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Introduction: Evidence examines how persons experiencing Long COVID (LC) struggle to secure healthcare for symptoms. However, few studies examine healthcare workers experiencing LC, nor the complex and multiple difficulties faced when seeking and receiving healthcare. Methods: This study is based on two phases of longitudinally conducted qualitative interviews, 6 months apart, with National Health Service (NHS) workers experiencing LC, from different occupational roles at NHS locales in Scotland (first interviews, n = 50; second interviews, n = 44). Results: Multiple factors restricted healthcare access, including worries about pressuring the NHS and concerns over LC being legitimised. When healthcare was sought, workers struggled to secure support, referrals and treatment. The following reasons were included: (1) context: the restrictive pandemic healthcare context; (2) illness climate: low GP knowledge surrounding LC and how this could be treated, trends for ascribing symptoms to other causes and reluctance to diagnose LC; (3) sense‐making of LC: healthcare availability linked to occupational role identity. To visualise and examine healthcare barriers, candidacy theory is applied, drawing inferences between healthcare context, illness climate, sense‐making and identities. Conclusion: NHS workers' complex journeys represent Disrupted Candidacy, intersecting challenges across candidacy domains, restricting the seeking and receiving of LC healthcare. Findings provide insights into why NHS workers resisted and withdrew from healthcare‐seeking, and the barriers they faced when attempting to secure LC support. This study presents a pathway for future LC illness research to use a modified candidacy theory framework. Patient and Public Contribution: This research focuses on amplifying and learning from lived experiences, and the voices of NHS workers in Scotland experiencing LC. Interviews represent primary data for this study; thus, participants and their healthcare journeys are centred in this research and all aspects of production, reporting and output. Explicit discussions of stakeholder group involvement are highlighted in the methods section. [ABSTRACT FROM AUTHOR]

Across the Global North, professional learning for social workers has become a matter of concern. Efforts to 'fix' the problem have focused narrowly on formal methods of learning and show limited connect with recent research. In this article, we report on findings from a mixed-method longitudinal cohort study, which examined early career social workers experiences of learning over the first five years of professional practice. Drawing on a repeat-measure annual online survey, our findings provide an inside-view of how early career social workers in Scotland experience work-based learning over time and how professional learning for social workers can be enhanced. Quantitative and qualitative data were analysed using descriptive statistical analysis and reflexive thematic analysis respectively and integrated using a convergence coding matrix to identify meta-themes. Our findings support an integrative, developmental and ecological approach to professional learning, embedded in a value-led understanding of social work as practice. We invite the profession to embrace and embed learning as a 'practice of value', both as an antidote to managerial approaches to practice and learning and as a way of valuing the extraordinary work that social workers do. [ABSTRACT FROM AUTHOR]

The Conservative Party has usually done well in rural areas, but its 'green wall' is now under threat from Labour more than the Liberal Democrats. Farmers did not support Brexit any more than the general population, and in income terms they are currently doing well, but fear for the future. In addition, food security issues are more complex than they are portrayed, as are the relations with the devolved governments. In Scotland, the government there is much more popular among Scottish farmers whilst the government in Wales is doing much worse among farming communities. [ABSTRACT FROM AUTHOR]

The impact of COVID-19 on the working lives of professionals has been of much interest. Within social work, the pandemic increased workload demands, whilst the way in which work was done shifted significantly. This article uses data gathered from newly qualified social workers (NQSWs) who began their working lives during the pandemic. These first years in practice are viewed as an extension to social workers' formal education and as a vital stage in their professional development. Survey (n  = 124) and interview (n  = 12) data were gathered from NQSWs across Scotland. Findings were considered through Giddens' lens of ontological security, to explore NQSW transitions during a context of pandemic disruption and its impacts on NQSWs' confidence and competence, as well as their sense of self and identity. Consistent with other studies, respondents were most impacted by home working and the associated isolation and separation from colleagues, particularly when engaged in emotionally charged work. Findings uncovered a trichotomy of experience, with variation in the quality and availability of some formal supports—induction, training and learning and development—and informal support. Implications for practice include a need to focus on how we support and nurture NQSWs at such a critical stage in their professional socialisation. [ABSTRACT FROM AUTHOR]

Separated children, seeking protection in a new country unaccompanied by parents or customary caregivers, have the right to education yet many face difficulties accessing appropriate provision. We analysed data from Scotland across different types of provision: one specialist programme for separated children and four areas providing a mixture of mainstream and adapted classes. Drawing on situated learning theory and the concept of communities of practice, we argue that supporting these learners requires collaborations with them and across professional boundaries. While highly effective communities of practice can and do develop organically, a coordinated approach to expanding them could bring additional benefits. [ABSTRACT FROM AUTHOR]

This article examines how Christians in a faith partnership between Malawi and Scotland sought and defined God's protection as they responded to the challenges of the COVID-19 pandemic. Malawi and Scotland have different cultures, societies and economic prosperity but a shared Presbyterian history, and long-standing faith partnerships through the two national churches. Qualitative interviews articulate striking comparisons of expectations of God's protection when confronting global disease. This research shows how the dynamics of this partnership allowed both member churches to contribute to each other's needs and hold a critical solidarity in each other's interpretation of God's protection. [ABSTRACT FROM AUTHOR]

Background There is a lack of national guidance specifying how skin surgery, including Mohs micrographic surgery (MMS), should be conducted, leading to a degree of heterogeneity in the set-up of skin surgery services and how skin surgeries are performed. Objectives To provide the first UK-wide cross-sectional study reporting real-world data on the set-up and waste management practices of skin surgery, including MMS. Methods A UK-wide service evaluation study was conducted between 1 March 2022 and 30 June 2022 using a standardized data collection pro forma. Twelve participating sites from England, Northern Ireland, Scotland and Wales provided data from 115 skin surgery lists involving 495 patients and 547 skin surgery procedures between 1 March 2022 and 30 June 2022. Results Mean total weight of nonsharps skin surgery waste was 0.52 kg per procedure (0.39 kg clinical waste, 0.05 kg general waste and 0.08 kg recycling waste). Data from a single site using disposable surgical instruments reported a mean of only 0.25 kg of sharps waste per procedure. The recycling rate ranged between 0% and 44% across the cohort with a mean recycling rate of 16%. Conclusions We advocate that staff transition to the British Society of Dermatological Surgery 2022 sustainability guidance, which made wide-ranging recommendations to facilitate staff to transition to sustainable practices in skin surgery. [ABSTRACT FROM AUTHOR]

