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Background: There is a need for robust evidence on the effectiveness and cost-effectiveness of domestic abuse perpetrator programmes in reducing abusive behaviour and improving wellbeing for victim/survivors. While any randomised controlled trial can present difficulties in terms of recruitment and retention, conducting such a trial with domestic abuse perpetrators is particularly challenging. This paper reports the pilot and feasibility trial of a voluntary domestic abuse perpetrator group programme in the United Kingdom., Methods: This was a pragmatic individually randomised pilot and feasibility trial with an integrated qualitative study in one site (covering three local-authority areas) in England. Male perpetrators were randomised to either the intervention or usual care. The intervention was a 23-week group programme for male perpetrators in heterosexual relationships, with an average of three one-to-one sessions, and one-to-one support for female current- or ex-partners delivered by third sector organisations. There was no active control treatment for men, and partners of control men were signposted towards domestic abuse support services. Data were collected at three-monthly intervals for nine months from male and female participants. The main objectives assessed were recruitment, randomisation, retention, data completeness, fidelity to the intervention model, and acceptability of the trial design., Results: This study recruited 36 men (22 randomly allocated to attend the intervention group programme, 14 to usual care), and 15 current- or ex-partners (39% of eligible partners). Retention and completeness of data were high: 67% of male (24/36), and 80% (12/15) of female participants completed the self-reported questionnaire at nine months. A framework for assessing fidelity to the intervention was developed. In interviews, men who completed all or most of the intervention gave positive feedback and reported changes in their own behaviour. Partners were also largely supportive of the trial and were positive about the intervention. Participants who were not allocated to the intervention group reported feeling disappointed but understood the rationale for the trial., Conclusions: It was feasible to recruit, randomise and retain male perpetrators and female victim/survivors of abuse and collect self-reported outcome data. Participants were engaged in the intervention and reported positive benefits. The trial design was seen as acceptable., Trial Registration: ISRCTN71797549, submitted 03/08/2017, retrospectively registered 27/05/2022., (© 2024. The Author(s).)

Background: Self-harm and suicide behaviours are a major public health concern. Several factors are associated with these behaviours among military communities. Identifying these factors may have important implications for policy and clinical services. The aim of this review was to identify the risk and protective factors associated with self-harm and suicide behaviours among serving and ex-serving personnel of the United Kingdom Armed Forces, Canadian Armed Forces, Australian Defence Force and New Zealand Defence Force., Methods: A systematic search of seven online databases (PubMed, Web of Science, Embase, Global Health, PsycINFO, PTSDpubs and CINAHL) was conducted alongside cross-referencing, in October 2022. Following an a priori PROSPERO approved protocol (CRD42022348867), papers were independently screened and assessed for quality. Data were synthesised using a narrative approach., Results: Overall, 28 papers were included: 13 from Canada, 10 from the United Kingdom, five from Australia and none from New Zealand. Identified risk factors included being single/ex-relationship, early service leavers, shorter length of service (but not necessarily early service leavers), junior ranks, exposure to deployment-related traumatic events, physical and mental health diagnoses, and experience of childhood adversity. Protective factors included being married/in a relationship, higher educational attainment, employment, senior ranks, and higher levels of perceived social support., Conclusion: Adequate care and support are a necessity for the military community. Prevention and intervention strategies for self-harm and suicide behaviours may be introduced early and may promote social networks as a key source of support. This review found a paucity of peer-reviewed research within some populations. More peer-reviewed research is needed, particularly among these populations where current work is limited, and regarding modifiable risk and protective factors., Competing Interests: CW is currently in receipt of a funded PhD studentship via Phase 4 of the King’s Centre for Military Health Research Health and Wellbeing Cohort Study funded by the Office for Veterans’ Affairs (OVA), Cabinet Office, UK Government. BC is currently in receipt of a funded PhD studentship from The Economic and Social Research Council (ESRC), UK Government. AS is a full-time member of the British Army seconded to King’s College London. NTF is partly funded by the United Kingdom’s Ministry of Defence (MOD). MLS is fully funded by a grant from the OVA. SAMS is supported by the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and the National Institute for Health and Care Research, NIHR Advanced Fellowship, Dr Sharon Stevelink, NIHR300592. The views expressed in this publication are those of the authors and not necessarily those of the OVA, the ESRC, the British Army, the MOD, the NHS, or the NIHR. All authors have approved the manuscript and agree with its submission to PLOS ONE. Any conflicts of interest have been outlined in the manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Williamson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Vaccines reduce the severity of symptoms, and risk of hospitalisation and death from infectious diseases. Yet, vaccination hesitancy persists. Research identifying psychological risk factors for vaccination hesitancy is limited and reports conflicting results. This study sought to address these inconsistencies and explore the role of personality and cognitive ability in COVID-19 vaccination hesitancy and uptake in a prospective cohort study., Methods: Data came from young adults (Generation-1; G1) and their mothers (Generation-0; G0) in the Avon Longitudinal Study of Parents and Children (ALSPAC). Multinomial logistic regressions, adjusting for several sociodemographic confounders, were used to explore whether personality and cognitive ability were associated with COVID-19 vaccination hesitancy and uptake. 4,960 G1 and 4,853 G0 mothers were included in the study population., Findings: Among G1, 38.4% exhibited vaccination hesitancy, yet 91.9% of the cohort received the vaccine. In adjusted models, higher levels of openness, agreeableness, conscientiousness, and cognitive ability were associated with an increased probability of wanting the vaccine. Similarly, higher levels of agreeableness, openness and cognitive ability were associated with an increased probability of vaccination uptake. However, the evidence of associations with vaccine uptake were generally weaker than with vaccination hesitancy. 56.7% of the offspring who did not want the vaccine either received the vaccine or intended to, whilst 43.3% still had no intention.Among G0 mothers, 25.6% were vaccination hesitant, yet 99.0% of the cohort received the vaccine. 3.1% said they did not want the vaccine; approximately 80% of these either received the vaccine or intended to. We found inconclusive evidence for an association between cognitive ability and vaccination hesitancy among G0 mothers., Interpretation: This study identified psychological factors associated with vaccination hesitancy and uptake. If these associations are causal, these findings may help design more effective vaccination hesitancy interventions., 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., (Copyright © 2024. Published by Elsevier Ltd.)

Background: The prevalence of depression among people with chronic pain remains unclear due to the heterogeneity of study samples and definitions of depression. We aimed to identify sources of variation in the prevalence of depression among people with chronic pain and generate clinical prediction models to estimate the probability of depression among individuals with chronic pain. Methods: Participants were from the UK Biobank. The primary outcome was a "lifetime" history of depression. The model's performance was evaluated using discrimination (optimism-corrected C statistic) and calibration (calibration plot). Results: Analyses included 24,405 patients with chronic pain (mean age 64.1 years). Among participants with chronic widespread pain, the prevalence of having a "lifetime" history of depression was 45.7% and varied (25.0–66.7%) depending on patient characteristics. The final clinical prediction model (optimism-corrected C statistic: 0.66; good calibration on the calibration plot) included age, BMI, smoking status, physical activity, socioeconomic status, gender, history of asthma, history of heart failure, and history of peripheral artery disease. Among participants with chronic regional pain, the prevalence of having a "lifetime" history of depression was 30.2% and varied (21.4–70.6%) depending on patient characteristics. The final clinical prediction model (optimism-corrected C statistic: 0.65; good calibration on the calibration plot) included age, gender, nature of pain, smoking status, regular opioid use, history of asthma, pain location that bothers you most, and BMI. Conclusions: There was substantial variability in the prevalence of depression among patients with chronic pain. Clinically relevant factors were selected to develop prediction models. Clinicians can use these models to assess patients' treatment needs. These predictors are convenient to collect during daily practice, making it easy for busy clinicians to use them. [ABSTRACT FROM AUTHOR]

UK Biobank is a large-scale epidemiological resource for investigating prospective correlations between various lifestyle, environmental, and genetic factors with health and disease progression. In addition to individual subject information obtained through surveys and physical examinations, a comprehensive neuroimaging battery consisting of multiple modalities provides imaging-derived phenotypes (IDPs) that can serve as biomarkers in neuroscience research. In this study, we augment the existing set of UK Biobank neuroimaging structural IDPs, obtained from well-established software libraries such as FSL and FreeSurfer, with related measurements acquired through the Advanced Normalization Tools Ecosystem. This includes previously established cortical and subcortical measurements defined, in part, based on the Desikan-Killiany-Tourville atlas. Also included are morphological measurements from two recent developments: medial temporal lobe parcellation of hippocampal and extra-hippocampal regions in addition to cerebellum parcellation and thickness based on the Schmahmann anatomical labeling. Through predictive modeling, we assess the clinical utility of these IDP measurements, individually and in combination, using commonly studied phenotypic correlates including age, fluid intelligence, numeric memory, and several other sociodemographic variables. The predictive accuracy of these IDP-based models, in terms of root-mean-squared-error or area-under-the-curve for continuous and categorical variables, respectively, provides comparative insights between software libraries as well as potential clinical interpretability. Results demonstrate varied performance between package-based IDP sets and their combination, emphasizing the need for careful consideration in their selection and utilization. [ABSTRACT FROM AUTHOR]

