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A new epitaxial layer design with a double mode expander layer, high refractive index claddings, and an aluminum-free active area has been used to demonstrate distributed feedback lasers operating at 778.1 nm wavelength with reduced Lorentzian linewidth aimed at miniature atomic clock applications. The design also reduces the vertical beam divergence to improve the modal matching with optical fibers as well as maintain the high power output and reduce the emission linewidth. The lasers demonstrate single-mode operation with an over 35 dB side-mode suppression ratio, a power output ≤58 mW, a coupling efficiency to tapered fibers ≤40%, and a Lorentzian linewidth of 3.7 kHz. The performance allowed the free-running distributed feedback lasers to demonstrate spectroscopy of Rb vapor, which resolved the 85Rb and 87Rb two-photon transitions. [ABSTRACT FROM AUTHOR]

A Ge-SiGe multiple quantum well structure created by low energy plasma enhanced chemical vapour deposition, with nominal well thickness of 5.4 nm separated by 3.6 nm SiGe spacers, is analysed quantitatively using scanning transmission electron microscopy. Both high angle annular dark field imaging and electron energy loss spectroscopy show that the interfaces are not completely sharp, suggesting that there is some intermixing of Si and Ge at each interface. Two methods are compared for the quantification of the spectroscopy datasets: a self-consistent approach that calculates binary substitutional trends without requiring experimental or computational κ-factors from elsewhere and a standards-based cross sectional calculation. Whilst the cross section approach is shown to be ultimately more reliable, the self-consistent approach provides surprisingly good results. It is found that the Ge quantum wells are actually about 95% Ge and that the spacers, whilst apparently peaking at about 35% Si, contain significant interdiffused Ge at each side. This result is shown to be not just an artefact of electron beam spreading in the sample, but mostly arising from a real chemical interdiffusion resulting from the growth. Similar results are found by use of X-ray diffraction from a similar area of the sample. Putting the results together suggests a real interdiffusion with a standard deviation of about 0.87nm, or put another way—a true width defined from 10%–90% of the compositional gradient of about 2.9 nm. This suggests an intrinsic limit on how sharp such interfaces can be grown by this method and, whilst 95% Ge quantum wells (QWs) still behave well enough to have good properties, any attempt to grow thinner QWs would require modifications to the growth procedure to reduce this interdiffusion, in order to maintain a composition of ≥95% Ge. [ABSTRACT FROM AUTHOR]

Laser cooled atoms have proven transformative for precision metrology, playing a pivotal role in state-of-the-art clocks and interferometers and having the potential to provide a step-change in our modern technological capabilities. To successfully explore their full potential, laser cooling platforms must be translated from the laboratory environment and into portable, compact quantum sensors for deployment in practical applications. This transition requires the amalgamation of a wide range of components and expertise if an unambiguously chip-scale cold atom sensor is to be realized. We present recent developments in cold-atom sensor miniaturization, focusing on key components that enable laser cooling on the chip-scale. The design, fabrication, and impact of the components on sensor scalability and performance will be discussed with an outlook to the next generation of chip-scale cold atom devices. [ABSTRACT FROM AUTHOR]

Photoluminescence up to 2.25 μm wavelength is demonstrated from Ge nanopillars strained by silicon nitride stressor layers. Tensile biaxial equivalent strains of up to ~ 1.35% and ~ 0.9% are shown from 200 × 200 nm, and 300 × 300 nm square top Ge pillars respectively. Strain in the latter is confirmed by Raman spectroscopy, and supported by finite element modelling, which gives an insight into the strain distribution and its effect on the band structure, in pillar structures fully coated by silicon nitride stressor layers. [ABSTRACT FROM AUTHOR]

Mid-infrared intersubband absorption from p-Ge quantum wells with Si0.5Ge0.5 barriers grown on a Si substrate is demonstrated from 6 to 9 µm wavelength at room temperature and can be tuned by adjusting the quantum well thickness. Fourier transform infra-red transmission and photoluminescence measurements demonstrate clear absorption peaks corresponding to intersubband transitions among confined hole states. The work indicates an approach that will allow quantum well intersubband photodetectors to be realized on Si substrates in the important atmospheric transmission window of 8-13 µm. [ABSTRACT FROM AUTHOR]

