Search

This paper is based upon a collaborative research project with a group of eight second-year students studying on an Early Childhood BA at a Midlands (UK) University. The empirical research project emerged as a response to the concerning levels of disengagement demonstrated by this group post-pandemic. Because the focus of their module was research approaches, as module lead, I took the decision to engage the students in "real world" research. I reasoned that if the stakes were raised, they might feel more compelled to interact with the content in a meaningful way. An anonymous survey, exploring student health, wellbeing and motivation, was the result. Although the survey added little to the existing discourse concerning the drivers and barriers for Higher Education students in 2023, the process provided an extremely rich learning experience for the students, particularly in relation to the complexity of the ethical decisions required for research and researcher positionality. This article focuses upon the process of the research and the barriers encountered, but it also considers the ethics of using the incidental data that resulted.

Mathematics is one of the core school subjects in the UK and an emphasis is placed on developing pupils' mathematical competencies throughout all key stages. Despite that, the attainment of students with disabilities in mathematics remains low. The current study explored ways in which the Teaching Early Numeracy to children with Developmental Disabilities (TEN-DD) programme could be implemented by teaching staff in a special school in the UK to improve the numeracy skills of students with autism. Adaptations to the delivery of the programme were made during the study as a result of continued collaboration with the participating school. The findings suggest that it may be feasible to implement the TEN-DD programme using a school staff delivery model and it may help learners improve their early numeracy skills. Practical aspects of TEN-DD's implementation highlighted the need to incorporate more systematic adaptations for minimally verbal students, as well as for learners who might need additional training with prerequisite skills.

General practitioners (GPs) face complex decisions when choosing between prescribing medication or referring patients to social prescriptions. Increasing awareness of overprescribing and the risks of polypharmacy are a key driver of patient‐centred preventative approaches to healthcare. One such approach, increasingly common in the United Kingdom, is social prescribing (SP). GPs have a central role in prescribing medication or referring to a social prescription. Following a thematic analysis of data from interviews with 12 GPs, this study used the concept of mindlines to frame a consideration of their reasoning about the appropriateness of social prescriptions as adjuncts to or alternatives for medical prescriptions. We identified seven considerations that shaped their decision‐making process. These factors spanned the patient's socioeconomic circumstances, the severity of their symptoms and their expectations. Additionally, GPs factored in their time constraints, the extent to which medical options had been exhausted, and finally issues related to the SP system itself—specifically, the integration of SP workflows in GP practices and resource constraints. SP is, in theory at least, a part of the healthcare system that offers the possibility of improved health both for people and the environment. Our consideration of the role of the GP in this suggests that the challenges for design and evaluation of SP interventions that result in a reduction in medical prescriptions are considerable. [ABSTRACT FROM AUTHOR]

In their recent review of special educational needs in schools, the Education Endowment Foundation (EEF, 2020) highlights the fact that teaching strategies that are known to work well for mainstream learners are also likely to be effective for pupils with special educational needs and disabilities (SEND). In this article, the authors explain how they used systematic instruction to teach science enquiry skills and conceptual understanding in a special school.

There is a large science attainment gap between students with and without special educational needs, and many students with developmental disabilities (DD) struggle to access the mainstream science programmes of study. The purpose of the present project was to pilot the use of the Early Science (ES) curriculum over a six week period with nine students with moderate to severe DD in a special education setting in the UK. Staff members indicated positive experiences of using the curriculum, especially the use of the structured teaching methodology as a helpful tool. Evaluation data suggested that all nine pupils improved their science knowledge over the course of the intervention. Some suggestions are made to improve the delivery of the ES curriculum in UK special education settings, and the need for larger scale evaluation research.

Background: There is inadequate information regarding the factor structure of the Wechsler Intelligence Scale for Children -- Fifth UK Edition (WISC-V[superscript UK]; Wechsler, 2016a, Wechsler Intelligence Scale for Children-Fifth UK Edition, Harcourt Assessment, London, UK) to guide interpretation. Aims and methods: The WISC-V[superscript UK] was examined using complementary exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) for all models proposed by Wechsler (2016b, Wechsler Intelligence Scale for Children-Fifth UK Edition--Administration and scoring manual, Harcourt Assessment, London, UK) as well as rival bifactor models. Sample: The WISC-V[superscript UK] standardization sample (N = 415) correlation matrix was used in analyses due to denial of standardization sample raw data. Results: EFA did not support a theoretically posited fifth factor because only one subtest (Matrix Reasoning) had a salient pattern coefficient on the fifth factor. A model with four group factors and a general intelligence factor resembling the Wechsler Intelligence Scale for Children -- Fourth Edition (WISC-IV; Wechsler, 2003, Wechsler Intelligence Scale for Children-Fourth Edition, Psychological Corporation, San Antonio, TX, USA) was supported by both EFA and CFA. General intelligence (g) was the dominant source of subtest variance and large omega-hierarchical coefficients supported interpretation of the Full Scale IQ (FSIQ) score. In contrast, the four group factors accounted for small portions of subtest variance and low omega-hierarchical subscale coefficients indicated that the four-factor index scores were of questionable interpretive value independent of g. Present results replicated independent assessments of the Canadian, Spanish, French, and US versions of the WISC-V (Canivez, Watkins, & Dombrowski, 2016, "Psychological Assessment," 28, 975; 2017, "Psychological Assessment," 29, 458; Fennollar-Cortés & Watkins, 2018, "International Journal of School & Educational Psychology"; Lecerf & Canivez, 2018, "Psychological Assessment"; Watkins, Dombrowski, & Canivez, 2018, "International Journal of School and Educational Psychology"). Conclusion: Primary interpretation of the WISC-VUK should be of the FSIQ as an estimate of general intelligence.

Global shortages of critical equipment and supplies induced by COVID-19 forced countries to rapidly build and ramp up their indigenous testing and production capacities. However, the many ways in which institutional and organizational change occurred has not been sufficiently captured. Building domestic capacity requires the leveraging and repurposing of existing domestic scientific and technological capabilities, coupled with intensified global outreach to new and existing partners and suppliers. Using the framework of institutional variety, this paper looks at two facets of the UK's COVID emergency industrial response: (1) building its laboratory testing capabilities and (2) for increasing production of personal protective equipment; assessing the institutional capacities and relations that were leveraged in this regard. It uses these findings together with observations of 'innovation processes under emergency conditions' and the potential uses of a 'critical equipment policy' to sharpen some of the recommendations made in the UK's post-COVID Research and Development Roadmap. [ABSTRACT FROM AUTHOR]