Salicornia species have been explored as a substitute for salt, however the intensity of salty taste elicited remains unexplained by the sodium content alone. To investigate this, a study was conducted to determine the nutrient profile of samphire extract and relate this to its sensory quality in a nachos base. Freeze dried samphire extracts contain minerals, including Na (12-14 g/100 g), K (1-1.5 g/100 g) and Mg (0.3-0.5 g/100 g) and free amino acids such as lysine (28-41 mg/100 g), glutamic acid (20-31 mg/100 g), aspartic acid (20-56 mg/100 g) and arginine (54-109 mg/100 g), which are known to influence salty taste. The sensory panel found that 2.5 % addition of samphire extract produced a significantly saltier taste than the control product (0.7 % NaCl) at an equivalent sodium level. These findings suggest that the minerals and amino acids in samphire extract may collectively contribute to its salty taste, making it a viable option for reducing sodium in food products., 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., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Although previous studies of today's globalised and competitive research landscape have mentioned the research collaborations of CANZUK countries (i.e., Australia, Canada, New Zealand, and the United Kingdom), none have yet studied them in detail. Further, such studies have used different measures of international research collaboration (IRC), resulting in disparate findings. This paper, therefore, analyses the strengths of CANZUK research collaborations, how those collaborations have changed over time, and assesses the effect of three ways of measures on the results (absolute strength, bilateral similarity, and multilateral similarity). We provide a detailed characterisation of the CANZUK research network and its relationships with partner countries, which reveals that the most collaborative CANZUK countries are the UK and Australia, among other findings. We also confirm that many findings differ depending on which measures are used. We offer an explanation of this difference with reference to the nature of the measures (i.e., what they really measure) and make suggestions for suitable measures in future studies depending on their purpose. Finally, we discuss how this study's findings can be used by research policy makers (in CANZUK and elsewhere) in deciding on research strategy and by researchers in appropriately measuring IRC., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Nguyen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The 2023 Antarctic sea ice extent (SIE) maximum on 7 September was the lowest annual maximum in the satellite era (16.98 × 106 km2), with the largest contributions to the anomaly coming from the Ross (37.7%, −0.57 × 106 km2) and Weddell (32.9%, −0.49 × 106 km2) Seas. The SIE was low due to anomalously warm (>0.3°C) upper‐ocean temperatures combined with anomalously strong northerly winds impeding the ice advance during the fall and winter. Northerly winds of >12 ms−1 in the Weddell Sea occurred because of negative pressure anomalies over the Antarctic Peninsula, while those in the Ross Sea were associated with extreme blocking episodes off the Ross Ice Shelf. The Ross Sea experienced an unprecedented SIE decrease of −1.08 × 103 km2 d−1 from 1 June till the annual maximum. The passage of quasi‐stationary and explosive polar cyclones contributed to periods of southward ice‐edge shift in both sectors. Plain Language Summary: Sea ice provides a vital habitat for life in the Southern Ocean, and plays an important role in the ocean circulation, the dynamics of the Earth's climate, the biogeochemical cycle, and the regional ecosystem. Climatologically, Antarctic sea ice expands northwards from the continent each autumn and winter. However, in 2023 an unprecedented slow ice expansion occurred in the Southern Ocean ahead of the annual maximum on 7 September of 16.98 × 106 km2, which was 1.46 × 106 km2 below the long‐term average. In fact, the area covered by ice remained at a record low level every day from 21 April 2023 until 11 November 2023. Our findings suggest that an impact of upper‐ocean warming and changes in winds, combined with heat and moisture fluxes, extreme winds and high ocean waves associated with polar cyclones (storms), contributed to these record low ice conditions. In particular, cyclones caused episodes of exceptional slow ice expansion or even retreat, leading to negative ice anomalies. For instance, the ice‐edge in the Weddell Sea was moved southwards quickly in a few days (up to 256 km southward) with an ice area loss of ∼2.3 × 105 km2, equivalent to the size of United Kingdom. Key Points: The 2023 Antarctic sea ice extent maximum on 7 September (16.98 × 106 km2) was the lowest annual maximum in the satellite eraAnomalous upper‐ocean warming and strong northerly winds contributed to impeding the ice expansion in the Ross and Weddell SeasQuasi‐stationary and explosive polar cyclones contributed to periods of southward ice‐edge shift in both sectors [ABSTRACT FROM AUTHOR]

Research Questions: Can social media reach isolated domestic abuse victims? Secondly, does providing victims with more information and a safer means of contacting police change their likelihood of domestic abuse reporting? Data: This research is based on high-frequency and confidential administrative data on the population of domestic abuse calls during the period of the Covid-19 pandemic but also the preceding years from two police forces—the Thames Valley Police (TVP) and the Metropolitan Police Service (MPS). Methods: To answer the research questions, we ran a randomized control trial (RCT) using a novel social media campaign promoting a method of reporting through Facebook and Instagram. We randomized the treatment across geographic areas in one police force and across individuals in another police force. Findings: We found that while social media is an effective tool for engaging on domestic abuse topics, particularly with younger individuals, our intention-to-treat estimates between the treatment and control areas and individuals did not show any significant difference in domestic abuse reporting. One of the reasons to explain this finding was the geographically imprecise social media targeting features on Facebook. Conclusions: Our research contributes to the scarce experimental literature on how to increase domestic abuse reporting among victims with, to the best of our knowledge, the first randomized test of the effects of a social media campaign on engagement and reporting. As police forces across the UK, but also worldwide, start using social media more to engage with the citizens they serve, these results provide interesting and valuable implications for their effectiveness and the role of technology in the future policing. Our results contribute to the understanding of how police forces can use social media to reach specific groups of people, such as younger cohorts. [ABSTRACT FROM AUTHOR]

Objectives: To establish if Black adults and adult ethnic minorities, defined as any group except White British, were represented in UK-based COVID-19 vaccination randomised controlled trials (RCTs) when compared to corresponding UK population proportions, based on 2011 census data., Design: Systematic review of COVID-19 Randomised Controlled Vaccine Trials SETTING: United Kingdom PARTICIPANTS: Randomised Controlled Trials of COVID-19 vaccines conducted in the UK were systematically reviewed following PRISMA guidelines. MeSH terms included "Covid-19 vaccine", "Ad26COVS1", and "BNT162 Vaccine" with keywords such as [covishield OR coronavac OR Vaxzevria OR NVX-CoV2373] also used. Studies that provided (A) participant demographics and (B) full eligibility criteria were included. The following key data was extracted for analysis: number of participants analysed, number of Black adults and number of adult minority ethnicity participants., Primary and Secondary Outcome Measures: The primary outcome is the mean percentage of Black adults randomised to COVID-19 vaccine trials deemed eligible within this review. The secondary outcome is the mean percentage of adult ethnic minorities randomised., Results: The final review included 7 papers and a total of 87 sets of data collated from trial sites across the UK. The standard mean percentage of Black adults included in the trials (0.59%, 95% CI: 0.13% - 1.05%) was significantly lower compared to the recorded Black adult population (2.67%) indicating that they were under-served in UK based COVID-19 vaccine RCTs (p < 0.001). Adult ethnic minority presence (8.94%, 95% CI: 2.07% - 15.80%) was also lower than census data (16.30%), indicating they were also under-served (p = 0.039)., Conclusion: The findings show that COVID-19 vaccine trials failed to adequately randomise proportionate numbers of Black adults and adult minority ethnicities. More inclusive practices must be developed and implemented in the recruitment of underserved groups to understand the true impact of COVID-19., (© 2024. The Author(s).)

Background: Autism spectrum disorder (hereafter referred to as autism) is characterised by difficulties with (i) social communication, social interaction, and (ii) restricted and repetitive interests and behaviours. Estimates of autism prevalence within the criminal justice system (CJS) vary considerably, but there is evidence to suggest that the condition can be missed or misidentified within this population. Autism has implications for an individual's journey through the CJS, from police questioning and engagement in court proceedings through to risk assessment, formulation, therapeutic approaches, engagement with support services, and long-term social and legal outcomes. Methods: This consensus based on professional opinion with input from lived experience aims to provide general principles for consideration by United Kingdom (UK) CJS personnel when working with autistic individuals, focusing on autistic offenders and those suspected of offences. Principles may be transferable to countries beyond the UK. Multidisciplinary professionals and two service users were approached for their input to address the effective identification and support strategies for autistic individuals within the CJS. Results: The authors provide a consensus statement including recommendations on the general principles of effective identification, and support strategies for autistic individuals across different levels of the CJS. Conclusion: Greater attention needs to be given to this population as they navigate the CJS. [ABSTRACT FROM AUTHOR]