A self doping contact consisting of a silver/antimony alloy that produces an Ohmic contact to moderately doped n-type germanium (doped to a factor of four above the metal-insulator transition) has been investigated. An evaporation of a mixed alloy of Ag/Sb (99%/1%) onto n-Ge (ND = 1 × 1018 cm-3) annealed at 400°C produces an Ohmic contact with a measured specific contact resistivity of (1:1±0.2) × 10-5 Ω-cm². It is proposed that the Ohmic behaviour arises from an increased doping concentration at the Ge surface due to the preferential evaporation of Sb confirmed by transmission electron microscope analysis. It is suggested that the doping concentration has increased to a level where field emission will be the dominate conduction mechanism. This was deduced from the low temperature electrical characterisation of the contact, which exhibits Ohmic behaviour down to a temperature of 6.5 K. [ABSTRACT FROM AUTHOR]

Aims To develop, describe and evaluate clinical applicability of pudendal nerve block using a peripheral nerve locator. Methods In a pilot study, 6 ponies were used to determine the correlation between nerves serving the perineal region (namely pudendal, caudorectal and perineal nerves) and the muscle contractions observed when an electrolocation technique was used. After appropriate electrolocation a small volume of lidocaine/methylene blue solution was injected under general anaesthesia. The dye location relative to the specified nerves was examined after humane euthanasia followed by dissection of the relevant region. In a second experiment, 7 Thoroughbred horses were used to evaluate the appropriate volume of lidocaine solution for the nerve block. Lidocaine/methylene blue solution was injected after positive electrolocation immediately (5-40 min) after euthanasia. A stained segment of 2 cm or more of the nerve was deemed to be sufficient and was evaluated after dissection. Finally, evaluation of a bilateral pudendal nerve block was used to provide anaesthesia and analgesia in 10 clinical cases involving both mares and geldings. Results Anal twitch alone was associated with injection of the caudal rectal nerve, whereas combined twitch of the anus and perineum was required for reliable location and injection of the pudendal nerve. Injection was more accurate in standing rather than laterally recumbent horses. A volume of 10-20 ml bilaterally, reliably provided at least 60 min of clinical analgesia for perineal surgery. Procedures satisfactorily completed included; urethral extension and perineal body repair in mares and penile examination, removal of penile tumours and penile amputation in male patients. Conclusions and practical significance Pudendal nerve block is a practical and effective alternative to epidural analgesia for selected standing surgical procedures of the reproductive tract in male and female horses. Ethical animal research The Cornell University Institutional Animal Care and Use Committee approved the project and informed client consent was obtained. Sources of funding: None. Competing interests: None. [ABSTRACT FROM AUTHOR]

Kathleen Gallacher describes how decisions made over the care of one patient have informed practice. [ABSTRACT FROM AUTHOR]

A low temperature nickel process has been developed that produces Ohmic contacts to n-type germanium with specific contact resistivities down to (2.3 ± 1.8) × 10-7 Ω-cm2 for anneal temperatures of 340 °C. The low contact resistivity is attributed to the low resistivity NiGe phase which was identified using electron diffraction in a transmission electron microscope. Electrical results indicate that the linear Ohmic behaviour of the contact is attributed to quantum mechanical tunnelling through the Schottky barrier formed between the NiGe alloy and the heavily doped n-Ge. [ABSTRACT FROM AUTHOR]

Electroluminescence from strained n-Ge quantum well light emitting diodes grown on a silicon substrate are demonstrated at room temperature. Electroluminescence characterisation demonstrates two peaks around 1.55 μm and 1.8 μm, which correspond to recombination between the direct and indirect transitions, respectively. The emission wavelength can be tuned by around 4% through changing the current density through the device. The devices have potential applications in the fields of optical interconnects, gas sensing, and healthcare. [ABSTRACT FROM AUTHOR]

Abstract Introduction and aims Heart failure (HF) is as ‘malignant’ as many common cancers. It is known that end stage heart failure (ESHF) symptoms have a negative impact on the daily lives of patients who also feel unsupported. The aim of this study is to examine patient experiences of managing their condition, with a particular focus on their ‘treatment burden’, defined as the ‘work’ they do to manage their condition, including reference to the services they use and how they negotiate and mobilize these. It is essential to understand these issues if we are to be able to design more patient centred services. Methods This study involves semi-structured interviews with ESHF patients focusing on the work they do to manage and ‘live’ with their condition. Qualitative data analysed using framework methods informed by Normalization Process Theory. Inclusion criteria: at least Grade 3 or 4 NYHA classification HF; who have ongoing symptoms despite optimal therapy; and have a history of admissions for this condition. Results 33 patients identified, 21 consenting to participation. 16 male; 5 female. Patients described a vast range of treatment burdens many which were secondary to the health care systems and the lack of a patient centred approach. Issues raised included: the work imposed by disorganised systems of care necessitating multiple attendances for check-ups and investigations; lack of continuity; inadequate communication between health professionals; polypharmacy; and difficulties accessing services. Conclusions This study has highlighted a range of challenges for patients posed by current health care systems, highlighting clear points for intervention. [ABSTRACT FROM PUBLISHER]

