Hydrogen is expected to play a crucial role in decarbonizing hard-to-electrify industries and in serving as an energy storage vector in the UK's net zero transition. While many studies estimate the hydrogen storage capacity in onshore and offshore UK, they often do not account for feasibility constraints. This study reassesses the hydrogen storage capacity potential of salt caverns in England's east coast, defining a new ‘storage reserve potential’. This integrates the geographical distribution of Zechstein halite-bearing strata with land-use restrictions, including existing and planned industrial, social and environmental constraints. By considering high-level technical constraints, this study refines previous storage estimates, reducing them by c . 95%. Despite this significant reduction, the region still offers a hydrogen storage capacity of more than 22 TWh of. However, major challenges remain, particularly the long timescales required to develop and commission new salt cavern storage at scale, limiting its feasibility by 2050. These findings highlight the need for strategic planning and investment to overcome deployment challenges. The methodology presented can be applied to other key regions in the UK and internationally, providing a more realistic assessment of hydrogen storage potential in salt caverns.

Purpose The purpose of this study was to explore health-care access, experiences and barriers among people with learning disabilities from ethnic minority backgrounds and their informal carers within an NHS mental health trust in the East of England. The evaluation aimed to understand experiences of health-care access, and to generate practical, service-user- and carer-informed priorities for improving equity, coordination and reasonable adjustments across the local pathways. Design/methodology/approach Multi-method service evaluation. .An easy-read questionnaire was mailed to 64 eligible service users, where 13 responded (descriptive analysis). A focus group with six carers was conducted online and transcripts were analysed using reflexive thematic analysis. The design sought feedback on service use, satisfaction and reasonable adjustments, alongside carer experiences of access, information, coordination and support. Findings “Not knowing where to find help” was the most frequent barrier, alongside language barriers, stigma and insufficient reasonable adjustments. Carers reported high weekly caregiving hours and limited respite; coordination and signposting were inconsistent, with fewer than half of survey respondents (46.15%) reporting yearly specialist input. While 69.2% of people with learning disabilities had an annual GP health check and many felt involved in their care, information gaps undermined satisfaction. Desired adjustments included earlier/later appointments and easy-read materials. Carers advocated for stronger multidisciplinary working. Research limitations/implications As this evaluation did not set out to isolate the role of ethnicity, findings reflect general experiences of health-care access rather than providing an in-depth account of how ethnicity specifically shapes these experiences. Originality/value This evaluation contributes empirical evidence to the limited research on health-care access for people with learning disabilities from ethnic minority backgrounds and their carers, bringing together both service user and carer perspectives. It highlights actionable levers, such as clearer signposting, proactive communication, staff training in learning disability and better multidisciplinary coordination – to reduce avoidable burden on families and carers and improve equitable access, experiences and outcomes for people with learning disabilities.

Glomerulonephritis (GN) accounts for 20%–25% of the causes of chronic and end-stage kidney disease. The evolving treatment landscape with new targeted immunosuppressants has highlighted the unmet need for equity of access to specialist GN services. Regional networks and multidisciplinary team meetings (MDTs) provide access to clinical expertise, high-cost drugs (HCDs) and clinical trials, facilitating collaborative decision-making and optimal use of therapeutics to improve patient outcomes. Launched in May 2023 in the East of England (EoE), the Eastern Network Kidney Inflammatory Disease MDT (ENKID) provides a regional MDT framework designed to improve access to specialist expertise and HCDs- areas identified as lacking for 59% of nephrologists in a 2024 UK GN service survey. ENKID is led by the specialist vasculitis, lupus and primary GN service in Cambridge. A database build allows secure standardised data collection including referral indications and treatment decisions during fortnightly virtual regional MDTs. Over 24 months, 229 discussions were conducted for 198 patients in 43 ENKID MDTs, averaging 15 attendees from 6 centres per meeting. Patients were referred for both clinical complexity and HCD use in 46% (n = 106), solely HCD access in 42% (n = 96) and for clinical complexity alone in 12% (n = 27). Clinical trial eligibility was an additional reason in 9% (n = 20). Diagnoses discussed were ANCA-associated vasculitis (33%, n = 65), membranous nephropathy (18%, n = 35), IgA nephropathy (19%, n = 38), lupus nephritis (15%, n = 29), minimal change disease/focal segmental glomerulosclerosis (7%, n = 14), rarer diseases (5%, n = 10) and diagnostic uncertainty (3%, n = 7). Including rituximab, a HCD was endorsed in 71% and alternative treatment recommended in 29% of referrals for HCD discussions. A wide geographical distribution of referrals was observed and facilitated widespread access to HCDs. The ENKID regional MDT addresses the increasing demand for specialist advice for patients with complex and rare kidney diseases. High attendance and case load underscore the need for this service, aligning with the UK government’s mandate for rare autoimmune disease. Integration of this MDT within the EoE NHS England renal network structure, providing governance, education and HCD access, serves as an exemplar for improving GN patient care and accessibility of UK services. Not applicable.

