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As humanity reaches the 5.0 industrial revolution, education plays a critical role in boosting the quality of human resources. This paper reports bibliometric research on emerging TiP during 1993-2022 in the educational field to analyse its development on any level of education during the last three decades. This study employed a Scopus database. The findings are that the trend of TiP publication in educational fields has tended to increase every year during the past three decades and conference paper became the most published document type, the USA is the country which produces the most publications; "Students" being the most occurrences keyword and total link strength. The publication of the TiP is ranked to the Quartile 1, which implies that a publication with the cited performance is a publication with credibility because the publisher has a good reputation. Researchers can find the topics most relevant to other metadata sources such as Web of Science, Publish, and Perish.

Marketization of education in South Africa accelerated at the crossroads of the postapartheid democratic transition and global neoliberal turn, reflecting both educational policy impacts of the country's protracted negotiated settlement and transnational trends. A controversial 2018 provincial amendment further entrenched marketization in the Western Cape by introducing "collaboration schools," public-private partnerships modeled on charter schools from the United States and academy schools from the United Kingdom. This article employs critical policy ethnography to argue that racial capitalism shapes transnational policy borrowing and to illustrate that a perceived portability of marketized reforms rests on racialized notions of the function of schooling for marginalized youth across contexts. I draw on Cedric Robinson's analysis of capitalism as a ubiquitously racialized, interconnected global order and Neville Alexander's insistence that antiracism must be anticapitalist, particularly in education, a site and strategy of struggle with dual potential to perpetuate or undermine racial capitalism.

Academic conferences have a central role in shaping career trajectories, reproducing or resisting exclusions and moulding relations in and to academia, thus shaping academic networks. In this paper, we consider how precarious academics subvert and navigate conference spaces, including emerging online forms. Particularly, we explore how academic conferences generate and nurture friendship as an enduring political practice that undermines neoliberal economic, political and social structures. This is contextualised in UK higher education amidst mass job losses, increased precarity and the subsequent breaking of academic bonds. In interviews with academics and our own auto/ethnographical experiences, we explore how friendship emerges in and resists the exclusions of the conference space for precarious researchers. Finally, we explore how the nurture of friendship by precarious scholars at academic conferences promotes collective action to resist neoliberalism within the academy.

Background/Aims: Following stroke, people can present with spatial perceptual deficits, which are associated with vertical perception deficits and are known to negatively influence the outcome of rehabilitation. It is not known how vertical perception deficits influence rehabilitation therapists' assessment and treatment choices. A survey of mainly UK-based physiotherapists and occupational therapists was undertaken to explore views and current practice in relation to vertical perception following stroke. Specifically, the survey investigated rehabilitation therapists' views on terminology, assessment and treatment, impact on functional outcome and clinical decision making. Methods: An online survey was completed by a convenience sample of 70 rehabilitation therapists (52 physiotherapists and 18 occupational therapists). Results: Vertical perception deficits were commonly encountered by respondents and were diagnosed mainly through observation. Respondents were confident in their ability to assess and treat vertical perception deficits. Vertical perception deficits were understood to be associated with pushing behaviour, neglect, weight-bearing asymmetry and decreased balance. Respondents understood it was related to severe, right-sided strokes with sensory and proprioceptive loss, but were inconsistent in their awareness of the specific brain regions involved in vertical perception deficits, specifically in posterior circulation strokes. Respondents reported that stroke survivors with vertical perception deficits require longer periods of rehabilitation, and overall have a worse functional outcome than those without. A variety of treatment options were used to address vertical perception deficits. Conclusions: Further research should investigate the treatment and assessment used by rehabilitation therapists in relation to vertical perception deficits following stroke. Implications for practice: Vertical perception deficits are commonly encountered in stroke rehabilitation. Rehabilitation therapists identify this mainly through observation. There are currently no methods to quantify vertical perception deficits in the clinical environment. Individuals living with vertical perception deficit may require longer periods of rehabilitation. At present, there are no evidence-based interventions to address vertical perception deficits in people who have had a stroke. [ABSTRACT FROM AUTHOR]

Hospital at Home (HaH) provides hospital-level care within patients' homes. With services expanding, a London HaH service embedded new junior doctor posts. Currently, gaps exist in the under- and postgraduate curriculum to develop clinical skills required to deliver care in this context. HaH simulation (HaH-SIM) was developed, through a multi-cycle QIP, to improve early-career doctors' confidence in providing care in this unfamiliar environment. Surveys before and after HaH-SIM assessed confidence in practical, clinical and communication skills; ranked concerns; rated sessions and gained qualitative feedback. 41 doctors participated over 2 years. It currently includes six low-fidelity stations and three high-fidelity stations. Confidence improved, particularly in managing end of life, decision-making around hospital admission and administering intravenous medications/fluids. High-fidelity scenarios, practical skills and prescribing stations were most highly rated. As HaH services expand, HaH-SIM is a feasible, effective and transferable way of improving early-career doctors' confidence and skills to provide care in patients' homes. [ABSTRACT FROM AUTHOR]

Purpose: We developed and evaluated in a randomized controlled trial a computerized speechreading training program to determine (a) whether it is possible to train speechreading in deaf children and (b) whether speechreading training results in improvements in phonological and reading skills. Previous studies indicate a relationship between speechreading and reading skill and further suggest this relationship may be mediated by improved phonological representations. This is important since many deaf children find learning to read to be very challenging. Method: Sixty-six deaf 5- to 7-year-olds were randomized into speechreading and maths training arms. Each training program was composed of a 10-min sessions a day, 4 days a week for 12 weeks. Children were assessed on a battery of language and literacy measures before training, immediately after training, and 3 months and 11 months after training. Results: We found no significant benefits for participants who completed the speechreading training, compared to those who completed the maths training, on the speechreading primary outcome measure. However, significantly greater gains were observed in the speechreading training group on one of the secondary measures of speechreading. There was also some evidence of beneficial effects of the speechreading training on phonological representations; however, these effects were weaker. No benefits were seen to word reading. Conclusions: Speechreading skill is trainable in deaf children. However, to support early reading, training may need to be longer or embedded in a broader literacy program. Nevertheless, a training tool that can improve speechreading is likely to be of great interest to professionals working with deaf children.

Rationale: The National Health Service (NHS) Long Term Plan was published in January 2019. One of its objectives was restructuring outpatient services, as part of an Outpatient Transformation initiative. Monitoring of trusts' adherence to the objectives of the Long Term Plan is therefore required to benchmark progress against national objectives. Aims and Objectives: We aimed to explore whether outpatient transformation initiatives and phlebotomy services that are managed by outpatients are appropriately staffed and to evaluate trusts' adherence to the objectives outlined in the Long Term Plan. Method: A freedom of information (FOI) request was sent in January 2023 to 153 trusts across Great Britain (time span: 1 January 2022–31 December 2022). Parameters requested included number of outpatients seen/discharged, phlebotomy episodes, number of sites/wards covered by phlebotomy, target/actual did not attend (DNA) rates, time since inception of the outpatient transformation project (OTP), advice and refer (A&R) and patient‐initiated follow‐up (PIFU), phlebotomy and outpatient managerial establishment and use of electronic notes and patient portals. Results: A total of 117 trusts (76.5%) provided responses to the FOI request. The mean number of new outpatients seen face‐to‐face was 185,810. Of 73 trusts reporting both actual and target DNA rates, 62 (84.9%) did not meet their DNA targets. The actual DNA rate was significantly greater than the target DNA rate across trusts (p < 0.001, mean: 8.8% vs. 6.5%, respectively). A total of 58 different electronic systems and 29 patient portals were utilised across trusts. Thirty‐six trusts (30.3%) did not have an outpatient transformation project manager and 16 trusts (13.7%) did not initiate an OTP. With phlebotomy provision, the mean number of outpatient phlebotomy episodes was lower than inpatient episodes (83,383 vs. 91,020, respectively). Conclusion: There are deficiencies in current outpatient establishments that may hinder the achievement of objectives set in the NHS Long Term Plan. Changes at all levels of healthcare are required, with increased reliance on technologies and investment in support for transformation management. [ABSTRACT FROM AUTHOR]

