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General anaesthesia (GA) may be required to support the care of those seen in Special Care Dentistry (SCD) services for various reasons, such as enabling extensive dental care for people with severe learning disabilities or severe dental phobia. Guidance is needed for teams delivering SCD using GA due to the potential risks, implications, and costs of using GA to deliver dental care.To present evidence-based recommendations, where possible, for teams involved in providing GA for dental care for adults within SCD services.A multidisciplinary working group, supported by a formal literature search and stakeholder involvement, iteratively produced and refined the recommendations presented.There was little evidence to inform the guidelines. Recommendations are therefore based mainly on the working group's expert consensus opinion. Clinical guidelines are presented as a set of overarching principles followed by six key sections reflecting patients' pathways from referral to dental services through to their care during and after GA.Guidelines are presented to support those providing GA to provide SCD. The need for comprehensive and person-centered assessment and planning is emphasized.

Policing has become an increasingly sedentary occupation. At the same time, rates of depression are increasing across\ud the police force. Vigorous physical activity (VPA) has been associated with decreasing rates of depression, yet studies of\ud VPA in policing are limited. This study aimed to explore the prevalence of depression and examine its association with\ud VPA in police officers and staff in England, further stratified by gender. A cross-sectional, secondary data analysis of the\ud Airwave dataset was undertaken. The data were analyzed using descriptive statistics and multivariate logistic regression. Of 28,465 police officers and staff in England, 12% reported having doctor-diagnosed depression and 25% were\ud physically inactive. Relative to being physically inactive, undertaking VPA for either four or seven days was significantly\ud associated with having the lowest odds of reporting depression (OR 0.59, 95% CI: 0.51–0.70, p < 0.001) (OR 0.59, 95% CI:\ud 0.45–0.77, p < 0.001), respectively, suggesting a U-shaped/non-linear relationship. This relationship was also observed in\ud the gender-stratification analysis. While the odds of reporting depression were significantly lower for men than women,\ud VPA was significantly associated with reducing the odds of reporting depression slightly more in women (OR 0.43, 95%\ud CI: 0.27–0.67, p < 0.001) than in men (OR 0.50, 95% CI: 0.33–0.75, p < 0.01), indicating women may be more likely to benefit\ud from VPA than men. Vigorous physical activity may provide a protective effect against depression. To prevent the onset\ud of depression in the target population, policy-makers should consider designing physical activity guidelines for police\ud officers to promote VPA in the target population.

Telerehabilitation has increasingly been used since the COVID-19 pandemic but with limited guidance available on undertaking physical assessments using remote methods. We aimed to provide such guidance by developing a Telerehab Toolkit, an online information and training resource for practitioners, patients, and carers on telerehabilitation for people with physical disabilities and movement impairment.Development and evaluation of the toolkit were informed by the Knowledge to Action framework and took place iteratively in two phases-knowledge creation and action. Information was collated from various sources including literature review, online survey, service evaluation, and focus group discussions. The toolkit has been evaluated using think-aloud interviews, e-mail and social media feedback from users, and analytics data on user engagement with the website.The Telerehab Toolkit focuses on remote physical assessments, and contains information on technology, digital skills, remote assessment tools, information governance, and safety for telerehabilitation. Resources include top tips from practitioners and patients, how-to guides, checklists, videos, and links to evidence.The Telerehab Toolkit has been well-received by practitioners, healthcare students, patients, and carers, is being disseminated widely, and is freely available (www.plymouth.ac.uk/research/telerehab). IMPLICATIONS FOR REHABILITATIONTelerehabilitation has been increasingly used since the COVID-19 pandemic, but with limited guidance and training for practitioners on undertaking safe and effective remote physical assessments.The Telerehab Toolkit has been developed iteratively using the Knowledge to Action framework; it is a free online resource for practitioners and patients with specific guidance on telerehabilitation for physical disabilities and movement impairment.It is anticipated that the resource will help to improve the knowledge, skills, and confidence of the current and future rehabilitation workforce.

Objective The aim of this study was to explore the feasibility and acceptability of digital technology for improving health and wellbeing in social housing residents living in a deprived area in Cornwall, England. Methods Qualitative scoping study with focus groups and telephone interviews (23 participants in total). Focus groups and interviews were audio-recorded, transcribed verbatim and analysed thematically. Results Levels of use and experience with digital technology were diverse in this group, ranging from ‘willing and unable’ to ‘expert’ on a self-perceived scale. Overall, participants had positive perceptions of technology and were keen to try new technologies. Five categories of factors influencing technology use were identified: functional, physical / health, psychological and attitudinal, technology-associated barriers, and privacy, safety and security. Preferred types of digital technology were wearable activity monitors (e.g. Fitbit®), virtual assistants (e.g. Amazon Alexa) and social messaging (e.g. WhatsApp). There was a strong consensus that technology should be easy to use and should have a clear purpose. There was a need to improve awareness, knowledge and confidence in technology use and participants desired further training and support. Conclusions There is a need and desire to use digital technology to improve health, wellbeing and social connectedness in social housing residents in Cornwall. The findings will be used to inform a digital training and support programme for the participants of the Smartline project. This study also serves as a template for future research that seeks to scope the feasibility and acceptability of different digital interventions in similar populations.

