Search

Objective: The Patient Information Leaflet (PIL) is an authoritative document that all people with epilepsy in the EU receive when prescribed antiseizure medication (ASM). We undertook the first independent, comprehensive assessment to determine how understandable they are. Regulators state that when patients are asked comprehension questions about them, ≥80% should answer correctly. Also, recommended is that PILs have a maximum reading requirement of US grade 8. Methods: Study 1: We obtained 140 current ASM PILs written in English. "Readability" was assessed using four tests, with and without adjustment for influence of familiar, polysyllabic words. A total of 179 online materials on epilepsy were also assessed. Study 2: Two PILs from Study 1 were randomly selected (Pregabalin Focus; Inovelon) and shown to 35 people from the UK epilepsy population. Their comprehension was assessed. Study 3: To understand whether the student population provides an accessible alternative population for future examination of ASM PILs, Study 3 was completed, using the same methods as Study 2, except that participants were 262 UK university students. Results: Study 1: No PIL had a reading level of grade 8. Median was grade 11. Adjusting for context, the PILs were still at grade 10.5. PILs for branded ASMs were most readable. PILs were no more readable than (unregulated) online materials. Study 2: Users struggled to comprehend the PILs' key messages. The eight questions asked about pregabalin were typically answered correctly by 54%. For Inovelon, it was 62%. Study 3: Most student participants comprehended the PILs' key messages. The questions about Inovelon were answered correctly by 90%; for pregabalin it was 86%. Significance: This is the first independent and comprehensive examination of ASM PILs. It found that PILs being used fail to meet recommendations and regulatory requirements and risk not being understandable to a substantial proportion of users. In finding that people from the epilepsy population differ markedly in comprehension of PILs compared to students, this study highlights the importance of completing user testing with the target population. [ABSTRACT FROM AUTHOR]

Background: The 2022/23 influenza season in the United Kingdom saw the return of influenza to prepandemic levels following two seasons with low influenza activity. The early season was dominated by A(H3N2), with cocirculation of A(H1N1), reaching a peak late December 2022, while influenza B circulated at low levels during the latter part of the season. From September to March 2022/23, influenza vaccines were offered, free of charge, to all aged 2–13 (and 14–15 in Scotland and Wales), adults up to 49 years of age with clinical risk conditions and adults aged 50 and above across the mainland United Kingdom. Methods: End‐of‐season adjusted vaccine effectiveness (VE) estimates against sentinel primary‐care attendance for influenza‐like illness, where influenza infection was laboratory confirmed, were calculated using the test negative design, adjusting for potential confounders. Methods: Results In the mainland United Kingdom, end‐of‐season VE against all laboratory‐confirmed influenza for all those > 65 years of age, most of whom received adjuvanted quadrivalent vaccines, was 30% (95% CI: −6% to 54%). VE for those aged 18–64, who largely received cell‐based vaccines, was 47% (95% CI: 37%–56%). Overall VE for 2–17 year olds, predominantly receiving live attenuated vaccines, was 66% (95% CI: 53%–76%). Conclusion: The paper provides evidence of moderate influenza VE in 2022/23. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Motor neuron disease (MND) (also known as amyotrophic lateral sclerosis) is a life‐limiting neurodegenerative condition. In up to 20% of people with MND, a pathogenic variant associated with autosomal dominant inheritance can be identified. Children of people carrying a pathogenic variant have a 50% chance of inheriting this and a higher, although harder to predict, chance of developing the disease compared to the general adult population. This paper explores the experience of living with the genetic risk of MND. Methods: We undertook a UK‐based interview study with 35 individuals, including: 7 people living with genetically‐mediated forms of MND; 24 asymptomatic relatives, the majority of whom had an increased risk of developing the disease; and 4 unrelated partners. Results: We explore how individuals make sense of genetic risk, unpacking the interplay between genetic knowledge, personal perception, experiences of the disease in the family, age and life stage and the implications that living with risk has for different aspects of their lives. We balance an emphasis on the emotional and psychological impact described by participants, with a recognition that the salience of risk fluctuates over time. Furthermore, we highlight the diverse strategies and approaches people employ to live well in the face of uncertainty and the complex ways they engage with the possibility of developing symptoms in the future. Finally, we outline the need for open‐ended, tailored support and information provision. Conclusions: Drawing on wider literature on genetic risk, we foreground how knowledge of MND risk can disrupt individuals' taken‐for‐granted assumptions on life and perceptions of the future, but also its contextuality, whereby its relevance becomes more prominent at critical junctures. This research has been used in the development of a public‐facing resource on the healthtalk.org website. Patient or Public Contribution: People with experience of living with genetic risk were involved throughout the design and conduct of the study and advised on aspects including the topic guide, sampling and recruitment and the developing analysis. Two patient and public involvement contributors joined a formal advisory panel. [ABSTRACT FROM AUTHOR]

Introduction: Co‐production is gaining increasing recognition as a good way of facilitating collaboration among different stakeholders, including members of the public. However, it remains an ambiguous concept as there is no definitive or universal model of co‐production or clarity on what constitutes a good co‐production approach. This paper draws on the reflections of the academic researchers, practitioners and public advisors involved in co‐producing a priority‐setting exercise. The exercise was conducted by the Primary and Community Health Services (PCHS) Theme of the National Institute for Health and Care Research Applied Research Collaboration for Kent, Surrey and Sussex (NIHR ARC KSS). Methods: We collected data through written and verbal reflections from seven collaborators involved in the PCHS priority‐setting exercise. We used Gibbs' model of reflection to guide the data collection. We then analysed the data through an inductive, reflexive thematic analysis. Results: A common thread through our reflections was the concept of 'sharing'. Although co‐production is inherently shared, we used the virtuous cycle to illustrate a sequence of sharing concepts during the research cycle, which provides the underpinnings of positive co‐production outcomes. We identified six themes to denote the iterative process of a shared approach within the virtuous cycle: shared values, shared understanding, shared power, shared responsibilities, shared ownership and positive outcomes. Conclusion: Our results present a virtuous cycle of co‐production, which furthers the conceptual underpinnings of co‐production. Through our reflections, we propose that positive co‐production outcomes require foundations of shared values and a shared understanding of co‐production as a concept. These foundations facilitate a process of shared power, shared responsibilities and shared ownership. We argue that when these elements are present in a co‐production exercise, there is a greater potential for implementable outcomes in the communities in which the research serves and the empowerment of collaborators involved in the co‐production process. Public Members' Contributions: Three members of the public who are public advisors in the NIHR ARC KSS were involved in the priority‐setting exercise that informed this paper. The public advisors were involved in the design of the priority‐setting exercise and supported participants' recruitment. They also co‐facilitated the focus groups during data collection and were involved in the data analysis, interpretation and preparation of the priority‐setting report. For this current manuscript, two of them are co‐authors. They provided reflections and contributed to the writing and reviewing of this manuscript. [ABSTRACT FROM AUTHOR]

Introduction: To understand when knowledge objects in a computable biomedical knowledge library are likely to be subject to regulation as a medical device in the United Kingdom. Methods: A briefing paper was circulated to a multi‐disciplinary group of 25 including regulators, lawyers and others with insights into device regulation. A 1‐day workshop was convened to discuss questions relating to our aim. A discussion paper was drafted by lead authors and circulated to other authors for their comments and contributions. Results: This article reports on those deliberations and describes how UK device regulators are likely to treat the different kinds of knowledge objects that may be stored in computable biomedical knowledge libraries. While our focus is the likely approach of UK regulators, our analogies and analysis will also be relevant to the approaches taken by regulators elsewhere. We include a table examining the implications for each of the four knowledge levels described by Boxwala in 2011 and propose an additional level. Conclusions: If a knowledge object is described as directly executable for a medical purpose to provide decision support, it will generally be in scope of UK regulation as "software as a medical device." However, if the knowledge object consists of an algorithm, a ruleset, pseudocode or some other representation that is not directly executable and whose developers make no claim that it can be used for a medical purpose, it is not likely to be subject to regulation. We expect similar reasoning to be applied by regulators in other countries. [ABSTRACT FROM AUTHOR]