The mpox epidemic in the UK began in May 2022, with rates of new cases unexpectedly and rapidly declining during August 2022. Interpreting trends in infection requires disentangling the underlying growth rate of cases from the delay from symptom onset to presenting to healthcare. We developed a nowcasting Bayesian method which incorporates time-varying delays (EpiLine) to quantify the changes in the delay from symptom onset to healthcare presentation and the underlying mpox growth rate over the period May-August 2022 in the UK. We show that the mean delay between symptom onset and healthcare presentation for mpox in the UK decreased from 22 days in early May 2022 to 10 days by early June and 8 days in August 2022. When we account for these dynamic delays, the time-varying growth rate declined gradually and continuously in the UK during the May-August 2022 period. Not accounting for varying time delays would have incorrectly characterised the growth rate by a sharp increase followed by a rapid decline in mpox cases. Our results highlight the importance of correctly quantifying the delay between symptom onset to healthcare presentation when characterising the epidemic growth of mpox in the UK. The gradual reduction in the rate of epidemic spread, which pre-dated the vaccine roll-out, is consistent with gradual risk reduction or acquired immunity amongst the highest risk individuals. Our study highlights the need for public health agencies to record the delays from symptom onset to healthcare presentation early in an outbreak. [ABSTRACT FROM AUTHOR]

This paper presents findings from a doctoral study, which investigated effective methods for teaching social sustainability within product design courses in British and Irish universities. This paper explores approaches for encouraging students to explore the social aspects of sustainable product design through workshops specifically designed to foster deep learning through collaboration, discovery and critical reflection. The importance of deep learning is reflected in both the sustainable design education (O'Rafferty et al., 2008, Griffith and Bamford, 2007) and education for sustainability literature (Warburton, 2003) as important to an understanding of the holistic and complex nature of sustainability. Three "Rethinking Design" workshops were designed and developed as part of the doctoral main study to introduce students to the wider social aspects of sustainability and these were conducted in five universities in Britain and Ireland. The workshops were developed to foster principles that encourage students to adopt deep learning methods, taking into account the specific learning preferences of the current generation of students to enhance motivational factors such as relevance, appropriate teaching materials and opportunities for collaborative learning. The workshops were tested amongst 150 undergraduate and postgraduate students and found to be successful in fostering deep learning by facilitating learning through discovery, critical reflection, peer learning and creativity leading to an exploration of design thinking solutions.

As an approach to the internationalization of higher education, Internationalization at Home (IaH) looks beyond the mobility of a minority of students, emphasizing instead the delivery to all students of an internationally focused curriculum and the embedding of intercultural communication. This can be expanded to include extracurricular activities and building relationships with local cultural and ethnic community groups. The MA in international development at Nottingham Trent University, United Kingdom, has implemented this approach, looking beyond both mobility and curriculum to apply IaH directly to student employability, embracing intercultural competence as a key professional skill. This article explores the efficacy of this combination in the MA's professional development pathway, which requires students to complete a placement, which demonstrates international and intercultural engagement, usually undertaken "at home," and to critically reflect not just on their professional skills, but on their ability to engage in the ethical practice, which is a key element of IaH.

It is important to develop understanding of what underpins the engagement of students in online learning environments. This article reports on a multiple case study that explored student engagement in a set of postgraduate degrees offered on a fully online basis. The study was based on a theorization of student engagement as the exercise of intentional human action, or agency. It identified ways in which tasks and social relations in the online learning environments triggered reflexivity on the part of students, with "reflexivity" understood to mean the ordinary mental capacity to consider oneself in relation to one's social setting. A different relationship between reflexivity and student engagement was in view than that identified by Margaret Archer with regard to reflexivity and social mobility. Rather than displaying one dominant mode of reflexivity, the students considered in the study were seen to draw on a range of modes. The engagement of these students in their learning was also seen to depend on the manner in which they engaged in reflexivity centred on the pursuit of shared goals, that is in collective reflexivity. Specific practices were seen to trigger constructive forms of collective reflexivity, while fractured and restricted forms of collective reflexivity were linked to student disengagement in relation to joint tasks. As well as adverting to the importance of collective reflexivity to learning, the study highlights scope for dissonance between the modes of reflexivity and practices favoured by an online learning environment and the reflexive profile of the student.

Purpose: This service evaluation aims to understand the experiences of service users (SUs) who accessed an early intervention in psychosis (EIP) service during the Coronavirus pandemic using qualitative and quantitative methodologies and compare these to a previous pre-pandemic study conducted within the same service (Watkins et al., 2018). Design/methodology/approach: This paper collated experiences of individuals accessing an EIP service to inform service development. Questionnaires and individual interviews were conducted to provide quantitative and qualitative data. Descriptive statistics and T-test confidence intervals were created from the results and compared to findings of Watkins et al. (2018). Interviews were transcribed verbatim and analysed using Braun and Clarke's (2006) thematic analysis. Findings: Data showed participants were largely satisfied with all areas of the service with "work or education", "living skills", and "addictions" scoring highest. Though participants reported no overall dissatisfaction, satisfaction levels dropped in "social activities" compared to the findings of Watkins et al. (2018), perhaps due to the national restrictions put in place to manage the spread of Coronavirus during this time. Interview analysis identified three themes of importance consistent with prior literature, highlighting the importance of relationships and validation during recovery. Research limitations/implications: This evaluation did not consider whether participants had accessed the service prior to the pandemic or only during, meaning that some participants could have a point of comparison with the service pre-pandemic, whereas others might not. Similarly, the participants were not the same as those of the Watkins et al.'s (2018) evaluation, meaning that direct comparisons of pre- and post-pandemic experiences were not possible. In addition, this evaluation collected data at only one time point early in the pandemic; therefore, it is unknown if client experiences of services differed as the pandemic and restrictions continued over time. Originality/value: The Covid-19 pandemic has been an unprecedented challenge for health services, and the effects of this are becoming widely reported. This evaluation of clinical services offers a valuable perspective of service user experience of receiving mental health services during a global health crisis further offering a comparison to pre-pandemic services and the experiences of those who used them. [ABSTRACT FROM AUTHOR]

