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With the adoption of sustainability continuing to gain momentum, there has never been a better time for business schools to understand the extent to which they are preparing students to contribute to sustainable organizations and society. The current research seeks to help schools advance this aim by examining the extent to which sustainability is being integrated within business school curricula. We accomplish this through a systematic analysis of 529 websites from undergraduate marketing programs accredited by the Association to Advance Collegiate Schools of Business (AACSB). To further our understanding of how sustainability can be integrated into curricula, we draw upon prior research and the United Nations' Blueprint for Sustainable Development Goal (SDG) Integration to propose a new sustainability curriculum framework. This research fills a gap in the literature by offering a comprehensive look at the state of sustainability in marketing education and offers direction for programs seeking to meet market demands, advance SDG goals, and fulfill current AACSB standards.

Some antihypertensive medications are photosensitizing. The implications for skin cancer risk remain unclear because results from prior studies are inconsistent and as new evidence is published. We performed a systematic review and meta-analysis to evaluate the association between antihypertensives and common skin cancers (cutaneous squamous cell carcinoma, basal cell carcinoma, and melanoma) and to evaluate dose-response relationships. Forty-four articles met inclusion criteria, and 42 could be meta analyzed. Increased risks were seen for basal cell carcinoma with calcium channel blockers (relative risk [RR] = 1.17, 95% confidence interval [CI] = 1.11-1.22), diuretics (RR = 1.06, 95% CI = 1.03-1.10), and thiazides (RR = 1.10, 95% CI = 1.04-1.16); for squamous cell carcinoma with calcium channel blockers (RR = 1.08, 95% CI = 1.01-1.14), diuretics (RR = 1.29, 95% CI = 1.17-1.43), and thiazides (RR = 1.36, 95% CI = 1.15-1.61); and for melanoma in angiotensin-converting enzyme inhibitors (RR = 1.09, 95% CI = 1.03-1.14), calcium channel blockers (RR = 1.08, 95% CI = 1.03-1.12), and thiazides (RR = 1.09, 95% CI = 1.02-1.17). The quality of evidence was low or very low. We observed evidence for dose-response for thiazides with basal cell carcinoma; angiotensin-converting enzyme inhibitors, diuretics, and thiazides with squamous cell carcinoma; and angiotensin-converting enzyme inhibitors, diuretics, and thiazides with melanoma. Our meta-analysis supports a potential causal association between some antihypertensives, particularly diuretics, and skin cancer risk.