The ongoing electrification of road transportation sector, which is expected to continue to strongly increase over the next years, will result in the connection of a significant number of electric vehicle (EV) chargers in LV and MV distribution networks, particularly in residential applications with on‐board ("slow") EV chargers. In order to evaluate loading limits of existing distribution networks for the maximum number of EV chargers that can be safely connected (commonly denoted as a network EV "hosting capacity", HC), this paper introduces a general approach to determine one commonly used network design parameter (after‐diversity maximum demand, ADMD) and one new parameter (maximum daily energy demand, MDED), which are both obtained from the load profiles of maximum per‐hour demands for uncontrolled residential EV charging. The presented approach uses actual EV charging data from the UK as the inputs in Monte Carlo simulations to generate daily EV charging profiles for arbitrary numbers of EVs, enabling to identify related ADMD, MDED and per‐hour maximum demand values, as well as their seasonal variations. The assessed ADMD, MDED and hourly maximum EV charging demands for uncontrolled EV charging are then combined with available UK residential daily load profiles before the EVs are connected ("pre‐EV demands"), where their combined coincidental and noncoincidental maximum demands are evaluated against the static thermal rating (STR) and dynamic thermal rating (DTR) loading limits of network components (transformers and overhead lines), taking into account relevant weather/ambient conditions. This is denoted as a network HC for uncontrolled EV charging. Finally, evaluating the resulting per‐hour maximum demand values against the STR and DTR loading limits and MDED values allows to select one particular scheduling method for controlled EV charging, which gives the absolute maximum number of EVs that can be safely connected in the considered network, that is, maximum network HC for fully controlled EV charging. The presented approach is illustrated on the example of the IEEE 33‐bus test network (modelled using typical UK network components), for the pre‐EV residential demands taken from the recordings at a UK MV substation, and for ambient data taken from a UK Met Office weather station. Obtained results allow to evaluate the range of network EV HC values for uncontrolled and controlled EV charging, that is, lower and upper HC limits, which can be correlated with the commonly used allocations of the firm and non‐firm network HC, respectively. [ABSTRACT FROM AUTHOR]

Background: Liver disease is a growing health concern and a major cause of death. It causes multiple symptoms, including financial, psychological and social issues. To address these challenges, palliative care can support people alongside active treatment, and towards the end of life, but little is known about the care experiences of individuals with liver disease in the United Kingdom. This review aimed to explore the palliative and end‐of‐life care experiences of people with liver disease in the United Kingdom. Method: A systematic review was conducted using a five‐stage process and following Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. Searches were across Web of Science, Scopus, EBSCO and grey literature until 10 May 2023. The review was registered through International Prospective Register of Systematic Reviews (PROSPERO). NVivo 12.5 was used to facilitate data analysis (systematic review registration: PROSPERO CRD42022382649). Results: Of 6035 papers (excluding duplicates) found from searches, five met the inclusion criteria of primary research related to adults with liver disease receiving palliative and/or end‐of‐life care in the United Kingdom, published in English. Reflexive thematic analysis of the data was conducted. The themes identified were the experiences of people with liver disease of relating to healthcare professionals, using services, receiving support, and experiences of information and communication. These were connected by an overarching concept of disempowerment versus empowerment, with the notion of person‐centred care as an important feature. Conclusion: This review has found variations in the care experiences of people with advanced liver disease towards the end of life and an overall lack of access to specialist palliative care services. Where services are designed to be person‐centred, experiences are more empowering. Further research is needed but with recognition that it is often unclear when care for people with liver disease is palliative or end‐of‐life. Patient and Public Contribution: An online public involvement workshop was held on 18 April 2023 through Voice (2023). This included four people with liver disease and four carers to discuss the review findings and to design a qualitative research study to further explore the topic. [ABSTRACT FROM AUTHOR]

Introduction: Disparities in the uptake of routine and COVID‐19 vaccinations have been observed in migrant populations, and attributed to issues of mistrust, access and low vaccine confidence. Participatory research approaches and behaviour change theory hold the potential for developing tailored vaccination interventions that address these complex barriers in partnership with communities and should be explored further. Methods: This study used a theory‐informed, community‐based participatory research approach to co‐design a culturally tailored behaviour change intervention aimed at increasing COVID‐19 vaccine uptake among Congolese migrants in London, United Kingdom (2021–2022). It was designed and led by a community‐academic partnership in response to unmet needs in the Congolese community as the COVID‐19 pandemic started. Barriers and facilitators to COVID‐19 vaccination, information and communication preferences, and intervention suggestions were explored through qualitative in‐depth interviews with Congolese migrants, thematically analysed, and mapped to the theoretical domains framework (TDF) and the capability, opportunity, motivation, behaviour model to identify target behaviours and strategies to include in interventions. Interventions were co‐designed and tailored in workshops involving Congolese migrants. Results: Thirty‐two Congolese adult migrants (24 (75%) women, mean 14.3 (SD: 7.5) years in the United Kingdom, mean age 52.6 (SD: 11.0) years) took part in in‐depth interviews and 16 (same sample) took part in co‐design workshops. Fourteen barriers and 10 facilitators to COVID‐19 vaccination were identified; most barrier data related to four TDF domains (beliefs about consequences; emotion; social influences and environmental context and resources), and the behavioural diagnosis concluded interventions should target improving psychological capability, reflective and automatic motivations and social opportunities. Strategies included culturally tailored behaviour change techniques based on education, persuasion, modelling, enablement and environmental restructuring, which resulted in a co‐designed intervention comprising community‐led workshops, plays and posters. Findings and interventions were disseminated through a community celebration event. Conclusions: Our study demonstrates how behavioural theory can be applied to co‐designing tailored interventions with underserved migrant communities through a participatory research paradigm to address a range of health issues and inequalities. Future research should build on this empowering approach, with the goal of developing more sensitive vaccination services and interventions which respond to migrant communities' unique cultural needs and realities. Patient or Public Contribution: Patient and public involvement (PPI) were embedded in the participatory study design and approach, with community members co‐producing all stages of the study and co‐authoring this paper. An independent PPI board (St George's Migrant Health Research Group Patient and Public Involvement Advisory Board) comprising five adult migrants with lived experience of accessing healthcare in the United Kingdom were also consulted at significant points over the course of the study. [ABSTRACT FROM AUTHOR]

Introduction: People who call emergency ambulances frequently are often vulnerable because of health and social circumstances, have unresolved problems or cannot access appropriate care. They have higher mortality rates. Case management by interdisciplinary teams can help reduce demand for emergency services and is available in some UK regions. We report results of interviews with people who use emergency ambulance services frequently to understand their experiences of calling and receiving treatment. Methods: We used a two‐stage recruitment process. A UK ambulance service identified six people who were known to them as frequently calling emergency services. Through third‐sector organisations, we also recruited nine individuals with healthcare experiences reflecting the characteristics of people who call frequently. We gained informed consent to record and transcribe all telephone interviews. We used thematic analysis to explore the results. Results: People said they make frequent calls to emergency ambulance services as a last resort when they perceive their care needs are urgent and other routes to help have failed. Those with the most complex health needs generally felt their immediate requirements were not resolved and underlying mental and physical problems led them to call again. A third of respondents were also attended to by police and were arrested for behaviour associated with their health needs. Those callers receiving case management did not know they were selected for this. Some respondents were concerned that case management could label frequent callers as troublemakers. Conclusion: People who make frequent calls to emergency ambulance services feel their health and care needs are urgent and ongoing. They cannot see alternative ways to receive help and resolve problems. Communication between health professionals and service users appears inadequate. More research is needed to understand service users' motivations and requirements to inform design and delivery of accessible and effective services. Patient or Public Contribution: People with relevant experience were involved in developing, undertaking and disseminating this research. Two public contributors helped design and deliver the study, including developing and analysing service user interviews and drafting this paper. Eight public members of a Lived Experience Advisory Panel contributed at key stages of study design, interpretation and dissemination. Two more public contributors were members of an independent Study Steering Committee. [ABSTRACT FROM AUTHOR]