Objectives: Otolaryngology (ENT) plays a crucial role in healthcare, yet undergraduate education in the United Kingdom has historically not reflected this. This study aimed to assess the delivery of ENT education, focusing on teaching methods, clinical placements, and assessment practices. Methods: An online questionnaire was distributed to medical students. Data were collected via Qualtrics from 5 August 2023 to 17 October 2023. Results: Forty medical schools were involved. Thirty-seven schools had compulsory ENT teaching however 20 per cent lack an ENT placement. Clinical placements varied, with an average length of 7.3 days. Assessment of ENT knowledge included Objective, Structures, Clinical Examination stations (90 per cent) and written exams (80 per cent). Conclusion: The study highlights persistent gaps in ENT education. Deficiencies in clinical exposure and lack of alignment with national guidelines indicate the need for improvement. As the Medical Licensing Assessment approaches, standardising assessments may address disparities but should be accompanied by comprehensive changes in teaching methods and placements. [ABSTRACT FROM AUTHOR]

Within the last 50 years, the UK has moved from prosecuting male homosexuality to identifying sexual orientation as a protected characteristic. There have been differing explanations for how this change has occurred. In the present study, we investigate how this political and moral change is understood by those who witnessed it, with the aim of gaining new insight into this change process. We elicited accounts from 25 heterosexual UK residents over the age of 65 years. First, we conducted individual semi-structured interviews with 21 participants. Second, we used a memory work method. Specifically, a group of four participants met four times with one of the researchers to share and discuss memories relevant to the research question. The analytic process aimed to reconstruct and make sense of the participants' theorisations based on a thematic reading of the transcripts. Contact with LGBTQ people and increased awareness through the media were construed as central to the shift in societal homophobia. Participants remembered contact with LGBTQ people mediated by friends and family members but accounts show a complex understanding of social change that includes but also transcends direct personal experience and extant psychological theorising. Overall, this was a fragmented story of changing social norms, albeit one embedded within a canonical narrative of tolerance, decency and fairness. [ABSTRACT FROM AUTHOR]

Aims With an ageing population, the presence of asymptomatic valvular heart disease (VHD) in the community remains unknown. The aim of this study is to determine the prevalence and associated factors of asymptomatic VHD in individuals ≥60 years old and to evaluate the feasibility of echocardiographic screening for VHD in this population. Methods and results This was a prospective cohort study conducted between 2007 and 2016 in the UK. Asymptomatic patients with no prior indication for echocardiography were invited to participate and evaluated with a health questionnaire, clinical examination, and transthoracic echocardiography. A total of 10,000 individuals were invited through their general practices. A total of 5429 volunteered to participate, of whom 4237 were eligible for inclusion. VHD was diagnosed in more than a quarter of patients (28.2%). The most common types of VHD were regurgitation of the tricuspid (13.8%), mitral (12.8%), and aortic (8.3%) valves (trivial regurgitation was not included). The rate of prevalence of clinically significant VHD was 2.4% (2.2% moderate and 0.2% severe), with mitral and aortic regurgitation being the most common. The only parameter associated with significant VHD was age (odds ratio 1.07 per 1 year increment, 95% confidence interval 1.05–1.09, P < 0.001). The number needed to scan to diagnose one clinically significant case of VHD is 42 for individuals ≥60 and 15 for those ≥75 years old. Conclusion Asymptomatic VHD is present in a significant proportion of otherwise healthy individuals without known VHD over 60 years old. Age is strongly associated with an increased incidence of significant VHD. [ABSTRACT FROM AUTHOR]

Self-harming behaviours can include cutting the skin, ligaturing and taking overdoses. These actions can result in infection, blood loss, or even death. A young person's risk of dying by suicide increases if they engage in self-harm. Self-help empowers people to utilise different coping strategies and implement life changes without reliance on a clinical intervention, "helping people to help themselves". Self-help toolkits contain a variety of items that are selected by the person to help them manage the urge to self-harm. The items included sensory objects, distractions, prompts to seek help and creative prompts such as colouring books and pens and personal items that trigger positive memories. AMED, EMBASE, APA Psycinfo and MEDLINE were searched with no language restriction or date restriction. Of the 368 studies screened, 13 met the inclusion criteria. The studies were mainly small scale or case studies pertaining to the use of self-help toolkits or similar. They described the need for a flexible and/or individualised approach to self-help toolkits. Abstracts and studies were screened separately by two members of the research team for inclusion. Qualitative data was analysed using Grounded Theory. Nine themes were identified: Creativity, Hope, Social contact/help seeking, calming/relaxing, sensory items, reflection, distractions, therapeutic prompts and emotional release. Self-efficacy and self-awareness were the two main mechanisms identified. Self-help toolkits were found to be acceptable and helpful, but the limited evidence base means their efficacy for reducing self-harm episodes has not been established. [ABSTRACT FROM AUTHOR]

Despite the importance of menstruation and the menstrual cycle to health, human rights, and sociocultural and economic wellbeing, the study of menstrual health suffers from a lack of funding, and research remains fractured across many disciplines. We sought to systematically review validated approaches to measure four aspects of changes to the menstrual cycle—bleeding, blood, pain, and perceptions—caused by any source and used within any field. We then evaluated the measure quality and utility for clinical trials of the identified instruments. We searched MEDLINE, Embase, and four instrument databases and included peer-reviewed articles published between 2006 and 2023 that reported on the development or validation of instruments assessing menstrual changes using quantitative or mixed-methods methodology. From a total of 8,490 articles, 8,316 were excluded, yielding 174 articles reporting on 94 instruments. Almost half of articles were from the United States or United Kingdom and over half of instruments were only in English, Spanish, French, or Portuguese. Most instruments measured bleeding parameters, uterine pain, or perceptions, but few assessed characteristics of blood. Nearly 60% of instruments were developed for populations with menstrual or gynecologic disorders or symptoms. Most instruments had fair or good measure quality or clinical trial utility; however, most instruments lacked evidence on responsiveness, question sensitivity and/or transferability, and only three instruments had good scores of both quality and utility. Although we took a novel, transdisciplinary approach, our systematic review found important gaps in the literature and instrument landscape, pointing towards a need to examine the menstrual cycle in a more comprehensive, inclusive, and standardized way. Our findings can inform the development of new or modified instruments, which—if used across the many fields that study menstrual health and within clinical trials—can contribute to a more systemic and holistic understanding of menstruation and the menstrual cycle. [ABSTRACT FROM AUTHOR]