Background: Varicose vein is a chronic condition that affects the lower extremities of the human body. Several factors have been implicated in the development of this disease, viz age, gender, weight, height and prolonged standing. Recently, genome-wide studies have identified genetic biomarkers that are associated with varicose veins in different ethnic groups. Such genetic studies are lacking in South Asians specifically in Indians where the prevalence of varicose veins is high, and it is important to replicate these variants in the stated population. The study aimed to replicate the association of genetic variants associated with varicose veins in this target population, which were found to be associated with the other ethnic groups. Methodology: The studied cohort is of the Indian population comprising unrelated 104 varicose veins cases and 448 non-varicose vein controls. The samples were genotyped using the Illumina Global Screening Array. Using the genomic data from UK BioBank and 23andMe studied cohorts; eight genetic variants were selected to replicate in our dataset. The allelic association was performed to identify the effective allele and risk was estimated using odds ratio and p-value as level of significance. Multifactor Dimensionality Reduction was used to estimate the cumulative effect of variants in Indians. Result: Variant rs3791679 of EFEMP1 was found to be associated with varicose veins in Indians. After observing the association of the EFEMP1 with varicose veins, we further ensued to identify all genetic variants within EFEMP1 to uncover the additional variants associated with this trait. Interestingly, we identified six new variants of EFEMP1 gene that have shown association. Moreover, the cumulative effect of all associated variations was estimated and the risk was 2.7 times higher in cases than controls whereas independently their effect ranges from 0.37–1.58. Conclusion: This study identifies EFEMP1 as a potential gene related to the risk of varicose veins in Indians. It also highlights that evaluating the maximum number of variants of a gene rather than focusing solely on replicating single variations offers a more comprehensive and nuanced understanding of the genetic factors contributing to a complex trait like varicose veins. [ABSTRACT FROM AUTHOR]

Background: Varicella (chickenpox) is a highly contagious disease caused by the varicella-zoster virus. Although typically mild, varicella can cause complications leading to severe illness and even death. Safe and effective varicella vaccines are available. The Joint Committee on Vaccination and Immunisation has reviewed the evidence and recommended the introduction of varicella vaccine into the UK's routine childhood immunisation schedule., Objectives: To explore UK healthcare professionals' (HCPs) knowledge and attitudes towards varicella vaccination, its introduction to the UK routine childhood immunisation schedule, and their preferences for how it should be delivered., Design: We conducted an online cross-sectional survey exploring HCPs' attitudes towards varicella, varicella vaccine, and their preferences for delivery of the vaccine between August and September 2022 prior to the recommendation that varicella vaccine should be introduced., Participants: 91 HCPs working in the UK (81 % nurses/health visitors, 9 % doctors, 10 % researcher/other, mean age 48.7 years)., Results: All respondents agreed or strongly agreed that vaccines are important for a child's health. However, only 58% agreed or strongly agreed that chicken pox was a disease serious enough to warrant vaccination. Gaps in knowledge about varicella were revealed: 21.0% of respondents disagreed or were unsure that chickenpox can cause serious complications, while 41.8% were unsure or did not believe chickenpox was serious enough to vaccinate against. After receiving some basic information about chickenpox and the vaccine, almost half of the HCPs (47.3%) in our survey would prefer to administer the varicella vaccine combined with MMR., Conclusions: Given the positive influence of HCPs on parents' decisions to vaccinate their children, it is important to understand HCPs' views regarding the introduction of varicella vaccine into the routine schedule. Our findings highlighted areas for training and HCPs' preferences which will have implications for policy and practice when the vaccine is introduced., 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., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: ALL_EARS@UoS is a patient and public involvement and engagement (PPIE) group for people with lived experience of hearing loss. The purpose of the group is to share experiences of hearing loss and hearing healthcare, inform research and improve services for patients at University of Southampton Auditory Implant Service. A year after inception, we wanted to critically reflect on the value and challenges of the group. Four members of ALL_EARS@UoS were recruited to an evaluation steering group. This paper reports the evaluation of the group using the UK Standards for Public Involvement. Methods: An anonymous, mixed-methods questionnaire was co-designed and shared with members of ALL_EARS@UoS using an online platform. The questionnaire was designed to capture satisfaction, individual feedback through free-text answers, and demographic information. Descriptive statistics have been used to express the satisfaction and demographic data. Reflexive thematic analysis has been used to analyse the free-text responses. Group engagement and activity data over time were monitored and collected. Results: The questionnaire response rate was 61% (11/18). Areas identified as strengths were 'Communication' and 'Working together'. Five themes were developed from the thematic analysis; (1) Increased knowledge and awareness around the topic of hearing health for group members and wider society, (2) supporting research, (3) inclusivity within the group, (4) opportunity to make a difference for people in the future and (5) running of the group/group organisation. The data highlighted the value and challenges of PPIE. Members described feeling listened to and appreciation of being able to share experiences. Time of day and meeting format were identified as challenges as they affected who could attend the meetings. The ability to secure and maintain sufficient funding and time to support inclusive and diverse PPIE activities is a challenge for researchers. Conclusions: We have identified how PPIE added value to both group members and researchers, emphasising the true benefit of PPIE. We have highlighted challenges we are facing and our plan to tackle these. We aim to continue to develop and sustain a group that reflects the diversity of the Deaf/deaf or hard of hearing community and of our local community. Plain English Summary: Patient and public involvement and engagement enables members of the public to influence what research happens. We have established a group called ALL_EARS@UoS for people with lived experience of hearing loss. This is so we can work together and learn from our group members' experiences, to inform our research into hearing loss. The members of ALL_EARS have helped to decide the aims, objectives, and principles of the group. This paper is a report of the value and challenges of the first year of the group. We recruited members of the group to work with us to design a survey. This paper describes the findings from the survey. Our members described benefits, ranging from supporting research to being able to share their experience with others. A challenge for members is the difficulty in being involved alongside their other commitments. A challenge for researchers is the funding and time needed to maintain the group. Other challenges include ensuring the group is diverse and that we understand and meet the needs of our members. We report on how we will address these challenges, so we can continue to work in partnership as a group. [ABSTRACT FROM AUTHOR]

A reduction in meat consumption is urgently needed to address multiple harms related to the environment, animal welfare, and human health. Social norm interventions have been found to be feasible and effective at shifting consumer behaviour, however, evidence related to meat reduction behaviour is limited - especially in naturalistic settings. Two social norm interventions were conducted at university food outlets in Aotearoa New Zealand and in the UK, to assess the effect of social norm messages on meat and meatless food purchases. Both interventions consisted of a week-long intervention phase during which descriptive dynamic social norm messages referring to reduced meat intake were displayed in the food outlets (study one and two) and via social media (study two). Meat and meatless food purchases during the interventions were compared to pre- and post-intervention weeks. Surveys were also conducted with a sub-group of customers to assess demographics, dietary habits, and awareness of the social norm message. In both studies, there was no significant effect of the social norm interventions on meat or meatless food purchases, and awareness of the norms message across both studies was low. These findings indicate that social norm interventions alone may be ineffective in encouraging meat reduction. Implications for interventions to reduce meat intake to support pro-environmental food choices are discussed. [ABSTRACT FROM AUTHOR]

Identifying factors linked to autism traits in the general population may improve our understanding of the mechanisms underlying divergent neurodevelopment. In this study we assess whether factors increasing the likelihood of childhood autism are related to early autistic trait emergence, or if other exposures are more important. We used data from 536 toddlers from London (UK), collected at birth (gestational age at birth, sex, maternal body mass index, age, parental education, parental language, parental history of neurodevelopmental conditions) and at 18 months (parents cohabiting, measures of socio-economic deprivation, measures of maternal parenting style, and a measure of maternal depression). Autism traits were assessed using the Quantitative Checklist for Autism in Toddlers (Q-CHAT) at 18 months. A multivariable model explained 20% of Q-CHAT variance, with four individually significant variables (two measures of parenting style and two measures of socio-economic deprivation). In order to address variable collinearity we used principal component analysis, finding that a component which was positively correlated with Q-CHAT was also correlated to measures of parenting style and socio-economic deprivation. Our results show that parenting style and socio-economic deprivation correlate with the emergence of autism traits at age 18 months as measured with the Q-CHAT in a community sample. [ABSTRACT FROM AUTHOR]

Introduction: The incorporation of Artificial Intelligence (AI) in organizations is pivotal to deal with work-related tasks and challenges effectively, yet little is known about the organizational factors that influence AI acceptance (i.e., employee favorable AI attitudes and AI use). To address this limitation in the literature and provide insight into the organizational antecedents influencing AI acceptance, this research investigated the relationship between competitive organizational climate and AI acceptance among employees. Moreover, given the critical role of a leader in employee attitude and behavior, we examined the moderating role of leaders’ power construal as responsibility or as opportunity in this relationship. Methods: Study 1 was a three-wave field study among employees (N  =  237, Mage  =  38.28) working in various organizations in the UK. The study measured employees’ perception of a competitive organizational climate at Time 1, leaders’ power construal (as perceived by employees) at Time 2, and employee attitudes towards AI and their actual use of AI in the workplace at Times 2 and 3. Study 2 was a 2 (climate: highly competitive vs. low competitive) by 2 (power construal: responsibility vs. opportunity) experiment among employee participants (N  =  150, Mage  =  37.50). Results: Study 1 demonstrated a positive relationship between competitive climate and employee AI use over time. Furthermore, both studies revealed an interaction between competitive climate and leader’s power construal in the prediction of employee AI acceptance: In Study 1, competitive climate was negatively related to AI acceptance over time when leaders construed power as opportunity. In Study 2 competitive climate was positively related to AI acceptance when leaders construed power as responsibility rather than as opportunity. Discussion: These results underscore the organizational factors that are required in order for employees to shape favorable attitudes towards AI and actually use AI at work. Importantly, this research expands the limited body of literature on AI integration in organizations. [ABSTRACT FROM AUTHOR]

