South East England Research Articles

Feasibility study to boost ascertainment of FH in diverse primary care populations using FAMCAT tool and pharmacist review

Abstract Background Familial Hypercholesterolaemia (FH) is a greatly underdiagnosed genetic lipid disorder with high risk of morbidity from premature cardiovascular disease. However, early diagnosis can significantly reduce cardiovascular risk with lipid-lowering medicines. Patients identified with high risk primary dyslipidaemia are recommended for lipid clinic referral to inform patient management. Improving FH identification and addressing ethnic disparities in dyslipidaemia management, is a current NHS priority in the UK. Aim We aimed to explore inequalities in the FH care pathway within and across areas with different socio-demographic UK populations. Methods The study was carried out in 6 general practices in the South East of England with divergent ethnic densities and socioeconomic status. Eligible patients aged 18 years or over, fulfilling the NICE (1), Simon-Broome (2) and current NHS Directed Enhanced Service criteria (3) for possible FH were screened using our previously validated PRIMIS FAMCAT2 tool (4) to prioritise those most likely to have FH. The PRIMIS FAMCAT2 tool generated a report highlighting patients with a "High Risk" of FH Tier 1 and a "Higher Risk if family history is positive" of FH- Tier 2. Tier 1 patients were assessed for FH using local lipid pathways. For the 243 Tier 2 patients, an online family history questionnaire/telephone enquiry was administered. The accuracy of the information collected was assessed by a practice-based clinical pharmacist (overseen by the GP). This included repeat testing for full lipid profile, excluding secondary causes of raised cholesterol. New patients meeting the criteria for FH were referred to a lipid/specialist clinic to assess for genetic testing. Patients who did not meet the FH criteria were managed accordingly to the local lipid pathways. Results 131,930 records from 6 general practices in South East England were screened using the PRIMIS FAMCAT tool. In total, the high priority list yielded 369 patients (126 Tier 1 and 243 Tier 2). Ethnicity breakdown was White (40%), Asian (8%), Black African/Caribbean (22%), Mixed (14%), Other (16%) NS (1%). A total of 25/369 (7%) patients were previously referred to lipid clinics (4 underwent genetic testing, 2 had confirmed FH, 12 did not have FH, and 7 were not seen/missed appointments). There were 14/244 (4%) new referrals to lipid clinics. Only 1 patient had received a coded FH diagnosis in the primary care record. For Tier 2 patients, 65/243 (27%) patients completed an online family history questionnaire, the remainder were ascertained by phone (75% response rate overall). Conclusion Incorporating enhanced case-finding from electronic medical records based on current guidelines, and online family history questionnaire can enhance FH identification. However large inequalities remain in referral, attendance and testing at lipid clinics, and further work is underway to evaluate the FH care pathway in diverse populations.

Using satellite tracking to assess the use of protected areas and alternative roosts by Whooper and Bewick's Swans

Protected areas are one of the major tools used in the conservation of biodiversity, but animals are unlikely always to remain within these human‐made boundaries. Understanding when and why species choose to leave protected areas can help us to improve the effectiveness of these management tools. Here, we investigate the use of protected and non‐protected areas by two migratory species undergoing rapid wintering population changes in northwest Europe: Whooper Swans Cygnus cygnus and Bewick's Swans Cygnus columbianus bewickii. Global positioning system tags were fitted to 15 Whooper Swans in winter 2008/09 and to 18 Bewick's Swans from winter 2013/14 to 2014/15 at the Ouse Washes Special Protection Area (an internationally important roost for wintering waterbirds) and on adjacent fields in southeast England. Here, swans feed on farmland during the day but return to designated reserves to roost at night, where they receive protection from predators and disturbance within managed roost habitats. When swans roost elsewhere at alternative sites, they may face more adverse conditions, and so understanding the extent and causes of the use of alternative roosts is important for swan conservation efforts. The alternative roosting proportion, defined as the proportion of nights spent outside protected reserves, was 0.237 for Bewick's Swans and challenging to quantify accurately for Whooper Swans. A generalized additive mixed model to model repeated measurements on individuals showed that the proportion of time that Bewick's Swans spent at alternative roosts correlated positively with river level and negatively with temperature. Competition and foraging flight distances are thought to drive these relationships, as swans seek access both to roost space and to nearby feeding habitats. Our findings improve our understanding of the environmental conditions under which migratory waterbirds may choose to roost outside protected areas.

