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By employing superstatistical methods and machine learning, we analyze time series data of water quality indicators for the River Thames (UK). The indicators analyzed include dissolved oxygen, temperature, electrical conductivity, pH, ammonium, turbidity, and rainfall, with a specific focus on the dynamics of dissolved oxygen. After detrending, the probability density functions of dissolved oxygen fluctuations exhibit heavy tails that are effectively modeled using q-Gaussian distributions. Our findings indicate that the multiplicative Empirical Mode Decomposition method stands out as the most effective detrending technique, yielding the highest log-likelihood in nearly all fittings. We also observe that the optimally fitted width parameter of the q-Gaussian shows a negative correlation with the distance to the sea, highlighting the influence of geographical factors on water quality dynamics. In the context of same-time prediction of dissolved oxygen, regression analysis incorporating various water quality indicators and temporal features identify the Light Gradient Boosting Machine as the best model. SHapley Additive exPlanations reveal that temperature, pH, and time of year play crucial roles in the predictions. Furthermore, we use the Transformer, a state-of-the-art machine learning model, to forecast dissolved oxygen concentrations. For long-term forecasting, the Informer model consistently delivers superior performance, achieving the lowest Mean Absolute Error (0.15) and Symmetric Mean Absolute Percentage Error (21.96%) with the 192 historical time steps that we used. This performance is attributed to the Informer's ProbSparse self-attention mechanism, which allows it to capture long-range dependencies in time-series data more effectively than other machine learning models. It effectively recognizes the half-life cycle of dissolved oxygen, with particular attention to critical periods such as morning to early afternoon, late evening to early morning, and key intervals between the 16th and 26th quarter-hours of the previous half-day. Our findings provide valuable insights for policymakers involved in ecological health assessments, aiding in accurate predictions of river water quality and the maintenance of healthy aquatic ecosystems. [ABSTRACT FROM AUTHOR]

Melanoma of the skin is the 17th most common cancer worldwide. Early detection of suspicious skin lesions (melanoma) can increase 5-year survival rates by 20%. The 7-point checklist (7PCL) has been extensively used to suggest urgent referrals for patients with a possible melanoma. However, the 7PCL method only considers seven meta-features to calculate a risk score and is only relevant for patients with suspected melanoma. There are limited studies on the extensive use of patient metadata for the detection of all skin cancer subtypes. This study investigates artificial intelligence (AI) models that utilise patient metadata consisting of 23 attributes for suspicious skin lesion detection. We have identified a new set of most important risk factors, namely "C4C risk factors", which is not just for melanoma, but for all types of skin cancer. The performance of the C4C risk factors for suspicious skin lesion detection is compared to that of the 7PCL and the Williams risk factors that predict the lifetime risk of melanoma. Our proposed AI framework ensembles five machine learning models and identifies seven new skin cancer risk factors: lesion pink, lesion size, lesion colour, lesion inflamed, lesion shape, lesion age, and natural hair colour, which achieved a sensitivity of 80.46 ± 2.50 % and a specificity of 62.09 ± 1.90 % in detecting suspicious skin lesions when evaluated using the metadata of 53,601 skin lesions collected from different skin cancer diagnostic clinics across the UK, significantly outperforming the 7PCL-based method (sensitivity 68.09 ± 2.10 % , specificity 61.07 ± 0.90 % ) and the Williams risk factors (sensitivity 66.32 ± 1.90 % , specificity 61.71 ± 0.6 % ). Furthermore, through weighting the seven new risk factors we came up with a new risk score, namely "C4C risk score", which alone achieved a sensitivity of 76.09 ± 1.20 % and a specificity of 61.71 ± 0.50 % , significantly outperforming the 7PCL-based risk score (sensitivity 73.91 ± 1.10 % , specificity 49.49 ± 0.50 % ) and the Williams risk score (sensitivity 60.68 ± 1.30 % , specificity 60.87 ± 0.80 % ). Finally, fusing the C4C risk factors with the 7PCL and Williams risk factors achieved the best performance, with a sensitivity of 85.24 ± 2.20 % and a specificity of 61.12 ± 0.90 % . We believe that fusing these newly found risk factors and new risk score with image data will further boost the AI model performance for suspicious skin lesion detection. Hence, the new set of skin cancer risk factors has the potential to be used to modify current skin cancer referral guidelines for all skin cancer subtypes, including melanoma. [ABSTRACT FROM AUTHOR]

Transferring and replicating predictive algorithms across healthcare systems constitutes a unique yet crucial challenge that needs to be addressed to enable the widespread adoption of machine learning in healthcare. In this study, we explored the impact of important differences across healthcare systems and the associated Electronic Health Records (EHRs) on machine-learning algorithms to predict mental health crises, up to 28 days in advance. We evaluated both the transferability and replicability of such machine learning models, and for this purpose, we trained six models using features and methods developed on EHR data from the Birmingham and Solihull Mental Health NHS Foundation Trust in the UK. These machine learning models were then used to predict the mental health crises of 2907 patients seen at the Rush University System for Health in the US between 2018 and 2020. The best one was trained on a combination of US-specific structured features and frequency features from anonymized patient notes and achieved an AUROC of 0.837. A model with comparable performance, originally trained using UK structured data, was transferred and then tuned using US data, achieving an AUROC of 0.826. Our findings establish the feasibility of transferring and replicating machine learning models to predict mental health crises across diverse hospital systems. [ABSTRACT FROM AUTHOR]

In recent years, the escalating effects of climate change on surface water bodies have underscored the critical importance of analyzing streamflow trends for effective water resource planning and management. This study conducts a comprehensive regional investigation into the streamflow rate trends of 18 rivers across the United Kingdom (UK). An enhanced Mann–Kendall (MK) test was employed to meticulously analyze both rainfall and streamflow trends on monthly and annual scales. Additionally, the Innovative Trend Analysis (ITA) method was applied to elucidate the variability of streamflow rates, providing a more nuanced understanding of hydrological changes in response to climatic shifts. MK test reveals statistically significant positive trends in streamflow rates, particularly for rivers in south-central Scotland and northern England. Specifically, in January, rivers such as the Tay at Ballathie, Tweed at Peebles, and Teviot at Ormiston showed Z-scores above 2. Annually, similar positive trends were observed, with the Tay at Ballathie (Z = 3.42) and Nith at Friars Carse (Z = 3.35) exhibiting the highest increases in streamflow rates. The ITA method showed no relevant trends for the lowest values of streamflow, except for the Thames at Kingston, while considerable variability was observed for the highest streamflow rates, with several rivers showing positive trends and, however, some England rivers, like Bure at Ingworth, Test at Broadlands, and Trent at Colwick, showing negative trends. From this perspective, a more in-depth analysis of the extreme streamflow trends was carried out. In particular, the flood frequency of the maximum annual streamflow was assessed, based on the fitting of the Generalized Extreme Value (GEV) distribution on the annual maxima. Increasing location parameter (μ) and return period trends were observed for several rivers across the UK. In particular, the Tay at Ballathie (Scotland) showed the most marked increase, with μ that ranged from about 730 m3/s to more than 900 m3/s. At the same time, slight decreasing trends were observed for the Trent River (μ from 378 m3/s to 341 m3/s). The critical comparison of the MK test, ITA, and GEV distribution fitting revealed both agreements and discrepancies among the methods. While the analyses generally aligned in detecting significant trends in streamflow rates, notable discrepancies were observed, particularly in rivers with negligible trends. These inconsistencies highlight the complexity of hydrological responses and the limitations of individual methods. Overall, the study provides a comprehensive view of how streamflow dynamics are evolving in UK rivers, highlighting regional variations in the impact of climate change. This understanding can improve water resource management strategies by integrating diverse analytical approaches. [ABSTRACT FROM AUTHOR]

Fuel moisture content (FMC) is important for the ignitability, behaviour and severity of wildfires. Understanding the drivers of FMC and its spatial and temporal variability can help us develop fuel moisture models and inform assessments of wildfire behaviour and danger. Here we present the first United Kingdom (UK) national-scale temperate FMC dataset of 8,057 samples of eighteen different fuel constituents collected across 58 sampling sites between 2021–2023. We sampled fuels across emerging fire-prone ecosystems in the UK across three studies: (1) UK-wide longer-term sampling characterising the spatio-temporal drivers of FMC; (2) landscape-scale measurement through the North Yorkshire Moors to investigate landscape-driven variability in FMC; (3) plot-scale intensive sampling in the West Midlands to quantify diurnal patterns and among-sampler variability in fuel measurements. This database addresses a global fuel moisture measurement gap within traditionally non-fire prone regions. The database will advance our understanding of temperate fuel moisture dynamics and forms a fundamental contribution towards the development of a fire danger rating system for traditionally non-fire prone regions such as the UK. [ABSTRACT FROM AUTHOR]