Harsha Hemantha Kariyawasam,1,2 Dean Langan,3 Joanne Rimmer4– 6 1Specialist Allergy and Clinical Immunology, Royal National ENT Hospital, London, UK; 2Rhinology Section, Royal National ENT Hospital, London, UK; 3Great Ormond Street Institute of Child Health, UCL, London, UK; 4Department of Otolaryngology Head & Neck Surgery, Monash Health, Melbourne, Australia; 5Department of Surgery, Monash University, Melbourne, Australia; 6Department of Otolaryngology Head & Neck Surgery, St Vincent’s Hospital, Melbourne, AustraliaCorrespondence: Harsha Hemantha Kariyawasam, Specialist Allergy and Clinical Immunology, Rhinology Section, Royal National ENT Hospital London and UCLH NHS Foundation Trust, 47-49 huntley Street, London, WC1E 6DG, UK, Email harsha.kariyawasam@nhs.netAbstract: Chronic rhinosinusitis with nasal polyps (CRSwNP) is often severe, debilitating and difficult to treat. Recent randomised control trials (RCTs) of biologics that target key inflammatory pathways have demonstrated clinical efficacy in treating CRSwNP. Such RCTs must facilitate meta-analysis. Here we report the need for urgent improvement in double-blind randomised controlled trials of biologics in CRSwNP, having previously undertaken a systematic review and meta-analysis of such studies. The RCTs included in that systematic review did not conform to a standard study design. Patient selection criteria was not consistent in studies with several heterogeneous disease subgroups of CRSwNP patients present in each study. Different durations of treatment and variable outcome measures also made the comparative assessment of efficacy between different biologics difficult. Data presentation to allow extraction for meta-analysis was not always clear, such that on occasion selected data sets or even an entire RCT had to be excluded from further evaluation. As such, the high heterogeneity between studies made the overall interpretation of the findings difficult. We make an urgent call to design and conduct future RCTS of biologics in CRSwNP in a more standardised manner, and to present data in a clear way that is easily extractable. This will facilitate more inclusive and thus robust evaluation and interpretation via meta-analysis, which will in turn enable clearer insight into which CRSwNP patient subgroups might benefit from specific biologics and thus achieve better clinical outcomes.Plain Language Summary: Future randomised clinical trials should be performed in a more standardised manner, ensuring each trial team collects the same type of clinical information and outcome data at the required timepoints. All such trials should report the data in an easy-to-understand way. This will allow better meta-analysis interpretation of data.Primary researchers should aim to present summary statistics relating to outcomes separately for each arm of their project. This should also be reported separately at each evaluation timepoint.For numeric outcomes, this should include the mean, standard deviation and the number of observations that the summary is based on. For binary outcomes, the number of individuals experiencing the event should be reported alongside the number of observations that the summary is based on.Effect estimates and inferential statistics presented in a journal article are less ideal for meta-analysis. However, if researchers do choose this option, then estimates should be accompanied by a standard error or confidence interval. P-values can also be presented at the discretion of the researchers, but this does not best facilitate meta-analysis.Primary researchers should generally facilitate meta-analysis by presenting results in a flexible way that allows reviewers to change the type of effect measure (eg, to derive an odds ratio or a relative risk).Primary researchers should ensure that the corresponding author of the paper is available for questions via email.Keywords: biologics, nasal polyps, clinical trials, outcomes, standardisation

Additive manufacturing of metals often results in microstructural inhomogeneities, leading to the simultaneous or sequential activation of multiple deformation mechanisms. Real-time monitoring of these mechanisms is essential for understanding material behavior. While Digital Image Correlation (DIC) effectively evaluates strains during in-situ deformation, its accuracy diminishes at high strain levels, necessitating complementary techniques. This study integrates crystal orientation measurements from Electron Backscatter Diffraction (EBSD) with in-situ DIC to investigate deformation characteristics of wire arc directed energy deposited (WDED) single α-phase titanium. Quasi-in-situ tensile tests were conducted to model and validate twin traces focusing on twin system activation guided by crystal orientation and Schmid factor (m) calculations. The (011‾2) [01‾11] twin system displayed the maximum Schmid factor (m = 0.383), indicating a strong propensity for twinning, while the twin system (1‾102) [11‾01] exhibited the least m of 0.0015, exhibiting minimal twin activity during tensile deformation. The twin traces were validated using Schmid factor calculations, which reflect the tendency of preferential deformation twinning in WDED titanium. These findings reveal preferential deformation twinning behavior in WDED titanium, providing insights into the underlying deformation mechanisms and offering directions for the advancement of additively manufactured high-strength structural materials.

This article is a qualitative investigation of teachers' pedagogical approaches to the terror attacks on September 11, 2001. The ten participants are regionally diverse in-service teachers who attended workshops conducted by the 9/11 Memorial Museum and Gilder Lehrman Institute of American History in New York during June and July, 2019. Teachers presented their 9/11 lessons at a March 5, 2020 conference in New York City to pre- and in-service teachers. Surveys, interviews, and lessons determined how teachers implemented professional development in their schools. The paper seeks to improve teacher training through the use of primary sources and place-based education to engender student inquiry. The creation of 9/11 digital lesson plans on the Library of Congress' Teaching with Primary Sources site provides teachers access to ensure that 9/11 receives greater emphasis in the social studies curriculum. Findings indicate that in-situ, place-based experiences increased 9/11 curriculum in classrooms.