In this work, the growth and the fabrication of heavily doped germanium plasmonic antennas for mid-infrared applications are reported. By tuning the phosphorus doping concentration and the antenna geometrical parameters, plasma frequencies for targeting the 8–15 μm spectral region are achieved. 1 μm thick, heavily doped (2.3 × 10 19 cm − 3 ) germanium was used to fabricate dipole antennas of 800 nm width with a gap spacing of 300 nm which demonstrate resonance frequencies around 13 μm and 13.5 μm for 2 μm and 3 μm long structures, respectively. This technology has the potential to be used for mid-infrared sensing applications of hazardous gases and liquids. [ABSTRACT FROM AUTHOR]

Background: Prognostic models that identify individuals with chronic kidney disease (CKD) at greatest risk of developing kidney failure help clinicians to make decisions and deliver precision medicine. It is recognised that people with CKD usually have multiple long-term health conditions (multimorbidity) and often experience frailty. We undertook a systematic review to evaluate the representation and consideration of multimorbidity and frailty within CKD cohorts used to develop and/or validate prognostic models assessing the risk of kidney failure., Methods: We identified studies that described derivation, validation or update of kidney failure prognostic models in MEDLINE, CINAHL Plus and the Cochrane Library-CENTRAL. The primary outcome was representation of multimorbidity or frailty. The secondary outcome was predictive accuracy of identified models in relation to presence of multimorbidity or frailty., Results: Ninety-seven studies reporting 121 different kidney failure prognostic models were identified. Two studies reported prevalence of multimorbidity and a single study reported prevalence of frailty. The rates of specific comorbidities were reported in a greater proportion of studies: 67.0% reported baseline data on diabetes, 54.6% reported hypertension and 39.2% reported cardiovascular disease. No studies included frailty in model development, and only one study considered multimorbidity as a predictor variable. No studies assessed model performance in populations in relation to multimorbidity. A single study assessed associations between frailty and the risks of kidney failure and death., Conclusions: There is a paucity of kidney failure risk prediction models that consider the impact of multimorbidity and/or frailty, resulting in a lack of clear evidence-based practice for multimorbid or frail individuals. These knowledge gaps should be explored to help clinicians know whether these models can be used for CKD patients who experience multimorbidity and/or frailty., Systematic Review Registration: This review has been registered on PROSPERO (CRD42022347295)., (© 2024. The Author(s).)

Approximately 50 % of poor prognosis neuroblastomas arise due to MYCN over-expression. We previously demonstrated that MYCN and PRMT5 proteins interact and PRMT5 knockdown led to apoptosis of MYCN-amplified (MNA) neuroblastoma. Here we evaluate the highly selective first-in-class PRMT5 inhibitor GSK3203591 and its in vivo analogue GSK3326593 as targeted therapeutics for MNA neuroblastoma. Cell-line analyses show MYCN-dependent growth inhibition and apoptosis, with approximately 200-fold greater sensitivity of MNA neuroblastoma lines. RNA sequencing of three MNA neuroblastoma lines treated with GSK3203591 reveal deregulated MYCN transcriptional programmes and altered mRNA splicing, converging on key regulatory pathways such as DNA damage response, epitranscriptomics and cellular metabolism. Stable isotope labelling experiments in the same cell lines demonstrate that glutamine metabolism is impeded following GSK3203591 treatment, linking with disruption of the MLX/Mondo nutrient sensors via intron retention of MLX mRNA. Interestingly, glutaminase (GLS) protein decreases after GSK3203591 treatment despite unchanged transcript levels. We demonstrate that the RNA methyltransferase METTL3 and cognate reader YTHDF3 proteins are lowered following their mRNAs undergoing GSK3203591-induced splicing alterations, indicating epitranscriptomic regulation of GLS; accordingly, we observe decreases of GLS mRNA m6A methylation following GSK3203591 treatment, and decreased GLS protein following YTHDF3 knockdown. In vivo efficacy of GSK3326593 is confirmed by increased survival of Th-MYCN mice, with drug treatment triggering splicing events and protein decreases consistent with in vitro data. Together our study demonstrates the PRMT5-dependent spliceosomal vulnerability of MNA neuroblastoma and identifies the epitranscriptome and glutamine metabolism as critical determinants of this sensitivity., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Crown Copyright © 2024. Published by Elsevier B.V. All rights reserved.)