Aim: To evaluate adoption, implementation and maintenance of the Queen's Nursing Institute Scotland development programme. Design: A comprehensive, longitudinal, qualitative evaluation. Method: Participants from the first two cohorts were interviewed at different stages to explore adoption, implementation and maintenance. Managers of participants engaged in interviews to explore service changes. Facilitators took part in a focus group exploring delivery. A member‐checking event was held. Data collection was between March 2017 and October 2019. Data analysis was thematically followed by the application of Normalization Process Theory. Result: Ninety‐four interviews, two focus groups and a member‐checking event were conducted. Prior to the programme most participants were burnt‐out and considering leaving. Engaging led to a journey of self‐discovery and transformation. The programme was perceived to change their way of thinking, personally and professionally, unlike any training and development previously experienced. Participants were rejuvenated and reinvigorated, sharing their learning with colleagues, service users and family, implementing new working practices and furthering their careers. They developed communities of practice amongst their cohorts with strong bonds; enabling them to build and sustain learnings. Conclusion: Participants experienced a journey of self‐discovery and transformation unlike anything before due to the personal investment in them. Participants were rejuvenated and reinvigorated with many moving into new roles. The programme equipped them with a range of leadership and resilience skills. Impact The Queen's Nursing Institute Scotland Development Programme had a profound impact on participants, personally and professionally, which was perceived as lifelong. These findings and programmes are transferable beyond Scotland and to different professions. [ABSTRACT FROM AUTHOR]

Since May 1, 2018, every alcoholic drink sold in Scotland has had minimum unit pricing (MUP) of £0·50 per unit. Previous studies have indicated that the introduction of this policy reduced alcohol sales by 3%. We aimed to assess whether this has led to reductions in alcohol-attributable deaths and hospitalisations. Study outcomes, wholly attributable to alcohol consumption, were defined using routinely collected data on deaths and hospitalisations. Controlled interrupted time series regression was used to assess the legislation's impact in Scotland, and any effect modification across demographic and socioeconomic deprivation groups. The pre-intervention time series ran from Jan 1, 2012, to April 30, 2018, and for 32 months after the policy was implemented (until Dec 31, 2020). Data from England, a part of the UK where the intervention was not implemented, were used to form a control group. MUP in Scotland was associated with a significant 13·4% reduction (95% CI –18·4 to –8·3; p=0·0004) in deaths wholly attributable to alcohol consumption. Hospitalisations wholly attributable to alcohol consumption decreased by 4·1% (–8·3 to 0·3; p=0·064). Effects were driven by significant improvements in chronic outcomes, particularly alcoholic liver disease. Furthermore, MUP legislation was associated with a reduction in deaths and hospitalisations wholly attributable to alcohol consumption in the four most socioeconomically deprived deciles in Scotland. The implementation of MUP legislation was associated with significant reductions in deaths, and reductions in hospitalisations, wholly attributable to alcohol consumption. The greatest improvements were in the four most socioeconomically deprived deciles, indicating that the policy is positively tackling deprivation-based inequalities in alcohol-attributable health harm. Scottish Government. [ABSTRACT FROM AUTHOR]

Background: The reliability and validity of the subjective component of the Dutch Objective Burden Inventory (DOBI) are unknown. Objective: The validity and reliability of the subjective component of the DOBI were examined in caregivers of individuals with heart failure, using the original 38- and a 24-item version. Methods: In an online cross-sectional investigation, confirmatory factor analysis was used to examine factorial validity. In examining convergent validity, corrected item-dimension correlations assessed item performance and associations between subjective subscale scores and the Bakas Caregiving Outcomes Scale. Cronbach's α examined internal consistency. Results: The original 4-factor solution was retained and both the original and shorter versions of the subjective component of the DOBI supported adequate construct validity and internal consistency. Conclusions: Both the 38- and 24-item forms of the subjective DOBI supported construct validity and reliability. Further studies examining the usefulness of both versions are needed in carers of individuals with more severe HF. [ABSTRACT FROM AUTHOR]

Background: Disability-adjusted life years (DALYs) combine the impact of morbidity and mortality and can enable comprehensive, and comparable, assessments of direct and indirect health harms due to COVID-19. Our aim was to estimate DALYs directly due to COVID-19 in Scotland, during 2020; and contextualise its population impact relative to other causes of disease and injury.Methods: National deaths and daily case data were used. Deaths were based on underlying and contributory causes recorded on death certificates. We calculated DALYs based on the COVID-19 consensus model and methods outlined by the European Burden of Disease Network. DALYs were presented as a range, using a sensitivity analysis based on Years of Life Lost estimates using: cause-specific; and COVID-19 related deaths. All COVID-19 estimates were for 2020.Results: In 2020, estimates of COVID-19 DALYs in Scotland ranged from 96,500 to 108,200. Direct COVID-19 DALYs were substantial enough to be framed as the second leading cause of disease and injury, with only ischaemic heart disease having a larger impact on population health. Mortality contributed 98% of total DALYs.Conclusions: The direct population health impact of COVID-19 has been very substantial. Despite unprecedented mitigation efforts, COVID-19 developed from a single identified case in early 2020 to a condition with an impact in Scotland second only to ischaemic heart disease. Periodic estimation of DALYs during 2021, and beyond, will provide indications of the impact of DALYs averted due to the national rollout of the vaccination programme and other continued mitigation efforts, although new variants may pose significant challenges. [ABSTRACT FROM AUTHOR]