ObjectiveTo identify the available guidance and training to implement telerehabilitation movement assessments for people (adults and children) with a physical disability, including those recovering from COVID-19.DesignRapid scoping review.Included sources and articlesPubMed, CINAHL, PsychInfo, Cochrane, Embase, Web of Science, PEDro, UK Health Forum, WHO, National Archives and NHS England were searched using the participant–concept–context framework from 2015 to August 2020. Primary studies that recruited individuals with physical disabilities and guidance documents aimed at providers to implement movement-related telerehabilitation were included.Results23 articles (11 primary research studies, 3 systematic reviews and 9 guidance documents) were included out of 7857 that were identified from the literature search. Two main issues were found: (1) telerehabilitation guidance (from both research studies and guidance documents) was not specific to movement-related assessment and (2) most primary research studies provided neither guidance nor training of movement-specific assessment to practitioners. Of the COVID-19 related guidance, two articles reported COVID-19 management that only referred to identifying COVID-19 status without references to specific movement-related guidance.ConclusionsTelerehabilitation guidance and training have existed pre-COVID-19, yet the lack of specific movement-related information and provider support is surprising. This gap must be addressed to optimise effective implementation of remote assessments for those with physical disabilities.Review registrationOpen Science Framework: osf.io/vm6sp.

UNSTRUCTURED These are author responses to peer review.

BACKGROUND Understanding and assessing patients’ body movements is essential for physical rehabilitation but is challenging in video consultations, as clinicians are frequently unable to see the whole patient or observe the patient as they perform specific movements. OBJECTIVE The objective of this exploratory study was to assess the use of readily available technologies that would enable remote assessment of patient movement as part of a video consultation. METHODS We reviewed the literature and available technologies and chose four technologies (Kubi and Pivo desktop robots, Facebook Portal TV, wide-angle webcam), in addition to help from a friend or a simple mobile phone holder, to assist video consultations. We used 5 standard assessments (sit-to-stand, timed “Up & Go,” Berg Balance Test, ankle range of motion, shoulder range of motion) as the “challenge” for the technology. We developed an evaluation framework of 6 items: efficacy, cost, delivery, patient setup, clinician training and guidance, and safety. The coauthors, including 10 physiotherapists, then took the roles of clinician and patient to explore 7 combinations of 5 technologies. Subsequently, we applied our findings to hypothetical patients based on the researchers’ family members and clinical experience. RESULTS Kubi, which allowed the clinician to remotely control the patient’s device, was useful for repositioning the tablet camera to gain a better view of the patient’s body parts but not for tracking movement. Facebook Portal TV was useful, but only for upper body movement, as it functions based on face tracking. Both Pivo, with automated full body tracking using a mobile phone, and the wide-angle webcam for a laptop or desktop computer show promise. Simple solutions such as having a friend operate a mobile phone and use of a mobile phone holder also have potential. The setup of these technologies will require better instructions than are currently available from suppliers, and successful use will depend on the technology readiness of patients and, to some degree, of clinicians. CONCLUSIONS Technologies that may enable clinicians to assess movement remotely as part of video consultations depend on the interplay of technology readiness, the patient’s clinical conditions, and social support. The most promising off-the-shelf approaches seem to be use of wide-angle webcams, Pivo, help from a friend, or a simple mobile phone holder. Collaborative work between patients and clinicians is needed to develop and trial technological solutions to support video consultations assessing movement.

Soil organic carbon (SOC) sequestration across agroecosystems worldwide can contribute to mitigate the effects of climate change by reducing levels of atmospheric CO2. Stabilisation of organic carbon (OC) in the fine soil fraction (< 20 µm) is considered an important long-term store of SOC, and the saturation deficit (difference between measured OC and estimated maximum OC in the fine fraction) is frequently used to assess SOC sequestration potential following the linear regression equation developed by Hassink (1997). However, this approach is often taken without any assessment of the fit of the equation to the soils being studied. The statistical limitations of linear regression have previously been noted, giving rise to the proposed use of boundary line (BL) analysis and quantile regression (QR) to provide more robust estimates of maximum SOC stabilisation. The objectives of this work were to assess the suitability of the Hassink (1997) equation to estimate maximum fine-fraction OC in UK grassland soils of varying sward ages and to evaluate the linear regression, boundary line and quantile regression methods to estimate maximum fine-fraction OC. A chronosequence of 10 grasslands was sampled, in order to assess the relationship between sward age (time since the last reseeding event) and the measured and predicted maximum fine-fraction OC. Significantly different regression equations show that the Hassink (1997) equation does not accurately reflect maximum fine-fraction OC in UK grasslands when determined using the proportion of the fine soil fraction (< 20 µm, %) and measured fine-fraction OC (g C per kg soil). The QR estimate of maximum SOC stabilisation was almost double that of the linear regression and BL analysis (0.89 ± 0.074, 0.43 ± 0.017 and 0.57 ± 0.052 g C per kg soil, respectively). Sward age had an inconsistent effect on the measured variables and potential maximum fine-fraction OC. Fine-fraction OC across the grasslands made up 4.5 % to 55.9 % of total SOC, implying that there may be either high potential for additional C sequestration in the fine fraction of these soils or that protection in aggregates is predominant in these grassland soils. This work highlights the need to ensure that methods used to predict maximum fine-fraction OC reflect the soil in situ, resulting in more accurate assessments of carbon sequestration potential.