Context: Treatment burden is defined as the workload of healthcare for people with long-term conditions and the impact on wellbeing. Stroke survivors often live with considerable treatment burden because of high healthcare workload alongside deficiencies in care provision that can make navigating healthcare systems and managing health more difficult. Ways of measuring treatment burden after stroke are currently lacking. The Patient Experience with Treatment and Self-Management measure (PETS) is a 60-item patient-reported measure that was developed to measure treatment burden in a multi-morbid population. Although comprehensive, this is not a stroke-specific measure and therefore omits some burdens associated with stroke rehabilitation. Objective: Our aim was to adapt (PETS) (version 2.0, English), a patient-reported measure of treatment burden in multimorbidity, to create a stroke-specific measure (PETS-stroke), and to conduct content validity testing in a UK stroke survivor population. Study Design and analysis: PETS items were adapted to create PETS-stroke, using a previously developed conceptual model of treatment burden in stroke. Content validation involved three rounds of qualitative cognitive interviews with stroke survivors in Scotland recruited through stroke groups and primary care. Participants were asked for feedback on the importance, relevance and clarity of content of PETS-stroke. Framework analysis was used to explore responses. Setting: Community. Population studied: Stroke survivors. Instrument: Patient Experience with Treatment and Self-Management in stroke (PETS-stroke) scale. Results: Interviews (n=15) resulted in changes to the wording of instructions and items; location of items within the measure; answer options; and recall period. The final PETS-stroke tool has 34-items, spanning 13 domains. It includes 10 items unchanged from PETS, 6 new and 18 amended. Conclusions: The development of a systematic method of quantifying treatment burden from the perspective of stroke survivors will allow for the identification of patients at high risk of treatment burden and will aid the design and testing of tailored interventions aimed at lessening treatment burden., Competing Interests: None, (© 2023 Annals of Family Medicine, Inc.)

Context: To aid prioritisation of funding for stroke research, a Stroke Priority Setting Partnership is being conducted in the UK by The Stroke Association using surveys and workshops with stroke survivors, stroke carers and health professionals. Another valuable source of information about topics that require research is the social media platform Twitter. Objective: To ascertain common topics of discussion in relation to stroke recovery on Twitter amongst stroke survivors, their carers, and the general public. Study design and analysis: Content analysis of public posts on Twitter. Dataset: An electronic search of Twitter was performed to analyse the content of two major stroke discussion tags: #strokesurvivor and #strokerecovery. Tweets were collected using NCapture, an open-source extension for the internet browser Chrome. Tweets spanning 5 weeks over the course of January to February 2021 were analysed. Population studied: Tweets made by stroke survivors and their carers or other interested members of the public were included and those made by health professionals or organisations (e.g. charities or health care providers) were excluded. All tweets were fully anonymised and edited where necessary to omit any identifying information. Outcome measures: The content of each tweet was analysed thematically using NVIVO, with tweets being coded by their content and sentiment to identify trends in discussion. Results: 486 tweets were analysed following the removal of duplicate and unrelated material. From these, 6 themes were identified: motivation & positivity; raising of stroke awareness; experience of the stroke rehabilitation process; symptomatic aspects of stroke recovery; sharing of stroke-related resources; and concerns about COVID-19. Conclusions: Twitter's role as a space for peer-support and motivation amongst survivors was evident, as was its potential for promoting awareness of stroke and its sequalae to the public. Amongst the most prominent aspects of recovery discussed was the psychological impact of stroke, with users expressing difficulty in addressing the emotional sequalae in comparison to the physical aspects. This may be addressed by targeted funding of mental health services, and recognition of the specialised needs of stroke survivors. It is hoped that the findings of this project will be useful in guiding the apportioning of funding, as well as complementing the findings of the James Lind Alliance's Priority Setting Partnership., Competing Interests: Authors report none., (2021 Annals of Family Medicine, Inc.)