Investigating the Role of Cover-Crop Spectra for Vineyard Monitoring from Airborne and Spaceborne Remote Sensing

The monitoring of grape quality parameters within viticulture using airborne remote sensing is an increasingly important aspect of precision viticulture. Airborne remote sensing allows high volumes of spatial consistent data to be collected with improved efficiency over ground-based surveys. Spectral data can be used to understand the characteristics of vineyards, including the characteristics and health of the vines. Within viticultural remote sensing, the use of cover-crop spectra for monitoring is often overlooked due to the perceived noise it generates within imagery. However, within viticulture, the cover crop is a widely used and important management tool. This study uses multispectral data acquired by a high-resolution uncrewed aerial vehicle (UAV) and Sentinel-2 MSI to explore the benefit that cover-crop pixels could have for grape yield and quality monitoring. This study was undertaken across three growing seasons in the southeast of England, at a large commercial wine producer. The site was split into a number of vineyards, with sub-blocks for different vine varieties and rootstocks. Pre-harvest multispectral UAV imagery was collected across three vineyard parcels. UAV imagery was radiometrically corrected and stitched to create orthomosaics (red, green, and near-infrared) for each vineyard and survey date. Orthomosaics were segmented into pure cover-cropuav and pure vineuav pixels, removing the impact that mixed pixels could have upon analysis, with three vegetation indices (VIs) constructed from the segmented imagery. Sentinel-2 Level 2a bottom of atmosphere scenes were also acquired as close to UAV surveys as possible. In parallel, the yield and quality surveys were undertaken one to two weeks prior to harvest. Laboratory refractometry was performed to determine the grape total acid, total soluble solids, alpha amino acids, and berry weight. Extreme gradient boosting (XGBoost v2.1.1) was used to determine the ability of remote sensing data to predict the grape yield and quality parameters. Results suggested that pure cover-cropuav was a successful predictor of grape yield and quality parameters (range of R2 = 0.37–0.45), with model evaluation results comparable to pure vineuav and Sentinel-2 models. The analysis also showed that, whilst the structural similarity between the both UAV and Sentinel-2 data was high, the cover crop is the most influential spectral component within the Sentinel-2 data. This research presents novel evidence for the ability of cover-cropuav to predict grape yield and quality. Moreover, this finding then provides a mechanism which explains the success of the Sentinel-2 modelling of grape yield and quality. For growers and wine producers, creating grape yield and quality prediction models through moderate-resolution satellite imagery would be a significant innovation. Proving more cost-effective than UAV monitoring for large vineyards, such methodologies could also act to bring substantial cost savings to vineyard management.

The impact of weather patterns on inter-annual crop yield variability

Inter-annual variations in crop production have significant implications for global food security, economic stability, and environmental sustainability. Existing crop yield prediction models primarily using meteorological variables may not adequately encapsulate the full breadth of weather influences on crop development processes, such as compound or extreme events. Incorporating weather patterns into crop models could provide a more comprehensive understanding of the environmental conditions affecting growth, enabling more accurate and earlier yield predictions.Our study examines 30 distinct UK Met Office weather patterns (MO30) based on mean sea level pressure. We investigate their association with weather conditions that limit winter wheat yield in the UK (1990–2020). Blocked, negative North Atlantic Oscillation (NAO) patterns create the highest risk of temperatures that are below optimal for crop yield. However, the connection between weather patterns and yield is complex, with differing effects at a regional scale and even at which point in the growth cycle they appear. It was found that anticyclonic weather patterns during sowing, emergence, vernalisation, anthesis, and grain filling exhibit a relationship with good crop yields with a Spearman correlation coefficient of up to 0.55 for a single weather pattern (WP3 during vernalisation in South East England), whilst cyclonic patterns can help during the terminal spikelet phenological phase. The strongest positive correlations were during sowing, emergence, and vernalisation, whilst the largest negatives were observed in anthesis and grain filling.The potential of combining weather patterns with existing crop simulation models to produce earlier and more accurate yield predictions is shown. This would enable effective crop management and climate mitigation strategies, critical to strengthening food security. Projected changes in weather pattern occurrences in the late 21st century will likely reduce crop yields. This is due to increased cyclonic weather patterns, which bring warmer, wetter conditions during the wheat's vernalisation stage, followed by warmer, drier conditions during the anthesis and grain-filling phases.

