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The UK average survival rate from out of hospital cardiac arrest (OHCA) is 8.6%, which is significantly lower than in comparable countries where survival rates can exceed 20%. A cardiac arrest victim is two to four times more likely to survive OHCA with bystander cardiopulmonary resuscitation (CPR). Mandatory teaching of CPR in schools is an effective way, endorsed by the World Health Organization, to train the entire population and improve the bystander CPR rate. Despite this, as with other UK home nations, there is significant variation in provision of CPR training within schools in Wales. Virtual reality (VR) technology offers an accessible, immersive way to teach CPR skills to schoolchildren. Computer scientists at the University of Chester and the Welsh Ambulance Services NHS Trust developed Virtual Cardio Pulmonary Resuscitation (VCPR), which can be used to teach children CPR skills. There were three stages: identifying requirements and specifications; development of a prototype; and management—development of software, further funding and exploring opportunities for commercialisation.

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We report on the use of a novel constrained optimisation algorithm for calibrating the finite element model in an eddy current inspection application. An accurate finite element forward model is often important in such eddy current applications for training neural networks or as part of an iterative solver. However, the subject of calibration of the model has not received much attention in the literature to date.We consider amulti-frequency, eddy current depth profiling application, which is important for non-destructive testing in the nuclear industry. In the optimisation algorithm, we use a Levenberg-Marquardt algorithm and a bisection search to ensure constraints are satisfied, coupled with a truncated Gradient and Hessian method. We calibrate two types of finite element models, one using a filament representation for the coils and the other using a full 3D approach. The results show the feasibility of using the constrained non-linear optimisation algorithm for tuning the finite element model parameters. The mean signal-noise ratio after tuning on a truncated spectrum was 29.47 dB for the 3D model and 28.96 dB for the filament; in contrast the mean SNR using the measured coil parameters was 1.48 dB and 4.98 dB for the two uncalibrated models, respectively. The results show that a filament model is competitive with a 3D model of the coils (within the nuclear graphite application); therefore, a computationally faster filament model can be used with minimal effect on accuracy.

Background Over 1.2 million 16–18 year-olds are enrolled in further education (FE—advanced secondary education) in England. Life course transitions provide opportunities to change, establish or reinforce health behaviours. FE presents an opportunity for public health improvement, yet few interventions target this setting. Using a smoking prevention intervention, we explore how young people were viewed in FE and how this affected intervention acceptability. Methods Eleven student and five staff focus groups were conducted in three intervention institutions (two colleges, one school sixth-form), as part of the process evaluation of a smoking prevention feasibility study. FE managers in intervention and control institutions were also interviewed (n = 5). Data were analysed using thematic analysis. Results In both colleges and the sixth-form, students were viewed as emergent adults and treated differently from ‘school-children’, in practice if not in policy. Colleges permitted smoking in designated areas; in the school sixth-form smoking was unofficially tolerated but concealed from younger students. Using staff to deliver anti-smoking messages reintroduced an unwanted power dynamic which disrupted perceptions of students as young adults. Conclusions FE is an important setting for young people’s health. Understanding the culture and context of FE is critical in designing acceptable and effective public health interventions.

Background: Prevention of substance (alcohol, tobacco, illegal/legal drug) use in adolescents is a public health priority. As the scope for school ‐ based health education is constrained in school timetables, interventions integrating academic and health education have gained traction in the UK and elsewhere, though evidence for their effectiveness remains unclear. We sought to syn- thesize the effectiveness of interventions integrating academic and health education for the pre- vention of substance use. Methods: We searched 19 databases between November and December 2015, among other methods. We included randomized trials of interventions integrating academic and health educa- tion targeting school students aged 4 – 18 and reporting substance use outcomes. We excluded interventions for specific health ‐ related subpopulations (e.g., children with behavioural difficul- ties). Data were extracted independently in duplicate. Outcomes were synthesized by school key stage (KS) using multilevel meta ‐ analyses, for substance use, overall and by type. Results: We identified 7 trials reporting substance use. Interventions reduced substance use generally in years 7 – 9 (KS3) based on 5 evaluations ( d = − 0.09, 95% CI [ − 0.17, − 0.01], I 2 = 35%), as well as in years 10 – 11 (KS4) based on 3 evaluations ( − 0.06, [ − 0.09, − 0.02]; I 2 = 0%). Interventions were broadly effective for reducing specific alcohol, tobacco, and drug use in both KS groups. Conclusions: Evidence quality was highly variable. Findings for years 3 – 6 and 12 – 13 could not be meta ‐ analysed, and we could not assess publication bias. Interventions appear to have a small but significant effect reducing substance use. Specific methods of integrating academic and health education remain poorly understood.