In 2016, a design for detecting harbor porpoises (Phocoena phocoena) in the Belgian part of the North Sea (BPNS) was developed in the framework of the LifeWatch project using Passive Acoustic Monitoring (PAM) loggers. In 2018, the network of deployments fully matured, and eight locations across the BPNS are presently housed with a C-POD (Chelonia Ltd., UK), a PAM logger moored on the seafloor using a multi-use platform. The PAM logger continuously listens for harbor porpoise click trains, but only stores the click parameters. This paper presents the generated data series of harbor porpoise click trains at a minute-resolution and the details on the individual click trains. The field recordings, methodology and processing are described, along with its data curation, integration and quality control. The data are annually published online in a standardized format, accompanied with the metadata description, and labelled with a digital object identifier for traceability. Data are published under a CC-BY license, allowing the use of data under the condition of providing reference to the original source. [ABSTRACT FROM AUTHOR]

The move away from transmission-based lecturing toward a more student-centred active learning approach is well evidenced in STEM higher education. However, the examination of active learning has generally remained confined to formal timetabled contexts, with assumptions made that students independently manage the transition between timetabled and non-timetabled learning. This paper introduces research findings from a mixed methods study that used an ecological approach when investigating student transitions between a formal lecture theatre and adjacent informal breakout space in a UK STEM university. Using quantitative occupancy monitoring data to analyse usage patterns of both spaces, in combination with qualitative ethnographic observations and field interviews, permitted a purposeful exploration of student engagement with transitions within and between the two learning spaces. The ecological approach aided the discovery of spatial, pedagogic and agentic transitions and tensions, which subsequently informed strategic modification of space across the institution to facilitate the adoption of active learning pedagogy. [ABSTRACT FROM AUTHOR]

Imagery rescripting commonly seeks to target memories by imagining the intervention of a caregiver. In some cases, such as obsessive-compulsive disorder (OCD), the target imagery may also be episodic future imagery, and a sense of mastery may be more salient than an intervening caregiver. We aimed to compare how varying the target image and rescripting approaches influenced beliefs, emotions, or characteristics of idiopathic imagery relevant to OCD. We recruited 250 online participants high in OCD traits. Participants were randomly assigned to one of four conditions, reflecting variations in target image (memory/future) and rescripting approach (attachment/mastery). Self-administered audio-guided exercises were used to elicit the target image and facilitate rescripting. Participants completed a range of measures before and after rescripting. Participants in all groups tended to report changes in self-related beliefs, emotions, and imagery characteristics. In general, these results did not differ between target images or rescripting approaches. However, mastery-based rescripting reduced anxiety associated with episodic future imagery to a greater extent than attachment-based rescripting. These results suggest that the general benefit of modifying emotionally salient imagery tends to outweigh differential effects of varying the target image or rescripting approach. Standardised re-scripting protocols could be varied based on the individual's needs. [ABSTRACT FROM AUTHOR]

Background: Sport schools are popular environments for simultaneously delivering education and sport to young people. Previous research suggests sport school involvement to have impact (i.e. the positive/negative, intended/unintended and long/short-term outcomes, results and effects) on student athlete's holistic (i.e. academic, athletic, psychosocial and psychological) development. However, previous research is limited by (1) cross-sectional methods, (2) limited multidimensional assessments, (3) lack of consideration for athlete characteristics (e.g. sex) and (4) failure to evaluate how sport school features affect student-athlete impacts. Objectives: The study, using a mixed methods case study approach, aims to (1) longitudinally evaluate the impact of sport school involvement on the holistic development of student athletes, (2) evaluate the impact on holistic development by student-athlete characteristics and (3) explore the features and processes of the sport–school programme that drive/facilitate holistic impacts. Methods: A longitudinal mixed methods design was employed across one full academic school year (33 weeks). Six data-collection methods (i.e. online questionnaire, physical fitness testing battery, academic assessment grades, log diaries, field notes/observation and timeline diagram/illustration) were used to assess the academic, athletic, psychosocial and psychological impacts for 72 student athletes from one sport school in the United Kingdom (UK). Results: Student athletes developed positive long-term holistic overall impacts (i.e. academically, athletically and personally), including maintaining stable and relatively high levels of sport confidence, academic motivation, general recovery, life skills, resilience and friends, family and free time scores. Despite positive impacts, juggling academic and sport workload posed challenges for student athletes, having the potential to lead to negative holistic impacts (e.g. fatigue, stress and injury). Positive and negative impacts were linked to many potential features and processes of the sport school (e.g. academic and athletic support services versus insufficient training load build-up, communication, coordination, flexibility and planning). Furthermore, when considering student-athlete characteristics, females had lower sport confidence, higher general stress and body image concerns and less general recovery than males and student athletes who played sport outside the school had lower general recovery. Conclusions: This mixed method, longitudinal study demonstrated sport school involvement resulted in many positive academic (e.g. good grades), athletic (e.g. fitness development), psychosocial (e.g. enhanced confidence) and psychological (e.g. improved resilience) impacts attributed to the academic and athletic support services provided. However, juggling heavy academic and athletic workloads posed challenges leading to negative impacts including fatigue, pressure, stress and injury. Furthermore, holistic impacts may be sex dependent and further support may be required for female student athletes in sport school environments. Overall, these findings demonstrate the complex nature of combining education and sport commitments and how sport schools should manage, monitor and evaluate the features of their programme to maximise the holistic impacts of sport–school student athletes. [ABSTRACT FROM AUTHOR]

Purpose: To explore the joint association of dietary patterns and adiposity with colorectal cancer (CRC), and whether adiposity mediates the relationship between dietary patterns and CRC risk, which could provide deeper insights into the underlying pathogenesis of CRC. Methods: The data of 307,023 participants recruited between 2006 and 2010 were extracted from the UK Biobank study. Healthy diet scores were calculated based on self-reported dietary data at baseline, and participants were categorized into three groups, namely, low, intermediate, and high diet score groups. Cox regression models with hazard ratios (HRs) and 95% confidence intervals (CIs) were used to estimate the effects of the healthy diet score on CRC incidence, adjusting for various covariates. Furthermore, the mediation roles of obesity and central obesity between the healthy diet score and CRC risk were assessed using a counterfactual causal analysis based on Cox regression model. Additionally, joint association between dietary patterns and adiposity on CRC risks was assessed on the additive and multiplicative scales. Results: Over a median 6.2-year follow-up, 3,276 participants developed CRC. After adjusting for sociodemographic and lifestyle factors, a lower risk of CRC incidence was found for participants with intermediate (HR = 0.83, 95% CI: 0.72 to 0.95) and high diet scores (HR = 0.73, 95% CI: 0.62 to 0.87) compared to those with low diet scores. When compared with the low diet score group, obesity accounted for 4.13% and 7.93% of the total CRC effect in the intermediate and high diet score groups, respectively, while central obesity contributed to 3.68% and 10.02% of the total CRC risk in the intermediate and high diet score groups, respectively. The mediating effect of adiposity on CRC risk was significant in men but not in women. Concurrent unhealthy diet and adiposity multiplied CRC risk. Conclusion: Adiposity-mediated effects were limited in the link between dietary patterns and CRC incidence, implying that solely addressing adiposity may not sufficiently reduce CRC risk. Interventions, such as improving dietary quality in people with adiposity or promoting weight control in those with unhealthy eating habits, may provide an effective strategy to reduce CRC risk. [ABSTRACT FROM AUTHOR]

The notion of science as a stratified system is clearly manifested in the markedly uneven distribution of productivity, rewards, resources, and recognition. Although previous studies have shown that institutional environments for conducting research differ significantly between national science systems, disciplines, and subfields, it remains to be shown whether any systematic variations and patterns in inequalities exist among researchers in different national and domain specific settings. This study investigates the positioning of citation elites as opposed to 'ordinary' researchers by way of examining three dimensions of concentration (accumulation of publications and citations, specialisation, and institutional concentration) in biology, economics and physics in Denmark and the UK. Across all three dimensions, we put Richard Whitley's bipartite theory to the test, suggesting a nexus between the intellectual structure of a discipline and the configuration of its elite. The study draws on a dataset of researchers who published most of their publications in either physics, biology, or economics over the 1980–2018 period and with at least one publication in 2017–2018 while affiliated to either a British or a Danish university. We find higher degrees of concentration in the UK compared to Denmark, and that physics and biology respectively display the greatest and lowest degree of concentration. Similar patterns in disciplinary differences are observed in both countries, suggesting that concentration patterns are largely rooted in disciplinary cultures and merely amplified by the national context. [ABSTRACT FROM AUTHOR]