Phenology of the spruce bark beetle Ips typographus in the UK under past, current and future climate conditions

Summary The European spruce bark‐beetle, Ips typographus, is a major pest of Norway spruce across mainland Europe; however, until 2018, it was considered absent from the United Kingdom (UK). The finding of a breeding population of I. typographus in Kent, England, in 2018 and subsequent findings in pheromone traps across the southeast of England, has led to an urgent need to improve understanding of environmental suitability across the UK. Two distinct published phenological models for I. typographus, developed in Sweden and Austria, were adapted for use in the UK and validated against pheromone trap data collected at the original site of infestation and in the surrounding area from 2019 to 2022. Both models captured some, but not all, of the within‐season variation in trap catches. One, the PHENIPS model, more accurately captured early season flight patterns. The climate in the southeast of England is mild enough to facilitate two generations of the beetle, while further north the pest is expected to be univoltine. At high altitude in Scotland, there is insufficient thermal warming within a season for the completion of one annual generation. Phenological modelling does not explain why the pest failed to establish in England prior to 2018 including when a large amount of infested material was imported to sawmills in the 1940s. Under 2 and 3°C global warming scenarios, we might expect to see an increase in potential voltinism across the UK in the next few decades, increasing the risk of large outbreaks of I. typographus were it allowed to establish. Societal impact statementIn 2018, a breeding population of the European spruce bark‐beetle, Ips typographus, was discovered in woodland in southeast England. Ips typographus is a major forest pest in continental Europe; however, despite previous findings at ports and sawmills, this was the first recorded infestation in the UK. The number of generations per year (voltinism) varies with latitude and altitude. Applying a phenological model, we find that the current climate in southern UK could support two generations, while temperature accumulation in parts of Scotland may be insufficient to support one generation. Global warming will increase voltinism and hence the risk of establishment.

Improving assessment for work-based learning and degree apprenticeships in business through a co-designed peer review process

Involving students in peer review has substantial benefits for students’ learning and development and, more pragmatically, for staff workload. This paper reports on a student-led effort to co-design a peer review formative assessment task. The assessment is part of a personal development module within a higher education degree apprenticeship programme delivered via blended mode by a business school in South-East England. This case study on student-staff partnership offers a description of the process and a reflection on the impacts from both the student and staff perspective. It suggests that student co-design and peer review activities complement work-based learning, effectively bringing the prior experiences and academic skills of mature/professional students into the classroom.

Foraging distance distributions reveal how honeybee waggle dance recruitment varies with landscape

Honeybee (Apis mellifera) colonies use a unique collective foraging system, the waggle dance, to communicate and process the location of resources. Here, we present a means to quantify the effect of recruitment on colony forager allocation across the landscape by simply observing the waggle dance on the dancefloor. We show first, through a theoretical model, that recruitment leaves a characteristic imprint on the distance distribution of foraging sites that a colony visits, which varies according to the proportion of trips driven by individual search. Next, we fit this model to the real-world empirical distance distribution of forage sites visited by 20 honeybee colonies in urban and rural landscapes across South East England, obtained via dance decoding. We show that there is considerable variation in the use of dancing information in colony foraging, particularly in agri-rural landscapes. In our dataset, reliance on dancing increases as arable land gives way to built-up areas, suggesting that dancing may have the greatest impact on colony foraging in the complex and heterogeneous landscapes of forage-rich urban areas. Our model provides a tool to assess the relevance of this extraordinary behaviour across modern anthropogenic landscape types.