Abstract Background Robotic surgery is increasingly adopted across general surgical units in the United Kingdom, yet training opportunities remain inconsistent. This study explored the experiences, attitudes, and perceived barriers to robotic training among General Surgery higher surgical trainees in the East of England (EoE) deanery, with the aim of identifying areas for improvement to enhance future training provision. Methods A cross-sectional mixed-methods electronic survey was distributed to all ST3–ST8 General Surgery trainees in the EoE deanery (May–August 2025). Eligible participants were in a clinically active general surgical rotation within an EoE hospital. The 27-item questionnaire examined professional background, exposure to robotic surgery, and perceptions of training. Results Of 81 eligible trainees, 48 responded (59%), with representation from all 16 hospitals, 13 of which performed robotic procedures. Almost all respondents (98%) believed that robotic surgery would become integral to general surgical practice, and 77% intended to undertake a fellowship in robotic surgery. Twenty-seven trainees were in firms performing robotic cases, with a median exposure of one operating session per week. Satisfaction with training was low (mean 3.8/10). Independent console operating was rare (7%), with limited access to simulation (23%), structured induction (17%), and robotic courses (52%). Conclusions Trainees view robotic surgery as a valuable skill, yet current training opportunities are inadequate, inequitable and show marked variation between hospitals. Priorities for improvement include national curriculum integration, equitable access to simulation and formal training courses, and expansion of dual console operating to support safe progression from bedside assistance to independent practice.

Background: The Norfolk Initiative for Coastal and Rural Health Equalities (NICHE) is one of six ‘Anchor Institutes’ , funded by NHS England (East of England). Based at the University of East Anglia, NICHE aims to co-create a healthy place to live and work, underpinned by collaborative and innovative approaches to building embedded research, improvement and innovation capacity whilst maximising sustainable initiatives for the Integrated Care System (ICS). Approach: NICHE is working across an ICS made-up of three ‘Place’ localities with a geography of coastal and rural communities. We aim through embedded, participatory approaches to engage people and communities, coproducing meaningful outcomes relevant to local, national and international contexts. NICHE’s approach draws upon key principles of Collaboration, Inclusion and active Participation (CIP). Our embedded funded programmes of learning, research and evaluation offer significant opportunities for ICS development. NICHE core objectives are to: 1: Improve health inequalities across rural and coastal communities 2: Achieve workforce development and sustainable transformation 3: Enhance system collaboration and transformation through effective partnership working 4: Improve wellbeing and sustainable outcomes These objectives are mapped to our four workstreams which are: 1: Workforce Intelligence Network (WIN) 2: Therapeutic Optimisation (THEO) 3: Workforce Optimisation 4: Evaluation This presentation will focus on Workstream 3 (Workforce Optimisation) that is based within ‘Place’. We will present the programmes of embedded research, evaluation and learning activity that is impacting on the development of the ICS across the three Place based localities in Norfolk by drawing on the ‘voices’ of participant through embedded learning. Examples will be drawn from: Embedded NICHE Fellowships stretching across the lifespan of ageing ‘Kintsugi’ and ‘Mini Kintsugi’ Embedded Research and Programme Evaluations Results and Emerging Themes: Evaluation of NICHE work is underway and will be fully reported towards the end of 2025. Within the first 18 months of Place funded embedded projects across the Norfolk and Waveney ICS the following themes are emerging: a) Working with and through system complexity, by navigating changing, new and emergent ICS landscapes and structures. b) Embedded Transformation requires new approaches to authentic collaboration and joint working. c) Creative arts engagement, heritage and inclusion of historical aspects are all important and often overlooked assets when working in rural, coastal and isolated communities. d) Co-produced, embedded programmes of work, enhances talent release and promotes local expertise which are highly effective strategies for cultural ICS transformation. e) Cultural transformation cannot be rushed as new language, partnerships and interactions are formed. When based on the principles of CIP these can be built, based on trust, commitment and release of energy required to engage and sustain embedded transformation across complex, changing ICS’s. f) Shared Values and beliefs are key to authentic relationships based on the key principles of reciprocity, shared power, trust and learning. Implications: Whilst global health and social care challenges consist of similar themes across different countries, when working with coastal, rural and isolated communities it is imperative to engage local ICS partners, to curate cultural contextual wisdom across ‘Place’ with communities and people.

