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Forecasting plant responses under global change is a critical but challenging endeavour. Despite seemingly idiosyncratic responses of species to global change, greater generalisation of 'winners' and 'losers' may emerge from considering how species functional traits influence responses and how these responses scale to the community level. Here, we synthesised six long-term global change experiments combined with locally measured functional traits. We quantified the change in abundance and probability of establishment through time for 70 alpine plant species and then assessed if leaf and stature traits were predictive of species and community responses across nitrogen addition, snow addition and warming treatments. Overall, we found that plants with more resource-acquisitive trait strategies increased in abundance but each global change factor was related to different functional strategies. Nitrogen addition favoured species with lower leaf nitrogen, snow addition favoured species with cheaply constructed leaves and warming showed few consistent trends. Community-weighted mean changes in trait values in response to nitrogen addition, snow addition and warming were often different from species-specific trait effects on abundance and establishment, reflecting in part the responses and traits of dominant species. Together, these results highlight that the effects of traits can differ by scale and response of interest.

Abstract: Fine‐scale microclimate variation due to complex topography can shape both current vegetation distributional patterns and how vegetation responds to changing climate. Topographic heterogeneity in mountains is hypothesized to mediate responses to regional climate change at the scale of metres. For alpine vegetation especially, the interplay between changing temperatures and topographically mediated variation in snow accumulation will determine the overall impact of climate change on vegetation dynamics. We combined 30 years of co‐located measurements of temperature, snow and alpine plant community composition in Colorado, USA, to investigate vegetation community trajectories across a snow depth gradient. Our analysis of long‐term trends in plant community composition revealed notable directional change in the alpine vegetation with warming temperatures. Furthermore, community trajectories are divergent across the snow depth gradient, with exposed parts of the landscape that experience little snow accumulation shifting towards stress‐tolerant, cold‐ and drought‐adapted communities, while snowier areas shifted towards more warm‐adapted communities. Synthesis: Our findings demonstrate that fine‐scale topography can mediate both the magnitude and direction of vegetation responses to climate change. We documented notable shifts in plant community composition over a 30‐year period even though alpine vegetation is known for slow dynamics that often lag behind environmental change. These results suggest that the processes driving alpine plant population and community dynamics at this site are strong and highly heterogeneous across the complex topography that is characteristic of high‐elevation mountain systems.

Abstract: A central goal at the interface of ecology and conservation is understanding how the relationship between biodiversity and ecosystem function (B–EF) will shift with changing climate. Despite recent theoretical advances, studies which examine temporal variation in the functional traits and mechanisms (mass ratio effects and niche complementarity effects) that underpin the B–EF relationship are lacking. Here, we use 13 years of data on plant species composition, plant traits, local‐scale abiotic variables, above‐ground net primary productivity (ANPP), and climate from the alpine tundra of Colorado (USA) to investigate temporal dynamics in the B–EF relationship. To assess how changing climatic conditions may alter the B–EF relationship, we built structural equation models (SEMs) for 11 traits across 13 years and evaluated the power of different trait SEMs to predict ANPP, as well as the relative contributions of mass ratio effects (community‐weighted mean trait values; CWM), niche complementarity effects (functional dispersion; FDis) and local abiotic variables. Additionally, we coupled linear mixed effects models with Multimodel inference methods to assess how inclusion of trait–climate interactions might improve our ability to predict ANPP through time. In every year, at least one SEM exhibited good fit, explaining between 19.6% and 57.2% of the variation in ANPP. However, the identity of the trait which best explained ANPP changed depending on winter precipitation, with leaf area, plant height and foliar nitrogen isotope content (δ15N) SEMs performing best in high, middle and low precipitation years, respectively. Regardless of trait identity, CWMs exerted a stronger influence on ANPP than FDis and total biotic effects were always greater than total abiotic effects. Multimodel inference reinforced the results of SEM analysis, with the inclusion of climate–trait interactions marginally improving our ability to predict ANPP through time. Synthesis. Our results suggest that temporal variation in climatic conditions influences which traits, mechanisms and abiotic variables were most responsible for driving the B–EF relationship. Importantly, our findings suggest that future research should consider temporal variability in the B–EF relationship, particularly how the predictive power of individual functional traits and abiotic variables may fluctuate as conditions shift due to climate change.

Abstract Aim Relatives of patients who have experienced an out of hospital cardiac arrest (OHCA) experience confusion and distress during resuscitation. Clear information from ambulance clinicians and the opportunity to witness the resuscitation helps them navigate the chaotic scene. However, UK-based evidence concerning relatives’ experiences of unsuccessful resuscitation attempts and interactions with ambulance clinicians is lacking. This qualitative study explores those experiences to inform ambulance clinician practice. Methods Two ambulance services in the UK identified OHCA events attended by their clinicians within the previous two weeks. After a minimum of three months relatives of non-survivors of these events were invited to participate in either a remote or face-to-face interview. Interviews focussed on their experiences of the resuscitation attempt and interactions with ambulance clinicians, their feelings at the time, and their reflections on the event afterwards. Data were analysed using reflexive thematic analysis. Results Semi-structured interviews were conducted with 14 relatives of OHCA non-survivors. Thematic analysis identified four themes. Cardiac arrest is a traumatic event for relatives, with chaotic noisy scenes increasing their distress. Many described feelings symptomatic of Post-Traumatic Stress Disorder since the event. During resuscitation, participants needed information from clinicians about what was happening, and provided information about their relatives’ wishes. Participants needed reassurance from clinicians that everything possible was done to save their relative and were reassured when they could witness some of the resuscitation. Participants were surprised how long resuscitation seemed to last; some were distressed that it lasted so long. Conclusion Relatives’ experiences highlight two key challenges for ambulance clinicians: (1) being aware of the tension relatives feel between needing reassurance that the crew is doing everything to save the patient and wanting to avoid prolonged and ultimately futile resuscitation attempts; and (2) having ongoing conversations with those present to inform clinical decision-making whilst managing the resuscitation attempt.

Abstract Defect engineering has developed over the last decade to become an inimitable tool with which to shape Metal-Organic Framework (MOF) chemistry; part of an evolution in the perception of MOFs from perfect, rigid matrices to dynamic materials whose chemistry is shaped as much by imperfections as it is by their molecular components. However, challenges in defect characterisation and reproducibility persist and, coupled with an as-yet opaque role for synthetic parameters in defect formation, deny chemists the full potential of reticular synthesis. Herein we map the broad implications defects have on MOF properties, highlight key challenges and explore the remarkable ways imperfection enriches MOF chemistry.

Abstract Background Paramedics are responsible for critical resuscitation decisions when attending Out of Hospital Cardiac Arrests (OHCA). Existing research indicates that a range of clinical and non-clinical factors moderate their decision-making. Within the United Kingdom (UK), there is little evidence on how and why paramedics make their decisions at actual OHCA events. Methods We explored the experiences of UK paramedics using individually recalled OHCA events as catalysts for discussion. Pen portraits developed from semi-structured interviews with 31 paramedics across two UK ambulance services were thematically analysed, enabling cross-participant comparisons whilst retaining depth and context. Results We identified four themes: uncertainties encountered in resuscitation guidelines, influences on decision-making, holistic perspectives, and indirect moderators. We found that paramedics experienced uncertainty at all stages of the resuscitation process. Uncertainties arose from indeterminate, ambiguous or complex information and were described as having both clinical and ethical dimensions. Whilst guidelines drove paramedics’ decisions, non-clinical personal, practical and relational factors moderated their assessments of survivability and decision-making, with attitudes to interactions between patient age, frailty and quality of life playing a substantial role. Coping strategies such as uncertainty reduction, assumption-based reasoning and weighing pros and cons were evident from interviews. Conclusions The complexity of interactions between clinical and non-clinical factors points to an element of variability in paramedics’ responses to uncertainty. Exploring UK paramedics’ uncertainties and decision-making during specific OHCA events can help acknowledge and address uncertainties in resuscitation guidelines and paramedic training, providing paramedics with the tools to manage uncertainty in a consistent and transparent way.