The Impact of United Kingdom SARS-CoV-2 Spike Mutations on Spike-ACE2 Interactions Investigated Through Molecular Dynamic Simulation

Background: A newly emergent betacoronavirus, SARS-CoV-2, poses a tremendous global threat and causes severe acute respiratory syndrome coronavirus-2, a major pandemic that began worldwide in 2019. The trimeric spike glycoprotein (S) is located on the envelope of the virus and facilitates the fusion of viral and host cell membranes by interacting with a cellular receptor called angiotensin-converting enzyme 2 (ACE2). In the United Kingdom (UK), a variant of SARS-CoV-2 has been detected using sequencing technology. There has been a significant surge in the number of COVID-19 cases in South East England. These lineages are significantly more transmissible than previously circulating variants. Objectives: The aim of this study is to investigate the effects of UK SARS-CoV-2 spike mutations on its interactions with ACE2. Methods: In this study, the structure of the UK spike protein with multiple mutations, including deletion 69 - 70, deletion 144, N501Y, A570D, T716I, D614G, P681H, S982A, and D1118H, was investigated. The research focuses on studying the impact of these mutations on spike function and its interactions with ACE2 through molecular dynamic simulation. Results: The results indicated that hydrophobic interactions, hydrogen bonds, and double/triple bonds are more prevalent in the mutated spike-ACE2 complex. Additionally, the UK spike-ACE2 complex maintained a consistent conformation throughout the simulation, experiencing minimal changes in structure. The mutant spike protein structure is less stable compared to the wild-type spike structure. Conclusions: Multiple mutations, including deletion 69 - 70, deletion 144, N501Y, A570D, T716I, D614G, P681H, S982A, and D1118H in the spike protein of UK SARS-CoV-2, can affect its interaction with the ACE2 receptor and the transmissibility of this variant of SARS-CoV-2.

EP.14A.17 A Retrospective Study Looking at the Demographics and Occupations of Patients with Mesothelioma in Kent, South East England

EP.14A.17 A Retrospective Study Looking at the Demographics and Occupations of Patients with Mesothelioma in Kent, South East England

Becoming ‘Wild Citizens’: Children’s Articulation of Environmental Citizenship in the Context of Biodiversity Loss

AbstractCalls to tackle the global disasters of climate change and loss of biodiversity are becoming more and more prominent and urgent. Such calls require environmental citizens, that is citizens who act at local, national and transnational scales, assuming environmental agency through pro-environmental behaviours, attitudes and values in public and private spheres. To enable children to become active environmental citizens, we collaborated with five inner city primary schools in the south-east of England in co-designing a school-based, outdoor ‘Wild Citizens’ programme, underpinned by socioscientific inquiry-based learning, focusing on biodiversity loss. Approximately 130 primary school children (6–10 years old) explored their school grounds, discussed, decided on, and implemented interventions to enhance biodiversity, and communicated their findings within their community (schools, peers, parents, teachers). Semi-structured group interviews were conducted with a sub-sample (60%) exploring how children articulate environmental citizenship within this context. We found that environmental citizenship was articulated at both local and global scales of influence in relation to (a) environmental awareness, (b) values and (c) action competence. Children articulate the links between their performed actions to the impact these might have at a global scale, showing their ability to conceptualise and discuss implications and consequences of issues such as biodiversity loss in simple terms. Their articulation of actions as relevant and impactful to their school’s grounds, transforms the issue of biodiversity loss from a slow, invisible disaster to an observable phenomenon for children, which they then act to mitigate against. This work provides empirical grounding towards the operationalisation of environmental citizenship at the primary school level in the context of a less discussed, but as urgent, ecological disaster, that of biodiversity loss.