Previous studies reported mixed findings on autistic individuals' pitch perception relative to neurotypical (NT) individuals. We investigated whether this may be partly due to individual differences in cognitive abilities by comparing their performance on various pitch perception tasks on a large sample (n = 164) of autistic and NT children and adults. Our findings revealed that: (i) autistic individuals either showed similar or worse performance than NT individuals on the pitch tasks; (ii) cognitive abilities were associated with some pitch task performance; and (iii) cognitive abilities modulated the relationship between autism diagnosis and pitch perception on some tasks. Our findings highlight the importance of taking an individual differences approach to understand the strengths and weaknesses of pitch processing in autism. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the safety profile of robotic cholecystectomy performed within the United Kingdom (UK) Robotic Hepatopancreatobiliary (HPB) training programme. Methods: A retrospective evaluation of prospectively collected data from eleven centres participating in the UK Robotic HPB training programme was conducted. All adult patients undergoing robotic cholecystectomy for symptomatic gallstone disease or gallbladder polyp were considered. Bile duct injury, conversion to open procedure, conversion to subtotal cholecystectomy, length of hospital stay, 30-day re-admission, and post-operative complications were the evaluated outcome parameters. Results: A total of 600 patients were included. The median age was 53 (IQR 65–41) years and the majority (72.7%; 436/600) were female. The main indications for robotic cholecystectomy were biliary colic (55.5%, 333/600), cholecystitis (18.8%, 113/600), gallbladder polyps (7.7%, 46/600), and pancreatitis (6.2%, 37/600). The median length of stay was 0 (IQR 0–1) days. Of the included patients, 88.5% (531/600) were discharged on the day of procedure with 30-day re-admission rate of 5.5% (33/600). There were no bile duct injuries and the rate of conversion to open was 0.8% (5/600) with subtotal cholecystectomy rate of 0.8% (5/600). Conclusion: The current study confirms that robotic cholecystectomy can be safely implemented to routine practice with a low risk of bile duct injury, low bile leak rate, low conversion to open surgery, and low need for subtotal cholecystectomy. [ABSTRACT FROM AUTHOR]

Summary: The effect of deprivation on total bone health status has not been well defined. We examined the relationship between socioeconomic deprivation and poor bone health and falls and we found a significant association. The finding could be beneficial for current public health strategies to minimise disparities in bone health. Purpose: Socioeconomic deprivation is associated with many illnesses including increased fracture incidence in older people. However, the effect of deprivation on total bone health status has not been well defined. To examine the relationship between socioeconomic deprivation and poor bone health and falls, we conducted a cross-sectional study using baseline measures from the United Kingdom (UK) Biobank cohort comprising 502,682 participants aged 40–69 years at recruitment during 2006–2010. Method: We examined four outcomes: 1) low bone mineral density/osteopenia, 2) fall in last year, 3) fracture in the last five years, and 4) fracture from a simple fall in the last five years. To measure socioeconomic deprivation, we used the Townsend index of the participant's residential postcode. Results: At baseline, 29% of participants had low bone density (T-score of heel < -1 standard deviation), 20% reported a fall in the previous year, and 10% reported a fracture in the previous five years. Among participants experiencing a fracture, 60% reported the cause as a simple fall. In the multivariable logistic regression model after controlling for other covariates, the odds of a fall, fracture in the last five years, fractures from simple fall, and osteopenia were respectively 1.46 times (95% confidence interval [CI] 1.42–1.49), 1.26 times (95% CI 1.22–1.30), 1.31 times (95% CI 1.26–1.36) and 1.16 times (95% CI 1.13–1.19) higher for the most deprived compared with the least deprived quantile. Conclusion: Socioeconomic deprivation was significantly associated with poor bone health and falls. This research could be beneficial to minimise social disparities in bone health. [ABSTRACT FROM AUTHOR]

Objectives: Antenatal education (ANE) is part of National Health Service (NHS) care and is recommended by The National Institute for Health and Care Excellence (NICE) to increase birth preparedness and help pregnant women/birthing people develop coping strategies for labour and birth. We aimed to understand antenatal educator views about how current ANE supports preparedness for childbirth, including coping strategy development with the aim of identifying targets for improvement. Methods: A United Kingdom wide, cross-sectional online survey was conducted between October 2019 and May 2020. Antenatal educators including NHS midwives and private providers were purposively sampled. Counts and percentages were calculated for closed responses and thematic analysis used for open text responses. Results: Ninety-nine participants responded, 62% of these did not believe that ANE prepared women for labour and birth. They identified practical barriers to accessing ANE, particularly for marginalised groups, including financial and language barriers. Educators believe class content is medically focused, and teaching is of variable quality with some midwives being ill-prepared to deliver antenatal education. 55% of antenatal educators believe the opportunity to develop coping strategies varies between location and educators and only those women who can pay for non-NHS classes are able to access all the coping strategies that can support them with labour and birth. Conclusions for Practice: Antenatal educators believe current NHS ANE does not adequately prepare women for labour and birth, leading to disparities in birth preparedness for those who cannot access non-NHS classes. To reduce this healthcare inequality, NHS classes need to be standardised, with training for midwives in delivering ANE enhanced. Significance: What is Already Known on this Subject?: There is no detailed national guidance about the content or quantity of antenatal education that should be delivered by the NHS to patients and, how coping strategies are developed within these sessions is unknown. What this Study Adds?: Antenatal educators believe that quality of antenatal education needs to be improved. Access to coping strategies for labour and birth is hindered by the type of class, the educator's approach and socioeconomic status. This study can be used to support an argument for addressing the inequality in access to antenatal preparation, whilst better preparing all women through higher quality of antenatal education provision in the NHS. [ABSTRACT FROM AUTHOR]

Purpose The literature indicates that sexuality education provided in schools/colleges in the United Kingdom (UK) may not be appropriate for people with Autism Spectrum Disorder (ASD). There appears to be a lack of understanding of the subject regarding young people with Attention-Deficit/Hyperactivity Disorder (ADHD) and a dual diagnosis (ASD co-occurring with ADHD). Research also suggests that compared to neurotypical peers, young people with ASD tend to receive less support on sexuality from their parents, who often feel that they lack the appropriate skills to help their children with some sex-related issues. Some young people with ASD and ADHD also report lacking an understanding of the social nuances of dating and intimacy, which is crucial for navigating romantic relationships. Design/methodology/approach This study explored sexuality education and romantic relationships in young people based on a semi-structured interview approach to the topic. Thematic Analysis (TA) was employed to analyze the data. Findings Six themes were developed from the participants' narratives: Societal ideology about sexuality; Substandard school-based sexuality education; The role of adults in sexuality education; Pornography, as a very powerful alternative means of sexuality education; Young people and romance—a complicated world to navigate; Experience of abuse in the young neurodivergent population is a serious matter. Findings revealed that many neurodivergent and neurotypical young people received basic sex education in their schools/colleges and homes and encountered challenges navigating romantic relationships. Neurodivergent young people reported experiencing greater challenges related to their understanding of and building romantic relationships than their neurotypical peers. Originality/value To the researchers' knowledge, this is the first exploration of romantic relationships and sexuality education in neurotypical young people as well as three groups of neurodivergent young people (with ASD, ADHD, and ASD co-occurring with ADHD). [ABSTRACT FROM AUTHOR]

Introduction: There is a growing body of evidence demonstrating the benefit of flash glucose monitoring in people living with type 2 diabetes mellitus (T2DM). This real-world study aimed to evaluate the effect of initiating flash glucose monitoring on change in HbA1c after 3–6 months in adults living with T2DM treated with multiple daily injections of insulin. Methods: A retrospective observational study using data from ten clinical centres in the UK for adults with T2DM treated with multiple daily injections of insulin for at least 1 year was conducted. Patients who had been using the FreeStyle Libre/Libre 2 Flash Glucose Monitoring System for at least 3 months with baseline HbA1c 64–108 mmol/mol (8.0–12.0%) recorded up to 3 months prior to system use were included. Pregnant patients and those on dialysis were excluded. Patients with an HbA1c value measured 3–6 months after commencing flash glucose monitoring were included in the final analysis for evaluation of change. Results: In total, 87 patients were included in the final analysis (mean age, 60.0 ± 11.8 years, 60.9% male, mean body mass index (BMI), 31.6 ± 5.4 [mean ± SD]). From a mean baseline HbA1c of 80 ± 11 mmol/mol (9.5% ± 1.0%), HbA1c lowered by 11 ± 14 mmol/mol (1.0% ± 1.3%) at 3–6 months (p < 0.0001). A decrease was observed independent of age, baseline HbA1c, sex, duration of insulin use and BMI subgroups. Conclusions: Initiation of flash glucose monitoring was associated with a clinically and statistically significant improvement in HbA1c in a real-world setting at 3–6 months. [ABSTRACT FROM AUTHOR]