Background Policing is a highly stressful and increasingly sedentary occupation. The study aim was to assess the acceptability and impact of a mobile health (mHealth) technology intervention (Fitbit® activity monitor and ‘Bupa Boost’ smartphone app) to promote physical activity (PA) and reduce sedentary time in the police force. Methods Single-group, pre-post, mixed methods pilot study. Police officers and staff (n = 180) were recruited from two police forces in South West England. Participants used the technology for 12 weeks (an ‘individual’ then ‘social’ phase) followed by 5 months of optional use. Data sources included Fitbit®-recorded objective step count, questionnaire surveys and semi-structured interviews (n = 32). Outcome assessment points were baseline (week 0), mid-intervention (week 6), post-intervention (week 12) and follow-up (month 8). Paired t-tests were used to investigate changes in quantitative outcomes. Qualitative analysis involved framework and thematic analysis. Results Changes in mean daily step count were non-significant (p > 0.05), but self-reported PA increased in the short term (e.g. + 465.4 MET-minutes/week total PA baseline to week 12, p = 0.011) and longer term (e.g. + 420.5 MET-minutes/week moderate-to-vigorous PA baseline to month 8, p = 0.024). The greatest impact on behaviour was perceived by less active officers and staff. There were no significant changes in sedentary time; the qualitative findings highlighted the importance of context and external influences on behaviour. There were no statistically significant changes (all p-values > 0.05) in any secondary outcomes (physical and mental health-related quality of life, perceived stress and perceived productivity), with the exception of an improvement in mental health-related quality of life (SF-12 mental component score + 1.75 points, p = 0.020) from baseline to month 8. Engagement with and perceived acceptability of the intervention was high overall, but a small number of participants reported negative physical (skin irritation) and psychological (feelings of guilt and anxiety) consequences of technology use. Individual app features (such as goal-setting and self-monitoring) were generally preferred to social components (social comparison, competitions and support). Conclusions mHealth technology is an acceptable and potentially impactful intervention for increasing PA in the police force. The intervention was less useful for reducing sedentary time and the impact on secondary outcomes is unclear. Trial registration NCT03169179 (registered 30th May 2017).

Background Digital technology interventions for health and wellbeing are appealing, accessible, scalable and low cost. However, the evidence is far from established; many existing studies are of low quality, and there has been a focus on quantitative evaluation and on clinical and residential care populations. The Smartline project aims to explore the role that digital technology may play in improving health, wellbeing and social connectedness in social housing residents from low socioeconomic status communities in Cornwall. The aims of this study were: to explore existing digital technology use and competence; to explore digital willingness and readiness to use new technologies; to identify perceived barriers and facilitators to technology use; and to scope the feasibility and acceptability of potential digital interventions in the Smartline cohort. Methods Three semi-structured focus groups (19 participants) and individual telephone interviews (n=3, ongoing) in a purposive, maximal variation sample of Smartline participants. To complement the qualitative responses, some self-reported quantitative data was collected in the focus groups, including perceived technology competence (self-rated according to the UK government Digital Inclusion Scale) and preference ranking of eight interventions. Focus groups and interviews were audio-recorded, transcribed verbatim and analysed thematically. Results Existing levels of experience with digital technology are diverse, ranging from ‘willing and unable’ to ‘expert’. Perceived barriers include usability, cost, poor internet connection, lack of skills and knowledge, safety and privacy concerns, sensory impairments and physical disabilities. Facilitators include awareness, training and technical support, improved access to facilities, and availability of choice. Preferred types of digital technology were wearable activity monitors (e.g. Fitbit®), virtual assistants (e.g. Amazon Alexa) and social messaging (e.g. WhatsApp). Analysis is ongoing, but overarching themes include: a need to improve awareness (what technologies are available and their capabilities for improving health and wellbeing); a willingness to learn (new skills and/or improve existing skills); the need for human contact (this should not be replaced by technology); and individual preferences (the importance of tailoring and choice). Conclusion There is a need and desire to use digital technology to improve heath, wellbeing and social connectedness in the diverse group of Smartline participants. Barriers may be overcome with increased awareness and training, and tailoring and choice of interventions to meet individual needs and preferences. The findings will be used to inform piloting of different digital interventions in the next phase of the Smartline study.

Soil organic carbon (SOC) sequestration across agroecosystems worldwide can contribute to mitigate the effects of climate change by reducing levels of atmospheric CO2. Mineral associated organic carbon (MAOC) is considered an important long-term store of SOC and the saturation deficit (difference between measured MAOC and estimated maximum MAOC) is frequently used to assess SOC sequestration potential following the linear regression equation developed by Hassink (1997). However, this approach is often taken without any assessment of the fit of the equation to the soils being studied. The statistical limitations of linear regression have previously been noted, giving rise to the proposed use of boundary line (BL) analysis and quantile regression (QR) to provide more robust estimates of maximum SOC stabilisation. The objectives of this work were to assess the suitability of the Hassink (1997) equation to estimate maximum MAOC in UK grassland soils of varying sward ages and to evaluate the linear regression, BL and QR methods to estimate maximum MAOC. A chronosequence of 10 grasslands was sampled, in order to assess the relationship between sward age (time since last reseeding event) and current and predicted maximum MAOC. Significantly different regression equations show that the Hassink (1997) equation does not accurately reflect maximum MAOC in UK grasslands when determined using the proportion of fine soil fraction and current MAOC. The QR estimate of maximum SOC stabilisation was almost double that of linear regression and BL analysis (0.89 ± 0.074, 0.43 ± 0.017 and 0.57 ± 0.052 g C kg−1 soil, respectively). Sward age had an inconsistent effect on the measured variables and potential maximum MAOC. MAOC across the grasslands made up 4.5 to 55.9 % of total SOC, implying that there may be either high potential for additional C sequestration in the mineral fraction of these soils, or stabilisation in aggregates is predominant in these grassland soils. This work highlights the need to ensure that methods used to predict maximum MAOC reflect the soil in situ, resulting in more accurate assessments of carbon sequestration potential.