Aim: To explore the usefulness of a co‐designed wordless book showing processes of receiving COVID‐19 vaccines designed by, and for, adults with intellectual disabilities. Methods: A qualitative evaluation of the resource using mixed methods. Semi‐structured interviews were conducted with people with intellectual disabilities, carers and health professionals about resource content, and use. This was analysed thematically. A survey was circulated to intellectual disabilities networks to understand resource need, use, sharing and content. Results: Understanding the COVID‐19 vaccine was a process, not a single event using one resource. A visual resource had a place in facilitating conversations about vaccines between people with intellectual disabilities and carers. Differing perspectives were expressed regarding personal needs, existing awareness of vaccine programmes and communication preferences. Changes were suggested to improve the suggested storyline and relevance around COVID‐19 restrictions changing. Conclusion: A visual resource may help conversations about the COVID‐19 vaccine for people with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Idiopathic sudden sensorineural hearing loss (ISSNHL) is the rapid onset of reduced hearing due to loss of function of the inner ear or hearing nerve of unknown aetiology. Evidence supports improved hearing recovery with early steroid treatment, via oral, intravenous, intratympanic or a combination of routes. The STARFISH trial aims to identify the most clinically and cost-effective route of administration of steroids as first-line treatment for ISSNHL. STARFISH is a pragmatic, multicentre, assessor-blinded, three-arm intervention, superiority randomised controlled trial (1:1:1) with an internal pilot (ISRCTN10535105, IRAS 1004878). 525 participants with ISSNHL will be recruited from approximately 75 UK Ear, Nose and Throat units. STARFISH will recruit adults with sensorineural hearing loss averaging 30dBHL or greater across three contiguous frequencies (confirmed via pure tone audiogram), with onset over a ≤3-day period, within four weeks of randomisation. Participants will be randomised to 1) oral prednisolone 1mg/Kg/day up to 60mg/day for 7 days; 2) intratympanic dexamethasone: three intratympanic injections 3.3mg/ml or 3.8mg/ml spaced 7±2 days apart; or 3) combined oral and intratympanic steroids. The primary outcome will be absolute improvement in pure tone audiogram average at 12-weeks following randomisation (0.5, 1.0, 2.0 and 4.0kHz). Secondary outcomes at 6 and 12 weeks will include: Speech, Spatial and Qualities of hearing scale, high frequency pure tone average thresholds (4.0, 6.0 and 8.0kHz), Arthur Boothroyd speech test, Vestibular Rehabilitation Benefit Questionnaire, Tinnitus Functional Index, adverse events and optional weekly online speech and pure tone hearing tests. A health economic assessment will be performed, and presented in terms of incremental cost effectiveness ratios, and cost per quality-adjusted life-year. Primary analyses will be by intention-to-treat. Oral prednisolone will be the reference. For the primary outcome, the difference between group means and 97.5% confidence intervals at each time-point will be estimated via a repeated measures mixed-effects linear regression model. [ABSTRACT FROM AUTHOR]

Introduction: People who call emergency ambulances frequently are often vulnerable because of health and social circumstances, have unresolved problems or cannot access appropriate care. They have higher mortality rates. Case management by interdisciplinary teams can help reduce demand for emergency services and is available in some UK regions. We report results of interviews with people who use emergency ambulance services frequently to understand their experiences of calling and receiving treatment. Methods: We used a two‐stage recruitment process. A UK ambulance service identified six people who were known to them as frequently calling emergency services. Through third‐sector organisations, we also recruited nine individuals with healthcare experiences reflecting the characteristics of people who call frequently. We gained informed consent to record and transcribe all telephone interviews. We used thematic analysis to explore the results. Results: People said they make frequent calls to emergency ambulance services as a last resort when they perceive their care needs are urgent and other routes to help have failed. Those with the most complex health needs generally felt their immediate requirements were not resolved and underlying mental and physical problems led them to call again. A third of respondents were also attended to by police and were arrested for behaviour associated with their health needs. Those callers receiving case management did not know they were selected for this. Some respondents were concerned that case management could label frequent callers as troublemakers. Conclusion: People who make frequent calls to emergency ambulance services feel their health and care needs are urgent and ongoing. They cannot see alternative ways to receive help and resolve problems. Communication between health professionals and service users appears inadequate. More research is needed to understand service users' motivations and requirements to inform design and delivery of accessible and effective services. Patient or Public Contribution: People with relevant experience were involved in developing, undertaking and disseminating this research. Two public contributors helped design and deliver the study, including developing and analysing service user interviews and drafting this paper. Eight public members of a Lived Experience Advisory Panel contributed at key stages of study design, interpretation and dissemination. Two more public contributors were members of an independent Study Steering Committee. [ABSTRACT FROM AUTHOR]

Although mentoring has become increasingly popular within UK higher education, there is little evaluative research. The current longitudinal study aimed to evaluate the usage of a peer mentoring scheme during a first semester at university amongst 124 students. Results indicate that during the first week at university the majority accessed the scheme but this then diminished by 10 weeks. There were strong positive correlations among contact, satisfaction and perceived mentor social support. Additionally, expectations of mentoring mediated the relationship between contact time and satisfaction. Correlations with student well-being and intention to withdraw, however, indicated that students reporting high levels of mentor support were worse off than those reporting less support. Students wanting more support from mentors were significantly lower on levels of integration and well-being. Findings suggest a potentially vulnerable group of students who access and use the mentoring scheme because of the problems they are experiencing.

This article analyses the sort of classroom talk that leads to effective learning, and some of the forces which operate against such practices. It starts with an analysis of the classroom context and the dominant patterns of interaction. These cause processes of learning to be hidden. It then develops by an analysis of effective learning, comprising four headings: active, collaborative, learner-driven and learning-focused. Under each heading important forms of classroom talk are analysed, and principles are offered for developing improved practice.

Rates of Multimorbidity (also called Multiple Long Term Conditions, MLTC) are increasing in many developed nations. People with multimorbidity experience poorer outcomes and require more healthcare intervention. Grouping of conditions by health service utilisation is poorly researched. The study population consisted of a cohort of people living in Wales, UK aged 20 years or older in 2000 who were followed up until the end of 2017. Multimorbidity clusters by prevalence and healthcare resource use (HRU) were modelled using hypergraphs, mathematical objects relating diseases via links which can connect any number of diseases, thus capturing information about sets of diseases of any size. The cohort included 2,178,938 people. The most prevalent diseases were hypertension (13.3%), diabetes (6.9%), depression (6.7%) and chronic obstructive pulmonary disease (5.9%). The most important sets of diseases when considering prevalence generally contained a small number of diseases, while the most important sets of diseases when considering HRU were sets containing many diseases. The most important set of diseases taking prevalence and HRU into account was diabetes & hypertension and this combined measure of importance featured hypertension most often in the most important sets of diseases. We have used a single approach to find the most important sets of diseases based on co-occurrence and HRU measures, demonstrating the flexibility of the hypergraph approach. Hypertension, the most important single disease, is silent, underdiagnosed and increases the risk of life threatening co-morbidities. Co-occurrence of endocrine and cardiovascular diseases was common in the most important sets. Combining measures of prevalence with HRU provides insights which would be helpful for those planning and delivering services. [ABSTRACT FROM AUTHOR]

Background: Thoracotomy is considered one of the most painful surgical procedures and can cause debilitating chronic post-surgical pain lasting months or years postoperatively. Aggressive management of acute pain resulting from thoracotomy may reduce the likelihood of developing chronic pain. This trial compares the two most commonly used modes of acute analgesia provision at the time of thoracotomy (thoracic epidural blockade (TEB) and paravertebral blockade (PVB)) in terms of their clinical and cost-effectiveness in preventing chronic post-thoracotomy pain. Methods: TOPIC 2 is a multi-centre, open-label, parallel group, superiority, randomised controlled trial, with an internal pilot investigating the use of TEB and PVB in 1026 adult (≥ 18 years old) patients undergoing thoracotomy in up to 20 thoracic centres throughout the UK. Patients (N = 1026) will be randomised in a 1:1 ratio to receive either TEB or PVB. During the first year, the trial will include an integrated QuinteT (Qualitative Research Integrated into Trials) Recruitment Intervention (QRI) with the aim of optimising recruitment and informed consent. The primary outcome is the incidence of chronic post-surgical pain at 6 months post-randomisation defined as 'worst chest pain over the last week' equating to a visual analogue score greater than or equal to 40 mm indicating at least a moderate level of pain. Secondary outcomes include acute pain, complications of regional analgesia and surgery, health-related quality of life, mortality and a health economic analysis. Discussion: Both TEB and PVB have been demonstrated to be effective in the prevention of acute pain following thoracotomy and nationally practice is divided. Identification of which mode of analgesia is both clinically and cost-effective in preventing chronic post-thoracotomy pain could ameliorate the debilitating effects of chronic pain, improving health-related quality of life, facilitating return to work and caring responsibilities and resulting in a cost saving to the NHS. Trial registration: NCT03677856 [ClinicalTrials.gov] registered September 19, 2018. https://clinicaltrials.gov/ct2/show/NCT03677856. First patient recruited 8 January 2019. [ABSTRACT FROM AUTHOR]