Background: Despite global efforts to improve paediatric clinical trials, significant delays continue in paediatric drug approvals. Collaboration between research networks is needed to address these delays. This paper is a first step to promote interoperability between paediatric networks from different jurisdictions by comparing drivers for, and content of, metrics about clinical trial conduct. Methods: Three paediatric networks, Institute for Advanced Clinical Trials for Children, the Maternal Infant Child and Youth Research Network and conect4children, have each developed metrics to address delays and create efficiencies. We identified the methodology by which each network identified metrics, described the metrics of each network, and mapped consistency to come to consensus about core metrics that networks could share. Results: Metric selection was driven by site quality improvement in one network (11 metrics), by network performance in one network (13 metrics), and by both in one network (five metrics). The domains of metrics were research capacity/capability, site identification/feasibility, trial start-up, and recruitment/enrolment. The network driven by site quality improvement did not have indicators for capacity/capability or identification/feasibility. Fifteen metrics for trial start up and conduct were identified. Metrics related to site approvals were found in all three networks. The themes for metrics can inform the development of 'shared' metrics. Conclusion: We found disparity in drivers, methodology and metrics. Tackling this disparity will result in a unified approach to addressing delays in paediatric drug approvals. Collaborative work to define inter-operable metrics globally is outlined. [ABSTRACT FROM AUTHOR]

Understanding long-term change in fish populations often relies on comparing catches from historical and contemporary trawl surveys. However, such comparisons may not resolve biases associated with differences in fishing gears and their relative catchabilities. It is possible to reduce these uncertainties by replicating historical trawl gear and practices. With the availability of unique historical catch data, we investigated the trawl gear employed by the Northumberland Sea Fisheries Committee (NSFC) during scientific surveys conducted between 1892–1913 in inshore waters of the Northumberland coast (UK), and describe our attempt to reconstruct the gear using currently available materials. We reviewed the historical literature, photographs and acquired technical expertise to reconstruct a late nineteenth century beam trawl used by the NSFC. The replica gear consisted of a 6.7 m beam connected by two Brixham style wrought-iron trawl heads, which held open a triangular-shaped trawl net with rounded ground-rope. Following construction, we tested the performance and catchability of the replica gear by conducting comparative trawls using a modern otter trawl in August 2018 and March 2019. Both trawl gears exhibited similar catches for flatfish in August trials, yet a higher proportion of individuals were landed by the otter trawl in March. Zero or negligible catches were exhibited by the replica gear during this period. This work collates relevant information to describe the evolution, design and functioning of late nineteenth century beam trawls used around the British Isles, providing an important repository for investigators interested in trawl technology and survey designs. [ABSTRACT FROM AUTHOR]

Introduction: Homosexuality constitutes a topic of ongoing debates not only in lay, but also political and religious discourse. At the same time, conspiracy theories gain more and more popularity and narratives about the hidden gay agenda result in discriminatory behaviors against LGBTQI+ people. This study aims to test (a) the relationship between religiosity and social distance from LGBTQI+ people, and (b) the serial mediating effect of gender conspiracy beliefs and LGBTQI+ conspiracy beliefs in the aforementioned relationship. Methods: N = 703 participants were recruited online in the UK in August 2020. Ethical approval was secured and participants provided their written consent. We measured religious attitudes, gender and homosexuality conspiracy beliefs, and social distance from LGBTQI+ people. Results: People higher in religiosity were more distant from LGBTQI+ people, a relationship that was serially mediated by gender and LGBTQI+ conspiracy beliefs. Conclusion and Policy Implications: Results open up the discussion for policy-making implications reflected, for example, on the need to introduce critical thinking and skills to debunk conspiracy theories even more in workplaces, schools, universities, and institutions, which are supposed to foster diversity among their members. [ABSTRACT FROM AUTHOR]

Introduction: Until 12 January 2000, the UK Armed Forces retained a policy of discharging all gay, lesbian, bisexual, and transgender personnel under exemptive military laws. The so-called 'gay ban' was enforced with the rationale that homosexuality was incompatible with military service. Little research has explored the experiences of LGBT + veterans or the impact of the 'gay ban' policy. Methods: In 2021, 15 LGBT + veterans who had been affected by the 'gay ban' participated in semi-structured interviews lasting around 90 minutes. Interview transcripts were analysed using thematic analysis. Results: Five overarching themes were identified in exploring the experiences and impact of the 'gay ban' policy: LGBT + identity struggle; camouflage; intense investigative process; extraction, exclusion and loss; and the personal impact. Conclusions: Serving in the UK Armed Forces during this homosexuality ban policy affected the social, health and well-being of LGBT + veterans. The necessity for LGBT + veterans to hide their sexual orientation and/or gender identity, the impact of investigations, loss of careers and alienation have led to long-term experiences of social isolation, loneliness due to barriers to connecting to others and difficulties around health and well-being. Policy Implications: LGBT + veteran vulnerability and traumatic experiences need to be understood in the context of help-seeking behaviour and service provision. The implications for policy change include achieving health and social care equity in relation to access to support services. Support services need to ensure that there is an awareness of the impact of serving under the discriminatory 'gay ban' policy. [ABSTRACT FROM AUTHOR]

In this article we report some practical experiences of integrating education for sustainable development into established university teaching modules. The 2021 guidance on Education for Sustainable Development from the UK's standards bodies QAA and Advance HE is an important and urgent motivation for introducing sustainability into university courses. We take as our context a first-year introductory module in Chemical Products and Process in the School of Chemistry and Chemical Engineering and a second-year module in Software Engineering and Systems Development in the School of Electronics, Electrical Engineering and Computer Science, both at Queen's University Belfast. We outline some of the challenges of adding new themes to existing courses. We comment on ways of presenting themes of sustainable development alongside existing module content, and we indicate the type of work students produced. We identify approaches that resulted in good outcomes, and outline changes we have made with a view to improved future outcomes. [ABSTRACT FROM AUTHOR]

Background: Auditory reaction time (ART) and visual reaction time (VRT) are critical for patients with stroke, especially during balance training. According to the research, most patients with stroke are fatigued at sub-maximal levels during their stroke rehabilitation. Sub-maximal physical fatigue may affect ART and VRT and impede stroke rehabilitation. Hence, it is important to study the effect of submaximal physical fatigue on ART and VRT. A pilot study on healthy adults paves the way for further research on stroke rehabilitation. The purpose of this research is to find out if submaximal physical fatigue affects ART and VRT in healthy adults. In addition, this study also determines if ART and VRT recover to baseline after 15 min of rest post-fatigue session. Furthermore, the goal is to determine whether sub-maximal physical fatigue has a greater effect on ART or VRT. Methods: A repeated measures within-subject design was used in the study. Eighteen healthy participants (median age 24 years) completed two sessions of a sub-maximal fatigue protocol on a cycle ergometer until they reached a rating of perceived exertion (RPE) of 15 on a scale of 6–20. Two different fatigue sessions were conducted (one to study the effects of fatigue on ART and the other for VRT). ART or VRT was measured on computer software before (PRE), immediately after (POST-0), and 15 min after (POST-15) the sub-maximal physical fatigue protocol. Results: The value of median ART increased significantly from PRE to POST-0 (P = 0.002) and it decreased significantly at POST-15 (P = 0.010). Similarly, the value of mean VRT increased from PRE to POST-0 (P = 0.001) before decreasing significantly at POST-15 (P = 0.001). There was no significant difference between the effects of submaximal fatigue on ART and VRT (P = 0.156). Conclusion: Due to submaximal physical fatigue, ART and VRT were slower, but they returned to baseline after 15 min of rest. Submaximal physical fatigue had an equal impact on ART and VRT. As balance training requires quicker ART and VRT for optimal outcomes, it may be better if the physiotherapists consider a 15-min rest period between the exercise and balance training in patients with stroke. [ABSTRACT FROM AUTHOR]

The mpox epidemic in the UK began in May 2022, with rates of new cases unexpectedly and rapidly declining during August 2022. Interpreting trends in infection requires disentangling the underlying growth rate of cases from the delay from symptom onset to presenting to healthcare. We developed a nowcasting Bayesian method which incorporates time-varying delays (EpiLine) to quantify the changes in the delay from symptom onset to healthcare presentation and the underlying mpox growth rate over the period May-August 2022 in the UK. We show that the mean delay between symptom onset and healthcare presentation for mpox in the UK decreased from 22 days in early May 2022 to 10 days by early June and 8 days in August 2022. When we account for these dynamic delays, the time-varying growth rate declined gradually and continuously in the UK during the May-August 2022 period. Not accounting for varying time delays would have incorrectly characterised the growth rate by a sharp increase followed by a rapid decline in mpox cases. Our results highlight the importance of correctly quantifying the delay between symptom onset to healthcare presentation when characterising the epidemic growth of mpox in the UK. The gradual reduction in the rate of epidemic spread, which pre-dated the vaccine roll-out, is consistent with gradual risk reduction or acquired immunity amongst the highest risk individuals. Our study highlights the need for public health agencies to record the delays from symptom onset to healthcare presentation early in an outbreak. [ABSTRACT FROM AUTHOR]

