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Statistics is one of the important branches of mathematics taught in schools, colleges and universities. It is also an important tool in public policy discussions. This paper focuses on the use of statistics in the latter context, rather than its use in adult mathematics education research. I review the key characteristics of the statistical approach to constructing public knowledge, and give a very brief history of key points in its development. I discuss how what I call the "overt crisis of statistics," the apparent disenchantment of large sections of the public with the "expert" statistical methods, outputs and pronouncements, leads to dilemmas both for citizens and for democratic governments. Recently "Big Data" and data analytics seem to many to offer new solutions to problems resulting from the essential lack of certainty surrounding efforts to understand society, and from the need to make quick decisions in a rapidly changing world. These approaches have potential, but also limitations. This leads me to consider a second, "covert" crisis of statistics, resulting from a struggle between proponents of freely available public information and public argument, and those aiming to profit from the appropriation and sequestering of information for private ends. I finish by considering what can be done by ourselves, as citizens, as adult mathematics teachers, and as researchers.

Statistics anxiety is experienced by a large number of psychology students, and previous research has examined a range of potential correlates, including academic performance, mathematical ability and psychological predictors. These varying predictors are often considered separately, although there may be shared variance between them. In the present study a wide range of predictors were measured in a sample of 112 first year undergraduate psychology students. For statistics anxiety, trait anxiety was the clearest predictor, with students who have higher levels of trait anxiety also having higher levels of statistics anxiety. For attitudes towards statistics, students who have better mathematical ability, and greater enjoyment of and confidence in their maths ability, also having more positive attitudes towards statistics. These findings suggest that models of statistics anxiety need to consider a wide range of predictors, which may in turn necessitate the development of a range of different interventions to alleviate statistics anxiety.

Statistics anxiety has often been linked to performance in statistics modules for psychology students, despite this no research to date has examined whether attitudes towards statistics can predict whether or not a student chooses to carry on psychology from pre-tertiary to higher education. In this pilot study 41 second year A-level psychology students completed an online measure of statistics anxiety (Statistics Anxiety Rating Scale, STARS) and answered questions about their current A-levels and whether or not they were applying to study psychology at university. The findings showed that worth of statistics, but no other STARS measures significantly predicted whether or not an individual was planning on studying psychology at university. Findings are discussed primarily in relation to teacher variables that may impact subject choice and statistics anxiety in A-level students.

Statistics anxiety is extremely common in undergraduate psychology students. The Statistics Anxiety Rating Scale (STARS) is at present the most widely used measure to assess statistics anxiety, measuring six distinct scales: test and class anxiety, interpretation anxiety, fear of asking for help, worth of statistics, fear of statistics teachers and computational self-concept. In this paper we first review the existing research that uses the STARS with psychology undergraduates. We then provide an analysis of the factor and reliability analysis of the STARS measure using a sample of undergraduate psychology students (N=315). Factor analysis of the STARS yielded nine factors, rather than the six it is intended to measure, with some items indicating low reliability, as demonstrated by low factor loadings. On the basis of these data, we consider the further development and refinement of measures of statistics anxiety in psychology students. Keywords: STARS, psychology, statistics anxiety.

Statistics pervades everyone's lives, whether it is through media coverage, reading reports, weighing up internal risks or evaluating decisions. Most managers are swamped by endless targets, dashboards and spreadsheets, but few organisations have enough employees with statistical skills to support the requirement for evidence based decision making. The need to equip today's workforce to deal with the increased amount of data is imperative. The shortage of mathematics and statistics teachers is also likely to increase as the Government aims by 2020 to provide all post 16 students with continued mathematical education until the age of 18. At The Open University we have devised a highly successful first level statistics module which is simultaneously studied by students across a range of different disciplines, many of whom encounter statistics at some point in their qualification. This has been achieved by using topics which are of interest to everyone rather than being discipline specific. The module has produced some impressive results particularly when analysing the progress of different cohorts of students, not just from varying disciplines, but also across a broad spectrum of students with differing backgrounds. It is thought that by adapting these techniques it is possible to produce high quality statistics provision to be widely used as professional career development for employees.

Preparing students to be critical thinkers and effective communicators is essential in today's multinational and technologically sophisticated environment. New electronic technologies provide opportunities for creating learning environments that extend the possibilities of "old" but still essential technologies: books, blackboards, and linear, one-way communication media. Such technologies contribute to engagement and meaningful learning in the higher education sector. Greater understanding in educational psychology and the effectiveness of educational interventions has motivated the development of various student-centred pedagogies (e.g. Problem-Based Learning [PBL]) addressing perceived shortcomings of traditional didactic instruction. PBL as a pedagogy promotes meaningful learning due largely to its power to stimulate critical, reflective and creative thinking. Can teaching staff, then, adopt technology-based approaches to create multi-disciplinary interactive PBL environments that enhance learning and excite students, inspiring them to take ownership of their own education? This paper presents a cross-case analysis of four cases that explore how classroom-based learning activities have been transferred to online formats in universities to improve critical thinking, problem-solving skills, and other learning attributes across a range of disciplines.

Students often struggle with learning about statistics, which encompass a large proportion of a psychology degree. This pilot study explored how first- and final-year students reflected on their experiences of being taught this topic, in order to identify needs that could be addressed in a project to improve their learning. First-year students reported that they initially found their module challenging but that it became easier towards the end.Third-year students recognised the importance of the topic but were not confident in their abilities. Most students reported anxiety about statistics. Although students were positive about practical classes, many felt that they could not easily remember the materials. The findings suggested three areas of focus to improve student learning. Firstly, diverse needs and levels of ability should be catered for. Secondly, students need help to go beyond surface learning and button clicking. Finally, low levels of engagement should be addressed. This work has informed a project to develop an online resource to address the above identified needs to enhance teaching of this important topic.

Research methods and statistical analysis is typically the least liked and most anxiety provoking aspect of a psychology undergraduate degree, in large part due to the mathematical component of the content. In this first cycle of a piece of action research, students' mathematical ability is examined in relation to their performance across different assessments. A maths test, including only components relevant to psychological research and analysis, was designed and subsequently completed by 427 students. Factor analysis revealed three distinct facets: understanding of mathematical procedures; interpretation of findings; and understanding the semantics of mathematics. Only the procedural and interpretative factors were predictive of overall course performance. Higher scores on both factors predicted better performance on multiple choice questions assessment and an unseen exam, whereas only the interpretation factor predicted performance on a critical thinking assignment and a lab report. The findings are considered with a view to developing another cycle of action research that more actively involves students.