Background: The Eatwell guide reflects the UK government's recommendations for a healthy and balanced diet. Previous research has identified associations between healthy eating patterns and both cardiovascular and brain health, although there is little evidence specifically focusing on the Eatwell Guide. To date no research has investigated associations between the Eatwell Guide and risk for future dementia. Methods: Data from the PREVENT dementia cohort study baseline visit was used in this analysis. Binary and graded Eatwell Guide scores (BEWG, GEWG) were created from a self-reported Food Frequency Questionnaire. The CAIDE score was included as the primary outcome measure to represent risk for future Alzheimer's disease. Secondary outcome measures included cardiometabolic health measures and brain health measures. Generalised additive models were run in R. Results: A total of 517 participants were included in the analysis, with a mean BEWG score of 4.39 (± 1.66) (out of a possible 12 points) and GEWG score of 39.88 (± 6.19) (out of a possible 60 points). There was no significant association between either Eatwell Guide score and the CAIDE score (BEWG β: 0.07, 95% confidence interval (CI): -0.07, 0.22; GEWG β: 0.02, 95% CI: -0.02, 0.06) or any measures of brain health. There was a significant association between higher GEWG score and lower systolic and diastolic blood pressure and body mass index (BMI) (systolic β: -0.24, 95% CI: -0.45, -0.03; diastolic β: -0.16, 95% CI: -0.29, -0.03; BMI β: -0.09, 95% CI: -0.16, -0.01). Conclusions: Although not directly associated with the CAIDE score, the Eatwell Guide dietary pattern may be beneficial for dementia prevention efforts through the modification of hypertension and obesity, which are both known risk factors for dementia. Future work could replicate these findings in other UK-based cohorts as well as further development of Eatwell Guide scoring methodologies. [ABSTRACT FROM AUTHOR]

Background: Despite substantial research revealing that patients with rheumatoid arthritis (RA) have excessive morbidity and mortality of cardiovascular disease (CVD), the mechanism underlying this association has not been fully known. This study aims to systematically investigate the phenotypic and genetic correlation between RA and CVD. Methods: Based on UK Biobank, we conducted two cohort studies to evaluate the phenotypic relationships between RA and CVD, including atrial fibrillation (AF), coronary artery disease (CAD), heart failure (HF), and stroke. Next, we used linkage disequilibrium score regression, Local Analysis of [co]Variant Association, and bivariate causal mixture model (MiXeR) methods to examine the genetic correlation and polygenic overlap between RA and CVD, using genome-wide association summary statistics. Furthermore, we explored specific shared genetic loci by conjunctional false discovery rate analysis and association analysis based on subsets. Results: Compared with the general population, RA patients showed a higher incidence of CVD (hazard ratio [HR] = 1.21, 95% confidence interval [CI]: 1.15–1.28). We observed positive genetic correlations of RA with AF and stroke, and a mixture of negative and positive local genetic correlations underlying the global genetic correlation for CAD and HF, with 13 ~ 33% of shared genetic variants for these trait pairs. We further identified 23 pleiotropic loci associated with RA and at least one CVD, including one novel locus (rs7098414, TSPAN14, 10q23.1). Genes mapped to these shared loci were enriched in immune and inflammatory-related pathways, and modifiable risk factors, such as high diastolic blood pressure. Conclusions: This study revealed the shared genetic architecture of RA and CVD, which may facilitate drug target identification and improved clinical management. [ABSTRACT FROM AUTHOR]

In recent years, evidence has emerged that actinide (An) uptake at the enhanced actinide removal plant (EARP) at the UK's Sellafield nuclear site occurs via An interactions with an α-Fe13 Keggin molecular cluster during ferrihydrite formation. We here study theoretically the substitution of aquo complexes of the actinides Th–Pu onto a Na-decorated α-Fe13 Keggin cluster using DFT at the PBE0 level. The optimised Pu–O and Pu–Fe distances are in good agreement with experiment and Na/An substitutions are significantly favourable energetically, becoming more so across the early 5f series, with the smallest and largest ΔrG° being for Th and Pu at −335.7 kJ mol−1 and −396.0 kJ mol−1 respectively. There is strong correlation between the substitution reaction energy and the ionic radii of the actinides (Δrε0R2 = 0.97 and ΔrG° R2 = 0.91), suggesting that the principal An-Keggin binding mode is ionic. Notwithstanding this result, Mulliken and natural population analyses reveal that covalency increases from Th–Pu in these systems, supported by analysis of the occupied Kohn–Sham molecular orbitals where enhanced An(5f)–O(2p) overlap is observed in the Np and Pu systems. By contrast, quantum theory of atoms in molecules analysis shows that U-Keggin binding is the most covalent among the five actinides, in keeping with previous studies. [ABSTRACT FROM AUTHOR]

This study examines the feasibility of using hydrogen as a clean energy source for residential consumers in the UK through a low-carbon energy hub. Two cases were compared: a solid oxide fuel cell (SOFC) integrated combined heat and power (CHP) system fuelled by natural gas and hydrogen; and a SOFC-heat pump (HP) integrated CHP system fuelled by natural gas and hydrogen. The study used the actual electricity and heating demands of a UK cluster to model the CHP systems. The results indicate that the SOFC-based CHP system with hydrogen as fuel is more energy-efficient than the natural gas-fuelled system, with energetic efficiencies of 92.12% and 66.98%, respectively. The study also found that the system incorporating a heat pump is more economically viable, regardless of the fuel source, with the hydrogen-powered system equipped with a heat pump having a levelised cost of energy (LCOE) of 0.2984 £ per kW h. The study also evaluated the environmental impact of the natural gas-powered SOFC and SOFC-HP systems, with estimated levelised CO2 emissions of 0.308 kg per kW h and 0.213 kg per kW h, respectively. The study's findings provide insights into the potential of hydrogen as a cleaner energy source for residential consumers in the UK and highlight the importance of exploring low-carbon energy alternatives. [ABSTRACT FROM AUTHOR]

Background: Carotid Intima-Media Thickness (CIMT) is a key marker for atherosclerosis, with its modulation being crucial for cardiovascular disease (CVD) risk assessment. While thyroid function's impact on cardiovascular health is recognized, the causal relationship and underlying mechanisms influencing CIMT remain to be elucidated. Methods: In this study, Mendelian Randomization (MR) was employed to assess the causal relationship between thyroid function and CIMT. Thyroid hormone data were sourced from the Thyroidomics Consortium, while lipid traits and CIMT measurements were obtained from the UK Biobank. The primary analysis method was a two-sample MR using multiplicative random effects inverse variance weighting (IVW-MRE). Additionally, the study explored the influence of thyroid hormones on lipid profiles and assessed their potential mediating role in the thyroid function-CIMT relationship through multivariate MR analysis. Results: The study revealed that lower levels of Free Thyroxine (FT4) within the normal range are significantly associated with increased CIMT. This association was not observed with free triiodothyronine (FT3), thyroid-stimulating hormone (TSH), or TPOAb. Additionally, mediation analysis suggested that apolipoprotein A-I and B are involved in the relationship between thyroid function and CIMT. The findings indicate a potential U-shaped curve relationship between FT4 levels and CIMT, with thyroid hormone supplementation in hypothyroid patients showing benefits in reducing CIMT. Conclusion: This research establishes a causal link between thyroid function and CIMT using MR methods, underscoring the importance of monitoring thyroid function for early cardiovascular risk assessment. The results advocate for the consideration of thyroid hormone supplementation in hypothyroid patients as a strategy to mitigate the risk of carotid atherosclerosis. These insights pave the way for more targeted approaches in managing patients with thyroid dysfunction to prevent cardiovascular complications. [ABSTRACT FROM AUTHOR]

Heat pumps are a solution for decarbonising home heating in the UK. However, the readiness of UK homes for heat pumps is an area of concern regarding the policies aimed at increasing heat pump adoption. This work combines multiple perspectives in evaluating the technical readiness of homes with the market readiness of installers and homeowners to proceed with installing heat pumps. The effectiveness of past heating and energy efficiency policies in the UK are reviewed, along with building regulations, incentives to promote energy efficiency and the effectiveness of heat pump technology in heating homes. Current policies support the cost of a heat pump but home improvements to make homes 'heat pump-ready' can be necessary to achieve optimal heat pump system performance. This paper suggests the UK will face three major challenges. First, analysis highlights an 'eligibility-readiness gap' describing the difference between homes 'eligible' (50%) for the Government's Boiler Upgrade Scheme—a subsidy for heat pump installations—and the likely level of homes that are heat pump-ready (11%) for successful heat pump installations. Second, semi-structured interviews with heat pump installers identified gaps in capacity to deliver the necessary works to make homes heat pump-ready. As small or medium enterprises, the majority of installers do not currently see adding home improvement services to their existing business model as beneficial. All installers highlighted the need for Government to address the cost of electricity relative to gas. Third, a national survey of homeowners in England with gas boilers (n = 1,021) revealed low awareness of the necessary work to make homes heat pump-ready and low willingness to spend money on them unless supported by Government. This paper shows that the processes and costs involved in making homes heat pump-ready before successful design and installation are underappreciated by homeowners, inadequately served by industry, and insufficiently supported by Government. [ABSTRACT FROM AUTHOR]