Peer mentoring is becoming increasingly popular in UK higher education, however, there remains little good quality, theoretically driven and evaluative research. The current study aims to bridge the gap between theory, practice and evaluation by providing a controlled evaluation of a peer mentoring scheme within UK universities. 109 first year undergraduates from two matched universities completed questionnaires at two time points: during the first week of university and again 10 weeks later. Results focused on direct, mediating and moderating effects of mentoring on levels of wellbeing, integration and retention. Peer mentored individuals showed higher levels of integration to university. Four times as many non-peer mentored students had seriously considered leaving university compared to peer mentored students. Integration partially mediated the relationship between mentoring and intention to stay at university. Moderating effects analyses indicate that mentoring may buffer the effect of the transition to University. Results are discussed in relation to Tinto's theory of student retention, the benefits and practicalities of peer mentoring within UK universities and the methodological limitations within this study.

This paper reports on the findings from a study undertaken to explore students' perceptions of the timeliness, accessibility, consistency, and quality of feedback and grading received electronically. The system used was GradeMark®, an electronic tool available through the plagiarism software provider, Turnitin®. 296 students from the Schools of Nursing and Midwifery, Medicine, and Dentistry at Cardiff University were included in the study. Data collection included an online survey and a focus group for each discipline. Findings revealed that the use of GradeMark® improved the timeliness and accessibility of feedback due to its immediate availability via any personal computer with internet access. The use of annotation was proven to be valuable; however consistency and quality of feedback were affected by markers' individual comments, issues which GradeMark® may not necessarily address. Findings provide insight into what quality feed-back could look like from the students' perspective, which can help improve academic practice. Overall the study outcomes suggest there are benefits to using innovative technology such as GradeMark® to enhance learning. The paper provides valuable lessons that could assist others in adopting a pragmatic and planned approach to the introduction of electronic feedback using a system such as GradeMark®.

Background: Dehydration and malnutrition are common in hospitalised patients following stroke leading to poor outcomes including increased mortality. Little is known about hydration and nutrition care practices in hospital to avoid dehydration or malnutrition, and how these practices vary in different countries. This study sought to capture how the hydration and nutrition needs of patients' post-stroke are assessed and managed in the United Kingdom (UK) and Australia (AUS). Aim: To examine and compare current in-hospital hydration and nutrition care practice for patients with stroke in the UK and Australia. Methods: A cross-sectional survey was conducted between April and November 2019. Questionnaires were mailed to stroke specialist nurses in UK and Australian hospitals providing post-stroke inpatient acute care or rehabilitation. Non-respondents were contacted up to five times. Results: We received 150/174 (86%) completed surveys from hospitals in the UK, and 120/162 (74%) in Australia. Of the 270 responding hospitals, 96% reported undertaking assessment of hydration status during an admission, with nurses most likely to complete assessments (85%). The most common methods of admission assessment were visual assessment of the patient (UK 62%; AUS 58%), weight (UK 52%; AUS 52%), and body mass index (UK 47%; AUS 42%). Almost all (99%) sites reported that nutrition status was assessed at some point during admission, and these were mainly completed by nurses (91%). Use of standardised nutrition screening tools were more common in the UK (91%) than Australia (60%). Similar proportions of hydration management decisions were made by physicians (UK 84%; AUS 83%), and nutrition management decisions by dietitians (UK 98%; AUS 97%). Conclusion: Despite broadly similar hydration and nutrition care practices after stroke in the UK and Australia, some variability was identified. Although nutrition assessment was more often informed by structured screening tools, the routine assessment of hydration was generally not. Nurses were responsible for assessment and monitoring, while dietitians and physicians undertook decision-making regarding management. Hydration care could be improved through the development of standardised assessment tools. This study highlights the need for increased implementation and use of evidence-based protocols in stroke hydration and nutrition care to improve patient outcomes. [ABSTRACT FROM AUTHOR]

During pregnancy and early fatherhood, men are at higher risk of poor health, exacerbated by low engagement by healthcare services. Yet the transition to fatherhood presents an opportunity for men to improve their health and health behaviours. Health literacy refers to individuals' competence in accessing and applying health information. Poor health literacy is associated with poor health and low help-seeking. The aim of this study was to identify health literacy strengths, needs and profiles among fathers. Men who were expecting a baby ('antenatal') or had become fathers in the past 18 months ('postnatal') were recruited through an international, online paid survey platform. The survey included the nine-scale Health Literacy Questionnaire (HLQ). Of 889 survey respondents (n  = 416, 46.5% antenatal; n  = 473, 53.5% postnatal), 274 (31.0%) were residing in the USA and 239 (27.0%) in the UK. Relatively higher scores were reported for HLQ scales relating to having sufficient information and finding and understanding this information, as well as social support for health. Relatively lower scores were obtained for scales relating to actively managing one's own health and navigating the health care system. Three scale scores were significantly lower among nulliparous than multiparous men. Seven health literacy profiles were identified. In conclusion, while fathers have some health literacy strengths, they also experience some barriers, particularly first-time fathers. Awareness of diverse health literacy profiles among fathers may assist in developing strategies to strengthen health services' capacity to meet fathers' needs and reduce risks to their health at this critical juncture in families' lives. [ABSTRACT FROM AUTHOR]

This pilot study explored effects of hearing loss on deaf children's reading comprehension in an online context. Eighteen deaf secondary students, ages 12–14 years (11 with British Sign Language as their dominant language, seven with English as their dominant language) engaged in an online research comprehension task. Six age-matched hearing spoken language bilingual students served as a comparison group. All participants were identified as confident readers by their teachers. Participants were asked to "think aloud" during an online search task to provide insights into their strategies. Additionally, participants completed a battery of assessments related to reading comprehension, vocabulary, non-verbal IQ, and working memory. Overall results showed similar use of strategies across all students. Strategies applied by the most skilled readers involved drawing on prior knowledge sources, e.g. informational websites or search engines, prior knowledge of the topic, and taking the time to read and evaluate website headings before deciding which one to use as source. Participants also made use of working memory skills. Findings highlight the importance of teaching online search and evaluation skills as part of the reading curriculum in schools. [ABSTRACT FROM AUTHOR]