This paper compares 15 different non-linear optimisation algorithms for reconstructing the depth profile of electrical conductivity for a conductive block of material using multi-frequency measurements from an eddy current probe. Synthetic data was generated using a finite element model, where the underlying conductivity profile was randomly generated and smoothed, noise was then superimposed on the synthetic data. The compared algorithms were designed such that optimal performance was achieved for each algorithm by using the knowledge of the true underlying conductivity profile used to generate the synthetic data. The most competitive algorithm after ten iterations was determined to be dependent on the a priori estimate and level of noise, where the Broyden–Fletcher–Goldfarb–Shanno, augmented Levenberg-Marquardt and Levenberg-Marquardt are each top of different case studies. The augmented Levenberg-Marquardt and Levenberg-Marquardt were then employed on measured data, where the algorithms used a novel update procedure (in the nuclear graphite application) for the regularisation parameter. The study considers the conductivity profile of graphite blocks of the type used in the nuclear industry.

Summary Background Bullying, aggression, and violence among children and young people are some of the most consequential public mental health problems. We tested the Learning Together intervention, which involved students in efforts to modify their school environment using restorative practice and by developing social and emotional skills. Methods We did a cluster randomised trial, with economic and process evaluations, of the Learning Together intervention compared with standard practice (controls) over 3 years in secondary schools in south-east England. Learning Together consisted of staff training in restorative practice; convening and facilitating a school action group; and a student social and emotional skills curriculum. Primary outcomes were self-reported experience of bullying victimisation (Gatehouse Bullying Scale; GBS) and perpetration of aggression (Edinburgh Study of Youth Transitions and Crime (ESYTC) school misbehaviour subscale) measured at 36 months. We analysed data using intention-to-treat longitudinal mixed-effects models. This trial was registered with the ISRCTN registry (10751359). Findings We included 40 schools (20 in each group); no schools withdrew. 6667 (93·6%) of 7121 students participated at baseline and 5960 (83·3%) of 7154 at 36 months. Mean GBS bullying score at 36 months was 0·34 (SE 0·02) in the control group versus 0·29 (SE 0·02) in the intervention group, with a significant adjusted mean difference (−0·03, 95% CI −0·06 to −0·001; adjusted effect size −0·08). Mean ESYTC score at 36 months was 4·33 (SE 0·20) in the control group versus 4·04 (0·21) in the intervention group, with no evidence of a difference between groups (adjusted difference −0·13, 95% CI −0·43 to 0·18; adjusted effect size −0·03). Costs were an additional £58 per pupil in intervention schools than in control schools. Interpretation Learning Together had small but significant effects on bullying, which could be important for public health, but no effect on aggression. Interventions to promote student health by modifying the whole-school environment are likely to be one of the most feasible and efficient ways of addressing closely related risk and health outcomes in children and young people. Funding National Institute for Health Research, Educational Endowment Foundation.

Background This study investigates how the sexual health outcomes of a representative sample of students aged 15–16 in Wales vary according to the person delivering Sex and Relationships Education (SRE) in schools, students’ access to on-site sexual health services and access to free condoms. Methods Cross-sectional, self-report survey data were collected from students who participated in the 2015/16 School Health Research Network questionnaire in Wales. Data were analyzed from 59 schools, totalling 3781 students aged 15–16 (M = 15.7; SD = 0.3) who responded to questions about ever having had sex; age of sexual initiation and condom use at last intercourse. School level data were also collected, examining who delivers school SRE, provision of on-site, school ‘drop-in’ sexual health services and provision of free condoms for students. Binary and linear multi-level analyses explored the relationship between school level predictors and sexual health outcomes. Results Compared to teachers, other modes of SRE delivery were associated with better sexual health outcomes, including remaining sexually inactive, later age of first intercourse and condom use. Providing on-site sexual health services did not significantly reduce the odds of having ever had sex or delaying first intercourse; but was associated with increased condom use. On-site condom provision was associated with lower condom use. Conclusions SRE delivery by educators other than teachers is optimum to young people’s sexual health outcomes. Further funding and coordination of on-site sexual health advice services are required. Longitudinal research is needed to identify the temporal sequence of sexual health practices and outcomes.