Psychology lecturers are well-qualified to carry out action research which would contribute to the theoretical understanding of learning as well as having practical benefits for students. Pedagogical action research demonstrates how knowledge of psychology can be applied to solve practical problems, providing role models of psychological literacy to students, who can also beneficially be involved as participant researchers. Academics are urged to collect evidence to influence policy where higher education is facing new challenges, whether from changing economic conditions, technological developments, globalisation, student diversity, or greater expectations for personalised, engaging, and flexible learning. Five specific areas within the teaching of psychology are identified as offering rich opportunities for action research: study abroad; study skills for transition to university; engaging students with statistics; gamification; and teaching psychology to students from other disciplines. Readers are invited to join the authors in collaborating on future pedagogic action research in these areas.

Psychology students often feel anxious about learning statistics, which can impact their performance. However, little research has explored statistics confidence, which may be an important way to reduce the negative connotations of associating statistics with anxiety. We aimed to explore whether modifying an existing measure of statistics anxiety (the STARS scale) and reframing the questions so students rated their confidence instead, would be associated with competence, prior knowledge and experience. A total of 104 undergraduate students completed an online questionnaire comprising these measures. The factor structure of the STARS scale was predominantly maintained when wording was changed to measure confidence instead of anxiety. Confidence was related to experience and competence, but not knowledge. Two aspects of confidence (interpretation of statistics and exam confidence) plus initial experiences were significant predictors of competence. Confidence was a mediator of the relationship between experience and competence. These findings suggest statistics confidence can be measured in a similar way to anxiety, and highlight areas that could be addressed to increase competence. Future research is needed to explore the relationship between statistics anxiety and statistics confidence, as well as to determine their individual impact on performance in assessments.

Some psychology students achieve high grades in all classes except for research methods (RM). Previous research has usually treated low levels of achievement in RM as a unitary phenomenon, without reference to the grades the student is achieving in other subjects. The present internet survey explored preferences for learning RM in 140 psychology students. Students were categorised as: those who achieved higher grades for RM than other subjects in psychology; those whose grades for RM were equal to their grades for other subjects; and those who had lower grades for RM than other subjects. An interesting finding was that whereas wanting to see more humour in RM teaching was significantly associated with lower RM grades, wanting more visual aids in teaching RM was significantly associated with low grades only for RM. Implications of these findings are discussed in relation to explaining low achievement specific to RM. (Contains 4 tables.)

This article seeks to present some of the key challenges in facilitating autonomous learning and effective engagement in the teaching of statistics to undergraduate medical students involved in short-term research projects. With a view to addressing these challenges, recommendations for good practice are presented in the form of ten tips for teachers of medical statistics. The ten tips are justified by appeal to the more general educational literature on self-directed learning and engagement. Practical suggestions for the implementation of these tips are provided on the basis of the author's own experience of teaching statistics to medical students who have embarked on 14-week clinical research projects within the 4th year of their undergraduate curriculum. (Contains 1 figure and 2 endnotes.)

Within undergraduate psychology courses, students often have significant levels of anxiety and negative attitudes toward the statistical element. This has been attributed to poor interaction with teachers, fears about mathematical abilities, and simply being unaware of that portion of the course or its relevance to psychology. To address this, 196 undergraduate psychology students completed a survey on statistics anxiety and attitudes. Additionally, 27 different students in similar situations took part in focus group to share their experiences of introductory statistics courses. Survey results showed that fewer than half were aware of the statistics portion of their course and that the expectation was a key factor in their experiences. Qualitative feedback from the focus groups revealed much about how the teaching may or may not improve attitudes nor decrease anxiety. Findings support various broad strategies (i.e. increase awareness of statistics in psychology and confidence in success in the course) as opposed to skill-specific (better ways of teaching probability or using games to increase participation, for example) classroom interventions to improve statistics education. (Contains 2 tables and 1 figure.)

In this exploratory study, we investigated the personal epistemologies of statisticians in academia with the aim of offering some insight into what might be an availing epistemology for learning statistics. Findings from in-depth, semi-structured interviews with six academics in the UK currently researching within the field of statistics showed that their statistical personal epistemologies were consistent with constructivist theories of learning. Based on these findings, we proposed an integrated model to represent participants' beliefs about knowledge and knowing in statistics. Furthermore, we found differences between participants' mathematical and statistical personal epistemologies, and we offered an argument for domain-specificity of personal epistemologies. The implications of our findings for research in statistics education and statistical misconceptions are discussed.

Although our health professional students have some experience of simple charts, such as pie and bar, and some intuition of histograms, they do not appear to have much knowledge or understanding about box and whisker plots and their relation to the data they are describing or compared to histograms. The boxplot is a versatile charting tool, useful for presenting data from surveys and any other projects, where a reasonable quantity of data has been collected. An opportunity arose to create a reusable learning object (RLO) to describe, explore, and interpret boxplots, especially in relation to their data and summary statistics. Examples included interprofessional learning, as this was the main remit of the Centre for Excellence in Teaching and Learning, from which funding was obtained. The RLO is aimed at both undergraduate and post-graduate HP students, who would be able to use the resource flexibly, to augment their limited exposure to statistical techniques, and add to their appreciation of IP learning and working. The RLO includes animation and opportunities for students to interact with the resource. Existing, available "real" data, collected as part of research projects concerning (IP) learning, as well as generated data, is used as illustrative material. This paper explores some of the issues raised during the creation of the RLO, and presents limited feedback from users. Issues raised include the working of the project team, delivery platform, copyright and intellectual property rights and software incompatibilities. To date, feedback from colleagues and students has been very positive and has encouraged further improvements. The creation of this RLO has been a longer and more time-consuming experience than anticipated, and has highlighted the importance of a team approach, with constant reviewing. It will be interesting to see how the RLO will be used, and usage will be evaluated in the future.

Following the success of last year's teaching and career development workshop, this year's DART-P sponsored workshop at the Psychology Postgraduate Affairs Group (PsyPAG) Annual Conference held at Lancaster University focused on postgraduate's experiences of teaching research methods. This article provides a review of the invited speakers presentation, Dr. Emma McDonald, the Higher Education Academy (HEA) Psychology Technician of the year.

