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Physical activity (PA) participation was substantially reduced at the start of the COVID-19 pandemic. The purpose of this study was to assess the association between PA, mental health, and wellbeing during and following the easing of COVID-19 restrictions in the United Kingdom (UK) and New Zealand (NZ). In this study, 3363 adults completed online surveys within 2-6 weeks of initial COVID-19 restrictions (April/May 2020) and once restrictions to human movement had been eased. Outcome measures included the International Physical Activity Questionnaire Short-Form, Depression Anxiety and Stress Scale-9 (mental health) and World Health Organisation-5 Wellbeing Index. There were no differences in PA, mental health or wellbeing between timepoints ( p > 0.05). Individuals engaging in moderate or high volume of PA had significantly better mental health (-1.1 and -1.7 units, respectively) and wellbeing (11.4 and 18.6 units, respectively) than individuals who engaged in low PA ( p < 0.001). Mental health was better once COVID-19 restrictions were eased ( p < 0.001). NZ had better mental health and wellbeing than the UK ( p < 0.001). Participation in moderate-to-high volumes of PA was associated with better mental health and wellbeing, both during and following periods of COVID-19 containment, compared to participation in low volumes of PA. Where applicable, during the current or future pandemic(s), moderate-to-high volumes of PA should be encouraged.

Objectives: To assess physical activity (PA), mental health and well-being of adults in the United Kingdom (UK), Ireland, New Zealand and Australia during the initial stages of National governments' Coronavirus disease (COVID-19) containment responses., Design: Observational, cross-sectional., Methods: An online survey was disseminated to adults (n=8,425; 44.5±14.8y) residing in the UK, Ireland, New Zealand and Australia within the first 2-6 weeks of government-mandated COVID-19 restrictions. Main outcome measures included: Stages of Change scale for exercise behaviour change; International Physical Activity Questionnaire (short-form); World Health Organisation-5 Well-being Index; and the Depression Anxiety and Stress Scale-9., Results: Participants who reported a negative change in exercise behaviour from before initial COVID-19 restrictions to during the initial COVID-19 restrictions demonstrated poorer mental health and well-being compared to those demonstrating either a positive-or no change in their exercise behaviour (p<0.001). Whilst women reported more positive changes in exercise behaviour, young people (18-29y) reported more negative changes (both p<0.001). Individuals who had more positive exercise behaviours reported better mental health and well-being (p<0.001). Although there were no differences in PA between countries, individuals in New Zealand reported better mental health and well-being (p<0.001)., Conclusion: The initial COVID-19 restrictions have differentially impacted upon PA habits of individuals based upon their age and sex, and therefore have important implications for international policy and guideline recommendations. Public health interventions that encourage PA should target specific groups (e.g., men, young adults) who are most vulnerable to the negative effects of physical distancing and/or self-isolation., (Copyright © 2020 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

The coronavirus pandemic, referred to here as Covid-19, has brought into sharp focus the increasing divergence of devolved legislation and its implementation in the United Kingdom. One such instance is the emergency health and social care legislation and guidance introduced by the United Kingdom Central Government and the devolved Governments of Wales, Scotland and Northern Ireland in response to this pandemic. We provide a summary, comparison and discussion of these proposed and actual changes with a particular focus on the impact on adult social care and safeguarding of the rights of citizens. To begin, a summary and comparison of the relevant changes, or potential changes, to mental health, mental capacity and adult social care law across the four jurisdictions is provided. Next, we critique the suggested and actual changes and in so doing consider the immediate and longer term implications for adult social care, including mental health and mental capacity, at the time of publication.several core themes emerged: concerns around process and scrutiny; concerns about possible changes to the workforce and last, the possible threat on the ability to safeguard human rights. It has been shown that, ordinarily, legislative provisions across the jurisdictions of the UK are different, save for Wales (which shares most of its mental health law provisions with England). Such divergence is also mirrored in the way in which the suggested emergency changes could be implemented. Aside from this, there is also a wider concern about a lack of parity of esteem between social care and health care, a concern which is common to all. What is interesting is that the introduction of CVA 2020 forced a comparison to be made between the four UK nations which also shines a spotlight on how citizens can anticipate receipt of services., (Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.)

Background: Black, Asian and Minority Ethnic (BAME) medical students and professionals frequently underachieve when compared with their White counterparts not only in the United Kingdom, but across the globe. There is no consensus for the definitive causes of this attainment gap, but suggestions contributing towards it include: increased feelings of isolation as a member of a minority culture or religion; a poorer higher education (HE) experience compared with White counterparts; and stereotype threat, whereby students underperform in exams from the stresses of fearing confirming to a negative-stereotype., Methods: The aim of this study was to gather qualitative data on HE experiences of medical and biomedical science students to explore factors contributing to the attainment gap. Audio-recorded, semi-structured interviews and a novel approach for this research area of ethnically-homogenous student-led focus groups, were held with students and staff at a healthcare-based university in London, where lower attainment, slower rates of degree completion and lower levels of satisfaction with HE experience were identified in BAME students compared with White students. Thematic analysis was used to manage, summarize and analyse the data., Results: Forty-one students and eight staff members were interviewed or took part in focus groups. The student data were best explained by two main themes: social factors and stereotyping, whilst staff data were also best explained by two main themes: social factors and student and staff behaviour. Social factors suggested ethnically-defined social networks and the informal transfer of knowledge impacted academic performance, isolating minority groups from useful academic information. BAME students may also be at a further disadvantage, being unable to attend social and academic functions for cultural or family reasons. Black students also mentioned changing their behaviour to combat negative stereotypes in a variety of contexts., Conclusions: This study suggests that forms of discrimination, whether conscious or unconscious, may be negatively impacting the abilities of BAME students both in examinations and in coursework choice. It highlights the importance of social networks for the transfer of academic knowledge and the impact ethnicity may have on their formation, with issues around segregation and the sharing of information outside defined groups.

Psychiatric admissions in Central Manchester of Europeans, Afro-Caribbeans, and Asians (within three age-bands) were studied over four years. Among the Afro-Caribbean group there were more single or unemployed persons than in either the Asian or European groups, which suggested greater socio-economic disadvantage. Rates for first admissions and readmissions among Afro-Caribbeans were greater; among Asians they were similar except for the 16-29-year age-group, who tended to have lower rates than Europeans. A higher proportion of Afro-Caribbeans and Asians were psychotic. In the Afro-Caribbean group, the raised rates of admission were largely attributable to increased rates of schizophrenia. The highest rate occurred in second-generation (UK-born) Afro-Caribbeans and was nine times that among Europeans. The police were more frequently involved in the admissions of Afro-Caribbeans compared with Europeans or Asians. Higher proportions of Afro-Caribbeans and Asians who were readmitted were detained under the Mental Health Act 1983, when compared with Europeans. [ABSTRACT FROM AUTHOR]

Many people living with dementia have difficulties at mealtimes, which can result in serious complications for physical and mental health, leading to hospital admissions and even death. However, current training in mealtime care for staff working with this population has been found to be poorly reported, with variable effectiveness. It is essential that care home staff are able to provide good care at mealtimes. This study used ethnography to explore current practice in mealtime care for this population, identify good practice, and understand the factors influencing mealtime care. Approximately 28 h of mealtime observations were conducted in two UK care homes with diverse characteristics. Observations focused on interactions between care staff and residents living with dementia. Twenty-five semi-structured interviews were carried out with care home staff, family carers, and visiting health and social care professionals, to explore mealtime care from their perspectives. A constant comparative approach was taken, to probe emergent findings and explore topics in greater depth. Key thematic categories were identified, including: tensions in mealtime care; the symbolic nature of mealtime care; navigating tensions via a person-centred approach; contextual constraints on mealtime care; and teamwork in mealtime care. The findings indicated that a person-centred approach helps carers to find the right balance between apparently competing priorities, and teamwork is instrumental in overcoming contextual constraints. This evidence has contributed to development of a training intervention for care home staff. Future research should investigate the feasibility of mealtime care training in care homes. [ABSTRACT FROM AUTHOR]

