timescales and activities happening within each service whilst also meeting the aims of the project. Trial registration ISCTRN 16267685 (09/03/2016).

Abstract The PREDICTS project—Projecting Responses of Ecological Diversity In Changing Terrestrial Systems (https://www.nhm.ac.uk/our-science/our-work/biodiversity/predicts.html)—has collated from published studies a large, reasonably representative database of comparable samples of biodiversity from multiple sites that differ in the nature or intensity of human impacts relating to land use. We have used this evidence base to develop global and regional statistical models of how local biodiversity responds to these measures. We describe and make freely available this 2016 release of the database, containing more than 3.2 million records sampled at over 26,000 locations and representing over 47,000 species. We outline how the database can help in answering a range of questions in ecology and conservation biology. To our knowledge, this is the largest and most geographically and taxonomically representative database of spatial comparisons of biodiversity that has been collated to date; it will be useful to researchers and international efforts wishing to model and understand the global status of biodiversity.

This study aimed to explore replicable strategies and principles for reimagining higher education students as co creators of course content through small-scale curricular experiments. The research took place at a broad-access, minority, and Hispanic-serving university that seeks to disrupt patterns of inequity in higher education. In the 2021 22 academic year, Scholarship of Teaching and Learning (SoTL) faculty fellowships were launched to support a university-wide research agenda on equity-promoting teaching practices. Selected fellows formed a team of three, supported by research and faculty cofacilitators. They began by developing a shared definition of equity, focusing on student identity and voice. The research questions for this study focus on the impact of increased student input into course content on student engagement, students' experiences, and faculty members' experiences. Across all instances of small-scale curricular experiments designed to promote co-creation of curriculum, the majority of students reported positive impacts on engagement and experiences in the course. In describing implementation of their strategies, all three researchers found a process of moving from initial challenges in the unfamiliarity of co-creation to greater engagement for themselves and their students.

Agroforestry systems, where productive trees are integrated into agricultural land, can deliver benefits to biodiversity, natural pest control, and pollination, but the effects are highly variable. Recent advances in our understanding of flower strips in agricultural systems suggest that the management of the tree row understorey could be an important contributor to this variation. Here, we compare two cutting regimes for an understorey, originally seeded with the same flower mix, in the tree rows of an apple-arable agroforestry system: (i) uncut vegetation to promote a flowering understorey, and (ii) regularly mown vegetation. We recorded the effects of management on invertebrate pests, natural enemies, and pollinators, in both the apple and arable components. Apple trees above flowering understoreys supported significantly: (i) more natural enemies early in the season, (ii) fewer aphid colonies, (iii) fewer aphid-damaged fruits, and (iv) higher pollinator visitation, compared with those above mown understoreys. In the arable crop alleys, both the taxonomic richness and Shannon diversity of ground-based natural enemies were significantly higher adjacent to flowering understoreys, compared with those adjacent to mown understoreys, early in the season. Financial modelling based on aphid damage to apples, mowing costs, and income from Countryside Stewardship grants, indicated that flowering understoreys increased farm income by GBP 231.02 per ha of agroforestry compared with mown understoreys. Our results provide the first empirical evidence that management to promote flowering understoreys in agroforestry systems can be a win-win option to improve invertebrate diversity, associated ecosystem services, and farm income.

Abstract Background Although linkages have been found between agricultural interventions and nutritional health, and the development of clean fuels and improved solid fuel stoves in reducing household air pollution and adverse health effects, the extent of the potential of combined household interventions to improve health, nutrition and the environment has not been investigated. A systematic review was conducted to identify the extent and type of community-based agricultural and household interventions aimed at improving food security, health and the household environment in low and middle income countries. Methods A systematic search of Ovid MEDLINE, PUBMED, EMBASE and SCOPUS databases was performed. Key search words were generated reflecting the “participants, interventions, comparators, outcomes and study design” approach and a comprehensive search strategy was developed following “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” recommendations. Any community-based agricultural and/or household interventions were eligible for inclusion if the focus was to improve at least one of the outcome measures of interest. All relevant study designs employing any of these interventions (alone/in combination) were included if conducted in Low and middle income countries. Review articles, and clinical and occupational studies were excluded. Results A total of 123 studies were included and grouped into four intervention domains; agricultural (n = 27), air quality (n = 34), water quality (n = 32), and nutritional (n = 30). Most studies were conducted in Asia (39.2 %) or Africa (34.6 %) with the remaining 26.1 % in Latin America. Very few studies (n = 11) combined interventions across more than one domain. The majority of agricultural and nutritional studies were conducted in Africa and Asia, whereas the majority of interventions to improve household air quality were conducted in Latin America. Conclusions It is clear that very little trans-disciplinary research has been done with the majority of studies still being discipline specific. It also appears that certain low and middle income countries seem to focus on domain-specific interventions. The review emphasizes the need to develop holistic, cross-domain intervention packages. Further investigation of the data is being conducted to determine the effectiveness of these interventions and whether interdisciplinary interventions provide greater benefit than those that address single health or community problems.