Full Fact is an independent, non-partisan fact-checking charity. A particular focus is the analysis of factual claims in political debate in the UK; for example, fact-checking claims and counterclaims made during Prime Minister's questions. Facts do not appear in a vacuum as they are often used as key elements in an effort to make a coherent argument. This paper describes a number of case histories where facts are disputed, drawn from our election work, to give an overview of the contemporary state of statistical literacy among politicians and the media. Common pitfalls in politicians' claims are set out, along with descriptions of our attempts to close the communication gap between different communities.

The issue of poor statistical literacy amongst undergraduates in the United Kingdom is well documented. At university level, where poor statistics skills impact particularly on social science programmes, embedding is often used as a remedy. However, embedding represents a surface approach to the problem. It ignores the barriers to learning that students bring to class, which may not always be addressed solely through embedding, such as, mathematics anxiety. Instead, embedding can only work within a much deeper pedagogic model that places students at its heart, as active participants in learning. This paper examines the development of such a model within a large sociology programme, where there was an implementation of a range of pedagogic strategies to support the development of students' statistical literacy.

Statistical literacy involves engagement with the data one encounters. New forms of data and new ways to engage with data--notably via interactive data visualisations--are emerging. Some of the skills required to work effectively with these new visualisation tools are described. We argue that interactive data visualisations will have as profound an effect on statistical literacy as the introduction of statistics packages had on statistics in social science in the 1960s. Current conceptualisations of statistical literacy are too passive, lacking the exploration part in data analysis. Statistical literacy should be conceived of as empowerment to engage effectively with evidence, and educators should seek to move students along a pathway from using interactive data visualisations to building them and interpreting what they see.

Recent concerns about a shortage of capacity for statistical and numerical analysis skills among social science students and researchers have prompted a range of initiatives aiming to improve teaching in this area. However, these projects have rarely re-evaluated the content of what is taught to students and have instead focussed primarily on delivery. The emphasis has generally been on increased use of complex techniques, specialist software and, most importantly in the context of this paper, a continued focus on inferential statistical tests, often at the expense of other types of analysis. We argue that this "business as usual" approach to the content of statistics teaching is problematic for several reasons. First, the assumptions underlying inferential statistical tests are rarely met, meaning that students are being taught analyses that should only be used very rarely. Secondly, all of the most common outputs of inferential statistical tests--p-values, standard errors and confidence intervals--suffer from a similar logical problem that renders them at best useless and at worst misleading. Eliminating inferential statistical tests from statistics teaching (and practice) would avoid the creation of another generation of researchers who either do not understand, or knowingly misuse, these techniques. It would also have the benefit of removing one of the key barriers to students' understanding of statistical analysis. [For a response to this article, "A Response to White and Gorard: against Inferential Statistics: How and Why Current Statistics Teaching Gets It Wrong," see EJ1152509. For the rejoinder, "Still against Inferential Statistics: Rejoinder to Nicholson and Ridgway," see EJ1152510.]

This article reports an analysis of the relationship between women's increased participation in higher education and other recent social changes over the last four decades. To date, women's increased involvement in higher education has been studied as either a force for or a consequence of other sociocultural changes. Drawing on data from key international data sets and with a focus on a range of Organisation for Economic Co-Operation and Development (OECD) countries, this article details an exploratory factor analysis of women's higher education participation and a range of other variables identified as indicators of or mediators for social change. This analysis reveals the existence of four underlying factors showing the structural interrelationship between the variables.

The CASE project (Case-based Approaches to Statistics Education; see www.mas.ncl.ac.uk/~nlf8/innovation) was established to investigate how the use of real-life, discipline-specific case study material in Statistics service courses could improve student engagement, motivation, and confidence. Ultimately, the project aims to promote deep learning of course material, with students from other disciplines being equipped with the skills to undertake independent quantitative analyses (for example, in their final year dissertations). In this article, I describe the case-based materials and associated activities, developed as part of this project, for first year Business undergraduates taking a compulsory course in quantitative methods. I also attempt to evaluate the success of the CASE project through a trial in which a randomly selected subgroup of students was exposed to case-based learning and teaching activities. After adjusting for nuisance factors, I found that students in this subgroup outperformed their peers who were not selected for case-based learning and teaching, in terms of their grades in both routine algorithmic homework exercises and more open-ended projects requiring problem-solving and interpretative skills.

This study examined the relationships among statistics achievement and four components of attitudes toward statistics (Cognitive Competence, Affect, Value, and Difficulty) as assessed by the SATS. Meta-analysis results revealed that the size of relationships differed by the geographical region in which the studies were conducted as well as by the component of statistics attitudes being examined. Medium effect sizes were found between statistics achievement and scores on the Affect and Cognitive Competence components for studies conducted in the United States whereas those conducted in other countries yielded small effect sizes. The Value and Difficulty components exhibited small effect sizes for both regions. In every case, the U.S. effect sizes were about double in size in comparison to those from non-U.S. countries. (Contains 2 tables.)

Over the past few decades there has been a large amount of research dedicated to the teaching of statistics. The impact of this research has started to change course content and structure, in both introductory and advanced courses for statisticians and those from other disciplines. In the light of these changes future directions in the teaching and learning of statistics must take into account new innovative pedagogical instructions, educational technologies and the abundance of Web resources that are now available. This article examines different aspects of currently identified challenges in the teaching and learning of statistics and gives an overview of useful strategies and innovations for developing research-based statistics courses in the context of recommendations for reforms, outlining the place of information technology within this framework. The article presents a review of the literature on the topic of statistics education and gives instructors a set of guidelines for generating new and effective teaching material. The summarised recommendations incorporate many innovations employed in a variety of successful statistics classes today. The review is complemented by a collection of statistics related online resources currently available on the Web. (Contains 3 tables.)

Technology is increasingly used to aid the teaching of statistics. Personal Response Systems (PRS) involve equipping students with a handset allowing them to send responses to questions put to them by a lecturer. PRS allows lectures to be more interactive and can help reinforce material. It can also allow the lecturer to monitor students' understanding of course content. PRS is most commonly used in large lectures where interaction from the students is particularly difficult. However, we consider its use in a small group (around 15 students) of MSc in Statistics students. Recommendations based on this experience are discussed, in particular the importance of good question design. We consider possible diagnostics for the appropriateness of questions based on response data. (Contains 1 figure and 3 tables.)