Quantitative risk data are essential for efficient and consistent assessment of risk, and allow for the effective use of cost–benefit analysis to assess mitigating measures. Quantitative assessment of the risk posed by unexploded bombs (UXBs) on construction sites within the UK involves the identification of a set of contributory risk factors and modelling the interaction between them. This interaction of risk factors has been modelled using Monte Carlo simulation built into a new risk assessment tool (JG-MCS). Some of the output results from the tool are presented, including the limited validation that is possible against published work. The tool is used to assess the sensitivity of risk to some of the problem variables, and several of the underlying assumptions are investigated. The model has also been extended to explore the influence of investigative mitigation measures. Fundamental questions are raised regarding the risks being assessed, how they are presented and the efficacy of some mitigation measures. For the scenario used, it was found that the overall risk of UXB encounter was low before mitigation and only slightly lower after mitigation. Also, the cost of implementing measures to reduce the risk posed by UXBs might be considered to be below the bracket of what is described by the UK Health and Safety Executive as 'reasonably practicable'. [ABSTRACT FROM AUTHOR]

Background: Health and care research involving people who lack capacity to consent requires an alternative decision maker to decide whether they participate or not based on their 'presumed will'. However, this is often unknown. Advance research planning (ARP) is a process for people who anticipate periods of impaired capacity to prospectively express their preferences about research participation and identify who they wish to be involved in future decisions. This may help to extend individuals' autonomy by ensuring that proxy decisions are based on their actual wishes. This qualitative study aimed to explore stakeholders' views about the acceptability and feasibility of ARP and identify barriers and facilitators to its implementation in the UK. Methods: We conducted semi-structured interviews with 27 researchers, practitioners, and members of the public who had participated in a preceding survey. Interviews were conducted remotely between April and November 2023. Data were analysed thematically. Results: Participants were supportive of the concept of ARP, with differing amounts of support for the range of possible ARP activities depending on the context. Six main themes were identified: (1) Planting a seed – creating opportunities to initiate/engage with ARP; (2) A missing part of the puzzle – how preferences expressed through ARP could help inform decisions; (3) Finding the sweet spot – optimising the timing of ARP; (4) More than a piece of paper – finding the best mode for recording preferences; (5) Keeping the door open to future opportunities – minimising the risk of unintended consequences; and (6) Navigating with a compass – principles underpinning ARP to ensure safeguarding and help address inequalities. Participants also identified a number of implementation challenges, and proposed facilitative strategies that might overcome them which included embedding advance research planning in existing future planning processes and research-focused activities. Conclusions: This study provides a routemap to implementing ARP in the UK to enable people anticipating impaired capacity to express their preferences about research, thus ensuring greater opportunities for inclusion of this under-served group, and addressing the decisional burden experienced by some family members acting as proxies. Development of interventions and guidance to support ARP is needed, with a focus on ensuring accessibility. [ABSTRACT FROM AUTHOR]

Previous research on sleep and aging largely has failed to illustrate the optimal dose–response curve of this relationship. We aimed to analyze the associations between sleep duration and measures of predicted age. In total, 241,713 participants from the UK Biobank were included. Habitual sleep duration was collected from the baseline questionnaire. Four indicators, homeostatic dysregulation (HD), phenoAge (PA), Klemera–Doubal method (KDM), and allostatic load (AL), were chosen to assess predicted age. Multivariate linear regression models were utilized. The association of sleep duration and predicted age followed a U‐shape (All p for nonlinear <0.05). Compared with individuals who sleep for 7 h/day, the multivariable‐adjusted beta of ≤5 and ≥9 h/day were 0.05 (95% CI 0.03, 0.07) and 0.03 (95% CI 0.02, 0.05) for HD, 0.08 (95% CI 0.01, 0.14) and 0.36 (95% CI 0.31, 0.41) for PA, and 0.21 (95% CI 0.12, 0.30) and 0.30 (95% CI 0.23, 0.37) for KDM. Significant independent and joint effects of sleep and cystatin C (CysC) and gamma glutamyltransferase (GGT) on predicted age metrics were future found. Similar results were observed when conducting stratification analyses. Short and long sleep duration were associated with accelerated predicted age metrics mediated by CysC and GGT. [ABSTRACT FROM AUTHOR]

Internationally, research comparing education systems across countries and jurisdictions is valuable and can elicit nuanced insights into how particular systems operate. This paper's interest lies in considering the scope and content of research comparing education systems across the four UK nations (England, Northern Ireland, Scotland and Wales). This study sought to determine the coverage of UK cross-national comparative education research ('home international' research) between 2000 and 2022. We chose this time period as 1999 marks the devolution of education policy to each UK nation. We aimed to investigate what educational issues had been discussed in the literature and identify any gaps in the content covered by the research. An exploratory, high-level review of 'home international' education research was conducted, based on the review of abstracts. We searched several research databases using a variety of keyword combinations to identify relevant literature published since 2000. Our search identified 53 studies that met our selection criteria. Using a meta-synthesis approach, we coded the content of each abstract to build a picture of the range and thematic coverage of research involving comparisons between at least two of the four UK nations. The analysis of abstracts identified that, over the last two decades, UK 'home international' research has tended to include comparisons of all four nations, coverage of multiple educational phases and a focus on national education policy reviews. Furthermore, we pinpointed a number of gaps in coverage that might not have been anticipated (e.g. relatively little cross-national research focusing on assessment). This high-level review uncovers the landscape of recent 'home international' research, allowing us to view issues that are driving the cross-national research agenda in the UK and recognise implications relevant to education systems that may resonate with jurisdictions beyond these four UK nations. [ABSTRACT FROM AUTHOR]

stone k., traynor m., gould d. & maben j. (2011) Journal of Nursing Management 19, 803-809 The management of poor performance in nursing and midwifery: a case for concern Aim(s) To examine the evidence of how poorly performing nurses and midwives are managed in the UK National Health Service (NHS). Background Nurses and midwives form the largest clinical group in the NHS. There is little evidence, however, about poor performance and its management in nursing and midwifery literature. Method(s) The present study comprised a literature search, analysis of recent Nursing and Midwifery Council (NMC) data and observation at NMC fitness to practice hearings. Results Nurses and midwives are the clinical groups most likely to be suspended in the NHS; Trusts do not report data on suspensions therefore no data exist on numbers, reasons for suspensions, managerial processes, gender, area of work, or ethnicity of those suspended; the few major research projects identify variable management practices, the significant financial cost to the NHS and the personal cost to those suspended; there is evidence that inexperienced, poorly trained, or poorly supported managers use suspension inappropriately. Our observation supported this. Conclusion(s) There is a need for robust data gathering and research in the field of NHS managerial practice. Implications for nursing management Managers should refrain from adopting punitive forms of performance management. Frontline staff and management need better training and support for dealing with poor performance. [ABSTRACT FROM AUTHOR]

Background and Aims: Primary aldosteronism (PA) is an adrenal disorder of autonomous aldosterone secretion which promotes arterial injury. We aimed to explore whether PA is causally associated with lower-extremity arterial disease (LEAD). Methods: We included 39,713 patients with diabetes and 419,312 participants without diabetes from UK Biobank. We derived a polygenic risk score (PRS) for PA based on previous genome-wide association studies (GWAS). Outcomes included LEAD and LEAD related gangrene or amputation. We conducted a two-sample Mendelian randomization analysis for PA and outcomes to explore their potential causal relationship. Results: In whole population, individuals with a higher PA PRS had an increased risk of LEAD. Among patients with diabetes, compared to the subjects in the first tertile of PA PRS, subjects in the third tertile showed a 1.24-fold higher risk of LEAD (OR 1.24, 95% CI 1.03–1.49) and a 2.09-fold higher risk of gangrene (OR 2.09, 95% CI 1.27–3.44), and 1.72-fold higher risk of amputation (OR 1.72, 95% CI 1.10–2.67). Among subjects without diabetes, there was no significant association between PA PRS and LEAD, gangrene or amputation. Two-sample Mendelian randomization analysis indicated that genetically predictors of PA was significantly associated with higher risks of LEAD and gangrene (inverse variance weighted OR 1.20 [95% CI 1.08–1.34]) for LEAD, 1.48 [95% CI 1.28–1.70] for gangrene), with no evidence of significant heterogeneity or directional pleiotropy. Conclusions: Primary aldosteronism is genetically and causally associated with higher risks of LEAD and gangrene, especially among patients with diabetes. Targeting on the autonomous aldosterone secretion may prevent LEAD progression. [ABSTRACT FROM AUTHOR]