Background Telerehabilitation is a feasible and potentially effective alternative to face-to-face rehabilitation. However, specific guidance, training, and support for practitioners who undertake remote assessments in people with physical disabilities and movement impairment are limited. Objective The aims of this survey of United Kingdom–based health and social care practitioners were to explore experiences, assess training needs, and collate ideas on best practices in telerehabilitation for physical disabilities and movement impairment. The aim will be to use the findings to inform a practical tool kit and training package for telerehabilitation use. Methods UK rehabilitation practitioners were invited to complete an online questionnaire from November to December 2020. Opportunity and snowball sampling were used to recruit participants from professional and educational networks, special interest groups, and via social media. Closed questionnaire items were analyzed using descriptive statistics. Qualitative inductive analysis using NVivo was used for open responses. Results There were 247 respondents, of which 177 (72%) were physiotherapists and occupational therapists. Most (n=207, 84%) had used video-based consultations (typically supported by telephone and email), and the use of this method had increased in frequency since the COVID-19 pandemic. Practitioners perceived telerehabilitation positively overall and recognized benefits for patients including a reduced infection risk, convenience and flexibility, and reduced travel and fatigue. Common obstacles were technology related (eg, internet connection), practical (eg, difficulty positioning the camera), patient related (eg, health status), practitioner related (eg, lack of technical skills), and organizational (eg, lack of access to technology). Support from family members or carers was a major facilitator for successful remote consultations. Of the 207 respondents who had used video-based consultations, 103 (50%) had assessed physical impairments using this method, 107 (52%) had assessed physical function, and 121 (59%) had used patient-reported outcome measures. Although practitioners generally felt confident in delivering video-based consultations, they felt less proficient in undertaking remote physical assessments, expressing concerns about validity, reliability, and safety. Only 46 of the 247 (19%) respondents had received any training in telerehabilitation or video consultations, and some felt they were “feeling their way in the dark.” Practitioners desired training and guidance on physical assessment tools suitable for remote use, when to use video-based consultations or alternative methods, governance issues, digital platforms, and signposting to digital skills training for themselves and their patients. Conclusions In response to the COVID-19 pandemic, practitioners rapidly adopted telerehabilitation for people with physical disabilities and movement impairment. However, there are technical, practical, and organizational obstacles to overcome, and a clear need for improved guidance and training in remote physical assessments. The findings of this survey will inform the development of a tool kit of resources and a training package for the current and future workforce in telerehabilitation.

Background Understanding and assessing patients’ body movements is essential for physical rehabilitation but is challenging in video consultations, as clinicians are frequently unable to see the whole patient or observe the patient as they perform specific movements. Objective The objective of this exploratory study was to assess the use of readily available technologies that would enable remote assessment of patient movement as part of a video consultation. Methods We reviewed the literature and available technologies and chose four technologies (Kubi and Pivo desktop robots, Facebook Portal TV, wide-angle webcam), in addition to help from a friend or a simple mobile phone holder, to assist video consultations. We used 5 standard assessments (sit-to-stand, timed “Up & Go,” Berg Balance Test, ankle range of motion, shoulder range of motion) as the “challenge” for the technology. We developed an evaluation framework of 6 items: efficacy, cost, delivery, patient setup, clinician training and guidance, and safety. The coauthors, including 10 physiotherapists, then took the roles of clinician and patient to explore 7 combinations of 5 technologies. Subsequently, we applied our findings to hypothetical patients based on the researchers’ family members and clinical experience. Results Kubi, which allowed the clinician to remotely control the patient’s device, was useful for repositioning the tablet camera to gain a better view of the patient’s body parts but not for tracking movement. Facebook Portal TV was useful, but only for upper body movement, as it functions based on face tracking. Both Pivo, with automated full body tracking using a mobile phone, and the wide-angle webcam for a laptop or desktop computer show promise. Simple solutions such as having a friend operate a mobile phone and use of a mobile phone holder also have potential. The setup of these technologies will require better instructions than are currently available from suppliers, and successful use will depend on the technology readiness of patients and, to some degree, of clinicians. Conclusions Technologies that may enable clinicians to assess movement remotely as part of video consultations depend on the interplay of technology readiness, the patient’s clinical conditions, and social support. The most promising off-the-shelf approaches seem to be use of wide-angle webcams, Pivo, help from a friend, or a simple mobile phone holder. Collaborative work between patients and clinicians is needed to develop and trial technological solutions to support video consultations assessing movement.

Background Policing is an increasingly sedentary occupation that is associated with high levels of physical and psychological morbidities. Mobile health (mHealth) technology is increasingly popular, low cost and accessible. The study aim was to assess the potential impact, feasibility and acceptability of an mHealth technology intervention (Fitbit® activity monitor and ‘Bupa Boost’ smartphone app) to promote physical activity (PA), reduce sedentary time, and improve health and wellbeing, perceived stress and perceived productivity in the police force. Methods Single-group, pre-post, mixed methods exploratory trial. Police officers and staff (n=180) were recruited from two sites (Plymouth Basic Command Unit, Devon & Cornwall Police and North Dorset territorial area, Dorset Police). Participants used the technology for 12 weeks (an ‘individual’ then ‘social’ phase) followed by five months of optional use. Data sources included Fitbit®-recorded objective step count, questionnaire surveys and semi-structured interviews (n=32). Outcome assessment points were baseline (week 0), mid-intervention (week 6), post-intervention (week 12) and follow-up (month 8). Quantitative data was analysed using paired t-tests, regression and correlations. Qualitative analysis involved framework and thematic analysis. Findings were integrated during interpretation; qualitative findings confirmed, explained, and expanded on quantitative results. Results While self-reported PA increased overall (e.g. mean increase +421 MET-minutes/week moderate to vigorous PA baseline to month 8, 95% CI 56–785), significant increases in steps were observed only in participants with a baseline mean daily step count less than 10,000 (+1028 steps/day, 95% CI 417–1,639 baseline to week 12; +810 steps/day, 95% CI 115–1,506 baseline to month 8). Engagement and perceived acceptability were high overall, particularly for the less active participants, but some usability issues were reported with the Bupa Boost app, resulting in lower and declining engagement with this component. Participants preferred individual self-monitoring and goal-setting to social features of the app. There were no significant changes in sedentary time; participants perceived a need for more opportunities for breaks in the workplace. Mental health-related quality of life improved from baseline to month 8 (SF-12 mental component score +1.75 points, 95% CI 0.28–3.23). Despite interview-reported improvements in health and wellbeing, survey-assessed changes in physical health-related quality of life, perceived stress and perceived productivity were not statistically significant. Conclusion mHealth technology is a potentially impactful, feasible and acceptable intervention for increasing PA in the police force, particularly for less active officers and staff. The intervention was less useful for reducing sedentary time and the impact on health, wellbeing, stress and productivity is unclear.