Abstract: Many studies of community assembly focus on a single ontogenetic stage (typically adults) when trying to infer assembly processes from patterns of biodiversity. This focus ignores the finding that assembly mechanisms may strongly differ between life‐stages, and the role of ontogenetic dependency: the mechanisms by which one life stage directly affects the composition of another life stage. Within a 4‐ha forest dynamics plot in California USA, we explored how the relative importance of multiple assembly processes shifts across life stages and assessed ontogenetic dependency of seedlings on adults in woody plant communities. To assess variation in assembly processes across life stages, we examined how β‐diversity of adult and seedling communities were each influenced by space and 13 environmental variables (soils, topography) using distance‐based redundancy analysis and variation partitioning. We then assessed the ontogenetic dependency of seedlings on adults by including adult composition as a predictor in the seedling community variation partitioning. We found differences between adult and seedling composition. For the adults, we found 18 species including pines, oaks and manzanitas characteristic of this mid‐elevation forest. For seedlings, we found 11 species, and that oaks made up 75% of all seedlings while only making up 45% of all adults. Adult β‐diversity was primarily explained by space (44.0%) with environment only explaining 18.6% and 37.4% unexplained. In contrast, most of the explained variation in seedling β‐diversity was due to ontogenetic dependency alone (13.6% explained by adult composition) with 1.6% explained by space and the environment jointly, and 62.8% unexplained. Synthesis: Here, we describe a conceptual framework for integrating ontogeny more explicitly into community assembly research and demonstrate how different assembly processes structured adult and seedling β‐diversity in a temperate dry forest. While adult β‐diversity was largely driven by spatial processes, seedling β‐diversity was largely unexplained, with ontogenetic dependency comprising most of the explained variation. These patterns suggest that future assembly research should consider how assembly processes and their underlying mechanisms may shift with ontogeny, and that interactions between ontogenetic stages (ontogenetic dependency) are critical to consider when assessing variation in assembly processes.

Background Emergency care treatment plans provide recommendations about treatment, including cardiopulmonary resuscitation, to be considered in emergency medical situations. In 2016, the Resuscitation Council United Kingdom developed a standardised emergency care treatment plan, the recommended summary plan for emergency care and treatment, known as ReSPECT. There are advantages and potential difficulties in initiating the ReSPECT process in primary care. Hospital doctors and general practitioners may use the process differently and recommendations do not always translate between settings. There are no large studies of the use of ReSPECT in the community. Study aim To evaluate how, when and why ReSPECT is used in primary care and what effect it has on patient treatment and care. Design A mixed-methods approach using interviews, focus groups, surveys and evaluation of ReSPECT forms within an analytical framework of normalisation process theory. Setting A total of 13 general practices and 13 care homes across 3 areas of England. Participants General practitioners, senior primary care nurses, senior care home staff, patients and their relatives, community and emergency department clinicians and home care workers, people with learning disability and their carers. National surveys of (1) the public and (2) general practitioners. Results Members of the public are supportive of emergency care treatment plans. Respondents recognised benefits of plans but also potential risks if the recommendations become out of date. The ReSPECT plans were used by 345/842 (41%) of general practitioner survey respondents. Those who used ReSPECT were more likely to be comfortable having emergency care treatment conversations than respondents who used standalone ‘do not attempt cardiopulmonary resuscitation’ forms. The recommended summary plan for emergency care and treatment was conceptualised by all participants as person centred, enabling patients to have some say over future treatment decisions. Including families in the discussion is seen as important so they know the patient’s wishes, which facilitates decision-making in an emergency. Writing recommendations is challenging because of uncertainty around future clinical events and treatment options. Care home staff described conflict over treatment decisions with clinicians attending in an emergency, with treatment decisions not always reflecting recommendations. People with a ReSPECT plan and their relatives trusted that recommendations would be followed in an emergency, but carers of people with a learning disability had less confidence that this would be the case. The ReSPECT form evaluation showed 87% (122/141) recorded free-text treatment recommendations other than cardiopulmonary resuscitation. Patient preferences were recorded in 57% (81/141). Where a patient lacked capacity the presence of a relative or lasting power of attorney was recorded in two-thirds of forms. Limitations Recruitment for patient/relative interviews was less than anticipated so caution is required in interpreting these data. Minority ethnic groups were under-represented across our studies. Conclusions The aims of ReSPECT are supported by health and social care professionals, patients, and the public. Uncertainty around illness trajectory and treatment options for a patient in a community setting cannot be easily translated into specific recommendations. This can lead to conflict and variation in how recommendations are interpreted. Future work Future research should explore how best to integrate patient values into treatment decision-making in an emergency. Study registration This study is registered as NCT05046197. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR131316) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 42. See the NIHR Funding and Awards website for further award information. Plain language summary The recommended summary plan for emergency care and treatment, or ReSPECT, may help healthcare professionals to make decisions about emergency treatments when patients are too sick to speak for themselves. What did we want to find out? How, when and why ReSPECT plans are made and used outside hospital and how they affect patient care. How did we do this? We listened to general practitioners, patients and their families, and examined ReSPECT plans in patient records. We listened to staff in care homes, homecare workers and other healthcare professionals. We surveyed general practitioners and the public. We worked with people with a learning disability to find out what support they needed to complete a ReSPECT plan. What did we find out? People thought that ReSPECT plans could be a good way to record a person’s wishes about medical treatment. They thought that the plan should be made with a healthcare professional they knew and trusted. These conversations need time and preparation, especially for someone with a learning disability. Most people thought family involvement was important. General practitioners told us that it could be difficult to know what kind of emergencies and treatments to discuss and put in the plan. Most plans we looked at had recommendations about cardiopulmonary resuscitation and many plans had recommendations about other treatments. About half of plans recorded the patient’s wishes. It was not always clear who the plan had been discussed with to find out their wishes. Care home staff told us that they were often frustrated when healthcare professionals in an emergency did not always follow the plan. What does this mean? Further research is needed on how to improve ReSPECT conversations so that plans clearly reflect what is important to the individual, and how to help health professionals use ReSPECT when an emergency happens. Scientific summary Background Emergency care and treatment plans (ECTPs) focus on treatment and care in emergency or acute illness situations. Their aim is to make treatment recommendations that reflect the person’s preferences and values. They are reached in discussion with the person or their family. The recommendations made are intended to guide future treating clinicians. ECTPs were developed in response to problems identified with standalone ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) recommendations and aim to prompt wider considerations of treatment and care, including cardiopulmonary resuscitation (CPR), to provide a more holistic approach to anticipatory decision-making for emergencies. In 2016, implementation of the ‘recommended summary plan for emergency care and treatment’ (ReSPECT) began in NHS acute trusts and later extended into primary care. There may be advantages to initiating the ReSPECT process in primary care. People may have an established relationship with their general practitioner (GP) and conversations can occur over an extended period. Also, they are often less sick and able to engage in discussion, with recommendations placed in a wider context of advance care planning. However, there are also potential difficulties; individuals and their families may be reluctant to think about these decisions until a crisis emerges, GPs may be uncertain about hospital-based interventions, and both may have concerns about the effect of these discussions on the patient–doctor relationship. An evaluation of ReSPECT in early adopter NHS acute trusts sites in England found ReSPECT conversations were mainly initiated with patients nearing the end of their life or at imminent risk of deterioration. Doctors’ uncertainty about a patient’s prognosis, time constraints and the desire to minimise patient distress influenced both the prioritisation and content of conversations. GP focus groups suggested that hospital doctors and GPs use the process in different ways and recommendations do not always translate from one setting to another. A West of England interview study with GPs and care home staff found a generally positive attitude to ReSPECT but noted that its use was complex and there were challenges in incorporating patients’ preferences into decision-making. There are no large UK studies of the use of ReSPECT or other ECTPs in the community. Aim To evaluate the ReSPECT process for adults in primary care to determine how, when and why it is used, and what effect it has on patient treatment and care. Objectives To understand how ReSPECT is currently used in primary care from the perspective of patients, their families, clinicians and care home staff, and to identify enablers and obstacles to the implementation of ReSPECT in primary care practice To describe the views of the public and other health and social care professionals who encounter ReSPECT plans initiated in primary care, on ECTPs and ReSPECT in particular To explore the impact of ReSPECT on patient treatment decisions To understand how health and social care professionals can optimally engage people with learning disability in the ReSPECT process To develop a consensus on how ReSPECT should be used in primary care. Methods We used a mixed-methods approach within an analytical framework of normalisation process theory. Qualitative data were analysed thematically. Descriptive analyses of quantitative data are presented with regression analyses for some outcomes. Work package 1 We interviewed GPs and other practice staff, patients with a ReSPECT plan and/or their families and care home staff. We worked with 13 general practices and associated care homes across 3 areas of England. Work package 2 We used focus groups and interviews with other health and social care professionals, members of the public and faith leaders to explore their views on ReSPECT and other forms of ECTP. We did a national survey of attitudes of the public to ECTPs using a module in the 2022 British Social Attitudes Survey administered by the National Centre for Social Research. We surveyed the experience and attitudes of GPs to ECTPs and ReSPECT using medeConnect (Abingdon, UK), a market research company focusing on healthcare professionals. Work package 3 We used a structured evaluation tool to assess the quality of ReSPECT form completion in our 13 general practice sites. Work package 4 We ran co-production workshops with adults with learning disability to explore their understanding of, and views on, emergency care treatment planning and to co-create resources to support engagement of people with a learning disability with ReSPECT. Using focus groups and interviews with family carers of people with a learning disability, we captured their views and experiences of emergency care treatment planning. Work package 5 An initial synthesis of findings across the work packages informed the content of a stakeholder meeting with participants from professional and patient organisations, and implementers of ReSPECT across the UK. Key messages from small group discussions at the stakeholder meeting were integrated into the final synthesis to identify implications for practice and future research priorities. Results Attitudes and experiences of the public around ECTPs Focus groups Twenty-one members of the public participated in four groups. Participants supported the concept of ReSPECT and thought it could be an important tool in facilitating conversations about end-of-life care. However, they thought the process and form should be more person centred. Participants thought conversations would work best when the person had an established relationship with the health professional but recognised that this was not always possible. They thought that involving the family in ReSPECT discussions was important but expressed concern about whether the plans would be available or followed in an emergency. Public survey The module was completed by 1135 members of the public; 17 respondents had an ECTP in place. Respondents were supportive of anyone being able to have an ECTP if they wished 908/1135 (80%), and half of those without a plan would want one for themselves (620/1112; 56%). Most would also like to be involved in completing a plan for a close family member if the person was unable to do so themselves 930/1135 (82%). Respondents with a chronic condition that reduces daily activity were more likely to want an ECTP than those in good health [64% vs. 52%; odds ratio (OR) 1.78, 95% confidence interval (CI) 1.30 to 2.45; p