Objectives: Previous research has found an association of low bone mineral density (BMD) and regional gray matter (GM) volume loss in Alzheimer's disease (AD). We were interested whether BMD is associated with GM volume decrease in brains of a healthy elderly population from the UK Biobank. Materials and methods: T1-weighted images from 5,518 women (MAge = 70.20, SD = 3.54; age range: 65-82 years) and 7,595 men (MAge = 70.84, SD = 3.68; age range: 65-82 years) without neurological or psychiatric impairments were included in voxel-based morphometry (VBM) analysis in CAT12 with threshold-free-cluster-enhancement (TFCE) across the whole brain. Results: We found a significant decrease of GM volume in women in the superior frontal gyri, middle temporal gyri, fusiform gyri, temporal poles, cingulate gyri, precunei, right parahippocampal gyrus and right hippocampus, right ventral diencephalon, and right pre- and postcentral gyrus. Only small effects were found in men in subcallosal area, left basal forebrain and entorhinal area. Conclusion: BMD is associated with low GM volume in women but less in men in regions afflicted in the early-stages of AD even in a sample without neurodegenerative diseases. [ABSTRACT FROM AUTHOR]

Aims: This study aims to examine the association between the rest‐activity rhythm (RAR) and the incidence of type 2 diabetes (T2D). Materials and Methods: In total, 97 503 participants without diabetes in the UK Biobank cohort were recruited. Wearable accelerometry was used to monitor circadian behaviour. The parameters of RAR including inter‐daily stability, intra‐daily variability, relative amplitude (RA), most active continuous 10 h period (M10), and least active continuous 5 h period (L5) were calculated to evaluate the robustness and regularity of the RAR. The weighted polygenic risk score for T2D (T2D‐PRS) was calculated. Cox proportion hazards models were used to evaluate the survival relationship and the joint and interaction effects of RAR parameters and T2D‐PRS on the occurrence of T2D. Results: During 692 257 person‐years follow‐ups, a total of 2434 participants were documented. After adjustment for potential confounders, compared with participants in the highest quartile of RA and M10, the participants in the lowest quartile had a greater risk of T2D (HRRA = 2.06, 95% CI: 1.76‐2.41; HRM10 = 1.33, 95% CI: 1.19‐1.49). Meanwhile, the highest quartile of L5 was related to a higher risk of T2D (HR = 1.78, 95% CI: 1.55‐2.24). The joint analysis showed that the high T2D‐PRS with the lowest quartile of RA and M10, or highest quartile of L5 jointly increased the risk of T2D (HRRA = 4.46, 95% CI: 3.36‐6.42; HRM10 = 3.15, 95% CI: 2.29‐4.32; HRL5 = 3.09, 95% CI: 2.40‐3.99). No modification effects of T2D‐PRS on the association between the RAR parameters and risk of T2D were observed (p >.05). Conclusion: The unbalanced RAR are associated with a greater risk of T2D, which are independent of known risk factors of T2D. [ABSTRACT FROM AUTHOR]

Background: Anticipatory planning in the UK focuses on supporting people who anticipate periods of impaired capacity to express their wishes about future care through processes such as advance care planning. Other countries have extended anticipatory planning to include processes for people to prospectively express their preferences about research participation. Advance research planning (ARP) is thought to extend autonomy and ensure that 'proxy' decisions about research are based on their wishes and preferences. Methods: A cross-sectional survey was conducted with two stakeholder groups (members of the public including people living with capacity-affecting conditions and family members; researchers and other professionals) who were recruited via research registries and other routes. Online questionnaires were used to capture the perspectives of the two groups. Responses were analysed using descriptive statistics and content analysis. Results: A total of 327 participants (members of the public n = 277, professionals n = 50) completed the survey (November 2022 - March 2023). ARP was supported by 97% of public contributors and 94% of professionals. Participants thought that ARP should include the person's general wishes about research, specific types of studies, and who should make decisions on their behalf. They identified a number of challenges, including how ARP could take account of changes in individuals' preferences or circumstances whilst protecting their rights and interests. Implementation barriers included the potential time, complexity, and cost involved. These could be addressed by embedding ARP in existing anticipatory planning pathways and aligning it with other research enrolment activities. Relationships and trust played a key role, including underpinning who should support the delivery of ARP, how they are trained, and when it is undertaken. Conclusions: There were high levels of support for introducing ARP in the UK. Further research should explore practical barriers and stakeholder concerns and identify any unintended consequences. Future activities should include developing ARP interventions alongside training and other resources, and also focus on public awareness campaigns, and engaging policymakers and other stakeholders. [ABSTRACT FROM AUTHOR]

Clinical equipoise exists regarding early-stage lung cancer treatment among patients as trials comparing stereotactic body radiation therapy (SBRT) and surgical resection are unavailable. Given the potential differences in treatment effectiveness and side-effects, we sought to determine the associations between treatment type, decision regret and depression. A multicentre, prospective study of patients with stage IA–IIA non-small cell lung cancer (NSCLC) with planned treatment with SBRT or surgical resection was conducted. Decision regret and depression were measured using the Decision Regret Scale (DRS) and Patient Health Questionnaire-4 (PHQ-4) at 3, 6 and 12 months post-treatment, respectively. Mixed linear regression modelling examined associations between treatment and decision regret adjusting for patient sociodemographics. Among 211 study participants with early-stage lung cancer, 128 (61%) patients received SBRT and 83 (39%) received surgical resection. The mean age was 73 years (standard deviation = 8); 57% were female; 79% were White non-Hispanic. In the entire cohort at 3 months post-treatment, 72 (34%) and 57 (27%) patients had mild and severe decision regret, respectively. Among patients who received SBRT or surgery, 71% and 46% of patients experienced at least mild decision regret at 3 months, respectively. DRS scores increased at 6 months and decreased slightly at 12 months of follow-up in both groups. Higher DRS scores were associated with SBRT treatment (adjusted mean difference = 4.18, 95% confidence interval 0.82 to 7.54) and depression (adjusted mean difference = 3.49, 95% confidence interval 0.52 to 6.47). Neither patient satisfaction with their provider nor decision-making role concordance was associated with DRS scores. Most early-stage lung cancer patients experienced at least mild decision regret, which was associated with SBRT treatment and depression symptoms. Findings suggest patients with early-stage lung cancer may not be receiving optimal treatment decision-making support. Therefore, opportunities for improved patient–clinician communication probably exist. • Early-stage lung cancer patients have high decision regret levels after treatment. • One in four early-stage lung cancer patients has severe levels of decision regret. • Radiation therapy and depression are associated with increased decision regret. • Lung cancer patients may not be receiving optimal treatment decision-making support. [ABSTRACT FROM AUTHOR]

Tropospheric ozone is an important component of the Earth system as it can affect both climate and air quality. In this work, we use observed tropospheric column ozone derived from the Ozone Monitoring Instrument (OMI) and Microwave Limb Sounder (MLS) OMI-MLS, in addition to OMI ozone retrieved in discrete vertical layers, and compare it to tropospheric ozone from UM-UKCA simulations (which utilize the Unified Model, UM, coupled to UK Chemistry and Aerosol, UKCA). Our aim is to investigate recent changes (2005–2018) in tropospheric ozone in the North Atlantic region, specifically its seasonal, interannual and decadal variability, and to understand what factors are driving such changes. The model exhibits a large positive bias (greater than 5 DU or ∼ 50 %) in the tropical upper troposphere: through sensitivity experiments, time series correlation, and comparison with the Lightning Imaging Sensor and Optical Transient Detector lightning flash dataset, the model positive bias in the tropics is attributed to shortcomings in the convection and lightning parameterizations, which overestimate lightning flashes in the tropics relative to mid-latitudes. Use of OMI data, for which vertical averaging kernels and a priori information are available, suggests that the model negative bias (6–10 DU or ∼ 20 %) at mid-latitudes, relative to OMI-MLS tropospheric column, could be the result of vertical sampling. Ozone in the North Atlantic peaks in spring and early summer, with generally good agreement between the modelled and observed seasonal cycle. Recent trends in tropospheric ozone were investigated: whilst both observational datasets indicate positive trends of ∼ 5 % and ∼ 10 % in North Atlantic ozone, the modelled ozone trends are much closer to zero and have large uncertainties. North Atlantic ozone interannual variability (IAV) in the model was found to be correlated to the IAV of ozone transported to the North Atlantic from the stratosphere (R=0.77) and emission of NO x from lightning in the tropics (R=0.72). The discrepancy between modelled and observed trends for 2005–2018 could be linked to the model underestimating lower stratospheric ozone trends and associated stratosphere to troposphere transport. Modelled tropospheric ozone IAV is driven by IAV of tropical emissions of NO x from lightning and IAV of ozone transport from the stratosphere; however, the modelled and observed IAV differ. To understand the IAV discrepancy we investigated how modelled ozone and its drivers respond to large-scale modes of variability. Using OMI height-resolved data and model idealized tracers, we were able to identify stratospheric transport of ozone into the troposphere as the main driver of the dynamical response of North Atlantic ozone to the Arctic Oscillation (AO) and the North Atlantic Oscillation (NAO). Finally, we found that the modelled ozone IAV is too strongly correlated to the El Niño–Southern Oscillation (ENSO) compared to observed ozone IAV. This is again linked to shortcomings in the lightning flashes parameterization, which underestimates (overestimates) lightning flash production in the tropics during positive (negative) ENSO events. [ABSTRACT FROM AUTHOR]