There are many mature oil fields in the North Sea. One of them is the Clair Oil Field, located on the United Kingdom Continental Shelf (UKCS) in Scotland. This oil field is unique because of the results of failure studies of several fluid injections, constituting secondary and tertiary oil recovery techniques, on increasing oil production. Only waterflooding has shown a promising future. In this paper, three-dimensional (3D) numerical simulations investigate the influence of infill drilling optimization by waterflooding in the Clair Oil Field so as to maximize net present value (NPV). An important goal of this study of reservoir management was to determine optimal well locations and optimal operational parameters (production constraints) that maximize cumulative oil production. Theoretical ideas and mathematical models with field data performance demonstrated the factors that can be considered in infill drilling so as to increase oil reserves. Most of the factors were related to reservoir heterogeneities and were important quantitatively for fluid injection and production. The results revealed that the four infill wells added in this study led to an increase in the field's total cumulative oil production from 7.91×106 to 9.39×106 m3. The NPV after infill drilling optimization by waterflooding increased by 54.4% over the base case. The oil recovery factor rose from 17.2% to 20.2%, while the gas oil ratio (GOR) fell from 1,000 to 840 SCF/STB. After combining infill drilling with waterflooding, the horizontal infill producers outperformed vertical infill producers by 5.5%. The field water cut was reduced from 95% to 88%. In addition, an analysis of cumulative production between parent and child wells was made. It was found that child wells produce less cumulative oil production than do parent wells. This paper reveals the greater success of a combination of infill drilling with waterflooding in enhancing oil production compared to other findings where the influence of infill drilling and waterflooding were analyzed separately or compared. It can be concluded that the Clair Oil Field has great potential to increase oil production by combining infill drilling with waterflooding, after other improved oil recovery techniques fail. [ABSTRACT FROM AUTHOR]

This paper reports on survey work and group discussion by a Scottish parent-led support group (Parents Advocacy and Rights – PAR) that supports parents with children in the care system. A previous paper has been published discussing an overview of the survey results (www.pfan.uk/uncovering-the-pain/). The present paper delves further into parents' particular experiences of contact. The responses are preceded by a critical retrospective of the concept of contact. Our retrospective covers the language of contact, contact's origins, continuing confusions of meaning and the lack of appreciation of the parental experience and points to the artificiality of contact, the impracticalities of contact arrangements and the toll taken by these. We conclude by pointing out that we are in the fourth decade of recommendations about contact between parents and children in state care. We make the observations that there is a continuing failure to empathise with parents' experience of deprivation and loss, a lack of comprehension of the depth of detriment to parental identity caused by the process and practices of contact and avoidance of discussion of the damage to the parent–child relationship which, irrespective of the ultimate destination of a child in state care, cannot be obliterated. [ABSTRACT FROM AUTHOR]

Background: COVID-19 has caused almost unprecedented change across health, education, the economy and social interaction. It is widely understood that the existing mechanisms which shape health inequalities have resulted in COVID-19 outcomes following this same, familiar, pattern. Our aim was to estimate inequalities in the population health impact of COVID-19 in Scotland, measured by disability-adjusted life years (DALYs) in 2020. Our secondary aim was to scale overall, and inequalities in, COVID-19 DALYs against the level of pre-pandemic inequalities in all-cause DALYs, derived from the Scottish Burden of Disease (SBoD) study. Methods: National deaths and daily case data were input into the European Burden of Disease Network consensus model to estimate DALYs. Total Years of Life Lost (YLL) were estimated for each area-based deprivation quintile of the Scottish population. Years Lived with Disability were proportionately distributed to deprivation quintiles, based on YLL estimates. Inequalities were measured by: the range, Relative Index of Inequality (RII), Slope Index of Inequality (SII), and attributable DALYs were estimated by using the least deprived quintile as a reference. Results: Marked inequalities were observed across several measures. The SII range was 2048 to 2289 COVID-19 DALYs per 100,000 population. The rate in the most deprived areas was around 58% higher than the mean population rate (RII = 1.16), with 40% of COVID-19 DALYs attributed to differences in area-based deprivation. Overall DALYs due to COVID-19 ranged from 7 to 20% of the annual pre-pandemic impact of inequalities in health loss combined across all causes. Conclusion: The substantial population health impact of COVID-19 in Scotland was not shared equally across areas experiencing different levels of deprivation. The extent of inequality due to COVID-19 was similar to averting all annual DALYs due to diabetes. In the wider context of population health loss, overall ill-health and mortality due to COVID-19 was, at most, a fifth of the annual population health loss due to inequalities in multiple deprivation. Implementing effective policy interventions to reduce health inequalities must be at the forefront of plans to recover and improve population health. [ABSTRACT FROM AUTHOR]

This paper seeks to explore life during the post-medieval period in a small part of the Ochil Hills in Perthshire, Scotland, and in doing so, demonstrates how landscape archaeology can uncover stories which reflect the complexity and nuance of life in the past. Drawing on a range of approaches, this paper explores the stories uncovered through a programme of landscape archaeology. This includes considering the dramatic changes and reformations that have shaped the landscape over recent centuries, histories of specific people and places - and the relationship between the two. It asks questions of the role of archaeology in telling these stories and considers how a variety of approaches can reveal a multitude of voices and narratives from the past. [ABSTRACT FROM AUTHOR]

This article assembles the evidence for the presence of Greek refugees in early modern Scotland. These refugees came in two distinct waves: one in the aftermath of the fall of Constantinople in 1453, and another in the seventeenth century. In both periods, inter-regional religious networks brought Greeks to Scotland: in the first phase, these were structured around the church institutions of the Latin West; in the second, they followed ecumenical interest in Protestant Northern Europe. The wanderers were mostly clergymen. This movement of refugees, alongside the capture of Scots by North African corsairs, linked Scotland with the distant Ottoman world. [ABSTRACT FROM AUTHOR]

