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'How To Save A Life' (HTSAL) was a mass media campaign on drug-related death prevention which ran in Scotland from August 2021 to January 2022. It aimed to increase awareness of how to respond to an opioid overdose, and the uptake of take-home naloxone (THN). The objective of this study was to determine the reach and engagement with the campaign. Methods included a descriptive analysis of data from media sources, the campaign website, and an online naloxone training course. A quantitative content analysis was conducted on media articles. The campaign generated 57,402,850 non-unique impressions (the total number of times the campaign was seen or heard), and unique reach (the number of people who were exposed to the campaign) figures of 2,621,450. Engagement with the campaign was positive, and 96% of print/digital media articles had a positive view of the campaign. There were 40,714 visits to the campaign website, leading to 8,107 clicks to the free naloxone training course, and 3,141 clicks to order a free naloxone kit. This study showed that mass media campaigns on drug policy topics can achieve high levels of reach and engagement. There was a clear progression from viewing campaign materials, to visiting the campaign website, to completing naloxone training. Our research suggests that mass media campaigns can be used to disseminate harm reduction messages to the general public. [ABSTRACT FROM AUTHOR]

The current study explored the experiences of Asian International Students (AISs) in terms of mental health, disclosure and help-seeking within Higher Education in Scotland, UK. A qualitative study using individual semi-structured interviews with AISs (n = 20) was used and an inductive thematic approach to analysis was conducted. Three major themes were developed: (1) Negative beliefs, stigma and fear of judgment, (2) Adaptation and acculturation difficulties and (3) Barriers in communication, social disconnection and loneliness. Supporting AISs involves challenging negative judgements surrounding mental health, increasing mental health literacy and addressing barriers that may inhibit disclosure and help-seeking behaviour. The need for culturally sensitive mental health practitioners and awareness of diverse understandings of mental health issues is essential to improving support for AISs. [ABSTRACT FROM AUTHOR]

GPS satellite tracking allows novel investigations of how golden eagles Aquila chrysaetos use the landscape at several scales and at different life history stages, including research on geographical barriers which may prevent or limit range expansion or create population/sub-population isolation. If there are significant barriers to golden eagle movements, there could be demographic and genetic consequences. Genetic studies have led investigations on the identification of sub-species, populations, and sub-populations but should be conjoined with demographic studies and dispersal movements to understand fully such designations and their geographic delimitation. Scottish eagles are genetically differentiated from continental European birds, with thousands of years of separation creating a distinct population, though without sub-species assignation. They present unique research opportunities to examine barriers to movements illustrated by satellite tracking under Scotland's highly variable geography. We primarily examined two features, using more than seven million dispersal records from satellite tags fitted to 152 nestlings. The first was the presence of unsuitable terrestrial habitat. We found few movements across a region of largely unsuitable lowland habitat between upland regions substantially generated by geological features over 70 km apart (Highland Boundary Fault and Southern Uplands Fault). This was expected from the Golden Eagle Topography model, and presumed isolation was the premise for an ongoing reinforcement project in the south of Scotland, translocating eagles from the north (South Scotland Golden Eagle Project: SSGEP). Second was that larger expanses of water can be a barrier. We found that, for a northwestern archipelago (Outer Hebrides), isolated by ≥24 km of sea (and with prior assignation of genetical and historical separation), there were no tagged bird movements with the Inner Hebrides and/or the Highlands mainland (the main sub-population), confirming their characterisation as a second sub-population. Results on the willingness of eagles to cross open sea or sea lochs (fjords) elsewhere in Scotland were consistent on distance. While apparently weaker than the Outer Hebrides in terms of separation, the designation of a third sub-population in the south of Scotland seems appropriate. Our results validate the SSGEP, as we also observed no movement of birds across closer sea crossings from abundant Highland sources to the Southern Uplands. Based on telemetric results, we also identified where any re-colonisation of England, due to the SSGEP, is most likely to occur. We emphasise, nevertheless, that our study's records during dispersal will be greater than the natal dispersal distances (NDDs), when birds settle to breed after dispersal, and NDDs are the better shorter arbiter for connectivity. [ABSTRACT FROM AUTHOR]

Objective. To characterise cancer diagnosis in Scottish primary care in 2018/19 and draw comparisons with diagnostic activity in 2014. Methods. A national audit of cancer diagnosis undertaken in Scottish general practices. Participating GPs collected diagnostic pathway data on patients diagnosed with cancer in 2018/19 from medical records. These data were supplemented by linkage to the Scottish Cancer Registry and previous audit data from 2014. Analyses explored and compared patient demographics, presentation, diagnostic routes, and intervals. Results. Seventy-three practices submitted data on 2,014 cases in 2014 and 90 practices submitted data on 2,318 cases in 2018/2019. Individual demographics and types of cancer were similar. There was a higher proportion of USC (urgent suspected cancer) referrals in 2019 than 2014 (42.9% vs 38.1%, p = 0.008) but a similar proportion of emergency presentations (19.2% vs 20.4%). Primary care (median 4 (IQR 0–22) vs 5 (0–23)) and diagnostic intervals (27 (10–59) vs 30 (13–68)) were similar in both periods. Significantly fewer (24.5% vs 28.3, p = 0.015) had a diagnostic interval >60 days in 2019 than 2014. Harder to diagnose cancers were more likely to present as emergencies and be subject to prolonged delays in both cohorts. Conclusions. The 2014 and 2018/19 cohorts were broadly similar. There is limited evidence that USC use had increased between 2014 and 2018/19. Harder to diagnose cancers are still most likely to present as emergencies and be subject to delays. Overall, it seems there were small improvements in cancer diagnosis prepandemic and a further audit could examine evidence for a postpandemic recovery. [ABSTRACT FROM AUTHOR]

Aims: Pancreatic islet allotransplantation is an effective therapy for type 1 diabetes mellitus, restoring glycaemic control and hypoglycaemic awareness in patients with recurrent severe hypoglycaemia. Insulin independence following transplant is being increasingly reported; however, this is not a primary endpoint in the UK. Having surpassed 10 years of islet transplantation in Scotland, we aimed to evaluate the impact of insulin independence following transplant on metabolic outcomes and graft survival. Methods: We conducted a retrospective analysis on data collected prospectively between 2011 and 2022. Patients who underwent islet transplantation in Scotland up to the 31st January 2020 were included. Primary endpoint was graft survival (stimulated C‐peptide >50 pmol/L). Secondary endpoints included GOLD score, HbA1c, C‐peptide and insulin requirement. Outcomes were compared between patients who achieved insulin independence at any point following transplant versus those who did not. Results: 60 patients were included. 74.5% experienced >50 severe hypoglycaemic episodes in the year preceding transplant. There was a 55.0% decrease in insulin requirement following transplant and 30.0% achieved insulin independence. Mean graft survival time was 9.0 years (95% CI 7.2–10.9) in patients who achieved insulin independence versus 4.4 years (95% CI 3.4–5.3) in patients who did not. Insulin independence was associated with significantly improved graft function, glycaemic control and hypoglycaemic awareness at 1 year. Conclusions: This is the largest UK single‐centre study on islet transplant to date. Our findings demonstrate significantly improved outcomes in patients who achieved insulin independence following islet transplantation. [ABSTRACT FROM AUTHOR]