Introduction: Differential attainment is a well-known phenomenon in medical education. Despite a strong impetus for institutions and researchers to move away from a 'student deficit model' when exploring the attainment gap, little attention has been given to understanding the experiences of Black, Asian and Minority Ethnic (BAME) medical students. Informed by the social construction of learning theory, this is the first national study to explore how multiple dimensions of the medical school environment impact academic performance of BAME undergraduate medical students across the UK., Methods: Using a sequential explanatory mixed-methods approach, the authors conducted a survey and facilitated three focus groups across medical schools in the UK between 2020-2021. Participants self-identified as being from BAME backgrounds. Quantitative analyses included descriptive statistics and bivariate analyses. Qualitative data were analysed using thematic analysis, subsequently identifying inductive themes., Results: Three hundred sixty-two respondents completed the Phase 1 survey, and 17 participants participated in the Phase 2 focus groups. Although both survey and focus group participants identified facilitators to learning such as supportive relationships, students reported facing numerous barriers that they felt impeded their learning and performance. These barriers included limited access to educational resources, and undiversified curricula and medical school populations. Students also described both experiencing and witnessing various forms of racism throughout their educational journeys., Discussion: Students encountered various difficulties throughout their medical training that they felt impacted their learning and performance. This study offers novel insights into the experiences of BAME students and builds upon previous research. It also reveals the pervasive nature of racism within medical schools, highlighting the urgent need for institutional changes. Educators and institutions must go beyond merely recognising these barriers and facilitators; they must proactively innovate and adapt. In doing so, they pave the way for inclusive learning environments that truly foster a sense of belonging for BAME students., (© 2023 The Authors. Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Objectives: The aim of the present study is to explore whether there is a temporal association between anti-Islamic online and offline hate, and if so in which direction. Methods: We used data on hateful Twitter content, and hate incidents and hate crimes/offences recorded by the Metropolitan Police Service in the United Kingdom to analyse this association, using time-series analysis. This study is unique in its use of newly developed technology to undertake big data analysis with recent, disaggregated online and offline hate data. Results: Our study examined the 'everyday' incidents of (online and offline) hate that affect communities throughout the United Kingdom and we found that anti-Islamic hate speech followed rather than preceded Islamophobic hate offline. Conclusions: Our findings likely point to what we have referred to as compound retaliation, which suggests that media and social media dissemination about offline acts of hate compound already tense intergroup hostilities, providing further permission for those to express hatred online. Such a situation represents the compounding of hate and hostility through offline and online networks that are likely to be reinforcing. [ABSTRACT FROM AUTHOR]

The interest in lean management in the UK's civil infrastructure sector is on the rise. In parallel with this interest, a team-based, participative management technique called Continuous Improvement (CI) cells has been widely adopted by the sector. The research on the technique has been scarce even though it has been adopted widely in some sectors as part of lean management. The study presented in the paper explores implementation characteristics, benefits, challenges and roles of CI cells in other management strategies through a case study conducted at a large public client organisation in the infrastructure sector in the UK. Both qualitative and quantitative data were collected through interviews, participant observation at CI cell meetings, and from organisational and team records. It was found that CI cells show some similarities and differences in application with other participative management techniques in lean management. A large set of CI cell benefits and challenges were identified. CI cells were also found linked with Visual Management, kaizen, hoshin kanri, work coordination and planning, and employee training at team level. [ABSTRACT FROM AUTHOR]

Background: Only one study has explored the associations of subjective sleep difficulties with self-perceptions of aging. It focused on a global indicator of self-perceptions of aging (subjective age) despite individuals reporting different experiences of aging in relation to different life domains. The concept of awareness of negative age-related change, capturing perceived losses across five domains (e.g., physical health, cognition), may be more appropriate when relating subjective sleep difficulties to self-perceptions of aging. We examined whether nine different indicators of subjective sleep difficulties predict levels of awareness of negative age-related change and subjective age, measured concurrently and one year later, while controlling for covariates (mood and daily function). Participants/Methods: We used data from the PROTECT cohort study; 4,482 UK residents (mean age = 66.1; SD = 6.9) completed measures of awareness of age-related change, subjective age, mood, daily function, and subjective sleep difficulties. Results: Based on linear regression analyses, poorer quality of sleep, lower alertness after awakening, satisfaction with sleep, depth of sleep, more frequent early awakening, difficulty falling asleep, more times awake during a night, fewer hours of sleep during the night and more hours of sleep during the day predicted higher awareness of negative age-related change at baseline and follow-up (p<.001). Associations were small in size. Associations between subjective sleep difficulties and subjective age were either negligible or statistically non-significant. Conclusions: Although subjective sleep difficulties are one of the many factors associated with awareness of negative age-related change, addressing sleep difficulties, alongside negative mood, and poor daily functioning, may promote a small additional increase in positive self-perceptions of aging. [ABSTRACT FROM AUTHOR]

Current evidence suggests understaffing is related to poor quality and missed care in a global context, but this relationship is complex. There is also a research gap for quality in mental health care in the United Kingdom that includes a wider set of patient outcomes. This paper aims to investigate RMN's perception of quality of care on their last shift, their self-reported reasons for compromised care and potential impact on patient outcomes. A mixed methods approach, we used descriptive statistics to create a framework within which to qualitatively analyse data from the 2017 Royal College of Nursing (RCN) employment survey to consider the complex relationship between understaffing and care quality. We established three themes: 'Understaffing', 'Professional Code Expectations and Moral Distress' and 'Management'. In line with the current evidence; lack of resources and understaffing were consistently present throughout. Nurses also felt pressure from the Nursing and Midwifery Council (NMC) code of conduct which in turn instilled shame and fear for their registration when they were unable to achieve the standards expected. This was further exacerbated by poor management and supervision; leading nurses to reflect on poor outcomes for patients which compromised not only legal rights but safety of patients and staff alike. We conclude that focusing on staffing numbers alone is unlikely to improve care quality., (© 2023 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.)

Studies have reported reduced cognitive function following COVID-19 illness, mostly from hospital settings with short follow-up times. This study recruited non-hospitalized COVID-19 patients from a general population to study prevalence of late cognitive impairment and associations with initial symptoms. We invited patients with PCR-confirmed COVID-19. A postal questionnaire addressed basic demographics, initial COVID-19 symptoms and co-morbidity about 4 months after diagnosis. About 7 months later, we conducted cognitive tests using the Cambridge Neuropsychological Test Automated Battery, comprising four tests for short-term memory, attention and executive function. We present descriptive statistics using z-scores relative to UK population norms and defined impairment as z-score <-1.5. We used multivariable logistic regression with impairment as outcome. Continuous domain scores were analysed by multiple linear regression. Of the initial 458 participants; 305 were invited, and 234 (77%) completed cognitive testing. At median 11 (range 8–13) months after PCR positivity, cognitive scores for short term memory, visuospatial processing, learning and attention were lower than norms (p≤0.001). In each domain, 4–14% were cognitively impaired; 68/232 (29%) were impaired in ≥ 1 of 4 tests. There was no association between initial symptom severity and impairment. Multivariable linear regression showed association between spatial working memory and initial symptom load (6–9 symptoms vs. 0–5, coef. 4.26, 95% CI: 0.65; 7.86). No other dimension scores were associated with symptom load. At median 11 months after out-of-hospital SARS-Cov-2 infection, minor cognitive impairment was seen with little association between COVID-19 symptom severity and outcome. [ABSTRACT FROM AUTHOR]