Genetic research's growing importance in understanding pulmonary arterial hypertension (PAH) and developing effective treatments prompted the RAPID‐PAH study. This study sought feedback from stakeholders who participated in two genomic studies to enhance genetic study delivery and clinical integration. Stakeholders from nine UK PH centres, representing various roles, ages, genders, and mutation statuses, took part in 53 semi‐structured interviews and focus groups. Transcripts were thematically coded using inductive analysis. Clustering analysis was conducted to identify patient groups that shared attitudes. In this paper, we focus on patients', carers', and relatives' perspectives. The key interview themes revealed insights into participants' attitudes toward genetic research and testing more generally, expertise and knowledge of the disease itself, motivations and barriers to participating in genetic research, awareness of and interest in consent procedures and the use of personal and genetic data, as well as the process of communicating individual genetic results. Factors influencing genetic research participation included altruistic motives, personal diagnostic experiences, and family‐related hopes. Clustering analysis produced distinct clusters based on the presence of barriers and motivators for research participation; however, hardly any patients shared identical sets of attitudes, emphasising the need for personalised approaches to recruitment. Most patients reported poor engagement with study‐related materials. Patients who received individual genetic results expressed satisfaction with the process, whereas those who did not were disappointed with the lack of feedback. Reflecting on patient perspectives, we offer recommendations to improve the genetic study delivery process. Enhancing genetic research integration into clinical practice requires tailored engagement, clear communication, and support from healthcare stakeholders. [ABSTRACT FROM AUTHOR]

This paper describes a new seamless blended multi‐model ensemble configuration of an existing probabilistic medium‐ to extended‐range weather pattern forecasting tool (called Decider) run operationally at the Met Office. In its initial configuration, the tool calculated and presented probabilistic weather pattern forecast information for five individual ensemble forecasting systems, which varied in terms of their number of ensemble members, horizontal resolution, update frequencies and forecast lead time. This resulted in multiple forecasts for the same validity time which varied in terms of forecast skill depending on the lead time in question. This presented challenges for end‐users (e.g., operational meteorologists) in terms of knowing which forecast output is best to use and at which lead time, as well as knowing what to do in situations where forecasts varied between ensembles. To get around these challenges, a new seamless blended multi‐model ensemble configuration has been implemented operationally, comprising of output from five separate ensembles, and provides a single best forecast from day one out to day 45. Objective verification for a set of eight weather pattern groups covering forecasts initialized over a 6‐year period (2017–2022) shows that the seamless blended multi‐model ensemble forecasts are at least as good as, if not better than the best performing individual model. [ABSTRACT FROM AUTHOR]

Extreme high temperatures are associated with increased incidences of rail buckles. Climate change is predicted to alter the temperature profile in the United Kingdom with extreme high temperatures becoming an increasingly frequent occurrence. The result is that the number of buckles, and therefore delays, expected peryear will increase if the track is maintained to the current standard. This paper uses a combination of analogue techniques and a weather generator to quantify the increase in the number of buckles and rail related delays in the southeast of the United Kingdom. The paper concludes by assigning a cost to the resultant rise in delays and damage before making recommendations on how these effects can be mitigated. Copyright © 2008 Royal Meteorological Society [ABSTRACT FROM AUTHOR]

National censuses are expensive. They are conducted infrequently. They collect information that some feel infringes their human rights, and people are required by law to complete them. The outputs are not perfect, and in some situations may be misleading. Some suggest that censuses hark back to a period when regularly collected administrative data were not available. These are some of the views held about national censuses. Why, then, would others argue that they are an essential resource? In this paper, we consider some of the pros and cons of conducting national censuses, before introducing a series of papers that draw on early data available from the 2001 UK census. We argue that these papers, and the wealth of research that will be conducted in the future with 2001 census data, make a strong case for supporting the compulsory collection of personal information about the ‘entire’ population every ten years. [ABSTRACT FROM AUTHOR]

Examines the role and purpose ascribed to company law under the British government's White Paper 'Modernising Company Law.' British government's attitude towards corporate activity; Overview of the British Department of Trade and Industry Review, which provided for the White Paper's recommendations; Governments' perception of its role in regulating companies, their directors, shareholders and those affected by corporate activity.

Objectives: Established in March 2020, the C19PRC Study monitors the psychological and socio‐economic impact of the pandemic in the UK and other countries. This paper describes the protocol for Wave 6 (August–September 2021). Methods: The survey assessed: COVID‐19 related experiences; experiences of common mental health disorders; psychological characteristics; and social and political attitudes. Adult participants from any previous wave (N = 3170) were re‐invited, and sample replenishment procedures helped manage attrition. Weights were calculated using a survey raking algorithm to ensure the on‐going original panel (from baseline) was nationally representative in terms of gender, age, and household income, amongst other factors. Results: 1643 adults were re‐interviewed at Wave 6 (51.8% retention rate). Non‐participation was higher younger adults, those born outside UK, and adults living in cities. Of the adults recruited at baseline, 54.3% (N = 1100) participated in Wave 6. New respondent (N = 415) entered the panel at this wave, resulting in cross‐sectional sample for Wave 6 of 2058 adults. The raking procedure re‐balanced the longitudinal panel to within 1.3% of population estimates for selected socio‐demographic characteristics. Conclusions: This paper outlines the growing strength of the publicly available C19PRC Study data for COVID‐19‐related interdisciplinary research. [ABSTRACT FROM AUTHOR]

Introduction: Co‐production with communities is increasingly seen as best practice that can improve the quality, relevance and effectiveness of research and service delivery. Despite this promising position, there remains uncertainty around definitions of co‐production and how to operationalize it. The current paper describes the development of a co‐production strategy to guide the work of the ActEarly multistakeholder preventative research programme to improve children's health in Bradford and Tower Hamlets, UK. Methods: The strategy used Appreciative Inquiry (AI), an approach following a five‐step iterative process: to define (Step 1) scope and guide progress; to discover (Step 2) key issues through seven focus groups (N = 36) and eight in‐depth interviews with key stakeholders representing community groups, and the voluntary and statutory sectors; to dream (Step 3) best practice through two workshops with AI participants to review findings; to design (Step 4) a co‐production strategy building on AI findings and to deliver (Step 5) the practical guidance in the strategy. Results: Nine principles for how to do co‐production well were identified: power should be shared; embrace a wide range of perspectives and skills; respect and value the lived experience; benefits should be for all involved parties; go to communities and do not expect them to come to you; work flexibly; avoid jargon and ensure availability of the right information; relationships should be built for the long‐term; co‐production activities should be adequately resourced. These principles were based on three underlying values of equality, reciprocity and agency. Conclusion: The empirical insights of the paper highlight the crucial importance of adequate resources and infrastructure to deliver effective co‐production. This documentation of one approach to operationalizing co‐production serves to avert any misappropriations of the term 'co‐production' by listening to service users, stakeholders and other relevant groups, to develop trust and long‐term relationships, and build on the learning that already exists amongst such groups. Patient or Public Contribution: The work was overseen by a steering group (N = 17) of individuals, both professional and members of the public with experience in undertaking co‐production, and/or with some knowledge of the context of the two ActEarly field sites, who provided regular oversight and feedback on the AI process. [ABSTRACT FROM AUTHOR]