Background: NHS England East of England led a working group to develop the 'My Mouth Matters' programme, aimed at developing a sustainable model for a Dental Care Professional (DCP) led service improvement pilot to improve mouth care and the oral health of adults in care homes. Objectives: Develop a Primary Care model, to support implementation of NICE NG48 guidance and quality standards, with the potential to upscale. Support the reduction of oral health inequalities and improve oral health and oral health related quality of life as an integral part of general health. Method: Primary Care dental practices in the East of England were commissioned to deliver My Mouth Matters. DCPs were upskilled and liaised with a nominated Oral Health Champion in each care home to provide oral health training, aid oral health policy development, and act as a direct link to a primary dental service provider. A pathway was developed to refer residents for oral health care. Results: The programme engaged with 34 care homes and 1674 residents. 280 resident care plans were evaluated: 54% of residents did not have a regular dentist, 29% required domiciliary care and 48% had additional access needs, 54% of residents did not know if they paid for their dental treatment. 71% of residents with dentures had a denture pot, 14% had their dentures marked, 38% of residents required some support and 24% required full support for oral health care, 10% of residents were prescribed high fluoride toothpaste. Conclusion: The My Mouth Matters programme demonstrated positive steps in developing a Primary Care model to improve oral health for care home residents. Further work to support models of engagement and training were highlighted as the main areas requiring development.

Diabetes prevalence continues to rise in England, placing increasing pressure on primary and specialist healthcare services. This study examined how demographic, socioeconomic, and healthcare access factors influence Diabetes Mellitus register size across six Integrated Care Systems (ICSs) in the East of England and generated scenario based projections of future diabetes burden and specialist workforce requirements. A longitudinal panel design was applied using annual data (2012-2021) for six ICSs. Descriptive trend analysis summarised changes in diabetes registers, GP practice numbers, GP list size, deprivation (IMD scores), and population density. The association between these factors and Diabetes Mellitus register size was quantified using a fixed effects panel regression model, selected through F-tests, Breusch-Pagan LM tests, and Hausman specification testing. Future diabetes registers (2023-2027) were estimated using a regression based deterministic projection framework integrating: (i) model based forecasting, (ii) four scenario models based on plausible changes in population growth, deprivation, and GP capacity, and (iii) linear trend extrapolation of endocrinology consultant workforce numbers. Diabetes registers increased across all ICSs, with the region experiencing a 13% rise between 2012 and 2021. Regression findings showed that higher deprivation strongly predicted larger diabetes registers ([Formula: see text], [Formula: see text]), while increases in GP list size and GP practice numbers were also significant predictors. Under ScenarioI, projected diabetes registers for 2023 ranged from 60,603 (Cambridgeshire and Peterborough) to 85,574 (Hertfordshire and West Essex). ScenarioII, which incorporated greater increases in deprivation, produced larger projected registers across all ICSs, including 75,463 in Bedfordshire and 88,399 in Hertfordshire. Patient to consultant ratios were projected to increase in Bedfordshire and Mid and South Essex, suggesting potential specialist workforce shortages. Demographic growth, rising deprivation, and pressures in primary care are key drivers of the increasing diabetes burden in the East of England. Projection results indicate that several ICSs may face widening gaps between patient demand and specialist capacity. Strengthening consultant staffing, directing resources toward more deprived areas, and supporting primary care resilience will be essential to maintain equitable diabetes care in future years.