Objective This systematic review aimed to assess the effectiveness, feasibility and acceptability of mobile health (mHealth) technology (including wearable activity monitors and smartphone applications) for promoting physical activity (PA) and reducing sedentary behaviour (SB) in workplace settings. Methods Systematic searches were conducted in seven electronic databases (MEDLINE, SPORTDiscus, Scopus, EMBASE, PsycINFO, Web of Science and the Cochrane library). Studies were included if mHealth was a major intervention component, PA/SB was a primary outcome, and participants were recruited and/or the intervention was delivered in the workplace. Study quality was assessed using the Effective Public Health Practice Project (EPHPP) tool. Interventions were coded for behaviour change techniques (BCTs) using the Coventry, Aberdeen and London – Refined (CALO-RE) taxonomy. Results Twenty-five experimental and quasi-experimental studies were included. Studies were highly heterogeneous and only one was rated as ‘strong’ methodological quality. Common BCTs included self-monitoring, feedback, goal-setting and social comparison. A total of 14/25 (56%) studies reported a significant increase in PA, and 4/10 (40%) reported a significant reduction in sedentary time; 11/16 (69%) studies reported a significant impact on secondary outcomes including reductions in weight, systolic blood pressure and total cholesterol. While overall acceptability was high, a large decline in technology use and engagement was observed over time. Conclusions While methodological quality was generally weak, there is reasonable evidence for mHealth in a workplace context as a feasible, acceptable and effective tool to promote PA. The impact in the longer term and on SB is less clear. Higher quality, mixed methods studies are needed to explore the reasons for decline in engagement with time and the longer-term potential of mHealth in workplace interventions. Protocol registration: The review protocol was registered with PROSPERO: CRD42017058856

As part of a UK government funded research project to update the UK N2O inventory methodology, a systematic review of published nitrous oxide (N2O) emission factors was carried out of non-UK research, for future comparison and synthesis with the UK measurement based evidence base. The aim of the study is to assess how the UK IPCC default emission factor for N2O emissions derived from synthetic or organic fertiliser inputs (EF1) compares to international values reported in published literature. The availability of data for comparing and/or refining the UK IPCC default value and the possibility of analysing sufficient auxiliary data to propose a Tier 2 EF1 reporting strategy is evaluated. The review demonstrated a lack of consistency in reporting error bounds for fertiliser-derived EFs and N2O flux data with 8% and 44% of publications reporting EF and N2O flux error bounds respectively. There was also poor description of environmental (climate and soil) and experimental design auxiliary data. This is likely to be due to differences in study objectives, however potential improvements to soil parameter reporting are proposed. The review demonstrates that emission factors for agricultural-derived N2O emissions ranged − 0.34% to 37% showing high variation compared to the UK Tier 1 IPCC EF1 default values of 1.25% (IPCC 1996) and 1% (IPPC 2006). However, the majority (83%) of EFs reported for UK-relevant soils fell within the UK IPCC EF1 uncertainty range of 0.03% to 3%. Residual maximum likelihood (REML) analysis of the data collated in the review showed that the type and rate of fertiliser N applied and soil type were significant factors influencing EFs reported. Country of emission, the length of the measurement period, the number of splits, the crop type, pH and SOC did not have a significant impact on N2O emissions. A subset of publications where sufficient data was reported for meta-analysis to be conducted was identified. Meta-analysis of effect sizes of 41 treatments demonstrated that the application of fertiliser has a significant effect on N2O emissions in comparison to control plots and that emission factors were significantly different to zero. However no significant relationships between the quantity of fertiliser applied and the effect size of the amount of N2O emitted from fertilised plots compared to control plots were found. Annual addition of fertiliser of 35 to 557 kg N/ha gave a mean increase in emissions of 2.02 ± 0.28 g N2O/ha/day compared to control treatments (p

Silver (Ag) nanomaterials are increasingly used in a variety of commercial applications. This study examined the effect of size (20 and 110 nm) and surface stabilization (citrate and PVP coatings) on toxicity, particle uptake and NLRP3 inflammasome activation in a variety of macrophage and epithelial cell lines. The results indicated that smaller Ag (20 nm), regardless of coating, were more toxic in both cell types and most active in the THP-1 macrophages. TEM imaging demonstrated that 20 nm Ag nanospheres dissolved more rapidly than 110 nm Ag nanospheres in acidic phagolysosomes consistent with Ag ion mediated toxicity. In addition, there were some significant differences in epithelial cell line in vitro exposure models. The order of the epithelial cell lines’ sensitivity to Ag was LA4 > MLE12 > C10. The macrophage sensitivity to Ag toxicity was C57BL/6 AM > MARCO null AM, which indicated that the MARCO receptor was involved in uptake of the negatively charged Ag particles. These results support the idea that Ag nanosphere toxicity and NLRP3 inflammasome activation are determined by the rate of surface dissolution, which is based on relative surface area. This study highlights the importance of utilizing multiple models for in vitro studies to evaluate nanomaterials.