Reserve power systems are widely used to provide power to critical infrastructure systems in the event of power outages. The reserve power system may be subject to regulation, typically focussing on a strict operational time commitment, but the energy involved in supplying reserve power may be highly variable. For example, if heating or cooling is involved, energy consumption may be strongly influenced by prevailing weather conditions and seasonality. Replacing legacy assets (often diesel generators) with modern technologies could offer potential benefits and services back to the wider electricity system when not in use, therefore supporting a transition to low‐carbon energy networks. Drawing on the Great Britain telecommunications systems as an example, this paper demonstrates that meteorological reanalyses can be used to evaluate capacity requirements to maintain the regulated target of 5‐days operational reserve. Across three case‐study regions with diverse weather sensitivities, infrastructure with cooling‐driven electricity demand is shown to increase energy consumption during summer, thus determining the overall capacity of the reserve required and the availability of 'surplus' capacity. Lower risk tolerance is shown to lead to a substantial cost increase in terms of capacity required but also enhanced opportunities for surplus capacity. The use of meteorological forecast information is shown to facilitate increased surplus capacity. Availability of surplus capacity is compared to a measure of supply–stress (demand‐net‐wind) on the wider energy network. For infrastructure with cooling‐driven demand (typical of most UK telecommunication assets), it is shown that surplus availability peaks during periods of supply–stress, offering the greatest potential benefit to the national electricity grid. [ABSTRACT FROM AUTHOR]

This paper involves an examination of skilled manual work in the modern paper industry. The data were collected at five mills in three countries -- the UK, Australia and the USA. The questions were formulated in order to probe four theories of skilled work. The results suggest that the distinction between skilled and nonskilled work is a fundamental feature of occupational differentiation in all five plants. They also reveal that there are intra-skilled conflicts over relative pay and demarcation lines and that these are affected by the wider socio-political environment. [ABSTRACT FROM AUTHOR]

Studies the concept of urban politics and local governance in Great Britain. Representation of neoliberals and regulation theorists; Dominance of regulation theory-framed analyses of local governance; Extreme forms of policy design and intervention.

Continuous geomagnetic records of the strength and direction of the Earth's field at the surface extend back to the 1840s. Over the past two centuries, eight observatories have existed in the United Kingdom, which measured the daily field variations using light-sensitive photographic paper to produce analogue magnetograms. Around 350,000 magnetograms have been digitally photographed at high resolution. However, converting the traces to digital values is difficult and time consuming as the magnetograms can have over-lapping lines, low quality recordings and obscure metadata for conversion to SI units. We discuss our approach to digitizing the traces from large geomagnetic storms and highlight some of the issues to be aware of when capturing magnetic information from analogue measurements. These include cross-checking the final digitized values with the recorded hourly mean values from observatory year books and comparing several observatory records for the same storm to catch errors such as sign inversions or incorrect 'wrap-around' of data on the paper records. [ABSTRACT FROM AUTHOR]

The article presents a discursive analysis of Great Britain's Conservative Party 2011 Green Paper "One World Conservatism: A Conservative agenda for international development." It offers a comparison of the conception of development in that paper with the 1997 Labour Party White Paper which launched the development of the Department for International Development (DFID). The discourse used to describe Britain's role in promoting global development and reducing poverty is examined.

As global surface temperatures continue to rise, both the duration and the intensity of heat waves across most land areas are expected to increase. The 2022 European summer broke a number of temperature records where a new record daily maximum temperature of 40.3°C was reached on 19th July making it the hottest July heat wave event in the UK. This paper aims to detect and analyse historical heat wave events, particularly prior to 1927 and compare these with recent events, particularly, 2022, which featured four summer heat wave events in the UK. This allows us to understand how noteworthy historical extremes are in comparison to those in recent decades, to place modern events into historical context, and to extend the sample of extreme events. Summer heat wave events have been detected between 1878 and 2022 from long station data in the UK. Heat wave extent, duration, and intensity have been analysed to compare past heat waves to the recent 2022 heat waves. For each of the summer months at least one of the top 10 most intense events between 1878 and 2022 occurred in the earliest third of the dataset (before 1927) emphasising the value of analysing early heat events. In all detected events, the anomalous UK heat was part of large‐scale European extreme heat when examining 20th‐century reanalysis data, associated with a high‐pressure system. The 2022 July event resembles in pattern of warming and circulation some earlier events, for example, in 1925. While there is a clear trend in the monthly data and the overall frequency of anomalously hot days, heat wave activity on daily scales even in the period 1878 and 1926 is considerable and in some cases comparable to modern heat wave events in the UK. The most intense events detected led to societal impacts based on UK newspaper articles from the period including impacts on the agricultural sector, health impacts, and travel disruptions, broadly comparable to impacts from recent events. [ABSTRACT FROM AUTHOR]

Nowadays, the load monitoring system is an important element in smart buildings to reduce energy consumption. Nonintrusive load monitoring (NILM) is utilized to determine the power consumption of each appliance in smart homes. The main problem of NILM is how to separate each appliance's power from the signal of aggregated consumption. In this regard, this paper presents a combination between particle swarm optimization (PSO) and artificial neural networks (ANNs) to identify electrical appliances for demand‐side management. ANN is applied in NILM as a load identification task, and PSO is used to train the ANN algorithm. This combination enhances the NILM technique's accuracy, which is further verified by experiments on different datasets like Reference Energy Disaggregation Dataset, UK Domestic Appliance‐Level ElectricityUK‐DALE, and Indian data for Ambient Water and electricity Sensing. The high accuracy of the proposed algorithm is verified by comparisons with state of the art methods. Compared with other approaches, the total mean absolute error has decreased from 39.3566 to 18.607. Also, the normalized root mean square error (NRMSE) method has been used to compare the measured and predicted results. The NRMSE is in the range of 1.719%–16.514%, which means perfect consistency. This demonstrates the effectiveness of the proposed approach for home energy management. Furthermore, customer behavior has been studied, considering energy costs during day hours. [ABSTRACT FROM AUTHOR]

Millions of sub‐daily sea‐level pressure observations taken between 1919 and 1960 over the British and Irish Isles were transcribed from paper records in the early 2000s but were not published and subsequently forgotten. A chance discussion led to the rediscovery of the transcribed data and 5.47 million observations from 160 locations are now made available, although the data have not been fully quality‐controlled. Much of the data are 3‐hourly, allowing for detailed examinations of synoptic weather variations for this region and time period, and will be invaluable for constraining future reanalyses. We illustrate the value of the data using a stormy period during October and November 1928 and discuss the remaining quality‐control issues. [ABSTRACT FROM AUTHOR]

Objectives: The COVID‐19 Psychological Research Consortium (C19PRC) Study was established in March 2020 to monitor the psychological and socio‐economic impact of the pandemic in the UK and other countries. This paper describes the protocol for Wave 5 (March–April 2021). Methods: The survey assessed: COVID‐19 related experiences; experiences of common mental health disorders; psychological characteristics; and social and political attitudes. Adults who participated in any previous wave (N = 4949) were re‐invited to participate. Weights were calculated using a survey raking algorithm to ensure the longitudinal panel was nationally representative in terms of gender, age, and household income, amongst other factors. Results: Overall, 2520 adults participated. A total of 2377 adults who participated in the previous survey wave (November–December 2020) were re‐interviewed at Wave 5 (61.5% retention rate). Attrition between these two waves was predicted by younger age, lower household income, children living in the household, and treatment for mental health difficulties. Of the adults recruited into the C19PRC study at baseline, 57.4% (N = 1162) participated in Wave 5. The raking procedure re‐balanced the longitudinal panel to within 1.5% of population estimates for selected socio‐demographic characteristics. Conclusion: This paper outlines the growing strength of the publicly available C19PRC Study data for COVID‐19‐related interdisciplinary research. [ABSTRACT FROM AUTHOR]