Educator perceptions of the complex needs of young people in Pupil Referral Units: An exploratory qualitative analysis

Background Alternative education provision such as Pupil Referral Units support young people who have been excluded from mainstream school settings and often from disadvantaged backgrounds. However, there is limited research to date exploring educators’ perceptions of the complex needs of young people in PRUs, and the extent to which PRUs as currently configured can meet such needs. Methods Between March 2019 and October 2020 twenty-two participants holding various educational roles from five different Pupil Referral Units across London and Southeast England were interviewed. The interviews aimed to explore the participants’ experiences of working with students in PRU’s and examine some of the challenges that they might encounter. Semi-structured interviews were analysed using Reflexive thematic analysis. Results The three identified themes and their sub-themes highlighted the complex needs of these young people and identified significant barriers to effective service provision. The first theme ‘Complexities of PRU population’ highlighted the challenges that young people in PRUs face and perceived systemic short falls in addressing such complexity. The second theme ‘Challenges of the PRU environment’ highlights the frustrations that educators experience when it comes to providing adequate support to young people in PRU’s, the absence of agency support, and the uncertainty that these educational settings can bring. The third theme ‘Peer Group Influences’ highlights the impact of peer groups from beyond the classroom on engagement within the classroom. Conclusions Despite the clear complex needs of young people in PRUs, staff reported feeling ill-equipped to support these individuals and lacked access to effective inter-agency support. Participants reported that pupils’ mental health difficulties were exacerbated by exclusion and reintegration practices, an over-zealous focus on educational outcomes and the impact of gang influences on their school lives. Implications include more specific mental health training for staff working in PRU’s, improved inter-agency working and the incorporation of trauma-informed approaches in educational practice.

What makes a successful whole-school mental health intervention? A comparison of stakeholders’ perspectives and implications for schools and the future of English education

ABSTRACT This small-scale study compares stakeholders’ perspectives regarding what makes a successful whole-school Mental Health Intervention. Four study groups were included from an all-ability coeducational secondary school in south-east England: Students (n = 8), Teachers (n = 5), School-Leaders (n = 3), and YMCA Youth Workers (n = 3). Students took part in a focus group whereas the adult groups participated in semi-structured interviews. Subsequently, all participants ranked potential aspects of what might make a successful whole school Mental Health Intervention. No theme was mentioned consistently across the four groups, suggesting a diversity of perspectives regarding the benefits of Mental Health Interventions. All participants, except teachers, valued student involvement, a feature confirmed by the literature. Teachers occasionally adopted misinformed perspectives – arguably a result of insufficient training. Generally, participants’ job roles informed their responses. However, a loose trend existed whereby School-Leaders’ results were more aligned to an external charity association – the Young Men’s Christian Association (YMCA) – than Teachers’ despite the fact that the Teachers and School Leaders worked in the same context. Although the single context and small sample sizes for this research compromise generalisability, there are clear recommendations to inform future studies and for those who are leading and providing whole-school Mental Health Interventions. This study is set within the political and policy contexts of a competitive, market drive English education system and can comment on the wider system within which this intervention nests.

SP3.6 - Do non-colorectal surgeons produce an inferior lymph node yield in emergency colorectal cancer resections?

Abstract Introduction Lymph node yield is a surrogate indicator of adequate resection and yields of 20 or more have been shown to be associated with better survival outcomes. There is controversy as to whether colorectal cancers should be operated on by non-colorectal surgeons in the emergency setting. This study explores whether there are differences in lymph node yield between colorectal and non-colorectal surgeons in the context of emergency Hartmann's procedures performed for malignancy. Methods A retrospective study was conducted at a 3-site Trust in South East England between 2012 and 2022. Theatre and Info flex Cancer records were used to obtain patients who had undergone a Hartmann's procedure for malignancy and their operating surgeon. The histology reports were then reviewed and statistical analysis was undertaken. Results 346 patients were included in the study, in a 197:149 male-to-female ratio. The mean age was 73 (28-92 IQR). Histology confirmed malignancy in all the study participants. 11% (38/346) of the operations were conducted by non-colorectal surgeons (UGI, Breast, and Endocrine). The mean lymph node yield for the non-colorectal surgeons was 28 (24-33 IQR). The mean lymph node yield for colorectal surgeons was 29 (26-34 IQR). There was no statistical difference between the lymph node yield between colorectal and non-colorectal surgeons (p=0.671) Conclusion The study concluded that adequate oncological colonic resections could be conducted safely by non-colorectal surgeons in emergency settings.

FP3.15 - Are non-colorectal surgeons more likely to make a stoma in an emergency right hemicolectomy for cancer?