Summary: Ten years ago, (black) stem rust – the most damaging of wheat (Triticum aestivum) rusts – re‐emerged in western Europe. Disease incidences have since increased in scale and frequency. Here, we investigated the likely underlying causes and used those to propose urgently needed mitigating actions. We report that the first large‐scale UK outbreak of the wheat stem rust fungus, Puccinia graminis f. sp. tritici (Pgt), in 2022 may have been caused by timely arrival of airborne urediniospores from southwest Europe. The drive towards later‐maturing wheat varieties in the UK may be exacerbating Pgt incidences, which could have disastrous consequences. Indeed, infection assays showed that two UK Pgt isolates from 2022 could infect over 96% of current UK wheat varieties. We determined that the temperature response data in current disease risk simulation models are outdated. Analysis of germination rates for three current UK Pgt isolates showed substantial variation in temperature response functions, suggesting that the accuracy of disease risk simulations would be substantially enhanced by incorporating data from prevailing Pgt isolates. As Pgt incidences continue to accelerate in western Europe, we advocate for urgent action to curtail Pgt losses and help safeguard future wheat production across the region. [ABSTRACT FROM AUTHOR]

We describe why the Association of Clinical Psychologists-UK is changing its bank account, highlighting how this change can be viewed as a preventative health action in keeping with professional values. We hope other professional bodies and individual psychologists will take similar action. [ABSTRACT FROM AUTHOR]

Prior to the COVID pandemic, staffing levels, staff turnover and vacancies in adult social care and social work within the UK were a major concern, with staff experiencing high workloads, burnout, stress and poor morale. The paucity of published evidence in a rapidly evolving contemporary situation indicated the suitability of a scoping review. Systematic searching produced evidence published between 1 December 2019 and 9 May 2023. Out of ninety-seven articles retrieved, the final analysis included thirty nine articles. To report the review findings clearly and accessibly, the analysis used the Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework. Abundant evidence emerged on psychological distress and the impact of COVID-19 on the working environment for social care and social workers, but a paucity of psychosocial resilience, supporting social care managers, Personal Assistants and moral injury. Social care needs and the statutory duties of social work are likely to become even more intense. The COVID pandemic magnified a chronic lack of funding, staffing, support and regard for adult social care, with no future planning compared to the NHS. This legacy and backlogs of social care assessment and service delivery are of concern despite the proposed actions of the Adult Social Care Reform Act in England. [ABSTRACT FROM AUTHOR]

Introduction: Physical activity (PA) promotion is a core element of musculoskeletal rehabilitation. Many people with musculoskeletal conditions do not meet PA guidelines, such as those provided by the World Health Organization (WHO). This study aimed to explore the level of awareness and perspectives on the WHO PA guidelines among people with musculoskeletal conditions and identify how patients can be supported with PA in clinical practice. Methods: A mixed‐method cross‐sectional survey was conducted using a uniquely developed questionnaire, which was disseminated to patients attending outpatient physiotherapy or occupational therapy appointments. The questionnaire collected data on participant characteristics, awareness and perspectives on the WHO guidelines and suggestions for supporting patients with PA in clinical practice. Descriptive statistics and content analysis were used to analyse the quantitative and qualitative data respectively. Results: One‐hundred and two responses were included in the analysis. Forty‐two percent of respondents were aware of the guidelines, 50% knew why they existed and 53% felt they were achievable. Perspectives varied, ranging from the guidelines being positive and aiding motivation to being unachievable. Some respondents felt an individualised approach is required. Suggestions for supporting patients with PA included facilitating social support, providing education, exercise groups and personalised advice, and signposting to community services. Conclusion: There is limited awareness of the WHO PA guidelines and a variety of perspectives on the guidelines among patients with musculoskeletal conditions. There is a need to enhance the promotion of the guidelines in clinical practice, whilst considering local context and individual patient's circumstances. [ABSTRACT FROM AUTHOR]

Objective Sensory elements are core features in chronic pain and autism, yet knowledge of the pain experience in autistic adolescents is limited. Little is known regarding how autistic adolescents experience chronic pain, manage their pain and perceive psychological treatment for their chronic pain. Methods Ten autistic adolescents (6 female, 3 male, and 1 self-identified as agender) with chronic pain and their mothers (n  = 10) participated in semistructured interviews concerning their perceptions of living with chronic pain. Participants were recruited from U.K. pain management services. According to preference, interviews were conducted individually (n  = 10) or dyadically (n  = 10 participants across 5 dyads). Data were analyzed using inductive reflexive thematic analysis. Results Two themes were generated. Theme 1, "overstimulated and striving for control" described how adolescents' experience of heightened sensitivity enhanced adolescents' levels of anxiety and subsequent pain, illustrating a reciprocal relationship between anxiety, pain, and sensory elements. Theme 2, "not everyone fits the mold" captured how autistic adolescents positioned themselves as distinct from others due to the unique nature of being autistic and living with pain. This sense of difference negatively impacted adolescents' ability to engage with and benefit from the standard treatment for chronic pain. Conclusions Findings suggest that autistic adolescents living with pain experience pain and face barriers to effective pain treatment. Our results identify the need for educational resources to facilitate clinicians to better understand the experience of autistic adolescents living with pain. In turn, such understanding may improve treatment and outcomes in this population. [ABSTRACT FROM AUTHOR]

This practitioner research article sought to provide an interpretation of the parental experience of video interaction guidance (VIG). Two mothers and one grandmother participated in one cycle of VIG and one interview about their experiences. Transcripts were analysed using Interpretive Phenomenological Analysis (IPA). Findings indicated that parents valued the opportunity to use video to reflect on their interaction skills. They felt empowered to use their learning to develop relationships with their children. Questions emerged about parents' experiences of control and feeling judged during VIG. Participants' felt VIG involved some judgement of their parenting skills and their children's communication skills. This is discussed within the wider socio-cultural context of practitioner-client relationships. The article highlighted implications for VIG practitioners to be honest about their positions and mindful of the feelings of the clients they support. Understanding of the function of the relationship between the guider and the VIG client was identified as an area for future research.

In this commentary, Paget and Emond note that school exclusion is not just an education issue, but is increasingly recognised as pertinent to child health, with implications for how education, health, social care, and voluntary sector services should interact to support children at risk in a holistic, integrated manner. Children who are excluded from school due to behavioural difficulties may have an underlying mental health or developmental condition which is unrecognised or inadequately supported, and the consequences of exclusion go further than a few days missed from school. This commentary aims to outline the risk factors for school exclusion, to explore the role of community child health services in supporting schools to avoid exclusions that have a basis in health and suggests a potential care pathway by which this may occur. Although exclusion is clearly a cross-disciplinary issue, Paget and Emond desire to clarify the role of the Paediatrician for those in other sectors who may have less experience of what medical services can offer in such situations.

As a systemic approach to improving educational practice through research, "What Works" has come under repeated challenge from alternative approaches, most recently that of improvement science. While "What Works" remains a dominant paradigm for centralized knowledge-building efforts, there is need to understand why this alternative has gained support, and what it can contribute. I set out how the core elements of experimental and improvement science can be combined into a strategy to raise educational achievement with the support of evidence from randomized experiments. Central to this combined effort is a focus on identifying and testing mechanisms for improving teaching and learning, as applications of principles from the learning sciences. This article builds on current efforts to strengthen approaches to evidence-based practice and policy in a range of international contexts. It provides a foundation for those who aim to avoid another paradigm war and to accelerate international discussions on the design of systemic education research infrastructure and funding.