Despite advancements through satellite telemetry, knowledge of the behaviour and ecology of large raptors during natal dispersal is still poor, even though this transience phase is important in understanding the population dynamics and conservation of these keystone species. After this phase, which can take several years, the subsequent rapid transitional event on first territory settlement is less studied. It apparently occurs earlier without competition from existing territory occupants. The time of year when young large raptors settle on a territory has rarely been addressed empirically. Our study of seasonal timing of first settlement used data from 46 golden eagles GPS-tagged as nestlings in Scotland which were tracked to their first territory settlement, as adjudged by a robust algorithmic method. We show that when young golden eagles occupied their first territory, their settlements were uncommon in summer and most common in late winter/spring, but also occurred in autumn into early winter. The significant seasonal pattern was consistent, regardless of the probable prior occupancy status (vacant/occupied) of the settled territory (respectively, the likely absence or presence of defending territorial birds). This showed that seasonal territory settlement was unlikely to be related to any response from territory occupants. It infers further that seasonality in first territory settlement was underpinned by innate behaviours in dispersing eagles. Seasonal distribution of settlement dates was significantly different between sexes, with males more likely to settle in autumn, predominantly in prior vacant territories. We speculate on potential causative drivers behind our results and conclude that more research is clearly needed in this field of study. [ABSTRACT FROM AUTHOR]

Natal dispersal distance (NDD) is critical in understanding and defining populations and their conservation. It is defined as the linear distance between the natal location and first reproductive ('effective NDD') or potential reproductive ('gross NDD') location. It is a measure of gene flow and the functional connectivity across generations between individuals breeding in the same or different geographies. NDD is difficult to record in large raptors. GPS‐satellite telemetry has facilitated its recording. Previous Scottish studies showed that gross and effective NDD were apparently equivalent, and an algorithm based on telemetric data could identify the territory settlement timing and location of birds originally tagged as nestlings. We analysed natal dispersal data from 39 Golden Eagles GPS‐tagged in Scotland to estimate NDD. Raw median estimates were 29.8 km for males (n = 22) and 58.6 km for females (n = 17), 38.1 km averaged across sexes. Males had significantly shorter NDD, as theoretically predicted. Our NDD estimates were shorter but not grossly dissimilar to those from the USA, where sex differences in NDD had not been confirmed. Respective sample sizes may underly the latter contrast in confirmation. We also showed that in the absence of data from sexed birds, NDD estimates can be different. Natal dispersal duration was not related to NDD, suggesting that time to prospect a territory opportunity was not associated with the selected territory's distance from the natal site. The previous status of the subsequent settled territory (occupied or vacant) was also not related to NDD. We conclude that sex differences in NDD are important in application to population demography and conservation. Although we found no support for two other potential drivers of NDD (natal dispersal duration and previous territory status), identifying additional influences on NDD is in its infancy in large raptors and deserves more study. [ABSTRACT FROM AUTHOR]

Malcolm Petrie's book, "Politics and the People: Scotland, 1945–1979," focuses on the arguments and ideologies used by political parties in Scotland during this period. Petrie argues that support for the Scottish National Party (SNP) grew at the expense of the Unionist/Conservative party and the Liberal party. The SNP's appeal was based on classic liberal, anti-statist themes such as hostility to centralization and belief in local self-government. Petrie also discusses the Conservative and Labour parties, but does not delve into internal party history. The decline of heavy industry and the perception of control from London were key factors in the SNP's rise. David McCrone's study of contemporary Edinburgh explores the city's changing power dynamics. McCrone examines the town council, institutions like schools and the university, and property development. He argues that control has shifted to undemocratic bodies without roots in the city, leading to loss of local control and social impact. McCrone also touches on the excessive impact of tourism in Edinburgh. [Extracted from the article]

The study set out to examine the impact of the introduction of a national diabetic retinopathy screening programme in Scotland in 2006 on incidence and trends in severe sight impairment (SSI) certification due to diabetes over three decades. We analysed SSI certification due to diabetic eye disease in Fife, Scotland, between 2010 and 2019 and compared it to previously published estimates from 1990 onwards. Population estimates of the general population and those with diabetes were obtained from the National Records of Scotland and the National Diabetes Register, NHS SCI Diabetes, respectively. Mean annual incidence of SSI in the population with diabetes, 1990–2019, before and after the introduction of diabetic retinopathy screening was compared using a Mann–Whitney U Test. Mean incidence in 2007–2019 was 19.8/100,000 and was significantly less than the period before the systematic screening, 1990–2006 (57.5/100,000, p <.001). Mean SSI incidence due to diabetes in Fife between 2010 and 2019 was significantly lower than in the previous decades (p <.001) at 16.4 per 100,000 for the population with diabetes, per year (SD 10.0; 95% confidence interval: [9.2, 23.5]) compared to 42.7 per 100,000 in 2000–2009 and 64.3 per 100,000 in 1990–1999. This study demonstrates a significant reduction in the annual incidence of SSI due to diabetes before and after the introduction of the screening programme provides evidence for the benefit of systematic diabetic retinopathy screening programmes. Other factors including improved management of diabetes and risk factors will have also had an impact emphasizing the importance of a multidisciplinary approach to the prevention of sight loss in diabetes. [ABSTRACT FROM AUTHOR]

This study is based around Education Scotland's ambition to create a coherent learning framework for pupils aged 3–18, with particular focus on the technologies curricular area, and more specifically the subject of design and technology (D&T). The study investigates the views, definitions, and approaches adopted by primary and secondary educators applied to the D&T curricular area. Furthermore, the research explores curricular understanding and pedagogical approaches in addition to individual teacher's understanding of technology education. A mixed method research approach was utilised and applied within one local authority region in Scotland. Data was collected from primary teachers and secondary design and technology teachers using online questionnaires and interviews. Findings reveal that there is a varied approach to teaching design and technology across primary and secondary schools with educators recognising different definitions and pedagogical approaches in the subject. This indicates that pupils transitioning from primary to secondary learning will have to cope with these differing teaching approaches when studying design and technology. However, participants agree on the importance of the design element and application of the subject to real world scenarios. It is recommended that school communities find opportunities to collaborate further with the aim of creating a more continuous, coherent learning journey for young people in the design and technology curriculum area. These findings provide a basis for future professional discussion and critical reflection for practitioners in both primary and secondary sectors, and for leaders and administrators across Scotland, the UK and around the world. [ABSTRACT FROM AUTHOR]

Hybridisation between wild and domestic species poses a serious challenge to conservation management and can, potentially, lead to extinction. Alongside it, disease transmission will inevitably occur. However, the link between these two phenomena has historically been neglected. In Scotland, the European wildcat is particularly threatened by hybridisation with the domestic cat, a process promoted by long-term habitat loss, human encroachment, and persecution. Between 2015 and 2019, free-living cats (n = 120) were captured in six conservation priority areas of northern Scotland. Samples were collected for infectious disease screening (feline immunodeficiency virus, feline leukaemia virus, feline calicivirus, feline herpesvirus, Chlamydia felis, Mycoplasma felis, Bordetella bronchiseptica, Mycoplasma haemofelis, Candidatus Mycoplasma haemominutum, Candidatus Mycoplasma turicensis, and Tritrichomonas foetus) and genetic analysis. Polymerase chain reaction and reverse transcriptionPCR were used to detect infectious DNA or RNA, respectively. The hybrid score (Q) for each individual cat was determined using a 35-SNP-marker test. Statistical analysis investigated the association between Q and probability of infection, accounting for spatial clustering. The results confirmed the presence of 11 infectious agents circulating in the free-living cat population of northern Scotland, which consists of a hybrid swarm between F. silvestris and F. catus. For eight of them (feline leukaemia virus, feline herpesvirus C. felis, B. bronchiseptica, M. felis, M. haemofelis, Ca. M. haemominutum, and T. foetus), there was no significant association between infection probability and Q, supporting our hypothesis that the hybrid swarm may be functioning as a single epidemiological unit. Considering the impact of infectious diseases on health, welfare, and population dynamics of domestic cats, their presence in the extremely fragile and hybridised population of F. silvestris in Scotland could be population limiting or, potentially, contribute to local extinction. Comprehensive disease surveillance, risk analysis, and domestic cat management will be essential for the European wildcat conservation, particularly where hybridisation is increasing and anthropogenic factors are prevalent. [ABSTRACT FROM AUTHOR]