While previous observational studies have suggested a link between leukocyte counts and vascular dementia (VD), the causal relationship between leukocyte counts and various subtypes of VD remains elusive. This study aimed to investigate the causal relationship between five types of leukocyte counts and VD, with the goal of improving prevention and treatment strategies. In this study, leukocyte counts were used as the exposure variable, with genome-wide association study (GWAS) data sourced from both the UK Biobank and the Blood Cell Consortium. Additionally, GWAS data for five subtypes of vascular dementia were obtained from the FinnGen database. We conducted rigorous statistical analysis and visualization using Mendelian randomization (MR) to elucidate the potential causal relationship between leukocyte counts and vascular dementia. This study, utilizing MR analysis with data from the UK Biobank and Blood Cell Consortium, identified significant causal associations between increased lymphocyte counts and VD. Specifically, lymphocyte counts were found to be causally related to multiple and mixed VD subtypes. Sensitivity analyses, including MR-Egger regression and MR-PRESSO tests, confirmed the robustness of these findings, with no evidence of reverse causality or significant horizontal pleiotropy detected. The results underscore a potential inflammatory or immunological mechanism in the pathogenesis of VD, highlighting lymphocytes as a key component in their etiology. This investigation establishes a robust association between elevated lymphocyte and leukocyte counts and an increased risk of VD, emphasizing the roles of inflammation, immune activation, and hematological factors in disease pathogenesis. [ABSTRACT FROM AUTHOR]

Objective: To assess rates of traversing barriers to care to access optimal clinical outcomes in people with migraine internationally. Background: People in need of medical care for migraine should consult a health care professional knowledgeable in migraine management, obtain an accurate diagnosis, and receive an individualized treatment plan, which includes scientific society guideline-recommended treatments where appropriate. Methods: The Chronic Migraine Epidemiology and Outcomes-International (CaMEO-I) Study was a cross-sectional, web-based survey conducted from July 2021 through March 2022 in Canada, France, Germany, Japan, the United Kingdom, and the United States (US). Respondents who met modified International Classification of Headache Disorders, 3rd edition, criteria for migraine and had Migraine Disability Assessment Scale (MIDAS) scores of ≥ 6 (i.e., mild, moderate, or severe disability) were deemed to need medical care and were included in this analysis. Minimally effective treatment required that participants were currently consulting a health care professional for headache (barrier 1), reported an accurate diagnosis (barrier 2), and reported use of minimally appropriate pharmacologic treatment (barrier 3; based on American Headache Society 2021 Consensus Statement recommendations). Proportions of respondents who successfully traversed each barrier were calculated, and chi-square tests were used to assess overall difference among countries. Results: Among 14,492 respondents with migraine, 8,330 had MIDAS scores of ≥ 6, were deemed in need of medical care, and were included in this analysis. Current headache consultation was reported by 35.1% (2926/8330) of respondents. Compared with the US, consultation rates and diagnosis rates were statistically significantly lower in all other countries except France where they were statistically significantly higher. Total appropriate treatment rates were also statistically significantly lower in all other countries compared with the US except France, which did not differ from the US. All 3 barriers were traversed by only 11.5% (955/8330) of respondents, with differences among countries (P < 0.001). Conclusions: Of people with migraine in need of medical care for migraine, less than 15% traverse all 3 barriers to care. Although rates of consultation, diagnosis, and treatment differed among countries, improvements are needed in all countries studied to reduce the global burden of migraine. Trial registration: NA. [ABSTRACT FROM AUTHOR]

Openness and transparency in the research process are a prerequisite to the production of high quality research outputs. Efforts to maximise these features have substantially accelerated in recent years, placing open and transparent research practices at the forefront of funding and related priorities, and encouraging investment in resources and infrastructure to enable such practices. Despite these efforts, there has been no systematic documentation of current practices, infrastructure, or training and resources that support open and transparent research in the UK. To address this gap, we developed and conducted the Open and Transparent Research Practices survey, a large-scale audit study completed by research-active staff in UK research institutions to better understand existing practices, needs, support, and barriers faced when implementing open and transparent research. The data presented here capture responses from over 2,500 research-active staff based at 15 institutions affiliated with the UK Reproducibility Network. The data provide a snapshot of open research practices that can be used to identify barriers, training needs, and areas that require greater investments. [ABSTRACT FROM AUTHOR]

Background: There are limited tools to measure the burden of disease and effectiveness of medical/surgical interventions in patients with cryptoglandular fistulas. The aim of this study was to explore concepts that are relevant and important to patients with complex cryptoglandular fistulas (CCF) and to develop a patient-centred, disease-specific, patient-reported outcome measure (PROM) to assess symptom burden and impacts of CCF. Methods: A targeted literature review was conducted, followed by one-to-one telephone interviews with five colorectal surgeons (USA, n = 3; UK, n = 1; Spain, n = 1) and 20 US adult patients with CCF to inform the development of a conceptual model and a CCF-specific PROM. The targeted literature review informed the development of the preliminary conceptual model and identified a PROM in the literature that was used as a reference to generate the draft CCF-specific PROM. The colorectal surgeon interviews provided insights on the experience of patients with CCF to refine the conceptual model, formulate probing questions for use in patient interviews, and to develop the draft CCF-specific PROM. Patients' descriptions of their experiences with symptoms and the impacts on their lives and evaluation of the draft CCF-specific PROM in concept elicitation and cognitive interviews were used to develop the final conceptual model and final CCF-specific PROM. Results: Ten symptoms (odour, pain during bowel movement, abscess, post-operative pain, discharge/drainage/leakage, anal/perianal pain, inflammation/swelling, skin irritation, bleeding and itchiness) and 11 impacts (discomfort, inability to exercise, embarrassment, difficulty sitting, worry about disease, adapted life to maintain hygiene, negatively impacted social life/isolation, inability to perform daily activities, reduced interest in sex, negatively impacted intimate relationships and negatively impacted mood) were reported as most salient by patients. The patient experience, clinician perspective, and literature review provided input to item generation. Evaluation of relevance and patient understanding through cognitive interviews with patients provided evidence for the content validity of the new patient-reported outcome measure: the 20-item Complex Cryptoglandular Fistula Questionnaire™ (CCFQ-20™). Conclusion: The CCFQ-20™ is a new clinician-guided, patient-validated, disease-specific patient-reported outcome measure that measures disease impact and quality of life in patients with CCF. [ABSTRACT FROM AUTHOR]

The QUANT study represents the most extensive open-access evaluation of commercial air quality sensor systems to date. This comprehensive study assessed 49 systems from 14 manufacturers across three urban sites in the UK over a three-year period. The resulting open-access dataset captures high time-resolution measurements of a variety of gasses (NO, NO2, O3, CO, CO2), particulate matter (PM1, PM2.5, PM10), and key meteorological parameters (humidity, temperature, atmospheric pressure). The quality and scope of the dataset is enhanced by reference monitors' data and calibrated products from sensor manufacturers across the three sites. This publicly accessible dataset serves as a robust and transparent resource that details the methods used for data collection and procedures to ensure dataset integrity. It provides a valuable tool for a wide range of stakeholders to analyze the performance of air quality sensors in real-world settings. Policymakers can leverage this data to refine sensor deployment guidelines and develop standardized protocols, while manufacturers can utilize it as a benchmark for technological innovation and product certification. Moreover, the dataset has supported the development of a UK code of practice, and the certification of one of the participating companies, underscoring the dataset's utility and reliability. [ABSTRACT FROM AUTHOR]

Breast cancer is the most frequently diagnosed cancer in females globally. However, we know relatively little about trends in males. This study describes United Kingdom (UK) secular trends in breast cancer from 2000 to 2021 for both sexes. We describe a population-based cohort study using UK primary care Clinical Practice Research Datalink (CPRD) GOLD and Aurum databases. There were 5,848,436 eligible females and 5,539,681 males aged 18+ years, with ≥ one year of prior data availability in the study period. We estimated crude breast cancer incidence rates (IR), prevalence and survival probability at one-, five- and 10-years after diagnosis using the Kaplan–Meier method. Analyses were further stratified by age. Crude IR of breast cancer from 2000 to 2021 was 194.4 per 100,000 person-years for females and 1.16 for males. Crude prevalence in 2021 was 2.1% for females and 0.009% for males. Both sexes have seen around a 2.5-fold increase in prevalence across time. Incidence increased with age for both sexes, peaking in females aged 60–69 years and males 90+. There was a drop in incidence for females aged 70–79 years. From 2003–2019, incidence increased > twofold in younger females (aged 18–29: IR 2.12 in 2003 vs. 4.58 in 2018); decreased in females aged 50–69 years; and further declined from 2015 onwards in females aged 70–89 years. Survival probability for females after one-, five-, and ten-years after diagnosis was 95.1%, 80.2%, and 68.4%, and for males 92.9%, 69.0%, and 51.3%. Survival probability at one-year increased by 2.08% points, and survival at five years increased by 5.39% from 2000–2004 to 2015–2019 for females, particularly those aged 50–70 years. For males, there were no clear time-trends for short-term and long-term survival probability. Changes in incidence of breast cancer in females largely reflect the success of screening programmes, as rates rise and fall in synchronicity with ages of eligibility for such programmes. Overall survival from breast cancer for females has improved from 2000 to 2021, again reflecting the success of screening programmes, early diagnosis, and improvements in treatments. Male breast cancer patients have worse survival outcomes compared to females, highlighting the need to develop male-specific diagnosis and treatment strategies to improve long-term survival in line with females. [ABSTRACT FROM AUTHOR]