Abstract Atopic eczema may be related to multiple subsequent adverse health outcomes. Here, we provide evidence to judge and compare associations between eczema and a comprehensive set of outcomes. We conducted 71 cohort studies (age, sex, general practice-matched) using Clinical Practice Research Datalink Aurum primary care records (1997−2023), comparing up to 3.6 million people with eczema to 16.8 million without. Eczema was associated with subsequent diagnosis of outcomes with adjusted hazard ratios (99% confidence intervals) from Cox regression of up to 4.02(3.95–4.10) for food allergy (rate difference [RD] per 1,000 person-years of 1.5). Besides strong associations with atopic and allergic conditions (e.g., asthma 1.87[1.39–1.82], RD5.4) and skin infections (e.g., molluscum contagiosum 1.81[1.64–1.96], RD1.8), the strongest associations were with Hodgkin’s lymphoma (1.85[1.66–2.06], RD0.02), Alopecia Areata (1.77[1.71–1.83], RD0.2), Crohn’s disease (1.62[1.54–1.69], RD0.1), Urticaria (1.58[1.57–1.60], RD1.9), Coeliac disease (1.42[1.37–1.47], RD0.1), Ulcerative colitis (1.40[1.34–1.46], RD0.1), Autoimmune liver disease (1.32[1.21–1.43], RD0.01), and Irritable bowel syndrome (1.31[1.29–1.32], RD0.7). Sensitivity analyses revealed the impact of consultation bias or choice of cohort age cut-off on findings. Comparatively large HRs in severe eczema were seen for some liver, gastrointestinal and cardiovascular conditions, osteoporosis, and fractures. Most cancers and neurological conditions were not associated with eczema.

Abstract Waterlogging is expected to become a more prominent yield restricting stress for barley as rainfall frequency is increasing in many regions due to climate change. The duration of waterlogging events in the field is highly variable throughout the season, and this variation is also observed in experimental waterlogging studies. Such variety of protocols make intricate physiological responses challenging to assess and quantify. To assess barley waterlogging tolerance in controlled conditions, we present an optimal duration and setup of simulated waterlogging stress using image-based phenotyping. Six protocols durations, 5, 10, and 14 days of stress with and without seven days of recovery, were tested. To quantify the physiological effects of waterlogging on growth and greenness, we used top down and side view RGB (Red-Green-Blue) images. These images were taken daily throughout each of the protocols using the PSI PlantScreen™ imaging platform. Two genotypes of two-row spring barley, grown in glasshouse conditions, were subjected to each of the six protocols, with stress being imposed at the three-leaf stage. Shoot biomass and root imaging data were analysed to determine the optimal stress protocol duration, as well as to quantify the growth and morphometric changes of barley in response to waterlogging stress. Our time-series results show a significant growth reduction and alteration of greenness, allowing us to determine an optimal protocol duration of 14 days of stress and seven days of recovery for controlled conditions. Moreover, to confirm the reproducibility of this protocol, we conducted the same experiment in a different facility equipped with RGB and chlorophyll fluorescence imaging sensors. Our results demonstrate that the selected protocol enables the assessment of genotypic differences, which allow us to further determine tolerance responses in a glasshouse environment. Altogether, this work presents a new and reproducible image-based protocol to assess early stage waterlogging tolerance, empowering a precise quantification of waterlogging stress relevant markers such as greenness, Fv/Fm and growth rates.