Objectives To measure community attitudes to emergency care and treatment plans (ECTPs).Design Population survey.Setting Great Britain.Participants As part of the British Social Attitudes Survey, sent to randomly selected addresses in Great Britain, 1135 adults completed a module on ECTPs. The sample was nationally representative in terms of age and location, 619 (55%) were female and 1005 (89%) were of white origin.Outcome measures People’s attitudes having an ECTP for themselves now, and in the future; how comfortable they might be having a discussion about an ECTP and how they thought such a plan might impact on their future care.Results Predominantly, respondents were in favour of people being able to have an ECTP, with 908/1135 (80%) being at least somewhat in favour. People in good health were less likely than those with activity-limiting chronic disease to want a plan at present (52% vs 64%, OR 1.78 (95% CI 1.30 to 2.45) p

Across the UK, the National Referral Mechanism (NRM) is the framework by which those affected, or those at risk of, modern slavery, are referred by ‘first-responders’ (such as the police) to other support services. For children, a key support mechanism is the Independent Child Trafficking Guardianship (ICTG) service, run by Barnardo’s for the Home Office. Administrative data from the NRM and ICTG were utilised in a novel mixed-method study to evaluate child-centred outcomes for children receiving ICTG support. We utilised publicly available NRM data to look at the nature of reported modern slavery between 2017 and 2022. We also negotiated access to Home Office held ICTG service data for the same period. Whilst our findings reveal patterns in the extent of reported exploitation and the nature of service support, examination of the two data sets revealed a number of issues related to categorisation of children, exploitation experiences, and geographical representation that hinder a comprehensive understanding of outcomes for child exploitation and trafficking. Qualitative ICTG data, however, revealed a ‘pyramid’ of support areas that were crucial to supporting positive outcomes, whilst participatory research methods revealed significant positive outcomes for children. The research identified a failure of administrative data to directly collect information relevant to positive child-centred outcomes. The recommendations, detailed within the final report, suggest that there is further work that could be done to improve administrative data collection, and highlight the potential of linked administrative data sources to understand related outcomes, such as health, education and crime/justice.

Quantifying the determinants of educational attainment requires a multifaceted approach encompassing various domains, including individual, family, household, neighbourhood, and school. This study examines the importance of socio-economic status for educational attainment within Wales, shedding light on the ways this can be measured, the importance across domains, and how these relationships vary across geographic areas. Two main research questions guide this analysis. Firstly, it asks, what is the correlation between educational attainment and a range of socio-economic indicators derived from linked data, including free school meals and household measures? Secondly, is there variability of these associations across different geographical levels within Wales? Employing Geographically Weighted Regression, the study investigates the effects of spatial differences of socio-economic indicators’ on pupils' attainment. It achieves this by integrating multiple Wales-specific administrative datasets, such as pupil administrative records, school-level data, family/household demographics and deprivation measures through data linkage. This comprehensive approach provides a nuanced understanding and underscores the importance of integrated datasets in uncovering insights into pupils' attainment. Our findings reveal disparities in how socio-economic factors and family/household characteristics are associated with pupils’ attainment across distinct geographies in Wales. These disparities are visually depicted through maps generated in ArcGIS Pro. This emphasis on geographical variations not only underscores the pivotal role of local contexts in understanding educational disparities but also highlights the complex interplay between these factors and pupils' attainment. Incorporating such visual representation enriches our analysis and provides a compelling rationale for targeted interventions to mitigate disparities in educational outcomes.

Previous research has established an association between diagnosis of neurodevelopmental conditions and poorer academic outcomes. Many education policies advocate for early diagnosis and special education needs (SEN) support, however little is known about the association between timing of SEN identification and education outcomes. To address this, we used Welsh administrative education data to identify the age at which a child first received SEN support. Using data from 90,271 children across 5 cohorts, logistic and linear regressions were run to examine the association between SEN identification and children’s attainment, exclusions, and attendance at age 16. In the latest cohort, we show that timing of SEN identification significantly associated with attainment, exclusions, and attendance. Children identified in their first year of school were 8 times less likely (than those without SEN) to meet national expectations for attainment, while those identified at age 16 were three times less likely, (X^2= 41.7, p10% sessions), while those identified in their first year were 1.60 times more likely, (X^2= 8.9, p=.003). We show how these associations vary by gender, type of need, and timing of ending support. Early diagnosis is important across all outcomes, but most critical for attainment.