The UK net‐zero target requires the integration of significant renewable energy resources into the electrical grid. This, together with the projected growth in electricity demand imposes practical challenges on the power transfer capability of existing transmission feeders. For environmental and planning reasons, construction of new overhead lines is problematic, and where possible upgrading of existing substations and lines is preferred. This paper investigates the feasibility of transforming an existing three‐phase (3Φ) double‐circuit 400 kV line into a six‐phase (6Φ) feeder for a simulated future GB scenario. Results indicate a 6Φ feeder, operating at a 'phase‐adjacent phase' voltage of 400 kV can effectively solve the constraints of boundaries in transmission networks. When considering the various operating contingencies, associated with an important UK network boundary and its expected near‐future winter‐peak power transfer requirements, the thermal overload issues are mitigated by transforming a feeder from 3Φ to 6Φ. The paper demonstrates upgrading to 6Φ technology is a potential solution to certain future boundary constraints and in these cases avoids the need to build new underground or overhead AC/DC lines. [ABSTRACT FROM AUTHOR]

An evolving green agenda as the UK seeks to achieve 'net zero' in greenhouse gas emissions by 2050, coupled with our new trading relationship with the European Union, is resulting in new government policies, which will be disruptive to Britain's traditional food and farming practices. These policies encourage sustainable farming and land‐sparing to restore natural habitats and will provide an opportunity to address issues such as high emissions of GHGs and dwindling biodiversity resulting from many intensive agricultural practices. To address these and other food challenges such as global conflicts and health issues, Britain will need a revolution in its food system. The aim of this paper is to make the case for such a food revolution where additional healthy food for the UK population is produced in‐country in specialised production units for fruits and vegetables developed on sites previously considered unsuitable for crop production. High crop productivity can be achieved in low‐cost controlled environments, making extensive use of novel crop science and modern controlled‐environment technology. Such systems must be operated with very limited environmental impact. In recent years, growth in the application of plasticulture in UK horticulture has driven some increases in crop yield, quality and value. However, the environmental cost of plastic production and plastic pollution is regarded as a generational challenge that faces the earth system complex. The distribution of plastic waste is ubiquitous, with a significant pollution load arising from a range of agricultural practices. The primary receptor of agriplastic pollution is agricultural soil. Impacts of microplastics on crop productivity and quality and also on human health are only now being investigated. This paper explores the possibility that we can mitigate the adverse environmental effects of agriplastics and thereby exploit the potential of plasticulture to enhance the productivity and positive health impact of UK horticulture. [ABSTRACT FROM AUTHOR]

Introduction: A range of nonpharmaceutical public health interventions has been introduced in many countries following the rapid spread of Covid‐19 since 2020, including recommendations or mandates for the use of face masks or coverings in the community. While the effectiveness of face masks in reducing Covid‐19 transmission has been extensively discussed, scant attention has been paid to the lived experience of those wearing face masks. Method: Drawing on 40 narrative interviews with a purposive sample of people in the United Kingdom, with a particular focus on marginalised and minoritized groups, our paper explores experiences of face mask use during the pandemic. Results: We find that face masks have a range of societal, health and safety impacts, and prompted positive and negative emotional responses for users. We map our findings onto Lorenc and Oliver's framework for intervention risks. We suggest that qualitative data offer particular insights into the experiences of public health interventions, allowing the potential downsides and risks of interventions to be more fully considered and informing public health policies that might avoid inadvertent harm, particularly towards marginalised groups. Patient or Public Contribution: The study primarily involved members of the public in the conduct of the research, namely through participation in interviews (email and telephone). The conception for the study involved extensive discussions on social media with a range of people, and we received input and ideas from presentations we delivered on the preliminary analysis. [ABSTRACT FROM AUTHOR]

Introduction: An admission to a mental health ward is an uncertain and unexpected part of a person's journey with dementia and consequently, families require information about what to expect and how to prepare. This study aimed to establish the information needs of people with dementia and their families at the point of admission to a mental health ward and to collate existing ward information leaflets to explore if they meet these information needs. Methods: This research was conducted in two parts: (1) a qualitative study using focus groups, one with people with dementia and family carers with lived experience of such an admission (n = 6), and another with Admiral Nurses (n = 6) to explore information needs at the point of admission. (2) Each National Health Service (NHS) mental health trust (n = 67) was asked to provide a copy of their ward information shared at admission. A total of 30 leaflets were received from 15 NHS trusts; after removing duplicates, 22 were included. A content analysis was conducted to evaluate to what extent leaflets met the information needs identified by focus groups. Results: Two main categories 'honest, accurate and up‐to‐date information' and 'who is the information for' and four subcategories were derived from focus group data. Participants felt that people with dementia and their families were likely to have different information needs. Material for people with dementia needed to be in an accessible format. Information should cover the aim of the admission, a timeline of what to expect and details about how families will be involved in care. Practical information about what to pack and ward facilities was valued. Participants spoke about the need to consider the tone of the information, given that people are likely to be distressed. The information leaflets reviewed did not meet the information needs identified by focus group participants. Conclusions: People with dementia and family carers have different information needs at the point of admission to a mental health ward. Information provided to people with dementia needs to be in an accessible format with content relevant to these needs. Wards should aim to co‐create information to ensure that they meet people's information needs. Patient or Public Contribution: This research was supported by a patient and public involvement (PPI) group of people with dementia and carers who have experience in mental health wards. The idea for the study came from the group and was motivated by their experiences. The PPI group helped with the design of the study and took part in the focus groups. The information generated has been written up in this paper, and the knowledge generated has also been used to co‐create a guide for wards on writing their information leaflets and to support the co‐creation of a public information leaflet by Dementia UK about mental health admissions for people with dementia. [ABSTRACT FROM AUTHOR]

Aims: The Care Home Independent Pharmacist Prescriber Study (CHIPPS) process evaluation hypothesized that contextual factors influenced the likelihood of deprescribing by pharmacist-independent prescribers. The aim of this paper is to test this hypothesis. Methods: From CHIPPS study data, medications deprescribed totalled 284 for 370 residents in UK care homes. Regression analysis was used to describe the relationship between the number of medicines stopped and contextual factors (number of residents cared for, pharmacist employment within associated medical practice, previous care home experience, hours active within trial, years’ experience as a pharmacist and as a prescriber). Results: Number of residents and pharmacist-independent prescriber employment within a medical practice were positive predictors of deprescribing. Conclusion: Previous experiences were not related to deprescribing likelihood. Increasing the number of residents increases the opportunity for deprescribing and therefore this relationship is intuitive. The location within a medical practice is an interesting finding that requires further exploration to understand its exact nature. [ABSTRACT FROM AUTHOR]

Recovering additional historical weather observations from known archival sources will improve the understanding of how the climate is changing and enable detailed examination of unusual events within the historical record. The UK National Meteorological Archive recently scanned more than 66,000 paper sheets containing 5.28 million hand‐written monthly rainfall observations taken across the UK and Ireland between 1677 and 1960. Only a small fraction of these observations were previously digitally available for climate scientists to analyse. More than 16,000 volunteer citizen scientists completed the transcription of these sheets of observations during early 2020 using the RainfallRescue.org website, built using the Zooniverse platform. A total of 3.34 million observations from more than 6000 locations have so far been quality controlled and made openly available. This has increased the total number of monthly rainfall observations that are available for this time period and region by a factor of six. The newly rescued observations will enable longer and much improved reconstructions of past variations in rainfall across the British and Irish Isles, including for periods of significant flooding and drought. Specifically, this data should allow the official gridded monthly rainfall reconstructions for the UK to be extended back to 1836, and even earlier for some regions. [ABSTRACT FROM AUTHOR]

Introduction: Kidney dysfunction is a highly significant disease, both in the United Kingdom and globally. Many previous studies have reported associations between human leukocyte antigens (HLA) and renal function; this systematic review attempts to identify, summarize and appraise all published studies of these associations. Methods: A literature search was performed using Medline, Embase and Cochrane Central Register of Controlled Trials to identify papers whose keywords included each of the following concepts: HLA, renal failure and genetic association. A total of 245 papers were identified and assessed for eligibility; 35 of these were included in the final study. Results: A total of 95 HLA types and 14 three‐locus haplotypes were reported to be associated with either increased or decreased renal function. A number of these findings were replicated by independent studies that reported 16 types were protective against renal dysfunction and 15 types were associated with reduced renal function. A total of 20 HLA types were associated with both increased risk of renal disease and decreased risk by independent studies. Discussion: There is very little consensus on which HLA types have a protective or deleterious effect on renal function. Ethnicity may play a role, with HLA types possibly having different effects among different populations, and it is possible that the different primary diseases that lead to ESRD may have different HLA associations. Some of the studies may contain type I and type II errors caused by insufficient sample sizes, cohort selection and statistical methods. Although we have compiled a comprehensive list of published associations between renal function and HLA, in many cases, it is unclear which associations are reliable. Further studies are required to confirm or refute these findings. [ABSTRACT FROM AUTHOR]