Population‐level disease risk varies between communities, and public health professionals are interested in mapping this spatial variation to monitor the locations of high‐risk areas and the magnitudes of health inequalities. Almost all of these risk maps relate to a single severity of disease outcome, such as hospitalization, which thus ignores any cases of disease of a different severity, such as a mild case treated in a primary care setting. These spatially‐varying risk maps are estimated from spatially aggregated disease count data, but the set of areal units to which these disease counts relate often varies by severity. Thus, the statistical challenge is to provide spatially comparable inference from multiple sets of spatially misaligned disease count data, and an additional complexity is that the spatial extents of the areal units for some severities are partially unknown. This paper thus proposes a novel spatial realignment approach for multivariate misaligned count data, and applies it to the first study delivering spatially comparable inference for multiple severities of the same disease. Inference is via a novel spatially smoothed data augmented MCMC algorithm, and the methods are motivated by a new study of respiratory disease risk in Scotland in 2017. [ABSTRACT FROM AUTHOR]

Research on potentially adverse effects of wind farms is an expanding field of study and often focuses on large raptors, such as golden eagles, largely because of their life history traits and extensive habitat requirements. These features render them sensitive to either fatality (collision with turbine blades) or functional habitat loss (avoidance through wariness of turbines). Simplistically, avoidance is antagonistic to collision; although, the two processes are not necessarily mutually exclusive in risk. A bird that does not enter a wind farm or avoids flying close to turbines cannot collide with a blade and be killed. In the USA, collision fatality is implicated as the typical adverse effect. In Scotland, avoidance of functional habitat loss appears more likely, but this depends in part on the habitat suitability of turbine locations. Previous Scottish studies have largely concentrated on the responses of GPS-tagged non-territorial golden eagles during dispersal. Several arguments predict that territorial eagles may have lower avoidance (be less wary) of turbines than non-territorial birds. Hence, we contrasted the responses of GPS-tagged non-territorial (intruding) and territorial eagles to the same turbines at 11 operational Scottish wind farms. We show that territorial eagles rarely approached turbines, but, as in previous Scottish studies of non-territorial birds, the spatial extent of avoidance depended on the habitat suitability of both turbine locations and their wider surroundings. Unexpectedly, we found that territorial eagles were apparently as wary as intruding non-territorial conspecifics of the same turbines. Our results show that regardless of age or territorial status, Scottish golden eagles largely avoided wind turbine locations, but this avoidance was conditional, in part, on where those turbines were located. Responses to turbines were also strongly dependent on birds' identities and different wind farms. We speculate on how widespread our findings of avoidance of turbines by golden eagles are elsewhere in Europe, where there appear to be no published studies showing the level of collision fatalities documented in the USA. [ABSTRACT FROM AUTHOR]

Aims: To describe type 1 diabetes incidence in Scotland between 2006 and 2019. Methods: Repeated annual cross‐sectional studies of type 1 diabetes incidence were conducted. Incident cases were identified from the Scottish Care Information—Diabetes Collaboration (SCI‐DC), a population‐based register of people with diagnosed diabetes derived from primary and secondary care data. Mid‐year population estimates for Scotland were used as the denominator to calculate annual incidence with stratification by age and sex. Joinpoint regression was used to investigate whether incidence changed during the study period. Age and sex‐specific type 1 diabetes incidence over the whole time period was estimated by quintile of the Scottish Index of Multiple Deprivation (SIMD), an area‐based measure, in which Q1 and Q5 denote the most and least deprived fifths of the population, respectively, with quasi‐Poisson regression used to compare incidence for Q5 compared to Q1. Results: The median (IQR) age of the study population of 14,564 individuals with incident type 1 diabetes was 24.1 (12.3–42.4) years, 56% were men, 23% were in Q1 and 16% were in Q5. Incidence of T1DM was higher in men than women overall (at around 22 and 17 per 100,000, respectively) and in under 15 year olds (approximately 40 per 100,000 in both sexes) than other age groups and was similar across the study period in all strata. There was an inverse association between socio‐economic status and type 1 diabetes incidence for 15–29, 30–49 and 50+ year olds [incidence rate ratio (IRR) for Q5 compared to Q1; IRR (95% CI) 0.52 (0.47–0.58), 0.68 (0.61–0.76) and 0.53(0.46–0.61), respectively] but not for under 15 year olds [1.02 (0.92–1.12)]. Conclusion: Incidence of type 1 diabetes varies by age, sex and socio‐economic status and has remained approximately stable from 2006 to 2019 in Scotland. [ABSTRACT FROM AUTHOR]

The involvement of citizens in the production and creation of public services has become a central tenet for administrations internationally. In Scotland, co-production has underpinned the integration of health and social care via the Public Bodies (Joint Working) (Scotland) Act 2014. We report on a qualitative study that examined the experiences and perspectives of local and national leaders in Scotland on undertaking and sustaining co-production in public services. By adopting a meso and macro perspective, we interviewed senior planning officers from eight health and social care partnership areas in Scotland and key actors in national agencies. The findings suggest that an overly complex Scottish governance landscape undermines the sustainability of co-production efforts. As part of a COVID-19 recovery, both the implementation of meaningful co-production and coordinated leadership for health and social care in Scotland need to be addressed, as should the development of evaluation capacities of those working across health and social care boundaries so that co-production can be evaluated and report to inform the future of the integration agenda. [ABSTRACT FROM AUTHOR]

Recognition of peatlands as a key natural store of terrestrial carbon has led to new initiatives to protect and restore them. Some afforested bogs are being clear‐felled and restored (forest‐to‐bog restoration) to recover pre‐afforestation ecosystem function. However, little is known about differences in the peat properties between intact, afforested and restored bogs. A stratified random sampling procedure was used to take 122 peat cores from three separate microforms associated with intact (hollows; hummocks; lawns), afforested and restored bogs (furrows; original surface; ridges) at two raised and two blanket bog locations in Scotland. Common physical and chemical peat properties at eight depths were measured in the laboratory. Differences in bulk density, moisture and carbon content between the afforested (mean = 0.103 g cm−3, 87.8% and 50.9%, respectively), intact (mean = 0.091 g cm−3, 90.3% and 51.3%, respectively) and restored bogs (mean = 0.095 g cm−3, 89.7% and 51.1%, respectively) were small despite their statistical significance. The pH was significantly lower in the afforested (mean = 4.26) and restored bogs (mean = 4.29) than the intact bogs (mean = 4.39), whereas electrical conductivity was significantly higher (mean: afforested = 34.2, restored = 38.0, intact = 25.3 μS cm−1). While significant differences were found between treatments, effect sizes were mainly small, and greater differences in pH, electrical conductivity, specific yield and hydraulic conductivity existed between the different intact bogs. Therefore, interactions between geographic location and land management need to be considered when interpreting the impacts of land‐use change on peatland properties and functioning. [ABSTRACT FROM AUTHOR]

Providing care for the dependent older person is complex and there have been persistent concerns about care quality as well as a growing recognition of the need for systems approaches to improvement. The I-SCOPE (Improving Systems of Care for the Older person) project employed Resilient Healthcare (RHC) theory and the CARE (Concepts for Applying Resilience) Model to study how care organisations adapt to complexity in everyday work, with the aim of exploring how to support resilient performance. The project was an in-depth qualitative study across multiple sites over 24 months. There were: 68 hours of non-participant observation, shadowing care staff at work and starting broad before narrowing to observe care domains of interest; n = 33 recorded one-to-one interviews (32 care staff and one senior inspector); three focus groups (n = 19; two with inspectors and one multi-disciplinary group); and five round table discussions on emergent results at a final project workshop (n = 31). All interviews and discussion groups were recorded and transcribed verbatim. Resident and family interviews (n = 8) were facilitated through use of emotional touchpoints. Analysis using QSR NVivo 12.0 focused on a) capturing everyday work in terms of the interplay between demand and capacity, adaptations and intended and unintended outcomes and b) a higher-level thematic description (care planning and use of information; coordination of everyday care activity; providing person-centred care) which gives an overview of resilient performance and how it might be enhanced. This gives important new insight for improvement. Conclusions are that resilience can be supported through more efficient use of information, supporting flexible adaptation, coordination across care domains, design of the physical environment, and family involvement based on realistic conversations about quality of life. [ABSTRACT FROM AUTHOR]