Courses for non-statistics majors (service courses) play an integral role in teaching statistics and pose some unique challenges. In these courses, students are often undermotivated on the one hand while on the other hand the syllabus frequently is overly crowded. In this manuscript we target the issues arising from the latter problem by making use of technology. The use of screen capture, a fast and easy way of recording lectures, is discussed through an example of an introductory statistics course for first year biology students at Lancaster University. Student feedback on the use of these recordings is discussed. (Contains 1 table and 5 figures.)

In this paper we report the results from a major UK government-funded project, started in 2005, to review statistics and handling data within the school mathematics curriculum for students up to age 16. As a result of a survey of teachers we developed new teaching materials that explicitly use a problem-solving approach for the teaching and learning of statistics through real contexts. We also report the development of a corresponding assessment regime and how this works in the classroom. Controversially, in September 2006 the UK government announced that coursework was to be dropped for mathematics exams sat by 16-year-olds. A consequence of this decision is that areas of the curriculum previously only assessed via this method will no longer be assessed. These include the stages of design, collection of data, analysis and reporting which are essential components of a statistical investigation. The mechanism outlined here could provide some new and useful ways of coupling new teaching methods with learning and doing assessment--in short, they could go some way towards making up for the educational loss of "not" doing coursework. Also, our findings have implications for teaching, learning and assessing statistics for students of the subject at all ages. (Contains 4 tables and 15 figures.)

Little is known about the provision of statistics teaching for PhD students in UK medical schools. A recent survey found that statistics courses were available to PhD students in 13 of 21 schools responding. The provision across these 13 schools was variable in terms of contact hours and content. At a meeting of 27 medical statistics teachers, consensus was reached that such teaching should be undertaken by a subject specialist, however there was no consensus as to the best mode of delivery. We describe the rationale for, content of, and student feedback from our newly developed course programme which emphasises aspects of both design and analysis of research projects. (Contains 3 tables.)

Pasteurised donor human milk is recommended for very low birthweight infants who do not have access to their mother's milk. Although the use of donor milk continues to increase, little is known about the donation experiences of milk bank donors. We aimed to describe and compare enablers, barriers and patterns of human milk donation and identify factors predicting donation volume in a convenience sample of approved milk bank donors in the United Kingdom and the United States. A cross‐sectional online survey was conducted from August 2022 to December 2022. Approved milk bank donors (n = 556) from three milk banks in the United States (n = 369, Mothers' Milk Bank of Florida, Mother's Milk Bank of North Texas and Northwest Mothers Milk Bank) and one milk bank in the United Kingdom (n = 187, Hearts Milk Bank) completed the survey. A substantial portion of donors in both settings reported participating in other forms of milk exchange (51% of U.S. donors vs. 39% of UK donors, p = 0.009). Top donation barriers reported in both settings were completing the serological screening and having enough space to store collected milk. Most donors started donating when their infant was 3 months old or older and reported donating mature milk. The most common source of information related to milk banking in each setting was the internet (United Kingdom–70% vs. United States ‐ 63%, p = 0.112). Variables that predicted lifetime donation volume differed between the United States and the United Kingdom, highlighting the importance of setting‐specific milk banking research. Key messages: Milk bank donors in the United Kingdom and the United States reported primarily receiving milk banking information from the internet and not their health care provider.A substantial portion of human milk bank donors in the United Kingdom and the United States participate in other forms of milk exchange, including sharing with a peer.Participating in other forms of milk exchange did not predict lower milk bank donation volumes.Barriers to donation and predictors of donation volume differed between donors in the United Kingdom and the United States, suggesting setting‐specific research is warranted to improve the donation process globally. [ABSTRACT FROM AUTHOR]

Background: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition that often persists into adulthood. Underlying alterations in brain connectivity have been identified but some relevant connections, such as the middle, superior, and inferior cerebellar peduncles (MCP, SCP, and ICP, respectively), have remained largely unexplored; thus, we sought to investigate whether the cerebellar peduncles contribute to ADHD pathophysiology among adults. Methods: We applied diffusion-weighted spherical deconvolution tractography to dissect the cerebellar peduncles of male adults with ADHD (including those who did or did not respond to methylphenidate, based on at least 30% symptom improvement at 2 months) and controls. We investigated differences in tract metrics between controls and the whole ADHD sample and between controls and treatment-response groups using sensitivity analyses. Finally, we analyzed the association between the tract metrics and cliniconeuropsychological profiles. Results: We included 60 participants with ADHD (including 42 treatment responders and 18 nonresponders) and 20 control participants. In the whole ADHD sample, MCP fractional anisotropy (FA; t 78 = 3.24, p = 0.002) and hindrance modulated orientational anisotropy (HMOA; t 78 = 3.01, p = 0.004) were reduced, and radial diffusivity (RD) in the right ICP was increased (t 78 = −2.84, p = 0.006), compared with controls. Although case–control differences in MCP FA and HMOA, which reflect white-matter microstructural organization, were driven by both treatment response groups, only responders significantly differed from controls in right ICP RD, which relates to myelination (t 60 = 3.14, p = 0.003). Hindrance modulated orientational anisotropy of the MCP was significantly positively associated with hyperactivity measures. Limitations: This study included only male adults with ADHD. Further research needs to investigate potential sex- and development-related differences. Conclusion: These results support the role of the cerebellar networks, especially of the MCP, in adult ADHD pathophysiology and should encourage further investigation. Clinical trial registration: NCT 03709940 [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic significantly increased pressure on healthcare services globally. However, the impact of this prolonged and ever-changing pressure on pharmacist wellbeing, burnout and resilience is unexplored. Objective: To explore the changes in resilience, burnout and wellbeing for pharmacists longitudinally from June 2020 to March 2021. Methods: An online survey was distributed via social media in June/July 2020. Any UK pharmacist in a patient facing role (community, GP and hospital) was eligible to participate. Pharmacists were asked to leave their email address at the end of the survey if they wished to participate in follow-up surveys, which were distributed in October/November 2020 and February/March 2021. Surveys included validated scales to explore resilience (CD-RISC 10), burnout (OLBI) and wellbeing (transformed SWEMWBS). Qualitative free text comments on challenges faced, positive changes in working practice, and support needed were collected. Results: 202 responses were collected in June/July 2020. Of 145 that consented to continue participation, 87 responded in October/November 2020 and 85 in February/March 2021. Mean scores in June/July 2020 showed lower than the population mean for pharmacist wellbeing (transformed SWEMWBS 21.5) and resilience (CDRISC-10 26.8) and high burnout (OLBI 40.4). There were no significant changes in scores over time, demonstrating sustained poor wellbeing, resilience and risk of burnout. In February/March 2021, those with more years since registration had higher wellbeing and resilience and lower burnout scores. Over the course of the study, pharmacists reported multiple causes of stress, including workload, patient demands, lack of protected breaks and poor local and national management. Support from colleagues was described to be the most useful resource to manage this stress. Conclusion: This study has illustrated the experience and impact of prolonged work within stressful situations for UK pharmacists. [ABSTRACT FROM AUTHOR]