Research on women's experiences of infant feeding and related moral discourse suggests that self‐conscious emotions may be highly relevant to breastfeeding support interactions. However, the emotional impact of receiving support has not been fully explored. The aim of this review is to re‐examine qualitative UK research on receiving breastfeeding support, in order to explore the role of self‐conscious emotions and related appraisals in interactions with professional and peer supporters. From 2007 to 2020, 34 studies met criteria for inclusion. Using template analysis to identify findings relevant to self‐conscious emotions, we focused on shame, guilt, embarrassment, humiliation and pride. Because of cultural aversion to direct discussion of self‐conscious emotions, the template also identified thoughts about self‐evaluation, perceptions of judgement and sense of exposure. Self‐conscious emotions were explicitly mentioned in 25 papers, and related concerns were noted in all papers. Through thematic synthesis, three themes were identified, which suggested that (i) breastfeeding 'support' could present challenges to mothering identity and hence to emotional well‐being; (ii) many women managed interactions in order to avoid or minimise uncomfortable self‐conscious emotions; and (iii) those providing support for breastfeeding could facilitate women's emotion work by validating their mothering, or undermine this by invalidation, contributing to feelings of embarrassment, guilt or humiliation. Those supporting breastfeeding need good emotional 'antennae' if they are to ensure they also support transition to motherhood. This is the first study explicitly examining self‐conscious emotions in breastfeeding support, and further research is needed to explore the emotional nuances of women's interactions with supporters. [ABSTRACT FROM AUTHOR]

Extreme weather events can cause significant damage to power distribution network infrastructure, often resulting in power outages. Distribution Network Operators (DNOs) are faced with the challenging task of responding to these outages in real time while maintaining a resilient grid. Our paper presents an innovative approach to alert operators about the potential risk associated with upcoming extreme weather through a normalized fragility curve. The uniqueness of the curve is the ability to capture regional differences across a DNO's territory while presenting operators with a means of setting unified risk thresholds. This can support a proactive response and allow the staging of necessary resources to minimize the threat posed by such events. Our approach captures the changes in failure probability associated with differing wind regimes and demonstrates the benefit of sub‐regional meteorological information. The proposed approach is demonstrated for wind events using 20 years of historical fault records from a DNO in the United Kingdom (UK). While its efficacy is demonstrated for windstorms in the UK, the approach could be applied globally to develop normalized fragility curves for other types of seasonal extreme weather events such as snowstorms, hurricanes, or linked hazards such as wildfires. The approach can also facilitate an understanding of how infrastructure may operate under future climate conditions, supporting proactive adaptation. [ABSTRACT FROM AUTHOR]

In this paper, I will share findings from a qualitative study that offers a thematic analysis of 76 interviews with Muslim patients and families as well as doctors, nurses, allied health professionals, chaplains and community faith leaders across the United Kingdom. The data show that for many Muslims, Islam—its texts and lived practice—is of central importance when they are deliberating about death and dying. Central to these deliberations are virtues rooted within Islamic theology and ethics, the traditions of adab (virtue) and aqhlaq (proper conduct). Themes analysed include theological and moral understandings around the virtues of hope and acceptance. The study provides an analysis of these themes in relation to the experiences of Muslim patients and families arriving at meaning making around death and dying and how this interfaces with their interaction with biomedicine and healthcare. The study shows that the juxtaposition of different values and moral frameworks require careful negotiation when Muslim patients and families encounter the healthcare system. The study also describes how healthcare professionals and staff of other faiths and no faith encounter Muslim beliefs and practices, and the challenges they face in interpreting virtues and values rooted in faith, especially when these are perceived to be mutually opposed or inconsistent. [ABSTRACT FROM AUTHOR]

Despite seven decades of development of the European Union project, on 23 June 2016, the United Kingdom, Europe and the rest of the world were surprised when the Leave campaign won the Brexit referendum, offering an extraordinary case study for researchers. We spatially disaggregate the vote share data, which allows us to explore where anti‐European sentiment took root in the UK and why. In this paper, a spatial dependence model is applied to clarify and quantify the relevance of the different dimensions—demographic, cultural/educational and economic—that play a role in explaining the rise of support for the Leave campaign. The analysis is conducted at the local level, using local authorities (LAs) as the spatial unit of analysis due to the combination of official datasets with newly generated data in the context of an EU H2020 project. A new indicator capturing the affluence of each local area relative to its close neighbours is proposed and included in the model. In general, we observe that most of the main conclusions obtained by large regions or at the national level also hold at the local scale. However, it is particularly interesting that inequalities by LAs are clearly significant, indicating a marked influence on voters' decisions that have thus far been unaccounted for. This result provides further support for the existence of, to use Andrés Rodriguez‐Pose's terminology, an even more intense "revenge of the places that do not matter" at the local scale. [ABSTRACT FROM AUTHOR]

Introduction: A person‐centred model of care, developed in the early days of the HIV epidemic when there were no effective treatments for HIV, led to relatively close relationships between carers and people living with HIV (PLWH). Our study examines the experiences of carers using a relational framework, exploring the traumas and challenges involved, coping practices instigated by carers and the emergence of 'relational traumatic growth' opportunities. Methods: Twenty‐two UK healthcare workers and charity volunteers working with PLWH from the early years of the epidemic were recruited. Semistructured interviews were used to elicit participants' own stories of working with PLWH, from their initial involvement to the present time, and their reflections on the personal impact of working in the field of HIV. Data were analysed using a thematic approach employing relational categories. Results: The impact of care was related to the formation of close relationships, identification with PLWH, high numbers of deaths and the difficulties and challenges encountered relationally. Participants described attempts to cope through informal and formal support, as well as endeavours to manage professional boundaries. Various ways of making sense of experiences were described, ranging from denial to abandoning the HIV field, to intense commitment. For some, traumatic experiences lead to validation, a search for personal meaning and managing the sense of loss with an exploration of further ventures, contributing to the achievement of relational traumatic growth. Conclusion: The intensity of relationships in HIV work, developed through the emotional and practical work of caring for PLWH, led healthcare workers and volunteers to experience a range of psychological consequences, both negative (including distress and emotional exhaustion) and also positive (such as acquiring a sense of purpose). Patient or Public Contribution: People living with HIV and those working with them were involved in the initial study conceptualization and design. The second and fourth authors of this paper were professionals working in HIV throughout the pandemic and have led on all aspects of the study. People living with HIV and those working with them additionally guided participant selection by suggesting participants and supporting recruitment. Narrative transcripts were checked and amended (if necessary) by participants. Initial findings were presented at the AIDS impact conference, where PLWH and those working with them attended and feedback on important ideas that helped to prioritize and shape the study findings. [ABSTRACT FROM AUTHOR]

The COVID‐19 health crisis has imposed extensive shocks to many global systems, particularly the UK food production chains, further challenging Eurocentric development discourses and stereotypes. Thus, this paper investigates how the pandemic has challenged the UK's development status by analysing how the pandemic has impacted the country's food industry. A literature review was conducted and used to identify, select and critically appraise publications between 2000 and 2021 discussing the challenges in the UK food system. The findings reveal that the UK's food industry is unsustainable as there are significant flaws in the system, that is food insecurity and food waste that go unaddressed. The impact of the pandemic has exacerbated the social and economic impacts of operating with such a system. Compounded with the geopolitical adjustments caused by Brexit, the UK is faced with the challenge of restructuring and developing new frameworks such as policies, regulations, schemes and partnerships to support the food industry's sustainability. Lastly, the findings reinforce that 'developed' and 'developing' nations encounter similar food challenges, which manifest differently in various landscapes and contexts. Therefore, the world (not just the UK) needs to shift away from Eurocentrism, moving towards a universal but equally personalised development outlook. This review provides an outline of the major problem areas in the UK food system and presents potential solutions aimed at helping guide the government's decision‐making process. [ABSTRACT FROM AUTHOR]