This article charts changes and continuities in the social work role in adoption since 1968. The Social Work (Scotland) Act 1968 established the Children's Hearing System, Scotland's unique approach to child welfare in which lay volunteers make decisions on compulsory intervention relating to children. Although the Act was not intended to reform adoption practice, it has had two major impacts. First, as adoption moved from 'relinquishment' to more complex and contested legal routes, the Children's Hearing came to occupy an integral role in decision-making for children in need of care and protection. Secondly, since 1968, adoption has become understood as a resource for children who are unable to remain within their birth family or kinship networks. Using documentary analysis of adoption files and interviews with key informants, the research focused on three key periods: 1968, 1988 and 2014. The study found that fragmentation of the social work role has decreased the potential of adoption records to be a resource for adopted individuals curious about their origins and story. Paradoxically, over this period, there has been growing understanding of the identity needs of adopted people. Such unintended consequences suggest the need for more a thoughtful approach to adoption record keeping. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has necessitated unprecedented changes in the way that health, social, and housing services are delivered to individuals experiencing homelessness and problem substance use. Protecting those at high risk of infection/transmission, whilst addressing the multiple health and social needs of this group, is of utmost importance. This study aimed to document the impact of the COVID-19 pandemic on individuals who were experiencing homelessness in one city centre in Scotland, and how services adapted in response. Methods: Semi-structured interviews were conducted with individuals with lived/living experience of homelessness (n = 10), staff within onethird sector service (n = 5), and external professionals (n = 5), during April-August 2020, using a rapid case study design. These were audio-recorded, fully transcribed, and analysed using Framework. Analysis was informed by inclusion health and equity-orientated approaches to meeting the needs of people with multiple and complex needs, and emerging literature on providing harm reduction in the context of COVID-19. Results: Those with lived/living experience of homelessness and problem substance use faced a range of additional challenges during the pandemic. Mental health and use of substances were affected, influenced by social isolation and access to services. A range of supports were provided which flexed over the lockdown period, including housing, health and social care, substance use treatment, and harm reduction. As well as documenting the additional risks encountered, findings describe COVID-19 as a 'path-breaking' event that created opportunities to get evidence into action, increase partnership working and communication, to proactively address risks. Conclusions: This rapid case study has described the significant impact of the COVID-19 pandemic on a group of people experiencing homelessness and problem substance use within one city centre in Scotland and provides a unique lens on service/professional responses. It concludes with lessons that can inform the international and ongoing response to this pandemic. It is vital to recognise the vision and leadership that has adapted organisational responses in order to reduce harms. We must learn from such successes that were motivated both by compassion and care for those vulnerable to harms and the desire to provide high-quality, evidence-based, harm reduction services. [ABSTRACT FROM AUTHOR]

Background: Increasingly Burden of Disease (BOD) measures are being used to influence policy decisions because they summarise the complete effects of morbidity and mortality in an equitable manner. An important element of producing non-fatal BOD estimates are severity distributions. The Global Burden of Disease (GBD) study use the same severity distributions across countries due to a lack of available country-specific data. In the Scottish BOD (SBOD) study we developed national severity distributions for cancer types. The main aim of this study was to consider the extent to which the use of worldwide severity distributions in BOD studies are influencing cross-country comparisons, by comparing weighted-average disability weights (DW) based on GBD severity distributions with nationally derived severity distributions in Scotland for cancer types. Methods: We obtained individual records from the Scottish Cancer Registry for 21 cancer types and linked these to registered deaths. We estimated prevalent cancer cases for 2016 and assigned each case to sequelae using GBD 2016 study definitions. We compared the impact of using severity distributions based on GBD 2016, a Scotland-wide distribution, and distributions specific to deprivation strata in Scotland, on the weighted-average DW for each cancer type. Results: The relative difference in point estimates of weighted-average DW based on GBD 2016 worldwide severity distributions compared with Scottish national severity distributions resulted in overestimates in the majority of cancers (17 out of 21 cancer types). The largest overestimates were for gallbladder and biliary tract cancer (70.8%), oesophageal cancer (31.6%) and pancreatic cancer (31.2%). Furthermore, the use of weighted-average DW based on Scottish national severity distributions rather than sub-national Scottish severity distributions stratified by deprivation quintile overestimated weighted-average DW in the least deprived areas (16 out of 18 cancer types), and underestimated in the most deprived areas (16 out of 18 cancer types). Conclusion: Our findings illustrate a bias in point estimates of weighted-average DW created using worldwide severity distributions. This bias would have led to the misrepresentation of non-fatal estimates of the burden of individual cancers, and underestimated the scale of socioeconomic inequality in this non-fatal burden. This highlights the importance of not interpreting non-fatal estimates of burden of disease too precisely, especially for sub-national estimates and those comparing populations when relying on data inputs from other countries. It is essential to ensure that any estimates are based upon country-specific data as far as possible. [ABSTRACT FROM AUTHOR]

Background: The availability of robust evidence to inform effective public health decision making is becoming increasingly important, particularly in a time of competing health demands and limited resources. Comparative Risk Assessments (CRA) are useful in this regard as they quantify the contribution of modifiable exposures to the disease burden in a population. The aim of this study is to assess the contribution of a range of modifiable exposures to the burden of disease due to stroke, an important public health problem in Scotland. Methods: We used individual-level response data from eight waves (1995–2012) of the Scottish Health Survey linked to acute hospital discharge records from the Scottish Morbidity Record 01 (SMR01) and cause of death records from the death register. Stroke was defined using the International Classification of Disease (ICD) 9 codes 430–431, 433–4 and 436; and the ICD10 codes I60-61 and I63-64 and stroke incidence was defined as a composite of an individual’s first hospitalisation or death from stroke. A literature review identified exposures causally linked to stroke. Exposures were mapped to the layers of the Dahlgren & Whitehead model of the determinants of health and Population Attributable Fractions were calculated for each exposure deemed a significant causal risk of stroke from a Cox Proportional Hazards Regression model. Population Attributable Fractions were not summed as they may add to more than 100% due to the possibility of a person being exposed to more than one exposure simultaneously. Results: Overall, the results suggest that socioeconomic factors explain the largest proportion of incident stroke hospitalisations and deaths, after adjustment for confounding. After DAG adjustment, low education explained 38.8% (95% Confidence Interval 26.0% to 49.4%, area deprivation (as measured by the Scottish Index of Multiple Deprivation) 34.9% (95% CI 26.4 to 42.4%), occupational social class differences 30.3% (95% CI 19.4% to 39.8%), high systolic blood pressure 29.6% (95% CI 20.6% to 37.6%), smoking 25.6% (95% CI 17.9% to 32.6%) and area deprivation (as measured by the Carstairs area deprivation Index) 23.5% (95% CI 14.4% to 31.7%), of incident strokes in Scotland after adjustment. Conclusion: This study provides evidence for prioritising interventions that tackle socioeconomic inequalities as a means of achieving the greatest reduction in avoidable strokes in Scotland. Future work to disentangle the proportion of the effect of deprivation transmitted through intermediate mediators on the pathway between socioeconomic inequalities and stroke may offer additional opportunities to reduce the incidence of stroke in Scotland. [ABSTRACT FROM AUTHOR]