Background: Dating and relationship violence (DRV) is under-researched in the UK, especially among Further\ud Education (FE) students. This study examines the association between DRV victimisation and\ud sociodemographic characteristics, sexual identity and dating and relationship behaviours among 16-19 year-old\ud FE students.\ud Methods: Cross-sectional self-report data were collected from 1751 students aged 16-19 at six FE settings in\ud England and Wales. Factor analysis examined the structure of DRV victimisation by gender. Multilevel logistic\ud regression examined the odds ratios of DRV victimisation according to socio-demographics, sexual identity and\ud dating behaviours.\ud \ud Results: DRV victimisation clusters into two categories for females, and three for males. Among females,\ud 46.1% experienced controlling behaviours and 31.6% threatening behaviours; 49.9% of males experienced\ud controlling behaviours, 27.1% threatening behaviours and 5.8% online sexual violence. The odds of DRV\ud victimisation were 2-8 times greater for males and 2-4 times greater for females who had ever sent a sexually\ud explicit image. No consistent association was found between DRV and age, spending money per week,\ud educational attainment or meeting partners online.\ud Conclusions: The high prevalence, absence of gender differences and social patterning suggests DRV\ud victimisation may be becoming normalised and is of significant public health importance for young people in\ud England and Wales.

BackgroundBullying, aggression and violence among children and young people are some of the most consequential public mental health problems.ObjectivesThe INCLUSIVE (initiating change locally in bullying and aggression through the school environment) trial evaluated the Learning Together intervention, which involved students in efforts to modify their school environment using restorative approaches and to develop social and emotional skills. We hypothesised that in schools receiving Learning Together there would be lower rates of self-reported bullying and perpetration of aggression and improved student biopsychosocial health at follow-up than in control schools.DesignINCLUSIVE was a cluster randomised trial with integral economic and process evaluations.SettingForty secondary schools in south-east England took part. Schools were randomly assigned to implement the Learning Together intervention over 3 years or to continue standard practice (controls).ParticipantsA total of 6667 (93.6%) students participated at baseline and 5960 (83.3%) students participated at final follow-up. No schools withdrew from the study.InterventionSchools were provided with (1) a social and emotional curriculum, (2) all-staff training in restorative approaches, (3) an external facilitator to help convene an action group to revise rules and policies and to oversee intervention delivery and (4) information on local needs to inform decisions.Main outcome measuresSelf-reported experience of bullying victimisation (Gatehouse Bullying Scale) and perpetration of aggression (Edinburgh Study of Youth Transitions and Crime school misbehaviour subscale) measured at 36 months. Intention-to-treat analysis using longitudinal mixed-effects models.ResultsPrimary outcomes – Gatehouse Bullying Scale scores were significantly lower among intervention schools than among control schools at 36 months (adjusted mean difference –0.03, 95% confidence interval –0.06 to 0.00). There was no evidence of a difference in Edinburgh Study of Youth Transitions and Crime scores. Secondary outcomes – students in intervention schools had higher quality of life (adjusted mean difference 1.44, 95% confidence interval 0.07 to 2.17) and psychological well-being scores (adjusted mean difference 0.33, 95% confidence interval 0.00 to 0.66), lower psychological total difficulties (Strengths and Difficulties Questionnaire) score (adjusted mean difference –0.54, 95% confidence interval –0.83 to –0.25), and lower odds of having smoked (odds ratio 0.58, 95% confidence interval 0.43 to 0.80), drunk alcohol (odds ratio 0.72, 95% confidence interval 0.56 to 0.92), been offered or tried illicit drugs (odds ratio 0.51, 95% confidence interval 0.36 to 0.73) and been in contact with police in the previous 12 months (odds ratio 0.74, 95% confidence interval 0.56 to 0.97). The total numbers of reported serious adverse events were similar in each arm. There were no changes for staff outcomes. Process evaluation – fidelity was variable, with a reduction in year 3. Over half of the staff were aware that the school was taking steps to reduce bullying and aggression. Economic evaluation – mean (standard deviation) total education sector-related costs were £116 (£47) per pupil in the control arm compared with £163 (£69) in the intervention arm over the first two facilitated years, and £63 (£33) and £74 (£37) per pupil, respectively, in the final, unfacilitated, year. Overall, the intervention was associated with higher costs, but the mean gain in students’ health-related quality of life was slightly higher in the intervention arm. The incremental cost per quality-adjusted life year was £13,284 (95% confidence interval –£32,175 to £58,743) and £1875 (95% confidence interval –£12,945 to £16,695) at 2 and 3 years, respectively.LimitationsOur trial was carried out in urban and periurban settings in the counties around London. The large number of secondary outcomes investigated necessitated multiple statistical testing. Fidelity of implementation of Learning Together was variable.ConclusionsLearning Together is effective across a very broad range of key public health targets for adolescents.Future workFurther studies are required to assess refined versions of this intervention in other settings.Trial registrationCurrent Controlled Trials ISRCTN10751359.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 7, No. 18. See the NIHR Journals Library website for further project information. Additional funding was provided by the Educational Endowment Foundation.