Background: Selection into UK-based GP training has used the Multi-Specialty Recruitment Assessment (MSRA) and a face-to-face selection centre (SC). The MSRA comprises of a situational judgement test and clinical problem-solving test. The SC was suspended during the COVID-19 pandemic. Evidence is needed to guide national and international selection policy. Aim: To evaluate the validity of GP training selection. Design & setting: A retrospective cohort study using data from UK-based national recruitment to GP training, from 2015–2021. Method: Data were available for 32 215 GP training applicants. The ability of scores from the specialty selection process to predict subsequent performance in the Clinical Skills Assessment (CSA) of the Membership of the Royal College of General Practitioners examination was modelled using path analysis. The effect sizes for sex, professional family background, and world region of qualification were estimated. Results: All component scores of the selection process demonstrated statistically significant independent relationships with CSA performance (P<0.001), thus establishing their predictive validity. All were sensitive to demographic factors. The SC scores had the weakest relationship with future CSA performance. However, for candidates with MSRA scores below the lowest quartile, the relative contribution of the SC scores to predicting CSA performance was similar to that observed for MSRA components. Conclusion: The MSRA has predictive validity in this context. Re-instituting an SC for those with relatively low MSRA scores should be considered. However, the relative costs and potential advantages and disadvantages should be carefully weighed. [ABSTRACT FROM AUTHOR]

(1) Background: Preterm premature rupture of membranes (PPROM) has been associated with increased perinatal morbidity, but the effect of PPROM on respiratory disease has not been previously quantified. We hypothesised that PPROM would be associated with a higher incidence of invasive ventilation. (2) Methods: A retrospective cohort study at the Neonatal Unit at King's College Hospital NHS Foundation Trust, London, UK, was conducted on infants born before 37 weeks of gestation. PPROM was defined as the rupture of membranes for >48 h. (3) Results: We reviewed 1901 infants (434 with PPROM) with a median (IQR) gestational age of 32.4 (28.7–35.0) weeks. The median (IQR) duration of rupture of membranes in the infants with PPROM was 129 (78–293) h. The incidence of invasive ventilation was 56% in the infants with PPROM and 46% in the infants without PPROM (p < 0.001). Following regression analysis, PPROM was significantly related to a higher incidence of invasive ventilation (odds ratio: 1.48; 95% CI: 1.13–1.92, adjusted p = 0.004) after adjusting for birth weight [odds ratio = 0.34; 95% CI: 0.33–0.43, adjusted p < 0.001], Apgar score at 10 min [odds ratio =0.61; 95% CI: 0.56–0.66, adjusted p < 0.001] and antenatal corticosteroid use (adjusted p = 0.939). (4) Conclusions: PPROM was associated with a 1.48-fold higher risk of needing invasive ventilation. [ABSTRACT FROM AUTHOR]

Objective: To identify cortical and subcortical volume, thickness and cortical area features and the networks they constituted related to anxiety in Parkinson's disease (PD) using structural magnetic resonance imaging (sMRI), and to integrate multimodal features based on machine learning to identify PD-related anxiety. Methods: A total of 219 patients with PD were retrospectively enrolled in the study. 291 sMRI features including cortical volume, subcortical volume, cortical thickness, and cortical area, as well as 17 clinical features, were extracted. Graph theory analysis was used to explore structural networks. A support vector machine (SVM) combination model, which used both sMRI and clinical features to identify participants with PD-related anxiety, was developed and evaluated. The performance of SVM models were evaluated. The mean impact value (MIV) of the feature importance evaluation algorithm was used to rank the relative importance of sMRI features and clinical features within the model. Results: 17 significant sMRI variables associated with PD-related anxiety was used to build a brain structural network. And seven sMRI and 5 clinical features with statistically significant differences were incorporated into the SVM model. The comprehensive model achieved higher performance than clinical features or sMRI features did alone, with an accuracy of 0.88, a precision of 0.86, a sensitivity of 0.81, an F1-Score of 0.83, a macro-average of 0.85, a weightedaverage of 0.92, an AUC of 0.88, and a result of 10-fold cross-validation of 0.91 in test set. The sMRI feature right medialorbitofrontal thickness had the highest impact on the prediction model. Conclusion: We identified the brain structural features and networks related to anxiety in PD, and developed and internally validated a comprehensive model with multimodal features in identifying. [ABSTRACT FROM AUTHOR]

The mental health of healthcare workers was affected by physical and psychological challenges during the pandemic. The aim was to study how psychosocial considerations can help manage behaviour change, mental health, and work satisfaction of nurse trainees in the UK during the COVID-19 pandemic in 2021. This cross-sectional study involved ninety-nine students. Participants' anxiety, fear of the coronavirus, and perceived work satisfaction were measured by GAD-7, FCV19S, and COM-B scales and assessed using descriptive, correlational, and linear regression analysis. The significant zero-order correlations between job satisfaction and fear, anxiety, and psychosocial considerations were significant. They indicated moderate strength that allowed for further inferential development to find the best predictors of job satisfaction. The findings suggested that 50% of trainees showed anxiety above the suggested ≥8 cut-off on GAD-7, and 48% scored high for fear on FCV19S. There was a significant effect between year groups (F (2, 99) = 4.25, p = 0.02 , η2 = 0.081), with a Tukey post hoc test showing a significant difference between training years 1 and 2 with a p = 0.015. A significant linear regression found that psychosocial variables in behaviour change (p ≤ 0.001) and anxiety (p = 0.011) were significant factors in job satisfaction, explaining 53.4% of the variance. Conclusion. Satisfaction was associated with higher levels of psychosocial considerations and low levels of anxiety and fear, which adds to previous literature on job satisfaction in nurse education. Future implications must examine ways to alleviate mental health effects and support policies and curricula to address this need. [ABSTRACT FROM AUTHOR]