This randomized clinical trial evaluates which specific components of internet-delivered cognitive behavioral therapy are active ingredients that reduce symptoms among patients with depression. Key Points: Question: Which specific components within internet-delivered cognitive behavioral therapy (CBT) for depression are active ingredients that reduce symptoms? Findings: In this randomized optimization trial that included 767 adults with depression, 6 treatment components (activity scheduling, thought challenging, relaxation, concreteness training, functional analysis, and self-compassion training) did not show a significant main effect on depression. However, the presence of the absorption component outperformed its absence in reducing depression at 6-month follow-up. Meaning: The findings suggest that the majority of treatment benefit from internet-delivered CBT is likely to accrue from factors common to all CBT components and/or from generic factors common to all therapies, with the possible exception of absorption. Importance: There is limited understanding of how complex evidence-based psychological interventions such as cognitive behavioral therapy (CBT) for depression work. Identifying active ingredients may help to make therapy more potent, brief, and scalable. Objective: To test the individual main effects and interactions of 7 treatment components within internet-delivered CBT for depression to investigate its active ingredients. Design, Setting, and Participants: This randomized optimization trial using a 32-condition, balanced, fractional factorial optimization experiment (IMPROVE-2) recruited adults with depression (Patient Health Questionnaire−9 [PHQ-9] score ≥10) from internet advertising and the UK National Health Service Improving Access to Psychological Therapies service. Participants were randomized from July 7, 2015, to March 29, 2017, with follow-up for 6 months after treatment until December 29, 2017. Data were analyzed from July 2018 to April 2023. Interventions: Participants were randomized with equal probability to 7 experimental factors within the internet CBT platform, each reflecting the presence vs absence of specific treatment components (activity scheduling, functional analysis, thought challenging, relaxation, concreteness training, absorption, and self-compassion training). Main Outcomes and Measures: The primary outcome was depression symptoms (PHQ-9 score). Secondary outcomes include anxiety symptoms and work, home, and social functioning. Results: Among 767 participants (mean age [SD] age, 38.5 [11.62] years; range, 18-76 years; 635 women [82.8%]), 506 (66%) completed the 6-month posttreatment follow-up. On average, participants receiving internet-delivered CBT had reduced depression (pre-to-posttreatment difference in PHQ-9 score, −7.79 [90% CI, −8.21 to −7.37]; 6-month follow-up difference in PHQ-9 score, −8.63 [90% CI, −9.04 to −8.22]). A baseline score–adjusted analysis of covariance model using effect-coded intervention variables (−1 or +1) found no main effect on depression symptoms for the presence vs absence of activity scheduling, functional analysis, thought challenging, relaxation, concreteness training, or self-compassion training (posttreatment: largest difference in PHQ-9 score [functional analysis], −0.09 [90% CI, −0.56 to 0.39]; 6-month follow-up: largest difference in PHQ-9 score [relaxation], −0.18 [90% CI, −0.61 to 0.25]). Only absorption training had a significant main effect on depressive symptoms at 6-month follow-up (posttreatment difference in PHQ-9 score, 0.21 [90% CI, −0.27 to 0.68]; 6-month follow-up difference in PHQ-9 score, −0.54, [90% CI, −0.97 to −0.11]). Conclusions and Relevance: In this randomized optimization trial, all components of internet-delivered CBT except absorption training did not significantly reduce depression symptoms relative to their absence despite an overall average reduction in symptoms. The findings suggest that treatment benefit from internet-delivered CBT probably accrues from spontaneous remission, factors common to all CBT components (eg, structure, making active plans), and nonspecific therapy factors (eg, positive expectancy), with the possible exception of absorption focused on enhancing direct contact with positive reinforcers. Trial Registration: isrctn.org Identifier: ISRCTN24117387 [ABSTRACT FROM AUTHOR]

Introduction: Treatment retention is associated with better outcomes and reduced risk amongst people experiencing opioid use disorder (OUD). Despite this, treatment retention remains low amongst this population. Methods: We carried out an international cross‐sectional survey of substance use disorder (SUD) treatment service workers. We aimed to understand the barriers to treatment retention in the context of OUD from the provider perspective, identify differences in response preference between professional groups, and describe regional differences in treatment provision. Results: We report data from 497 respondents based in the USA and the UK. Personality disorders, low motivation to change and social problems were the most often reported obstacles to retention. Comorbid SUD, hepatitis and HIV were not reported as often as expected. We identified associations between professional groups and response preferences related to comorbid SUD, low motivation, living arrangements and communication difficulties. UK respondents used behavioural treatments more than their US counterparts. US respondents more often reported using objective methods of measuring retention such as urine analysis, compared to their UK counterparts. Discussion: The findings from this survey suggest that regional differences exist between US and UK based SUD treatment service workers. Personality disorders represented the most often experienced obstacles to treatment retention amongst patients with OUD, with mental health and social problems more often reported than comorbid drug problems or physical health problems. Statistically significant relationships exist between professional group and obstacles reported. These data may be used to identify additional training needs amongst SUD treatment service staff. [ABSTRACT FROM AUTHOR]

Viewing another person's hand actions enhances excitability in an observer's left and right primary motor (M1) cortex. We aimed to determine whether viewing communicative hand actions alters this bilateral sensorimotor resonance. Using single-pulse transcranial magnetic stimulation (TMS), we measured excitability in the left and right M1 while right-handed non-signing participants observed bimanual communicative hand actions, i.e., meaningful signs in British Sign Language. TMS-induced motor evoked potentials were recorded from hand muscles during sign observation before and after teaching the participants to associate meanings with half of the signs. Before this teaching, when participants did not know that the presented hand actions were signs, excitability of left and right M1 was modulated equally. After learning the meanings of half the signs, excitability of the left, but not right, M1 was significantly enhanced. This left-lateralized enhancement of M1 excitability occurred during observation of signs with known and unknown meanings. The findings suggest that awareness of the communicative nature of another person's hand actions strengthens sensorimotor resonance in the left M1 cortex and alters hemispheric balance during action observation.

There are numerous claims that playing computer and video games may be educationally beneficial, but there has been little formal investigation into whether or not the frequency of exposure to such games actually affects academic performance. This paper explores the issue by analysing the relationships between gaming frequency--measured as the amount of time undergraduate students spend playing games in their free time--and their academic performance as measured by their examination marks. Using a sample of 713 students, correlation analyses between gaming frequency and examination performance were conducted for students of varying gaming frequency, study discipline, gender, and general attitudes towards gaming and study. The results reveal that examination marks are in fact negatively correlated with gaming frequency--.e. frequent gamers generally achieve lower marks than less frequent gamers. (Contains 12 tables and 3 figures.)