Epithelial cells migrate across wounds to repair injured tissue. Leader cells at the front of migrating sheets often drive this process. However, it is unclear how leaders emerge from an apparently homogeneous epithelial cell population. We characterized leaders emerging from epithelial monolayers in cell culture and found that they activated the stress sensor p53, which was sufficient to initiate leader cell behavior. p53 activated the cell cycle inhibitor p21 WAF1/CIP1 , which in turn induced leader behavior through inhibition of cyclin-dependent kinase activity. p53 also induced crowding hypersensitivity in leader cells such that, upon epithelial closure, they were eliminated by cell competition. Thus, mechanically induced p53 directs emergence of a transient population of leader cells that drive migration and ensures their clearance upon epithelial repair.

Background: A Learning Health System (LHS) is a model of how routinely collected health data can be used to improve care, creating 'virtuous cycles' between data and improvement. This requires the active involvement of health service stakeholders, including patients themselves. However, to date, research has explored the acceptability of being 'data donors' rather than considering patients as active contributors. The study aimed to understand how patients should be actively involved in an LHS., Design: Ten participatory codesign workshops were conducted with eight experienced public contributors using visual, collective and iterative methods. This led contributors to challenge and revise not only the idea of an LHS but also revise the study aims and outputs., Results: The contributors proposed three exemplar roles for patients in patient-driven LHS, which aligned with the idea of three forms of transparency: informational, participatory and accountability. 'Epistemic injustice' was considered a useful concept to express the risks of an LHS that did not provide active roles to patients (testimonial injustice) and that neglected their experience through collecting data that did not reflect the complexity of their lives (hermeneutic injustice)., Discussion: Patient involvement in an LHS should be 'with and by' patients, not 'about or for'. This requires systems to actively work with and respond to patient feedback, as demonstrated within the study itself by the adaptive approach to responding to contributor questions, to work in partnership with patients to create a 'virtuous alliance' to achieve change., Patient or Public Contribution: Public contributors were active partners throughout, and co-authored the paper., (© 2021 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Introduction: The transition of patients across care settings is associated with a high risk of errors and preventable medication-related harm. Ensuring effective communication of information between health professionals is considered important for improving patient safety. A National Health Service(NHS) organisation in the North West of England introduced an electronic transfer of care around medicines (TCAM) system which enabled hospital pharmacists to send information about patient's medications to their nominated community pharmacy. We aimed to understand the adoption, and the implications for sustainable use in practice of the TCAM service., Methods: We evaluated the TCAM service in a Clinical Commissioning Group (CCG) and NHS Foundation Trust in Salford, United Kingdom (UK). Participants were opportunistically recruited to take part in qualitative interviews through stakeholder networks and during hospital admission, and included hospital pharmacists, hospital pharmacy technicians, community pharmacists, general practice-based pharmacists, patients and their carers. A thematic analysis, that was iterative and concurrent with data collection, was undertaken using a template approach. The interpretation of the data was informed by broad sociotechnical theory., Results: Twenty-three interviews were conducted with health care professionals patients and carers. The ways in which the newly implemented TCAM intervention was adopted and used in practice and the perceptions of it from different stakeholders were conceptualised into four main thematic areas: The nature of the network and how it contributed to implementation, use and sustainability; The material properties of the system; How work practices for medicines safety were adapted and evolved; and The enhancement of medication safety activities. The TCAM intervention was perceived as effective in providing community pharmacists with timely, more accurate and enhanced information upon discharge. This allowed for pharmacists to enhance clinical services designed to ensure that accurate medication reconciliation was completed, and the correct medication was dispensed for the patient., Conclusions: By providing pharmacy teams with accurate and enhanced information the TCAM intervention supported healthcare professionals to establish and/or strengthen interprofessional networks in order to provide clinical services designed to ensure that accurate medication reconciliation and dispensing activities were completed. However, the intervention was implemented into a complex and at times fragmented network, and we recommend opportunities be explored to fully integrate this network to involve patients/carers, general practice pharmacists and two-way communication between primary and secondary care to further enhance the reach and impact of the TCAM service., Competing Interests: The authors have declared that no competing interests exist.