Background Schools struggle to timetable health education. Interventions integrating academic and health education to reduce substance use and violence offer promise. No current systematic reviews examine such interventions. Objectives To review evidence to explore the following questions: (1) what types of interventions integrating health and academic education in schools serving those aged 4–18 years have been evaluated? (2) What theories of change inform these interventions? (3) What factors facilitate or limit the successful implementation and receipt of such interventions, and what are the implications for the delivery of such implementations in the UK? (4) How effective are such interventions in reducing smoking and violence and the use of alcohol and drugs, and at increasing attainment? Does this vary by students’ sociodemographic characteristics? (5) What factors appear to influence the effectiveness of such interventions? Data sources In total, 19 databases were searched from 18 November to 22 December 2015, updating searches for outcome evaluations for violence on 28 February 2018 and for substance use on 14 May 2018. References were extracted from included studies and authors contacted. Review methods Included studies reported on theories of change, and process or outcome evaluations of interventions that integrated academic and health education to reduce substance use and/or violence. References were screened on the title/abstract and then on the full report. Data extraction and appraisal used Cochrane, Evidence for Policy and Practice Information Centre and other established tools. Theories of change and process data were qualitatively synthesised. Outcome evaluations were synthesised narratively and meta-analytically. Results In total, 78,451 unique references were originally identified and 62 reports included. Search updates on 28 February and 14 May 2018 retrieved a further 2355 and 1945 references, respectively, resulting in the inclusion of six additional reports. Thirty-nine reports described theories, 16 reports (15 studies) evaluated process and 41 reports (16 studies) evaluated outcomes. Multicomponent interventions are theorised to erode ‘boundaries’ (strengthen relationships) between academic and health education, teachers and students, behaviour in classrooms and in the wider school, and schools and families. Teachers, pro-social peers and parents are theorised to act as role models and reinforcers of healthy behaviours learnt in lessons. There was clear evidence that interventions are facilitated by supportive senior management and alignment with the schools’ ethos, collaborative and supportive teaching environments, and positive pre-existing student, teacher and parent attitudes towards interventions. The barriers were overburdened teachers who had little time to both learn and implement integrated curricula. The strongest evidence for effectiveness was found for the reduction of substance use in school key stages (KSs) 2 and 3. For example, a meta-analysis for substance use at KS3 reported a mean difference of –0.09 (95% confidence interval –0.17 to –0.01). A meta-analysis for effectiveness in reducing violence victimisation in KS2 found no effect. There was mixed evidence for effects on academic outcomes, with meta-analysis precluded by methodological heterogeneity. Limitations Study quality was variable. Integration was sometimes not emphasised in theories of change. Conclusions These interventions are undertheorised but involve multiple forms of boundary erosion. There is clear evidence of characteristics affecting implementation. Interventions are likely to have the greatest impact on substance use. These programmes may be effective in reducing substance use but do not appear to reduce violence and findings on educational impacts are mixed. Future work Future evaluations should assess interventions with clearer theories of change and examine academic outcomes alongside violence and substance use outcomes. Study registration This study is registered as PROSPERO CRD42015026464. Funding The National Institute for Health Research Public Health Research programme.

Evidence that health and education are interlinked is transforming investment in adolescent health. However, no comprehensive theory of how schools influence mental and physical health, which could guide, and be tested through, empirical studies, exists. Using neuroscience, sociology, and other disciplines, we theorise that schools catering for students age 11-18 years can influence health by affecting the behavioural roles that are available for students to perform, the resources available to influence student behaviour, and how peers and teachers (known as the audience) respond. Some schools offer opportunities for students to adopt diverse pro-school roles and to maintain these roles via constructive feedback. Other schools focus narrowly on high academic attainment. Where pro-school roles are unavailable, are beyond students' resources, or elicit negative responses from teachers and peers, students might experience anxiety and choose to adopt anti-school roles, particularly in later adolescence. Behaviours that harm health, such as violence and drug use, are central to anti-school roles because they can facilitate belonging and status within anti-school peer groups and symbolise alternative transitions to adulthood.