Background: Migrant and ethnic inequalities in maternal and perinatal mortality persist across high‐income countries. Addressing social adversity and inequities across the childbirth trajectory cannot be left to chance and the good intentions of practitioners. Robust, evidence‐based tools designed to address inequity by enhancing both the quality of provision and the experience of care are needed. Methods: An inductive modelling approach was used to develop a new evidence‐based conceptual model of woman–midwife relationships, drawing on data from an ethnographic study of relationships between migrant Pakistani women and midwives, conducted between 2013 and 2016 in South Wales, UK. Key analytic themes from early data were translated into social–ecological concepts, and a model was developed to represent how these key themes interacted to influence the woman–midwife relationship. Results: Three key concepts influencing the woman–midwife relationship were developed from the three major themes of the underpinning research: (1) Healthcare System; (2) Culture and Religion; and (3) Family Relationships. Two additional weaving concepts appeared to act as a link between these three key concepts: (1) Authoritative Knowledge and (2) Communication of Information. Social and political factors were also considered as contextual factors within the model. A visual representation of this model was developed and presented. Conclusions: The model presented in this paper, along with future work to further test and refine it in other contexts, has the potential to impact on inequalities by facilitating future discussion on cultural issues, encouraging collaborative learning and knowledge production and providing a framework for future global midwifery practice, education and research. Patient or Public Contribution: At the outset of the underpinning research, a project involvement group was created to contribute to study design and conduct. This group consisted of the three authors, an Advocacy Officer at Race Equality First and an NHS Consultant Midwife. This group met regularly throughout the research process, and members were involved in discussions regarding ethical/cultural/social issues, recruitment methods, the creation of participant information materials, interpretation of data and the dissemination strategy. Ideas for the underpinning research were also discussed with members of the Pakistani community during community events and at meetings with staff from minority ethnic and migrant support charities (BAWSO, Race Equality First, The Mentor Ring). Local midwives contributed to study design through conversations during informal observations of antenatal appointments for asylum seekers and refugees. [ABSTRACT FROM AUTHOR]

Objectives: The COVID‐19 Psychological Research Consortium (C19PRC) Study aims to assess the impact of the COVID‐19 pandemic in the adult population in multiple countries. This paper describes the third wave of the UK survey (the 'parent' strand of the Consortium) during July‐August 2020. Methods: Adults (N = 2025) who participated in the baseline and/or first follow‐up surveys were reinvited to participate in this survey, which assessed: (1) COVID‐19 related knowledge, attitudes, and behaviours; (2) the occurrence of common mental disorders; as well as the role of (3) psychological factors and (4) social and political attitudes, in influencing the public's response to the pandemic. Weights were calculated using a survey raking algorithm to ensure that the cross‐sectional sample is nationally representative in terms of gender, age, and household income, and representative of the baseline sample characteristics for household composition, ethnicity, urbanicity and born/raised in UK. Results: 1166 adults (57.6% of baseline participants) provided full interviews at Wave 3. The raking procedure successfully re‐balanced the cross‐sectional sample to within 1% of population estimates across selected socio‐demographic characteristics. Conclusion: This paper demonstrates the strength of the C19PRC Study data to facilitate and stimulate interdisciplinary research addressing important public health questions relating to the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Background: In Britain's National Health Service (NHS), medical consumerism is disliked by many doctors but managed by NHS leaders. Managed consumers have choices about treatment options, but are expected to help contain costs, improve quality of care, take part in clinical research and advocacy, and increase productivity. There are so many meanings for medical consumerism that it can be categorized, in post‐structuralist terms, as a 'symbol without meaning', but meanings are plentiful in the NHS. Policy expectations: Choices made by discriminating consumers were expected to improve the quality of medical care for all. Extending choice to the many, and not restricting options to the few, would allow gains from choices to accumulate, so that choice would sustain social solidarity. Managed consumerism would in theory, therefore, instil reasonable choices and responsible behaviours in a moralized citizenry, across the nation. The advocates of New Labour's espousal of medical consumerism expected the accumulative effects of customer choices to challenge professional and occupational power, erode the medical model of health and illness, constrain professional judgements, and open the NHS to new ways of working. Almost all their expectations have been thwarted, so far. Conclusions: Managed consumerism is far from being a meaningless symbol. This discussion paper explores the territory of managed consumerism and suggests realistic ways to make it more effective in shaping the NHS. Patient & Public Contribution: We developed the arguments in this discussion paper with insights provided by a lay expert (see Acknowledgements) with experience of consumerism in both public sector management and a disease‐related charity. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to examine the cooccurrence of heightened media attention after the publication of a paper by Skovlund et al in September 2016 on the link between hormonal contraception and depression or mood on adverse drug reaction (ADR) reports in the UK. Methods: A quantitative analysis of relevant newspaper articles published between January 2014 and December 2017 was performed, as well as a content analysis. ADR reports were collected from the Medicines and Healthcare Products Regulatory Agency website and via a Freedom of Information request. A quantitative analysis was performed on ADR reports of hormonal contraceptives for all ADRs and for depressed mood disorders and disturbances. Results: The publication of the Skovlund et al paper did not lead to a peak in relevant newspaper articles, but there was a change in the content of the newspaper articles, which focussed more on the link between hormonal contraceptives and depression or mood. There was an overall increase in ADR reports by women relating to hormonal contraceptives between 2016 and 2017, and for combined contraceptives this was due to an increase in ADR reports of depressed mood disorders and disturbances. Conclusions: The content of media attention appears to affect ADR reporting by women for combined contraceptives. In general, patients report the majority of depressed mood disorders and disturbances ADRs as opposed to health professionals, who report other ADRs. Care providers can anticipate the effect of heightened media attention and help patients when they experience these ADRs. [ABSTRACT FROM AUTHOR]

Societal Impact Statement: The contentious debate over genetically modified (GM) crops in Britain has entered a new era following Brexit and the development of gene editing. At the same time, the events of the 1980s and 1990s are now entering historical archives, including the GM Archive at the Science Museum in London. This article explores how fears of unnaturalness and arguments from historical continuity informed the British GM controversy. It also analyses the limitations of these modern archives. The concerns surrounding the naturalness and continuity of biotechnology have recently been resurrected following suggestions that gene editing will be employed in plant breeding. Summary: This research examines the introduction of genetically modified (GM) crops to Britain, including the backlash from environmentalist groups and the public that led to a de facto government moratorium on their commercialisation in 1998.Harnessing archival materials from the Science Museum's GM Archive, this paper shows that GM was viewed as an alien or unnatural technology in Britain, while campaigns from Monsanto and scientific supporters of GM attempted to show how recombinant DNA technology was simply the latest step in a long history of plant breeding.By moving outside the archive, it becomes clear that the creation of this narrative from continuity was a standard industry strategy. Appeals to the history of plant breeding was a strategy adopted by Monsanto well before the British GM controversy, while twentieth‐century food scares had already undermined public trust in government and industry.Public concern over the naturalness of biotechnology remains. Meanwhile, contemporary advocates of gene editing have begun to make similar arguments to those deployed in the 1990s, highlighting the similarity of gene editing to natural variation and selection. [ABSTRACT FROM AUTHOR]