Even though sunlight is viewed as the most important determinant of 25-hydroxyvitamin D (25(OH)D) status, several European studies have observed higher 25(OH)D concentrations among north-Europeans than south-Europeans. We studied the association between geographical latitude (derived from ecological data) and 25(OH)D status in six European countries using harmonised immunoassay data from 81 084 participants in the Biomarkers for Cardiovascular Risk Assessment in Europe (BiomarCaRE) project (male sex 48·9 %; median age 50·8 years; examination period 1984–2014). Quantile regression models, adjusted for age, sex, decade and calendar week of sampling and time from sampling to analysis, were used for between-country comparisons. Up until the median percentile, the ordering of countries by 25(OH)D status (from highest to lowest) was as follows: Sweden (at 65·6–63·8°N), Germany (at 48·4°N), Finland (at 65·0–60·2°N), Italy (at 45·6–41·5°N), Scotland (at 58·2–55·1°N) and Spain (at 41·5°N). From the 75th percentile and upwards, Finland had higher values than Germany. As an example, using the Swedish cohort as a comparator, the median 25(OH)D concentration was 3·03, 3·28, 5·41, 6·54 and 9·28 ng/ml lower in the German, Finnish, Italian, Scottish and Spanish cohort, respectively (P -value < 0·001 for all comparisons). The ordering of countries was highly consistent in subgroup analyses by sex, age, and decade and season of sampling. In conclusion, we confirmed the previous observation of a north-to-south gradient of 25(OH)D status in Europe, with higher percentile values among north-Europeans than south-Europeans. [ABSTRACT FROM AUTHOR]

Habitat quality can have far‐reaching effects on organismal fitness, an issue of concern given the current scale of habitat degradation. Many temperate upland streams have reduced nutrient levels due to human activity. Nutrient restoration confers benefits in terms of invertebrate food availability and subsequent fish growth rates. Here we test whether these mitigation measures also affect the rate of cellular ageing of the fish, measured in terms of the telomeres that cap the ends of eukaryotic chromosomes. We equally distributed Atlantic salmon eggs from the same 30 focal families into 10 human‐impacted oligotrophic streams in northern Scotland. Nutrient levels in five of the streams were restored by simulating the deposition of a small number of adult Atlantic salmon Salmo salar carcasses at the end of the spawning period, while five reference streams were left as controls. Telomere lengths and expression of the telomerase reverse transcriptase (TERT) gene that may act to lengthen telomeres were then measured in the young fish when 15 months old. While TERT expression was unrelated to any of the measured variables, telomere lengths were shorter in salmon living at higher densities and in areas with a lower availability of the preferred substrate (cobbles and boulders). However, the adverse effects of these habitat features were much reduced in the streams receiving nutrients. These results suggest that adverse environmental pressures are weakened when nutrients are restored, presumably because the resulting increase in food supply reduces levels of both competition and stress. [ABSTRACT FROM AUTHOR]

As part of work to develop Infant Mental Health services and systems in Scotland, the authors embarked on a project to facilitate the voices of babies and young children in our work, in the appraisal and evaluation of that work and in the design and development of our services. Our Best Practice Guidelines provide guidance on how to take account of infants' views and rights in all encounters they may have with professionals in statutory or third sector services, or in public spaces, such as shops, libraries or galleries. The Infant Pledge details what babies and young children should expect from adults. In this paper, we will describe theoretical considerations underpinning this initiative and also place the work in the context of relevant policies and legislation, including the UNCRC. [ABSTRACT FROM AUTHOR]

Background: Intercostal chest drain (ICD) insertion is a skill that medical trainees lack confidence in performing. This study explores the impact of a national programme of Simulation-Based Mastery Learning (SBML) on procedural confidence, including the impact of time intervals between booster sessions and interim clinical experience. Methods: Internal Medicine Trainees in Scotland were surveyed about confidence and clinical experience with ICD insertion before and immediately after SBML and booster session. Data were matched and analysed using paired sample t-tests. Short interval and long interval groups were compared using Student's unpaired t-test. The impact of interim clinical experience was assessed using Analysis of Variance. Results: Mean confidence in ICD insertion rose following SBML, fell between initial and booster session, and increased again following booster session (P = < 0.001). 33 of 74 trainees had successfully inserted an ICD between sessions. Fall in confidence was unaffected by the time interval between training sessions, but was mitigated by interim clinical experience. Conclusions: SBML boosts trainee confidence in ICD insertion. However, there is evidence of confidence decay, possibly due to a lack of clinical experience between sessions. More research is needed to explore barriers to transfer of skills from simulated to real-world environments. [ABSTRACT FROM AUTHOR]

There remains a considerable concern among both patients and oncologists that having a live birth (LB) after breast cancer might adversely impact survival. analysis of survival in a national cohort of women with breast cancer diagnosed at age 20–39 years between 1981 and 2017 (n = 5181), and subsequent LB using Scottish Cancer Registry and national maternity records. Cases had at least one subsequent LB, each was matched with up to six unexposed cases without subsequent LB, accounting for guaranteed time bias. In 290 women with a LB after diagnosis, overall survival was increased compared to those who did not have a subsequent LB, HR 0.65 (95%CI 0.50–0.85). Women with subsequent LB who had not had a pregnancy before breast cancer showed increased survival (HR 0.56, 0.38–0.82). There was a progressively greater interaction of subsequent LB with survival with younger age, thus for women aged 20–25 years, HR 0.30 (0.12–0.74) vs. those aged 36–39, HR 0.89 (0.42–1.87). In women with LB within five years of diagnosis, survival was also increased (HR 0.66; 0.49–0.89). Survival following LB was similar to unexposed women by ER status (both positive and negative) and in those known to have been exposed to chemotherapy. This analysis provides further evidence that for the growing number of women who wish to have children after breast cancer, LB does not have a negative impact on overall survival. This finding was confirmed within subgroups, including the youngest women and those not previously pregnant. • The impact of childbirth on survival after breast cancer remains controversial. • National cancer and birth data were used to analyse an unbiased large cohort. • Live birth was associated with improved or similar survival after breast cancer. • This was confirmed by age at diagnosis, previous pregnancy, and ER status. • These findings are reassuring for young women wishing children after breast cancer. [ABSTRACT FROM AUTHOR]

Objective: To understand the process of formulating, implementing and enacting national recommendations into practice, by exploring the interactions between government policymakers and national and local organisations supporting and delivering policy implementation within a Child and Adolescent Mental Health Service (CAMHS) context in Scotland. Methods: Data collection involved 16 semi-structured individual and four focus group interviews with a purposeful sample of policymakers, national health and social care stakeholders and local outpatient and inpatient CAMHS teams representing three NHS health boards in Scotland. Results: Study participants highlighted the challenges of navigating through evolving and often conflicting policy agendas, seen to not acknowledging the current evidence base or experiential learning from services and prior evaluations. Accounts of transformation fatigue often emerged from increased expectations for staff to adopt new approaches to accommodate constantly changing recommendations. Participants also reported a lack of integration and implementation support from national health and social care organisations, leading to duplication of effort and gaps in provision or waste. Policy recommendations were perceived as sometimes vague, lacking clarity about how to deliver service transformation using a whole-system approach. The collective narratives reflected increased tension between the need for local autonomy to innovate and the limitations created vertically by the relative inflexibility of policy recommendations, and horizontally by the proliferation of national organisations delivering the same transformation aims using different approaches in a resource-constrained environment. Conclusion: The findings contribute to the wider literature by offering an exploration of importance of evaluation and evidence uptake in policy formulation; the roles and remits in supporting the implementation of policy recommendations; and how the dynamics of central control and local autonomy might impact on the local enactment of policy recommendations. [ABSTRACT FROM AUTHOR]