Physician-based prehospital teams provide advanced critical care services in the UK (eg, prehospital anaesthesia). The last review of such teams in 2009, which included England, Wales and Northern Ireland, reported only one physician-based prehospital team available 24/7. Helicopter Emergency Medical Services (HEMS) across the UK offer paid physician-based teams, while other organisations may provide physician-based teams on a voluntary ad hoc basis. The primary aim of this study was to determine if access to a physician-based HEMS team has changed in the past 12 years. An online survey was distributed to all UK HEMS organisations in January 2024. The primary outcome measure was the number of physician-based teams operated by HEMS in 2024 and the operational hours of such teams. Secondary outcomes included interventions offered by HEMS teams and any additional medical teams offered (eg, paramedic only). All 21 HEMS responded. The number of potentially available physician-based HEMS teams has increased from 11 in England, Wales and Northern Ireland in 2009 to 28 in 2024, with two services in Scotland (total=30). HEMS providing consistent 24/7 physician-based prehospital teams increased from one (5.9%) in 2009 to 11 (52.4%) in 2024. The East of England has the highest 24/7 availability, with Northern Ireland, South West England and Northern England the least. Within physician-based teams, variation remains in advanced interventions available-for example, 19 services (90.4%) offer blood transfusion while only one (4.7%) offers resuscitative balloon occlusion of the aorta. Only one service is completely government funded; the others are funded by charity alone or a combination of charity and government sources. Both geographical and temporal variations in access to a physician-based HEMS remain across the UK, although there has been improvement since 2009. However, within this provision, variation exists in terms of interventions provided such as the provision of blood products.

Feedback is a vital yet underused tool for improving clinical outcomes in prehospital emergency care. This study aimed to develop and pilot a novel, theoretically grounded feedback mechanism for helicopter emergency medical service (HEMS) clinicians involved in out-of-hospital cardiac arrest (OHCA) in the East of England, UK. Semistructured interviews were conducted in September 2022 with HEMS clinicians from Essex & Herts Air Ambulance, and the feedback process was co-designed with the Essex Cardiothoracic Centre (Essex, UK). Using the COM-B model (Capability, Opportunity, Motivation-Behaviour), we conducted qualitative interviews with prehospitalists (seven paramedics, three prehospital doctors) to explore gaps in existing feedback processes and identify their information needs, then iteratively co-developed a structured feedback proforma with stakeholders. Three themes emerged, specifically about weaknesses in current feedback and preferences for an improved system: (1) dissatisfaction with current ad hoc, 'punitive' approaches; (2) the educational and emotional importance of timely, targeted feedback; and (3) a strong preference for standardised, confidentiality-compliant delivery methods. The resulting feedback proforma included working diagnoses, key investigations completed, optimisation opportunities and patient outcomes (if already available), to be delivered within 24-48 hours of hospital admission. Our study underscores the importance of stakeholder-driven development in shaping an effective prehospital feedback mechanism for OHCA aligned to clinicians' needs. By exploring feedback preferences and mapping insights onto the COM-B model, we highlight how knowledge, context and motivation can all steer behavioural change. Further research is needed in diverse emergency medical service contexts to test its impact on clinical practice and patient outcomes.