Aim: Biological treatment is effective in maintaining remission in ulcerative colitis (UC), although the effect on colectomy rates remains unclear. In the UK the use of antitumour necrosis factor and anti‐α4β7 treatments for maintenance therapy in UC was restricted until 2015. The aim of this study was to describe the impact that this change in the prescribing of biologicals had on colectomy rates for UC. Method: All patients (adult and paediatric) with a diagnosis of UC who received maintenance biological treatment and/or underwent a colectomy in Lothian, Scotland between 2005 and 2018 were identified. Linear and segmental regression analyses were used to identify the annual percentage change (APC) and temporal trends (statistical joinpoints) in biological prescription and colectomy rates. Results: Rates of initiation of maintenance biological therapy increased from 0.05 per 100 UC patients in 2005 to 1.26 in 2018 (p < 0.001). Colectomy rates per 100 UC patients fell from 1.47 colectomies in 2005 to 0.44 in 2018 (p < 0.001). The APC for colectomy decreased by 4.1% per year between 2005 and 2014 and by 18.9% between 2014 and 2018. Temporal trend analysis (2005–2018) identified a significant joinpoint in colectomy rates in 2014 (p = 0.019). Conclusion: The use of maintenance biological therapy increased sharply following the change in guidance. This has been paralleled by a significant reduction in the rates of colectomy over the same time period. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has necessitated unprecedented changes in the way that services are delivered to individuals experiencing homelessness and problem substance use. Protecting those at high risk of infection/transmission, whilst addressing the multiple health and social needs of this group, is of utmost importance. The aim of this novel qualitative study was to document how one service in Scotland, the Wellbeing Centre run by The Salvation Army, adapted in response. Methods: Care was taken to identify methods that did not create additional stress at this pressured time. Semi-structured interviews were conducted with Centre clients (n = 10, in-person and telephone) and staff (n = 5, telephone), and external professionals (n = 5, telephone), during April–August 2020. These were audio-recorded, fully transcribed, and analysed using Framework. Service documents were used to enhance contextual understanding. Analysis was informed by theories of psychologically informed environments and enabling environments. Results: The start of the pandemic was a time of confusion, disruption, and isolation. Centre staff rapidly adapted methods of engagement to provide a range of comprehensive physical and emotional supports, to both existing and new clients, through telephone and online communication and, eventually, socially distanced in-person support. This involved balancing the risks of COVID-19 infection/transmission with the benefits of continuity of support to those highly vulnerable to a range of harms. Whilst the pandemic created many challenges, it also facilitated removal of barriers, particularly concerning provision of harm reduction services which had previously been severely constrained. Clients described the Centre as a 'lifeline', providing stability and safety during a period of profound disruption when other services closed their doors. Strong leadership, intensive team working, support/training for staff, a focus on relationships, and active use of client feedback, enabled responsive adaptation to fast-changing demands and the creation of a 'culture of care'. Conclusion: This study provides a unique insight into the pandemic by analysing the response of one homeless service during the height of the pandemic. We present a range of implications that have international relevance for those designing policies, and adapting front-line services, to proactively respond to COVID-19 and the continued public health crises of homelessness and drug-related deaths. [ABSTRACT FROM AUTHOR]

Within the system of national accounts the electricity sector is typically reported as a single entry representing generation, transmission, distribution and trade. The ways in which these components interact with the economy differ greatly, a feature lost within the standard accounting framework. In this paper we propose an Electricity Satellite Account (ELSA) approach to better understand the linkages between the electricity sector and economy, with a particular focus on generation technologies. In developing this framework, we draw parallels with Tourism Satellite Accounts (TSAs). To illustrate the practical steps in constructing ELSAs, we develop an ELSA for Scotland for 2012, and show how the ELSA framework gives an improved understanding of the economic contribution of the electricity sector, which is critical in improving the usefulness of such accounts for climate, energy, and economic policy. [ABSTRACT FROM AUTHOR]

ABSTRACTCOVID-19 is compromising all aspects of society, with devastating impacts on health, political, social, economic and educational spheres. A premium is being placed on scientific research as the source of possible solutions, with a situational imperative to carry out investigations at an accelerated rate. There is a major challenge not to neglect ethical standards, in a context where doing so may mean the difference between life and death. In this paper we offer a rubric for considering the ethical challenges in COVID-19 related research, in the form of an ethics toolkit for global research developed at the University of Edinburgh in collaboration with more than 200 global researchers from around the world. This toolkit provides a framework to support confrontation of ethical conflicts through the integrated and iterative analysis of Place, People, Principles and Precedents, throughout the research journey. Two case analyses are offered to exemplify the utility of the toolkit as a flexible and dynamic tool to promote ethical research in the context of COVID-19. [ABSTRACT FROM AUTHOR]

Our study explores how human resources (HR) actors from 24 public sector organisations in Scotland interpret and address multiple and competing institutional logics in the context of the implementation of an inter‐organisational collaboration within the public sector to develop and implement talent management (TM). Our findings reveal that HR actors encountered day‐to‐day difficulties in blending different versions of TM, the need to have professional autonomy versus the requirement to develop some shared TM practices, and the fit of TM practices with public sector organisations. We therefore found that institutional logics impacted in different ways on efforts to collaborate and the types of TM practices developed and implemented. Theoretically, our study findings reveal that HR actors have agency at the practice level and that powerful actors can advocate particular logics to protect their professional and organisational interests. [ABSTRACT FROM AUTHOR]