Cross-national surveys of young adults’ simultaneous polydrug use (SPU) are rare, as measuring polydrug use requires multiple questions capturing the timing, sequence, and dosage of mixing drugs. This study proposes a new way of measuring SPU by examining how preferences for simultaneous polydrug use (PSPU) vary among club/bar-goers in two European countries, Denmark and England, typically cited as exemplars of the normalization of illegal drug use. The study considers the utility of the normalization thesis for understanding preferences for polydrug use in the European nighttime economy. An in situ survey of 1,298 young adults (18–35 years) conducted in 50 bars, pubs, and nightclubs in England and Denmark assessed sociodemographics, substance use patterns, and personal preference(s) for mixing alcohol and drug use. Multinomial regression analyses examined the relative risk of PSPU categories among those reporting drug use, according to sociodemographics, alcohol intake, frequency of intoxication, and smoking. Illicit drug use was more prevalent among young adults in England than Denmark. The difference was smallest for cannabis use: Lifetime cannabis use is 66% in England and 58% in Denmark. Lifetime cocaine use was 38% in England and 17% in Denmark. In England, young adults with drug experience preferred to mix alcohol with cocaine (65%). In Denmark, young adults with drug experience preferred to mix alcohol with cannabis (78%). In multinominal regression, Danish young adults’ educational level was associated with PSPU, whereas in England legal substance use was associated with PSPU. This study calls for a more differentiated understanding of normalization. Preferences for mixing alcohol and drug use varied significantly cross nationally (alcohol/cocaine, England; alcohol/cannabis, Denmark). Different factors are associated with PSPU in each country. In England, not Denmark, drinking behaviors appear to shape preferences for mixing alcohol with cocaine, suggesting caution should be taken when replicating harm reduction interventions.

Purpose– Evaluation of the Teens & Toddlers (T & T) positive youth development (PYD) and teenage pregnancy prevention programme suggested that the intervention had minimal effectiveness partly due to its unclear theory of change. The purpose of this paper is to examine the lived experiences of young women participating in the programme to contribute to a clearer understanding of intervention process and potential mechanisms.Design/methodology/approach– The authors conducted four focus groups (n=20), eight paired or triad interviews (n=12) and 15 interviews with young women participating in an randomized controlled trial of the T & T programme in England, analysing these data using a phenomenological approach.Findings– T & T provided some opportunities to experience the “five Cs” that underpin PYD programme theory: competence, confidence, connection, character and caring. However, the young women did not experience the programme in a way that would consistently develop these characteristics. The lack of opportunities for skill-building and challenge in the activities constrained their ability to build competence and confidence. Some programme facilitators and counsellors were able to achieve connections and caring relationships with the young women, though other adults involved in the programme were sometimes perceived by the participants as overly critical. The character development activities undertaken in the programme addressed attitudes towards sexual risk-taking.Originality/value– Few studies of the PYD approach examine young people’s perspectives. This research suggests that the young women were not consistently provided with opportunities to achieve youth development within the T & T programmes. In refining the programme, more thought is needed regarding how delivery of particular components may facilitate or impede a PYD experience.

The theory of human functioning and school organisation informed by Basil Bernstein?s sociology of education suggests that to gain the commitment and promote the health of students, particularly those from disadvantaged backgrounds, schools require radical transformations eroding various ?boundaries?: between and among staff and students; between students? academic learning and broader social development and welfare; and between schools and their local communities. Existing research examining this theory has reported associations between school-level proxy measures of student commitment and lower rates of student smoking, drinking alcohol, use of drugs and violence. But this research has not directly assessed whether reduced school boundaries explain this. We piloted a new scale derived from teacher reports to measure unhealthy school boundaries and examined its inter-item reliability and its criterion validity in terms of associations with various measures of school commitment and smoking. Data on boundaries came from 101 teachers across 40 schools. Data on student commitment and smoking came from 6667 students. We assessed reliability by examining correlations between scale-items and criterion validity in terms of associations with student-reported commitment and smoking. Inter-item reliability was sub-optimal but better within the subscales about boundaries between academic/broader learning and schools/local communities. The scale had good criterion validity, strongly associated with reduced student-reported school commitment and increased student-reported smoking. We reflect on the implications of these findings in terms of critical perspectives on health promotion in schools and the strengths and limitations of quantitative research in examining health behaviours as opposed to practices.

