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Background: Gay, bisexual and other men who have sex with men (GBMSM) are at far greater risk of experiencing poor mental health (MH) than wider society. This disparity was exacerbated by additional 'unique to sexual minority status' COVID-19 stressors. Objective: This sequential, mixed-methods study examined remote MH help-seeking among GBMSM in the U.K. and Ireland during the first COVID-19 lockdown. Methods and Results: Quantitative survey data (n = 1368), analysed with logistic regression, suggested GBMSM experiencing moderate-to-severe anxiety and those with a past MH diagnosis were most likely to seek MH support. Thematic analysis of qualitative interview (n = 18) data identified multiple barriers and enablers to GBMSM seeking remote MH help, with the help primarily sought from GBMSM-facing organisations and generic online resources. Finally, the behaviour change wheel was used to generate theoretically informed recommendations to promote MH help-seeking among GBMSM in Scotland. Implications: We discuss how applying these recommendations in the short, medium and long term will begin to address GBMSM's MH needs, post COVID-19. [ABSTRACT FROM AUTHOR]

Background: In 2010, a national enquiry into elderly patient outcomes after surgery identified that only 36% received 'good' care. Guidance was subsequently published by the Association of Anaesthetists of Great Britain and Ireland regarding perioperative care of the elderly and those with dementia; this study aims to assess current adherence to these guidelines in anaesthetic departments across Scotland. Methods: A web-based survey was sent to all Scottish departments. The questions assessed department patient demographic, access to specialist pre-assessment services, availability of multidisciplinary input, perioperative care of patients with cognitive impairment and departmental training on geriatric perioperative care. Results: Responses were collected from November-December 2020 with a 92.6% response rate. A total of 64% of departments stated that > 50% of their workload involved patients over 75. One department had a lead clinician for geriatric anaesthesia, whilst 20% could access a geriatric specialist when coordinating perioperative care. Specialist geriatric pre-assessment services operate in 20% of centres. A total of 60% of respondents used a clinical frailty score when pre-assessing patients over 75, with 48% specifically screening for cognitive impairment. The vast majority of centres, 76%, did not routinely provide information regarding post-operative delirium and 24% 'never or very rarely' invite caregivers to accompany patients with dementia into the department. Education sessions regarding perioperative elderly care had occurred in 56% of departments. Conclusions: Elderly patients represent a significant proportion of anaesthetic workload in Scotland. Despite this, adherence to recommended practice is low. The vast majority of centres lack access to specialist multidisciplinary input or specialist pre-assessment services which are essential to providing good care. Reported screening for frailty and cognitive impairment is variable, with opportunities for improvement in communication and education (patient and clinician) surrounding these conditions. [ABSTRACT FROM AUTHOR]

There are two competing accounts for explaining Britain's technological transformation during the Industrial Revolution. One sees it as the inevitable outcome of a largely exogenous increase in the supply of new ideas and ways of thinking. The other sees it as a demand side response to economic incentives--that in Britain, it paid to invent the technology of the Industrial Revolution. However, this second interpretation relies on the assumption that inventors were sufficiently responsive to new commercial opportunities. This paper tests this assumption, using a new dataset of Scottish and Irish patents. It finds that the propensity of inventors to extend patent protection into Scotland and/or Ireland was indeed closely correlated with the relative market opportunity of the patented invention. [ABSTRACT FROM AUTHOR]

This paper reviews chipped stone tool industries of the Earlier Neolithic in eastern Scotland. Assemblage size, raw materials and primary and secondary technology are discussed and some preliminary models are proposed: these suggest that assemblages are often small and dominated by flint. Very small quantities of Arran pitchstone are often present. Narrow flake and blade platform technologies are present and there is evidence for curation of cores. Bipolar working forms an important component of these assemblages. Retouched pieces are generally in keeping with earlier Neolithic forms in other regions: leaf shaped arrowheads, elongate piano-convex knives, and a range of convex scrapers. Polished axes are rare in the kinds of contexts in which flaked lithic artefacts are found. Lithic assemblages are often included in 'structured' deposits of varied kinds. The eastern Scottish material is thus in keeping with Early Neolithic stone-working across most of Britain and Ireland. [ABSTRACT FROM AUTHOR]

Background: Palliative care day services provide a safe environment for people with palliative care needs, enabling them to access a range of services while acting as a respite services for family caregivers. Viewed as marginal services, they are often under resourced and under researched. The aim of this study was to understand how palliative day care services contribute to client care from the perspective of management and hospice multidisciplinary teams. Methods: A descriptive qualitative study, using six focus groups conducted with staff at three United Kingdom hospices in England, Scotland and Northern Ireland. Thirty-five participants were recruited, including management and staff. Discussions were transcribed and analysed thematically. Results: Four key themes emerged: (1) variations of care, beyond heterogeneity of patients; (2) unclear referrals and inconsistent patient population; (3) recognising strengths and challenges and (4) an uncertain future. A major focus of group discussions was the model of care and the benefits of the service, however the importance of demonstrating services' effectiveness and value for money was highlighted. Conclusions: Management and hospice staff believed day-services to be a helpful introduction to palliative care, providing both social and medical support. Economic pressures and patient demand were influencing them to move from a social model to a hybrid model. Further research is needed to understand the effectiveness of the service. [ABSTRACT FROM AUTHOR]