Abstract Introduction Right sided colonic cancers can often cause bowel obstruction and present as an emergency. The decision to perform an anastomois following a right hemicolectomy resection is frequently multifactorial. There is controversy as to whether colorectal cancers should be operated on by non-colorectal surgeons in the emergency setting. This study explores whether there are differences in stoma formation rates between colorectal and non-colorectal surgeons in the context of emergency right hemicolectomy operations performed for malignancy. Methods A retrospective study was conducted at a 3 site Trust in South East England between 2017 and 2022. Theatre and Infoflex Cancer records were used to obtain patients who had undergone an open right hemicolectomy for malignancy and their operating surgeon. Results There were 281 patients included in the study, in a 152:129 female:male ratio. The mean age was 68 (34-86 IQR). 13% (37/281) of operations were conducted by Upper Gastro-intestinal Surgeons. 54% (20/37) of these patients had stoma formation as part of their operation. 47% (115/244) of operations undertaken by colorectal surgeons also had stoma formation. There was no significant difference between the stoma formation between colorectal and non-colorectal surgeons (p=0.108) Conclusion The study shows that although the decision to form a stoma following a right hemicolectomy multifactorial and is dependent on a wealth of patient and operative factors, there is no statistical difference between colorectal and non-colorectal surgeons in the emergency setting.

FP7.13 - Is There A Difference In Anastomotic Leak Rates Requiring Re-Operation Following Emergency Right Hemicolectomy Between Colorectal And Non-Colorectal Surgeons?

Abstract Aim Right sided colonic cancers can often obstruct and present as an emergency. The decision to perform an anastomosis following the right hemicolectomy resection is often multifactorial. This study explores whether there are differences in leak rates between colorectal and non-colorectal surgeons in the context of emergency right hemicolectomy operations performed for malignancy. Methods A retrospective study was conducted at a 3-site Trust in South-East England between 2017 and 2022. Theatre and Infoflex Cancer records were used to obtain patients who had undergone an open right hemicolectomy for malignancy and their operating surgeon. Discharge summaries and clinic letters were then used to ascertain return to theatre for an anastomotic leak. Results There were 281 patients who had undergone an emergency right hemicolectomy in this time interval. There was a 152:129 female:male ratio. 17 out of 37 patients had an anastomosis undertaken by an Upper Gastrointestinal Surgeon. 2 out of the 17 (12%) had an anastomotic leak. 129 out of 244 had an anastomosis undertaken by a Colorectal Surgeon. 17 of the 129 (13%) had an anastomotic leak. There was no significant difference between the leak rates between colorectal and non-colorectal surgeons (p=0.888). Conclusion The study shows that there is no statistical difference in right hemicolectomy anastomotic leak rates between colorectal and non-colorectal surgeons in the emergency setting.

The UK: international child poverty outlier

ABSTRACT The UK has not only one of the highest rates of child poverty in the rich world, but also the most rapidly rising rate in this grouping. Within the UK, a higher proportion of children are poor in the South East of England than in Scotland. The huge rise in economic inequality in the 1980s caused the UK to become an international outlier in terms of child poverty. All subsequent UK governments have maintained inequality at high levels – by choice. The results are telling: children in England are, on average, becoming shorter in height and child death rates in England are rising, almost certainly due to rising poverty and destitution. As inequality rises poverty rises, but so too does ignorance of each other. Those who study human geography in the UK, if they went to university in recent years, are the least likely graduates to have ever been poor. Child poverty remains off our mental maps and largely outside of our geographical imaginations. That has to change.