ObjectivesTo systematically review evidence on the effectiveness of interventions including integration of academic and health education for reducing physical aggression and violence, and describe the content of these interventions.Data sourcesBetween November and December 2015, we searched 19 databases and 32 websites and consulted key experts in the field. We updated our search in February 2018.Eligibility criteriaWe included randomised trials of school-based interventions integrating academic and health education in students aged 4–18 and not targeted at health-related subpopulations (eg, learning or developmental difficulties). We included evaluations reporting a measure of interpersonal violence or aggression.Data extraction and analysisData were extracted independently in duplicate, interventions were analysed to understand similarities and differences and outcomes were narratively synthesised by key stage (KS).ResultsWe included 13 evaluations of 10 interventions reported in 20 papers. Interventions included either full or partial integration, incorporated a variety of domains beyond the classroom, and used literature, local development or linking of study skills and health promoting skills. Evidence was concentrated in KS2, with few evaluations in KS3 or KS4, and evaluations had few consistent effects; evaluations in KS3 and KS4 did not suggest effectiveness.DiscussionIntegration of academic and health education may be a promising approach, but more evidence is needed. Future research should consider the ‘lifecourse’ aspects of these interventions; that is, do they have a longitudinal effect? Evaluations did not shed light on the value of different approaches to integration.

Introduction Teenage pregnancy remains a worldwide health concern which is an outcome of, and contributor to, health inequalities. The need for gender-aware interventions with a focus on males in addressing teenage pregnancy has been highlighted as a global health need by WHO and identified in systematic reviews of (relationship and sexuality education (RSE)). This study aims to test the effectiveness of an interactive film-based RSE intervention, which draws explicit attention to the role of males in preventing an unintended pregnancy by reducing unprotected heterosexual teenage sex among males and females under age 16 years. Methods and analysis A phase III cluster randomised trial with embedded process and economic evaluations. If I Were Jack encompasses a culturally sensitive interactive film, classroom materials, a teacher-trainer session and parent animations and will be delivered to replace some of the usual RSE for the target age group in schools in the intervention group. Schools in the control group will not receive the intervention and will continue with usual RSE. Participants will not be blinded to allocation. Schools are the unit of randomisation stratified per country and socioeconomic status. We aim to recruit 66 UK schools (24 in Northern Ireland; 14 in each of England, Scotland and Wales), including approximately 7900 pupils. A questionnaire will be administered at baseline and at 12–14 months postintervention. The primary outcome is reported unprotected sex, a surrogate measure associated with unintended teenage pregnancy. Secondary outcomes include knowledge, attitudes, skills and intentions relating to avoiding teenage pregnancy in addition to frequency of engagement in sexual intercourse, contraception use and diagnosis of sexually transmitted infections. Ethics and dissemination Ethical approval was obtained from Queen’s University Belfast. Results will be published in peer-reviewed journals and disseminated to stakeholders. Funding is from the National Institute for Health Research. Trial registration number ISRCTN99459996

Introduction Teenage pregnancy remains a worldwide health concern which is an outcome of, and contributor to, health inequalities. The need for gender-sensitive interventions with a focus on males in addressing teenage pregnancy has been highlighted as a global health need by the World Health Organisation and identified in systematic reviews of relationship and sexuality education (RSE). This study aims to test the effectiveness of an interactive film-based RSE intervention which draws explicit attention to the role of males in preventing an unintended pregnancy by reducing unprotected heterosexual teenage sex among males and females under age 16 years. Methods and analysis A Phase III effectiveness cluster randomised trial with embedded process and economic evaluations. If I Were Jack encompasses a culturally sensitive interactive film, classroom materials, a teacher-trainer session and parent animations, and will supplement usual RSE for the target age group in schools in the intervention group. Schools in the control group will not receive the intervention and will continue with usual RSE. Participants will not be blinded to allocation. Schools are the unit of randomisation stratified per country and socio-economic status. We aim to recruit 66 UK schools (24 in Northern Ireland; 14 in each of England, Scotland and Wales) and approximately 7900 pupils. A questionnaire will be administered at baseline and at 12-14 months post-intervention. The primary outcome is reported unprotected sex, a surrogate measure associated with unintended teenage pregnancy. Secondary outcomes include knowledge, attitudes, skills and intentions relating to avoiding teenage pregnancy in addition to frequency of engagement in sexual intercourse, contraception use, and diagnosis of sexually transmitted infections. Ethics and dissemination Ethical approval was obtained from Queen’s University Belfast. Results will be published in peer-reviewed journals and disseminated to stakeholders. Funding is from the National Institute for Health Research.Trial registration ISRCTN: 99459996; Pre-resultsSTRENGTHS AND LIMITATIONS OF THIS STUDY • The study is evaluating the first RSE intervention to be developed and trialled which explicitly promotes a gender-sensitive approach to addressing teenage pregnancy by focussing on male perspectives. • The intervention is culturally sensitive to different parts of the UK, non-directive in terms of pregnancy resolution options and sufficiently flexible to allow use within schools which vary in their personal development/RSE policy, including in faith-based schools.• It is the first RSE Intervention to be developed and trialled across all four nations of the UK, allowing for exploration of what works best where.• Due to the nature of the intervention and setting – within schools – participating teachers, pupils and parents cannot be blinded to allocation.• A biological measure of adolescent conception rates was not possible and hence we rely on a surrogate measure of incidence of unprotected sex.