Background: Suicide is a leading cause of maternal death during pregnancy and the year after birth (the perinatal period). While maternal suicide is a relatively rare event with a prevalence of 3.84 per 100,000 live births in the UK [1], the impact of maternal suicide is profound and long-lasting. Many more women will attempt suicide during the perinatal period, with a worldwide estimated prevalence of 680 per 100,000 in pregnancy and 210 per 100,000 in the year after birth [2]. Qualitative research into perinatal suicide attempts is crucial to understand the experiences, motives and the circumstances surrounding these events, but this has largely been unexplored. Aim: Our study aimed to explore the experiences of women and birthing people who had a perinatal suicide attempt and to understand the context and contributing factors surrounding their perinatal suicide attempt. Methods: Through iterative feedback from a group of women with lived experience of perinatal mental illness and relevant stakeholders, a qualitative study design was developed. We recruited women and birthing people (N = 11) in the UK who self-reported as having undertaken a suicide attempt. Interviews were conducted virtually, recorded and transcribed. Using NVivo software, a critical realist approach to Thematic Analysis was followed, and themes were developed. Results: Three key themes were identified that contributed to the perinatal suicide attempt. The first theme 'Trauma and Adversities' captures the traumatic events and life adversities with which participants started their pregnancy journeys. The second theme, 'Disillusionment with Motherhood' brings together a range of sub-themes highlighting various challenges related to pregnancy, birth and motherhood resulting in a decline in women's mental health. The third theme, 'Entrapment and Despair', presents a range of factors that leads to a significant deterioration of women's mental health, marked by feelings of failure, hopelessness and losing control. Conclusions: Feelings of entrapment and despair in women who are struggling with motherhood, alongside a background of traumatic events and life adversities may indicate warning signs of a perinatal suicide. Meaningful enquiry around these factors could lead to timely detection, thus improving care and potentially prevent future maternal suicides. [ABSTRACT FROM AUTHOR]

Background: Women's pelvic health is a globally important subject, included in international and United Kingdom health policies, emphasising the importance of improving information and access to pelvic health services. Consequences of pelvic symptoms are intimate, personal, and varied, often causing embarrassment and shame, affecting women's quality of life and wellbeing. AIM: To understand the experience of seeking healthcare for stigmatised pelvic health symptoms by synthesising all types of published primary research and mapping the results to behavioural theory, to identify potential targets for intervention. Methods: Systematic search of MEDLINE, CINAHL, PsycINFO, SocINDEX, PubMED databases, CDSR and CENTRAL registers, from inception to May 2023 for all types of research capturing women's views and experiences of seeking help with stigmatised urogenital and bowel symptoms. Studies only reporting prevalence, predictors of help-seeking, non-health related help-seeking, or written in languages other than English, German, French, Spanish and Swedish were excluded. Reference checking and forward citation searching for all included studies was performed. A results-based synthesis approach was used to integrate quantitative and qualitative data. Themes were mapped to the Common-Sense model and Candidacy framework. The Mixed Methods Appraisal Tool was used for critical appraisal. Grading of Recommendations Assessment, Development and Evaluation - Confidence in Evidence from Reviews of Qualitative research for assessing certainty of review findings. Results: 86 studies representing over 20,000 women from 24 high income countries were included. Confidence was high that barriers to help-seeking were similar across all study types and pelvic symptoms: stigma, lack of knowledge, women's perception that clinicians dismissed their symptoms, and associated normalising and deprioritising of low bother symptoms. Supportive clinicians and increased knowledge were key facilitators. Conclusions: Using the Common-Sense Model to explore women's help-seeking behaviour with stigmatised pelvic symptoms reveals problems with cognitive representation of symptom identity, emotional representations of embarrassment and shame, and a subjective norm that women believe their symptoms will be trivialised by clinicians. Together these barriers frustrate women's identification of their candidacy for healthcare. Addressing these issues through behavioural change interventions for women and clinicians, will help to achieve universal access to pelvic healthcare services (United Nations Sustainable Development Goal 3.7). Systematic Review Registration: PROSPERO CRD42021256956. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes in young people is an aggressive disease with a greater risk of complications leading to increased morbidity and mortality during the most productive years of life. Prevalence in the UK and globally is rising yet experience in managing this condition is limited. There are no consensus guidelines in the UK for the assessment and management of paediatric type 2 diabetes. Methods: Multidisciplinary professionals from The Association of Children's Diabetes Clinicians (ACDC) and the National Type 2 Diabetes Working Group reviewed the evidence base and made recommendations using the Grading Of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. Results and discussion: Young people with type 2 diabetes should be managed within a paediatric diabetes team with close working with adult diabetes specialists, primary care and other paediatric specialties. Diagnosis of diabetes type can be challenging with many overlapping features. Diabetes antibodies may be needed to aid diagnosis. Co-morbidities and complications are frequently present at diagnosis and should be managed holistically. Lifestyle change and metformin are the mainstay of early treatment, with some needing additional basal insulin. GLP1 agonists should be used as second-line agents once early ketosis and symptoms are controlled. Glycaemic control improves microvascular but not cardiovascular risk. Reduction in excess adiposity, smoking prevention, increased physical activity and reduction of hypertension and dyslipidaemia are essential to reduce major adverse cardiovascular events. Conclusions: This evidence-based guideline aims to provide a practical approach in managing this condition in the UK. [ABSTRACT FROM AUTHOR]

Background: End-of-life (EoL) care volunteers in hospitals are a novel approach to support patients and their close ones. The iLIVE Volunteer Study supported hospital volunteer coordinators from five European countries to design and implement an EoL care volunteer service on general wards in their hospitals. This study aimed to identify and explore barriers and facilitators to the implementation of EoL care volunteer services in the five hospitals. Methods: Volunteer coordinators (VCs) from the Netherlands (NL), Norway (NO), Slovenia (SI), Spain (ES) and United Kingdom (UK) participated in a focus group interview and subsequent in-depth one-to-one interviews. A theory-inspired framework based on the five domains of the Consolidated Framework for Implementation Research (CFIR) was used for data collection and analysis. Results from the focus group were depicted in radar charts per hospital. Results: Barriers across all hospitals were the COVID-19 pandemic delaying the implementation process, and the lack of recognition of the added value of EoL care volunteers by hospital staff. Site-specific barriers were struggles with promoting the service in a highly structured setting with many stakeholders (NL), negative views among nurses on hospital volunteering (NL, NO), a lack of support from healthcare professionals and the management (SI, ES), and uncertainty about their role in implementation among VCs (ES). Site-specific facilitators were training of volunteers (NO, SI, NL), involving volunteers in promoting the service (NO), and education and awareness for healthcare professionals about the role and boundaries of volunteers (UK). Conclusion: Establishing a comprehensive EoL care volunteer service for patients in non-specialist palliative care wards involves multiple considerations including training, creating awareness and ensuring management support. Implementation requires involvement of stakeholders in a way that enables medical EoL care and volunteering to co-exist. Further research is needed to explore how trust and equal partnerships between volunteers and professional staff can be built and sustained. Trial registration: NCT04678310. Registered 21/12/2020. [ABSTRACT FROM AUTHOR]

Background: Subjective well-being (SWB) is associated with social support in cross-sectional studies. However, it remains unclear whether and how social support predicts SWB longitudinally, especially during the COVID-19 contingency. Methods: By adopting a prospective design, the current work addressed this research question in a sample of 594 participants from the U.K. The data were collected via the online platform, Prolific, at two time points (June, 2020 and August, 2021) with a 14-month interval. Descriptive analysis and a moderated mediation model were conducted to test the proposed hypotheses. Results: Baseline social support was a significant predictor of subjective well-being (SWB) 14 months later, even after controlling for baseline SWB and other covariates such as personality traits. Additionally, affect balance (i.e., the affective component of SWB) fully mediated the link between baseline social support and subsequent life satisfaction (i.e., the cognitive component of SWB). Moreover, household income moderated this relationship, indicating a stronger mediation for individuals with lower monthly household income. Conclusion: The present work sheds light on the underlying mechanism and boundary condition of the association between social support and different components of SWB during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

An editorial is presented on broad range of UK professionals involved in the care of patients with head and neck cancer. Topics include underpinning the basis of care of patients with head and neck cancer, which apply across the spectrum of management; and guidelines can be also used as an educational resource for clinicians, and for insight into head and neck cancer care for non-clinicians.