Aims: Patient dissatisfaction following primary total knee arthroplasty (TKA) with manual jig-based instruments has been reported to be as high as 30%. Robotic-assisted total knee arthroplasty (RA-TKA) has been increasingly used in an effort to improve patient outcomes, however there is a paucity of literature examining patient satisfaction after RA-TKA. This study aims to identify the incidence of patients who were not satisfied following RA-TKA and to determine factors associated with higher levels of dissatisfaction. Methods: This was a retrospective review of 674 patients who underwent primary TKA between October 2016 and September 2020 with a minimum two-year follow-up. A five-point Likert satisfaction score was used to place patients into two groups: Group A were those who were very dissatisfied, dissatisfied, or neutral (Likert score 1 to 3) and Group B were those who were satisfied or very satisfied (Likert score 4 to 5). Patient demographic data, as well as preoperative and postoperative patient-reported outcome measures, were compared between groups. Results: Overall, 45 patients (6.7%) were in Group A and 629 (93.3%) were in Group B. Group A (vs Group B) had a higher proportion of male sex (p = 0.008), preoperative chronic opioid use (p < 0.001), preoperative psychotropic medication use (p = 0.01), prior anterior cruciate ligament (ACL) reconstruction (p < 0.001), and preoperative symptomatic lumbar spine disease (p = 0.004). Group A was also younger (p = 0.023). Multivariate analysis revealed preoperative opioid use (p = 0.012), prior ACL reconstruction (p = 0.038), male sex (p = 0.006), and preoperative psychotropic medication use (p = 0.001) as independent predictive factors of patient dissatisfaction. Conclusion: The use of RA-TKA demonstrated a high rate of patient satisfaction (629 of 674, 93.3%). Demographics for patients not satisfied following RA-TKA included: male sex, chronic opioid use, chronic psychotropic medication use, and prior ACL reconstruction. Patients in these groups should be identified preoperatively and educated on realistic expectations given their comorbid conditions. Cite this article: Bone Jt Open 2024;5(9):758–765.

This study explores dissatisfaction and neutrality metrics from 12 years of a national-level undergraduate student survey. The notion of dissatisfaction is much less prevalent in the narratives surrounding student survey outcomes, and the underpinning metrics are seldom considered. This is despite an increasingly vociferous debate about "value for money" of higher education and the positioning of students as consumers in a marketised sector. We used machine learning methods to explore over 2.7 million national survey outcomes from 154 institutions to describe year-on-year stability in the survey items that best predicted dissatisfaction and neutrality, together with their similarity to known metric predictors of satisfaction. The widely publicised annual increases in student 'satisfaction' are shown to be the result of complex reductions in the proportions of disagreement and neutrality across different survey dimensions. Due to the widespread use of survey metrics in university league tables, we create an anonymised, illustrative table to demonstrate how UK institutional rankings would have differed if dissatisfaction metrics had been the preferred focus for reporting. We conclude by debating the tensions of balancing the provision of valuable information about dissatisfaction, with perpetuating negative impacts that derive from this important subset of the survey population.

Background: Robotic-assisted total knee arthroplasty (RA-TKA) was introduced to provide surgeons with virtual preoperative planning and intraoperative information to achieve the desired surgical goals in an effort to improve patient outcomes. The purpose of this study was to compare clinical outcomes and patient-reported outcome measures following primary TKA using RA-TKA vs manual instrumentation. Methods: This was a retrospective cohort review study comparing 393 primary RA-TKAs vs 312 manual TKAs at a minimum 2-year follow-up. The same cementless implant design was utilized in all cases at a single institution. There were no significant differences in age or gender between groups. Outcome measures included range-of-motion, Knee Society (KSS), Western Ontario and McMaster Universities Osteoarthritis Index, Forgotten Joint Score-12, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, and overall patient satisfaction scores along with complications and survivorship. Results: Compared to manual TKA, the RA-TKA group had significant higher postoperative KSS Function and Knee scores, Western Ontario and McMaster Universities Osteoarthritis Index, and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores (P < .001). A total percentage of 95.0% of RA-TKA vs 87.4% of manual TKAs were very satisfied or satisfied (P = .001). Survivorship with all-cause failure as the endpoint at 3 years was 96.9% in the RA-TKA group compared to 95.8% in the manual group (P = .54). Conclusions: RA-TKA demonstrated significant improvement over manual jig-based instruments in KSS Function, KSS Knee, Western Ontario and McMaster Universities Osteoarthritis Index, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, and patient satisfaction scores following primary TKA with no differences in complications and revision incidence. RA-TKA provided a virtual 3-dimensional preoperative plan along with intraoperative information for adjustments to approximate the patients' native joint line and achieve a well-balanced soft-tissue sleeve about the knee for primary TKA.