Objective: Clinician-scientists are critical to medical innovation and research. However, the number of clinician scientists in the UK has been declining steadily over the last decade. One of the cited reasons is poor student recruitment to academic training pathways. The SMART study aims to assess current student perceptions on research and identify key factors influencing whether a student is interested in research. Design: We conducted a cross-sectional survey study between January and May 2022. Setting: This was a multi-centre national study with data collected across 40 universities offering medical courses in the UK. Participants: Participants were UK medical students enrolled in medicine for 21/22 academic year. Main outcome and measure: The main outcomes were related to participant perceptions on research and whether they were interested in engaging with research in their future career. These measures were correlated with demographic and non-demographic details using regression analyses. Results: One thousand seven hundred seventy-four individuals participated in the SMART survey from 40 medical schools. Nearly half the participants felt there were barriers preventing them from doing research (46.67%) and almost three-quarters felt it was at least somewhat difficult to combine research with medical school (73.49%). Of the options available, most commonly students did not want to pursue an academic career (43.11%) or training pathway (42.49%). However, most participants felt it was useful to do research at medical school (59.54%) and were also interested in doing more research in the future (69.16%). Regression analysis identified many factors influencing student's perceptions of research including year of study, gender, socioeconomic status, family background, research exposure at medical school, ethnicity, and country of pre-university education. Conclusions: The SMART study is the first of its kind in the UK, shedding light on medical student perceptions. While some express strong interest in academic careers, a larger proportion show a broader interest in research. Demographic factors like gender, parental occupation, and socioeconomic status play a role. Further exploration is needed for specific groups to address barriers, promote research, and boost academic pathway recruitment. [ABSTRACT FROM AUTHOR]

Brexit has been a game-changer for Britain, and its key partners. Strategic shifts as well as historic relations have impacted the UK's relationship with France in a number of unexpected ways. This article explores some of the key historical events that have caused both agreement and strife between the two states, looking at the bilateral treaties established to deepen cooperation on security and defence, specifically the Lancaster House agreements, and considers the series of intriguing accords and conventions that have arisen from the mid-1980s, as well as the logistical challenges of the shared border and juxtaposed border controls of Britain and France. Post-Brexit diplomatic forums in which Britain and France are joined by Germany are then explored, before assessing Britain's attempts to forge its new role in relation to long-standing commitments to France and an evolving relationship with the EU. [ABSTRACT FROM AUTHOR]

Three days of nitrofurantoin at 100 mg twice daily is recommended as first-line treatment for uncomplicated urinary tract infection (UTI) in evidence-based guidelines across the UK. A review of international guidelines shows that the evidence base has been interpreted in very different ways. UK guidelines are unusual in promoting short (3 day) courses, and we find little direct evidence to support this. Although 'short' courses of antibiotics for other agents may provide optimum balance between providing effective treatment whilst reducing selective pressure driving resistance amongst colonizing microbial flora, it remains unclear that course lengths can be extrapolated to nitrofurantoin. Three days of nitrofurantoin may indeed be a useful intervention in a large group of patients. However, without supporting evidence and because clinical response should be expected to vary widely, it is unclear that establishing and promoting an antibiotic duration for UTI is the best approach to optimizing prescribing in this important area. [ABSTRACT FROM AUTHOR]

Background: Depression symptoms are thought to be associated with lower educational attainment, but patterns of change in attainment among those who receive a clinical diagnosis of depression at any point during childhood and adolescence remain unclear. Methods: We conducted a secondary analysis of an existing data linkage between a national educational dataset (National Pupil Database) and pseudonymised electronic health records (Clinical Record Interactive Search) from a large mental healthcare provider in London, United Kingdom (2007 to 2013). A cohort of 222,027 pupils were included. We used Growth Mixture Modelling (GMM) and stakeholder input to estimate trajectories of standardised educational attainment over School Years 2, 6 and 11. Multinomial logistic regression analyses were then used to investigate the association between resulting educational attainment trajectory membership (outcome) and depression diagnosis any time before age 18 (exposure). Results: A five‐trajectory GMM solution for attainment was derived: (1) average/high‐stable, (2) average‐modest declining, (3) average‐steep declining, (4) low‐improving and (5) low‐stable. After adjusting for clinical and sociodemographic covariates, having a depression diagnosis before age 18 was associated with occupying the average‐modest declining trajectory (RRR = 2.80, 95% CI 2.36–3.32, p <.001) or the average‐steep declining trajectory (RRR = 3.54, 95% CI 3.10–4.04, p <.001), as compared to the average/high‐stable trajectory. Conclusions: Receiving a diagnosis of depression before age 18 was associated with a relative decline in attainment throughout school. While these findings cannot support a causal direction, they nonetheless suggest a need for timely mental health and educational support among pupils struggling with depression. [ABSTRACT FROM AUTHOR]

Throughout the COVID-19 pandemic, the concept of solidarity has been invoked frequently. Much interest has centred around how citizens and communities support one another during times of uncertainty. Yet, empirical research which accounts and understands citizen's views on pandemic solidarity, or their actual practices has remained limited. Drawing upon the analysis of data from 35 qualitative interviews, this article investigates how residents in England and Scotland enacted, understood, or criticised (the lack of) solidarity during the first national lockdown in the United Kingdom in April 2020—at a time when media celebrated solidarity as being at an all-time high. It finds that although solidarity was practiced by some people, the perceived lack of solidarity was just as pronounced. We conclude that despite frequent mobilisations of solidarity by policy makers and other public actors, actual practices of solidarity are poorly understood—despite the importance of solidarity for public health and policy. [ABSTRACT FROM AUTHOR]

Background Due to limited inclusion of patients on kidney replacement therapy (KRT) in clinical trials, the effectiveness of coronavirus disease 2019 (COVID-19) therapies in this population remains unclear. We sought to address this by comparing the effectiveness of sotrovimab against molnupiravir, two commonly used treatments for non-hospitalised KRT patients with COVID-19 in the UK. Methods With the approval of National Health Service England, we used routine clinical data from 24 million patients in England within the OpenSAFELY-TPP platform linked to the UK Renal Registry (UKRR) to identify patients on KRT. A Cox proportional hazards model was used to estimate hazard ratios (HRs) of sotrovimab versus molnupiravir with regards to COVID-19-related hospitalisations or deaths in the subsequent 28 days. We also conducted a complementary analysis using data from the Scottish Renal Registry (SRR). Results Among the 2367 kidney patients treated with sotrovimab (n  = 1852) or molnupiravir (n  = 515) between 16 December 2021 and 1 August 2022 in England, 38 cases (1.6%) of COVID-19-related hospitalisations/deaths were observed. Sotrovimab was associated with substantially lower outcome risk than molnupiravir {adjusted HR 0.35 [95% confidence interval (CI) 0.17–0.71]; P  = .004}, with results remaining robust in multiple sensitivity analyses. In the SRR cohort, sotrovimab showed a trend toward lower outcome risk than molnupiravir [HR 0.39 (95% CI 0.13–1.21); P  = .106]. In both datasets, sotrovimab had no evidence of an association with other hospitalisation/death compared with molnupiravir (HRs ranged from 0.73 to 1.29; P  > .05). Conclusions In routine care of non-hospitalised patients with COVID-19 on KRT, sotrovimab was associated with a lower risk of severe COVID-19 outcomes compared with molnupiravir during Omicron waves. [ABSTRACT FROM AUTHOR]

Existing international research suggests that widespread performative pedagogy has contributed to producing educational inequalities for "disadvantaged" learners. There have also been calls for alternative pedagogies, which can be characterised as child-centred. This paper analyses pupils' hierarchical positioning in a contemporary, mixed socio-economic, child-centred classroom using Bernstein's theory of competence pedagogy and the concept of the ideal pupil. The ideal pupil's central characteristics were perceived "intelligence" and "good humour", which were closely associated with middle-class boys. Middle-class and working-class girls were positioned against a female ideal pupil, who would take on a supporting role by creating a facilitating environment for boys' learning. While middle-class girls were moderately successful in approximating these characteristics, working-class girls were positioned at the bottom of the class hierarchy. These findings have implications for these pupils' self-perceptions, and raise questions about the implications of child-centred pedagogy for social justice.

