There are significant regional disparities in NHS Tier 3 specialist weight management services (SWMS) across the UK. In the context of an ongoing policy shift from hospital to community-based care, a detailed examination of the components of Tier 3 services is needed to clarify the distribution of responsibilities across the weight management pathway. We conducted a comparative service mapping of SWMS across four NHS sites in England and Wales, with on-site observation, staff interviews and document review. While the core structure and service delivery at the four sites broadly aligned with the National Institute for Health and Care Excellence (NICE) guidance, substantial variations were identified in service accessibility and content, alongside widespread resource constraints and communication challenges. These findings suggest that the strategic shift of SWMS care from hospitals to community settings is proceeding without an infrastructure to meet anticipated demand. Clearer definitions of service requirements within SWMS, sustainable funding mechanisms and data-driven commissioning may help reduce regional variation and inequalities in service provision.

Parents of autistic children support their children through additional challenges, often experiencing adversity as a result. Such parents report high support needs, yet service provision is often limited. Services often support children through providing various psychological interventions to parents. Quantitative evidence for such interventions is mixed and qualitative evidence is sparse. This review therefore aimed to synthesise the perspectives of UK parents regarding interventions for their autistic child. The databases Scopus, Embase, Medline, PubMed, PsycInfo, CINAHL, Web of Science and ASSIA were searched in February 2025. Inclusion criteria constituted qualitative articles published in English from 2004 onwards exploring UK parents' perspectives of interventions aimed at supporting autistic children. Articles were evaluated using Standard Quality Assessment Criteria. Thematic meta-synthesis was conducted. Fourteen papers were identified: eight high-quality, one medium-quality, and four low-quality. Interventions were psychoeducational behavioural, communication-based, sensory-related or mental-health based in nature. Themes included change, relationship with help, parents' need to process and solidarity. Facilitators of positive change included learning, empowerment, structure and rigour, while barriers included delivery issues and unhelpful information. Parents reported finding solidarity amongst similar parents helpful. Reflective space was deemed useful in facilitating new understanding of autistic lives. Methodological quality varied, with more reflexive and theoretically grounded research encouraged. Future research should also consider implementing embedding processes into qualitative designs.

The current Mental Health Practitioner (MHP) workforce within NHS primary care is without a competency framework to guide job planning, interviews and service provision. This paper aims to present an inclusive level-based framework for MHPs in primary care. The competency framework is based on previous frameworks and the results of service evaluation projects. Research into other existing competency frameworks allowed for the expansion of the identified competencies to ensure a thorough and complete framework was produced. The document was circulated to stakeholders and sense checked with colleagues working in primary care mental health service delivery. The framework provided has an explicit focus on seven key features: (1) knowledge for primary care-based MHPs, (2) core relational skills, (3) core clinical skills, (4) personal characteristics and values, (5) leadership and working with teams, (6) self-care and support and (7) competencies for primary care services supporting MHPs. Consideration of the competencies presented can help develop job descriptions, interview content and service provision requirements for MHPs across a variety of primary care settings. Following this paper further evaluation as to acceptability and implementation of this framework within primary care settings may be a beneficial undertaking.

Leveraging networks to access basic services: Understanding preference for patronage and collective action networks based on housing precarity

“You're not necessarily pregnant”: Confusion about emergency contraception

In 2006, the American College of Clinical Pharmacy (ACCP) issued a position statement recommending residency training as a prerequisite for entering direct patient care activities. Additional recommendations in 2013 added residency training as a prerequisite for providing direct patient care. Over the subsequent 12 years, patient-level services by pharmacists expanded, and the frequency of team-based care increased. The Educational Affairs Committee acknowledges these changes in education and clinical pharmacy practice and asserts that postgraduate year one (PGY1) residency training remains a prerequisite to prepare a pharmacist to provide comprehensive clinical pharmacy services. A postgraduate year two (PGY2) residency in specialty care is recommended for the provision of specialty care, recognizing the current system lacks the capacity to provide training for all. The 2025 committee adds the recommendation that completion of residency training is also necessary for the advancement of indirect patient care skills, and all programs should be accredited through standards-based review. When residency training is not available, the committee recommends resident equivalency be achieved through professional development. The complexities of medication management necessitate residency training; therefore, the pharmacy profession needs to actively expand training programs and establish standards for alternative training models.