H5Nx Clade 2.3.4.4b high pathogenicity avian influenza viruses (HPAIVs) have been detected repeatedly in Great Britain (GB) since autumn 2020, with H5N1 dominating detections but with low level detection of H5N5 during 2025. Globally, these viruses have caused mass mortalities in captive and wild avian and mammalian populations, including terrestrial and marine mammals. H5N1 has been the dominant subtype, and whilst detections have overlapped temporally, occurrences have often been spatially distinct. Here, we report the detection of a mortality event in wild birds on the Norfolk coastline in the East of England, where H5N1 HPAIV was detected in five Great Black‐backed Gulls (GBBGs; Larus marinus) and a Northern Fulmar (Fulmarus glacialis). Interestingly, at the same site, and as part of the same mortality event, a total of 17 GBBGs, one Herring Gull (Larus argentatus), one Atlantic Puffin (Fratercula arctica) and one Northern Fulmar tested positive for H5N5 HPAIV. Additionally, H5N5 was also detected in 17 co‐located Grey Seal carcases (Halichoerus grypus). The H5N1 HPAIV from an infected bird belonged to genotype DI.2, closely related to contemporaneous detections in GB wild birds and poultry. In contrast, all H5N5 HPAIVs from birds and seals were Genotype I with a 22‐amino acid stalk deletion in neuraminidase (NA) and the 627K polymorphism in PB2. This represents the first recorded instance in GB of two subtypes being detected within the same avian population at the same location. It is also the first mass detection of HPAIV H5N5 in mammals within GB. Potential infection mechanisms are discussed.

Luton, a super-diverse town in the East of England, is home to one of the largest Roma populations in the UK. Roma communities experience significant health inequalities, particularly in accessing healthcare services, contributing to poorer health outcomes. However, there is limited research on effective ways to engage Roma communities and address these disparities. This study aimed to explore the views of the Luton Roma community on accessing healthcare services and to co-develop solutions. A qualitative study was conducted using eleven focus groups with 64 participants. Discussions were transcribed verbatim and analysed using Thematic Framework Analysis. Three main themes emerged. First, key health concerns included maternity and child healthcare, dissatisfaction with emergency care, long waiting times, and perceived quality of care. Second, barriers to access comprised limited knowledge of services, language difficulties, the need to travel to Romania for care, and perceived discrimination from providers. Third, suggested improvements focused on raising awareness of services, providing language support, and ensuring culturally competent, compassionate care. Gender and age shaped healthcare experiences. Women emphasised caregiving responsibilities and communication challenges, while men highlighted work-related pressures and system-level issues. Younger participants faced digital literacy challenges, middle-aged adults navigated caregiving demands, and older participants reported cumulative discrimination and distrust. Improving healthcare access for Roma communities requires systemic, rights-based interventions addressing language, discrimination, and structural obstacles, rather than expecting individuals to adapt. Policy actions should include professional interpretation, culturally competent care, anti-discrimination mechanisms, and active Roma involvement in service design. Improving health-seeking behaviours among Roma communities requires attention to age and gender dynamics, as socially constructed gender roles and life-course experiences shape health perceptions, caregiving responsibilities, and engagement with healthcare services. Community-led models, such as Roma health mediators, are essential for building trust, bridging communication gaps, and promoting equitable health outcomes.

Student engagement and effort in physical education (PE) can influence long-term physical fitness development. This study examined whether self-reported effort in PE (ePE) predicts changes in physical fitness among English secondary school students. A 4-year longitudinal study involved 1422 adolescents from 9 public schools in the East of England. Assessments took place at years 7, 9, and 11 (year 7 = 12 [0.5]y), measuring aerobic fitness, muscular strength, and muscular power. ePE was self-reported using the Physical Activity Questionnaire for Adolescents. Latent growth curve models examined changes in fitness over time, and whether these associations were modified by sex, body mass index (BMI), or socioeconomic status (via Index of Multiple Deprivation). Girls had lower baseline fitness and smaller gains over the 4-year period than boys across aerobic fitness, muscular power, and muscular strength. Higher baseline BMI and living in a disadvantaged area were associated with lower initial fitness, and changes in BMI influenced longitudinal changes in fitness. Baseline ePE positively predicted all baseline fitness measures, with aerobic fitness showing the strongest association. Change in ePE over time was the strongest predictor of improvements across all fitness components. Effort in PE classes supports long-term fitness development. Interventions that encourage students to be active and engaged in PE may benefit all adolescents, especially girls and those with higher BMI or from disadvantaged areas. These findings highlight the value of promoting effortful participation in PE to enhance adolescent health and physical fitness.