Background: Palliative Care Day Services (PCDS) offer supportive care to people with advanced, progressive illness who may be approaching the end of life. Despite the growth of PCDS in recent years, evidence of their costs and effects is scarce. It is important to establish the value of such services so that health and care decision-makers can make evidence-based resource allocation decisions. This study examines and estimates the costs and effects of PCDS with different service configurations in three centres across the UK in England, Scotland and Northern Ireland. Methods: People who had been referred to PCDS were recruited between June 2017 and September 2018. A pragmatic before-and-after descriptive cohort study design analysed data on costs and outcomes. Data on costs were collected on health and care use in the 4 weeks preceding PCDS attendance using adapted versions of the Client Service Receipt Inventory (CSRI). Outcomes, cost per attendee/day and volunteer contribution to PCDS were also estimated. Outcomes included quality of life (MQOL-E), health status (EQ-5D-5L) and capability wellbeing (ICECAP-SCM). Results: Thirty-eight attendees were recruited and provided data at baseline and 4 weeks (centre 1: n = 8; centre 2: n = 8, centre 3: n = 22). The cost per attendee/day ranged from £121–£190 (excluding volunteer contribution) to £172–£264 (including volunteer contribution) across the three sites. Volunteering constituted between 28 and 38% of the total cost of PCDS provision. There was no significant mean change at 4 week follow-up from baseline for health and care costs (centre 1: £570, centre 2: -£1127, centre 3: £65), or outcomes: MQOL-E (centre 1: − 0.48, centre 2: 0.01, centre 3: 0.24); EQ-5D-5L (centre 1: 0.05, centre 2: 0.03, centre 3: − 0.03) and ICECAP-SCM (centre 1:0.00, centre 2: − 0.01, centre 3: 0.03). Centre costs variation is almost double per attendee when attendance rates are held constant in scenario analysis. Conclusions: This study highlights the contribution made by volunteers to PCDS provision. There is insufficient evidence on whether outcomes improved, or costs were reduced, in the three different service configurations for PCDS. We suggest how future research may overcome some of the challenges we encountered, to better address questions of cost-effectiveness in PCDS. [ABSTRACT FROM AUTHOR]

We present a mass balance approach to estimate the seasonal and annual budgets of carbon dioxide (CO2) and methane (CH4) of the United Kingdom (excluding Scotland) and the Republic of Ireland from concentration measurements taken on a ferry along the east coast of the United Kingdom over a 3-year period (2015–2017). We estimate the annual emissions of CH4 to be 2.55±0.48 Tg, which is consistent with the combined 2.29 Tg reported to the United Nations Framework Convention on Climate Change by the individual countries. The net CO2 budget (i.e. including all anthropogenic and biogenic sources and sinks of CO2) is estimated at 881.0±125.8 Tg, with a net biogenic contribution of 458.7 Tg (taken as the difference between the estimated net emissions and the inventory value, which accounts for anthropogenic emissions only). The largest emissions for both gases were observed in a broad latitudinal band (52.5–54 ∘ N), which coincides with densely populated areas. The emissions of both gases were seasonal (maxima in winter and minima in summer), strongly correlated with natural gas usage and, to a lesser extent, also anti-correlated with mean air temperature. Methane emissions exhibited a statistically significant anti-correlation with air temperature at the seasonal timescale in the central region spanning 52.8–54.2 ∘ N, which hosts a relatively high density of waste treatment facilities. Methane emissions from landfills have been shown to sometimes increase with decreasing air temperature due to changes in the CH4 -oxidising potential of the topsoil, and we speculate that the waste sector contributes significantly to the CH4 budget of this central region. This study brings independent verification of the emission budgets estimated using alternative products (e.g. mass balance budgets by aircraft measurements, inverse modelling, inventorying) and offers an opportunity to investigate the seasonality of these emissions, which is usually not possible. [ABSTRACT FROM AUTHOR]

Following the execution of his father Charles I in January 1649, the exiled king Charles II pursued various political, military, and diplomatic strategies to recover his kingdoms. Proclaimed king of Ireland and Scotland, Charles II adopted the traditional view of monarch–subject relations and expected the loyalty of his subjects and their devotion to his restoration. The recent experiences of war and regicide, however, had changed the ways in which Irish and Scottish subjects determined the nature and degree of allegiance owed to the king. In Ireland and Scotland, subjects placed their own interests above the royalist cause. Tensions in Ireland among Catholics and between Catholics and Protestants tested the bonds of loyalty to Charles II, and Scottish Covenanters circumscribed the king's authority and imposed strict conditions upon their political and military support. Moreover, Charles II's position of exile exacerbated existing tensions within his kingdoms. While Charles I experienced the withdrawal of his subjects' allegiance and strove to recover that loyalty, as an exiled king Charles II struggled to gain the allegiance of his kingdoms and to secure loyalty in the face of religious tension, geographic distance, failing war efforts, and conflicting interests among his subjects. [ABSTRACT FROM PUBLISHER]