Governments around the globe have realised that meeting UNESCO's Sustainable Development Goal (SDG) 4 of ensuring inclusive and equitable quality education requires meaningful changes to policy and practice. There are numerous ways localities have attempted to do so: policies aimed at intentional hiring of more diverse teachers, policies requiring professional development for current teachers, and including diversity, equity, and inclusion (DEI) training as part of pre-service preparation programmes. In this paper we argue that each of these is necessary, but none is sufficient on its own, to move the needle towards SDG4. Policy implementation literature suggests the importance of the social dimension of those tasked with implementing new policies, which guides our argument for how policies can move from aspirational to enacted. We offer examples of policies and practices at each of these three inflexion points for change (pre-service, hiring, and in-service), with implications for teacher education in other contexts working to create truly inclusive, equitable schools.

Abstract Aim: To examine chronic disease (CD)‐related clinical activity and outcomes associated with introduction of a more systematic approach to chronic disease care in a remote Aboriginal community, using data from Communicare patient record management system. Methods: We examined CD process measures, outcomes and clinical profiles in adults age 15+ years from Communicare data and compared results for two intervals. Process measures were clinic visits and proportions of eligible patients with recorded CD‐related procedures or diagnostic tests. Outcome measures were results of CD care items and CD morbidities. Data in the interval 2007–2009 were compared with data from 2009 to 2011, in which an intensified CD program was conducted in the clinic by its own staff. Results: About one‐third of adult visits were related to CD care; CD‐cycle of care encounters increased significantly in the second interval, from 3.2% to 9.1%, and proportions of adults having CD‐related procedures or tests were also higher. For already commonly performed items, like blood pressure, weight and lipids, proportions of adults tested were 30–50% higher in the second interval, while proportions tested for more recently emphasised items, like waist, HbA1C, urine ACR, rose by more than 200%. Levels of SBP, DBP, HbA1c and HDL‐C significantly improved in the second interval. Proportions of adults with clinical values outside normal ranges decreased for at least half of observations. Conclusions: Parameters of CD care activities and outcomes have increased significantly over the last four years in this setting, accompanied by stabilisation of or improvement in outcomes.

The use of limited organic resources to build resilience to drought in semi-arid regions was investigated using systems modelling. The study focused on Halaba in Ethiopia, drawing on biophysical and socio-economic data obtained from a survey of farms before, during and after the 2015/16 El Niño event. Using a simplified weather dataset to remove noise from weather fluctuations, a ten yearly El Niño was demonstrated to cause significant long-term degradation of soil, reducing crop yields by 9%–14% and soil carbon by 0.5%–4.1%; more frequent droughts would increase this impact. Farmers in Halaba usually apply manures to soils untreated. Counteracting the impact of El Niño on soil degradation is possible by increasing application of untreated manure, but would result in a small net cost due to loss of dung as fuel. By composting manure its recalcitrance increases, allowing soil degradation to be counteracted without cost. The best option investigated, in terms of both food and fuel security, for households with access to water and finances needed for anaerobic digestion (500–2000 US$), is to use manure to produce biogas and then apply the nutrient-rich bioslurry residue to the soil. This will result in a significant benefit of over 5000 US$ per decade from increased crop production and saved fuel costs. However, many households are limited in water and finances; in that situation, the much cheaper pyrolysis cook-stove (50 US$) can provide similar economic benefits without the need for water. The biochar residue from pyrolysis is highly recalcitrant, but pyrolysis results in loss of nutrients, so may result in lower yields than other uses of manures. This may be countered by using biochar to capture nutrients from elsewhere in the farm, such as from animal housing or compost pits; more work is needed to quantify the impact of treated biochar on crop yields.