In this paper we use a numerical glacier-climate model, a detailed photogrammetric survey and lichenometry to reconstruct small palaeoglaciers on Ben Nevis and surrounding mountains in western Scotland. These glaciers would have been sustained under a climate where the mean annual air temperature was –1.0°C to –2.0°C compared to present-day values either with or without a decrease in precipitation amount of 10–30%. Historical meteorological data show that these air temperatures were reached on Ben Nevis in the latter part of the 19th century. Although we have no data on the age of these small glaciers, palaeoclimate reconstructions suggest that such conditions almost certainly existed several times during the Holocene in Scotland; the last time being the Little Ice Age of the 16th to 19th Centuries. We argue from this that small Scottish glaciers may have been able to develop in high sheltered cirques at many times during the Holocene and that the glacial history of Scotland therefore requires revision. [ABSTRACT FROM AUTHOR]

Offshore wind is in a rapid transitional phase, pushed worldwide by efforts of those to reduce climate change. Wind power is becoming a commercialised, unsubsidised competitive form of low carbon generation of renewable energy. Marketplaces reflect this growing trend with the first introduction of subsidy free bids in a tender for the Dutch and German governments. The analysis of surrounding literature of subsidy free bids and governmental policies revealed that integration of subsidy free bids have been carried out to various extents. Bids like those seen in the German and Dutch governments have been done in accompaniment with supportive policies and measures. For the UK, a possible subsidy free bid could be developed under the Scottish Sectoral Marine Plan. Owing to that, this paper investigates the feasibility of a subsidy free bid for the Scottish government. Utilising the Department for Business, Energy and Industrial Strategy (BEIS) levelised cost of electricity (LCOE) metric were inserted into a detailed excel spreadsheet. This paper calculates multiple financial scenarios under the LCOE metric to provide an insight into the possible scenarios of which different models of subsidy free bids can be implemented. The main parameters associated with the BEIS metric and calculator design were investigated. These included financial cost predictions, discount rate, generational capacity and net capacity factors. The final conclusion of the generated output data, showed it was indeed possible to adopt a subsidy free bid under the current UK contract for difference (CfD) scheme under strict and favourable conditions. [ABSTRACT FROM AUTHOR]

Introduction: On 1 May 2018 Scotland introduced a minimum unit price (MUP) of GB50 pence per unit of alcohol (8 g) sold. We analysed household purchase data to assess the impact of MUP in shifting purchases from higher to lower strength beers. Methods: Data from Kantar Worldpanel's household shopping panel, with 75 376 households and 4.76 million alcohol purchases, 2015–2020. We undertook interrupted time series analyses of the impact of introducing MUP in Scotland on changes in the proportion of the volume of purchased beer with an alcohol by volume (ABV) ≤3.5% using purchases in England as control. We analysed the moderating impact of the volume of purchased beer with an ABV ≤3.5% on the size of the associated impact of MUP in reducing purchases of grams of alcohol within beer. Results: MUP was associated with a relative increase in the proportion of the volume of beer purchased with an ABV ≤3.5%, Scotland minus England, of 10.9% (95% CI 10.6–11.1), following a 43.6% (95% CI 40.1–47.1) increase in the volume of beer purchased with an ABV ≤3.5%, and a 9.6% (95% CI 9.4–9.8) decrease in the volume of beer purchased with an ABV >3.5%. MUP was associated with reduced purchases of grams of alcohol within beer by 8% (95% CI 7.8–8.3), increasing to 9.6% (95% CI 9.3–9.9), when accounting for the moderating impact of shifts to lower strength beer. Discussion and Conclusions: MUP seems an effective policy to reduce off‐trade purchases of alcohol and encourage shifts to lower strength beers. [ABSTRACT FROM AUTHOR]

Poverty, poor housing and poor health are complexly interconnected in a cycle that has proven resistant to intervention by housing providers or policy makers. Research often focuses on the impacts of the physical housing defects, particularly upon rates of (physical) illness and disease. There has been comparatively little research into the ways in which housing services can underpin the generation of positive health and, especially, wellbeing. Drawing on qualitative data from 75 tenants in the social and private rented sectors, this paper describes the findings of a research project that tracked tenants' experiences across their first year in a new tenancy in Greater Glasgow, Scotland. The project collected data on tenants' perceptions of housing and housing service quality, financial coping and health and wellbeing, which was analysed using the principles of Realist Evaluation to elucidate impacts and causal pathways. Being able to establish a sense of home was key to tenants' wellbeing. The home provided many tenants with a recuperative space in which to shelter from daily stressors and was a source of autonomy and social status. A sense of home was underpinned by aspects of the housing service, property quality and affordability which are potentially amenable to intervention by housing providers. These findings raise questions about the extent to which social housing providers and the private rental market in the UK are able to meet the needs of vulnerable tenants. They suggest that approaches to housing provision that go beyond providing a basic dwelling are needed to successfully intervene in the cycle of poverty, poor housing and poor health. [ABSTRACT FROM AUTHOR]

Background: For people experiencing homelessness and problem substance use, access to appropriate services can be challenging. There is evidence that the development of trusting relationships with non-judgemental staff can facilitate service engagement. Peer-delivered approaches show particular promise, but the evidence base is still developing. Methods: The study used mixed methods to assess the feasibility, acceptability and accessibility of a peer-delivered, relational intervention to reduce harms and improve health/well-being, quality of life and social functioning, for people experiencing homelessness and problem substance use. Four Peer Navigators were employed to support individuals (n = 68 total, intervention participants). They were based in outreach services and hostels in Scotland and England. Qualitative interviews were conducted with intervention participants, Peer Navigators and staff in services, and observations were conducted in all settings. Quantitative outcomes relating to participants' substance use, physical and mental health, and quality of the Peer Navigator relationship, were measured via a 'holistic health check' with six questionnaires completed at two time-points. Results: The intervention was found to be acceptable to, and feasible and accessible for, participants, Peer Navigators, and service staff. Participants reported improvements to service engagement, and feeling more equipped to access services independently. The lived experience of the Peer Navigators was highlighted as particularly helpful, enabling trusting, authentic, and meaningful relationships to be developed. Some challenges were experienced in relation to the 'fit' of the intervention within some settings. Among participants there were reductions in drug use and risky injecting practices. There were increases in the number of participants receiving opioid substitution therapy. Overall, the intervention was positively received, with collective recognition that the intervention was unique and highly valuable. While most of the measures chosen for the holistic health check were found to be suitable for this population, they should be streamlined to avoid duplication and participant burden. Conclusions: The study established that a peer-delivered, relational harm reduction intervention is acceptable to, and feasible and accessible for, people experiencing homelessness and problem substance use. While the study was not outcomes-focused, participants did experience a range of positive outcomes. A full randomised controlled trial is now required to assess intervention effectiveness. Trial registration: Study registered with ISRCTN: 15900054. [ABSTRACT FROM AUTHOR]

Objective: To assess family size and timescale for achieving pregnancy in women who remain fertile after cancer.Design: Population-based analysis.Setting: National databases.Patient(s): All women diagnosed with cancer before the age of 40 years in Scotland, 1981-2012 (n = 10,267) with no previous pregnancy; each was matched with 3 population controls.Intervention(s): None.Main Outcome Measure(s): The number and timing of pregnancy and live birth after cancer diagnosis, to 2018.Result(s): In 10,267 cancer survivors, the hazard ratio for a subsequent live birth was 0.56 (95% confidence interval, 0.53-0.58) overall. In women who achieved a subsequent pregnancy, age at live birth increased (mean ± SD, 31.2 ± 5.5 vs. 29.7 ± 6.1 in controls), and the family size was lower (2.0 ± 0.8 vs. 2.3 ± 1.1 live births). These findings were consistent across several diagnoses. The interval from diagnosis to last pregnancy was similar to that of controls (10.7 ± 6.4 vs. 10.9 ± 7.3 years) or significantly increased, for example, after breast cancer (6.2 ± 2.8 vs. 5.3 ± 3.3 years) and Hodgkin lymphoma (11.1 ± 5.1 vs. 10.1 ± 5.8 years).Conclusion(s): These data quantify the reduced chance of live birth after cancer. Women who subsequently conceived achieved a smaller family size than matched controls, but the period of time after cancer diagnosis across which pregnancies occurred was similar or, indeed, increased. Thus, we did not find evidence that women who were able to achieve a pregnancy after cancer had a shorter timescale over which they have pregnancies. [ABSTRACT FROM AUTHOR]