This paper will explore the effect that creative, non-traditional uses of audio description (AD) have on the audience during a performance, and how they trouble normative understandings of aesthetics and representation. This will be done by analysing two pieces created by Extant Theatre, the UK's only professional theatre company of visually impaired people. Both pieces use highly visual forms of performance in order to highlight the necessity of descriptive access for both practitioners and spectators experiencing these pieces, as well as the effect that description can have on the comprehension of an image. I will dissect these performances by juxtaposing my experience as a practitioner in these pieces with some of the methodological structures inherent within disability studies and identity politics, such as Rosemary Garland-Thomson's research on staring. AD, in its standard form, is an access tool for blind and visually impaired spectators that is almost always placed on top of an already completed performance, and hidden from the view of those not using the service. When that dynamic is shifted to allow for everyone, performer and audience alike, to experience and potentially contribute to the descriptions being given, regardless of visual status, the perceptions around the performance can change. This paper argues that the creative input of AD into a theatrical piece can open up wider questions around how aesthetics are viewed by performer and audience alike. Also, by making an access tool into a collaboration between audience and performer, the story that is communicated and the way the characters within that story are represented can break away from normative methods of performance. This then opens up possibilities for new ways of thinking about and perceiving how performance is made, why it is done and what it might become.

Purpose: COVID-19 pandemic has had long-standing consequences for all aspects of life. Although young people appear less susceptible to severe forms of physical illness due to the coronavirus, they have not escaped unscathed from its' psychological impacts. The present study measured the content of worries in young people residing in the UK during the pandemic and how it varied with sociodemographic factors. Methods: Between May and December 2020, UK-residing participants aged 12–25 years completed an online survey that presented participants with free-text fields to describe their top three worries over the last two weeks, in addition to demographic and other information. Cross-sectional data from 2560 participants (Males = 767; Female = 1793) was analyzed. Results: Irrespective of sociodemographic, a majority of the participants reported worries related to academics, followed by social relationships, own physical health, social and work routines, and physical health of others. Significantly more females reported concerns about academics, finances, physical health, social and work routines, social relationships, mental health and emotions, and physical health of others. Expectedly, more older (18–25 years) than younger (12–17 years) participants reported concerns about career-prospects and finances, while more younger than older ones were worried about academics (98.41% vs. 80.90%). With respect to financial worries, a higher percentage of BAME (Black, Asian and Minority Ethnic) communities in the UK reported such worries. Ethnicity significantly predicted more worries about social relationships among White than BAME participants. Significant differences also existed across different SES groups regarding endorsement of a particular category of worry. Conclusion: These findings highlight the need for tailored interventions depending on the major concerns for young people of different ages, sexes, ethnicities, and SES. [ABSTRACT FROM AUTHOR]

This paper examines the effect of school social class composition on pupil learner identities in British primary schools. In the current British education system, high-stakes testing has a pervasive effect on the pedagogical relationship between teachers and pupils. The data in this paper, from ethnographic research in a working-class school and a middle-class school, indicate that the effect of the "testing culture" is much greater in the working-class school. Using Bernsteinian theory and the concept of the "ideal pupil", it is shown that these pupils' learner identities are more passive and dominated by issues of discipline and behaviour rather than academic performance, in contrast to those in the middle-class school. While this study includes only two schools, it indicates a potentially significant issue for neo-liberal education policy where education is marketised and characterised by high-stakes testing, and schools are polarised in terms of social class. (Contains 3 notes.)

Background: Migraine and depression are two of the most common and debilitating conditions. From a clinical perspective, they are mostly prevalent in women and manifest a partial overlapping symptomatology. Despite the high level of comorbidity, previous studies hardly investigated possible common patterns in brain volumetric differences compared to healthy subjects. Therefore, the current study investigates and compares the volumetric difference patterns in sub-cortical regions between participants with migraine or depression in comparison to healthy controls. Methods: The study included data from 43 930 participants of the large UK Biobank cohort. Using official ICD10 diagnosis, we selected 712 participants with migraine, 1 853 with depression and 23 942 healthy controls. We estimated mean volumetric difference between the groups for the different sub-cortical brain regions using generalized linear regression models, conditioning the model within the levels of BMI, age, sex, ethnical background, diastolic blood pressure, current tobacco smoking, alcohol intake frequency, Assessment Centre, Indices of Multiple Deprivation, comorbidities and total brain volume. Results: We detected larger overall volume of the caudate (mean difference: 66, 95% CI [-3, 135]) and of the thalamus (mean difference: 103 mm3, 95% CI [-2, 208]) in migraineurs than healthy controls. We also observed that individuals with depression appear to have also larger overall (mean difference: 47 mm3, 95% CI [-7, 100]) and gray matter (mean difference: 49 mm3, 95% CI [2, 95]) putamen volumes than healthy controls, as well as larger amygdala volume (mean difference: 17 mm3, 95% CI [-7, 40]). Conclusion: Migraineurs manifested larger overall volumes at the level of the nucleus caudate and of the thalamus, which might imply abnormal pain modulation and increased migraine susceptibility. Larger amygdala and putamen volumes in participants with depression than controls might be due to increased neuronal activity in these regions. [ABSTRACT FROM AUTHOR]

Background: Medication reviews in primary care provide an opportunity to review and discuss the safety and appropriateness of a person's medicines. However, there is limited evidence about access to and the impact of routine medication reviews for older adults in the general population, particularly in the UK. We aimed to quantify the proportion of people aged 65 years and over with a medication review recorded in 2019 and describe changes in the numbers and types of medicines prescribed following a review. Methods: We used anonymised primary care electronic health records from the UK's Clinical Practice Research Datalink (CPRD GOLD) to define a population of people aged 65 years or over in 2019. We counted people with a medication review record in 2019 and used Cox regression to estimate associations between demographic characteristics, diagnoses, and prescribed medicines and having a medication review. We used linear regression to compare the number of medicines prescribed as repeat prescriptions in the three months before and after a medication review. Specifically, we compared the 'prescription count' - the maximum number of different medicines with overlapping prescriptions people had in each period. Results: Of 591,726 people prescribed one or more medicines at baseline, 305,526 (51.6%) had a recorded medication review in 2019. Living in a care home (hazard ratio 1.51, 95% confidence interval 1.40-1.62), medication review in the previous year (1.83, 1.69-1.98), and baseline prescription count (e.g. 5-9 vs 1 medicine 1.41, 1.37-1.46) were strongly associated with having a medication review in 2019. Overall, the prescription count tended to increase after a review (mean change 0.13 medicines, 95% CI 0.12-0.14). Conclusions: Although medication reviews were commonly recorded for people aged 65 years or over, there was little change overall in the numbers and types of medicines prescribed following a review. This study did not examine whether the prescriptions were appropriate or other metrics, such as dose or medicine changes within the same class. However, by examining the impact of medication reviews before the introduction of structured medication review requirements in England in 2020, it provides a useful benchmark which these new reviews can be compared with. [ABSTRACT FROM AUTHOR]