This study examined test-retest reliability of soccer-specific skills within a modified version of the soccer match simulation (SMS) protocol. Ten professional youth academy soccer players (18 ± 1 years) from the United Kingdom completed 30 minutes of the modified SMS on two occasions under standardised conditions. During each trial, participants performed 20-m dribbling, short passing (4.2-m), long passing (7.9-m), shooting skills, and 15-m sprints within four blocks of soccer specific activity. Collapsed normative data (mean (SD)) for trial 1 and trial 2 for dribbling speed was 2.7 (0.2) m/s, for sprint speed 5.9 (0.4) m/s, for short pass speed 11.1 (0.5) km/h, for long pass speed was 12.2 (0.5) km/h, and for shooting speed was 13.3 (0.4) km/h. Mean results from trial 1 and trial 2 were not different for all measures evaluated (P > 0.05). Good to excellent reliability (ICC 0.76-0.99) was observed for long and short passing speed, shooting speed, sprint speed, and long pass accuracy, with CVs typically < 5-10%. Moderate reliability (ICC 0.50-0.75) was observed for dribbling speed. Poor reliability (ICC <0.50) was observed for dribbling accuracy and shooting accuracy. The reliability of the modified version of the SMS protocol is promising for most of the skills assessed, with the exception of dribbling and shooting accuracy in this group of professional youth soccer players. The modified protocol is easy to implement within professional clubs without specialist equipment, but due to the limited sample size the reliability requires further confirmation in a larger sample. [ABSTRACT FROM AUTHOR]

Introduction: The relationship between sensory impairments and the risk of dementia is inconclusive. We aim to investigate the association of visual impairment (VI), hearing impairment (HI), and dual sensory impairment (DSI) with incident dementia. Methods: The UK Biobank study recruited more than 500,000 participants aged 40–69 years across the United Kingdom. Participants with available visual acuity (VA) measurements and speech-reception-threshold (SRT) information and free of dementia at the baseline assessment were included in the analysis. VI was defined as VA worse than 0.3 LogMAR units and HI were defined as an SRT of −5.5 dB or over. DSI was defined as the presence of both VI and HI. Incident dementia was identified through linked data to primary care or hospital admission records and death registries. Multivariable Cox proportional hazard regression models were used to examine the association of VI, HI, and DSI with incident dementia. Results: Among 113,511 participants (mean age: 56.8 ± 8.09 years, female: 54.4%), a total number of 1,135 (1.00%) cases of incident dementia were identified during a median follow up period of 11.1 years [interquartile range (IQR): 10.9–11.4 years]. The incidence of dementia showed significant differences among the non-sensory impairment (NSI) group, VI-only group, HI-only group, and DSI group (p < 0.001). After adjusting for demographic, lifestyle, health, and genetic factors, isolated VI (HR = 1.50, 95% CI : 1.06–2.12, p = 0.023), isolated HI (HR = 1.42, 95% CI :1.20–1.69, p < 0.001), and DSI (HR = 1.82, 95% CI : 1.10–3.00, p = 0.020) were independently associated with higher risks of incident dementia. Conclusions: Visual, hearing, and dual sensory impairments were associated with an increased risk of developing dementia, suggesting that visual and hearing impairments are modifiable risk factors that can be targeted to prevent dementia. [ABSTRACT FROM AUTHOR]

This scoping review examined the literature on decision making by practitioners in the social professions involved in compulsory admission to mental health hospital in the UK. This aimed to find out(i) what processes shape social profession decision making about compulsory admission to mental health hospitals in practice? and (ii) what methods have informed studies in this area, and how have these shaped the current state of knowledge? Three main themes emerged are: professional positioning; characteristics of the person assessed; and organisational factors. The literature has approached answering this question by focusing on social professional jurisdictional perspectives, emphasising concern whether a social perspective is privileged in decision making. Lack of realistic options to avoid in-patient care underpins decisions to detain. The process involves a logistical challenge for the social profession. The social milieu of those assessed is associated with social vulnerability and social deprivation, highlighting the relevance for social work. Concerns about risk and a citizen's lack of mental capacity to make decisions about care are associated with decisions to detain. Implications for social work include a need for research that explores the institutional and social context of decision making. Finally, implementing supported decision making in social work practice is proposed as an imperative for future research. [ABSTRACT FROM AUTHOR]

Background: Racially minoritised groups across the globe continue to experience differential outcomes in both health and education. Medical schools can play an instrumental role in addressing both these disparities, by creating inclusive student communities and ensuring that tomorrow's doctors can care for our increasingly diverse populations. Objectives: This collaborative, qualitative study led by three United Kingdom (UK) institutions aimed to explore the perspectives of Heads of Primary Care Teaching (HOTs) on cultural diversity and inclusion across UK medical schools. Methods: In December 2020, five focus groups were conducted remotely with 23 HOTs, or a nominated deputy. We explored participants' opinions regarding opportunities and barriers to cultural diversity and inclusion in medical education, ways to overcome these challenges and shared examples of best practice. Data were transcribed verbatim and thematically analysed by three researchers. Results: Investigators identified six themes from the data: lack of faculty diversity, tokenistic faculty training, institutional mindset, diversifying the formal and hidden curricula, intersectionality and student voice. Conclusion: Medical schools worldwide face similar challenges, uncertainties and opportunities when integrating diversity and inclusion throughout the learning environment. Although the importance of the topic is increasingly acknowledged, current efforts are viewed as being passive and tokenistic, hindered by challenges at multiple levels. Partnership with students and collaboration within and between institutions nationally and internationally will enable us to move forwards with both local and global positive, sustainable change. [ABSTRACT FROM AUTHOR]

Background: Evidence acknowledges inequalities to progression and achievement for black, Asian and minority ethnic students within higher education, as well as barriers for promotion of black, Asian and minority ethnic staff within the NHS. In the UK, legislation and regulatory guidance requires students studying undergraduate midwifery to undertake their programme across both these institutions. Aims: To understand the experiences of black, Asian and minority ethnic students studying undergraduate midwifery at a UK university. Methods: This qualitative study used semi-structured interviews with five student midwives who identified as black, Asian or minority ethnic from a university, conducted by a peer researcher. Thematic analysis was used to analyse anonymised transcript data. Results: Three key themes were identified: 'invisibility', 'emerging visibility' and 'managing visibility'. Participants experienced a monocultural focus in the curriculum and in practice and were exposed to racist behaviours, causing them to modify behaviours. Conclusions: A need for diverse teaching materials and cultural inclusivity across institutions was identified to help combat outdated systemic Eurocentric practices and support the implementation of recently published midwifery standards. [ABSTRACT FROM AUTHOR]

The work of Alexander Thom on the geometrical and astronomical achievements of prehistoric Britain-depending as it does almost entirely on data gained from surveying and statistical analysis-is rarely referred to now by British archaeologists. Yet his idea of the prehistoric sixteen-"month" solar calendar-in which the year is divided successively into halves, quarters, eighths and sixteenths-can now be tested with evidence from other fields, including some spectacular archaeological artifacts and from excavations specifically designed to examine the hypothesis. This article reviews the origins of the idea and presents some new evidence which has emerged since Thom's time which bears on it. This material includes five sites which excavation and surveying have shown to be probable accurate solar-calendar markers and three spectacular artifacts which, in their different ways, shed further light on the idea. These are the gold lozenge from Bush Barrow,Wiltshire, the "sky disc" from near Nebra in eastern Germany, and the fan-shaped design on stone K 15 at the Knowth passage grave in Ireland. This diversity of evidence provides powerful support for Thom's hypothesis and, it is suggested, makes more likely the existence of intellectually skilled professional priesthoods in north-western Europe in the Neolithic period and the early Bronze Age. [ABSTRACT FROM AUTHOR]

Background: Delirium is a distressing neurocognitive disorder recently linked to sleep disturbances. However, the longitudinal relationship between sleep and delirium remains unclear. This study assessed the associations of poor sleep burden, and its trajectory, with delirium risk during hospitalization.Methods: About 321 818 participants from the UK Biobank (mean age 58 ± 8 years [SD]; range 37-74 years) reported (2006-2010) sleep traits (sleep duration, excessive daytime sleepiness, insomnia-type complaints, napping, and chronotype-a closely related circadian measure for sleep timing), aggregated into a sleep burden score (0-9). New-onset delirium (n = 4 775) was obtained from hospitalization records during a 12-year median follow-up. About 42 291 (mean age 64 ± 8 years; range 44-83 years) had repeat sleep assessment on average 8 years after their first.Results: In the baseline cohort, Cox proportional hazards models showed that moderate (aggregate scores = 4-5) and severe (scores = 6-9) poor sleep burden groups were 18% (hazard ratio = 1.18 [95% confidence interval: 1.08-1.28], p < .001) and 57% (1.57 [1.38-1.80], p < .001), more likely to develop delirium, respectively. The latter risk magnitude is equivalent to 2 additional cardiovascular risks. These findings appeared robust when restricted to postoperative delirium and after exclusion of underlying dementia. Higher sleep burden was also associated with delirium in the follow-up cohort. Worsening sleep burden (score increase ≥2 vs no change) further increased the risk for delirium (1.79 [1.23-2.62], p = .002) independent of their baseline sleep score and time lag. The risk was highest in those younger than 65 years at baseline (p for interaction <.001).Conclusion: Poor sleep burden and worsening trajectory were associated with increased risk for delirium; promotion of sleep health may be important for those at higher risk. [ABSTRACT FROM AUTHOR]