Over the last few decades, the nature of life sciences research has changed enormously, generating a need for a workforce with a variety of computational skills such as those required to store, manage, and analyse the large biological datasets produced by next-generation sequencing. Those with such expertise are increasingly in demand for employment in both research and industry. Despite this, bioinformatics education has failed to keep pace with advances in research. At secondary school level, computing is often taught in isolation from other sciences, and its importance in biological research is not fully realised, leaving pupils unprepared for the computational component of Higher Education and, subsequently, research in the life sciences. The 4273pi Bioinformatics at School project (https://4273pi.org) aims to address this issue by designing and delivering curriculum-linked, hands-on bioinformatics workshops for secondary school biology pupils, with an emphasis on equitable access. So far, we have reached over 180 schools across Scotland through visits or teacher events, and our open education resources are used internationally. Here, we describe our project, our aims and motivations, and the practical lessons we have learned from implementing a successful bioinformatics education project over the last 5 years. [ABSTRACT FROM AUTHOR]

British supermarket-panel data suggest no increases in overall sales and purchases of alcohol following COVID-19 lockdowns, yet survey and mortality data suggest otherwise. This paper attempts to unravel the paradox. Based on purchase data of 79,417 British households from Kantar Worldpanel, we undertake controlled interrupted time series analysis of the impact of COVID-19 confinement introduced on 23rd March 2020, and variably applied during 2020, compared to purchases during 2015 to 2019 as controls. We also undertook Poisson regression analyses to estimate if changes in purchases differed by household socio-demographic and economic factors. Excess off-trade household alcohol purchases (expressed as grams of ethanol) following the introduction of confinement, were 29.2% higher (95% CI = 25.8% to 32.5%) for the post-confinement months of 2020, being larger until mid-July 2020 (37.5%, 95%CI = 33.9 to 41.26%) when pubs re-opened with restrictions, and smaller (24.6%, 95%CI = 21.6 to 27.7) thereafter. During the time of complete pub closures, and fully adjusting for no on-trade purchases, household purchases of alcohol did not change when compared with the same time period during 2015–2019 (coefficient = -0.9%, 95%CI = -5.6 to 3.8). Excess purchases from 23rd March to 31st December 2020 varied by region of Great Britain, being higher in the north of England, and lower in Scotland and Wales. Excess purchases were greater in the most deprived households, compared with the least deprived households. Excess purchases increased substantially as the amount of alcohol normally purchased by a household increased, with the top one fifth of households that normally bought the most alcohol increasing their purchases more than 17 times than the bottom one fifth of households that bought the least alcohol. That the heaviest buyers of alcohol increased their purchases the most, with some independent impact of socio-economic disadvantage, might explain why reported alcohol problems and recent alcohol-related death rates might have increased. A conclusion of this is that alcohol policy to reduce high consumption of alcohol, and the availability of help and treatment to reduce alcohol consumption become more important during extraordinary times, such as COVID lockdowns. [ABSTRACT FROM AUTHOR]

Purpose There are limited real-world data on long-term mortality and visual outcomes in patients treated with anti-vascular endothelial growth factor (VEGF) for exudative age-related macular degeneration (exudative AMD). We assessed 10-year mortality and clinical outcomes in exudative AMD patients treated with intravitreal therapy (IVT) anti-VEGF injections on a pro-re-nata (PRN) regime following a standard loading regime. Methods Retrospective cohort study of the first 216 exudative AMD patients receiving IVT anti-VEGF for exudative AMD at a public tertiary referral hospital in Scotland. Main outcome measures were mortality, cause of death and best-corrected visual acuity (BCVA). Results A total of 216 patients were included. Mean age at presentation was 79.1 years [standard deviation (SD) 6.9]. Mean follow-up duration was 6.6 years (SD 3.2) during which there was a mean 24.3 Early Treatment Diabetic Retinopathy Study (ETDRS) letter loss in BCVA (P  < 0.0001). Patients received a mean of 2.2 (SD 1.8) injections per year of follow-up. Overall, 52.6% (113/216) died during the period studied. Observed annual mortality incidence risk was 6.5% (SD 3.1) and was found to be significantly lower (P  = 0.0064) than the expected annual death incidence risk (9.6%, SD 1.5) based on age and sex standardised Scottish mortality risk. The most common causes of death were malignancies (21.3%) and infection (20.0%). Conclusions This study highlights the relatively good long-term prognosis in vision and mortality in exudative AMD treated with a PRN regime in the real world. Although the majority lost vision, the rate of decline was significantly slower than that which would have been experienced in the pre-anti-VEGF era and reassuringly standardised mortality risk was lower than the national average. [ABSTRACT FROM AUTHOR]

Wind farms may have two broad potential adverse effects on birds via antagonistic processes: displacement from the vicinity of turbines (avoidance), or death through collision with rotating turbine blades. Large raptors are often shown or presumed to be vulnerable to collision and are demographically sensitive to additional mortality, as exemplified by several studies of the Golden Eagle Aquila chrysaetos. Previous findings from Scottish Eagles, however, have suggested avoidance as the primary response. Our study used data from 59 GPS‐tagged Golden Eagles with 28 284 records during natal dispersal before and after turbine operation < 1 km of 569 turbines at 80 wind farms across Scotland. We tested three hypotheses using measurements of tag records' distance from the hub of turbine locations: (1) avoidance should be evident; (2) older birds should show less avoidance (i.e. habituate to turbines); and (3) rotor diameter should have no influence (smaller diameters are correlated with a turbine's age, in examining possible habituation). Four generalized linear mixed models (GLMMs) were constructed with intrinsic habitat preference of a turbine location using Golden Eagle Topography (GET) model, turbine operation status (before/after), bird age and rotor diameter as fixed factors. The best GLMM was subsequently verified by k‐fold cross‐validation and involved only GET habitat preference and presence of an operational turbine. Eagles were eight times less likely to be within a rotor diameter's distance of a hub location after turbine operation, and modelled displacement distance was 70 m. Our first hypothesis expecting avoidance was supported. Eagles were closer to turbine locations in preferred habitat but at greater distances after turbine operation. Results on bird age (no influence to 5+ years) rejected hypothesis 2, implying no habituation. Support for hypothesis 3 (no influence of rotor diameter) also tentatively inferred no habituation, but data indicated birds went slightly closer to longer rotor blades although not to the turbine tower. We proffer that understanding why avoidance or collision in large raptors may occur can be conceptually envisaged via variation in fear of humans as the 'super predator' with turbines as cues to this life‐threatening agent. [ABSTRACT FROM AUTHOR]