Introduction: The Social Communication Questionnaire is used to identify children and young people (CYP) who may require formal ASD assessment. However, there is a paucity of research on its utility in Children and Adolescent Mental Health Services. This evaluation aimed to determine the sensitivity and specificity of the Social Communication Questionnaire (SCQ) in a UK, Midlands CAMHS service. Method: Forty young people (mean age 13.75 years) were screened using the caregiver reported SCQ before completing 'gold standard' assessment. Results: The SCQ had a sensitivity of 80% and a specificity of 25.7%. ROC curve analysis indicated low diagnostic accuracy. Differences in predictive accuracy of SCQ and diagnostic standard were statistically significant (p < 0.0001). Conclusion: This evaluation builds on previous research suggesting that the SCQ may not be an efficient screening tool in CAMHS settings. [ABSTRACT FROM AUTHOR]

There has been growing concern about rising physical inactivity levels in female adolescents, with schools taking some responsibility to address this. Programmes designed for and by girls are increasingly being used by developing or delivering a programme of change and consultation to improve physical activity, physical education, and sport in school. However, to build an understanding of the nuances of such interventions, and better appreciate any gendered benefits and challenges, girls' voices need to be heard. Based on data from 16 focus groups from 8 schools participating in a female-focused intervention trial ("Girls Active"), we explored adolescent girls' views of this type of intervention. We used reflexive organic thematic analysis to understand key issues. Four themes were developed: stereotypes; choice; empowerment and voice; and equality. Our feminist approach centralised adolescent girls' voices, thereby recognising that physical activity is rooted in patriarchal constructions that position girls as naturally uninterested in sport and activity. We suggest gender-focused interventions can actively address stereotypes by listening to girls. [ABSTRACT FROM AUTHOR]

Emulating a hypothetical "target trial" using observational data assembled during vaccine rollouts can help manage potential sources of bias in observational studies of the COVID-19 vaccines. This article describes 2 approaches to target trial emulation using observational data that can help design studies that provide robust evidence to guide clinical and policy decisions. The COVID-19 vaccines were developed and rigorously evaluated in randomized trials during 2020. However, important questions, such as the magnitude and duration of protection, their effectiveness against new virus variants, and the effectiveness of booster vaccination, could not be answered by randomized trials and have therefore been addressed in observational studies. Analyses of observational data can be biased because of confounding and because of inadequate design that does not consider the evolution of the pandemic over time and the rapid uptake of vaccination. Emulating a hypothetical "target trial" using observational data assembled during vaccine rollouts can help manage such potential sources of bias. This article describes 2 approaches to target trial emulation. In the sequential approach, on each day, eligible persons who have not yet been vaccinated are matched to a vaccinated person. The single-trial approach sets a single baseline at the start of the rollout and considers vaccination as a time-varying variable. The nature of the confounding depends on the analysis strategy: Estimating "per-protocol" effects (accounting for vaccination of initially unvaccinated persons after baseline) may require adjustment for both baseline and "time-varying" confounders. These issues are illustrated by using observational data from 2 780 931 persons in the United Kingdom aged 70 years or older to estimate the effect of a first dose of a COVID-19 vaccine. Addressing the issues discussed in this article should help authors of observational studies provide robust evidence to guide clinical and policy decisions. [ABSTRACT FROM AUTHOR]

Background: Migraine is associated with hypertensive disorders of pregnancy through common pathophysiological features. This study evaluates the association between migraine diagnosis and treatment, and risk of hypertensive disorders of pregnancy. Methods: We conducted a prospective cohort study in the Clinical Practice Research Datalink GOLD, a large longitudinal database of patient records in the UK. We analyzed data from liveborn or stillborn singleton deliveries from 1993-2020 with at least 24 months of medical history and no history of cardiovascular disease (n=1,049,839). We ascertained migraine through diagnosis or prescription codes before 20 weeks of gestation and hypertensive disorders of pregnancy through diagnosis codes between 20 weeks of pregnancy and delivery. We used log-binomial regression models to estimate the risk ratio and 95% confidence intervals, comparing risk of hypertensive disorders of pregnancy among individuals with migraine to those without migraine, adjusting for confounders. Conclusions: A history of migraine prior to pregnancy was associated with an increased risk of hypertensive disorders of pregnancy (RR=1.17, 95% CI: 1.09-1.26). The greatest risk was among those with pre-pregnancy migraine that persisted into the first trimester (RR=1.84, 95% CI: 1.35-2.50). Use of migraine medication was associated with a higher risk of hypertensive disorders of pregnancy compared to non-migraineurs (RR=1.50, 95% CI: 1.15-1.97). Results from this study indicate that migraine is a potential risk factor for hypertensive disorders of pregnancy. [ABSTRACT FROM AUTHOR]

During the COVID‐19 pandemic, the United Kingdom implemented physical distancing measures to minimize viral transmission, which may have adversely impacted health and wellbeing. Evidence suggests that social support may be key to mitigating against adverse health impacts of such measures, particularly when such social support is identity‐based. In this longitudinal study, we examined the role of social identity and perceived social support in mental and physical health outcomes during the COVID‐19 pandemic. Participants completed a survey at 4 time points during the first year of the pandemic: May/June 2020 (T1; N = 443); September/October 2020 (T2; N = 235); December 2020/January 2021 (T3; N = 243); and April 2021 (T4; N = 206). Results showed that at each time point, social support was predicted by identification with multiple groups before COVID‐19, identity continuity, and identification with communities. Higher identity continuity and identification with communities both predicted greater mental and physical health at the same time point, mediated by perceived social support. Interestingly, higher identity continuity and identification with communities predicted higher social support at the same time point, which in turn predicted worse mental and physical health outcomes at the subsequent time point. Findings are discussed in relation to the context of the first year of the pandemic and the changing nature of societal restrictions across the four survey time points. [ABSTRACT FROM AUTHOR]

Left ventricular mass is a risk marker for cardiovascular events, and may indicate an underlying cardiomyopathy. Cardiac magnetic resonance is the gold-standard for left ventricular mass estimation, but is challenging to obtain at scale. Here, we use deep learning to enable genome-wide association study of cardiac magnetic resonance-derived left ventricular mass indexed to body surface area within 43,230 UK Biobank participants. We identify 12 genome-wide associations (1 known at TTN and 11 novel for left ventricular mass), implicating genes previously associated with cardiac contractility and cardiomyopathy. Cardiac magnetic resonance-derived indexed left ventricular mass is associated with incident dilated and hypertrophic cardiomyopathies, and implantable cardioverter-defibrillator implant. An indexed left ventricular mass polygenic risk score ≥90th percentile is also associated with incident implantable cardioverter-defibrillator implant in separate UK Biobank (hazard ratio 1.22, 95% CI 1.05-1.44) and Mass General Brigham (hazard ratio 1.75, 95% CI 1.12-2.74) samples. Here, we perform a genome-wide association study of cardiac magnetic resonance-derived indexed left ventricular mass to identify 11 novel variants and demonstrate that cardiac magnetic resonance-derived and genetically predicted indexed left ventricular mass are associated with incident cardiomyopathy. A genome-wide association study of cardiac magnetic resonance-derived left ventricular mass index including 43,000 UK Biobank participants reveals 12 associations (11 novel), implicating genes involved in cardiac contractility and cardiomyopathy. [ABSTRACT FROM AUTHOR]

A correction is presented to the article "The Knowledge of Autism Questionnaire-UK: Development and Initial Psychometric Evaluation" which appeared in the previous issue of the periodical.