Background: Mental capacity legislation in the UK is designed to safeguard the rights of people who may need support, or may be unable, to make autonomous decisions. Very limited evidence has been published about the impact of the COVID‐19 pandemic on the application of mental capacity legislation and, to our knowledge, none on the ability of speech and language therapists (SLTs) to support people with communication disabilities to engage in decision‐making. Aims: To describe how UK SLTs supported people with communication disabilities to make decisions and participate in mental capacity assessments, best interests decision‐making and advance care planning during the COVID‐19 pandemic. Methods & Procedures: This descriptive, cross‐sectional study used an online survey to collect quantitative and qualitative data about SLTs' practice experiences between August and November 2020. SLTs working with a range of adult clinical populations in different care settings were sampled purposively from all UK jurisdictions. Participants were recruited through professional networks and social media. Quantitative data were summarized using descriptive statistics. Qualitative data were analysed thematically. Outcomes & Results: Data were collected from 107 SLTs working in a range of settings across all four UK nations. The sample included SLTs working with people with neurological conditions, learning disabilities, mental health conditions and acute confusion. The need for SLT support appeared to increase during the pandemic. Most respondents were still able to offer support; however, the amount and nature of support varied. Quality of support was impacted by adjustments associated with social distancing and infection control restrictions. Personal protective equipment (PPE) was identified as a barrier to communication. Indirect working methods (e.g., telehealth) were inaccessible to some people with communication disabilities. Most respondents felt confident that legal requirements were upheld, but suggested this group was less able to engage in decision‐making and had reduced access to support to manage their own health conditions. Conclusions & Implications: Some SLT services were limited in their ability to meet the decision‐making support needs of people with communication disabilities during the COVID‐19 pandemic due to structural and systemic barriers. This suggests that existing inequities in the provision of care for people with communication disabilities in the UK were amplified during the pandemic. What this paper adds: What is already known on the subject: People with communication disabilities may require support from healthcare professionals, including SLTs, to make decisions and communicate their wishes and preferences about their care, in line with mental capacity legislation. There is a lack of published evidence relating to how changes in staff deployment and resource during the COVID‐19 pandemic may have impacted on the ability of SLTs to provide this support. What this paper adds to existing knowledge: This study provides novel evidence about the ways in which UK SLTs supported people with communication disabilities to engage in mental capacity assessments, best interests decision‐making and advance care planning during the COVID‐19 pandemic. In some cases, the amount and quality of decision‐making support available was affected negatively due to changes in healthcare delivery and resource management and SLT working practices. What are the potential or actual clinical implications of this work?: This study suggests that some people with communication disabilities experienced greater barriers to receiving professional support to maximize their autonomy and manage their health conditions during the COVID‐19 pandemic. Speech and language therapy services and healthcare commissioners should consider how best to ensure equitable service delivery to this population in resource‐limited situations. [ABSTRACT FROM AUTHOR]

Geographic atrophy (GA) secondary to age-related macular degeneration accounts for close to one-quarter of cases of legal blindness in the USA and the UK. Despite this notable disease burden, the pathophysiology of GA is complex and not fully understood, and there is currently no approved treatment to prevent or slow its progression. GA is heterogeneous in its appearance and extent, and underlying associated traits such as drusen and complement factor polymorphisms vary between patients and by ethnicity, posing a challenge for treatment development. The root cause of vision loss in GA is photoreceptor death; therefore, protecting photoreceptors from damage and delaying their degeneration are key to successful GA treatment. There are multiple neuroprotective pathways that may contribute to protecting photoreceptors from damage, and compounds that target these pathways include antioxidants, neurotrophic factors, and catalases. However, the efficacy of previously trialled neuroprotective therapies in GA, such as brimonidine, tandospirone, and NT-501, has been inconsistent; this may be due to their target of action, method of delivery, and/or suboptimal duration of action. Neurotrophic factors, or molecules involved in neuroprotective signalling cascades, may be ideal agents for further investigation for the treatment of GA. Future neuroprotective strategies in GA must focus on the development of agents with a long duration of action that can combat the progression of chronic damage in GA to provide clinically meaningful benefits for patients. [ABSTRACT FROM AUTHOR]

Almost 80 million people globally are forcibly displaced. A small number reach wealthy western countries and seek asylum. Over half are children. Wealthy reception countries have increasingly adopted restrictive reception practices including immigration detention. There is an expanding literature on the mental health impacts of immigration detention for adults, but less about children. This scoping review identified 22 studies of children detained by 6 countries (Australia, Canada, Hong Kong, Netherlands, the UK and the US) through searches of Medline, PsychINFO, Emcare, CINAHL and Scopus data bases for the period January 1992–May 2019. The results are presented thematically. There is quantitative data about the mental health of children and parents who are detained and qualitative evidence includes the words and drawings of detained children. The papers are predominantly small cross-sectional studies using mixed methodologies with convenience samples. Despite weaknesses in individual studies the review provides a rich and consistent picture of the experience and impact of immigration detention on children's wellbeing, parental mental health and parenting. Displaced children are exposed to peri-migration trauma and loss compounded by further adversity while held detained. There are high rates of distress, mental disorder, physical health and developmental problems in children aged from infancy to adolescence which persist after resettlement. Restrictive detention is a particularly adverse reception experience and children and parents should not be detained or separated for immigration purposes. The findings have implications for policy and practice. Clinicians and researchers have a role in advocacy for reception polices that support the wellbeing of accompanied and unaccompanied children who seek asylum. [ABSTRACT FROM AUTHOR]

Introduction: Most widening participation (WP) research is focused on medical school recruitment; there is a paucity of research examining whether the experience of medical school itself is an equal experience for both 'traditional' and WP students. Methods: This qualitative systematic review used the Joanna Briggs Institute (JBI) meta-aggregative approach to characterise the experience of undergraduate medical education in the UK from the perspective of WP students. Seven databases were searched, 27 studies were critically appraised, and 208 findings were grouped into 12 categories and four synthesised findings. Results: The majority of the research found relates to ethnic minority groups, with reports of other WP groups being less frequent. Whilst WP programmes attempt to alleviate disadvantages prior to entering university, our findings suggest that difficulties follow WP students into medical school. Unfamiliarity with higher education and lack of representation of WP staff in faculty can deter help-seeking behaviour and result in lack of trust. Furthermore, students from different backgrounds can find their identity conflicted upon entering medical school. Despite difficulties in establishing social networks with 'traditional' medical student peers, WP students form strong relationships with students from similar backgrounds. Conclusions: Ultimately, these students find that the uniqueness of their experience is a useful tool for communicating with diverse patients which they come across and are able to overcome adversity with the help of a supportive institution. [ABSTRACT FROM AUTHOR]

Increasing 24‐h demand for products, services and health care is resulting in a substantial portion of the workforce engaging in shift work. Observational studies suggest an association between shift work exposure and increased incidence of cardiometabolic disease. Shift workers report less healthy diets compared to day workers. As diet is a modifiable behaviour, it is important to understand how it might mediate the relationship between shift work and health. We reviewed online dietary advice for shift workers by searching for existing guidelines for shift workers published by websites of credible sources, for example institutions or government agencies. Based on the 26 guidelines retrieved, the most common categories of advice were eating patterns (n = 25), general healthy eating and/or specific food groups (n = 22), control of caffeine intake (n = 23) and maintaining hydration/fluid intake (n = 17). Although the majority of publicly available advice for shift workers follows general healthy eating guidelines, there are inconsistencies in the recommendations around the frequency of eating and snacking. Few studies have investigated modification of diet quality in shift workers. With the goal of adding to the evidence base, the Shift‐eat study is a feasibility trial designed to test whether dietary intakes in line with UK healthy eating recommendations during night work improve markers of health (interstitial glucose and heart rate variability) in free‐living shift‐working employees. Shift work is unavoidable and necessary for many industries. With an increasing section of the population employed in jobs requiring shift work, consistent dietary guidance based on evidence from shift‐working populations is urgently needed to support maintenance of health and wellbeing in employees working outside standard daytime hours. [ABSTRACT FROM AUTHOR]