Handedness is a manifestation of brain hemispheric specialization. Left-handedness occurs at increased rates in neurodevelopmental disorders. Genome-wide association studies have identified common genetic effects on handedness or brain asymmetry, which mostly involve variants outside protein-coding regions and may affect gene expression. Implicated genes include several that encode tubulins (microtubule components) or microtubule-associated proteins. Here we examine whether left-handedness is also influenced by rare coding variants (frequencies ≤ 1%), using exome data from 38,043 left-handed and 313,271 right-handed individuals from the UK Biobank. The beta-tubulin gene TUBB4B shows exome-wide significant association, with a rate of rare coding variants 2.7 times higher in left-handers than right-handers. The TUBB4B variants are mostly heterozygous missense changes, but include two frameshifts found only in left-handers. Other TUBB4B variants have been linked to sensorineural and/or ciliopathic disorders, but not the variants found here. Among genes previously implicated in autism or schizophrenia by exome screening, DSCAM and FOXP1 show evidence for rare coding variant association with left-handedness. The exome-wide heritability of left-handedness due to rare coding variants was 0.91%. This study reveals a role for rare, protein-altering variants in left-handedness, providing further evidence for the involvement of microtubules and disorder-relevant genes. Left-handedness is a common and partly heritable trait. Here, the authors perform a genome-wide screen for rare, protein-altering genetic variants associated with handedness in over 350,000 people, and implicate the tubulin gene TUBB4B. [ABSTRACT FROM AUTHOR]

Background: Two million people in the UK are living with or beyond cancer and a third of them report poor quality of life (QoL) due to problems such as fatigue, fear of cancer recurrence, and concerns about returning to work. We aimed to develop and evaluate an intervention based on acceptance and commitment therapy (ACT), suited to address the concerns of cancer survivors and in improving their QoL. We also recognise the importance of exercise and vocational activity on QoL and therefore will integrate options for physical activity and return to work/vocational support, thus ACT Plus (+). Methods: We will conduct a multi-centre, pragmatic, theory driven, randomised controlled trial. We will assess whether ACT+ including usual aftercare (intervention) is more effective and cost-effective than usual aftercare alone (control). The primary outcome is QoL of participants living with or beyond cancer measured using the Functional Assessment of Cancer Therapy: General scale (FACT-G) at 52 weeks. We will recruit 344 participants identified from secondary care sites who have completed hospital-based treatment for cancer with curative intent, with low QoL (determined by the FACT-G) and randomise with an allocation ratio of 1:1 to the intervention or control. The intervention (ACT+) will be delivered by NHS Talking Therapies, specialist services, and cancer charities. The intervention consists of up to eight sessions at weekly or fortnightly intervals using different modalities of delivery to suit individual needs, i.e. face-to-face sessions, over the phone or skype. Discussion: To date, there have been no robust trials reporting both clinical and cost-effectiveness of an ACT based intervention for people with low QoL after curative cancer treatment in the UK. We will provide high quality evidence of the effectiveness and cost-effectiveness of adding ACT+ to usual aftercare provided by the NHS. If shown to be effective and cost-effective then commissioners, providers and cancer charities will know how to improve QoL in cancer survivors and their families. Trial registration: ISRCTN: ISRCTN67900293. Registered on 09 December 2019. All items from the World Health Organization Trial Registration Data Set for this protocol can be found in Additional file 2 Table S1. [ABSTRACT FROM AUTHOR]

Nitrogen fertiliser in agriculture continues to be one of the largest contributors to water pollution driven by the global food demand. Consequently, policies designed to tackle nitrogen pollution tend to be focused on the farm level. Applying mitigation measures requires knowledge, local labour and financial investment to achieve desired goals. Influencing farming activity comes with challenges as policies result in economic losses. We propose Water Quality Trading (WQT) to minimize the cost of controlling water pollution and develop it for policy recommendations in the River Alde catchment in Suffolk. We apply WQT to three scenarios named Reference Pollution Target, Livestock Target Plan and Variation of Farming. Our findings demonstrate that WQT can reduce farmers nitrogen load by 8%, 7% and 18% respectively from the baseline of 6 mg/L. The scenario simulations show a net revenue increase of 6%, 5% and 18% respectively. Our study demonstrates the effectiveness of the WQT approach in reducing water pollution, promoting sustainable agriculture and meeting water management goals., 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., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Community dental services (CDS) provide dental treatment for patients who cannot gain access or have treatment with their general dental practitioner. This includes groups of patients who are dentally phobic, medically compromised, or with physical or learning disabilities.This paper provides insight into the experience and the challenges of working in CDS as a dental core trainee (DCT). The post involves an equal split in the management of paediatric and special care dental patients.Patients seen in CDS can be split into cohorts such as paediatric, special care adults, dental anxious and others. Case discussions throughout the paper will illustrate commonly seen scenarios and exemplify patient management pathways though the service.NHS England Education provide training for DCTs through study days which focus on dental disciplines specific to their post., (© 2024. The Author(s), under exclusive licence to the British Dental Association.)

Background: The association between air quality and risk of SARS-CoV-2 infection is poorly understood. We investigated this association using serological individual-level data adjusting for a wide range of confounders, in a large population-based cohort (COVIDENCE UK)., Methods: We assessed the associations between long-term (2015-19) nitrogen dioxide (NO 2 ) and fine particulate matter with an aerodynamic diameter of ≤2.5 μm (PM 2.5 ), exposures with SARS-CoV-2 infection, level of antibody response among those infected, and COVID-19 disease severity. We used serological data from 10,489 participants in the COVIDENCE UK cohort, and estimated annual average air pollution exposure at each participant's home postcode., Results: After controlling for potential confounders, we found a positive association between 5-year NO 2 and PM 2.5 exposures and the risk of seropositivity: 10 unit increase in NO 2 (μg/m 3 ) was associated with an increasing risk of seropositivity by 1.092 (95% CI 1.02 to 1.17; p-for-trend 0.012). For PM 2.5 , 10 unit increase (μg/m 3 ) was associated with an increasing risk of seropositivity by 1.65 (95% CI 1.015-2.68; p-for-trend 0·049). In addition, we found that NO 2 was positively associated with higher antibody titres (p-for-trend 0·013) among seropositive participants, with no evidence of an association for PM 2.5 ., Conclusion: Our findings suggest that the long-term burden of air pollution increased the risks of SARS-CoV-2 infection and has important implications for future pandemic preparedness. This evidence strengthens the case for reducing long-term air pollution exposures to reduce the vulnerability of individuals to respiratory viruses., 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., (Copyright © 2024. Published by Elsevier Ltd.)

Background: The advent of lateral flow devices (LFDs) for SARS-CoV-2 detection enabled widespread use of rapid self-tests during the pandemic. While self-testing using LFDs is now common, whether self-testing provides comparable performance to professional testing was a key question that remained important for pandemic planning., Methods: Three prospective multi-centre studies were conducted to compare the performance of self- and professional testing using LFDs. Participants tested themselves or were tested by trained (professional) testers at community testing sites in the UK. Corresponding qRT-PCR test results served as reference standard. The performance of Innova, Orient Gene and SureScreen LFDs by users (self) and professional testers was assessed in terms of sensitivity, specificity, and kit failure (void) rates. Impact of age, sex and symptom status was analysed using logistic regression modelling., Results: 16,617 participants provided paired tests, of which 15,418 were included in the analysis. Self-testing with Innova, Orient Gene or SureScreen LFDs achieved sensitivities of 50 %, 53 % or 72 %, respectively, compared to qRT-PCR. Self and professional LFD testing showed no statistically different sensitivity with respect to corresponding qRT-PCR testing. Specificity was consistently equal to or higher than 99 %. Sex and age had no or only marginal impact on LFD performance while sensitivity was significantly higher for symptomatic individuals. Sensitivity of LFDs increased strongly to up to 90 % with higher levels of viral RNA measured by qRT-PCR., Conclusions: Our results support SARS-CoV-2 self-testing with LFDs, especially for the detection of individuals whose qRT-PCR tests showed high viral concentrations., 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., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Accurate diagnosis and treatment depend upon detailed knowledge of both the child's presenting symptoms and their past medical history. However, the process of soliciting past medical history has never been subject to systematic scrutiny in actual clinical practice., Objective: To examine the function of the question "are you otherwise fit and well?" to elicit a child's general medical history in UK paediatric allergy outpatient consultations., Methods: Examination of 30 video-recorded UK paediatric outpatient consultations involving children (2-10 years), caregivers, and one doctor. We identified, transcribed, and interrogated 13 examples, deploying the systematic and rigorous method of conversation analysis to elucidate the question's micro-design elements and their consequences for the consultation's trajectory., Results: Asking "Are you otherwise fit and well?" is built to efficiently solicit a problem-free report of good health. Nonetheless patients can and do raise other relevant matters. In practice, the question initiates several interactional matters simultaneously: establishing/resolving (mis)understandings of "fitness" and "wellness"; negotiating opportunities for children's participation; and importantly, a shift towards discussing more general wellbeing., Conclusion: Past medical history questions unavoidably generate broader interactional matters which are skilfully resolved in real-time between clinicians, caregivers, and children., Practice Implications: Clinical training could be greatly enhanced by integrating insights into the interactional consequences of asking questions, particularly in the complex multiparty environment of paediatrics. While the question 'Are you otherwise fit and well' clearly serves an important function, clinicians should be alert to the possible problems it might raise, especially when directed towards younger children., 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., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: Improved outcomes of liver disease in childhood and young adulthood have resulted in an increasing number of young adults (YA) entering adult liver services. The adult hepatologist therefore requires a working knowledge in diseases that arise almost exclusively in children and their complications in adulthood., Aims: To provide adult hepatologists with succinct guidelines on aspects of transitional care in YA relevant to key disease aetiologies encountered in clinical practice., Methods: A systematic literature search was undertaken using the Pubmed, Medline, Web of Knowledge and Cochrane database from 1980 to 2023. MeSH search terms relating to liver diseases ('cholestatic liver diseases', 'biliary atresia', 'metabolic', 'paediatric liver diseases', 'autoimmune liver diseases'), transition to adult care ('transition services', 'young adult services') and adolescent care were used. The quality of evidence and the grading of recommendations were appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system., Results: These guidelines deal with the transition of YA and address key aetiologies for the adult hepatologist under the following headings: (1) Models and provision of care; (2) screening and management of mental health disorders; (3) aetiologies; (4) timing and role of liver transplantation; and (5) sexual health and fertility., Conclusions: These are the first nationally developed guidelines on the transition and management of childhood liver diseases in adulthood. They provide a framework upon which to base clinical care, which we envisage will lead to improved outcomes for YA with chronic liver disease., (© 2024 John Wiley & Sons Ltd.)