The clinical advantages of the newborn screening programme (NBS) in the UK are well described in the literature. However, there has been little exploration of the psychosocial impact on the family. This study followed the principles of grounded theory to explore parents' experiences of receiving the initial positive NBS result for their child with cystic fibrosis (CF) or sickle cell disease (SCD). Semi-structured, qualitative interviews were conducted with 22 parents (12 mothers and 10 fathers) whose children had been diagnosed with CF or SCD via NBS and were under the age of 1 year at the time of interview. The main themes that arose from the data were; parents previous knowledge of the condition and the NBS programme, the method of delivery and parental reactions to the result, sharing the results with others, the impact on parental relationships and support strategies. Study conclusions indicate that most parents thought initial positive NBS results should be delivered by a health professional with condition specific knowledge, preferably with both parents present. Genetic counselling needs to include a focus on the impact of NBS results on parental relationships. Careful consideration needs to be given to strategies to support parents of babies who have positive NBS results both in terms of the psychological health and to assist them in sharing the diagnosis.

Despite a growing interest in how group membership can positively impact health, little research has addressed directly the role social identity processes can have on recovery from addiction. Drawing on social identity theory and self-categorization theory, the present study investigated how recovery group membership can introduce a new social identity associated with recovery, compared to the social identity associated with addiction. We hypothesized that two processes--evaluative differentiation and identity preference--would be linked with higher self-efficacy and positive health outcomes (i.e., reduced relapse, lower levels of appetitive behavior, and elevated feelings of social connectedness [Study 2]). Study 1 recruited members (N = 61) from United Kingdom based mutual aid groups of Alcoholics Anonymous and Narcotics Anonymous. Study 2 recruited ex-smokers (N = 81) from online sources. In Study 1, evaluative differentiation was significantly related to lowered relapse and reduced appetitive behavior. Identity preference was related to higher levels of self-efficacy, which was related to months drug-free and reduced levels of appetitive behaviors. In Study 2, evaluative differentiation was related to identity preference. Identity preference was also related to higher self-efficacy, which in turn was related to lower relapse. Although exploratory, these results suggest that developing a social identity as a "recovering addict" or an "ex-smoker" and subsequently highlighting the difference between such identities may be a useful strategy for reducing relapse among people with problems associated with addictive behaviors.

Background Information regarding recruitment of infants to research studies following the diagnosis of cystic fibrosis (CF) via newborn screening (NBS) is not currently available. This study aimed to assess parental attitudes and the feasibility of recruiting and retaining both NBS infants with CF and healthy control infants to a longitudinal, observational study. Methods All infants underwent pulmonary function tests (PFTs) at ~3 and ~12months of age. Infants with CF had additional combined chest high resolution computed tomography (HRCT), bronchoscopy and broncho-alveolar lavage (BAL) at ~12months of age. Parental attitude questionnaires (PAQs) were administered to all parents following the ~3month PFTs and to parents of infants with CF after completion of all tests at ~12months. Results 86% (92/107) of families whose infant had CF consented to participate, of whom 92% had PFTs at ~3months of age with 99% of these having PFTs at ~12months of age. Recruitment of healthy controls was feasible but more challenging; 29% of those contacted agreed to participate; 73% of these had PFTs at ~3months of age; of whom 83% had repeated PFTs at ~12months of age. Completed PAQs were received from 71% of parents, (both of CF and healthy infants) at ~3months and from 58% parents of infants with CF at ~12months. Responses from the PAQs were generally positive, 95% of parents indicated they would recommend participation in such studies to other families. Discrepancies between responses at 3 and 12months suggested that parental understanding of what the research entailed developed during the course of the study. Conclusions The high recruitment and retention rates for newly diagnosed CF NBS infants to this observational study are encouraging. These findings will help inform future study design both in the field of CF and other conditions diagnosed by NBS.

Background: There is a lack of biochar field trials in temperate climate regions. Wood biochar was applied during 2009–2011 to seven field experiments on five working farms in the UK, for arable, legume, horticultural and root crops. Results: Three trials showed no significant (p > 0.05) effect on crop yield, two showed positive effects of 5–6%, one showed a very strong increase of 100% and one showed a decrease of 2–16%. A meta-analysis of effect sizes was conducted for all treatments (n = 47), which showed a significant (p < 0.05) positive effect, increasing average yield by 0.4 t ha-1. Biochar application rates of 20 t ha-1 or under led to the greater benefits. Conclusion: This paper shows that, in some situations, biochar can bring benefits in modern temperate farming.

Background We aimed to establish the support needs of people with heart failure and their caregivers and develop an intervention to improve their health-related quality of life. Methods We used intervention mapping to guide the development of our intervention. We identified “targets for change” by synthesising research evidence and international guidelines and consulting with patients, caregivers and health service providers. We then used behaviour change theory, expert opinion and a taxonomy of behaviour change techniques, to identify barriers to and facilitators of change and to match intervention strategies to each target. A patient and public involvement group helped to identify patient and caregiver needs, refine the intervention objectives and strategies and deliver training to the intervention facilitators. A feasibility study (ISRCTN25032672) involving 23 patients, 12 caregivers and seven trained facilitators at four sites assessed the feasibility and acceptability of the intervention and quality of delivery and generated ideas to help refine the intervention. Results The Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) intervention is a comprehensive self-care support programme comprising the “Heart Failure Manual”, a choice of two exercise programmes for patients, a “Family and Friends Resource” for caregivers, a “Progress Tracker” tool and a facilitator training course. The main targets for change are engaging in exercise training, monitoring for symptom deterioration, managing stress and anxiety, managing medications and understanding heart failure. Secondary targets include managing low mood and smoking cessation. The intervention is facilitated by trained healthcare professionals with specialist cardiac experience over 12 weeks, via home and telephone contacts. The feasibility study found high levels of satisfaction and engagement with the intervention from facilitators, patients and caregivers. Intervention fidelity analysis and stakeholder feedback suggested that there was room for improvement in several areas, especially in terms of addressing caregivers’ needs. The REACH-HF materials were revised accordingly. Conclusions We have developed a comprehensive, evidence-informed, theoretically driven self-care and rehabilitation intervention that is grounded in the needs of patients and caregivers. A randomised controlled trial is underway to assess the effectiveness and cost-effectiveness of the REACH-HF intervention in people with heart failure and their caregivers. Electronic supplementary material The online version of this article (doi:10.1186/s40814-016-0075-x) contains supplementary material, which is available to authorized users.