Though climate change and its adverse ecological and geohydrological impacts are being experienced across the world in all types of ecosystems but as far as the Himalaya mountain ecosystem is concerned, the rate of climate change and subsequent impacts have reached an alarming stage due to anthropogenic and technogenic intervention on natural process and now need most effective and less time taking management strategy. Addressing this burning environmental problem, a geospatial artificial intelligence (GeoAI) technique–based case study is presented here from one of the most densely populated and urbanized regions of Himalaya mountain, viz Uttarakhand Himalaya, which is also called central Himalaya. The results of the study suggest that due to quite a high rate of climate change, the climatic zones shifting towards higher altitudes at the average rate of 5.6 2 m/year, causing several adverse ecological impacts in terms of decreasing quality dense temperate forest cover (0.05%/year), snow cover (0.02%/year), water bodies (0.01%/year), agricultural land (0.31%/year), and horticultural land (0.01%/year). Conversion of these eco-friendly land use land cover into barren land, fallow land, and built-up land causes geohydrological consequences of climate change in terms of decreasing rainy days (1%/year), drying perennial springs (0.20%/year), perennial streams (0.11%/year), decreasing spring and stream discharge during non-monsoon season, increased extreme rainfall events (6–8%/year), and subsequent surface runoff during monsoon season. Further, the study advocates that the degraded geohydrological process has resulted in an increased frequency of disaster events (floods, cloudbursts, landslides. etc.) with a 3% (12 events) annual rate, causing great loss of environment, infrastructure, lives, and economy each year. Therefore, it has been very urgent to mitigate climate change and increase geohydrological disaster events through an integrated approach. Keep in view this, the present study proposed an integrated watershed management plan which is equally useful to be implemented across the Himalaya region and other similar ecosystems across the world. [ABSTRACT FROM AUTHOR]

Large language models (LLMs) like ChatGPT have potential applications in medical education such as helping students study for their licensing exams by discussing unclear questions with them. However, they require evaluation on these complex tasks. The purpose of this study was to evaluate how well publicly accessible LLMs performed on simulated UK medical board exam questions. 423 board-style questions from 9 UK exams (MRCS, MRCP, etc.) were answered by seven LLMs (ChatGPT-3.5, ChatGPT-4, Bard, Perplexity, Claude, Bing, Claude Instant). There were 406 multiple-choice, 13 true/false, and 4 "choose N" questions covering topics in surgery, pediatrics, and other disciplines. The accuracy of the output was graded. Statistics were used to analyze differences among LLMs. Leaked questions were excluded from the primary analysis. ChatGPT 4.0 scored (78.2%), Bing (67.2%), Claude (64.4%), and Claude Instant (62.9%). Perplexity scored the lowest (56.1%). Scores differed significantly between LLMs overall (p < 0.001) and in pairwise comparisons. All LLMs scored higher on multiple-choice vs true/false or "choose N" questions. LLMs demonstrated limitations in answering certain questions, indicating refinements needed before primary reliance in medical education. However, their expanding capabilities suggest a potential to improve training if thoughtfully implemented. Further research should explore specialty specific LLMs and optimal integration into medical curricula. [ABSTRACT FROM AUTHOR]

Challenging others who post misinformation is a type of social correction that complements algorithm-based approaches. However, participation rates in such social acts remain limited. In this paper, we study design techniques that leverage principles of persuasive system design and communication theories to foster such prosocial behaviour across two distinct cultural contexts: the British and the Arab. A total of 462 participants completed an online survey (250 UK, 212 Arabs). The study compared the two cultural contexts regarding willingness to challenge misinformation and the persuasiveness of seven design techniques to increase that willingness, namely predefined question stickers, thinking face reaction, sentence openers, fact checker badge, social norm messages, tone detector, and private commenting. Moreover, it explores the impact of individuals' characteristics on their perception of the techniques as being more or less persuasive than a standard comment box. The study found that the willingness to challenge misinformation was significantly higher in the Arab context than in the UK context. Moreover, except for the private commenting, all techniques were more impactful in the Arab context than in the UK context. Some techniques, such as predefined question stickers, were more effective in both cultures compared to the standard comment box, while others, like the fact checker badge, were more effective only in the Arab context. However, in the UK, sentence openers had a lower impact. Furthermore, personality traits, age, and perspective-taking showed the potential but also the varying impacts on the persuasiveness of the techniques on users' correction of misinformation across both cultural contexts while pointing to the need for considering both personal and cultural factors in designing social-correction-based solutions. [ABSTRACT FROM AUTHOR]

Purpose: The management of geriatric femoral neck fractures, which includes options like hemiarthroplasty (HA), total hip arthroplasty (THA), and fixation, exhibits regional and healthcare setting variations. However, there is a lack of information on global variations in practice patterns and surgical decision factors for this injury. Methods: Survey data were collected from April 2020 to June 2023 via Orthobullets Case Studies, a global clinical case collaboration platform hosted on a prominent orthopedic educational website. Collaboratively developed standardized polls, based on the best available evidence and a comprehensive, peer-reviewed, evidence-based item list, were used to capture surgeons' treatment preferences worldwide. Subsequent analyses explored preferences within subspecialties and practice settings. Multivariable regression analysis identified associations between subspecialty, practice type, the likelihood of choosing THA, and the preferred femoral fixation method. Results: Our study encompassed 2595 respondents from 76 countries. Notably, 51.5% of participants (n = 1328; 51.5%, 95% CI 49.6–53.4%) leaned towards THA and 44.9% for HA, while 3.6% favoured surgical fixation. Respondents affiliated with academic institutions and large non-university-affiliated hospitals were 1.74 times more likely to favour THA, and arthroplasty specialists exhibited a 1.77-fold preference for THA. There was a 19-fold variation for cemented femoral fixation between the United Kingdom (UK) and USA with the UK favouring cemented fixation. Conclusion: Our study reveals a significant shift towards THA preference for managing geriatric femoral neck fractures, influenced by subspecialty and practice settings. We also observed a pronounced predominance of cement fixation in specific geographic locations. These findings highlight the evolving fracture management landscape, emphasizing the need for standardization and comprehensive understanding across diverse healthcare settings. [ABSTRACT FROM AUTHOR]

Purpose: To examine the effects of fresh fruit, dried fruit, raw vegetables, and cooked vegetables on type 2 diabetes (T2D) progression trajectory. Methods: We included 429,886 participants in the UK Biobank who were free of diabetes and diabetes complications at baseline. Food groups were determined using a validated food frequency questionnaire. Outcomes were T2D incidence, complications, and mortality. Multi-state model was used to analyze the effects of food groups on T2D progression. Results: During a follow-up of 12.6 years, 10,333 incident T2D cases were identified, of whom, 3961 (38.3%) developed T2D complications and 1169 (29.5%) died. We found that impacts of four food groups on T2D progression varied depending on disease stage. For example, compared to participants who ate less than one piece of dried fruit per day, the hazard ratios and 95% confidence intervals for those who ate ≥ 2 pieces of dried fruit per day were 0.82 (0.77, 0.87), 0.88 (0.85, 0.92), and 0.86 (0.78, 0.95) for transitions from diabetes-free state to incident T2D, from diabetes-free state to total death, and from incident T2D to T2D complications, respectively. Higher intake of fresh fruit was significantly associated with lower risk of disease progression from diabetes-free state to all-cause death. Higher intake of raw and cooked vegetables was significantly associated with lower risks of disease progression from diabetes-free state to incident T2D and to total death. Conclusions: These findings indicate that higher intake of fresh fruit, dried fruit, raw vegetables, and cooked vegetables could be beneficial for primary and secondary prevention of T2D. [ABSTRACT FROM AUTHOR]

Purpose: The present study investigated school absence among 1,076 5–15 year-old children with neurodevelopmental conditions (intellectual disability and/or autism) approximately one year following the start of COVID-19 in the UK. Methods: Parents completed an online survey indicating whether their child was absent from school during May 2021 and the reason for each absence. Multi-variable regression models investigated child, family and school variables associated with absenteeism and types of absenteeism. Qualitative data were collected on barriers and facilitators of school attendance. Results: During May 2021, 32% of children presented with persistent absence (missing ≥ 10% of school). School refusal and absence due to ill-health were the most frequent types of absence, accounting for 37% and 22% of days missed, respectively. COVID-19 related absence accounted for just 11% of days missed. Child anxiety was associated with overall absenteeism and with days missed because of school refusal. Parent pandemic anxiety and child conduct problems were not associated with school absenteeism. Hyperactivity was associated with lower levels of absenteeism and school refusal but higher levels of school exclusion. A positive parent-teacher relationship was associated with lower levels of absenteeism, school refusal and exclusion. Child unmet need in school was the most frequently reported barrier to attendance while COVID-19 was one of the least frequently reported barriers. Conclusion: COVID-19 had a limited impact on school attendance problems during this period. Findings highlighted the role of child mental health in different types of absence and the likely protective role of a positive parent-teacher relationship. [ABSTRACT FROM AUTHOR]