Spatial and temporal implications of the platformization of work in the logistics chain: From Rotterdam to Madrid

This paper presents a planning and control strategy to manage the provision of ancillary services with aggregates of electric vehicles (EVs). The study is inspired by recent directives from the Italian Regulatory Authority for Energy, Networks and Environment (ARERA), which opens the way for the participation of new actors in the ancillary services market, including EV aggregates. On a day-ahead basis, the charging point operator computes its total EV power baseline and upward/downward bids for the next day, by solving a dynamic scheduling problem, based on a vehicle-by-vehicle assessment of the next day’s charging demand. Then, in real time, a model predictive controller manages the EV charging sessions to track the baseline and to respond to possible upward/downward regulation signals from the TSO. This two-level approach allows to fulfill the day-ahead obligations (the agreed baseline and regulation bids) and to provide efficient charging service to the EV users, also in presence of deviations of the actual demand from the day ahead forecast. Simulation results validate the approach on realistic scenarios in line with the ARERA resolution 300/17, and show that demand-based ancillary services paradigm is feasible, if supported by a flexible recharging planning and control system. • Electric vehicles aggregates participation in the ancillary services market. • Joint day-ahead planning and real time control of binding services. • Assessment of service technical feasibility in relation to electric vehicles flexibility margins. • A bidding strategy based on a vehicle-by-vehicle representation of charging demand. • A multi-player model predictive control application.

Strategies for collaborative mental health care in post-conflict Tigray: A qualitative study

Assessing the impact of targeted interventions on access to self-managed abortion care in Zambia.

Caught in a machine that de-emphasizes human potential: Using Goffman’s theory of the total institution to understand service provider perspectives on boredom among unhoused persons

Societal impact assessment and differentiated governance of urban shrinkage in China

Mapping the costs of mental health- and substance use-related grant cancellations

Systematic reduction of negative laparoscopy for pelvic pain is crucial to reducing surgical morbidity, improving diagnostic accuracy and minimising cost. This study aims to determine the incidence and consider the underlying causes of negative laparoscopy in women presenting with pelvic pain. A 5-year, retrospective cohort study was undertaken for women undergoing laparoscopy for pelvic pain. Patient selection was from an Australian tertiary public hospital with both non-fellowship trained gynaecologists and an Australasian Gynaecological Endoscopic Surgery (AGES) accredited training programme (fellowship trained) as well as one private clinic comprising two fellowship trained gynaecologists. Data was collected from the medical records. A 'negative' laparoscopy was defined either visually or by vision and negative biopsy on histology. The rate of negative laparoscopy in the public and private sector was compared using an odds ratio. Of 1309 women, 174 (13%) had a negative laparoscopy. The negative laparoscopy rate was significantly higher amongst non-fellowship trained gynaecologists compared to those with fellowship training (OR = 2.48; 95% CI: 1.76-3.43, p < 0.05). Visually negative laparoscopy was made in 48/174 (28%) of cases, all from the public sector, with 41/48 (85%) of laparoscopies without biopsy performed by non-fellowship trained gynaecologists. A 56% discordance between intraoperative visualisation and histopathological findings was identified. Overall, negative laparoscopy rates are low compared to previously reported data. The discrepancy between the healthcare sectors likely relates to patient factors, surgical training, and clinician bias. Peritoneal biopsy for symptomatic patients undergoing laparoscopy should be considered due to the potential to miss superficial disease.

Participant experiences of the Knee Care for Arthritis through Pharmacy Service (KneeCAPS): A personalised hīkoi (journey) through care.

Power control systems (PCSs) can exploit low-carbon technologies (LCTs) to provide grid ancillary services. This work develops a bilevel mixed-integer linear programming PCS of photovoltaics (PVs), electric vehicles (EVs), heat pumps (HPs), and battery energy storage systems (BESS), for providing automatic frequency restoration reserves (aFRR) with energy arbitrage, PV self-consumption, and customers’ thermal and charging comfort. The contribution of the BESS and the flexible loads is evaluated under different seasons, grid types and sizes, and energy/reserve prices. Validating against a PCS solely for minimum grid energy cost (energy arbitrage), the findings demonstrate the increased cost savings when a PCS participates in the reserve market with BESS and EV combined. The cost of solely energy arbitrage was found consistently higher than 100% (e.g. 40 compared to only 19 with aFRR provision). These benefits become more important recently in 2023, with the higher energy prices, and much higher reserve prices compared to 2018 (up to 540% increase). While the always present BESS is able to contribute more to ancillary services compared to the uncertain EV fleets, the contribution of EVs increased to a notable 38.5% of the total provided aFRR energy share at larger grids. Finally, mixed nodes that comprise both residential-commercial buildings and home-public chargers have a higher potential for ancillary services provision, demonstrating a 5x and 12x higher potential compared to residential and commercial nodes, respectively. Overall, this work highlights the importance of PCSs in large grids or with a variety of loads to provide ancillary services for enhanced savings. • Providing aFRR by EVs and BESS on top of energy arbitrage yields double cost savings. • EVs’ contribution to ancillary services can become comparable to BESS in large grids. • Higher potential for ancillary services for grids of diverse buildings and chargers. • In contrast with solely energy arbitrage, V2G is highly used in ancillary services. • Increasingly varied imbalance prices favor participation in the reserve market.