Purpose: Traumatic abdominal injury is associated with significant mortality, especially in hemodynamically unstable patients. Trauma management now supports more conservative surgical management with judicious non-operative management. The aim of this study is to use STAG data to characterize abdominal trauma outcomes, focusing on factors that may influence mortality. Methods: A retrospective analysis of prospectively collected STAG data was queried using AIS codes for Scottish abdominal trauma patients between 2011 and 2015. Patients were divided into non-survivor and survivor groups, reflecting mortality. Following this, outcomes and injury patterns of patients undergoing operative or non-operative management were compared between groups. Results: A total of 1226 were analyzed. The mean age of the cohort was 42.47 ± 19.42 years, with most patients suffering blunt injuries. Non-survivors had more severe injuries to the liver, diaphragm, pancreas, vasculature, and pelvis (p < 0.001, p = 0.005, p = 0.025, p < 0.001, and p < 0.001, respectively). Survivors more often received CT scanning (0.09 [0.03–0.27]) and underwent surgical intervention (57.4% vs 39.7%; p = 0.001). Non-survivors more often had a shorter time till operative intervention (2.6 h vs 6.3 h, p < 0.001). Conclusions: About 7% of patients in the STAG registry display abdominal injury. Mortality was found to have strong associations with older age, hemodynamic instability, poor neurological status, and head and neck injury. Outcomes may improve with the anticipated creation of the Scottish Trauma System. [ABSTRACT FROM AUTHOR]

During the COVID-19 outbreak, most face-to-face teaching and practice-based learning placements were suspended. Universities provided ongoing health and social care education, including interprofessional education, using online technology. Focusing on changes in the delivery of interprofessional education, this second article in a series on interprofessional education provides an international perspective through facilitators' case reports. It considers the key factors that enabled a rapid shift from face-to-face to online interprofessional education, and the key aspects that had to change. The significant changes reported from literature and case reports reflect on remote and online learning, the duration of education sessions, individual and team learning aspects and facilitation skills. [ABSTRACT FROM AUTHOR]

Long short-term memory (LSTM) models are recurrent neural networks from the field of deep learning (DL) which have shown promise for time series modelling, especially in conditions when data are abundant. Previous studies have demonstrated the applicability of LSTM-based models for rainfall–runoff modelling; however, LSTMs have not been tested on catchments in Great Britain (GB). Moreover, opportunities exist to use spatial and seasonal patterns in model performances to improve our understanding of hydrological processes and to examine the advantages and disadvantages of LSTM-based models for hydrological simulation. By training two LSTM architectures across a large sample of 669 catchments in GB, we demonstrate that the LSTM and the Entity Aware LSTM (EA LSTM) models simulate discharge with median Nash–Sutcliffe efficiency (NSE) scores of 0.88 and 0.86 respectively. We find that the LSTM-based models outperform a suite of benchmark conceptual models, suggesting an opportunity to use additional data to refine conceptual models. In summary, the LSTM-based models show the largest performance improvements in the north-east of Scotland and in south-east of England. The south-east of England remained difficult to model, however, in part due to the inability of the LSTMs configured in this study to learn groundwater processes, human abstractions and complex percolation properties from the hydro-meteorological variables typically employed for hydrological modelling. [ABSTRACT FROM AUTHOR]

Background: Access to high-quality palliative care is inadequate for most people living and dying with serious illness. Policies aimed at optimising delivery of palliative and end of life care are an important mechanism to improve quality of care for the dying. The extent to which palliative care is included in national health policies is unknown. We aimed to identify priorities and opportunities for palliative and end of life care in national health policies in the UK. Methods: Documentary analysis consisting of 1) summative content analysis to describe the extent to which palliative and end of life care is referred to and/or prioritised in national health and social care policies, and 2) thematic analysis to explore health policy priorities that are opportunities to widen access to palliative and end of life care for people with serious illness. Relevant national policy documents were identified through web searches of key government and other organisations, and through expert consultation. Documents included were UK-wide or devolved (i.e. England, Scotland, Northern Ireland, Wales), health and social care government strategies published from 2010 onwards. Results: Fifteen policy documents were included in the final analysis. Twelve referred to palliative or end of life care, but details about what should improve, or mechanisms to achieve this, were sparse. Policy priorities that are opportunities to widen palliative and end of life care access comprised three inter-related themes: (1) integrated care – conceptualised as reorganisation of services as a way to enable improvement; (2) personalised care – conceptualised as allowing people to shape and manage their own care; and (3) support for unpaid carers – conceptualised as enabling unpaid carers to live a more independent lifestyle and balance caring with their own needs. Conclusions: Although information on palliative and end of life care in UK health and social care policies was sparse, improving palliative care may provide an evidence-based approach to achieve the stated policy priorities of integrated care, personalised care, and support for unpaid carers. Aligning existing evidence of the benefits of palliative care with the three priorities identified may be an effective mechanism to both strengthen policy and improve care for people who are dying. [ABSTRACT FROM AUTHOR]

Background: The transfer of training to the workplace is the aim of training interventions. Three primary factors influence transfer: trainee characteristics, training design and work environment influences. Within medical education, the work environment factors influencing transfer of training remain underexplored. Burke and Hutchins' review of training transfer outlined five work environment influences: opportunity to perform, supervisor/peer support, strategic link, transfer climate and accountability. This study aimed to explore the ways in which work environment factors influence the transfer of training for medical trainees. Methods: Internal Medicine Training in Scotland includes a three-day boot camp involving simulation-based mastery learning of procedural skills, immersive simulation scenarios and communication workshops. Following ethical approval, trainees were invited to take part in interviews at least three months after following their boot camp. Interviews were semi-structured, anonymised, transcribed verbatim and analysed using template analysis. Member checking interviews were performed to verify findings. Results: A total of 26 trainees took part in interviews between January 2020 and January 2021. Trainees reported a lack of opportunities to perform procedures in the workplace and challenges relating to the transfer climate, including a lack of appropriate equipment and resistance to change in the workplace. Trainees described a strong sense of personal responsibility to transfer and they felt empowered to change practice in response to the challenges faced. Conclusions: This study highlights barriers to transfer of training within the clinical workplace including procedural opportunities, a transfer climate with challenging equipment availability and, at times, an unsupportive workplace culture. Trainees are driven by their own sense of personal responsibility; medical educators and healthcare leaders must harness this enthusiasm and take heed of the barriers to assist in the development of strategies to overcome them. [ABSTRACT FROM AUTHOR]

This article contributes to a growing body of research on the police reforms in Scotland. It examines the particular place given to prevention in public policy and its impact on police practice. We show how public policy reconfigured the place and purpose of prevention for the police, with a focus on safety, wellbeing, and the prevention of harm. The research draws on qualitative data collected in four areas as part of a 4-year evaluation of the police reforms. We refine a public health typology of prevention and operationalize it empirically for the first time to analyse cases of innovative practice. We distinguish a pattern of prevention practice heavily weighted towards secondary prevention, focused predominantly on issues of crime and disorder. In fewer cases, the police applied primary and tertiary prevention, with a focus on vulnerability and harm. Looking in detail at two cases, we illustrate the importance of collaboration for the police, which created opportunities and brought additional resources and expertise to support new prevention approaches which had a significant impact on effectiveness. The police realized collaborative advantage through common aims, trust-building, and leadership. We do not suggest this demonstrates a transformation in police prevention; it illustrates successful police innovation, and identifies the potential to go further. The implications for policy and practice are to recognize the value to the police of investing in new partnerships. They create opportunities for the police to collaborate, innovate, and focus more sharply on the prevention of harm. [ABSTRACT FROM AUTHOR]

Wind farms can have two broad potential adverse effects on birds via antagonistic processes: displacement from the vicinity of turbines (avoidance), or death through collision with rotating turbine blades. These effects may not be mutually exclusive. Using detailed data from 99 turbines at two wind farms in central Scotland and thousands of GPS-telemetry data from dispersing golden eagles, we tested three hypotheses. Before-and-after-operation analyses supported the hypothesis of avoidance: displacement was reduced at turbine locations in more preferred habitat and with more preferred habitat nearby. After-operation analyses (i.e. from the period when turbines were operational) showed that at higher wind speeds and in highly preferred habitat eagles were less wary of turbines with motionless blades: rejecting our second hypothesis. Our third hypothesis was supported, since at higher wind speeds eagles flew closer to operational turbines; especially–once more–turbines in more preferred habitat. After operation, eagles effectively abandoned inner turbine locations, and flight line records close to rotor blades were rare. While our study indicated that whole-wind farm functional habitat loss through avoidance was the substantial adverse impact, we make recommendations on future wind farm design to minimise collision risk further. These largely entail developers avoiding outer turbine locations which are in and surrounded by swathes of preferred habitat. Our study illustrates the insights which detailed case studies of large raptors at wind farms can bring and emphasises that the balance between avoidance and collision can have several influences. [ABSTRACT FROM AUTHOR]