Introduction Paediatric fractures are common but can be easily missed on radiography leading to potentially serious implications including long-term pain, disability and missed opportunities for safeguarding in cases of inflicted injury. Artificial intelligence (AI) tools to assist fracture detection in adult patients exist, although their efficacy in children is less well known. This study aims to evaluate whether a commercially available AI tool (certified for paediatric use) improves healthcare professionals (HCPs) detection of fractures, and how this may impact patient care in a retrospective simulated study design.Methods and analysis Using a multicentric dataset of 500 paediatric radiographs across four body parts, the diagnostic performance of HCPs will be evaluated across two stages—first without, followed by with the assistance of an AI tool (BoneView, Gleamer) after an interval 4-week washout period. The dataset will contain a mixture of normal and abnormal cases. HCPs will be recruited across radiology, orthopaedics and emergency medicine. We will aim for 40 readers, with ~14 in each subspecialty, half being experienced consultants. For each radiograph HCPs will evaluate presence of a fracture, their confidence level and a suitable simulated management plan. Diagnostic accuracy will be judged against a consensus interpretation by an expert panel of two paediatric radiologists (ground truth). Multilevel logistic modelling techniques will analyse and report diagnostic accuracy outcome measures for fracture detection. Descriptive statistics will evaluate changes in simulated patient management.Ethics and dissemination This study was granted approval by National Health Service Health Research Authority and Health and Care Research Wales (REC Reference: 22/PR/0334). IRAS Project ID is 274 278. Funding has been provided by the National Institute for Heath and Care Research (NIHR) (Grant ID: NIHR-301322). Findings from this study will be disseminated through peer-reviewed publications, conferences and non-peer-reviewed media and social media outlets.Trial registration number ISRCTN12921105.

Anatoxin-a is a globally occurring, yet understudied, chiral cyanobacterial toxin that threatens public health and the environment. It has led to numerous dog. livestock and bird poisonings and although it has been studied in rodent models, comparatively little research has occurred in aquatic species. To advance a comparative toxicology understanding of this toxin in alternative vertebrate models, developing zebrafish and fathead minnow were exposed to environmentally relevant and elevated levels (13–4400 μg/L) of (+) anatoxin-a to examine potential mortality and sublethal effects, including photolocomotor behavior and gene expression responses. We observed significantly higher mortality (p 0.05) transcriptional changes were observed in the fathead minnow model. These differential responses between commonly employed species employed as alternative vertebrate models in toxicology research and chemicals risk assessments highlight the need for more comparative studies to understand sensitivities and variations in organismal response. Furthermore, we identified higher mortality, refractory behavioral effects, and gene expression in (+) anatoxin-a exposed fish when compared to previously reported (±) anatoxin-a (racemic 50:50 enantiomer mixture) studies, which is frequently used as a surrogate chemical for experimental work. Our findings identify the importance of understanding species and enantiomer specific effects of natural toxins.