Objective: Positive youth development (PYD) often aims to prevent tobacco, alcohol, and drugs use and violence. We systematically reviewed PYD interventions, synthesizing process, and outcomes evidence. Synthesis of outcomes, published elsewhere, found no overall evidence of reducing substance use or violence but notable variability of fidelity. Our synthesis of process evaluations examined how implementation varied and was influenced by context. Data Source: Process evaluations of PYD aiming to reduce substance use and violence. Study Inclusion Criteria: Overall review published since 1985; written in English; focused on youth aged 11 to 18 years; focused on interventions addressing multiple positive assets; reported on theory, process, or outcomes; and concerned with reducing substance use or violence. Synthesis of process evaluations examined how implementation varies with or is influenced by context. Data Extraction: Two reviewers in parallel. Data Synthesis: Thematic synthesis. Results: We identified 12 reports. Community engagement enhanced program appeal. Collaboration with other agencies could broaden the activities offered. Calm but authoritative staff increased acceptability. Staff continuity underpinned diverse activities and durable relationships. Empowering participants were sometimes in tension with requiring them to engage in diverse activities. Conclusion: Our systematic review identified factors that might help improve the fidelity and acceptability of PYD interventions. Addressing these might enable PYD to fulfill its potential as a means of promoting health.

A major challenge in cancer genomics is identifying "driver" mutations from the many neutral "passenger" mutations within a given tumor. To identify driver mutations that would otherwise be lost within mutational noise, we filtered genomic data by motifs that are critical for kinase activity. In the first step of our screen, we used data from the Cancer Cell Line Encyclopedia and The Cancer Genome Atlas to identify kinases with truncation mutations occurring within or before the kinase domain. The top 30 tumor-suppressing kinases were aligned, and hotspots for loss-of-function (LOF) mutations were identified on the basis of amino acid conservation and mutational frequency. The functional consequences of new LOF mutations were biochemically validated, and the top 15 hotspot LOF residues were used in a pan-cancer analysis to define the tumor-suppressing kinome. A ranked list revealed MAP2K7, an essential mediator of the c-Jun N-terminal kinase (JNK) pathway, as a candidate tumor suppressor in gastric cancer, despite its mutational frequency falling within the mutational noise for this cancer type. The majority of mutations in MAP2K7 abolished its catalytic activity, and reactivation of the JNK pathway in gastric cancer cells harboring LOF mutations in MAP2K7 or the downstream kinase JNK suppressed clonogenicity and growth in soft agar, demonstrating the functional relevance of inactivating the JNK pathway in gastric cancer. Together, our data highlight a broadly applicable strategy to identify functional cancer driver mutations and define the JNK pathway as tumor-suppressive in gastric cancer.