Background: It is the responsibility of healthcare regulators to ensure healthcare professionals remain fit for practice in healthcare settings. If there are concerns about an individual healthcare professional they may undergo a fitness to practice investigation. This process is known to be hugely stressful for doctors and social workers, but little is known about the impact of this experience on other professions. This study explores the experiences of registrants going through the process of being reported to the UK's Health and Care Professions Council (HCPC) and attending fitness to practice (FTP) hearings. We discuss the implications of this process on registrants' wellbeing and, from our findings, present recommendations based on registrants experiences. In doing so we articulate the structural processes of the HCPC FTP process and the impact this has on individuals.Methods: This study uses semi-structured interviews and framework analysis to explore the experiences of 15 registrants who had completed the FTP process. Participants were sampled for maximum variation and were selected to reflect the range of possible processes and outcomes through the FTP process.Results: The psychological impact of undergoing a FTP process was significant for the majority of participants. Their stories described influences on their wellbeing at both a macro (institutional/organisational) and micro (individual) level. A lack of information, long length of time for the process and poor support avenues were macro factors impacting on the ability of registrants to cope with their experiences (theme 1). These macro factors led to feelings of powerlessness, vulnerability and threat of ruin for many registrants (theme 2). Suggested improvements (theme 3) included better psychological support (e.g. signposting or provision); proportional processes to the incident (e.g. mediation instead of hearings); and taking context into account.Conclusions: Findings suggest that improvements to both the structure and conduct of the FTP process are warranted. Implementation of better signposting for support both during and after a FTP process may improve psychological wellbeing. There may also be value in considering alternative ways of organising the FTP process to enable greater consideration of and flexibility for registrants' context and how they are investigated. [ABSTRACT FROM AUTHOR]

In the past three decades, snoring (affecting more than 30 % adults of the UK population) has been increasingly studied in the transdisciplinary research community involving medicine and engineering. Early work demonstrated that, the snore sound can carry important information about the status of the upper airway, which facilitates the development of non-invasive acoustic based approaches for diagnosing and screening of obstructive sleep apnoea and other sleep disorders. Nonetheless, there are more demands from clinical practice on finding methods to localise the snore sound's excitation rather than only detecting sleep disorders. In order to further the relevant studies and attract more attention, we provide a comprehensive review on the state-of-the-art techniques from machine learning to automatically classify snore sounds. First, we introduce the background and definition of the problem. Second, we illustrate the current work in detail and explain potential applications. Finally, we discuss the limitations and challenges in the snore sound classification task. Overall, our review provides a comprehensive guidance for researchers to contribute to this area. [ABSTRACT FROM AUTHOR]

Breast cancer is the most prevalent cancer in women worldwide. In the United Kingdom, approximately 5% of all breast cancers are already metastatic at the time of diagnosis. An abundance of literature shows that exercise can have beneficial effects on the outcome and prognosis of breast cancer patients, yet the molecular mechanisms remain poorly understood. There are several in vitro models that aim to recapitulate the response of breast cancer to exercise in vivo; this systematic review and metaanalysis summarizes the existing literature. The following search terms were used to conduct a systematic literature search using a collection of databases (last search performed May 2020): "in vitro," "exercise," and "breast cancer." Only studies that investigated the effects of exercise on breast cancer in vitro were included. Standardized mean differences (SMD) were calculated to determine pooled effect sizes. This meta-analysis has successfully demonstrated that various identified exercise interventions on breast cancer cells in vitro significantly reduced breast cancer cell viability, proliferation, and tumorigenic potential (SMD = -1.76, P = 0.004, SMD = -2.85, P = 0.003, and SMD = -3.15, P = 0.0008, respectively). A clear direction of effect was found with exercise on breast cancer cell migration in vitro, however this effect was not significant (SMD = -0.62, P = 0.317). To our knowledge, this is the first meta-analysis and systematic review investigating and summarizing literature on exercise and breast cancer in vitro, highlighting models used and priority areas for future research focus. [ABSTRACT FROM AUTHOR]

Background: Depression is a clinically heterogeneous disorder. Previous large-scale genetic studies of depression have explored genetic risk factors of depression case–control status or aggregated sums of depressive symptoms, ignoring possible clinical or genetic heterogeneity. Methods: We analyse data from 148 752 subjects of white British ancestry in the UK Biobank who completed nine items of a self-rated measure of current depressive symptoms: the Patient Health Questionnaire (PHQ-9). Genome-Wide Association analyses were conducted for nine symptoms and two composite measures. LD Score Regression was used to calculate SNP-based heritability (h2SNP) and genetic correlations (rg) across symptoms and to investigate genetic correlations with 25 external phenotypes. Genomic structural equation modelling was used to test the genetic factor structure across the nine symptoms. Results: We identified nine genome-wide significant genomic loci (8 novel), with no overlap in loci across symptoms. h2SNP ranged from 6% (concentration problems) to 9% (appetite changes). Genetic correlations ranged from 0.54 to 0.96 (all p < 1.39 × 10−3) with 30 of 36 correlations being significantly smaller than one. A two-factor model provided the best fit to the genetic covariance matrix, with factors representing 'psychological' and 'somatic' symptoms. The genetic correlations with external phenotypes showed large variation across the nine symptoms. Conclusions: Patterns of SNP associations and genetic correlations differ across the nine symptoms, suggesting that current depressive symptoms are genetically heterogeneous. Our study highlights the value of symptom-level analyses in understanding the genetic architecture of a psychiatric trait. Future studies should investigate whether genetic heterogeneity is recapitulated in clinical symptoms of major depression. [ABSTRACT FROM AUTHOR]

Informed by literature identifying the role of fear in decision making processes, the study upon which this paper is based sought to explore Mental Health Officers' (MHOs) experiences of fear and whether this influences their decisions to use powers of compulsory detention under the Mental Health (Care and Treatment) (Scotland) Act (Scottish Government 2003). Semi-structured interviews exploring the experience of fear in mental health assessments were undertaken with eight MHOs employed by a Scottish Local Authority and findings indicated that it had a marked impact on MHO decision making. Two central themes emerged: first, a fear of doing harm to service users, their families or the wider public though making the 'wrong' decision; second, fear of public and professional scrutiny, should any such harm arise. The findings raise a number of recommendations for policy and practice in the statutory mental health field, in particular, the importance of acknowledging fear and identifying strategies to manage it in training and post qualifying practice for MHOs and equivalent roles in the UK and other jurisdictions. The findings also add weight to calls for additional research exploring the MHO role. [ABSTRACT FROM AUTHOR]

Seeking ethical approval and conducting research in an ethical manner are necessary components of research with human participants. Using the experiences of four individual studies undertaken separately into the same role, that of the Approved Mental Health Professional (AMHP), this article critically examines the challenges for multi-site research in health and social care settings. Issues arising are discussed: these are systemic and procedural, or barriers encountered using the integrated approach of the National Research Ethics Service. We discuss the lessons learned and argue that seeking ethical approval in multi-site research is currently a static construct involving the satisfying of what are in effect closed systemic and procedural requirements. We suggest that being a virtuous social work researcher, which we explore in the context of contemporary debates in social sciences, should instead afford open-ended integrity whereby the 'permission' granted is constantly revisited by the researcher or, in other words, that the integrated approach should allow being a virtuous researcher. We suggest that this cyclical activity has particular resonance for those researchers who are, simultaneously, health and social care practitioners. The article adds to the literature on ethics, conduct and integrity in health and social care. [ABSTRACT FROM AUTHOR]

Age is one of the most important parameters influencing the occurrence of hip fractures in patients over the age of 65 but also their mental state is a decisive factor. In the first three months, older adults have eight times higher risk of dying of a hip fracture if compared with people who have not suffered such type of injury. In the last 10 years, several studies showed considerable increase in the well-being of patients who have both pathologies but for the caregivers it proved to be a very hard task. The management of hospitalization costs of dementia and hip fracture patients cannot include only the period of hospitalization, but should also include the 1-year period of recovery. In UK, the annual incidence of hip fracture is 79,243, accident and emergency costs per hip fracture is 297 pounds and hospitalization costs per hip fracture is 13,765 pounds. Health and social care for hip bone fractures in one year amounts to 2 billion euros but specialists expect the number of hip fractures to increase reaching 104,000 cases by 2025. [ABSTRACT FROM AUTHOR]