Objective The Wales Commission for Tertiary Education and Research (CTER) was created in 2024 to oversee a complex system of training and education for adults and young people. The objective of our research was to examine demographic features that prevent or encourage engagement with education after formal schooling, that can be used to inform future CTER strategies. Approach This research considered the personal and family characteristics of learners, and evaluated differentials between characteristics in terms of enrolment, progression/exit and completion in different tertiary education settings (Sixth Forms, Further Education, and Higher Education). Using novel data linkages across 5 different data sources, we used household characteristics from the UK Census 2011 to help contextualise the experiences of learners and explore the manifestation of inequalities in the tertiary education system. Results The results indicated that inequities were apparent. Gender, Special Education Needs (SEN) status, and household characteristics including disability, deprivation, socio-economic, occupational and education status’ created barriers to continued engagement in education post schooling. Conclusions and Implications The complex and disparate nature of data collections was highlighted by the research, whilst the findings offer areas and characteristics that CTER should consider when creating new initiatives or governance systems for the tertiary education sector in Wales in order to reduce persistent inequalities. Recommendations for CTER that were drawn from the research included: 1) a more cohesive approach to data collection across the tertiary sector, and 2) strategies should assess impacts for those experiencing multiple forms of disadvantage.

Aflatoxins, potent carcinogens produced by Aspergillus species (A. flavus and A. parasiticus), are primarily consumed through dietary sources. Aflatoxin management using non-aflatoxigenic Aspergillus to outcompete their aflatoxigenic congeneric to achieve low residual toxin levels is a promising biological control (BC) field intervention. A prerequisite for the BC program is the accurate delineation of aflatoxigenic fungi from their non-aflatoxigenic relatives. In this study, we use three methods: Chemical (Dichlorvos-ammonia), Metabolic (ELISA coupled live cultures), and Molecular (10 aflatoxin biosynthetic genes) to determine the aflatoxigenicity of Aspergillus spp. previously collected from Eastern Kenya, an aflatoxin hotspot. Thirty-six different Aspergillus isolates were identified and studied microscopically from a total of 314 fungal cultures. The chemical method reported 21 aflatoxigenic and 15 non-aflatoxigenic isolates, while the metabolic technique distinguished 20 aflatoxigenic and 16 non-aflatoxigenic isolates. A large proportion (97.22 %) of the isolates harboured the aflR, aflO, and aflM genes, while 91.67 % of the isolates possessed the aflS gene. All isolates (100 %) harboured the aflD, aflQ, aflP, and aflK genes. ELISA-coupled live cultures positively correlated with Dichlorvos-ammonia (p > 0.01), only differing in one sample, indicating a strong concurrence between the two methods at segregating toxigenic A. flavus isolates. Cluster analysis based on Multiple Correspondence revealed that the non-aflatoxigenic group exhibited similar characteristics correlating with the absence of aflR, aflS, aflI, and aflO genes. These findings indicate the reliability of the Chemical and Metabolic methods and can function as confirmatory assays to complement the molecular detection approach in determining aflatoxigenicity among Aspergillus spp.

Abstract Background The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) was launched in the UK in 2016. ReSPECT is designed to facilitate meaningful discussions between healthcare professionals, patients, and their relatives about preferences for treatment in future emergencies; however, no study has investigated patients’ and relatives’ experiences of ReSPECT in the community. Objectives To explore how patients and relatives in community settings experience the ReSPECT process and engage with the completed form. Methods Patients who had a ReSPECT form were identified through general practice surgeries in three areas in England; either patients or their relatives (where patients lacked capacity) were recruited. Semi-structured interviews were conducted, focusing on the participants’ understandings and experiences of the ReSPECT process and form. Data were analysed using inductive thematic analysis. Results Thirteen interviews took place (six with patients, four with relatives, three with patient and relative pairs). Four themes were developed: (1) ReSPECT records a patient’s wishes, but is entangled in wider relationships; (2) healthcare professionals’ framings of ReSPECT influence patients’ and relatives’ experiences; (3) patients and relatives perceive ReSPECT as a do-not-resuscitate or end-of-life form; (4) patients’ and relatives’ relationships with the ReSPECT form as a material object vary widely. Patients valued the opportunity to express their wishes and conceptualised ReSPECT as a process of caring for themselves and for their family members’ emotional wellbeing. Participants who described their ReSPECT experiences positively said healthcare professionals clearly explained the ReSPECT process and form, allocated sufficient time for an open discussion of patients’ preferences, and provided empathetic explanations of treatment recommendations. In cases where participants said healthcare professionals did not provide clear explanations or did not engage them in a conversation, experiences ranged from confusion about the form and how it would be used to lingering feelings of worry, upset, or being burdened with responsibility. Conclusions When ReSPECT conversations involved an open discussion of patients’ preferences, clear information about the ReSPECT process, and empathetic explanations of treatment recommendations, working with a healthcare professional to co-develop a record of treatment preferences and recommendations could be an empowering experience, providing patients and relatives with peace of mind.

ABSTRACT: Understanding what motivates and prevents behavioral change in farmers is a critical step in disease control in dairy cattle. A total of 101 New Zealand dairy farmers across 8 regions were randomly enrolled into a cross-sectional study to investigate farmer barriers and motivators to lameness control for cows managed 100% at pasture and the relationship between these responses and the true lameness status on farm. Trained technicians lameness scored all lactating cows on the enrolled farms on 2 occasions during one lactation. Farm-level prevalence proportions were calculated as the mean of the 2 lameness scores. Enrolled farmers were asked their perception of lameness in the current milking season and responded to 26 ordinal Likert-type items with 5 options ranging from not important at all to extremely important. The questions were grouped under 3 categories; barriers to lameness control (n = 9), impacts of lameness (n = 10), and motivators to control lameness (n = 7). The association between farmer perception of lameness and lameness prevalence was reported using linear regression. Multiple-factor analysis was conducted to identify latent variable themes within the responses. Linear discriminant analysis was used to assess whether barriers, impacts, and motivators could be used to predict farmer perception of lameness and lameness prevalence. Lameness prevalence was 0.8% greater on farms where farmers perceived lameness as a moderate or a major problem compared with farms where the farmer perceived lameness as a minor problem or not a problem. Farmers ranked all potential motivators to lameness control as important and declared few barriers to be important at preventing them from controlling lameness. Feeling sorry for lame cows and pride in a healthy herd were the most important motivators, with lack of time and skilled labor the most important barriers. The most important effects of lameness were cow-related factors such as pain and production, with farm and industry impacts of less importance. Farmers place different weightings of importance on barriers to lameness control compared with motivators for lameness control. The impacts and motivators were strongly correlated with the first dimension from the multiple-factor analysis, with only weak correlation between barriers and the first dimension. Linear discriminant analysis identified that the importance that farmers place on barriers, motivators, and impacts of lameness were poor predictors of farmers' belief in regard to their lameness problem or actual lameness prevalence (above or below the median lameness prevalence for the study cohort). Despite relatively low lameness prevalence, many New Zealand dairy farmers believe lameness is a problem on their farm, and they rank welfare effects of lameness of high importance. To investigate how farmer behavior change can be used to manage lameness, future studies should consider theoretical social science frameworks beyond the theory of planned behavior or involve prospective interventional studies investigating farmer actions instead of beliefs.

Background: The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) includes agreed clinical recommendations for a person’s care in a future emergency which have been informed by discussion of the person’s preferences. Previous evaluation of ReSPECT plans in acute NHS hospitals found inconsistencies in recording patient’s preferences and involvement in the plan, and infrequent justification for recommendations. Aim: To explore to what extent ReSPECT recommendations reflect individual preferences, as documented in the plan. Methods: ReSPECT plans of adults were collected from 11 General Practices in England. We adapted an evaluation tool used previously to analyse ReSPECT plans in acute settings. Free text sections for individual values/preferences and clinical recommendations were examined for clarity, consistency and congruency between them. Results: We retrieved 141 ReSPECT plans. Patients or those close to the patient were recorded as being consulted in most plans (94%). Individual preferences were completed in 57% of plans. Clinical recommendations reflected individual preferences by directly referencing the person and their preferences (31%), by being consistent with the documented preferences (30%), or by using the same wording as the preferences (6%). Conclusion: While many clinical recommendations reflect individual preferences, the preferences themselves are only recorded in just over half of ReSPECT plans. This is problematic, because the recording of individual preferences facilitates person-centred care, both directly by informing recommendations and indirectly when used to guide decision-making in situations not anticipated in the plan. Future training for clinicians should emphasize the need to document the personal values section of the plan.