Purpose: The purpose of this paper is to explore views about cycling among members of identified community groups living near the Loop Line, a cycling and walking path in a deprived part of North Liverpool, UK. Design/methodology/approach: Following a literature review, qualitative focus group research was conducted among six groups of children, single mothers and older people living near the Loop Line. Findings: The paper finds that one of the strongest reported barriers to cycling for young boys was fear of bicycles being stolen--especially by a peer or someone known to the bike owner who asks to borrow the bike. The existence of high levels of crime and anti-social behaviour near the Loop Line is creating an unhealthy environment by deterring local people from exercising in their local area. For young girls in North Liverpool cycling has significant image problems, with many saying that they simply would not consider cycling as a regular mode of transport. Organising led rides along the Loop Line may be a potential solution, as this might both help to encourage cycling and increase visibility of cyclists. Research limitations/implications: Because the research in this paper was conducted among a small self-selected sample, it should be regarded as a pilot study. Results need to be verified with a larger sample drawn from a wider variety of community groups. Originality/value: The study has important implications for agencies aiming to improve public health through cycling, and shows the need to consider the broader environmental and social determinants affecting health alongside more traditional health promotion approaches. (Contains 1 figure.)

According to the Royal National Institute for the Deaf, between eight and nine million people suffer from some form of deafness or loss of hearing. Modern technology, however, together with the work of audiologists such as Karen Shepherd, enables many adults and children to recover near-normal levels of hearing, even when they have suffered some partial loss. This article discusses the work of an audiologist and highlights some primary science links. (Contains 3 figures.)

The article discusses the impact of the United Kingdom's (UK) exit from the European Union (EU) on food trade within the UK, between the UK and the EU, and the border controls affecting higher-risk food, with a particular focus on Northern Ireland. Topics include the EU border controls, intra-EU trade, trade agreements, and the GB-NI border's complexity. It also explores the historical context of Brexit and the complex challenges associated with border controls and food regulations.

This study intends to find what are the experiences of international students semiotically adapting to unfamiliar signs in the United Kingdom before and during the COVID-19 pandemic. Semi-structured interviews were conducted with six international university students to learn about their experiences of adapting to a new country. Data were analysed using thematic analysis. Two themes were classified as dialogical self in interpersonal adaptation and linguistic elements of semiotic adaptation, each with two subthemes. Participants' experiences of merging self-constructs seem reflective of proculturation theory. The researchers termed 'language bridges' to refer to social representations dependent on language-specific signs. Some of the participants' self-constructs relied on signs not provided by the environment during the COVID-19 pandemic. Overall, proculturation offers insight into the complex psychological and social processes of adapting to unfamiliar signs. [ABSTRACT FROM AUTHOR]

Background: Bacterial vaginosis is a common and distressing condition for women. Short-term antibiotic treatment is usually clinically effective, but recurrence is common. We assessed the effectiveness of intravaginal lactic acid gel versus oral metronidazole for treating recurrent bacterial vaginosis. Methods: We undertook an open-label, multicentre, parallel group, randomised controlled trial in nineteen UK sexual health clinics and a university health centre. Women aged ≥ 16 years, with current bacterial vaginosis symptoms and a preceding history of bacterial vaginosis, were randomised in a 1:1 ratio using a web-based minimisation algorithm, to 400 mg twice daily oral metronidazole tablets or 5 ml once daily intravaginal lactic acid gel, for 7 days. Masking of participants was not possible. The primary outcome was participant-reported resolution of symptoms within 2 weeks. Secondary outcomes included time to first recurrence of symptoms, number of recurrences and repeat treatments over 6 months and side effects. Results: Five hundred and eighteen participants were randomised before the trial was advised to stop recruiting by the Data Monitoring Committee. Primary outcome data were available for 79% (204/259) allocated to metronidazole and 79% (205/259) allocated to lactic acid gel. Resolution of bacterial vaginosis symptoms within 2 weeks was reported in 70% (143/204) receiving metronidazole versus 47% (97/205) receiving lactic acid gel (adjusted risk difference -23·2%; 95% confidence interval -32.3 to -14·0%). In those participants who had initial resolution and for whom 6 month data were available, 51 of 72 (71%) women in the metronidazole group and 32 of 46 women (70%) in the lactic acid gel group had recurrence of symptoms, with median times to first recurrence of 92 and 126 days, respectively. Reported side effects were more common following metronidazole than lactic acid gel (nausea 32% vs. 8%; taste changes 18% vs. 1%; diarrhoea 20% vs. 6%, respectively). Conclusions: Metronidazole was more effective than lactic acid gel for short-term resolution of bacterial vaginosis symptoms, but recurrence is common following both treatments. Lactic acid gel was associated with fewer reported side effects. Trial registration: ISRCTN14161293, prospectively registered on 18th September 2017. [ABSTRACT FROM AUTHOR]

Describes action research conducted at two universities in the United Kingdom to discover how students learn in different disciplines. Results of questionnaires and focus group interviews are presented that discuss how learning takes place; different learning outcome demands of different disciplines; and differences in knowledge structures, epistemologies, and discourse. (Author/LRW)

Outreach to small businesses in the United Kingdom since the 1970s has resulted in 45% of universities now offering courses on business startup. The government is investing 25 million pounds to develop centers of excellence in universities with leading-edge science and technology programs, for the startup of high-tech firms. (SK)

Considers the effects of major changes occurring in the late 1980s and early 1990s on the role of professional associations regarding the education, training, and development of professional occupations. Changes include the expansion of the university sector, introduction of competency-based qualifications, and the rapid growth of the professional work force. (JOW)

Focus groups of 50 British professional associations and interviews in 30 identified key trends driving change in professional continuing education (PCE): movement toward structured and mandatory PCE, links to career planning, and new methods of measuring achievement. Trends reflect the impact of changes in standards and values of practice and the need to keep a portfolio of skills updated. (SK)

Background: There is limited evidence in the literature on the long-term effectiveness and cost-effectiveness of treatments for Acute Severe Ulcerative Colitis (ASUC). The study aimed to perform decision analytic model-based long-term cost-utility analysis (CUA) of infliximab versus ciclosporin for steroid-resistant ASUC investigated in CONSTRUCT pragmatic trial. Methods: A decision tree (DT) model was developed using two-year health effect, resource use and costs data from CONSTRUCT trial to estimate relative cost-effectiveness of two competing drugs from the United Kingdom (UK) National Health Services (NHS) perspective. Using short-term trial data, a Markov model (MM) was then developed and evaluated over further 18 years. Both DT and MM were combined to investigate cost-effectiveness of infliximab versus ciclosporin for ASUC patients over 20-year time horizon, with a rigorous multiple deterministic and probabilistic sensitivity analyses to address uncertainty in results. Results: The decision tree mirrored trial-based results. Beyond 2-year trial follow-up, Markov model predicted a decrease in colectomy rate, but it remained slightly higher for ciclosporin. NHS costs and quality adjusted life years (QALYs) over base-case 20 year time horizon were £26,793 and 9.816 for ciclosporin and £34,185 and 9.106 for infliximab, suggesting ciclosporin dominates infliximab. Ciclosporin had 95% probability of being cost-effective at a willingness-to-pay (WTP) threshold value up to £20,000. Conclusion: Using data from a pragmatic RCT, the cost-effectiveness models produced incremental net health benefit in favour of ciclosporin relative to infliximab. Results from long-term modelling indicated that ciclosporin remains dominant compared with infliximab for the treatment of NHS ASUC patients, however, these need to be interpreted cautiously. Trial registration: CONSTRUCT Trial registration number ISRCTN22663589; EudraCT number: 2008- 001968-36 (Date 27/08/2008). [ABSTRACT FROM AUTHOR]