We describe the scientific and technical implementation of two models for a core set of experiments contributing to the sixth phase of the Coupled Model Intercomparison Project (CMIP6). The models used are the physical atmosphere‐land‐ocean‐sea ice model HadGEM3‐GC3.1 and the Earth system model UKESM1 which adds a carbon‐nitrogen cycle and atmospheric chemistry to HadGEM3‐GC3.1. The model results are constrained by the external boundary conditions (forcing data) and initial conditions. We outline the scientific rationale and assumptions made in specifying these. Notable details of the implementation include an ozone redistribution scheme for prescribed ozone simulations (HadGEM3‐GC3.1) to avoid inconsistencies with the model's thermal tropopause, and land use change in dynamic vegetation simulations (UKESM1) whose influence will be subject to potential biases in the simulation of background natural vegetation. We discuss the implications of these decisions for interpretation of the simulation results. These simulations are expensive in terms of human and CPU resources and will underpin many further experiments; we describe some of the technical steps taken to ensure their scientific robustness and reproducibility. Plain Language Summary: Complex models of the Earth system are valuable tools for understanding the processes responsible for our changing climate. The Coupled Model Intercomparison Project (CMIP) is a well‐established activity of the World Climate Research Programme that brings together results from these models to better understand their process representation and to pool their projections for robust understanding of future climate pathways. The latest phase of CMIP (CMIP6) is larger and more ambitious than previous phases. We detail the setup of two U.K. models (HadGEM3‐GC3.1 and UKESM1) for a core set of experiments contributing to CMIP6, including simulations of historical and future periods covering 1850 to 2300. We highlight assumptions made in applying the prescribed CMIP6 input data to these models. We outline the technical steps to ensure the reproducibility of these simulations. Key Points: We describe the implementation of U.K. Earth system models for CMIP6 experimentsWe document the assumptions made in implementing the external forcing in line with experiment protocolsSpecial attention was paid to ensuring that these expensive simulations were reproducible [ABSTRACT FROM AUTHOR]

The effectiveness of transport of short-lived halocarbons to the upper troposphere and lower stratosphere remains an important uncertainty in quantifying the supply of ozone-depleting substances to the stratosphere. In early 2014, a major field campaign in Guam in the western Pacific, involving UK and US research aircraft, sampled the tropical troposphere and lower stratosphere. The resulting measurements of CH3I , CHBr3 and CH2Br2 are compared here with calculations from a Lagrangian model. This methodology benefits from an updated convection scheme that improves simulation of the effect of deep convective motions on particle distribution within the tropical troposphere. We find that the observed CH3I , CHBr3 and CH2Br2 mixing ratios in the tropical tropopause layer (TTL) are consistent with those in the boundary layer when the new convection scheme is used to account for convective transport. More specifically, comparisons between modelled estimates and observations of short-lived CH3I indicate that the updated convection scheme is realistic up to the lower TTL but is less good at reproducing the small number of extreme convective events in the upper TTL. This study consolidates our understanding of the transport of short-lived halocarbons to the upper troposphere and lower stratosphere by using improved model calculations to confirm consistency between observations in the boundary layer, observations in the TTL and atmospheric transport processes. Our results support recent estimates of the contribution of short-lived bromocarbons to the stratospheric bromine budget. [ABSTRACT FROM AUTHOR]

While lean management practices (LMP) help small and medium‐sized enterprises (SMEs) to be efficient, sustainability‐oriented innovation (SOI) facilitates adopting environmental and social practices. Although prior research looks into the effect of LMP on the economic performance (EP) of SMEs, less is known about the effect of LMP on sustainability (economic, environmental and social) performance. Studies on the effect of SOI on sustainability and economic performance are also scant. Additionally, examining the mediating effect of corporate social responsibility (CSR) practices (environmental and social practices) on both LMP and SOI achieving sustainability performance (SP) is rare. This research bridges these knowledge gaps by answering the question of how LMP, SOI, CSR practices, sustainability and economic performance are correlated. Through hypothesis testing using structural equation modelling, this study reveals the impact of LMP, SOI, CSR (environmental and social) practices on sustainability and economic performance. The study uses data from 119 SMEs within manufacturing industries in the Midlands, UK. The analysis reveals that LMP and SOI facilitate achieving both sustainability and economic performance, and SOI mediates LMP to achieve sustainability performance. Additionally, although CSR practices mediate LMP to achieve sustainability performance, they only borderline mediate SOI to achieve sustainability performance. [ABSTRACT FROM AUTHOR]

This paper contends that since 2010 in the UK, there has been an unprecedented attempt to disrupt the traditional civil service 'monopoly' over policy advice, outsourcing policy-making to actors beyond the central state. The author argues that the policy-making processes of Whitehall and Westminster governance are being radically overhauled. In many Anglophone countries, ministers have sought to reduce their structural dependence on the permanent civil service. In so doing, ministers sought to gain political control over the machinery of policy-making. These efforts to restructure the permanent bureaucracy have had unintended consequences, however. The policy process in the UK state has become more fragmented, as policy-making and implementation have increasingly diverged. Those policy-makers and practitioners who have contact with civil servants and government ministers need to better understand the more fluid and unpredictable policy environment that is emerging at various tiers of UK governance, shaped by a multiplicity of actors sitting within, and outside, the formal boundaries of the state. The diverse ecology of policy-making institutions includes think-tanks, research institutes, non-governmental organizations, charities, community groups, management consultancies, and professional services companies, all of whom are involved in directly providing policy advice to ministers. The 'monopoly' over policy-making traditionally enjoyed by the civil service is eroding, with important implications for the work of policy-makers and public managers who have to negotiate the more fractious system of Whitehall bureaucracy. A subtle but perceptible shift is occurring whereby elected politicians and their advisers are gaining greater control over the policy-making processes of the UK state. [ABSTRACT FROM AUTHOR]

The NLSAA survey was conducted in 1985 with 1,042 participants. As of 31st May 2006 (21 years from baseline), there were 919 recorded deaths (368 men and 551 women). Mortality analyses were from baseline interview to death or censorship (May 2006). Men and women were analysed separately in unadjusted models and adjusting for demographic and health-related variables. In separate unadjusted models, participation in outdoor activities, indoor productive activities, leisure activities, walking, undertaking activities requiring flexibility, and physical effort each were associated with reduced long-term mortality among both men and women. In adjusted models, participation in physical activities had no significant association with mortality risk for men. Among women, participation in outdoor activities and leisure activities remained significantly associated with long-term survival in adjusted models. Among men, the benefits of physical activities for mortality risk were explained through demographic, health, and psychosocial variables. However, participation in outdoor and leisure physical activities was beneficial for women and had a significant association with survival, even when controlling for demographic, health and psychosocial variables. Therefore, encouraging participation in specific physical activities, such as gardening, swimming, and dancing among older women may improve long-term survival. [ABSTRACT FROM AUTHOR]

Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) is an emerging problem in many parts of the world. Although animal-adapted LA-MRSA has been known for many years, recent reports suggest a possible increasing trend in the zoonotic transmission of LA-MRSA in Europe. Since its emergence in the early 2000's, several investigations have indicated that persons in prolonged, repeated contact with affected livestock are at a higher risk of becoming colonized with LA-MRSA. LA-MRSA monitoring in livestock is voluntary under current EU legislation, and not all member states, including the UK, participate. UK LA-MRSA isolates have been detected through scanning surveillance, where samples are submitted from clinically diseased livestock for diagnostic investigation, and research studies. Surveys conducted on retail beef, pig and poultry meat on sale in the UK have also detected LA-MRSA. Taken together these results suggest that LA-MRSA is present in the UK, possibly at low prevalence level, as suggested by available evidence. In this review, we examine the data available from UK livestock and animal products, and make recommendations for future. We also review the findings from whole genome sequencing (WGS) of the possible lineage of some UK livestock isolates. [ABSTRACT FROM AUTHOR]

The exploitation of workers can be understood on a spectrum of 'less severe' to 'severe' acts or omissions, where less severe exploitation can create conditions for severe exploitation to develop. Exploitation is not an isolated phenomenon perpetrated solely by 'criminals', but is closely related to developments in the economy, labour markets and society at large. Exploitation is enabled through otherwise legitimate business practices that disadvantageously affect vulnerable workers in product and labour supply chains. In this article, labour exploitation - and ultimately human trafficking - is framed as a form of corporate crime due to the significant role that businesses and supply chains have in facilitating exploitation. This corporate crime lens therefore argues that labour exploitation is driven by common market factors and business processes, which are closely associated with inadequate regulatory oversight of exploitation in local supply chains. The article draws on qualitative, semi-structured interviews conducted with workers and supply chain stakeholders in the UK agri-food industry, as well as the Finnish cleaning industry. Through thematic analysis, the dynamics of industry, labour subcontracting, and a lack of regulatory oversight are discussed, which are framed as key factors that enable exploitation to occur. Ultimately the corporate crime lens emphasises the economic, political and societal context in which exploitation takes place, and by doing so, uncovers the structural nature of such crimes. [ABSTRACT FROM AUTHOR]