In order to facilitate increased renewable energy production, there continues to be a global increase in wind turbine installation. When quantifying the carbon offsets from these installations, the production emissions are rarely accounted for. This paper reports on the embodied carbon emissions from the production of 14 wind turbines, rated between 50 kW and 3.4 MW. The embodied emissions were quantified from emission factors specific to each material involved in manufacture, transport to site, and installation of the turbines. The resulting trend was that higher-rated turbines had greater embodied carbon emissions with one 3 MW turbine incorporating 1046 tCO2eq compared to only 58 tCO2eq for an 80 kW turbine. However, the greater electricity output of the turbines offset these emissions more quickly with a recovery in 64 days for a 3.4 MW turbine compared to 354 days for a 100 kW one. This also resulted in lower carbon emissions per kilowatt hour of electricity generated and quicker payback as a percentage of lifetime of 0.9% for a 3.4 MW turbine compared to 4.3% and 4.9% for a 50 and 100 kW turbines, respectively. The findings of this analysis indicate that a preference for installation of higher-rated, over lower-rated, turbines should be favoured for greater environmental benefits.

INTRODUCTION: The Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) trial is part of a research programme designed to develop and evaluate a health professional facilitated, home-based, self-help rehabilitation intervention to improve self-care and health-related quality of life in people with heart failure and their caregivers. The trial will assess the clinical effectiveness and cost-effectiveness of the REACH-HF intervention in patients with systolic heart failure and impact on the outcomes of their caregivers. METHODS AND ANALYSIS: A parallel two group randomised controlled trial with 1:1 individual allocation to the REACH-HF intervention plus usual care (intervention group) or usual care alone (control group) in 216 patients with systolic heart failure (ejection fraction

Monitoring data over the period 1994–2007 were analysed for three streams (Cottage Hill Sike, CHS; Rough Sike, RS; Trout Beck, TB) draining blanket peat underlain by glacial clay and limestone-rich sub-strata at Moor House (Northern England). Dissolved organic carbon concentration, [DOC], showed complex relationships with both discharge and calcium concentration, [Ca]. A model based on [Ca] was constructed to simulate stream [DOC] by mixing dissolved organic matter (DOM) from shallow peat, quantified by measured [DOC] (15–30 mg l−1) in peat porewater, with DOM assumed to be present at a constant concentration (c. 5 mg l−1) in groundwater. A temperature-based adjustment to the measured porewater [DOC] was required to account for relatively low streamwater [DOC] during winter and spring. The fitted model reproduced short-term variation in streamwater [DOC] satisfactorily, in particular variability in RS and TB due to groundwater contributions. Streamwater DOM is largely derived from surface peat, which accounts for more than 96% of the total DOC flux in both RS and TB, and 100% in CHS. Model outputs were combined with streamwater and porewater DO14C data to estimate the 14C contents, and thereby the ages, of DOM from peat and groundwater. The peat-derived DOM is 5 years old on average, with most of it very recently formed. The derived age of groundwater DOM (8,500 years) is comparable to the 4,000–7,000 years estimated from the DO14C of water extracts of clay underlying the peat, suggesting that the clay is the source of groundwater DOM.

Soil samples, collected to a depth of 15 cm from 24 plots at six UK deciduous woodland sites in 1971 and 2002, were analysed for 14C, and total soil carbon pools (gC m−2) were estimated. The results, together with data from a further woodland site, were interpreted using steady-state models, driven by the 14C content of atmospheric CO2. The average soil pool is 6700 (±1100)gC m−2, where the error term is the standard deviation. Application of a single soil pool model yielded a mean residence time (MRT) of 87 (±82)years, with an input of 113 (±52)gC m−2 a−1. This implies that the remainder of the total litter production, about 300 gC m−2 a−1, passes through a fast pool with a short MRT (i.e. rapid mineralisation occurs). Slightly better fits, with less bias, were obtained using a model that has two soil C pools with fixed MRTs of 15 (slow pool) and 350 (passive pool), based on the findings of DD Harkness, AF Harrison and PJ Bacon (Radiocarbon 28, 328–337, 1986). From the 21 soils that gave similar results with the two C pool model, it is calculated that, on average, the soil contains 3300 gC m−2 in the slow pool (input 215 gC m−2 a−1) and 3400 gC m−2 in the passive pool (10 gC m−2 a−1); about 200 gC m−2 a−1 of the litter input is rapidly mineralised. The slow pool is approximately constant for all the soils, variations in total soil C being due to the range of passive pools (1800 to 5900 gC m−2). Equally good fits of the bulk soil 14C data were obtained with different assumptions about the MRTs of the slow and passive pools; therefore additional information about soil fractions is needed for more exact characterisation of soil organic matter cycling on timescales of decades to millennia.