Background: Clinicopathological scores are used to predict the likelihood of recurrence-free survival for patients with clear cell renal cell carcinoma (ccRCC) after surgery. These are fallible, particularly in the middle range. This inevitably means that a significant proportion of ccRCC patients who will not develop recurrent disease enroll into clinical trials. As an exemplar of using digital pathology, we sought to improve the predictive power of "recurrence free" designation in localized ccRCC patients, by precise measurement of ccRCC nuclear morphological features using computational image analysis, thereby replacing manual nuclear grade assessment. Materials and Methods: TNM 8 UICC pathological stage pT1-pT3 ccRCC cases were recruited in Scotland and in Singapore. A Leibovich score (LS) was calculated. Definiens Tissue studio® (Definiens GmbH, Munich) image analysis platform was used to measure tumor nuclear morphological features in digitized hematoxylin and eosin (H&E) images. Results: Replacing human-defined nuclear grade with computer-defined mean perimeter generated a modified Leibovich algorithm, improved overall specificity 0.86 from 0.76 in the training cohort. The greatest increase in specificity was seen in LS 5 and 6, which went from 0 to 0.57 and 0.40, respectively. The modified Leibovich algorithm increased the specificity from 0.84 to 0.94 in the validation cohort. Conclusions: CcRCC nuclear mean perimeter, measured by computational image analysis, together with tumor stage and size, node status and necrosis improved the accuracy of predicting recurrence-free in the localized ccRCC patients. This finding was validated in an ethnically different Singaporean cohort, despite the different H and E staining protocol and scanner used. This may be a useful patient selection tool for recruitment to multicenter studies, preventing some patients from receiving unnecessary additional treatment while reducing the number of patients required to achieve adequate power within neoadjuvant and adjuvant clinical studies. [ABSTRACT FROM AUTHOR]

Background: Psychometric properties of the 38-item version of the Dutch Objective Burden Inventory (DOBI) have been evaluated primarily in older female caregivers, with no published studies that vary by a different gender and age distribution. Objective: The aimof this study was to test the construct validity and reliability of the DOBI in caregivers of individuals with heart failure from the United States and other countries. Methods: This secondary analysis from a cross-sectional study used an online survey. Factorial validity was tested with confirmatory factor analysis, item performance was examined with ordinal item response analysis, and convergent validity was tested correlating DOBI subscale scores with Bakas Caregiving Outcomes Scale scores. Internal consistency reliability was assessed with Cronbach α. Results: Item response analysis removed 14 items. Confirmatory factor analysis retained the original 4-factor solution. Original and reduced instruments demonstrated good internal consistency. Validity was supported by meaningful associations with the Bakas Caregiving Outcomes Scale. Conclusions: Both the original 38-item DOBI and the reduced 24-item DOBI had support for their construct validity and internal consistency. The 24-item DOBI may be a useful alternative to the 38-item version, because it maintains psychometric properties of the original instrument while decreasing data collection burden. However, more research is needed to assess whether the shorter version is useful in assessing objective caregiving burden. [ABSTRACT FROM AUTHOR]

• We decompose changes in industrial water demand in Scotland between 2012 and 2016. • Changes in sectoral water intensity a key factor explaining fall in water demand. • Role of electricity generation policies aimed at encouraging renewables important. • Future changes in water availability, demand and technologies important to examine. Future climate scenarios predict significant changes in the availability of water resources at global and regional scales. Knowledge of the possible economic consequences of this are limited by a shortage of data linking economic activity with physical water use. Matching a unique premise-level dataset to economic indicators at industrial/sector level, this paper undertakes a decomposition of changes in industrial water demand for Scotland between 2012 and 2016. Results highlight the importance of taking a sectoral approach, as changes in sectoral water intensity are significant. Furthermore, changes in the structure of the economy, i.e. a move away from water-intensive industries, highlight further reductions in overall water consumption. By considering future scenarios for Scottish water resources, this paper identifies key multi-disciplinary research challenges to address the major obstacles in developing a climate-ready water policy, which also captures the potential economic opportunities for Scotland from an awareness of the role of water in the economy. [ABSTRACT FROM AUTHOR]

In the month approaching the 2014 Scottish Independence referendum, we tested the Identity‐Deprivation‐Efficacy‐Action‐Subjective Well‐Being model using an electorally representative survey of Scottish adults (N = 1,156) to predict voting for independence and subjective well‐being. Based on social identity theory, we hypothesized for voting intention that the effects of collective relative deprivation, group identification, and collective efficacy, but not personal relative deprivation (PRD), should be fully mediated by social change ideology. Well‐being was predicted to be associated with PRD (negatively) and group identification (positively and, indirectly, negatively). Unaffected by demographic variables and differences in political interest, nested structural equation model tests supported the model, accounting for 82% of the variance in voting intention and 31% of the variance in subjective well‐being. However, effects involving efficacy depended on its temporal framing. We consider different ways that social identification can simultaneously enhance and diminish well‐being and we discuss ramifications of the model for collective mobilization and separatist nationalism. Findings also suggest new directions for research on social identity, collective efficacy, and collective action. [ABSTRACT FROM AUTHOR]

Background: Lung cancer is the most common cause of cancer related death worldwide and survival is poor. Patients with lung cancer may develop a critical illness, but it is unclear what features are associated with an Intensive Care Unit (ICU) admission.Methods: This retrospective, observational, population-based study of linked cancer registration, ICU, hospital discharge and mortality data described the factors associated with ICU admission in patients with lung cancer. The cohort comprised all incident cases of adult lung cancer diagnosed between 1st January 2000 and 31st December 2009 in the West of Scotland, UK, who were subsequently admitted to an ICU within 2 years of cancer diagnosis. Multiple logistic regression was used to determine factors associated with admission.Results: 26,731 incident cases of lung cancer were diagnosed with 398 (1.5%) patients admitted to an ICU. Patients were most commonly admitted with respiratory conditions and there was a high rate of invasive mechanical ventilation. ICU, in-hospital and six-month survival were 58.5, 42.0 and 31.2%, respectively. Surgical treatment of lung cancer increased the odds of ICU admission (OR 7.23 (5.14-10.2)). Odds of admission to ICU were reduced with older age (75-80 years OR 0.69 (0.49-0.94), > 80 years OR 0.21 (0.12-0.37)), female gender (OR 0.73 (0.59-0.90)) and radiotherapy (OR 0.54 (0.39-0.73)) or chemotherapy treatment (OR 0.52 (0.38-0.70)).Conclusion: 1.5% of patients diagnosed with lung cancer are admitted to an ICU but both short term and long term survival was poor. Factors associated with ICU admission included age < 75 years, male gender and surgical treatment of cancer. [ABSTRACT FROM AUTHOR]