Background and aims: Within the context of Scotland's policy change to implement a minimum unit price (MUP) per unit of alcohol sold in licensed premises, this study used an N‐of‐1 design to assess between‐person differences in the psychological and social factors associated with daily alcohol consumption. Design and setting: A mixed‐methods approach combined N‐of‐1 observational studies, comprising daily surveys followed by qualitative social network interviews (not reported here). Peer researchers with lived experience of substance use were involved in the study design and fieldwork was conducted in towns and rural areas in the East of Scotland. Participants/cases: Twenty‐five adults with current or recent history of alcohol dependence recruited for three 12‐week waves: 11 in wave 1 (pre‐MUP), 11 in wave 2 (pre‐ and post‐MUP) and three in wave 3 (post MUP). Measurements Gender, age, alcohol and other drug use history. Daily surveys for 12 weeks captured information about factors in the last 24 hours, e.g. amount and type of alcohol consumed, stress, social contact. Findings Each participant was in the daily survey for a mean of 64 days [standard deviation (SD) = 42; median = 59], with a response rate of 48%; 15 participants provided sufficient data for analysis. Factors related to daily alcohol consumption differed between individuals. Models suggested that some individuals with high initial consumption reduced drinking after MUP, but explanatory factors differed, e.g. changing motivation was important for some, while alcohol availability was important for others. Conclusions: Adapting N‐of‐1 methods for an observational study uncovered differences in alcohol consumption change before and after minimum unit pricing implementation in Scotland, evidence of individual differences in the factors relating to alcohol consumption patterns and some evidence that post‐MUP consumption changes may be related to changing psychosocial factors. [ABSTRACT FROM AUTHOR]

Background: It is estimated that around 30% of breast cancers in post-menopausal women are related to lifestyle. The breast cancer-pooling project demonstrated that sustained weight loss of 2 to 4.5 kg is associated with an 18% lower risk of breast cancer, highlighting the importance of small changes in body weight. Our study aimed to assess the effectiveness a volunteer-delivered, community based, weight management programme (ActWELL) for women with a BMI > 25 kg/m2 attending NHS Scotland Breast Screening clinics. Methods: A multicentre, 1:1 parallel group, randomised controlled trial was undertaken in 560 women aged 50 to 70 years with BMI > 25 kg/m2. On completion of baseline measures, all participants received a breast cancer prevention leaflet. Intervention group participants received the ActWELL intervention which focussed on personalised diet advice and pedometer walking plans. The programme was delivered in leisure centres by (the charity) Breast Cancer Now volunteer coaches. Primary outcomes were changes between groups at 12 months in body weight (kg) and physical activity (accelerometer measured step count). Results: Two hundred seventy-nine women were allocated to the intervention group and 281 to the comparison group. Twelve-month data were available from 240 (81%) intervention and 227 (85%) comparison group participants. Coaches delivered 523 coaching sessions and 1915 support calls to 279 intervention participants. Mean weight change was − 2.5 kg (95% CI − 3.1 to − 1.9) in the intervention group and − 1.2 kg (− 1.8 to 0.6) in the comparison group. The adjusted mean difference was − 1.3 kg (95% CI − 2.2 to − 0.4, P = 0.003). The odds ratio for losing 5% weight was 2.20 (95% CI 1.4 to 3.4, p = 0.0005) in favour of the intervention. The adjusted mean difference in step counts between groups was 483 steps/day (95% CI − 635 to 1602) (NS). Conclusions: A community weight management intervention initiated at breast screening clinics and delivered by volunteer coaches doubled the likelihood of clinically significant weight loss at 12 months (compared with usual care) offering significant potential to decrease breast cancer risk. Trial registration: Database of registration: ISCRTN. Registration number:11057518. Date trial registered:21.07.2017. Date of enrolment of first participant: 01.09.2017. [ABSTRACT FROM AUTHOR]

Resumen: Con datos de la encuesta de población activa del Reino Unido (2011–2014), se estima el número de empleos verdes en Escocia y su variación, utilizando un marco metodológico aplicable a cualquier región basado en la CIUO‐08 y en la O*NET. Los resultados apuntan a la importancia de utilizar definiciones de empleo verde que no se restrinjan a los nuevos empleos en determinadas industrias a fin de captar el impacto de la ecologización en el empleo en general. También indican la necesidad de prestar mayor atención analítica a las cuestiones de la calidad y del crecimiento del empleo verde en sentido amplio. [ABSTRACT FROM AUTHOR]

In 2011, the Scottish Government took the decision to create a single, national police force, reconfiguring a structure of regional police forces, which had prevailed since the 19th century. Despite a strong narrative around localism in the legislation establishing Police Scotland, the new force that was established in 2013 quickly found itself at the centre of a debate around an emerging 'crisis of localism' as critics expressed concerns over the centralization of decision-making and a lack of sensitivity to local contexts. Drawing on qualitative research carried out in four communities across Scotland in 2016, the analysis presented in this article examines the experience of organizational change from the perspective of officers in local policing teams and from local stakeholders. The analysis is structured around the strategic aims of reform of improved local service delivery, more equal local access to specialist expertise, and enhanced connections with local communities. The article highlights the sense of exclusion from the decision-making surrounding the organizational changes associated with the implementation of reform experienced by local, rank-and-file officers. [ABSTRACT FROM AUTHOR]

Drawing on data from the Labour Force Survey of the United Kingdom (2011–14), this article estimates the number of green jobs in Scotland and identifies change over time, using a methodological framework that can be applied to any region, based on ISCO‐08 and O*NET. The findings highlight the value of charting changes in green jobs based on inclusive rather than "purist" definitions to better capture the broader impact of greening on jobs. The findings also indicate a need for greater analytical attention to issues of green job quality and inclusive green job growth. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic halted non-emergency surgery across Scotland. Measures to mitigate the risks of transmitting COVID-19 are creating significant challenges to restarting all surgical services safely. We describe the development of a risk stratification tool to prioritise patients for cataract surgery taking account both specific risk factors for poor outcome from COVID-19 infection as well as surgical 'need'. In addition we report the demographics and comorbidities of patients on our waiting list.Methods: A prospective case review of electronic records was performed. A risk stratification tool was developed based on review of available literature on systemic risk factors for poor outcome from COVID-19 infection as well as a surgical 'need' score. Scores derived from the tool were used to generate 6 risk profile groups to allow prioritised allocation of surgery.Results: There were 744 patients awaiting cataract surgery of which 66 (8.9 %) patients were 'shielding'. One hundred and thirty-two (19.5 %) patients had no systemic comorbidities, 218 (32.1 %) patients had 1 relevant systemic comorbidity and 316 (46.5 %) patients had 2 or more comorbidities. Five hundred and ninety patients (88.7 %) did not have significant ocular comorbidities. Using the risk stratification tool, 171 (23 %) patients were allocated in the highest 3 priority stages. Given an aging cohort with associated increase in number of systemic comorbidities, the majority of patients were in the lower priority stages 4 to 6.Conclusions: COVID-19 has created an urgent challenge to deal safely with cataract surgery waiting lists. This has driven the need for a prompt and pragmatic change to the way we assess risks and benefits of a previously regarded as low-risk intervention. This is further complicated by the majority of patients awaiting cataract surgery being elderly with comorbidities and at higher risk of mortality related to COVID-19. We present a pragmatic method of risk stratifying patients on waiting lists, blending an evidence-based objective assessment of risk and patient need combined with an element of shared decision-making. This has facilitated safe and successful restarting of our cataract service. [ABSTRACT FROM AUTHOR]

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