Background: With the primary objective of addressing the disparity in global surgical care access, the College of Surgeons of East, Central, and Southern Africa (COSECSA) trains surgeons. While sufficient operative experience is crucial for surgical training, the extent of utilization of minimally invasive techniques during COSECSA training remains understudied. Methods: We conducted an extensive review of COSECSA general surgery trainees' operative case logs from January 1, 2015, to December 31, 2020, focusing on the utilization of minimally invasive surgical procedures. Our primary objective was to determine the prevalence of laparoscopic procedures and compare this to open procedures. We analyzed the distribution of laparoscopic cases across common indications such as cholecystectomy, appendicitis, and hernia operations. Additionally, we examined the impact of trainee autonomy, country development index, and hospital type on laparoscopy utilization. Results: Among 68,659 total cases, only 616 (0.9%) were laparoscopic procedures. Notably, 34 cases were conducted during trainee external rotations in countries like the United Kingdom, Germany, and India. Gallbladder and appendix pathologies were most frequent among the 582 recorded laparoscopic cases performed in Africa. Laparoscopic cholecystectomy accounted for 29% (276 of 975 cases), laparoscopic appendectomy for 3% (76 of 2548 cases), and laparoscopic hernia repairs for 0.5% (26 of 5620 cases). Trainees self-reported lower autonomy for laparoscopic (22.5%) than open cases (61.5%). Laparoscopy usage was more prevalent in upper-middle-income (2.7%) and lower-middle-income countries (0.8%) compared with lower-income countries (0.5%) (p < 0.001). Private (1.6%) and faith-based hospitals (1.5%) showed greater laparoscopy utilization than public hospitals (0.5%) (p < 0.001). Conclusions: The study highlights the relatively low utilization of minimally invasive techniques in surgical training within the ECSA region. Laparoscopic cases remain a minority, with variations observed based on specific diagnoses. The findings suggest a need to enhance exposure to minimally invasive procedures to ensure well-rounded training and proficiency in these techniques. [ABSTRACT FROM AUTHOR]

Background: Liver surgery is associated with a significant hospital stay regardless the type of liver resection. A large incision is essential for open liver surgery which is a major factor in the course of the patient's recovery. For patients with small parenchyma liver lesions requiring surgical resection, robotic surgery potentially offers the opportunity to transform the patient's post-operative course. A day-case robotic liver resection pathway was formulated and implemented at our institution when patients were planned for discharge within 24 h of admission for liver surgery. Methods: Single surgeon case series of cases performed at a tertiary hepatobiliary and pancreatic centre between September 2022 and November 2023. The inclusion criteria were non-anatomical wedge resections, < 2 anatomical segmental resections, left lateral hepatectomy and minimally invasive surgery. Results: This is the first series of robotic day-case minor liver resection in the United Kingdom. 20 patients were included in this case series. The mean operative time was 86.6 ± 30.9 min and mean console time was 58.6 ± 24.5 min. Thirteen patients (65%) were discharged within 24 h of surgery. The main cause of hospitalisation beyond 24 h was inadequate pain relief. There were no Clavien–Dindo grade III or above complications, no 30-day readmission and 90-day mortalities. Conclusion: This case series demonstrates that robotic day-case liver resection is safe and feasible. Robust follow-up pathways must be in place to allow for the safe implementation of this approach, to monitor for any complications and to allow intervention as required in a timely manner. [ABSTRACT FROM AUTHOR]

We detected isolates with SdhC-I87F-conferring mutations that were slightly SDHI-adapted in the barley leaf rust Puccinia hordei in France and the UK in 2019. SdhC-I87F of P. hordei is orthologous to SdhC-I86F in Phakopsora pachyrhizi, and SdhC-I88F in Puccinia horiana induced SDHI resistance. Nevertheless, the field performance of SDHIs against P. hordei was good, although strains with SdhC-I87F dominated the field. The sensitivity ranges were narrow for wheat leaf rust and Puccinia triticina in 2019; however, isolates with slightly higher EC50 values were obtained in southern France and the eastern UK in 2021. These isolates of P. triticina harbored an orthologous SdhC-I87F-conferring mutation. The range of EC50 values for the SDHI fungicide inpyrfluxam overlapped between the wild type and SdhC-I87F isolates. Further analyses are currently underway. [ABSTRACT FROM AUTHOR]

Purpose: In April 2020, the UK Government implemented NHS Test and Trace to provide SARS-CoV-2 quantitative reverse transcription polymerase chain reaction (qRT-PCR) testing for the public, with nose-and-throat swabbing for samples performed by trained staff. Self-swabbing (SS) would allow rapid scale-up of testing capacity and access. Six studies were undertaken to determine whether SS was as effective for detecting SARS-CoV-2 as swabbing performed by trained staff. Methods: Six prospective studies were conducted between April–October 2020, using six swab/media combinations. Differences between assisted swabbing (AS) and SS were evaluated for concordance, positivity, sensitivity, cycle threshold (Ct) values and void rates. Statistical analysis was performed using 95% confidence intervals (CIs), paired t-tests and model-based methods. Results: Overall, 3,253 individuals were recruited (median age 37 years, 49% female), with 2,933 having valid paired qRT-PCR results. Pooled concordance rate was 98% (95% CI: 96%, 99%). Positivity rate differences for SS (8.1%) and AS (8.4%) and differences in pooled sensitivities between SS (86%; 95% CI: 78%, 92%) and AS (91%; 95% CI: 78%, 96%) were nonsignificant. Both types of swabbing led to pooled void rates below 2% and strongly correlated Ct values. Age, sex and previous swabbing experience did not have a significant impact on concordance or sensitivity. Conclusion: The UK adopted a policy to promote self-testing for SARS-CoV-2 based on data demonstrating equivalence of SS versus AS. Positive outcomes with SS are likely generalisable to testing for other respiratory pathogens, and we consider self-sampling and self-testing essential for future pandemic preparedness. [ABSTRACT FROM AUTHOR]

With considerable debate concerning the impact of culture on the expression of callous–unemotional (CU) traits, it is unclear whether the core features of CU traits generalize to youth across cultures. This study aimed to examine whether cultural differences are reflected in the core features of CU traits and the associations among these features. Network analysis was employed to identify the core features and to examine the network structure of CU traits operationalized by the Inventory of Callous Unemotional traits (ICU) in four community youth samples from different nations (Australia, N = 190; the UK, N = 437; the USA, N = 330; China, N = 503). The item "Apologizes to people" was identified as a cross-cultural core feature in the ICU network with a greater centrality of this item compared to others in all four samples. In addition, some items were identified as culture-specific core features in the network, differing in their centrality across samples. The network structures of the youth self-report ICU items were moderately similar across samples, while the structures of parent-report items showed substantial differences. These findings have important implications for cross-cultural research on CU traits as well as practical implications for screening and treatment. The core features of ICU appear to be generalizable in youth across cultures, although cultural-specific manifestations should be noted. [ABSTRACT FROM AUTHOR]

Current prospective reports suggest a pandemic-related increase in adolescent mental health problems. We examine whether age-related change over 11–14 years accounts for this increase. Mothers and adolescents in a UK-based birth cohort (Wirral Child Health and Development Study; WCHADS; N = 737) reported on adolescent depression and behavioural problems pre-pandemic (December 2019–March 2020), mid-pandemic (June 2020–March 2021) and late pandemic (July 2021–March 2022). Analysis used repeated measures models for over-dispersed Poisson counts with an adolescent-specific intercept with age as a time-varying covariate. Maturational curves for girls, but not for boys, showed a significant increase in self-reported depression symptoms over ages 11–14 years. Behavioural problems decreased for both. After adjusting for age-related change, girls' depression increased by only 13% at mid-pandemic and returned to near pre-pandemic level at late pandemic (mid versus late – 12%), whereas boys' depression increased by 31% and remained elevated (mid versus late 1%). Age-adjusted behavioural problems increased for both (girls 40%, boys 41%) and worsened from mid- to late pandemic (girls 33%, boys 18%). Initial reports of a pandemic-related increase in depression in young adolescent girls could be explained by a natural maturational rise. In contrast, maturational decreases in boys' depression and both boys' and girls' behavioural problems may mask an effect of the pandemic. [ABSTRACT FROM AUTHOR]