The emergence of severe acute respiratory syndrome 2 (SARS-CoV-2) variants of concern (VOCs), with mutations linked to increased transmissibility, vaccine escape and virulence, has necessitated the widespread genomic surveillance of SARS-CoV-2. This has placed a strain on global sequencing capacity, especially in areas lacking the resources for large scale sequencing activities. Here we have developed three separate multiplex high-resolution melting assays to enable the identification of Alpha, Beta, Delta and Omicron VOCs. The assays were evaluated against whole genome sequencing on upper-respiratory swab samples collected during the Alpha, Delta and Omicron [BA.1] waves of the UK pandemic. The sensitivities of the eight individual primer sets were all 100%, and specificity ranged from 94.6 to 100%. The multiplex HRM assays have potential as a tool for high throughput surveillance of SARS-CoV-2 VOCs, particularly in areas with limited genomics facilities. [ABSTRACT FROM AUTHOR]

Introduction: Long COVID (LC), the persistent symptoms ≥12 weeks following acute COVID-19, presents major threats to individual and public health across countries, affecting over 1.5 million people in the UK alone. Evidence-based interventions are urgently required and an integrated care pathway approach in pragmatic trials, which include investigations, treatments and rehabilitation for LC, could provide scalable and generalisable solutions at pace. Methods and analysis: This is a pragmatic, multi-centre, cluster-randomised clinical trial of two components of an integrated care pathway (Coverscan™, a multi-organ MRI, and Living with COVID Recovery™, a digitally enabled rehabilitation platform) with a nested, Phase III, open label, platform randomised drug trial in individuals with LC. Cluster randomisation is at level of primary care networks so that integrated care pathway interventions are delivered as "standard of care" in that area. The drug trial randomisation is at individual level and initial arms are rivaroxaban, colchicine, famotidine/loratadine, compared with no drugs, with potential to add in further drug arms. The trial is being carried out in 6–10 LC clinics in the UK and is evaluating the effectiveness of a pathway of care for adults with LC in reducing fatigue and other physical, psychological and functional outcomes at 3 months. The trial also includes an economic evaluation which will be described separately. Ethics and dissemination: The protocol was reviewed by South Central—Berkshire Research Ethics Committee (reference: 21/SC/0416). All participating sites obtained local approvals prior to recruitment. Coverscan™ has UK certification (UKCA 752965). All participants will provide written consent to take part in the trial. The first participant was recruited in July 2022 and interim/final results will be disseminated in 2023, in a plan co-developed with public and patient representatives. The results will be presented at national and international conferences, published in peer reviewed medical journals, and shared via media (mainstream and social) and patient support organisations. Trial registration number: ISRCTN10665760. [ABSTRACT FROM AUTHOR]

Introduction: Arts and cultural engagement activities have long been found to support wellbeing within the general population. In particular, community arts and cultural involvement during the COVID-19 pandemic have been an invaluable source of mental health and wellbeing support for many individuals across the globe. The initial move to remote engagement following the first United Kingdom lockdown demonstrated the importance of hybrid provisions, with isolated and vulnerable individuals finding online provisions important for wellbeing. With restrictions on movement and service access in the United Kingdom having gradually eased from March 2021, it is now important to explore how individuals navigated the ability to engage with either remote or in-person provisions. The current study aimed to explore the impact of the COVID-19 pandemic on arts and cultural engagement during periods of restrictions and initial easings on movement within the Liverpool City Region. Method: The study consisted of two waves of qualitative interviews within a broader longitudinal study. Twelve interviews were conducted during wave 1, which aimed to capture data during the initial COVID-19 lockdown period and the initial easing of restrictions. Eight of these participants were interviewed again for wave 2, which aimed to capture data during the winter 2020 lockdown period. Results: Framework analysis revealed three overarching themes: (1) The Importance of Arts and Culture for Personal Enrichment, (2) Belongingness through Socialization, and (3) Transitioning and Adjusting Throughout the COVID-19 Pandemic. Discussion: Findings presented in the current study provide further evidence of the value of arts and cultural activities in supporting wellbeing. Specifically, the current data emphasize the value of arts and cultural engagement throughout the COVID-19 pandemic and particularly during times of national restriction. Furthermore, the current study demonstrated that remote engagement provided important wellbeing support throughout the pandemic in a way that protected against mental health consequences, but with limitations on feelings of social connectedness within online environments. Amidst continuing risks from the COVID-19 virus and feelings of uncertainty, this study highlights the importance of hybrid provisions. [ABSTRACT FROM AUTHOR]

Introduction: As mortality rates from COVID-19 disease fall, the high prevalence of long-term sequelae (Long COVID) is becoming increasingly widespread, challenging healthcare systems globally. Traditional pathways of care for Long Term Conditions (LTCs) have tended to be managed by disease-specific specialties, an approach that has been ineffective in delivering care for patients with multi-morbidity. The multi-system nature of Long COVID and its impact on physical and psychological health demands a more effective model of holistic, integrated care. The evolution of integrated care systems (ICSs) in the UK presents an important opportunity to explore areas of mutual benefit to LTC, multi-morbidity and Long COVID care. There may be benefits in comparing and contrasting ICPs for Long COVID with ICPs for other LTCs. Methods and analysis: This study aims to evaluate health services requirements for ICPs for Long COVID and their applicability to other LTCs including multi-morbidity and the overlap with medically not yet explained symptoms (MNYES). The study will follow a Delphi design and involve an expert panel of stakeholders including people with lived experience, as well as clinicians with expertise in Long COVID and other LTCs. Study processes will include expert panel and moderator panel meetings, surveys, and interviews. The Delphi process is part of the overall STIMULATE-ICP programme, aimed at improving integrated care for people with Long COVID. Ethics and dissemination: Ethical approval for this Delphi study has been obtained (Research Governance Board of the University of York) as have approvals for the other STIMULATE-ICP studies. Study outcomes are likely to inform policy for ICPs across LTCs. Results will be disseminated through scientific publication, conference presentation and communications with patients and stakeholders involved in care of other LTCs and Long COVID. Registration: Researchregistry: https://www.researchregistry.com/browse-the-registry#home/registrationdetails/6246bfeeeaaed6001f08dadc/. [ABSTRACT FROM AUTHOR]