This study explored the body mass (BM) management practices among competitive male and female Olympic weightlifting athletes, hypothesizing that athletes compete in lighter weight categories than their habitual training weight (i.e., making weight). Utilizing a validated, anonymous survey, data were collected from 149 Olympic weightlifting athletes (>18 years; female = 94). The survey comprised five sections: demographics, training/competition history, weight history, source of influence, and BM management practices. The prevalence, magnitude, and methods employed for BM management were analyzed with subgroup analysis using one-way analysis of variance. Post hoc testing including Spearman's rho and chi-square analysis was completed when a significant effect was found. Three quarters (76%) of athletes acknowledged using chronic weight loss and/or acute weight loss strategies to make weight. Usual BM loss (2%–3%) in the week before competition was within recommended guidelines. Gradual dieting, fluid restriction, and low food weight, high-calorie options were the most commonly used BM management strategies. Female athletes were more likely to use gradual dieting (p =.043; r =.104) and were less likely to increase their exercise (p =.046; r = −.105) and utilize fasting (p =.038; r =.05) compared with their male counterparts. Women further identified dietitians/nutritionists (p =.006; r =.022) as a highly influential source of information. This research offers new insights into the BM management practices of Olympic weightlifting athletes, identifying that the majority of athletes compete at a BM lighter than their habitual training weight, achieved using a range of chronic weight loss and acute weight loss strategies. [ABSTRACT FROM AUTHOR]

BACKGROUND: Lymphocyte skin homing in atopic eczema (AE) may induce lymphopenia. OBJECTIVE: To determine if AE is associated with lymphopenia. METHODS: We used UK primary care electronic health records (Clinical Practice Research Datalink GOLD) for a matched cohort study in adults (18 years+) (1997-2015) with at least one recorded lymphocyte count. We matched people with AE to up to five people without. We used multivariable logistic regression to estimate the association between AE and lymphopenia (two low lymphocyte counts within 3 months) and linear mixed effects regression to estimate the association with absolute lymphocyte counts using all available counts. Cox proportional hazard models were used to investigate the effect of lymphopenia on common infections. We replicated the study using US survey data (National Health and Nutrition Examination Survey [NHANES]). RESULTS: Among 71,731 adults with AE and 126,349 adults without AE, we found an adjusted odds ratio (OR) for lymphopenia of 1.16 (95% CI: 1.09-1.23); the strength of association increased with increasing eczema severity. When comparing all recorded lymphocyte counts from adults with AE (n = 1,497,306) to those of people without AE (n = 4,035,870) we saw a lower mean lymphocyte (adjusted mean difference -0.047 × 109 /L [95% CI: -0.051 to -0.043]) in those with AE. The difference was larger for men, with increasing age, and with increasing AE severity and was present among people with AE not treated with immunosuppressive drugs. In NHANES (n = 22,624), the adjusted OR for lymphopenia in adults with AE was 1.30 (95% CI: 0.80-2.11), and the adjusted mean lymphocyte count difference was -0.03 × 109 /L (95% CI: -0.07 to 0.02). Despite having a lower lymphocyte count, adjusting for time with lymphopenia, did not alter risk estimates of infections. CONCLUSION: Atopic eczema, including increasing AE severity, is associated with a decreased lymphocyte count, regardless of immunosuppressive drug use. Whether the lower lymphocyte count has wider health implications for people with severe eczema warrants further investigation.

Abstract Background Loss of function mutations in the filaggrin gene (FLG) play an important role in the pathogenesis of atopic dermatitis (AD). However, FLG is structurally challenging to sequence using conventional high‐throughput techniques. Genome‐wide association studies (GWAS) chips and imputation panels are also not designed to detect most of these mutations. Furthermore, bioinformatics tools have variable sensitivity for identification of loss of function variants. Targeted sequencing is often performed for AD but requires a comprehensive list of potential variants. Objectives This study sought to compile all published FLG single nucleotide polymorphisms (SNPs) in AD and characterize the methods for assessing the associated phenotype. Methods We searched nine electronic databases for studies that reported measures of association between FLG and AD. Data regarding FLG SNPs and participant demographics were extracted. The identified SNPs were compared to those available in the National Human Genome Research Institute‐European Bioinformatics Institute (NHGRI‐EBI) GWAS Catalogue and the 1000Genomes reference panel. Results We identified 168 SNPs in FLG that have been associated with AD, with the most studied being R501X, 2282del4, R2447X, 3321delA, S3247X and p.S2554 in European and Asian ancestries. A total of 153 of these SNPs are not available from GWAS studies, and 78 are not included in the 1000Genomes reference panel. Conclusions Because FLG is a complex gene, current GWAS chips do not capture most of the polymorphisms that have been associated with AD.

