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This paper considers representations of change, internal and external to a changeable and changing subject, in W. H. Auden’s New Year Letter. This long poem focuses on three aspects of change: personal responses to a sense of accountability, as experienced especially by poetic artists; diagnoses of change, across three historical epochs, within a world exposed at once to individual and public pressures, most recently those of crowd-consciousness and Fascist dictatorship; and a possible embrace of performative genres and modes, including dramatic conversation and Horatian epistolography, through which these lines of personal and conceptual discourse may tend towards convergence.

Abstract Objective The objective of this study was to measure and describe the national patient experience of radical cystectomy (RC) pathways in the UK using the validated Cystectomy‐Pathway Assessment Tool (C‐PAT). Patients and Methods A cohort of 1081 patients who underwent RC for bladder cancer, between 1 January 2021 and 31 July 2022 at 33 UK cystectomy centres, returned completed C‐PAT responses. SPSS was employed for data summary statistics, including median, interquartile range, Mann Whitney U test or Chi‐square test with a 95% confidence interval to assess statistical significance between potentially associated variables. Open‐text responses in the C‐PAT tool were analysed and coded using NVivo software. Results In this cohort, the greatest perceived delay in the RC pathway, reported by 19% of patients (n = 208), was at the GP consultation to first hospital referral stage with suspected bladder cancer. Around 10% of patients perceived delays at each of the other stages in their pathway. Cancer nurse specialist (CNS) contact was strongly associated with an improved patient experience (p

Abstract Basaltic fissure eruptions emit volatile and environmentally reactive gases and particulate matter (PM) into the lower troposphere (e.g., SO2, HCl, and HF in the gas phase; Se, As, Pb as complexes in the PM phase). Lava flows from fissure eruptions can be spatially extensive, but the composition and fluxes of their emissions are poorly characterized compared to those from main vent(s). Using uncrewed aircraft systems‐mounted (drone) samplers and ground‐based remote Fourier Transform Infrared Spectroscopy, we investigated the down‐flow compositional evolution of emissions from active lava flows during the Fagradalsfjall 2021–2023 eruptions. The calculated fluxes of volatile trace metals from lava flows are considerable relative to both main vent degassing and anthropogenic fluxes in Iceland. We demonstrate a fractionation in major gas emissions with decreasing S/halogen ratio down‐flow. This S‐Cl fractionation is reflected in the trace element degassing profile, where the abundance of predominantly sulfur‐complexing elements (e.g., Se, Te, As, Pb) decreases more rapidly in down‐flow emissions relative to elements complexing as chlorides (e.g., Cu, Rb, Cs), oxides (e.g., La, Ce) and hydroxides (e.g., Fe, Mg, Al, Ti). Using thermochemical modeling, we explain this relationship through temperature and composition dependent element speciation as the lava flow ages and cools. As a result, some chloride‐complexing elements (such as Cu) become relatively more abundant in emissions further down‐flow, compared to emissions from the main vent or more proximal lava flows. This variability in down‐flow element fluxes suggests that the output of metals to the environment may change depending on lava flow age and thermal evolution.

Background: In the UK, epilepsy care involves both specialists (for example, neurologists) and generalists (for example, GPs). Policymakers typically consider that epilepsy care should be integrated and involve both specialists and generalists. However, few understand exactly how patients view and compare specialist and generalist care. Aim: To explore patient perspectives of specialist care and generalist care for epilepsy in a qualitative evidence synthesis. Design & setting: A systematic review of patient perspectives of epilepsy care. A qualitative evidence synthesis was conducted using an identified framework. Method: Systematic searches in five databases retrieved 17 eligible studies. Data were extracted and synthesised using framework analysis informed by the ‘United Model of Generalism’. Results: The following three themes were developed: ‘Epilepsy care can be burdensome’ (for example, through care fragmentation); ‘Patients' experiences of care is that care is not always accessible’ (for example, lack of a continuum between standardised and interpretive care); and ‘How care could change for people with epilepsy’ (for example, clinicians currently have insufficient time to deviate from protocol-driven care to address psychosocial needs). People with epilepsy frequently observe that generalists lack expertise in epilepsy management. Conclusion: This synthesis of patient experiences indicates recommendations should focus on improving communication and integration between specialists and generalists for epilepsy care. Patient experiences indicate specialist care risks being burdensome and generalist knowledge insufficient, requiring enhanced primary care clinician skills and improved awareness of patient psychosocial needs. The findings argue in favour of healthcare policies, materials, and tools to continually support patient perspectives in developing epilepsy services.