Current EU regulations allow 5% of feed for organic poultry to come from non-organic production. This is due to concerns about a 100% organic diet meeting the requirements for specific amino acids such as methionine. This exception is due to end on 31st December 2017. While this may match consumer expectations, protein sourced from global organic production may have a negative impact on perceptions of organic poultry in other ways. Soybean is a commonly used ingredient in poultry feed but soybean production has negative environmental and social impacts. Consumers may also prefer organic poultry to have been fed on locally produced feed and, indeed, this would be in line with organic principles. Preliminary feasibility feed trials were carried out during a summer and a winter season using organic broilers in the UK to test three 100% organic feeds: a control diet with globally sourced ingredients including soybean expeller, a diet based on locally sourced (i.e. within Europe) organic ingredients, and a diet based on locally sourced organic ingredients and algae (a good source of methionine). The results of the summer feed trial showed that there were no significant differences in broiler weight gains. In the winter feed trial differences were found. There was a significant difference (P = 0.034) in weight gain between the local feed (lower weight gain) and the local feed with algae but no significant difference between the control diet with soybean and the two local diets. These preliminary feed trials indicate that there is no significant impact on broiler performance or animal welfare parameters when replacing soybean with European protein sources, possibly including algae, suggesting that, although the research is still at a very early stage, such feeds may be a viable option for 100% organic poultry feed in the future.

Current regulations for organic pig and poultry production systems permit feed ingredients of non-organic origin at an inclusion rate of up to 5 per cent. This is primarily due to concerns that there is an insufficient supply of organic protein on the European Union market, in terms of quality and quantity, to meet the nutritional requirements of pigs and poultry raised on organic farms. However, 100 per cent organic diets for monogastric livestock will become compulsory in the EU from 1 January 2018, and there is therefore a need to develop sustainable feeding strategies based on organic feeds. This feed trial conducted in the UK explores the feasibility of using a silage-based feeding system for Gloucester Old Spot pigs, and compares the inclusion of soya, beans and peas as protein sources in terms of pig growth performance. No significant difference in the pen mean daily live weight gain was observed during the grower phase (pen mean age of 11-14 weeks) between the diet groups. However, during the finisher phase (pen mean age of 15-22 weeks), pigs on the soya and pea rations had significantly faster growth rates than pigs fed the bean ration. It is speculated that the slight shortfall in growth rate observed in the pigs fed the bean ration may be offset by the lower cost of production of beans in the UK. This feasibility trial demonstrates that a 100 per cent organic diet for pigs using alternative, locally-grown sources of protein as part of a forage-based ration can provide a viable alternative to a soya-based diet.

Background: Using two researchers as independent instruments for interpretation in education policy evaluation, this study applies a collaborative grounded theory approach to qualitative data analysis and theory generation. Purpose: This study argues that varied perspectives should be a critical component in the methodological and analytical choices of education research, especially when the sought after outcome is deeper understanding of the impact, both positive and negative, of an education program or policy. In this study, rather than using one researcher to confirm the reliability of the other, the study explores the outcome of drawing on the positional reflexivity of two researchers, each with a distinct perspective, as a potential strength to co-generate themes and theory in the evaluation of complex policy or programs. Setting: The data for this analysis originated from interviews of education leaders (n = 13) from two states with contrasting approaches to teacher evaluation: Kentucky and California. Intervention: NA Research Design: Qualitative developmental evaluation Data Collection and Analysis: Semi-structured interviews and grounded theory coding Findings: Results suggest that more robust theory and analysis may result from independent thematic development and converged theory generation when working in a research team, as opposed to early application of inter-rater reliability. The reflexivity of different perspectives was, in part, reflexive of the self—their own biased perspective and prior experience. When merged, their joint interpretation may have unearthed greater dimensionality. Findings from this study can inform future strategies for evaluating qualitative research data, especially within a developmental evaluation approach aimed at understanding system complexity in education policy and practice.