Overcoming barriers to agri-environmental management at landscape scale: Balancing farmer coordination and collaboration with the aid of facilitators and pioneers

Policy instruments that integrate the actions of multiple farmers are of growing interest for improving landscape scale environmental sustainability of agriculture. We conducted in-depth, semi-structured interviews with farmers in south-east England and applied thematic analysis to the responses to perform a qualitative investigation into the combined role of economic, social, and cultural barriers to cooperative environmental management, and identify possible solutions for these barriers. Interviewees recognised environmental benefits of cooperative management, but this was a low priority compared to other management activities, being seen as complex and time-consuming, with uncertainty over direct benefits to participants. External coordination could address this by overseeing information sharing on cooperation benefits and minimising the logistical burden for participants, but given farmer mistrust of outside intervention, these projects will be more successful when collaborating farmers feel they are in control. The efforts of both pioneering farmers able to initiate projects with their peers, and respected facilitators who embody local knowledge and experience, will be vital for balancing coordination and collaboration. Finding the optimal balance between these different elements will vary with local circumstances: policy should have the flexibility to accommodate this. Farmers were wary of connecting with others possessing different farming ideals and thus having to compromise on their management approach. Some respondents sought to bridge these gaps by focusing on aspects of farming identities they shared with their peers, raising the possibility that support targeting these individuals will help develop relationships that foster lasting cultural change for farmer cooperative environmental management.

Characteristics of consumers of alcohol-free and low-alcohol drinks in Great Britain: A cross-sectional study.

The impact of alcohol-free and low-alcohol (no/lo) drinks on public health and health inequalities depends on who consumes them and how they are consumed. This study aimed to estimate: (i) the proportions of adults in Great Britain who consume no/lo drinks at different frequencies and in different settings; and (ii) the associations between no/lo drink consumption and individual characteristics. Pooled data (N = 7691) from four waves of a repeat cross-sectional survey on alcohol use completed in 2022-2023 by adults (16+) resident in Great Britain were analysed using descriptive statistics and logistic regression models. In all, 31.3% of adults reported ever consuming no/lo drinks and 9.8% reported drinking them weekly. Ever consumption of no/lo drinks was associated with: being an increasing risk drinker of alcohol relative to not drinking (ORadj: 3.96, 95% CI 3.27-4.80), being aged 16-24 compared with 65+ (ORadj:1.29, 95% CI 1.07-1.57), having previously smoked compared with having never smoked (ORadj:1.19, 95% CI 1.05-1.34) and living in a rural rather than urban area (ORadj:1.14, 95% CI 1.00-1.29). It was less likely among those in lower social grades or with lower educational qualifications; those living in Yorkshire and the Humber, and Scotland, compared with the South-East of England; and those using nicotine products. A third of adults in Great Britain have consumed no/lo drinks and approximately one in 10 do so weekly. Consumption is more common among riskier drinkers of alcohol and among more advantaged social groups, which may contribute to the sustaining or widening of health inequalities.

Socially Sustainable Mobility as a Service (MaaS): A practical MCDM framework to evaluate accessibility and inclusivity with application

Promoting socially sustainable mobility services for all social groups is one of the key elements for sustainable development according to the UN's sustainable development goals. Mobility as a Service (MaaS), a rapidly growing smart mobility concept, has the potential to achieve this goal. However, measuring societal impacts of MaaS considering vulnerable social groups' (elderly, disabled, low-income people) needs is still a question for scholars, practitioners, and policy makers. This paper presents a practical 3-stage framework to evaluate the accessibility and inclusion of MaaS systems based on a range of indicators, and a multi-criteria decision making (MCDM) method. A worldwide experts' view survey was conducted among transportation academics and practitioners with 105 valid responses to prioritise the main and sub-criteria in proving an accessible and inclusive MaaS system. The results of MCDM analysis show that accessible transport services, accessible MaaS platforms, and accessibility data collection have a share of 51 %, 29 %, and 20 %, respectively. The functionality of the proposed framework has been illustrated on a real-world multi-city MaaS implementation within the Solent area, in particular Portsmouth city located in Southeast England (UK). The policy recommendations proposed in this study shed light on guiding stakeholders and policymakers to select and implement an accessible and inclusive MaaS system.

VIVALDI ASCOT and Ethnography Study: protocol for a mixed-methods longitudinal study to evaluate the impact of COVID-19 and other respiratory infection outbreaks on care home residents’ quality of life and psychosocial well-being

IntroductionOlder adults in care homes experienced some of the highest rates of mortality from SARS-CoV-2 globally and were subjected to strict and lengthy non-pharmaceutical interventions, which severely impacted their daily...