Aim:: The ICIQ-Cog questionnaire was developed in German to measure the impact of incontinence and/or toilet use problems on people living with dementia and their paid carers and unpaid caregivers; it has been translated into English. This study aimed to (1) examine the linguistic validity of the ICIQ-Cog English translation and (2) determine whether it addresses what is important to unpaid caregivers. Methods:: Cognitive debriefing interviews were conducted with 13 unpaid caregivers of people with dementia and problems with incontinence or toilet use recruited via Joint Dementia Research. Interviews were conducted across 3 rounds and transcribed then thematically analysed based on the questionnaire framework. Results:: All participants were unpaid caregivers; they highlighted the need for the questionnaire. Changes were made to the title and response options were added to 10 of 12 questions; wording changes were made to 5 questions. One of the questions was deemed difficult to answer as an unpaid caregiver due to the need for more general caring experience; another used phraseology potentially more understandable by professional carers. Several participants emphasised missing questions (such as cost of buying continence aids and extra washing). The interviews were halted because the questionnaire did not fully meet unpaid caregivers needs. Conclusion:: This linguistic validation of the ICIQ-Cog questionnaire identified that it is not appropriate for use among unpaid caregivers. A questionnaire to assess impact of managing incontinence designed purposefully for unpaid caregivers of a person with dementia is needed. Further work is required to finalise the English translation for paid carers.

BackgroundApproximately 4.5 million people live with type 2 diabetes mellitus (T2DM) in the United Kingdom. Evidence shows that structured education programs can improve glycemic control and reduce the risk of complications from T2DM, but they have low attendance rates. To widen access to T2DM structured education, National Health Service England commissioned a national rollout of Healthy Living, a digital self-management program. ObjectiveThe objectives were to understand the barriers and enablers to adopting, implementing, and integrating Healthy Living into existing T2DM care pathways across England. MethodsWe undertook a cross-sectional, qualitative telephone semistructured interview study to address the objectives. In total, 17 local National Health Service leads responsible for implementing Healthy Living across their locality were recruited. We conducted 16 one-time interviews across 16 case sites (1 of the interviews was conducted with 2 local leads from the same case site). Interview data were analyzed using thematic analysis. ResultsThree overarching themes were generated: (1) implementation activities, (2) where Healthy Living fits within existing pathways, and (3) contextual factors affecting implementation. Of the 16 sites, 14 (88%) were implementing Healthy Living; the barrier to not implementing it in 2 case sites was not wanting Healthy Living to compete with their current education provision for T2DM. We identified 6 categories of implementation activities across sites: communication strategies to raise awareness of Healthy Living, developing bespoke local resources to support general practices with referrals, providing financial reimbursement or incentives to general practices, promoting Healthy Living via public events, monitoring implementation across their footprint, and widening access across high-need groups. However, outside early engagement sites, most implementation activities were “light touch,” consisting mainly of one-way communications to raise awareness. Local leads were generally positive about Healthy Living as an additional part of their T2DM structured education programs, but some felt it was more suited to specific patient groups. Barriers to undertaking more prolonged, targeted implementation campaigns included implementation not being mandated, sites not receiving data on uptake across their footprint, and confusion in understanding where Healthy Living fit within existing care pathways. ConclusionsA passive process of disseminating information about Healthy Living to general practices rather than an active process of implementation occurred across most sites sampled. This study identified that there is a need for clearer communications regarding the type of patients that may benefit from the Healthy Living program, including when it should be offered and whether it should be offered instead of or in addition to other education programs. No sites other than early engagement sites received data to monitor uptake across their footprint. Understanding variability in uptake across practices may have enabled sites to plan targeted referral campaigns in practices that were not using the service.