Background: Childbirth is a major risk factor for urinary incontinence (UI). As a result, pelvic floor muscle training (PFMT) is commonly recommended during and after pregnancy to prevent the onset of UI. PFMT is often classed as a physical activity (PA) behaviour, hence PA guidelines for postnatal women encourage PFMT alongside aerobic activities. However, postnatal lifestyle interventions tend to overlook PFMT which can be detrimental to women's health and future health risks, including urinary incontinence. This study aimed to explore perceptions and acceptability of a postnatal physical activity and PFMT intervention with postnatal women in Scotland.Methods: We recruited women who had given birth within the last 5 years by displaying posters in health centres and community centres in Stirling and through Facebook. Data was gathered via online and face-to-face focus groups, that were audio recorded and transcribed verbatim. Analytic themes were initially organised under related concepts derived from the topic guide and thematic analysis conducted. Subsequent analysis was by the Framework technique.Results: A total of seven online and face-to-face focus group discussions with 31 women identified there was a clear intention behaviour gap for engagement in PA, with both psychological and logistical barriers identified such as motivation and childcare. This was distinct from PFMT where there was a feeling of helplessness around not knowing how to perform a correct PFMT contraction subsequently resulting in women not adhering to PFMT guidance. Women felt there was no accessible PFMT advice available through the NHS. Some participants had received PFMT advice after childbirth and spoke of the Squeezee app being useful in adhering to a PFMT regimen but they did require additional teaching on how to do correct contractions. There was need for clarity and practical support for PFMT in the postnatal period with an approved intervention incorporating an accessible app being suggested by participants.Conclusions: Women would like to be trained on postnatal PFMT but face barriers to accessing adequate information and education on how to do a PFMT contraction. An intervention combining PFMT training and an app would be the most useful for their needs and circumstances. [ABSTRACT FROM AUTHOR]

Background: Cause-specific mortality trends are routinely reported for Scotland. However, ill-defined deaths are not routinely redistributed to more precise and internationally comparable categories nor is the mortality reported in terms of years of life lost to facilitate the calculation of the burden of disease. This study describes trends in Years of Life Lost (YLL) for specific causes of death in Scotland from 2000 to 2015. Methods: We obtained records of all deaths in Scotland by age, sex, area and underlying cause of death between 2000 and 2015. We redistributed Ill-Defined Deaths (IDDs) to more exact and meaningful causes using internationally accepted methods. Years of Life Lost (YLL) using remaining life expectancy by sex and single year of age from the 2013 Scottish life table were calculated for each death. These data were then used to calculate the crude and age-standardised trends in YLL by age, sex, cause, health board area, and area deprivation decile. Results: Between 2000 and 2015, the annual percentage of deaths that were ill-defined varied between 10% and 12%. The proportion of deaths that were IDDs increased over time and were more common: in women; amongst those aged 1–4 years, 25–34 years and >80 years; in more deprived areas; and in the island health boards. The total YLL fell from around 17,800 years per 100,000 population in 2000 to around 13,500 years by 2015. The largest individual contributors to YLL were Ischaemic Heart Disease (IHD), respiratory cancers, Chronic Obstructive Pulmonary Disease (COPD), cerebrovascular disease and Alzheimer’s/dementia. The proportion of total YLL due to IHD and stroke declined over time, but increased for Alzheimer’s/dementia and drug use disorders. There were marked absolute inequalities in YLL by area deprivation, with a mean Slope Index of Inequality (SII) for all causes of 15,344 YLL between 2001 and 2015, with IHD and COPD the greatest contributors. The Relative Index of Inequality (RII) for YLL was highest for self-harm and lower respiratory infections. Conclusion: The total YLL per 100,000 population in Scotland has declined over time. The YLL in Scotland is predominantly due to a wide range of chronic diseases, substance misuse, self-harm and increasingly Alzheimer’s disease and dementia. Inequalities in YLL, in both relative and absolute terms, are stark. [ABSTRACT FROM AUTHOR]

Background: The Cancer Drugs Fund (CDF) was established in 2010 to improve access to treatments not routinely available. Having widely overspent, stricter budgeting rules were introduced in 2016. The CDF can now only include treatments with potential to be cost effective once sufficient data are collected.Objectives: Our objective was to explore the process and criteria used for consideration of treatments under the new CDF framework and to describe the extent of evidence collection.Methods: We identified CDF list, UK National Institute for Health and Care Excellence (NICE) and Scottish Medicines Consortium documents (10 May 2018). Data were collected on drugs and indications, reasons for inclusion in the CDF, data collection, incremental cost-effectiveness ratios (ICERs), and corresponding recommendations for Scotland.Results: In total, 12 drugs were listed on the CDF in 17 indications, 12 of which were considered end-of-life care. The most common cancers were non-small-cell lung (n = 4), urothelial (n = 3), lymphocytic leukaemia (n = 2) and multiple myeloma (n = 2). The companies' ICERs were generally lower than those from the committee and the evidence review group. Drugs were included in the CDF for 6-42 months, with the majority included for ≥18 months. Data were frequently collected on overall survival (n = 16) and progression-free survival (n = 5) using NHS systems and, frequently, ongoing trials.Conclusions: Data collection frequently included overall survival and exceeded the 2 years recommended in the CDF strategy. It appears the CDF is allowing patients access to drugs long before they may become available for routine use. Our results are limited by the availability of published information and the small dataset. [ABSTRACT FROM AUTHOR]

This paper takes as its central focus the development of the Scottish Highland Gatherings. Questioned is the extent to which the transformation and reproduction of this Highland tradition has paralleled broader transformations within the Highland social formation. Such an analysis certainly encompasses some of the most basic questions that might be asked about Scottish cultural identity and social structure. [ABSTRACT FROM AUTHOR]

A correction is presented to the article "Inequalities in population health loss by multiple deprivation: COVID-19 and pre-pandemic all-cause disability-adjusted life years (DALYs) in Scotland."