Purpose – The purpose of this paper is to explore the process of involving students and staff on school action groups, and staff and student experiences of reviewing local data and initiating school-level changes, to address bullying and other aggression. Design/methodology/approach – The authors draw on qualitative, process data collected at four purposively sampled pilot intervention schools in England via semi-structured interviews with school managers, action group members and facilitators (n=33), focus groups with students (n=16) and staff (n=4), and observations. Findings – School staff used multiple methods to recruit a diverse range of students onto school action groups. Locally tailored data reports were an important catalyst for action groups to identify priorities and plan whole school change – both through the process of “validation” (whereby existing concerns were confirmed) and “discovery” (whereby new problems were identified). An unexpected benefit of providing schools with these data was that it triggered analyses of other data sources, including routine monitoring data. External facilitators were important in promoting student voice and ensuring the intervention retained integrity as a whole-school restorative approach. Practical implications – It was feasible to involve young people using action groups, and there was evidence of school-level actions led by students, including in disadvantaged school contexts. Future Health Promoting Schools interventions could incorporate this approach to support locally appropriate, school-level change. Originality/value – The micro-level processes that were observed, whereby action groups interrogated feedback reports and collected additional data, suggest the responsiveness of such youth-involvement interventions to local needs. Contrary to many public health interventions, implementation appeared to be facilitated rather than hindered by features of the secondary-school “market” whereby parents have some choice between schools.

The experience of fatigue is common to all human beings, since fatigue is a naturally occurring state of being. In occupational settings, fatigue can pose a threat to people, equipment, the environment, and corporate reputations. Although significant progress has been made in terms of understanding the causes of, and solutions for, worker fatigue, a great deal of complexity remains. This complexity is partly related to the fact that individuals are different in many ways (e.g., in terms of their genetically determined sleep need) and because of the general biological, psychological, and social components of personal fatigue. This chapter focuses on key fatigue-related principles, terminology, example frameworks, and key issues now and in the foreseeable future. The challenges for industry relate to both opportunities and potential threats, such as automation, fatigue-monitoring technologies, staffing levels, cultural differences within the workforce, and the remote locations of many operations. With evidence-based program development and evaluation, enhanced fatigue management can deliver improvements in safety, compliance, operational flexibility, worker satisfaction, and other relevant metrics. Keywords: Driver distraction; Language: en

The School Health Research Network is a policy–practice–research partnership established in Wales in 2013. The network aims to: provide health and well-being data for national, regional and local stakeholders, including schools; co-produce school-based health improvement research for Wales; and build capacity for evidence-informed practice in the school health community. School-focused engagement activities include providing member schools with bespoke Student Health and Well-being Reports, hosting school health webinars, producing schoolfriendly research briefings and holding annual events for schools. The network's model for co-producing research with schools is described and its impacts on schools is explored. These include more efficient recruitment of schools to research projects, school involvement in intervention development, schools beginning to embed evidence-informed practice by using their Health and Well-being Reports and other network resources, and securing funding to evaluate innovative health and well-being practices identified by schools. Drawing on the transdisciplinary action research (TDAR) literature, the article reflects on how TDAR principles have underpinned the progress of the network. The concept of reciprocity in the co-production literature, and its relevance to engagement with schools, is also explored, along with the network's contribution to our understanding of how we can build sustainable co-production at large scale in order to generate nationallevel action and benefit.

Background Associations between adolescent health-related quality of life (HRQoL), bullying, and aggression are not well understood. We used baseline data from a large-cluster randomized school trial to study the relationship between HRQoL, bullying experience, and other demographic factors. Methods Cross-sectional self-reported questionnaires collected pre-randomization from the on-going INCLUSIVE trial. The questionnaires were completed in the classroom. The Gatehouse Bullying Scale measured bullying victimization and the Edinburgh Study of Youth Transitions and Crime school misbehavior subscale (ESYTC) measured aggressive behaviors. HRQoL was assessed using the Child Health Utility 9 Dimensions (CHU-9D) and general quality of life using the Pediatric Quality of Life Inventory (PedsQL). Participants were a cohort of year 7 students (age 11–12 years) from 40 state secondary schools in England. Descriptive statistics for the CHU-9D and PedsQL were calculated using standard methods with tests for differences in median scores by sex assessed using quantile regression. Correlation between HRQoL measures was conducted using Spearman’s rank correlation coefficients. Predictors of HRQoL were identified using univariate and multiple regressions. Results A total of 6667 students filled out the questionnaire. The CHU-9D was correlated with the PedsQL (0.63, p < 0.001). The multivariable regression results suggest that if students were bullied frequently and upset it resulted in a decrement in CHU-9D scores of (−0.108) and fall in PedsQL score of (−16.2). The impact of the antisocial/aggressive behavior on the ESYTC scale resulted in a utility decrement of −0.004 and fall of −.5 on the PedsQL. Conclusions Adolescents’ involvement in bullying and aggression is a strong correlate of HRQoL. These data have important implications for the potential cost-effectiveness of reducing bullying and aggression in schools.