Background and aims Individuals living with severe mental illness such as schizophrenia and bipolar can have significant emotional, cognitive, physical and social challenges. Most people with severe mental illness in the United Kingdom do not receive specialist mental health care. Collaborative care is a system of support that combines clinical and organisational components to provide integrated and person-centred care. It has not been tested for severe mental illness in the United Kingdom. We aimed to develop and evaluate a primary care-based collaborative care model (PARTNERS) designed to improve quality of life for people with diagnoses of schizophrenia, bipolar or other psychoses when compared with usual care. Methods Phase 1 included studies to (1) understand context: an observational retrospective study of primary and secondary care medical records and an update of the Cochrane review ‘Collaborative care approaches for people with severe mental illness’; (2) develop and formatively evaluate the PARTNERS intervention: a review of literature on collaborative care and recovery, interviews with key leaders in collaborative care and recovery, focus groups with service users and a formative evaluation of a prototype intervention model; and (3) develop trial science work in this area: a core outcome set for bipolar and recruitment methods. In phase 2 we conducted a cluster randomised controlled trial measuring quality of life using the Manchester Short Assessment of Quality of Life and secondary outcomes including time use, recovery and mental well-being; a cost-effectiveness study; and a mixed-methods process evaluation. Public involvement underpinned all of the workstream activity through the study Lived Experience Advisory Panel and the employment of service user researchers in the project team. Results phase 1 The study of records showed that care for individuals under secondary care is variable and substantial and that people are seen every 2 weeks on average. The updated Cochrane review showed that collaborative care interventions were highly variable, and no reliable conclusions can be drawn about effectiveness. The PARTNERS model incorporated change at organisational, practitioner and individual levels. Coaching was selected as the main form of support for individuals’ personal goals. In the formative evaluation, we showed that more intensive supervision and ‘top-up’ training were needed to achieve the desired shifts in practice. A core outcome set was developed for bipolar, and measures were selected for the trial. We developed a stepped approach to recruitment including initial approach and appointment. Results phase 2 The trial was conducted in four areas. In total, 198 participants were recruited from 39 practices randomised. Participants received either the PARTNERS intervention or usual care. The follow-up rate was 86% at 9–12 months. The mean change in overall Manchester Short Assessment Quality of Life score did not differ between the groups [0.25 (standard deviation 0.73) for intervention vs. 0.21 (standard deviation 0.86) for control]. We also found no difference for any secondary measures. Safety outcomes (e.g. crises) did not differ between those receiving and those not receiving the intervention. Although the costs of intervention and usual care were similar, there is insufficient evidence to draw conclusions about the overall cost-effectiveness of PARTNERS. The mixed-methods process evaluation demonstrated that a significant proportion of individuals did not receive the full intervention. This was partly due to care partner absence and participant choice. The in-depth realist informed case studies showed that participants generally appreciated the support, with some describing having a ‘professional friend’ as very important. For some people there was evidence that delivery of the intervention had led to specific personal changes. Strengths and limitations The phase 1 records study provided insights into usual care that had not been previously documented. The realist informed complex intervention development was both theoretical and pragmatic. The trial continued through the COVID-19 pandemic with high levels of follow-up. The process evaluation had the depth to explore individual changes in participants’ response to the intervention. Weaknesses in the trial methodology included suboptimal implementation, outcome measures that may not have been sensitive to changes patients most appreciated and difficulties collecting some outcomes. Conclusions While PARTNERS was not shown to be superior to usual care, the change to PARTNERS care was not shown to be unsafe. Full intervention implementation was challenging, but this is to be expected in studies of care that include those with psychosis. Some individuals responded well to the intervention when psychological support in the form of individualised goal setting was flexibly deployed, with evidence that having access to a ‘professional friend’ was experienced as particularly helpful for some individuals. Future work Key components of the PARTNERS model could be developed further and tested, along with improved supervision in the context of ongoing community mental health care change. Trial registration This trial is registered as ISRCTN95702682. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme (NIHR award ref: NIHR200625) and is published in full in Programme Grants for Applied Research; Vol. 12, No. 6. See the NIHR Funding and Awards website for further award information. Plain language summary Over 7 years, the PARTNERS2 research programme co-developed and evaluated a new way of working to support people with schizophrenia, bipolar or other psychoses in order to fill the gap in provision between primary care and secondary mental health services. The intervention involved a ‘care partner’ and followed a collaborative care approach. We completed several studies, including a full randomised controlled trial, in four sites: Birmingham, Cornwall, Plymouth and Somerset. We found the following: Analysis of secondary care records showed that many individuals received a lot of specialist care contacts that are not visible in primary care records. Our outcomes work for bipolar identified several themes, including personal recovery, connectedness, clinical recovery and mental health/well-being. These helped us choose quality of life as the primary outcome for the PARTNERS2 trial. Our preliminary work developing the ‘care partner’ collaborative care coaching approach was well received but showed problems with delivery, including supervision. The full trial was completed despite the COVID-19 pandemic but with fewer participants (a total of 198) than intended. No differences were found between those receiving and those not receiving PARTNERS care. Some participants received little or no intervention, partly due to care partner absences. The care partner approach was appreciated by some service users whom we interviewed for feedback. They described positive benefits of working with a ‘professional friend’ but only more limited examples of longer-term impact. Care partners sometimes appeared to take time to learn to put joined-up individualised care into practice. Although the PARTNERS2 trial produced a neutral result – meaning that people were no worse or no better as a result of receiving primary-care-based collaborative care – there are both practical and theoretical reasons that are likely to explain this. As the PARTNERS approach aligns well with current mental health policy, we are continuing to test the approach in practice. Scientific summary Background People with a diagnosis of schizophrenia, bipolar or other psychoses have a significantly reduced life expectancy; two-thirds of this mortality gap can be explained by physical health disparities. For many people with severe mental illness, about 1% of the population, their primary and secondary mental health care is delivered by separate teams, causing a negative impact on continuity of care. The PARTNERS1 study found that nearly one-third of people with severe mental illness in the UK were seen only in primary care, and other studies show that more than a half of individuals receive no specialist input. A significant policy shift in the UK prioritises the better integration of place-based mental health systems involving primary and secondary care, the voluntary sector and local authorities. Collaborative care is a system of care that includes clinicians from primary and secondary care working together, proactive review and psychological support. Previous studies have mostly included populations with depression and anxiety, who have different challenges from individuals with serious mental illness. Most of the work on collaborative care for serious mental illness has been in the USA, where the nature of service user populations and of service use differ from the way we fund, structure and use the NHS. Research into effectiveness is, so far, equivocal. Aims, objectives and summary of approach The aim of the PARTNERS2 research programme was to co-develop and evaluate a model of collaborative care for people diagnosed with schizophrenia, bipolar and other forms of psychosis in addition to usual care, in comparison with usual care alone. The programme was carried out between 2014 and 2021, adapting according to circumstances, and included: Phase 1: development work (2014–7) – describing the context of current care delivery by assessment of support provided to people with SMI in three areas of England, including investigation of collaborative care evidence (workstream 1) developing a theoretical model of the intervention (workstream 3) developing trial methodology (workstreams 2, 4 and 5). Phase 2: full trial and process evaluation (2017–21) (workstream 6) – a randomised controlled trial a health economics analysis a parallel process evaluation to examine fidelity, evaluate process of delivery and