Low job satisfaction has been associated with both negative health and negative organizational outcomes. Knowledge on which factors influence job satisfaction remains limited. This study assesses the associations between job satisfaction and three personality traits related to cognitive- and inhibitory control: delay discounting, risk-taking and sensation seeking (DRS-traits). Delay discounting and sensation seeking were inferred using self-reported behavioral data and health measurements for 80,676 participants in the UK Biobank. Multiple linear regression analysis produced beta coefficients and confidence intervals for each DRS-trait and job satisfaction. Analyses were adjusted for age, socioeconomic status and sleep quality. A combination of the three DRS-traits (CDRS) was assessed as well. Delay discounting and risk-taking were associated with, respectively, lower and higher job satisfaction in both sexes. Sensation seeking had no significant association with job satisfaction for either sex. The combined score, CDRS, was only negatively associated with job satisfaction in females but not in males. We discuss that the negative association between delay discounting and job satisfaction may be due to career related delay discounting effects, but also highlight that low job satisfaction itself may also lead to increased delay discounting. Additionally, we discuss why increased risk-taking behavior may have a positive effect on job satisfaction. [ABSTRACT FROM AUTHOR]

Integrative local health delivery models in the UK, under the framework of Enhanced Health in Care Homes (EHICH), have been developed to improve joint working between health and social care to benefit the patient. Despite this drive toward health and social care integration, research on the barriers, facilitators, and impact of partnership working on role of care home staff is underdeveloped. This study set out to explore views on how closer working between health and social care can impact on the role of care home staff and any barriers to effective integration. Staff from 25 care homes and GPs from their partnered practices were interviewed to explore the impact of the partnership. Homes receiving regular visits from the same health professional found the relationship between the two sectors had benefitted both residents and staff. The development of trusting relationships, access to support and information, and recognition and respect were all seen as facilitating the partnership and enhancing patient care. Regular and effective interactions with health-care professionals were key and had the potential to empower and increase confidence of care home staff in their role around health care. Factors negatively impacting on strength of relationship such as visits by inconsistent professional and high turnover of care home staff were a barrier to successful partnerships. Experiences of poor interactions with those from health-care services where there was an absence of a trusting relationship were disempowering to care home staff and remain a barrier to effective wider health and social care collaboration. [ABSTRACT FROM AUTHOR]

Aims: To determine the prevalence of vitamin D deficiency in adults with Crohn's Disease (CD) in Birmingham, UK (latitude 52.4°N, −1.9°E) and identify modifiable risk factors. Design/Method: A nurse‐led, single‐centre, prospective study was conducted over 5 months in 2019 and 2020 in outpatients with CD, at a tertiary referral hospital in Birmingham UK. Vitamin D (25OHD) levels were measured at a single timepoint by a dried blood spot sample. Modifiable risk factor data were collected including intake of vitamin D‐containing foods, use of vitamin D supplements, sun exposure and current smoking. Results: Total 150 participants (53.3% male, 79.3% white British). Vitamin D deficiency (25OHD <50 nmol/L) was found in 53.3%. 32.7% of participants took over‐the‐counter vitamin D supplements and 20.7% used prescribed supplements. We found that diets were generally poor in relation to vitamin D‐rich foods. In terms of sun exposure, few (18%) had visited a sunny country recently, and few (6%) covered their whole body with clothing. Most used High Sun Protection Factor (80%) with a median grade of SPF 45. Conclusion: Patients with CD are at high risk of vitamin D deficiency as defined by 25OHD < 50 nmol/L, with the prevalence of deficiency being highest during the winter months. Patients with CD in the UK are unlikely to maintain vitamin D levels from sunlight exposure, dietary sources or over‐the‐counter supplements. Impact: Patients with Crohn's Disease are at high risk of developing vitamin D deficiency but there is little data from the UK at this latitude.We demonstrate the prevalence and severity of vitamin D deficiency in people with Crohn's Disease in the UK.The prevalence of vitamin D deficiency in this group is high and warrants monitoring by nurses and clinical teams. Nurses and clinical teams should consider strategies for vitamin D supplementation in patients with Crohn's Disease. [ABSTRACT FROM AUTHOR]

Rice is consumed by nearly half of the global population and a significant source of energy and nutrients. However, rice consumption can also be a significant pathway of inorganic arsenic (iAs) exposure, thus requiring a risk–benefit assessment. This study assessed nutrient element (NE) densities in fifty-five rice types (white, brown and wild rice) marketed in the UK. Densities of essential NE were used to rank rice types in meeting daily NE targets under different consumption scenarios through a newly developed optimisation approach. Using iAs data from these rice types, we assessed the margin of exposure (MOE) for low (the UK) and high (Bangladesh) rice intake scenarios. Our results showed that brown and wild rice are significantly higher in many NE and significantly contribute to dietary reference value (DRV). Our modelling showed that switching to brown or wild rice could increase the intake of several essential nutrients by up to eight times that of white rice. Using rice consumption data for mid-to-high-consumption countries, we estimate that brown rice could provide 100 % adult DRV for Fe, Mg, Cr, P and Mo, and substantial contributions for Zn, Se and K. Our results show that the amount of rice primarily determines risk from iAs consumed rather than the type of rice. Therefore, switching from white to brown or wild rice could be beneficial, provided iAs concentration in rice is within the recommended limits. [ABSTRACT FROM AUTHOR]

Purpose: During the coronavirus disease 2019 (COVID-19) pandemic, intensive care units (ICUs) around the world introduced virtual visiting to mediate the psychological impact of in-person visiting restrictions. Our objective was to evaluate levels of distress, depression, anxiety, and stress among family members experiencing virtual visits.Methods: Multi-centre prospective observational study recruiting adult family members of critically ill patients in the United Kingdom (UK) using a bespoke virtual visiting solution (aTouchAway). We recruited participants and administered validated questionnaires digitally via their aTouchAway account. Prior to first virtual visit, participants completed the Distress Thermometer (score range 0-10) and the Depression, Anxiety and Stress Scale (DASS)-21. Following first and subsequent virtual visits, participants repeated the Distress Thermometer and completed the Discrete Emotions Questionnaire.Results: We recruited 2166 adult family members of ICU patients in 37 UK hospitals. Most were grown up children (33%) or spouses/partners (23%). Most (91%) were ≤ 65 years. Mean (SD) pre-virtual-visit Distress Thermometer score was 7 (2.6) with 1349/2153 (62%) reporting severe distress. Pre-visit Distress Thermometer scores were associated with relationship type (spouse/partner OR 1.65, 95% CI 1.27-2.12) but not family member age, or length of ICU stay. Mean (SD) post-visit Distress Thermometer score provided by 762 (35%) participants was 1.6 (3.2) points lower than pre-visit (P < 0.001). Of participants experiencing multiple visits, 22% continued to report severe distress. Median (IQR) pre-visit DASS-21 score was 18 (2-42) (1754 participants). Severe-to-extremely severe depression, anxiety, or stress were reported by 249 (14%), 321 (18%), and 165 (9%) participants, respectively. Participants reported a range of emotions with reassurance being the most common, anger being the least.Conclusion: Family members exposed to COVID-19 pandemic ICU visiting restrictions experienced severe distress. One fifth of family members reported severe-to-extremely sever anxiety or depression. Distress score magnitude and prevalence of severe distress decreased after undertaking one or more virtual visits. [ABSTRACT FROM AUTHOR]