Background: This paper investigates whether age of onset of depression, duration of the last episode, number of episodes, and residual symptoms of depression and anxiety are associated with depression relapse in primary care patients who have been on long-term maintenance antidepressant treatment and no longer meet ICD10 criteria for depression., Methods: An observational cohort using data from ANTLER ( N = 478), a double-blind placebo-controlled trial. The primary outcome was time to relapse using the retrospective CIS-R. Participants were followed for 12 months., Results: Primary outcome was available for 468 participants. Time to relapse in those with more than five previous episodes of depression was shorter, hazard ratio (HR) 1.84 (95% confidence interval [CI] 1.23-2.75) compared to people with two episodes; HR 1.57 (95% CI 1.01-2.43) after adjustment. The residual symptoms of depression at baseline were also associated with increased relapse: HR 1.05 (95% CI 1.01-1.09) and HR 1.06 (95% CI 1.01-1.12) in the adjusted model. There was evidence of reduced rate of relapse in older age of onset group: HR 0.86 (95% CI 0.78-0.95); HR attenuated after adjustment HR 0.91 (95% CI 0.81-1.02). There was no evidence of an association between duration of the current episode and residual anxiety symptoms with relapse., Conclusions: The number of previous episodes and residual symptoms of depression were associated with increased likelihood of relapse. These factors could inform joint decision making when patients are considering tapering off maintenance antidepressant treatment or considering other treatments to prevent relapse.

Objectives: In celebration of the journal's 50th anniversary, the aim of the study was to review the whole collection of Community Dentistry and Oral Epidemiology (CDOE) publications from 1973 to 2022 and provide a complete overview of the main publication characteristics., Methods: The study used bibliometric techniques such as performance and science mapping analysis of 3428 articles extracted from the Scopus database. The data were analysed using the 'Bibliometrix' package in R. The journal's scientific production was examined, along with the yearly citation count, the distribution of publications based on authors, the corresponding author's country and affiliation and citation count, citing source and keywords. Bibliometric network maps were constructed to determine the conceptual, intellectual and social collaborative structure over the past 50 years. The trending research topics and themes were identified., Results: The total number of articles and average citations has increased over the years. D Locker, AJ Spencer, A Sheiham and WM Thomson were the most frequently published authors, and PE Petersen, GD Slade and AI Ismail published papers with the highest citations. The most published countries were the United States, United Kingdom, Brazil and Canada, frequently engaging in collaborative efforts. The most common keywords used were 'dental caries', 'oral epidemiology' and 'oral health'. The trending topics were healthcare and health disparities, social determinants of health, systematic review and health inequalities. Epidemiology, oral health and disparities were highly researched areas., Conclusion: This bibliometric study reviews CDOE's significant contribution to dental public health by identifying key research trends, themes, influential authors and collaborations. The findings provide insights into the need to increase publications from developing countries, improve gender diversity in authorship and broaden the scope of research themes., (© 2023 The Authors. Community Dentistry and Oral Epidemiology published by John Wiley & Sons Ltd.)

Objectives: Choices about which dental treatments to provide in a publicly funded system should be guided by the value that the general population place on those treatments. The aim of this study was to estimate United Kingdom (UK) general population willingness to pay (WTP) for dental check-ups, and to investigate what factors influence WTP., Methods: WTP was elicited using a hypothetical question in an online survey. The sample consisted of 594 participants, nationally representative of the UK general population in terms of age and gender. Regression analysis was used to examine what factors are associated with WTP. Analyses were conducted including and excluding protest answers., Results: The mean WTP for a dental check-up is £31.32 for the full sample and £33.17 excluding protest answers. Respondents on higher incomes and those with higher university education had higher WTP. Respondents in Scotland were WTP less than respondents living in the rest of the UK which may be the result of NHS dental check-ups being free to patients in Scotland., Conclusion: The general UK population value dental check-ups. This study provides estimates of WTP for dental check-ups which can be used in Cost-Benefit Analyses., (© 2023 The Authors. Community Dentistry and Oral Epidemiology published by John Wiley & Sons Ltd.)

There has been growing awareness in recent years of the wide-ranging negative impacts that counter-terrorism measures and sanctions impose on humanitarian action. Drawing on semi-structured interviews with the staff of international non-governmental organisations (INGOs), this paper examines these impacts on INGOs based in the United Kingdom. This is a context where a particularly complex array of laws, policies, and regulatory regimes have emerged alongside an increasingly hostile political and media setting for INGOs, creating an environment characterised by uncertainty. The paper shows that counter-terrorism measures and sanctions are leading INGOs to adopt more conservative approaches to partnership in areas controlled by proscribed groups, undermining broader commitments to the localisation agenda. The analysis reveals that perceptions of risk within INGOs vary considerably, but that despite this, INGOs have developed strategies to reduce the impacts of counter-terrorism measures, which over time, have led to improved coordination, and in some instances, a willingness to push back against regulations., (© 2023 The Authors. Disasters published by John Wiley & Sons Ltd on behalf of ODI.)

The recent clearance by the United States Food and Drug Administration of Tidepool Loop sets an important precedent within the medical device landscape. For the first time, an automated insulin delivery mobile application-based on an algorithm initially designed and developed by users -has been recognised as safe and effective by a regulatory body. The aim of this paper is twofold: firstly, we map out the regulatory pathways and processes that were navigated by Tidepool, the non-profit behind Tidepool Loop, in order to make this landmark moment possible. Secondly, we set out potential approvals processes in the European Union and United Kingdom with a view to examining the challenges to obtaining regulatory clearance for Tidepool Loop in these jurisdictions. In so doing, we highlight the significant differences, not only between the United States and European systems but also between the European Union and Great Britain systems. We conclude by arguing that the complexity encountered when seeking to introduce an innovative solution in different regulatory systems has the potential to act as a disincentive to open source developers from seeking regulatory approvals for such technologies in the future., (© 2023 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.)