Future energy scenarios include both green and blue hydrogen, as both are needed to scale up decarbonized energy supply. A transition to renewable energy is predicted over time, but the urgency we are facing cannot be met by renewable energy alone. For blue hydrogen production, the overall greenhouse gas (GHG) emissions are primarily affected by emissions from natural gas production, processing, and transport (CO2 and methane), as well as process efficiency and carbon capture ratio. Few complete and updated analyses are available that cover the entire blue hydrogen value chain with the best available technology for process facilities, as well as the proper design, operation, and maintenance of all relevant systems and infrastructure. This paper analyses the GHG intensity of blue hydrogen, using recent data as well as input from technology providers on state‐of‐the‐art gas reforming technologies. Data are primarily based on natural gas production and transport in the North Sea Basin, with gas export from the Norwegian continental shelf to continental Europe or the United Kingdom, and with blue hydrogen production either in Norway or near pipeline landfall in the European Union or United Kingdom. Some data related to potential blue hydrogen production in the US Appalachian region are also given. The data show that the properly designed and operated value chains for blue hydrogen supply, with minimal emissions from natural gas supply and high carbon capture in hydrogen production, will give a major reduction in GHG emissions from energy end‐use. GHG footprint for end‐users based on blue hydrogen will typically be 80%–90% lower than for direct supply and use of natural gas. [ABSTRACT FROM AUTHOR]

Introduction: British South Asians have a higher prevalence of overweight and obesity than the wider population. Bradford (UK), with its high Pakistani presence and levels of economic deprivation, has exceptionally high instances, especially in deprived areas where many Pakistanis reside. British Pakistani women in Bradford are more likely to be overweight and obese. There is uncertainty on how these women can be aided to manage their weight. Therefore, the objective of this study was to explore the obesity concerns of Pakistani women living in deprived inner‐city areas of Bradford. Methods: Three focus groups interviews were carried out with 23 Pakistani women living in deprived areas of Bradford. Data were analysed thematically. Results: This exploratory study identified a wide range of concerns that women had around managing their weight. Participants disclosed distrust in information given around medication, conflicting dietary information and reported low levels of trust in women‐only organized physical activities. Cultural barriers were identified, which included the gender role of the woman, the lack of culturally appropriate dietary advice, cultural misunderstandings of what constitutes a healthy diet and healthy weight, the lack of culturally suitable exercise facilities and conforming to family and community expectations. Other concerns were language barriers around a lack of understanding, the inability to read Urdu and reliance on others to translate information. Conclusion: These findings have implications for researchers, local authorities, policy makers and others with an interest in reducing the rates of obesity in this population. Recommendations include training health practitioners to be culturally aware of the diet and eating practices of this community, exploring different ways to support socially isolated women to be more physically active at home, addressing physical activity and diet misconceptions and designing obesity management information materials appropriate for a range of literacy levels. Patient or Public Contribution: Public contributors were involved in the development of the interview guide and design of the research. A pilot focus group with participants not included in the present paper was used to help test and refine the focus group questions. Interview transcripts were member checked by participants, and participants assisted with data analysis. [ABSTRACT FROM AUTHOR]

Introduction: This paper explores doctor–patient and companion communication about care decisions in a UK emergency department (ED). Doctors interface between patients and healthcare systems and facilitate access to care across a range of encounters, drawing on information and authority to make and communicate clinical care decisions. Materials and Methods: We explored characteristics of communication through ethnographic observation of 16 video‐recorded case studies of ED consultations (average length: 1 h) collected over 6 months. Companions were present in 10 cases. We conducted a framework analysis to understand the roles of doctors, consultants, patients and companions in relaying ED care decisions. Findings: We present two cases to reflect companion roles and their effect on the consultation. The urgency for care and scarcity of resources means clinicians justify decisions and strategize to move patients along ED pathways. Discussion: Everyday care interactions between patients and doctors are goal‐oriented and companions participate by providing case information, querying decisions and advocating for care. Our findings reflect how doctors justify decisions made in communicating the next steps in ways that characterize the clinical encounter. Conclusion: By exploring everyday interactions our study contributes to a growing understanding of patient–clinician and companion communication in the ED. Patient or Public Contribution: Patients and caregivers voluntarily participated in data collection and consented to video recordings being conducted of ED consultations between them and junior doctors. There was extensive consultation with all grades of staff about the acceptability of the work and the best way to conduct it to minimize the impact on patients and staff. Through this manuscript, we have demonstrated the presence and important role of companions. On reflection it would have been valuable to have included patients and companions in discussions about the work; however, this project was conducted with very limited funding and no resources were committed to patient and public involvement. Given the setting and scope of the study, it was not feasible to involve patients or members of the public in other stages of the research or preparation of the manuscript. We recognize this as a potential limitation of the work. [ABSTRACT FROM AUTHOR]

The article offers information on the Conservative Green paper released by Conservative Party to improve the contribution of Great Britain to gross national income. It mentions that Green Paper was written at the time of recession. It mentions that Green Paper focuses on the role of corporate contributions to international aid.

Aim: To report the differential diagnosis in children with progressive intellectual and neurological deterioration (PIND) in the UK. Method: Since 1997 the PIND Study has searched for variant Creutzfeldt‐Jakob disease (vCJD) in children, using the British Paediatric Surveillance Unit to perform prospective surveillance of those younger than 16 years with PIND. Results: From May 1997 to October 2019, 2255 children meeting PIND criteria had been notified, of whom 2008 (1085 males, 923 females) had underlying diagnoses. There were over 220 different diseases, including six cases of vCJD. The numbers presenting in four age groups were: <1 year, 805 (40%); 1 to 4 years inclusive, 825 (41%); 5 to 9 years inclusive, 264 (13%); and 10 to 15 years inclusive, 114 (6%). The two largest ethnic groups were White and Pakistani (58.2% and 17% of diagnosed cases). The most common diseases in these two ethnic groups are shown for the four age groups. The distribution of diseases varied with age but was quite similar in White and Pakistani children. Interpretation: This paper provides a unique guide to the complex differential diagnosis of childhood PIND, showing considerable differences between four age groups, but similarities between ethnic groups. The PIND Study still provides the only systematic surveillance for vCJD in children in the UK. What this paper adds: The prevalence of diseases causing childhood progressive intellectual and neurological deterioration in the UK is low (approximately 0.1/1000 live births).There were more than 220 different disorders, mainly genetically determined.The majority of disorders presented early in childhood: 81% before the age of 5 years.There were similarities in the disease spectrum in White and Pakistani children. What this paper adds: The prevalence of diseases causing childhood progressive intellectual and neurological deterioration in the UK is low (approximately 0.1/1000 live births).There were more than 220 different disorders, mainly genetically determined.The majority of disorders presented early in childhood: 81% before the age of 5 years.There were similarities in the disease spectrum in White and Pakistani children. Video Podcast: https://youtu.be/QbUG-ZVJLHc This article is commented on by van Karnebeek on page 243 of this issue. [ABSTRACT FROM AUTHOR]

A grandfather clause is a provision whereby an old rule continues to apply to some existing situation while a new rule applies to all future cases. This paper focuses on the use of grandfather clauses in health technology appraisals (HTAs) issued by the National Institute for Health and Care Excellence (NICE) in the United Kingdom. NICE provides evidence‐based guidance on healthcare technologies and public health interventions that influence resource allocation decisions in the National Health Service (NHS) and the broader public sector in England and Wales. In this context, a grandfather clause is included when NICE does not recommend treatment with a given technology. The grandfather clause provides an exemption from the general recommendation for patients who have already started treatment with the technology in question, before the publication of the NICE guidance. In this paper we first lay out the contexts in which grandfather clauses occur in NICE guidance, and then consider ethical arguments against and in support of grandfather clauses and the continuation of treatment. We argue that NICE's current practice of automatic inclusion of a grandfather clause is ethically problematic and unfair. While the inclusion of a grandfather clause may be appropriate and justified in specific cases, we argue that inclusion of such a clause should be considered as part and parcel of the decision making process on a case by case basis, rather than adopted as the default. [ABSTRACT FROM AUTHOR]