Background: Migraine is a highly prevalent neurological disease with a substantial societal burden due to lost productivity. From a societal perspective, we assessed the cost-effectiveness of eptinezumab for the preventive treatment of migraine. Methods: An individual patient simulation of discrete competing events was developed to evaluate eptinezumab cost-effectiveness compared to best supportive care for adults in the United Kingdom with ≥ 4 migraine days per month and prior failure of ≥ 3 preventive migraine treatments. Individuals with sampled baseline characteristics were created to represent this population, which comprised dedicated episodic and chronic migraine subpopulations. Clinical efficacy, utility, and work productivity inputs were based on results from the DELIVER randomised controlled trial (NCT04418765). Timing of natural history events and treatment holidays—informed by the literature—were simulated to unmask any natural improvement of the disease unrelated to treatment. The primary outcomes were monthly migraine days, migraine-associated costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratio, and net monetary benefit, each evaluated over a 5-year time horizon from 2020. Secondary analyses explored a lifetime horizon and an alternative treatment stopping rule. Results: Treatment with eptinezumab resulted in an average of 0.231 QALYs gained at a saving of £4,894 over 5 years, making eptinezumab dominant over best supportive care (i.e., better health outcomes and less costly). This result was confirmed by the probabilistic analysis and all alternative assumption scenarios under the same societal perspective. Univariate testing of inputs showed net monetary benefit was most sensitive to the number of days of productivity loss, and monthly salary. Conclusions: This economic evaluation shows that from a societal perspective, eptinezumab is a cost-effective treatment in patients with ≥ 4 migraine days per month and for whom ≥ 3 other preventive migraine treatments have failed. Trial registration: N/A. [ABSTRACT FROM AUTHOR]

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

Background: Lifetime risk of fragility fractures is 50% in post-menopausal women and 20% in men aged >50 years. Identifying people at high risk facilitates early intervention and reduction of biopsychosocial morbidity associated with these fractures. Aim: To explore if bone health assessment (BHA) rates differ between women and men aged =50 years with fragility fracture risk factors. Design & setting: A primary care-based cohort study in North Staffordshire, UK. Method: Patients were identified from the Consultations in Primary Care Archive (CiPCA) database between 2002 and 2014 with one or more fragility fracture risk factors (previous fractures, falls, and prolonged steroid use). Evaluation of BHA within 12 months of presentation of the first risk factor was carried out by searching for codes for fracture risk assessment tools (FRAX and QFracture), bone density measurement, specialist service referral, or if bone-protection medication was started. Results: A total of 15 581 patients with risk factors were identified; men represented 40.4% of the cohort. The study found 1172 (7.5%) had BHA performed within 1 year of presentation, and 8.9% of women and 5.5% of men had BHAs, which was found with strong statistical evidence (χ2 = 59.88, P = 1 × 10-14). This relationship prevailed after adjusting for other covariates, such as comorbidity and number of consultations, with an odds ratio of 1.25 (95% confidence interval [CI] = 1.08 to 1.43). Conclusion: This study has shown that rates of BHA were generally low and even lower in men compared with women. Primary care clinicians should be alert to fragility fracture risk factors in both men and women to enable early assessment and intervention. [ABSTRACT FROM AUTHOR]

Video gamers can play to negate the psychological impact of stress, which may become problematic when users over-rely on the stress relief potential of gaming. This study used a repeated measures experimental design to investigate the relationships between stress, video gaming, and problematic video gaming behaviours in a convenience sample of 40 students at a UK university. The results indicated that positive affect increased and negative affect decreased, whilst a biological stress measure (instantaneous pulse rate) also decreased after a short video gaming session (t(36) = 4.82, p < 0.001, d = 0.79). The results also suggested that video gaming can act as a short-term buffer against the physiological impact of stress. Further research should focus on testing individuals who have been tested for gaming disorder, as opposed to the general population. Research could also utilise variations of the methodological framework used in this study to examine the intensity of a stress relief effect under different social situations. The study's findings in relation to published works are also discussed. [ABSTRACT FROM AUTHOR]

Simple Summary: Ripretinib is a novel drug used to treat patients with advanced gastrointestinal stromal tumors. We investigated its efficacy and safety in a group of 45 patients treated in a real-world setting in the UK. We investigated the safety of the drug and its activity in causing tumor shrinkage and delaying tumor progression or death. Importantly, we also investigated the overall duration of the treatment, including when it was continued after radiological progression on the basis of clinical benefit, which is a common practice in the real-world setting. Our results show that both the efficacy and the safety of ripretinib in this group of patients were comparable to what had been reported in available clinical trials, supporting its use in patients with advanced gastrointestinal stromal tumors. Ripretinib, a novel tyrosine kinase inhibitor used in advanced gastrointestinal stromal tumors (GIST) resistant to standard therapies, was assessed in the United Kingdom (UK) within an Expanded Access Program (EAP). A retrospective review of patients treated between January 2020 and October 2021 within the ripretinib EAP in our Institution was conducted. Clinician-documented and mRECIST 1.1 assessments were collected. The primary endpoints were progression-free survival (PFS) and time to treatment discontinuation (TTD). Treatment beyond progression (TBP), overall survival (OS), objective response rates and safety data were also analyzed. Survival curves were constructed using the Kaplan–Meier method, and univariate and multivariate Cox regression analyses were performed. All analyses were performed with R software. Overall, forty-five patients were included. After a median follow-up of 24.2 (95% CI 19.7–29.7) months, the median PFS of the group receiving 150 mg ripretinib once daily (OD) was 7.9 (95% CI 5.6–19.3) months. In the cohort of 22 patients with dose escalation upon tumor progression to 150 mg ripretinib twice daily (BD), the median PFS from BD was 5.4 (95% CI 2.8–9.3) months. Overall, median PFS and OS values for patients on ripretinib were 9.7 (95% CI 8.3–18.1) and 14.0 (95% CI 9.9–NA) months, respectively. TTD was similar to PFS. TBP was observed in about one third of all patients. Objective responses to ripretinib OD and BD treatments were observed in 16.7% and 10.0% of the patients, respectively. No new safety signals were identified. In conclusion, patients with advanced GIST receiving ripretinib in the UK within the EAP reported prolonged benefits, in line with the recent phase III clinical trials. [ABSTRACT FROM AUTHOR]