Five hundred and seventy-three Scottish high school students were surveyed in the 2 months following the 2014 referendum on Scotland's independence. We used the Social Identity, Relative Deprivation, collective Efficacy (SIRDE) model of social change to examine the social psychological factors that should have influenced the voting choices of these teenagers. Structural equation modelling indicated that the SIRDE model fit the data and largely supported four sets of hypotheses derived from the model. Specifically, (1) those with a stronger Scottish identity, (2) those who felt frustrated and angry that Scottish people are discriminated against in British society, and (3) those who believed that Scottish people are not able to improve their relatively poor social conditions within the United Kingdom (a lack of collective efficacy) were more likely to hold separatist beliefs. Further, the relationships between identity, relative deprivation, and collective efficacy, on the one hand, and voting for Scotland's independence, on the other, were fully mediated by separatist social change beliefs. Consistent with the specificity of the model, neither political engagement nor personal relative deprivation were associated with voting choice, whereas the latter was associated with lower life satisfaction. The implications and limitations of these findings are discussed. [ABSTRACT FROM AUTHOR]

Sport is being used by a number of countries to raise profile, and create influence. Sports diplomacy has an increasing presence in terms of theory, practice and evidence within international relations. Sports diplomacy may occur both within sport and through sport. The channels through which this is facilitated are complex. Scotland has much to learn from places such as Australia that have put in place a dedicated four-year sports diplomacy strategy. The article sets out to answer key questions and doing so suggests that Scottish sport is capable of making the art of the possible, possible, but that Scotland has yet to grasp the opportunities provided by sport's global currency. The article concludes by making six recommendations. [ABSTRACT FROM AUTHOR]

Background: Two to 4% of emergency hospital admissions are caused by preventable adverse drug events. The estimated costs of such avoidable admissions in England were £530 million in 2015. The data-driven quality improvement in primary care (DQIP) intervention was designed to prompt review of patients vulnerable from currently prescribed non-steroidal anti-inflammatory drugs (NSAIDs) and anti-platelets and was found to be effective at reducing this prescribing. A process evaluation was conducted parallel to the trial, and this paper reports the analysis which aimed to explore response to the intervention delivered to clusters in relation to participants' perceptions about which intervention elements were active in changing their practice.Methods: Data generation was by in-depth interview with key staff exploring participant's perceptions of the intervention components. Analysis was iterative using the framework technique and drawing on normalisation process theory.Results: All the primary components of the intervention were perceived as active, but at different stages of implementation: financial incentives primarily supported recruitment; education motivated the GPs to initiate implementation; the informatics tool facilitated sustained implementation. Participants perceived the primary components as interdependent. Intervention subcomponents also varied in whether and when they were active. For example, run charts providing feedback of change in prescribing over time were ignored in the informatics tool, but were motivating in some practices in the regular e-mailed newsletter. The high-risk NSAID and anti-platelet prescribing targeted was accepted as important by all interviewees, and this shared understanding was a key wider context underlying intervention effectiveness.Conclusions: This was a novel use of process evaluation data which examined whether and how the individual intervention components were effective from the perspective of the professionals delivering changed care to patients. These findings are important for reproducibility and roll-out of the intervention.Trial Registration: ClinicalTrials.gov, NCT01425502 . [ABSTRACT FROM AUTHOR]

Background: 'Social prescribing' can be used to link patients with complex needs to local (non-medical) community resources. The 'Deep End' Links Worker Programme is being tested in general practices serving deprived populations in Glasgow, Scotland. Objectives: To assess the implementation and impact of the intervention at patient and practice levels. Methods: Study design: Quasi-experimental outcome evaluation with embedded theory-driven process evaluation in 15 practices randomized to receive the intervention or not. Complex intervention: Comprising a practice development fund, a practice-based community links practitioner (CLP), and management support. It aims to link patients to local community organizations and enhance practices' social prescribing capacity. Study population: For intervention practices, staff and adult patients involved in referral to a CLP, and a sample of community organization staff. For comparison practices, all staff and a random sample of adult patients. Sample size: 286 intervention and 484 comparator patients. Outcomes: Primary patient outcome is health-related quality of life (EQ-5D-5L). Secondary patient outcomes include capacity, depression/anxiety, self-esteem, and healthcare utilization. Practice outcome measures include team climate, job satisfaction, morale, and burnout. Outcomes measured at baseline and 9 months. Processes: Barriers and facilitators to implementation of the programme and possible mechanisms through which outcomes are achieved. Analysis plan: For outcome, intention-to-treat analysis with differences between groups tested using mixed-effects regression models. For process, case-study approach with thematic analysis. Discussion: This evaluation will provide new evidence about the implementation and impact of social prescribing by general practices serving patients with complex needs living in areas of high deprivation. [ABSTRACT FROM AUTHOR]

Scotland is a small nation, yet it leads the field in key areas of aging research. With the creation of a devolved government with authority over health and social services, the country has witnessed practice and policy developments that offer distinctive opportunities for innovative research. With multidisciplinary groups of internationally recognized researchers, Scotland is able to take advantage of a unique set of opportunities for aging research: a well-profiled population brings opportunities in population data and linkage to understand people's interactions with health, social care, and other public services; while research on technology and telecare is a distinctive area where Scotland is recognized internationally for using technology to develop effective, high-quality and well-accepted services at relatively low financial cost. The paper also considers free personal care for older people and the national dementia strategy in Scotland. The potential to evaluate the impact of free personal care will provide valuable information for other global health and social care systems. Exploring the impact of the national dementia strategy is another unique area of research that can advance understanding in relation to quality of life and the development of services. The paper concludes that, while Scotland benefits from unique opportunities for progressive public policy and innovative aging research that will provide valuable lessons at the forefront of a globally aging population, the challenges associated with an aging population and increasing cultural diversity must be acknowledged and addressed to ensure that the vision of equality and social justice for all is realized. [ABSTRACT FROM AUTHOR]

In contrast to prison personnel, practice cultures of penal agents charged with delivering 'community punishment' are surprisingly under-researched. Recent evidence from Scotland and England suggests that community-based penal agents demonstrate strong capacities for resistance against state-level punitive discourse. This indicates that despite several turns in penal policy, successive UK Governments have failed to produce tougher systems of community punishment as intended. By deploying Bourdieu's conceptual tools of habitus and field, and referring to evidence from empirical studies, this article will attempt to show that penal agents possess durable and deeply embedded dispositions that not only protect them from punitive field conditions, but also guide and underpin their everyday practice with offenders. By doing so, this article offers a conceptual starting point for an emerging sociology of community punishment. [ABSTRACT FROM AUTHOR]