On July 19th 2021, the UK government lifted the COVID-19 restrictions that had been in place since March 2020, including wearing masks, social distancing, and all other legal requirements. The return to in-person events has been slow and gradual, showing that audiences are still cautious when (and if) they resume engaging in arts and culture. Patterns of audience behavior have also changed, shifting toward local attendance, greater digital and hybrid engagement, and openness to event format changes. As the arts and cultural industry recovers from the pandemic, it is important to adopt an audience-oriented approach and look at the changing patterns of engaging in arts and culture. This study aims to better understand the impact of the pandemic on the patterns of cultural and arts engagement. Eight qualitative interviews were conducted to explore the changes in arts and cultural engagement since the restrictions were lifted, focusing particularly on the audience's experiences of returning to in-person arts and cultural events in the Liverpool City Region (LCR). Using framework analysis, three themes were identified from the data: The new normal: reframing prepandemic and pandemic experiences of arts and culture, Re-adjusting to in-person provision, and Moving forward: online and blended provision. The findings show that the pandemic altered the ways that people engage in arts and culture. The "new normal," a blend of pandemic and pre-pandemic experiences, illustrates how the pandemic has highlighted and reconfigured the importance of arts and culture, in terms of personal and cultural identity. Resuming in-person engagement after a long break, participants noted that they were able to feel more like themselves again. Arts and culture were perceived to be beneficial in rebuilding personal resilience and confidence. Engaging in arts and culture, following the isolating experience of the pandemic, has also helped participants feel reconnected to others through their shared experiences. Finally, the findings suggest that online provision remains vital for many, ensuring wider inclusivity, particularly for vulnerable audiences. At the same time, it is important to acknowledge the barriers to online inclusion and the possibility of this resulting in a growing digital divide. [ABSTRACT FROM AUTHOR]

Background: Choosing medical careers is complex but the undergraduate period is formative. St George's University of London (SGUL) students called for greater careers information. Aim: To develop and evaluate students' careers resources. Design & setting: A quality improvement student-staff project at SGUL, UK. Method: A 'Plan-Do-Study-Act' (PDSA) cycle was completed. For the 'Plan' element, students' career intentions and information preferences were surveyed. For the 'Do' element, video interviews with clinicians and infographic posters were produced and published on SGUL's virtual learning environment. For the 'Study' element, feedback questionnaires were thematically analysed using Kirkpatrick's framework. For the 'Act' element, the model was rolled out across SGUL programmes. Results: In the 'Plan' stage, 79 students ranked interest in specialties, with general practice being the second most popular. Students were unconfident in how to pursue careers and wanted more information. For the 'Do' element, 13 careers videos and infographics were created for 10 specialties. The 'Study' questionnaire showed changes across three of the four levels in Kirkpatrick's model of evaluation of training. Level 1 (Response): students found resources helpful and accessible. Level 2 (Learning): students reported increased understanding of careers. Level 3 (Transfer): students planned using checklists and made career comparisons by specialty. Level 4 (Results): students' career choices were not demonstrated, but there were tentative proxy measures such as copying and modelling career routes and choices. 'Act' involved rolling out and regularly updating resources. Conclusion: This PDSA model enabled development of resources by students mapped to students' needs. Changes were demonstrated in relation to students' response, learning, and transfer, with tentative suggestions of impact on career choice. [ABSTRACT FROM AUTHOR]

Background: Reducing bullying is a public health priority. KiVa, a school-based anti-bullying programme, is effective in reducing bullying in Finland and requires rigorous testing in other countries, including the UK. This trial aims to test the effectiveness and cost-effectiveness of KiVa in reducing child reported bullying in UK schools compared to usual practice. The trial is currently on-going. Recruitment commenced in October 2019, however due to COVID-19 pandemic and resulting school closures was re-started in October 2020.Methods: Design: Two-arm pragmatic multicentre cluster randomised controlled trial with an embedded process and cost-effectiveness evaluation.Participants: 116 primary schools from four areas; North Wales, West Midlands, South East and South West England. Outcomes will be assessed at student level (ages 7-11 years; n = approximately 13,000 students).Intervention: KiVa is a whole school programme with universal actions that places a strong emphasis on changing bystander behaviour alongside indicated actions that provide consistent strategies for dealing with incidents of bullying. KiVa will be implemented over one academic year.Comparator: Usual practice.Primary Outcome: Student-level bullying-victimisation assessed through self-report using the extensively used and validated Olweus Bully/Victim questionnaire at baseline and 12-month follow-up.Secondary Outcomes: student-level bullying-perpetration; student mental health and emotional well-being; student level of, and roles in, bullying; school related well-being; school attendance and academic attainment; and teachers' self-efficacy in dealing with bullying, mental well-being, and burnout.Sample Size: 116 schools (58 per arm) with an assumed ICC of 0.02 will provide 90% power to identify a relative reduction of 22% with a 5% significance level.Randomisation: recruited schools will be randomised on 1:1 basis stratified by Key-Stage 2 size and free school meal status. Process evaluation: assess implementation fidelity, identify influences on KiVa implementation, and examine intervention mechanisms. Economic evaluation: Self-reported victimisation, Child Health Utility 9D, Client Service Receipt Inventory, frequency of services used, and intervention costs. The health economic analysis will be conducted from a schools and societal perspective.Discussion: This two-arm pragmatic multicentre cluster randomised controlled trial will evaluate the KiVa anti-bullying intervention to generate evidence of the effectiveness, cost-effectiveness and scalability of the programme in the UK. Our integrated process evaluation will assess implementation fidelity, identify influences on KiVa implementation across England and Wales and examine intervention mechanisms. The integrated health economic analysis will be conducted from a schools and societal perspective. Our trial will also provide evidence regarding the programme impact on inequalities by testing whether KiVa is effective across the socio-economic gradient.Trial Registration: Trials ISRCTN 12300853 Date assigned 11/02/2020. [ABSTRACT FROM AUTHOR]

Objectives: To assess the inter‐rater agreement of corneal cytology findings in canine ulcerative keratitis by veterinary surgeons of different training levels and the agreement of corneal cytology with culture. Materials and Methods: Dogs with progressive ulcerative keratitis were prospectively recruited for corneal cytology and culture. Corneal cytology slides were reviewed by veterinary surgeons of different training levels (three general practitioners, three ophthalmologists and three pathologists). The inter‐rater agreement of cytology findings and agreement of cytology with culture was assessed using the kappa measure of agreement. Results: The study included 145 corneal cytology samples from 143 dogs (145 eyes) with progressive ulcerative keratitis. Positive cultures were obtained from 81 of 145 (56%) eyes. The most commonly isolated pathogens were Streptococcus canis, Pseudomonas aeruginosa and Staphylococcus pseudintermedius. The results demonstrated increased inter‐rater agreement of corneal cytology and increased agreement with culture with increased ocular pathology expertise (pathologists > ophthalmologists > general practitioners). Clinical Significance: This study provides important information about the diagnostic value of corneal cytology in canine ulcerative keratitis and the most common pathogens involved in such cases in the UK. Based on the results of this study, cytology findings should be interpreted in conjunction with the expertise of the observer. For maximal pathogen identification, both cytology and culture should be considered. [ABSTRACT FROM AUTHOR]