Objective Educating clinicians about artificial intelligence (AI) is urgent as the UK General Medical Council places liability with practitioners and the European Union AI Act with employers for appropriate training, but also because AI, like any tool, requires training to use safely. National Health Service England (NHSE) Capability Framework provides guidance, but frontline clinicians’ perspectives are unknown, so we sought to identify their priorities. Methods and analysis Iterative interviews with residents, educators and experts synthesised 10 contextualised AI-related problem statements. We surveyed residents and consultant-educators in the East of England, who rated their confidence and importance. Participants also ranked their preferred learning modality. Results We received 317 responses. Clinicians’ priorities, defined by high importance (I) and low confidence (C), were: ‘understanding liability implications’ (I: 40%; C: 1.82/5), ‘determining appropriate levels of confidence in AI algorithms’ (I: 36.5%; C: 1.98/5) and ‘mitigating security and privacy risks’ (I: 34%; C: 1.68). Confidence was low (mean 20, range 10–50), with no significant difference between educators and residents. Residents preferred integration of training into regional teaching, while consultant–educators favoured webinars. Conclusion Our findings show that clinicians prioritise practical concerns, such as liability and determining confidence in algorithmic outputs. In contrast, critical appraisal and explaining AI to patients were deprioritised, despite their relevance to clinical safety. This study enhances the NHSE Capability Framework by contextualising AI-related capabilities for clinicians as users and identifying priorities with which to develop scalable training.

HIV pre-exposure prophylaxis (PrEP) demonstrates the value of biomedical interventions as part of combination prevention. Some gay, bisexual and other men who have sex with men (GBMSM) use antibiotics to prevent sexually transmitted infections (STIs), primarily as post-exposure prophylaxis (PEP). We aimed to understand variations in awareness and use of HIV PrEP and STI PEP/PrEP among people attending specialist sexual health services (SHSs) in England. We collected data from 1732 SHS attendees aged >16 years in London and the East of England using an online questionnaire between April 2022 and December 2023, including awareness and use of HIV-PrEP and STI PEP/PrEP. We ran regression analyses: one to identify demographic factors associated with STI PEP/PrEP use among all SHS attendees, and a second to identify behavioural factors (controlling for sociodemographic factors) associated with antibiotic prophylaxis use among GBMSM. The study recruited 1732 participants (50% GBMSM, 12% men who had reported sex with women only (MSW), 31% women). 74% had heard of HIV-PrEP but this varied by group (GBMSM: 98%, MSW: 39%, women: 49%). 34% of GBMSM had heard of STI PEP/PrEP and 11% reported using it (MSW: 15%/5%, women: 18%/4%). 61% of STI PEP/PrEP users reported taking doxycycline, mostly to prevent chlamydia, gonorrhoea and syphilis. 80% of all participants reported being somewhat/very likely to use event-based STI PEP/PrEP, with a higher proportion of GBMSM saying they would be likely to use STI PEP/PrEP in this way. In the behavioural regression model of GBMSM, use was independently associated with reporting higher-risk sexual behaviour (OR: 2.11, 95% CI 1.29 to 3.48). We found that a sizeable minority of GBMSM already use STI PEP/PrEP, but some MSW and women also use or have an interest in antibiotic prophylaxis, suggesting potential benefits may exist for populations other than GBMSM. Communication should therefore emphasise appropriate antibiotic use and the risks of antibiotic resistance among all populations.

On 6–8 May 2025 took place the 12th International Conference of the UISPP Commission on Flint Mining in Pre- and Protohistoric Times titled “Excavating in the Land of the Devil: Past and Current Research on Prehistoric Flint Mines” (see Werra ed. 2025). It was organised by the Institute of Archaeology and Ethnology of the Polish Academy of Sciences (IAE PAN), Worthing Museum and Art Gallery, English Heritage, and the UISPP Commission on Flint Mining in Pre- and Protohistoric Times. The conference was hosted jointly by Worthing Museum and Art Gallery (West Sussex) and English Heritage Grime’s Graves and the Grime’s Graves Visitors Centre (Norfolk, East of England). The symposium was organised at the initiative of Dagmara H. Werra (IAE PAN), Jon Bączkowski (University of Southampton), and Anne Teather (Past Participate / Bournemouth University).