Background: The ProMPT-2 trial (Propofol for Myocardial Protection Trial #2) aims to compare the safety and efficacy of low- and high-dose propofol supplementation of the cardioplegia solution during adult cardiac surgery versus sham supplementation. This update presents the statistical analysis plan, detailing how the trial data will be analysed and presented. Outlined analyses are in line with the Consolidated Standards of Reporting Trials and the statistical analysis plan has been written prior to database lock and the final analysis of trial data to avoid reporting bias (following recommendations from the International Conference on Harmonisation of Good Clinical Practice). Methods/design: ProMPT-2 is a multi-centre, blinded, parallel three-group randomised controlled trial aiming to recruit 240 participants from UK cardiac surgery centres to either sham cardioplegia supplementation, low dose (6 µg/ml) or high dose (12 µg/ml) propofol cardioplegia supplementation. The primary outcome is cardiac-specific troponin T levels (a biomarker of cardiac injury) measured during the first 48 h following surgery. The statistical analysis plan describes the planned analyses of the trial primary and secondary outcomes in detail, including approaches to deal with missing data, multiple testing, violation of model assumptions, withdrawals from the trial, non-adherence with the treatment and other protocol deviations. It also outlines the planned sensitivity analyses and exploratory analyses to be performed. Discussion: This manuscript prospectively describes, prior to the completion of data collection and database lock, the analyses to be undertaken for the ProMPT-2 trial to reduce risk of reporting and data-driven analyses. Trial registration: ISRCTN ISRCTN15255199. Registered on 26 March 2019. [ABSTRACT FROM AUTHOR]

Introduction: Monitoring the evolution of COVID-19 has been essential for health decision-making. But this requires reliable numbers of the infected, dead and hospitalized, often difficult to have for multiple reasons. The use of fast and reliable estimation techniques, such as indirect surveys, is an option. Objectives: To present the CoronaSurveys project, which monitors COVID-19 by combining indirect surveys with the Network Scaleup Method (NSUM). Methodology: The system uses indirect online anonymous surveys to inquire about COVID-19, and the NSUM method to estimate cases. The system offers multi-language surveys with questions to track active cases, new cases, and fatalities, among others. Results: CoronaSurveys has been operating since March 2020, and continues to collect data, with over one hundred responses to date (over one million samples). The system has made good estimates for Spain and the United Kingdom, among other countries. Conclusion: This system is suitable in countries with limited health infrastructure or in situations of lack of knowledge about the pandemic, such as at the beginning of COVID-19, because its implementation cost is small and it requires simple devices to use it and few participants to obtain good estimates. [ABSTRACT FROM AUTHOR]

Motivation Summary statistics from genome-wide association studies enable many valuable downstream analyses that are more efficient than individual-level data analysis while also reducing privacy concerns. As growing sample sizes enable better-powered analysis of gene–environment interactions, there is a need for gene–environment interaction-specific methods that manipulate and use summary statistics. Results We introduce two tools to facilitate such analysis, with a focus on statistical models containing multiple gene–exposure and/or gene–covariate interaction terms. REGEM (RE-analysis of GEM summary statistics) uses summary statistics from a single, multi-exposure genome-wide interaction study to derive analogous sets of summary statistics with arbitrary sets of exposures and interaction covariate adjustments. METAGEM (META-analysis of GEM summary statistics) extends current fixed-effects meta-analysis models to incorporate multiple exposures from multiple studies. We demonstrate the value and efficiency of these tools by exploring alternative methods of accounting for ancestry-related population stratification in genome-wide interaction study in the UK Biobank as well as by conducting a multi-exposure genome-wide interaction study meta-analysis in cohorts from the diabetes-focused ProDiGY consortium. These programs help to maximize the value of summary statistics from diverse and complex gene–environment interaction studies. Availability and implementation REGEM and METAGEM are open-source projects freely available at https://github.com/large-scale-gxe-methods/REGEM and https://github.com/large-scale-gxe-methods/METAGEM. [ABSTRACT FROM AUTHOR]

Context.-- Serology plays a vital role in celiac disease (CD) diagnosis, and the latest European guidelines advocate for biopsy-free diagnoses in patients with ≥10x the upper limit of normal (ULN) of anti-tissue transglutaminase (tTG) immunoglobulin A (IgA) antibodies. Objective.-- To assess performance characteristics of a novel automated particle-based multianalyte technology (Aptiva) for anti-tTG and anti-deamidated gliadin peptide (DGP) antibody detection as compared to the traditional enzyme-linked immunosorbent assay (QUANTA Lite). Performance characteristics of the ≥10x ULN anti-tTG IgA criteria for serologic diagnosis of CD were also evaluated. Design.-- Sera samples from 703 patients were tested for anti-tTG IgA, anti-tTG immunoglobulin G (IgG), anti-DGP IgA, and anti-DGP IgG antibodies on both platforms. In total, 127 patients had medical information and were classified as CD-positive (n = 58) and CD-negative (n = 69) based on biopsy results. Clinical performance characteristics were evaluated. Results.-- Anti-tTG IgA detection showed equal clinical sensitivity and specificity of 91% sensitivity and 99% specificity on both platforms. Anti-tTG IgG resulted in moderate sensitivity of 69% and 72%, but high specificity of 100% and 94% on Aptiva and QUANTA Lite, respectively. Anti-DGP IgG displayed comparable sensitivity of 90% and 81%, and a specificity of 94% and 99%, on Aptiva and QUANTA Lite, respectively. Anti-DGP IgA demonstrated greater sensitivity on QUANTA Lite (83%) than Aptiva (69%) and similar specificities of 97% and 98% on QUANTA Lite and Aptiva, respectively. At ≥10x ULN levels for anti-tTG IgA, Aptiva displayed a sensitivity of 72% and a specificity of 100%, and QUANTA Lite showed a sensitivity of 69% and a specificity of 100%. Conclusions.-- Aptiva is a reliable method to measure CD biomarkers with reduced hands-on necessity and high-throughput capabilities. This study supports the use of a ≥10x ULN anti-tTG IgA biopsy-free approach for serologic diagnosis of CD. [ABSTRACT FROM AUTHOR]