Childhood conduct problems and head injuries share a bidirectional association, but how this affects the risk of adolescent delinquency is unknown. Due to their similar underlying mechanisms (i.e. increased impulsivity), this study aims to identify whether their co-occurrence increases the risk of adolescent delinquency. Data was obtained from 11,272 children at age 14 and 10,244 at age 17 years enrolled in the UK Millennium Cohort Study. Conduct problem symptoms (via the Strengths and Difficulties Questionnaire) and head injuries were parent reported from ages 3 to 14 years. Delinquency was self-reported at ages 14 and 17 including substance use, criminality, and antisocial behaviour. Incident rate ratios (IRR) were estimated for delinquency at ages 14 and 17 by childhood conduct problem and head injury status. Co-occurring head injuries and high conduct problem symptoms presented the greatest risk for overall delinquency and substance use at age 14 compared to those with the presence of one or neither (IRRs from 1.20 to 1.60). At age 17, conduct problems (with or without co-occurring head injuries) presented the greatest risk for overall delinquency, substance use, and antisocial behaviour. There was no evidence for an increased risk of delinquency at ages 14 or 17 following a head injury only. Whilst these findings suggest childhood head injuries alone do not increase the risk of adolescent delinquency, when co-occurring alongside high conduct problem symptoms there is a heightened earlier risk. These results provide further insight into adolescent delinquency and the outcomes of co-occurring childhood head injury and conduct problem symptoms. [ABSTRACT FROM AUTHOR]

Research shows that, in mental healthcare, empathy and active listening skills play a fundamental role in the therapeutic relationship. Despite this, clinicians receive little training in cultivating these qualities, and there is a dearth of training in therapeutic relationships and relational care in this field more generally. In response to this paucity of training, a new intensive three-day training programme has been developed called Compassionate and Relational Enquiry (CARE). The CARE training programme has recently been delivered to a number of mental health teams in different boroughs of an NHS Trust and has undergone several rounds of redevelopment. This paper outlines the CARE training programme's objectives and mode of delivery, and subsequently presents questionnaire results from recent CARE trainees regarding their experience of the nature and utility of the training. Four main themes emerged from responses to the question of the utility of the training, these were 'A shift towards more person-centred care', 'Strengthens the therapeutic relationship', 'Facilitates more collaborative care with patients and their families' and 'Development of new skills and therapeutic techniques'. The paper concludes by discussing the potential of this training to help forge a substantial shift in the culture of mental health services in a systemic way. [ABSTRACT FROM AUTHOR]

Purpose: The association between type 2 diabetes mellitus (T2DM), lifestyle factors, and the risk of osteoporosis (OP) is well-established. However, the impact of a healthy lifestyle on diabetes-related osteoporosis needs further investigation. Our objective was to explore if a combination of healthy lifestyle factors could mitigate the risk of OP in individuals with type 2 diabetes. Methods: This longitudinal analysis included 237,725 middle-aged and older participants. An overall lifestyle score, ranging from 0 to 7, was calculated by assigning a point for each of the seven healthy lifestyle factors, including no current smoking, non-excessive alcohol consumption, regular physical activity, healthy diet, adequate sleep duration, less sedentary behavior, and adequate sunshine exposure. Results: During a median follow-up 12.21 years, 5760 OP cases were documented. Participants with T2DM showed a higher risk of OP than those without diabetes. Compared with participants without diabetes who had a lifestyle score of 6–7, the hazard ratios (HRs) for OP were 1.58 (95% CI 1.23–2.03), 1.62 (95% CI 1.16–2.25), and 2.58 (95% CI 1.64–4.05) for participants with T2DM who had a lifestyle score of 4, 3, and 0–2, respectively. There was a graded association between higher lifestyle scores and lower risks of incident OP among participants without diabetes as well as among those with T2DM. We estimated that the population attributable fraction for not adhering to 6–7 lifestyle behaviors was 15.7%. Conclusions: Participants with T2DM who adhered to a variety of healthy lifestyle factors demonstrated a substantially reduced risk of developing OP. [ABSTRACT FROM AUTHOR]

Psychiatric disorders frequently co-occur and share common symptoms and genetic backgrounds. Previous research has used genome-wide association studies to identify the interrelationships among psychiatric disorders and identify clusters of disorders; however, these methods have limitations in terms of their ability to examine the relationships among disorders as a network structure and their generalizability to the general population. In this study, we explored the network structure of the polygenic risk score (PRS) for 13 psychiatric disorders in a general population (276,249 participants of European ancestry from the UK Biobank) and identified communities and the centrality of the network. In this network, the nodes represented a PRS for each psychiatric disorder and the edges represented the connections between nodes. The psychiatric disorders comprised four robust communities. The first community included attention-deficit hyperactivity disorder, autism spectrum disorder, major depressive disorder, and anxiety disorder. The second community consisted of bipolar I and II disorders, schizophrenia, and anorexia nervosa. The third group included Tourette's syndrome and obsessive–compulsive disorder. Cannabis use disorder, alcohol use disorder, and post-traumatic stress disorder make up the fourth community. The PRS of schizophrenia had the highest values for the three metrics (strength, betweenness, and closeness) in the network. Our findings provide a comprehensive genetic network of psychiatric disorders and biological evidence for the classification of psychiatric disorders. [ABSTRACT FROM AUTHOR]

Introduction: Pregnancy and the postpartum period is a difficult time for women living with HIV (WLWH) and postpartum engagement with HIV care is often reduced, with implications for health and well-being. We aimed to explore the postpartum health experiences of WLWH in relation to engagement in HIV care. Methods: The NESTOR (iNvESTigating the pregnancy and pOst-paRtum health experience of women living with HIV) study was a UK based qualitative semi-structured interview study. 61 eligible women were identified. We used a purposive sampling technique to recruit women with differing levels of engagement in HIV care. Interviews were conducted via telephone or video call. Interviews were audio recorded and fully transcribed. We used a thematic approach for data analysis, and two researchers independently coded the data and established the key themes. Results: 11 of 61 (18%) eligible women participated in the interviews, and the three main themes were 'infant feeding decisions', 'managing the risk of mother to child transmission', and 'managing the knowledge of their HIV status'. These themes offer detailed insights into the significant psychological and emotional challenges these women had experienced, and the practical support from healthcare professionals in both HIV and maternity services that had enabled them to navigate those challenges. Discussion: There have been life-changing developments in the treatment and care for people living with HIV. However, even in the U = U (undetectable = untransmittable) era, traditional concerns about breastfeeding, risk of transmission to the infant and stigma continue to shape the postpartum experience of WLWH. As these impact on their emotional and psychological wellbeing, support in these areas needs to be prioritised. Significance: Studies report that postpartum retention in HIV care and viral load suppression are suboptimal for women living with HIV, where an important reason is the financial cost and access to healthcare. However, there is a relative scarcity of evidence describing the problems faced by women accessing HIV and maternity services within socialised healthcare systems, such as those in the UK. Women living with HIV face unanticipated challenges when becoming new mothers relating to disclosure of their HIV status, fears of vertical transmission and perceived perceptions of others deeming them inadequate mothers. Importantly, our analysis illustrates potential opportunities where intervention might mitigate the emotional and physical impact of these issues on their wellbeing throughout pregnancy and postpartum. [ABSTRACT FROM AUTHOR]

Background and objectives: Most previous studies suggested obesity deteriorates the functional outcome after ischemic stroke. But there are researches claiming that obesity is associated with lower mortality, recurrence, and readmission rates, which is known as the obesity paradox. Our current research aimed to investigate the correlation between genetically obesity and the post-stroke outcome with the Mendelian randomization (MR) method. Methods: The UK Biobank and the GIANT consortium provided instrumental variables for body mass index (BMI, 806,834 individuals) and waist-to-hip ratio (WHR, 697,734 individuals). Data of functional outcome after ischemic stroke were obtained from the Genetics of Ischemic Stroke Functional Outcome network (6012 individuals). Inverse-variance weighted approach was utilized as the primary analyses. Sensitivity analyses involved the utilization of different MR methods. The heterogeneity among genetic variants was assessed by I2 and Q value statistics. Results: In univariable analysis, there was a significant connection between genetic susceptibility to WHR and worse functional outcome (modified Rankin Scale 3) after ischemic stroke (OR [95%CI] = 1.47 [1.07, 2.02], P = 0.016). Genetic liability to BMI and was not associated with post-stroke functional outcome (all P > 0.05). The overall patterns between genetic liability to WHR and functional outcome post-ischemic outcome no longer existed in the multivariable MR analysis after adjusting for BMI (OR [95%CI] = 1.26[0.76,1.67], P = 0.56). Conclusion: The current MR study provided evidence that WHR was correlated to unfavorable outcome post-ischemic stroke. Exploring interventions against obesity may potentially improve recovery after ischemic stroke. [ABSTRACT FROM AUTHOR]