Abstract The UK contribution to the Detection and Attribution Model Intercomparison Project (DAMIP), part of the sixth phase of the Climate Model Intercomparison Project (CMIP6), is described. The lower atmosphere and ocean resolution configuration of the latest Hadley Centre global environmental model, HadGEM3‐GC3.1, is used to create simulations driven either with historical changes in anthropogenic well‐mixed greenhouse gases, anthropogenic aerosols, or natural climate factors. Global mean near‐surface air temperatures from the HadGEM3‐GC31‐LL simulations are consistent with CMIP6 model ensembles for the equivalent experiments. While the HadGEM3‐GC31‐LL simulations with anthropogenic and natural forcing factors capture the overall observed warming, the lack of marked simulated warming until the 1990s is diagnosed as due to aerosol cooling mostly offsetting the well‐mixed greenhouse gas warming until then. The model has unusual temperature variability over the Southern Ocean related to occasional deep convection bringing heat to the surface. This is most prominent in the model's aerosol only simulations, which have the curious feature of warming in the high southern latitudes, while the rest of the globe cools, a behavior not seen in other CMIP6 models. This has implications for studies that assume model responses, from different climate drivers, can be linearly combined. While DAMIP was predominantly designed for detection and attribution studies, the experiments are also very valuable for understanding how different climate drivers influence a model, and thus for interpretating the responses of combined anthropogenic and natural driven simulations. We recommend institutions provide model simulations for the high priority DAMIP experiments.

Abstract Urbanisation has reduced the abundance and diversity of many taxonomic groups, and the effects may be more pronounced on islands, which have a smaller regional species pool to compensate. Green spaces within urban environments may help to safeguard wildlife assemblages, and the associated habitat heterogeneity can even increase species diversity. Here, total abundance and species diversity of butterflies, birds, and vegetation at nine rural and nine urban locations were quantified on Lipsi Island, Greece. Sites were assessed using Pollard walks for butterflies, point‐count surveys for birds, and quadrats for vegetation. There was no significant difference in the abundance or species diversity of butterflies or vegetation among rural and urban locations, which could pertain to the low building density within urbanised areas and the minimal extent of urbanisation on the island. However, urban areas hosted a significantly greater abundance, richness, and diversity of birds compared to rural sites. The community composition of butterflies, birds, and vegetation also differed significantly between urban and rural locations, highlighting the impact of urbanisation on species across a broad range of trophic groups. This study contributes to ecological knowledge on the impacts of urbanisation across multiple trophic levels in island ecosystems, with comparisons across a gradient of island size and urbanisation intensity needed in future research.

BackgroundDiabetes Self-Management Education and Support programs for people living with type 2 diabetes mellitus (T2DM) can increase glycemic control and reduce the risk of developing T2DM-related complications. However, the recorded uptake of these programs is low. Digital self-management interventions have the potential to overcome barriers associated with attendance at face-to-face sessions. Healthy Living is an evidence-based digital self-management intervention for people living with T2DM, based on the Healthy Living for People with Type 2 Diabetes (HeLP-Diabetes) intervention, which demonstrated effectiveness in a randomized controlled trial. NHS England has commissioned Healthy Living for national rollout into routine care. Healthy Living consists of web-based structured education and Tools components to help service users self-manage their condition, including setting goals. However, key changes were implemented during the national rollout that contrasted with the trial, including a lack of facilitated access from a health care professional and the omission of a moderated online support forum. ObjectiveThis qualitative study aims to explore service users’ experiences of using Healthy Living early in the national rollout. MethodsA total of 19 participants were interviewed via telephone or a videoconferencing platform. Topics included users’ experiences and views of website components, their understanding of the intervention content, and the overall acceptability of Healthy Living. Transcripts were analyzed thematically using a framework approach. ResultsParticipants valued having trustworthy information that was easily accessible. The emotional management content resonated with the participants, prompting some to book an appointment with their general practitioners to discuss low mood. After completing the structured education, participants might have been encouraged to continue using the website if there was more interactivity (1) between the website and other resources and devices they were using for self-management, (2) with health professionals and services, and (3) with other people living with T2DM. There was consensus that the website was particularly useful for people who had been newly diagnosed with T2DM. ConclusionsDigital Diabetes Self-Management Education and Support programs offering emotional aspects of self-management are addressing an unmet need. Primary care practices could consider offering Healthy Living to people as soon as they are diagnosed with T2DM. Participants suggested ways in which Healthy Living could increase interaction with the website to promote continued long-term use.