further develop the programme theory for implementation. The programme was co-produced with our patient and public involvement team, including the Lived Experience Advisory Panel. The originally planned external pilot trial was replaced with an internal pilot trial feeding into a fully powered randomised controlled trial. Phase 1 Understanding context Method An observational retrospective cohort study of primary and secondary care medical notes (2012–4). A total of 297 participants with serious mental illness under a specialist were selected from three participating mental health services (West Midlands, Lancashire and Devon). An update of our original Cochrane review ‘Collaborative care approaches for people with severe mental illness’. Results From the notes review activity, we found that for individuals with serious mental illness who are in contact with secondary mental health services, these services are centrally involved in their care. On average, three-quarters of all direct contacts were from secondary care, and individuals were seen on average every 2 weeks. These individuals were also seen on average every 6 weeks in primary care. However, a significant minority (12%) did not receive any specialist care. The Cochrane update comprised 8 randomised controlled trials, with a total of 1165 participants for review. The trials provided data for comparison between collaborative care and standard care. Collaborative care interventions varied a lot. There was no evidence that they are more effective than standard care; however, confidence in these findings is limited. Development of the intervention Method A realist informed approach was taken to identify underlying mechanisms and to integrate findings as an initial model from: a review of the literature on collaborative care for mental health (from workstream 1) and personal recovery literature interviews with key leaders in collaborative care and personal recovery to explore their perceptions about best practice (n = 11) focus groups with service users about their experiences of care (n = 33). The intervention was delivered by care partners at the three sites to those recruited for pilot work. A formative evaluation of this initial model used semistructured interviews with practitioners, service users, carers, general practitioners and secondary care practitioners along with recordings of interactions to adapt the intervention. Results Researchers extracted ‘explanatory statements’ representing candidate mechanisms that could make collaborative care effective. These were consolidated to 106 statements and used to develop the programme theory for the initial model. This was represented graphically and in a manual for practitioners and in guides for service users and carers. The PARTNERS intervention involves change at three levels: institutional level (secondary care trusts/Community Mental Health Teams and primary care), practitioner level (care partners, supervisors, other primary and secondary care staff, third-sector and community organisational staff) and service user level (service users and friends and family, where there was consent). The manual details how practitioners should work flexibly to provide person-centred care through a coaching approach. The formative evaluation found that some aspects of implementation were not always delivered as expected, particularly interaction with primary care teams, the use of coaching and the supervision of practitioners. The model was further refined based on these results, with added training and support for the care partners in the main trial. Development of trial methodology Method A core outcome set was developed for bipolar using three stages and with Lived Experience Advisory Panel input: A long list of outcomes was derived from focus groups with people with a bipolar diagnosis and their carers, interviews with healthcare professionals and a rapid review of outcomes used in trials. An expert panel with personal and/or professional experience of bipolar participated in a two-stage online Delphi survey, with 50 participants in round 1 and 33 in round 2. A consensus meeting was held to finalise the core outcome set. Outcomes and associated measures for the randomised controlled trial were selected using a further consensus meeting, which took into account the wider population and nature of intervention. The feasibility of trial processes was tested in the formative evaluation study. Different methods of approaching potentially suitable individuals using primary and secondary care databases, and involving practitioners, were tested. These took into account legal and research governance requirements while prioritising an ambition to include those individuals considered most likely to benefit from support. Results The Delphi survey included 66 outcomes, and participants were invited to add others. A consensus meeting generated the final core outcome set consisting of 11 outcome domains: personal recovery; connectedness; clinical recovery of bipolar symptoms; mental health; well-being; physical health; self-monitoring and management; medication effects; quality of life (QoL), service outcomes; service user experience of care; and use of coercion. Quality of life was selected as the most important outcome domain for the proposed PARTNERS2 trial. The Manchester Short Assessment of Quality of Life (MANSA) was selected because it was clinically relevant to the target population and potentially amenable to change by the intervention. To test approach procedures, we recruited 37 participants across three sites. Those eligible from secondary care were approached by a clinician known to them. Those seen in primary care received an invitation letter with an expression of interest from the general practitioner practice. Two strategies were tested to improve recruitment among those who did not respond to initial contacts: a telephone call from a clinician or the research team to discuss the study an ‘appointment letter’ inviting them to a short meeting at the practice to discuss the study. Both approaches were acceptable to participants and added to recruitment. Phase 2 Internal pilot and randomised controlled trial Method The cluster randomised trial recruited in four areas (Birmingham and Solihull, Cornwall, Plymouth and Somerset), involving 39 general practices. In total 198 participants were recruited, and practices were randomised (1 : 1 allocation) so that individuals received either the PARTNERS intervention (20 practices, 116 participants) or usual care only (19 practices, 82 participants). The PARTNERS intervention involved a trained secondary mental healthcare worker in primary care (a ‘care partner’) working collaboratively with the participant, primary care, secondary care and other organisations, aiming to improve the participant’s QoL, mental health and physical health care. Participants received the intervention for up to 12 months, including a 2-month transition period back to usual care only. During the COVID-19 pandemic, the intervention was moved online (using telephone calls and video conferencing). All participants allocated to the control arm of the trial continued to receive usual care, either within primary care only or also with secondary care. At baseline, the following data were collected: QoL (MANSA), Time Use Survey (ONS TUS), general health status (EuroQol-5 Dimensions, five-level, Warwick–Edinburgh Mental Wellbeing Scale), capability measure (ICEpop CAPability) and experience of care (Brief-INSPIRE). All assessments were completed again at the follow-up visit (10 months from the point of unmasking), as was an extra questionnaire on the impact of COVID-19 for participants recruited during the pandemic. Results Primary outcome data were available for 99 (85.3%) intervention and 71 (86.6%) control participants. Mean change in overall MANSA score did not differ between the groups [0.25 (standard deviation 0.73) for intervention vs. 0.21 (standard deviation 0.86) for control]; the estimated fully adjusted between-group difference was 0.03 (95% confidence interval −0.25 to 0.31; p = 0.819). None of the secondary outcomes differed significantly between the groups. Acute mental health episodes (safety outcome) included three crises among those who received the intervention and four among those who did not. Cost effectiveness analysis Methods The economic evaluation aimed to estimate the cost-effectiveness of PARTNERS2 compared with usual care. Quality-adjusted life-years measured health benefit. Patient-level service use data were costed using national unit costs for 2019–20. The primary outcome was the incremental cost-effectiveness ratio, which combines service use costs and health benefit. Participant-reported service use at follow-up was collected for a 3-month recall period. The planned audit of primary and secondary care notes was not feasible given the impact of the COVID-19 pandemic. Regression analysis estimated the net costs and quality-adjusted life-years of PARTNERS2, adjusting for key covariates. Results Using the multiple imputed data, the average quality-adjusted life-years (usual care: mean 0.55, 95% confidence interval 0.48 to 0.61; PARTNERS2: mean 0.51, 95% confidence interval 0.45 to 0.57) and costs (usual care: mean £2689, 95% confidence interval £999 to £4378; PARTNERS2: mean £1743, 95% confidence interval £1149 to £2338) were similar for the two groups. Overall, the 95% confidence intervals are wide and overlap, indicating a high level of variance and uncertainty. The net, bootstrapped quality-adjusted life-years (−0.007, 95% confidence interval −0.086 to 0.071) and costs (−£213, 95% confidence interval −£1030 to £603) were similarly inconclusive, with wide 95% confidence interval that overlapped zero. At the prespecified willingness-to-pay threshold of £15,000 to gain one additional quality-adjusted life-year, the probability that the PARTNERS2 intervention is cost-effective is