Background: The NHS continues to employ an increasing number of advanced practitioners; however, very few of them are from the global majority. Aims: To better understand the barriers to practitioners from the global majority becoming or progressing as advanced practitioners. Methods: A purposeful sample of stakeholders from different roles (advanced practitioners from the global majority, organisational advanced practitioner leads and higher education institution advanced clinical practice programme leads) completed semi-structured interviews. Interviews were analysed using a qualitative exploratory approach employing thematic analysis, guided by an established framework. Findings: Sixteen participants completed this study: eight advanced practitioners, five organisational advanced practitioner leads and three higher education institution advanced clinical practice programme leads. Three overall themes related to the work experience, recruitment process and career progression, and suggestions on how to address these issues, emerged. The need for more accurate information about the numbers of advanced practitioners from the global majority was highlighted. Conclusions: The participants described several barriers to people from the global majority becoming or progressing as advanced practitioners and several factors that could positively influence career development.

This study investigated the potential of utilising cool season grasses naturally associated with Epichloë endophytic fungi for the management of plant-parasitic stubby root nematodes (Trichodorus spp. and Paratrichodorus spp.). Stubby root nematodes are economically important in East England where they cause docking disorder in sugar beet which causes up to 50% root yield reduction. The lack of chemical nematicides for the management of stubby root nematodes due to environmental concerns warrants the development of more eco-friendly measures. Epichloë fungal endophytes are known to confer protection from herbivory to their cool-season grass hosts, via the production of alkaloidal compounds. Several Epichloë species are known to produce loline alkaloids, a group of compounds known for their insecticidal and insect-deterrent properties. Lolines have also been reported to inhibit nematode mobility, egg hatching and mortality. In this study, Festulolium loliaceum and its associated endophyte Epichloë uncinata, known for its production of loline alkaloids, were investigated for their efficacy in suppressing stubby root nematodes. In a field experiment in Docking, Norfolk, England, endophyte-infected grasses significantly reduced the reproduction of stubby root nematodes by seven times compared to endophyte-free grass associations. Laboratory experiments using extracts from shoots and roots of F. loliaceum plants showed that both endophyte-infected and endophyte-free plants could immobilize nematodes. Age, source of extract and extract concentration had a significant effect on the nematocidal activity. Extracts from younger grasses were more potent compared to older grasses, where shoot extracts from 8-week-old endophyte-infected grass plants had six times lower LD50 values compared to 20-week-old grass plants. A contrasting effect was found for grass root extracts where roots from older plants were more potent than extracts from roots from younger plants, and had lower potency compared to shoot extracts. Further laboratory experiments showed that artificial wounding of endophyte-infected F. loliaceum plants elevated the loline alkaloids in the regrowth tissue within the first 11 days. Nematicidal activity of extracts from this regrowth tissue was significantly greater as compared to extracts from unwounded grass tissue. Overall, the results from this study suggest that endophyte-infected grasses could serve as a potential cultural management strategy for stubby root nematodes in a sugar beet crop rotation system. It is also evident that stubby root nematodes are sensitive to loline alkaloids produced from the grass-endophyte symbiosis used in this study, and this system could be optimised in the future to support nematode suppression under field conditions.

OP 12: Health Services 4, B210 (FCSH), September 3, 2025, 17:00 - 18:00AimAntenatal care plays an important role in preventing adverse maternal?and new-born outcomes. The United Kingdom (UK)?clinical?guidelines recommend that women attend their first antenatal appointment by 10 weeks of pregnancy. Women from ethnic minority backgrounds are more likely to initiate antenatal care later than the recommended 10 weeks, compared to white British women.The aim of this study was to explore the experiences and perspectives of timely initiation and uptake of antenatal care among mothers from ethnically diverse areas in East of England, UK who initiated antenatal care after 10 weeks.MethodsWe conducted in-depth qualitative semi-structured interviews with 20 expectant or recent mothers in ethnically diverse areas who started care after 10 weeks. Mothers were recruited using purposive and snowball sampling, through a number of channels including local networks and online advertisements. Interviews lasted approximately one hour and were conducted in-person, over the phone or online based on participants’ preferences. Data were analysed using a thematic framework guided by Levesque Conceptual Framework.ResultsThree key themes emerged: 1.experiences of and perceptions about antenatal care appointments; 2.factors hindering timely initiation of antenatal care; and 3.strategies to enhance antenatal care uptake. Women felt dissatisfied with limited engagement during appointments and suggested that seeing the same midwife could improve trust and confidence. Delays were linked to low awareness and insufficient information on scheduling, as well as employment and childcare constraints. Participants recommended simplified health information about care pathways, appointment reminders, and multilingual resources to improve access.ConclusionKey barriers and delays in antenatal care appointments highlight the need for targeted interventions, including provision of simplified health information and culturally inclusive resources. Findings highlight?the need for addressing systemic challenges through culturally sensitive community based approaches to enhance timely uptake of antenatal care among women from ethnically diverse areas.