Institutional objection to abortion care in Australia: Exploring the perspectives and experiences of key interest-holders

Paediatric ACL injuries are increasingly common and present significant challenges. Inappropriate treatment can lead to long-term complications like instability, growth disturbance, and osteoarthritis. The Paediatric ACL National Audit (PANA) Study assesses UK practices and adherence to Best Orthopaedic Practice (BOAST) guidelines for managing these injuries, identifying opportunities to improve care for young patients. PANA was a collaborative audit of 22 hospitals in England, Wales, and Scotland, measuring adherence to BOAST guidelines in treating paediatric ACL injuries. Orthopaedic surgeons and trainees collected data through a secure online questionnaire about service provision for skeletally immature patients, including diagnostic imaging, rehabilitation, post-operative follow-up, and surgical techniques. Our analysis revealed variability in adherence to the BOAST guidelines for ACL injuries in paediatric patients, with 65% of centres using acute knee pathways and 68% utilising collaborative imaging pathways. About 59% of centres conduct radiological growth monitoring, while only 30% report functional outcomes. Less than 50% report re-rupture rates, and 74% adhere to rehabilitation protocols. The rise in ACL injuries in the paediatric population highlights the need for standardised care delivery and reporting. Following the release of the BOAST guidelines in 2022, this nationwide audit has revealed discrepancies in UK practices. A multidisciplinary approach is essential for improving patient care and outcomes by standardising and promoting best practice.

The intensification of urbanization has exacerbated the urban heat islands effect, potentially amplifying energy consumption and posing risks to thermal comfort and human health. Urban vegetation offers significant potential for mitigating extreme thermal events and reducing surface urban heat island effects. However, effective urban planning requires considering the interactions between vegetation and built structures, rather than solely focusing on green cover parameters. Considering this interaction and three-dimensional metrics, we applied a spatially explicit approach and linear mixed models to evaluate how the landscape structure impacts the climate regulation ecosystem services provision chain in São Paulo (Brazil), the largest metropolis in the Southern Hemisphere. While composition metrics, particularly total vegetation cover, are the primary factors explaining local climate regulation service supply, configuration metrics also significantly influence this service. Specifically, vegetation edge density positively impacted service supply, whereas building edge density had a negative effect. Additionally, arboreal volume and the interface between vegetated and built areas contributed to lowering land surface temperatures, suggesting that green spaces should be not only abundant but also strategically distributed in fragmented patches to maximize contact with built surfaces and enhance urban cooling. Furthermore, our analysis revealed spatial mismatches between service supply and demand, identifying high-risk areas where insufficient climate regulation could exacerbate health vulnerabilities during extreme events. These findings offer crucial insights for urban planners, highlighting the need to expand green areas and integrate them within built environments, especially in locations where supply does not meet local demand, in order to enhance adaptive capacity to heat. • Urbanization increases urban heat islands, but landscape structure role is unclear • Spatially evaluate climate regulation ecosystem service provision in São Paulo • Although vegetation cover effect is stronger, landscape configuration has a key role • Identified areas with climate regulation ecosystem service supply-demand mismatches • Provide key insights for public policies aiming to mitigate climate change effects

Cataract surgery is among the most frequently performed procedures globally and in Iran, often regarded as highly effective and cost-efficient. However, its rapid growth, particularly under a fee-for-service model, raises concerns about supplier-induced demand, where providers may influence patients to undergo potentially discretionary procedures to maintain income. We analyzed administrative data from the Iranian Armed Forces Insurance Organization, covering active and retired military personnel and their families across all 31 provinces. In total, 108 055 cataract surgeries performed by 644 ophthalmic surgeons during the study period were included. As service provision and coverage for armed forces beneficiaries may differ from the general population, through dedicated military hospitals or subsidized services in public hospitals, the findings primarily reflect utilization patterns within this insured population. We employed regression-based methods to examine the relationship between surgeon density and surgery rates. A 10% increase in ophthalmologist density is associated with a 4.9%-6.2% increase in surgery count, 7.3%-7.9% in service volume, and 1.5%-1.9% in service value, indicating both quantitative and qualitative dimensions of inducement. Lagged service variables demonstrated significant persistence, reflecting clinical inertia. Income became a significant determinant only in the dynamic model, highlighting the role of latent demand-side factors. Our findings provide evidence consistent with supply-sensitive utilization patterns predicted by SID theory in Iran's cataract surgery sector. These insights underscore the need for targeted policy interventions, including payment reform, utilization oversight, and equitable workforce distribution, to align provider behavior with clinical necessity and system efficiency.