Social prescribing is poorly defined and there is little evidence for its effectiveness. It cannot address the social determinants of mental health and it is unlikely to produce enduring change for that part of the population that suffers the worst physical and mental health, namely the most deprived and marginalised. It has emerged at a time of growing health inequity. This has occurred alongside the neglect of social care and of the social aspects of mental health intervention. Social prescribing gives a false impression of addressing social factors, and as such is counterproductive. We can do better than this.

Abstract Background There is increasing evidence for the role of environmental factors and exposure to the natural environment on a wide range of health outcomes. Whether exposure to green space, blue space, and the natural environment (GBN) is associated with risk of psychiatric disorders in middle-aged and older adults has not been prospectively examined. Methods Longitudinal data from the UK biobank was used. At the study baseline (2006–2010), 363,047 participants (women: 53.4%; mean age 56.7 ± 8.1 years) who had not been previously diagnosed with any psychiatric disorder were included. Follow-up was achieved by collecting records from hospitals and death registers. Measurements of green and blue space modeled from land use data and natural environment from Land Cover Map were assigned to the residential address for each participant. Cox proportional hazard models with adjustment for potential confounders were used to explore the longitudinal associations between GBN and any psychiatric disorder and then by specific psychiatric disorders (dementia, substance abuse, psychotic disorder, depression, and anxiety) in middle-aged and older adults. Results During an average follow-up of 11.5 ± 2.8 years, 49,865 individuals were diagnosed with psychiatric disorders. Compared with the first tertile (lowest) of exposure, blue space at 300 m buffer [hazard ratio (HR): 0.973, 95% confidence interval (CI): 0.952–0.994] and natural environment at 300 m buffer (HR: 0.970, 95% CI: 0.948–0.992) and at 1000 m buffer (HR: 0.975, 95% CI: 0.952–0.999) in the third tertile (highest) were significantly associated with lower risk of incident psychiatric disorders, respectively. The risk of incident dementia was statistically decreased when exposed to the third tertile (highest) of green space and natural environment at 1000 m buffer. The third tertile (highest) of green space at 300 m and 1000 m buffer and natural environment at 300 m and 1000 m buffer was associated with a reduction of 30.0%, 31.8%, 21.7%, and 30.3% in the risk of developing a psychotic disorder, respectively. Subgroup analysis suggested that the elderly, men, and those living with some comorbid conditions may derive greater benefits associated with exposure to GBN. Conclusions This study suggests that GBN has significant benefits for lowering the risk of psychiatric disorders in middle-aged and older adults. Future studies are warranted to validate these findings and to understand the potential mechanistic pathways underpinning these novel findings.

Abstract Background Some patients involved in a road traffic collision (RTC) are physically entrapped and extrication is required to provide critical interventions. This can be performed either in an expedited way, or in a more controlled manner. In this study we aimed to derive a data-driven extrication algorithm intended to be used as a decision-support tool by on scene emergency service providers to decide on the optimal method of patient extrication from the vehicle. Methods A retrospective observational study was performed of all trauma patients trapped after an RTC who were attended by a Helicopter Emergency Medical Service (HEMS) in the United Kingdom between March 2013 and December 2021. Variables were identified that were associated with the need for HEMS interventions (as a surrogate for the need for expedited extrication), based on which a practical extrication algorithm was devised. Results During the study period 12,931 patients were attended, of which 920 were physically trapped. Patients who scored an “A” on the AVPU score (n = 531) rarely required HEMS interventions (3%). Those who did were characterised by a shorter than average (29 vs. 37 min) 999/112 emergency call to HEMS on-scene arrival interval. A third of all patients responding to voice required HEMS interventions. Absence of a patent airway (OR 6.98 [1.74–28.03] p

Using the rights contained in the Freedom of Information Act, we collected data on the teaching undertaken by staff at 52 UK universities. In contrast to workload modelling, our data reveals the extent of the variation in contact hours by institution, subject, and seniority. We provide for the first time an accurate measure of the teaching undertaken by staff on different contract types. One of our findings is that few universities employ full-time Teaching-only staff. It is some of the most prestigious universities that are leading the way in promoting this specialisation, with important implications for teaching and research.

The increasing emergence and re-emergence of resistant pathogenic microbes causes a health threat to the human population. Scientists have been striving to find novel bioactive compounds and drugs to overcome these obstacles. This study aimed to characterize mangrove endophytic fungi and evaluate their antibacterial activity. Heritiera littoralis, Rhizophora mucronata, Bruguiera gymnorrhiza, Avicennia marina, and Xylocarpus granatum species were collected from Tudor Creek, Mida Creek, and Gazi Bay. A total of 30 fungal isolates were subjected to molecular identification based on analysis of their ITS gene region. The isolates in the inferred phylogenetic trees were affiliated with the genus Aspergillus. Ethyl acetate and butanol crude extracts of 38.2% of the 76 isolated fungal endophytes and eight mycelia samples were screened for antibacterial activity against Staphylococcus aureus (ATCC 27853), Escherichia coli (ATCC 25922), and Pseudomonas aeruginosa (ATCC 25923) using the disc diffusion method. A. marina and R. mucronata harbored the most fungal endophytes that showed the highest antibacterial activity. Seven fungal broth extracts exhibited higher antibacterial activities against the tested microorganisms than the positive control. The minimum inhibitory concentration (MIC) activity for the isolates demonstrated that the ethyl acetate extract of a root endophytic fungal isolate (RC6) (3.31 ± 0.01) of A. marina is a strong inhibitor since it showed significantly lower MIC activity compared to the positive control (3.84 ± 0.00) against Pseudomonas aeruginosa (P

Fungi are among key actors in the biogeochemical processes occurring in mangrove ecosystems. In this study, we investigated the changes of fungal communities in selected mangrove species by exploring differences in diversity, structure and the degree of ecological rearrangement occurring within the rhizospheres of four mangrove species (Sonneratia alba, Rhizophora mucronata, Ceriops tagal and Avicennia marina) at Gazi Bay and Mida Creek in Kenya. Alpha diversity investigation revealed that there were no significant differences in species diversity between the same mangrove species in the different sites. Rather, significant differences were observed in fungal richness for some of the mangrove species. Chemical parameters of the mangrove sediment significantly correlated with fungal alpha diversity and inversely with richness. The fungal community structure was significantly differentiated by mangrove species, geographical location and chemical parameters. Taxonomic analysis revealed that 96% of the amplicon sequence variants belonged to the Phylum Ascomycota, followed by Basidiomycota (3%). Predictive FUNGuild and co-occurrence network analysis revealed that the fungal communities in Gazi Bay were metabolically more diverse compared to those of Mida Creek. Overall, our results demonstrate that anthropogenic activities influenced fungal richness, community assembly and their potential ecological functions in the mangrove ecosystems investigated.

Unhealthy diet is associated with increased risk of cardiovascular diseases (CVD). However, there are no studies reporting the impact and trends of dietary risk factors on CVD in Australia. This study aimed to determine the burden of CVDs attributable to dietary risk factors in Australia between 1990 and 2019. We used data from the Global Burden of Diseases (GBD) study and quantified the rate (per 100,000) of deaths, disability-adjusted life years (DALYs), years lived with a disability (YLDs), and years of life lost (YLLs) for 21 CVDs attributable to 13 dietary risk factors (eight food groups and five nutrients) in Australia by sex and age groups (≥25 years and over). In 2019, the age-standardised rates of deaths, YLDs, YLLs, and DALYs attributable to dietary risk factors attributable to CVDs in the Australian population were 26.5, 60.8, 349.9, and 410.8 per 100,000 in women and 46.1, 62.6, 807.0, and 869.6 in men. Between 1990 and 2019, YLLs consistently contributed more towards the rates of DALYs than YLDs. Over the 30-year period, CVD deaths, YLLs, and DALYs attributable to dietary risk factors declined in both women and men. The leading dietary risk factors for CVD deaths and DALYs were a diet high in red meat (6.1 deaths per 100,000 [3.6, 8.7] and 115.6 DALYs per 100,000 [79.7, 151.6]) in women and a diet low in wholegrains (11.3 deaths [4.4, 15.1] and 220.3 DALYs [86.4, 291.8]) in men. Sex differences were observed in the contribution of dietary risk factors to CVD over time such that the lowest rate of decrease in deaths and DALYs occurred with diets high in sodium in women and diets high in processed meat in men. Although the burden of diet-related CVD has decreased significantly in the Australian population over the past 30 years, diets low in wholegrains and high in red meat continue to contribute significantly to the overall CVD burden. Future nutrition programs and policies should target these dietary risk factors.