INTRODUCTION: The Rehabilitation EnAblement in CHronic Heart Failure in patients with Heart Failure (HF) with preserved ejection fraction (REACH-HFpEF) pilot trial is part of a research programme designed to develop and evaluate a facilitated, home-based, self-help rehabilitation intervention to improve self-care and quality of life (QoL) in heart failure patients and their caregivers. We will assess the feasibility of a definitive trial of the REACH-HF intervention in patients with HFpEF and their caregivers. The impact of the REACH-HF intervention on echocardiographic outcomes and bloodborne biomarkers will also be assessed. METHODS AND ANALYSIS: A single-centre parallel two-group randomised controlled trial (RCT) with 1:1 individual allocation to the REACH-HF intervention plus usual care (intervention) or usual care alone (control) in 50 HFpEF patients and their caregivers. The REACH-HF intervention comprises a REACH-HF manual with supplementary tools, delivered by trained facilitators over 12 weeks. A mixed methods approach will be used to assess estimation of recruitment and retention rates; fidelity of REACH-HF manual delivery; identification of barriers to participation and adherence to the intervention and study protocol; feasibility of data collection and outcome burden. We will assess the variance in study outcomes to inform a definitive study sample size and assess methods for the collection of resource use and intervention delivery cost data to develop the cost-effectiveness analyses framework for any future trial. Patient outcomes collected at baseline, 4 and 6 months include QoL, psychological well-being, exercise capacity, physical activity and HF-related hospitalisation. Caregiver outcomes will also be assessed, and a substudy will evaluate impact of the REACH-HF manual on resting global cardiovascular function and bloodborne biomarkers in HFpEF patients. ETHICS AND DISSEMINATION: The study is approved by the East of Scotland Research Ethics Service (Ref: 15/ES/0036). Findings will be disseminated via journals and presentations to clinicians, commissioners and service users. TRIAL REGISTRATION NUMBER: ISRCTN78539530; Pre-results .

Dissolved organic carbon (DOC) concentrations in soil water samples collected from depths of 5 to 20 cm at 10 moorland and 11 forest sites during the period 2000-2006 were obtained from new measurements and from the monitoring programmes of the UK Environmental Change Network and the International Cooperative Programme (ICP) on Forests. Data on soil properties and vegetation type were also assembled. Considering data from Prenart tension collectors, which were used at nearly all the sites, mean annual concentrations ranged from 1.3 to 97.5 g m(-3) with means of 19.5 (standard deviation 15.2) and 27.6 (SD 23.3) g m(-3) for moorland and forest sites respectively. Interannual mean DOC concentration at an individual site varied by only 1.5-fold, averaged over all sites with at least three years' data. Concentrations during summer months (April to September) were on average 17% greater than those in winter (October to March). If data from two sites (the single peatland and an unusual forest site) were ignored, DOC concentrations were strongly inversely related to water flux, estimated from rainfall and evaporation data. Fluxes of DOC, calculated by combining concentration with water flux, ranged from 2.2 to 71.9 gC m(-2) yr(-1) over all sites and years, with overall means of 19.2 (SD 13.6) and 12.2 (SD 13.9) gC m(-2) yr(-1) for the moorland and forest sites respectively. However, if the two exceptional sites were omitted, the overall mean was 9.1 gC m(-)(2) yr(-1) with a standard deviation of only 4.9 gC m(-2) yr(-1). Annual DOC flux was strongly dependent upon annual water flux, varying by 3.5-fold between years when averaged over all sites. On average, 75.5% of the DOC was exported during the winter period (October to March).

Objective While the clinical benefits of newborn screening (NBS) for cystic fibrosis (CF) are recognised, the psychosocial impact has been largely overlooked although recent literature suggests this may include long term alterations in parent–child relationships [1]. The objective of this pilot study was to explore parents' perspectives of the experience of receiving positive NBS results for CF, identify factors that influence this and ways to improve the communication process. Methods Grounded theory underpinned data collection and analysis. Semi-structured, qualitative interviews were conducted with 10 parents of 5 infants who were diagnosed with CF via NBS and were Results The main factors that impacted on families experiences were: –Perceived knowledge of the health care professional (HCP) involved and the method used to give the initial CF suspected result –Parents' experience of sharing the diagnosis with others –Ongoing professional support available to families Conclusion Parents reported the process of receiving positive NBS results for CF as being sub optimal. The theory to emerge is; better information provided when the initial NBS result is given could improve outcomes in terms of parental satisfaction and ongoing relationships with HCPs and avoid unnecessary anxiety caused by parents seeking advice from unreliable sources. The use of peer support groups to provide additional support to parents may be beneficial.

Background Percutaneous liver biopsy (PLB) is the “gold standard” in the diagnosis of liver diseases. A pilot trial has shown pethidine may reduce anxiety and the need for post-procedural pain relief. The aim of this study was to investigate the role of pre-procedural pethidine. Methods A double-blinded, randomized, placebo-controlled trial was conducted to assess the need for pethidine prior to PLB. 98 patients were randomly assigned to receive either 50 mg pethidine i.v. (n = 48), or an equal volume of 0.9% normal saline (n = 50). PLB was performed with ultrasound guidance after adequate local anaesthesia with xylocaine. Patients were asked to self-evaluate pain experienced using a visual analogue score (0–10) immediately and an hour after PLB. Patients were then followed up 24 hours after the procedure to assess their pain score, retrospective pain score and willingness to have a repeat procedure. Results Pethidine administration resulted in significantly lower pain scores (0.60 ± 0.1 vs 1.2 ± 0.2, p = 0.006) and required less analgesia (0% vs 10%, p = 0.03) immediately after PLB in comparison to the placebo group. There was no significant difference in the pain score and analgesia requirement one hour after the procedure, the pain score at 24 hours after procedure and retrospective pain score. 94% of all patients of either group are willing to under go a repeat liver biopsy (NS). Conclusions The administration of pethidine routinely prior to PLB reduces the immediate post procedural pain but has no lasting effect and does not influence the patients’ decision making process for future investigations. Trial registration ACTRN12614001194651, 13 November 2014