Local journalism is fundamental for a thriving democracy, yet the UK faces a decline in the number of print and digital local news outlets. Large-scale mappings of the surviving outlets offer invaluable insights to policymakers designing interventions to strengthen the sector. Due to the lack of a comprehensive national directory of UK print and digital local news outlets, researchers have resorted to datasets such as circulation auditors' databases, which have been noted to be incomplete and outdated. A lack of understanding of the magnitude of these data limitations hinders researchers from selecting optimal datasets. This study evaluates four commonly used local news databases, uncovering significant variations in their currentness and comprehensiveness. Thereafter, statistical analyses demonstrate the significant effect of each dataset's shortcomings on findings in local news research. To address this issue, triangulation and manual verification are employed to create a more comprehensive and robust dataset. This procedure generates a new national dataset of print and digital local news outlets that can be used in future research, alongside a framework for leveraging public data to build an independent research dataset. This work paves the way for more rigorous research in data-driven local news provision studies. Concluding remarks stress the importance of setting definitions and establishing clear data pipelines in an increasingly diversified and dynamic sector. [ABSTRACT FROM AUTHOR]

Background: Gout is the most common inflammatory arthritis and is almost exclusively managed in primary care, however the course and severity of the condition is variable and poorly characterised. This research aims improve understanding about the frequency of, and factors associated with, gout flares in the UK and characterise the factors associated with the initiation of ULT. Methods: Using the Clinical Practice Research Database, patients with a coded incident gout diagnosis without a prior prescription for urate-lowering therapy (ULT) were identified. Gout flares post diagnosis and ULT initiation were identified through prescribing and coded data. Patient characteristics, co-morbidities and co-prescribing were co-variants. Factors associated with gout flares and ULT initiation were analysed using cox-proportional hazard model and logistic regression. Results: Fifty-one thousand seven hundred eighty-four patients were identified: 18,605 (35.9%, 95%CI 35.5–36.3%) had experienced ≥ 1 recurrent flare, 17.4% (95%CI 17.1–17.8%) within 12 months of diagnosis. Male sex, black ethnicity, higher BMI, heart failure, CKD, CVD and diuretic use were associated with flares, with the highest HR seen with high serum urate levels (≥ 540 µmol/L HR 4.63, 95%CI 4.03–5.31). ULT initiation was associated with similar variables, although higher alcohol intake and older age were associated with lower odds of ULT initiation but were not associated with flares. ULT was initiated in 27.7% (95%CI 27.3–28.0%): 5.7% (95%CI 5.5–5.9%) within 12 months of diagnosis. ULT initiation rates were higher in patients with recurrent flares. Conclusion: Approximately one in six people with incident gout had a second flare within 12 months. Factors associated with flare recurrence and ULT initiation were similar, but ULT initiation occurred later after diagnosis than previously thought. [ABSTRACT FROM AUTHOR]

Background: Fractures are rare events and can occur because of a fall. Fracture counts are distinct from other count data in that these data are positively skewed, inflated by excess zero counts, and events can recur over time. Analytical methods used to assess fracture data and account for these characteristics are limited in the literature. Methods: Commonly used models for count data include Poisson regression, negative binomial regression, hurdle regression, and zero-inflated regression models. In this paper, we compare four alternative statistical models to fit fracture counts using data from a large UK based clinical trial evaluating the clinical and cost-effectiveness of alternative falls prevention interventions in older people (Prevention of Falls Injury Trial; PreFIT). Results: The values of Akaike information criterion and Bayesian information criterion, the goodness-of-fit statistics, were the lowest for negative binomial model. The likelihood ratio test of no dispersion in the data showed strong evidence of dispersion (chi-square = 225.68, p-value < 0.001). This indicates that the negative binomial model fits the data better compared to the Poisson regression model. We also compared the standard negative binomial regression and mixed effects negative binomial models. The LR test showed no gain in fitting the data using mixed effects negative binomial model (chi-square = 1.67, p-value = 0.098) compared to standard negative binomial model. Conclusions: The negative binomial regression model was the most appropriate and optimal fit model for fracture count analyses. Trial registration: The PreFIT trial was registered as ISRCTN71002650. [ABSTRACT FROM AUTHOR]

Background: There is a workforce shortage in the children's hospice sector, but there has been little research on the specific challenges of working in this setting and on how these challenges might be alleviated. To identify appropriate interventions to improve staff wellbeing, the drivers of wellbeing in children's hospices need to be known and measured. This paper reports on the development of two measures, one for work-related rewards and one for work-related stressors, for use in children's hospice care teams. Methods: A mixed-methods, four-stage study; the first three phases focused on the development of the scales, and the last stage focused on the validation of the scales. Participants of all stages were children's hospice care team staff members in the UK. Stage 1: survey assessing the relevance and comprehensiveness of the original scale items (N = 60); Stages 2 (focus groups; N = 16) and 3 (cognitive interviews; N = 14) to assess content validity; Stage 4: UK-wide survey (N = 414) to validate the final version of the new, children's hospice-specific scales using Rasch Analysis (RA) and Confirmatory Factor Analysis (CFA). Results: Due to poor fitting indices shown in the results from the RA, five items (out of 36) were removed from the new rewards scale used in the UK-wide survey and 20 (out of 62) were removed from the new stressors scale. CFA also supported the removal of the items and showed a one-factor structure for the rewards scale and a three-factor structure for the stressors scale were adequate—the sub-scales for the stressors scale related to caring for an ill or dying child ("Child" sub-scale), working with parents and families ("Parent" sub-scale), and stressors related to organisational factors, such as team conflict and workload ("Organisation" sub-scale). Conclusions: Both of the new scales showed good psychometric properties and can be useful in clinical settings and research to assess the perceived intensity of the work-related rewards and stressors for children's hospice staff. [ABSTRACT FROM AUTHOR]