Objective Neonatal outcomes in women with and without medically managed gestational diabetes mellitus (GDM) were compared after accounting for differences in maternal baseline characteristics using a propensity score (PS) analysis.Methods Women without preexisting diabetes, delivering singletons during 2010-2017 in a large hospital, were eligible for inclusion. Using nearest-neighbour PS matching, women with non-pharmacological managed GDM were matched with women whose GDM was medically managed. A conditional logistic regression consequently compared the neonatal adverse outcomes between the groups after adjusting for gestational age, induction of labor, birth type, and number of ultrasounds conducted during the pregnancy.Results Of the overall 10028 births, GDM was diagnosed in 930 (9.3%), of whom 710 (76.3%) were successfully matched. The conditional regressions found higher risk of neonatal adverse outcomes in neonates of women with non-pharmacological managed GDM compared to neonates of women with medically managed GDM. These included a higher risk of hypoglycemia (odds ratio (OR) 1.56, 95% confidence interval (CI) 1.03–2.38, p = 0.037), hypothermia (OR 2.29, 95%CI 1.05-5.00, p = 0.037), and birth injuries (OR 3.50, 95%CI 1.62–7.58, p = 0.001), and a higher risk of being small for gestational age (OR 2.06, 95%CI 1.01-4.18, p = 0.046) and being admitted to a special care unit (OR 2.04, 95%CI 1.29-3.21, p = 0.002).Conclusions The increased neonatal morbidity associated with non-medicated GDM identified in our study may indicate that diet and lifestyle changes alone are not sufficient to achieve glycaemic control in some women with GDM. Our findings indicate that gestational diabetes management approach is independently associated with neonatal outcomes.

Climate refugia, where local populations of species can persist through periods of unfavorable regional climate, play a key role in the maintenance of regional biodiversity during times of environmental change. However, the ability of refugia to buffer biodiversity change may be mediated by the landscape context of refugial habitats. Here, we examined how plant communities restricted to refugial sky islands of alpine tundra in the Colorado Rockies are changing in response to rapid climate change in the region (increased temperature, declining snowpack, and earlier snow melt-out) and if these biodiversity changes are mediated by the area or geographic isolation of the sky island. We resampled plant communities in 153 plots at seven sky islands distributed across the Colorado Rockies at two time points separated by 12 years (2007/2008–2019/2020) and found changes in taxonomic, phylogenetic, and functional diversity over time. Specifically, we found an increase in species richness, a trend toward increased phylogenetic diversity, a shift toward leaf traits associated with the stress-tolerant end of leaf economics spectrum (e.g., lower specific leaf area, higher leaf dry matter content), and a decrease in the functional dispersion of specific leaf area. Importantly, these changes were partially mediated by refugial area but not by geographic isolation, suggesting that dispersal from nearby areas of tundra does not play a strong role in mediating these changes, while site characteristics associated with a larger area (e.g., environmental heterogeneity, larger community size) may be relatively more important. Taken together, these results suggest that considering the landscape context (area and geographic isolation) of refugia may be critical for prioritizing the conservation of specific refugial sites that provide the most conservation value.

In this study, anatomical and functional differences between men and women in their cardiovascular systems and how these differences manifest in blood circulation are theoretically and experimentally investigated. A validated mathematical model of the cardiovascular system is used as a virtual laboratory to simulate and compare multiple scenarios where parameters associated with sex differences are varied. Cardiovascular model parameters related with women’s faster heart rate, stronger ventricular contractility, and smaller blood vessels are used as inputs to quantify the impact (i) on the distribution of blood volume through the cardiovascular system, (ii) on the cardiovascular indexes describing the coupling between ventricles and arteries, and (iii) on the ballistocardiogram (BCG) signal. The model-predicted outputs are found to be consistent with published clinical data. Model simulations suggest that the balance between the contractile function of the left ventricle and the load opposed by the arterial circulation attains similar levels in females and males, but is achieved through different combinations of factors. Additionally, we examine the potential of using the BCG waveform, which is directly related to cardiovascular volumes, as a noninvasive method for monitoring cardiovascular function. Our findings provide valuable insights into the underlying mechanisms of cardiovascular sex differences and may help facilitate the development of effective noninvasive cardiovascular monitoring methods for early diagnosis and prevention of cardiovascular disease in both women and men.

Nitrogen (N) and phosphorus (P) are essential nutrients necessary for plant growth and support life in aquatic ecosystems. However, excessive N and P can lead to algal blooms that deplete oxygen and lead to fish death and the release of toxins that are harmful to humans. Estimates of N and P levels in rivers are typically calculated at station or grid (>1 km) scale; therefore, it is difficult to visualise the evolution of water quality as water travels downstream. Using a high-resolution reach-scale river network and associating each reach with land cover fractions and catchment descriptors, we trained random forest models on aggregated data (2010–2020) from the Environmental Agency Open Water Quality Data Archive for 2,343 stations to predict long-term nitrate and orthophosphate concentrations at each river reach in Great Britain (GB). We separated the model training and predictions for different seasons to investigate the potential difference in feature importance. Our model predicted concentrations with an average testing coefficient of determination (R2) of 0.71 for nitrate and 0.58 for orthophosphate using 5-fold cross-validation. Our model showed slightly better performance for higher Strahler stream orders, highlighting the challenges of making predictions in small streams. Our results revealed that arable and horticultural land use is the strongest and most reliable predictor for nitrate, while floodplain extents and standard percentage runoff are stronger predictors for orthophosphate. Nationally, higher orthophosphate concentrations were observed in urbanised areas. This study shows how combining a river network model with machine learning can easily provide a river network understanding of the spatial distribution of water quality levels.

Mangrove ecosystems provide important ecological benefits and ecosystem services, including carbon storage and coastline stabilization, but they also suffer great anthropogenic pressures. Microorganisms associated with mangrove sediments and the rhizosphere play key roles in this ecosystem and make essential contributions to its productivity and carbon budget. Understanding this nexus and moving from descriptive studies of microbial taxonomy to hypothesis-driven field and lab studies will facilitate a mechanistic understanding of mangrove ecosystem interaction webs and open opportunities for microorganism-mediated approaches to mangrove protection and rehabilitation. Such an effort calls for a multidisciplinary and collaborative approach, involving chemists, ecologists, evolutionary biologists, microbiologists, oceanographers, plant scientists, conservation biologists, and stakeholders, and it requires standardized methods to support reproducible experiments. Here, we outline the Mangrove Microbiome Initiative, which is focused around three urgent priorities and three approaches for advancing mangrove microbiome research.

Uncertainty exists regarding the relation of body size and weight change with dementia risk. As populations continue to age and the global obesity epidemic shows no sign of waning, reliable quantification of such associations is important. We examined the relationship of body mass index, waist circumference, and annual percent weight change with risk of dementia and its subtypes by pooling data from 19 prospective cohort studies and four clinical trials using meta-analysis. Compared with body mass index-defined lower-normal weight (18.5-22.4 kg/m2 ), the risk of all-cause dementia was higher among underweight individuals but lower among those with upper-normal (22.5-24.9 kg/m2 ) levels. Obesity was associated with higher risk in vascular dementia. Similarly, relative to the lowest fifth of waist circumference, those in the highest fifth had nonsignificant higher vascular dementia risk. Weight loss was associated with higher all-cause dementia risk relative to weight maintenance. Weight gain was weakly associated with higher vascular dementia risk. The relationship between body size, weight change, and dementia is complex and exhibits non-linear associations depending on dementia subtype under scrutiny. Weight loss was associated with an elevated risk most likely due to reverse causality and/or pathophysiological changes in the brain, although the latter remains speculative.