Background Despite common use, anticholinergic medications have been associated with serious health risks. Interventions to reduce their use are being developed and there is a need to understand their implementation into clinical care. Aim of review This systematic review aims to identify and analyse qualitative research studies exploring the barriers and facilitators to reducing anticholinergic burden. Methods Medline (OVID), EMBASE (OVID), CINAHL (EMBSCO) and PsycINFO (OVID) were searched using comprehensive search terms. Peer reviewed studies published in English presenting qualitative research in relation to the barriers and facilitators of deprescribing anticholinergic medications, involving patients, carers or health professionals were eligible. Normalization Process Theory was used to explore and explain the data. Results Of 1764 identified studies, two were eligible and both involved healthcare professionals (23 general practitioners, 13 specialist clinicians and 12 pharmacists). No studies were identified that involved patients or carers. Barriers to collaborative working often resulted in poor motivation to reduce anticholinergic use. Low confidence, system resources and organisation of care also hindered anticholinergic burden reduction. Good communication and relationships with patients, carers and other healthcare professionals were reported as important for successful anticholinergic burden reduction. Having a named person for prescribing decisions, and clear role boundaries, were also important facilitators. Conclusions This review identified important barriers and facilitators to anticholinergic burden reduction from healthcare provider perspectives which can inform implementation of such deprescribing interventions. Studies exploring patient and carer perspectives are presently absent but are required to ensure person-centeredness and feasibility of future interventions., (© 2021. The Author(s).)

Background and Purpose: Stroke is the second commonest cause of death worldwide and a leading cause of severe disability, yet there are no published trials of palliative care in stroke. To design and evaluate palliative care interventions for people with stroke, researchers need to know what measurable outcomes matter most to patients and families, stroke professionals, and other service providers., Methods: A multidisciplinary steering group of professionals and laypeople managed the study. We synthesized recommendations from respected United Kingdom and international consensus documents to generate a list of outcome domains and then performed a rapid scoping literature review to identify potential outcome measures for use in future trials of palliative care after stroke. We then completed a 3-round, online Delphi survey of professionals, and service users to build consensus about outcome domains and outcome measures. Finally, we held a stakeholder workshop to review and finalize this consensus., Results: We generated a list of 36 different outcome domains from 4 key policy documents. The rapid scoping review identified 43 potential outcome measures that were used to create a shortlist of 16 measures. The 36 outcome domains and 16 measures were presented to a Delphi panel of diverse healthcare professionals and lay service users. Of 48 panelists invited to take part, 28 completed all 3 rounds. Shared decision-making and quality of life were selected as the most important outcome domains for future trials of palliative care in stroke. Additional comments highlighted the need for outcomes to be feasible, measurable, and relevant beyond the initial, acute phase of stroke. The stakeholder workshop endorsed these results., Conclusions: Future trials of palliative care after stroke should include pragmatic outcome measures, applicable to the evolving patient and family experiences after stroke and be inclusive of shared decision-making and quality of life.

Introduction: People living with type 2 diabetes undertake a range of tasks to manage their condition, collectively referred to as self-management. Interventions designed to support self-management vary in their content, and efficacy. This systematic review will analyse self-management interventions for type 2 diabetes drawing on theoretical models of patient workload and capacity., Methods and Analysis: Five electronic databases (Medline, Embase, CENTRAL, CINAHL and PsycINFO) will be searched from inception to 27th April 2021, supplemented by citation searching and hand-searching of reference lists. Two reviewers will independently review titles, abstracts and full texts. Inclusion criteria include Population: Adults with type 2 diabetes mellitus; Intervention: Randomised controlled trials of self-management support interventions; Comparison: Usual care; Outcomes: HbA1c (primary outcome) health-related quality of life (QOL), medication adherence, self-efficacy, treatment burden, healthcare utilization (e.g. number of appointment, hospital admissions), complications of type 2 diabetes (e.g. nephropathy, retinopathy, neuropathy, macrovascular disease) and mortality; Setting: Community. Study quality will be assessed using the Effective Practice and Organisation of Care (EPOC) risk of bias tool. Interventions will be classified according to the EPOC taxonomy and the PRISMS self-management taxonomy and grouped into similar interventions for analysis. Clinical and methodological heterogeneity will be assessed within subgroups, and random effects meta-analyses performed if appropriate. Otherwise, a narrative synthesis will be performed. Interventions will be graded on their likely impact on patient workload and support for patient capacity. The impact of these theoretical constructs on study outcomes will be explored using meta-regression. Conclusion This review will provide a broad overview of self-management interventions, analysed within the cumulative complexity model theoretical framework. Analyses will explore how the workload associated with self-management, and support for patient capacity, impact on outcomes of self-management interventions., Registration Number: PROSPERO CRD42021236980., Competing Interests: No competing interests were disclosed., (Copyright: © 2021 Hanlon P et al.)