Often unrecognized for their accomplishments, women of color in educational leadership positions are change agents whose practices must be analyzed in order to transform education at all levels. Dr. Nadia Lopez is the founding principal of Mott Hall Bridges Academy (MHBA) Middle School in Brownsville, New York City--one of the poorest congressional districts in the United States. Due to Dr. Lopez's leadership, MHBA has a 98% graduation rate and students gain admittance to some of the most academically competitive high schools in New York City. This article examines the leadership role and work of Dr. Lopez, and how she operationalized Lipman-Blumen's Connective Leadership model to overcome poverty, low academic expectations, and racial stereotypes. As evidenced by the data, Dr. Lopez presents as a connective leader by monitoring and reacting to situational cues while determining the appropriate combinations of behaviors/achieving styles to address unique sets of circumstances.

Objectives To examine the impact of the COVID-19 pandemic on deprivation-related inequalities in hospitalisations for cardiovascular disease (CVD) conditions in Denmark and England between March 2018 and December 2021.Design Time-series studies in England and Denmark.Setting With the approval of National Health Service England, we used English primary care electronic health records, linked to secondary care and death registry data through the OpenSAFELY platform and nationwide Danish health registry data.Participants We included adults aged 18 and over without missing age, sex or deprivation information. On 1 March 2020, 16 234 700 people in England and 4 491 336 people in Denmark met the inclusion criteria.Primary outcome measures Hospital admissions with the primary reason for myocardial infarction (MI), ischaemic or haemorrhagic stroke, heart failure and venous thromboembolism (VTE).Results We saw deprivation gradients in monthly CVD hospitalisations in both countries, with differences more pronounced in Denmark. Based on pre-pandemic trends, in England, there were an estimated 2608 fewer admissions than expected for heart failure in the most deprived quintile during the pandemic compared with an estimated 979 fewer admissions in the least deprived quintile. For all other outcomes, there was little variation by deprivation quintile. In Denmark, there were an estimated 1013 fewer admissions than expected over the pandemic for MI in the most deprived quintile compared with 619 in the least deprived quintile. Similar trends were seen for stroke and VTE, though absolute numbers were smaller. Heart failure admissions were similar to pre-pandemic levels with little variation by deprivation quintile.Conclusions Overall, we did not find that the pandemic substantially worsened pre-existing deprivation-related differences in CVD hospitalisations, though there were exceptions in both countries.

Routinely collected health data (RCD) including electronic health records, disease registries, health administrative data and wearables data are not specifically collected for research purposes. Analysis of these data poses unique methodological challenges that must be addressed when conducting research, particularly as availability and use increase. This scoping review aimed to identify methodological challenges in research using RCD from existing literature (registered protocol: https://doi.org/10.17605/OSF.IO/EBM4D). We searched 6 electronic databases, including medical, health economics, nursing and psychology research databases, between Jan 2015 and Jan 2023, combining multiple “RCD” and “research” search terms (e.g., epidemiologic, informatics, pharmaceutical research). After screening abstracts and full-texts, we doubly extracted methodological themes, categorizing them into different study stages. We screened more than 23,000 records and included 430 papers. Bias and confounding were the most common methodological issues identified, discussed in relation to both study design and data analysis. Data quality, including data accuracy, validation, completeness, timeliness and cleaning, also posed substantial challenges, particularly during data processing stage. Record linkage and conducting analyses using distributed health networks also pose unique methodological challenges. Heterogeneity, incorporating social determinants of health and statistical models that address methodological challenges are also described in the literature. External validity and reporting are important considerations for RCD research. Our review identified several methodological challenges facing researchers using RCD. These issues should be addressed to ensure methodologically sound research. These findings will inform the development of a standardized protocol template and accompanying educational platform aimed at enhancing methodological quality and transparency when conducting research using RCD.