ObjectiveTo examine how socioeconomic deprivation influences referral pathways to emergency departments (EDs) and to assess how these pathways affect subsequent hospital outcomes.DesignRetrospective observational study.SettingEmergency department of a large teaching hospital in the East of England, providing secondary and tertiary care.Participants482 787 ED attendances by patients aged 16 years and over, recorded between January 2019 and December 2023. Patients were assigned Index of Multiple Deprivation (IMD) deciles based on residential postcode.Main outcome measuresReferral source (general practitioner (GP), National Health Service (NHS) 111, ambulance, self-referral, other), total ED time, 4-hour breach, hospital admission and unplanned return within 72 hours.ResultsSubstantial socioeconomic inequalities were observed in referral pathways. Patients from the most deprived areas were significantly less likely to be referred by a GP (4.7%) than those from the least deprived areas (14.7%) and more likely to arrive via ambulance (32% vs 24%). These differences persisted after adjusting for demographic, clinical and contextual variables. Ambulance referrals showed the longest ED stays, ranging from 347 to 351 min across IMD deciles (overall 95% CI 343 to 363) and the highest probability of 4-hour breaches (51%; 95% CI 50% to 53%). Self-referrals had the greatest rates of unplanned returns within 7 days (up to 7.1%; 95% CI 5.5% to 8.7%). In contrast, NHS 111 and GP referrals were associated with shorter stays, lower breach rates and fewer reattendances. Minimal variation in outcomes was observed across deprivation levels once referral source was accounted for.ConclusionsInequalities in how patients access emergency care, particularly reduced GP and NHS 111 referrals among more deprived groups, appear to underpin disparities in ED outcomes. Referral source captures important clinical and system-level factors that influence patient experience and resource use. Interventions to improve equitable access to structured referral pathways, particularly in more deprived areas, may enhance both the efficiency and fairness of emergency care delivery. Further research using national data is needed to assess broader policy implications and economic costs associated with differential access.

BackgroundYoung people aged 16–25 are reporting rising rates of poor mental health, exacerbated by service gaps. Key life transitions such as moving from school to college, or into the workforce can increase vulnerability.MethodA mixed-methods evaluation was conducted of a multi-component, mental health intervention in the East of England. The evaluation aimed to: (1) Assess the fidelity, dose, and reach of the intervention; (2) Understand the mechanisms of impact and how change was generated; (3) Explore the influence of context, including dynamic relationships between those involved in delivering and accepting support, settings, and service delivery models; and (4) Assess if the intervention offered good value for money. Semi-structured interviews were held with local public health staff (n = 3), and an intervention lead. A focus group was conducted with intervention leads (n = 3). Photo production interviews were held with young people (n = 10). Quantitative outcomes were explored through pre- and post- questionnaires (n = 34), and pre-post intervention assessment of young people’s wellbeing, and satisfaction with the intervention, using the DIALOG (n = 34) and Wellbeing star measures (n = 37). Value for money was assessed using commissioned, in-house cost data and qualitative insights.ResultsThe intervention demonstrated positive outcomes in life satisfaction and functional wellbeing for young people, with young people engaging across the intervention components (n = 82, CC Hubs, n = 74, WN, n = 53, BR). The most cost-effective components were Upskilling the Workforce and Wellbeing Navigator support. Third spaces, and creative methods, fostered engagement and acceptability among young people.ConclusionIntegrated, co-produced, and place-based approaches can support young people’s mental health needs during life transitions. Investment in local partnerships and youth-centred design is important.