Purpose: The aim of this study was to report the demographic and mechanism of injury data in the UK National Ligament Registry (NLR) at 10 years and determine factors leading to poor compliance with completion of Patient-Reported Outcome Scores (PROMs)., Methods: A retrospective review was performed for prospectively collected data on the NLR between January 2013 and December 2022. All patients who underwent primary anterior cruciate ligament reconstruction (ACLR) were included. Patient demographics, mechanism of injury and patient compliance with completing PROMs were analysed. Patient characteristics were further analysed in relation to compliance with completing the different PROMs at the predefined time points. Patients were identified as nonresponders if they had not completed either 1- or 2-year postoperative Knee injury and Osteoarthritis Outcome Score (KOOS)., Results: A total of 17,492 patients were included in this study. The average age for patients undergoing ACLR between 2013 and 2022 was 29.4 (SD, 10.3). Seventy percent were men and 30% women. Football was the most common activity associated with an ACL injury. Patient compliance with recording PROMs was 55% preoperatively and 37%, 32% and 24% at 1-, 2- and 5-year postoperative follow-up, respectively. Nonresponders represented 54% of eligible patients. Multivariate analyses showed that sex, age, smoking, time interval between injury and surgery and low socioeconomic status were associated with low compliance with postoperative PROM completion (p < 0.001)., Conclusion: This study reports the demographic characteristics for patients on the NLR since 2013. Male sex, young age, increased waiting time between injury and surgery, smoking and lower socioeconomic class were predictors of low compliance with completion of postoperative PROMs on the UK NLR. Understanding the factors that affect patient compliance with PROMs improves our ability to provide targeted interventions and information to specific patient populations with the aim of enhancing inclusiveness and representation of population in the registry., Level of Evidence: Level III., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Introduction: Those with severe and enduring mental ill health are at greater risk of long-term physical health conditions and have a reduced life expectancy as a result. Multiple factors compound this health inequality, and the need for setting research priorities in this area is highlighted with physical and mental healthcare services being separate, and limited multimorbidity research., Methods: The aim of this exercise was to work in partnership with healthcare professionals and carers, family, friends and individuals with lived experience of both mental and physical health conditions, to set research priorities to help people with mental health conditions to look after their physical health. The exercise was guided by the James Lind Alliance approach. For this, a steering group was set up, two surveys were completed and a final priority workshop was conducted., Results: This priority setting exercise guided by people's needs and lived experience has produced a set of well-defined research topics. Initially, 555 research questions were suggested in the first survey, which were refined to 54 questions for the second survey. A priority setting workshop was then conducted to get the final 10 priorities., Conclusions: Taking these topics forward to improve services and treatment for both mental and physical ill health may in turn improve physical health and lessen the reduced life expectancy of those living with mental ill health., Patient or Public Contribution: This work was completed in collaboration with people who have lived experience of mental ill health and physical health conditions, as well as carers, family and friends. Their contribution has been significant for this work from piloting surveys, amending language used and educating the researchers and contributing to this paper. The initial work was completed with a steering group and continued with surveys and workshops., (© 2024 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Background: Globally, it is estimated that one in three adults live with two or more long-term conditions (multiple long-term conditions, MLTCs), that require self-management. People who experience socioeconomic deprivation face significant health inequalities due to a range of interrelated characteristics that lead to a lack of resources and opportunities. Previous research with underserved populations indicate low levels of trust towards primary care providers and potential barriers for developing patient-healthcare professional relationships. The purpose of this paper is to explore the barriers and facilitators to self-managing MLTCs, amongst people who experience socioeconomic deprivation., Methods: Semistructured one-to-one interviews with adults (n = 28) living in London and Sheffield, United Kingdom with MLTCs who are experiencing socioeconomic deprivation. Participants were recruited through general practices, community channels and social media. Data were analysed in NVivo using reflexive thematic analysis methods., Findings: Four analytical themes were developed: (1) challenges in accessing healthcare services, financial assistance, and cultural awareness; (2) empowerment and disempowerment through technology, including digital exclusion, and use of technology; (3) impact and causes of exclusion on self-management, including social isolation, area-based and economic exclusion, and health-related stigma and (4) adapting self-management strategies, including cost-effective, and culturally/lifestyle appropriate strategies., Conclusions: Future health interventions and services need to be developed with consideration of the combined complexities of managing MLTCs while experiencing socioeconomic deprivation. Increased awareness in practitioners and commissioners of the complexities surrounding the lives of people experiencing socioeconomic deprivation, and the need for targeted strategies to promote self-management of MLTCs are of great importa., Patient or Public Contribution: A patient advisory group contributed to all stages of the study, including providing important feedback on study documents (topic guides and recruitment materials), as well as providing critical insights surrounding the interpretation of interview data., (© 2024 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Efficiently allocating scarce healthcare resources requires nuanced understanding of individual and collective interests as well as relative concerns, which may overlap or conflict. This paper is the first to empirically investigate whether and to what extent self-interest (SI), positional concerns (PC) and distributional considerations (DC) simultaneously explain individual decision making related to access to healthcare services. Our investigation is based on a stated choice experiment conducted in two countries with different healthcare systems, the United States (US) and the United Kingdom (UK). The choice experiment is on allocation of medical treatment waiting times for a hypothetical disease. We carry out the investigation under two different perspectives: (i) in a socially inclusive personal perspective decision makers were asked to choose between waiting time distributions for themselves and (ii) in a social perspective decision makers were asked to make similar choices for a close relative or friend of opposite gender. The results obtained by estimating a variety of advanced choice models indicate that DC, SI and PC, in this order of importance, are significant drivers of choice behaviour in our empirical context. These findings are consistent regardless of the choice perspective and the country where decision makers live. Comparing the results from different choice perspectives, we find that US respondents who chose for their close relative or friend attach significantly larger weight to their close relative's or friend's waiting times as well as to the overall distribution of waiting times than US respondents who chose for themselves. Looking at differences between countries, our results show that UK respondents who made choices for themselves placed significantly larger weight on SI and DC than US respondents, while US respondents, in turn, displayed relatively stronger but not significantly different positional concerns than UK respondents. In addition, we observe that UK respondents who chose for their close relative or friend put a larger weight on DC than their US counterparts. We conclude that the methodological (data collection and analysis) approach allows for disentangling the relative importance of the three motivations and discusses the potential implications of these findings for healthcare decision making., (© 2023. The Author(s).)

Introduction: Paediatric urologists manage a spectrum of conditions, much of the evidence for relevant treatment pathways is of low quality. For many conditions treatment varies according to location and surgeon; children with the same condition might have surgery in one unit but watchful waiting in another. Underlying this variation are differences in opinion, and insufficient high-level evidence with few prospective randomized studies. Such studies may be challenging to design, fund and recruit into, and are more likely to succeed if there is a collaborative approach. Research prioritization is a tool to identify the research of most value. Delphi methodology is an interpretive technique aiming to gain the consensus view of interested parties. The British Association of Paediatric Urologists (BAPU) set out to ascertain consensus on what paediatric urologists, working in the UK, consider to be areas of priority for research. This paper describes the process used, and the resulting list of research questions., Methods: A scoping survey of paediatric urologists in the UK was undertaken to identify an initial set of research questions. These were refined by the BAPU research committee (BAPU RC), then prioritized using a modified Delphi process. During Stage 1a multiple new research questions were submitted leading to Stage 1b, an interim process. All UK paediatric urologists were invited to take part in Stage 2 of the prioritization process., Results: Sixty-five questions were submitted to the scoping survey by 24 paediatric urologists. The BAPU RC refined these to 60 questions, which were submitted to Stage 1a of the modified Delphi process. Sixty-seven people completed Stage 1a, at the same time submitting 224 additional research questions. The BAPU RC revised the entire question set, ensuring the key subject of the original question was not altered and novel questions were retained. The BAPU RC undertook interim scoring of the resultant 79 questions, the top scoring 25 questions plus 5 lower scoring 'wild card' questions (to ensure the breadth of the specialty was represented) were put forward to Stage 2. A total of 65 people completed Stage 2, including a lay representative. A list of 30 priority research questions was generated; the top 10 includes management of neuropathic bladder, posterior urethral valves, antibiotic prophylaxis, DSD & CAH, continence, male external genitalia, VUR and transition care (Table)., Conclusion: This process has provided BAPU, paediatric urologists in the UK, and funders with areas of research considered a priority in the specialty., Competing Interests: Conflict of interest None of the authors have any relevant conflicts of interest., (Copyright © 2023 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Background: Nurses, midwives and paramedics are the largest collective group of clinical staff in the National Health Service and have some of the highest prevalence of psychological ill-health. Existing literature tends to be profession-specific and focused on individual interventions that place responsibility for good psychological health with nurses, midwives and paramedics themselves., Aim: To improve understanding of how, why and in what contexts nurses, midwives and paramedics experience work-related psychological ill-health; and determine which high-quality interventions can be implemented to minimise psychological ill-health in these professions., Methods: Realist synthesis methodology consistent with realist and meta-narrative evidence syntheses: evolving standards' reporting guidelines., Data Sources: First round database searching in Medical Literature Analysis and Retrieval System Online Database ALL (via Ovid), cumulative index to nursing and allied health literature database (via EBSCO) and health management information consortium database (via Ovid), was undertaken between February and March 2021, followed by supplementary searching strategies (e.g. hand searching, expert solicitation of key papers). Reverse chronology screening was applied, aimed at retaining 30 relevant papers in each profession. Round two database searches (December 2021) targeted COVID-19-specific literature and literature reviews. No date limits were applied., Results: We built on seven key reports and included 75 papers in the first round (26 nursing, 26 midwifery, 23 paramedic) plus 44 expert solicitation papers, 29 literature reviews and 49 COVID-19 focused articles in the second round. Through the realist synthesis we surfaced 14 key tensions in the literature and identified five key findings, supported by 26 context mechanism and outcome configurations. The key findings identified the following: (1) interventions are fragmented, individual-focused and insufficiently recognise cumulative chronic stressors; (2) it is difficult to promote staff psychological wellness where there is a blame culture; (3) the needs of the system often override staff well-being at work ('serve and sacrifice'); (4) there are unintended personal costs of upholding and implementing values at work; and (5) it is challenging to design, identify and implement interventions to work optimally for diverse staff groups with diverse and interacting stressors., Conclusions: Our realist synthesis strongly suggests the need to improve the systemic working conditions and the working lives of nurses, midwives and paramedics to improve their psychological well-being. Individual, one-off psychological interventions are unlikely to succeed alone. Psychological ill-health is highly prevalent in these staff groups (and can be chronic and cumulative as well as acute) and should be anticipated and prepared for, indeed normalised and expected. Healthcare organisations need to (1) rebalance the working environment to enable healthcare professionals to recover and thrive; (2) invest in multi-level system approaches to promote staff psychological well-being; and use an organisational diagnostic framework, such as the NHS England and NHS Improvement Health and Wellbeing framework, to self-assess and implement a systems approach to staff well-being., Future Work: Future research should implement, refine and evaluate systemic interventional strategies. Interventions and evaluations should be co-designed with front-line staff and staff experts by experience, and tailored where possible to local, organisational and workforce needs., Limitations: The literature was not equivalent in size and quality across the three professions and we did not carry out citation searches using hand searching and stakeholder/expert suggestions to augment our sample., Study Registration: This study is registered as PROSPERO CRD42020172420. Available from: https://www.crd.york.ac.uk/prospero/display&#95;record.php?ID=CRD42020172420., Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129528) and is published in full in Health and Social Care Delivery Research ; Vol. 12, No. 9. See the NIHR Funding and Awards website for further award information.