AUTH Why you should read this article: • To understand the clinical reasons for pre-treatment assessment of patients undergoing systemic anticancer therapy (SACT) • To appreciate the benefits of a digital SACT pre-assessment pathway for cancer patients • To familiarise yourself with the challenges of providing a digital service During the coronavirus disease 2019 (COVID-19) pandemic measures have been implemented in healthcare systems to reduce transmission of the infection. People with cancer are immunocompromised and at higher risk of contracting infections, therefore many cancer services have been conducting routine reviews and pre-treatment assessments remotely through telephone and video consultations during the pandemic. Patients who are to receive systemic anticancer therapy (SACT) should have an additional consultation to provide them with specific information about the therapy, including side effects and who to contact for advice if they develop these at home. This article describes the development and implementation of a digital SACT pre-assessment pathway in a large university hospital during the COVID-19 pandemic, which aimed to deliver information to groups of patients remotely. The article explores the challenges to implementation and discusses some of the findings of a patient feedback survey, which suggest that the digital SACT pre-assessment sessions have been successful overall. [ABSTRACT FROM AUTHOR]

Anthropogenic climate change and its sequelae are de-stabilizing our environmental, social, economical and political systems. Not surprisingly, the direct and indirect effects of disrupting these key determinants of health are profoundly detrimental to mental health and wellbeing. Psychiatrists feel compelled to speak out. However, decades of gentle persuasion have failed to invoke sufficient government action so many have turned to activism. Others doubt whether this is, or should be, within their scope of practice. In this article we present the case for medical activism. History has shown prominent activist medics and psychiatrists have been instrumental in creating social and cultural change. We propose that psychiatrists are well-placed to advocate for health issues that cross socio-politico-environmental boundaries. We suggest that, not only do we have a moral imperative to act for the wider determinants of health, but we are also advantageously positioned as trusted professionals with the necessary skills to articulate the problem and advocate for the most vulnerable in society. We call on our training and regulatory bodies to support health activism. [ABSTRACT FROM AUTHOR]

Summary: Background: Previous studies suggest that polygenic risk scores (PRSs) may improve melanoma risk stratification. However, there has been limited independent validation of PRS‐based risk prediction, particularly assessment of calibration (comparing predicted to observed risks). Objectives: To evaluate PRS‐based melanoma risk prediction in prospective UK and Australian cohorts with European ancestry. Methods: We analysed invasive melanoma incidence in the UK Biobank (UKB; n = 395 647, 1651 cases) and a case‐cohort nested within the Melbourne Collaborative Cohort Study (MCCS, Australia; n = 4765, 303 cases). Three PRSs were evaluated: 68 single‐nucleotide polymorphisms (SNPs) at 54 loci from a 2020 meta‐analysis (PRS68), 50 SNPs significant in the 2020 meta‐analysis excluding UKB (PRS50) and 45 SNPs at 21 loci known in 2018 (PRS45). Ten‐year melanoma risks were calculated from population‐level cancer registry data by age group and sex, with and without PRS adjustment. Results: Predicted absolute melanoma risks based on age and sex alone underestimated melanoma incidence in the UKB [ratio of expected/observed cases: E/O = 0·65, 95% confidence interval (CI) 0·62–0·68] and MCCS (E/O = 0·63, 95% CI 0·56–0·72). For UKB, calibration was improved by PRS adjustment, with PRS50‐adjusted risks E/O = 0·91, 95% CI 0·87–0·95. The discriminative ability for PRS68‐ and PRS50‐adjusted absolute risks was higher than for risks based on age and sex alone (Δ area under the curve 0·07–0·10, P < 0·0001), and higher than for PRS45‐adjusted risks (Δ area under the curve 0·02–0·04, P < 0·001). Conclusions: A PRS derived from a larger, more diverse meta‐analysis improves risk prediction compared with an earlier PRS, and might help tailor melanoma prevention and early detection strategies to different risk levels. Recalibration of absolute risks may be necessary for application to specific populations. [ABSTRACT FROM AUTHOR]

This prophylactic regimen has been previously described in solid organ lung transplant patients.[7] Based on this evidence, the prolonged turnaround times of fungal diagnostic tests and voriconazole supply issues, the decision was made to initiate antifungal prophylaxis on all mechanically ventilated COVID-19 patients. A further three patients did not meet the ECMM/ISHAM criteria; two patients had radiological findings consistent with CAPA, with BAL GM levels detectable below the ECMM/ISHAM threshold, and a single patient had low-level BAL GM positivity, which did not clinically correlate. A literature review identified a single publication describing antifungal prophylaxis in CAPA patients[6] using nebulized liposomal amphotericin B (AmBisome SP ® sp ) in mechanically ventilated patients. [Extracted from the article]

Personality is a strong determinant for several health-related behaviours and has been linked to the development of cardiovascular diseases. However, the reports of personality's mediating role have been inconsistent with no data available from large population-based cohorts. The study aimed to create proxies for the Big Five personality traits, extraversion, agreeableness, conscientiousness, openness and neuroticism, to examine the longitudinal relationship between personality and myocardial infarction in the UK Biobank. The study sample comprised of 484,205 participants (55% female, 45% male, mean age 56.4 ± 8.1 years) from UK Biobank cohort with a mean follow-up of 7 years. The personality proxies sociability, warmth, diligence, curiosity and nervousness were created using self-reported data on psychological factors, mental health and social support, to match the facets of the Big Five traits. As neuroticism is the only Big Five personality trait available in the UK Biobank, it was included to validate the personality proxies. Myocardial infarction outcome information was collected from hospital records, death registries or was self-reported. Logistic regression and Cox proportional hazard regression were used to estimate odds ratio (OR) and hazard ratios (HR), respectively with 95% confidence intervals (CI) adjusted for demographics (age, sex, socioeconomic status, ethnicity), health-related factors (BMI, diabetes, systolic and diastolic blood pressure) and lifestyle factors (alcohol intake, smoking, and moderate-to-vigorous physical activity). Diligence was found to be significantly associated with lower prevalent myocardial infarction [OR: 0.87; (CI 0.84–0.89)] and lower incident myocardial infarction [HR: 0.88; (CI 0.85–0.92)]. Sociability was also protective against prevalent [OR: 0.89; (CI 0.87–0.92)] and incident [HR: 0.90; (CI 0.87–0.93)] myocardial infarction. Conversely, nervousness inferred a higher risk for both prevalent [OR: 1.10; (CI 1.08–1.12)] and incident [HR: 1.07; (CI 1.04–1.09)] myocardial infarction during follow-up. Sex-stratified analyses revealed that nervousness significantly increases the risk for incident myocardial infarction among women [HR: 1.13; (CI 1.08–1.19)] compared to men [HR: 1.05; (CI 1.02–1.08)]. By using our created proxies, we were able to investigate the impact of personality on the development of myocardial infarction. Persons with higher levels of diligence and sociability mimicking predominantly conscientiousness and extraversion personalities respectively are less likely to experience myocardial infarction, while personalities predominantly characterised by nervousness pose higher risk for developing myocardial infarction. These initial findings invite further validation of the use of the personality proxies in UK Biobank cohort. [ABSTRACT FROM AUTHOR]