Southwest England Research Articles

Evaluation of a new out-of-hospital newborn life support (OH-NLS) course in the UK South West region: a mixed-methods survey study

Introduction: Unplanned out-of-hospital births (UOHBs) are associated with poorer outcomes for babies, especially those born prematurely. The current Newborn Life Support (NLS) course offered by Resuscitation Council UK (RCUK) is not designed to address the challenges associated with birth out of hospital. A new course was developed to address these challenges. This study aimed to evaluate the impact of this course on attendees’ knowledge and confidence in supporting transition, resuscitation, stabilisation and onward transfer of newborns in an out-of-hospital setting.Methods: A convergent mixed-methods approach was used consisting of pre-, post- and follow-up surveys and a post-course multiple-choice questionnaire (MCQ). The surveys asked participants to rate their confidence, on a five-point Likert scale (from ‘Underconfident/fearful’ to ‘Very confident’) across seven domains of NLS, as well as making an individual assessment of provider confidence before and after the course. Free-text comments were collected and analysed using thematic analysis.Results: Attendees comprised multidisciplinary staff from the South West of England. The pre-course survey was completed by 32 of the 33 participants, the post-course survey by 31 and the MCQ by all 33. A total of 18 participants completed the follow-up survey. Analysis showed a significant, positive change in confidence across NLS domains between the pre- and post-course surveys (p <0.0001).The follow-up survey data showed self-reported increases in knowledge and largely sustained confidence. The qualitative analysis revealed themes relating to the participants’ feelings about managing babies born out of hospital.Conclusion: The proof-of-concept OH-NLS course appears to address the learning needs of the target professional group, and the results suggest improved knowledge and confidence in the immediate management of babies born out of hospital. Further evaluation is required to determine whether such training has a long-term impact and translates into improved outcomes across a larger group of participants.

The location of solar farms within England's ecological landscape: Implications for biodiversity conservation.

A global energy transition to using sustainable renewable sources is being driven by global agreements. Simultaneously there is a call for increased biodiversity conservation. This creates a green-green dilemma, where the expansion of renewables could lead to the demise of biodiversity if not carefully assessed, managed and monitored. Recognition of the dilemma is central to the development of Sustainable Development Goals. It is therefore important to understand whether renewable energy sources such as solar farms are being sited in areas where they have minimal impact on biodiversity. If solar farms were sited with minimal impacts on biodiversity, we hypothesised that they would be less likely to be sited close to ecologically sensitive areas than near random points. We used Geographic Information System methods to explore the density of solar photovoltaic (PV) farms in England and assessed their siting relative to sensitive ecological features, including priority habitat types, designated sites, and land conservation initiatives. We compared the area of 25 sensitive ecological features around solar farms and random points across three spatial scales (100m, 1000m, and 6000m radius scales). Solar farms were distributed throughout England, with the highest concentration in South West England. Solar sites were primarily surrounded by habitats with anthropogenic influences, such as agricultural and urban settings. Priority habitats, such as woodland, grassland, wetland and heathland, were more extensive around random points across spatial scales (except for woodland at the largest scale). Most designated sites were significantly more extensive around random points. We conclude that, under current planning regulations, solar sites in England are being placed appropriately with regard to sensitive ecological habitats, and are often sited in areas already impacted by farming and development. Adaptive planning should be implemented to ensure that the evolving research around biodiversity and solar farms is incorporated into decision making, and monitoring is completed across the lifespan of solar farms to assess impacts and effective mitigation.

Factors Influencing the Oral Health Behaviours of Autistic Children and Young People: A Qualitative Study.

Poor oral health (OH) in childhood can cause pain, affect quality of life and significantly impact adult OH. Autistic children and young people (CYP) experience inequalities in OH and are at higher risk of cavities and gum disease than neurotypical CYP. To provide evidence and insights into the factors affecting the OH behaviours of ACYP from the perspective of ACYP, their parents/carers and Dental Health Professionals (DHPs). Semi-structured online or face-to-face interviews were conducted with CYP, parents/carers and DHPs in Southwest England. Nineteen ACYP (aged 5-18 years old), 20 parents/carers and 16 DHPs were interviewed. The themes identified were as follows: Sensory sensitivities and diet; Toothbrushing 'battles'; Coping with the stresses of daily life in a neurotypical world; Awareness of autism and understanding of challenges to good OH; The impact on parents of trying to care their child's OH; CYP and parent/carers difficulties in obtaining OH support; What 'good support' looks like. An increased awareness among DHPs, health and social care professionals of autism and the challenges to OH that CYP face is needed. Providing early support, strategies and resources to CYP and their parents/carers has the potential to help establish positive OH behaviours. The research team worked closely with members of the autistic community on this project. The methods used in this project were developed together with a research advisory group which included four ACYP (aged 9-17) and their parents. The team also worked with members of a youth club for ACYP aged 10-17 years old. All research documents and materials were co-produced. Members of the advisory group (T.V. and I.V.) contributed to the interpretation of the research findings and the writing of this manuscript.

A multi-perspective qualitative exploration of the reasons for changes in the physical activity among 10–11-year-old children following the easing of the COVID-19 lockdown in the UK in 2021

Abstract Background Active-6 is exploring how the COVID-19 pandemic has impacted physical activity behaviour among Year 6 children (aged 10–11 years) and their parents in Southwest England. Initial findings from the Active-6 project have shown a 7–8 min decrease in moderate-to-vigorous physical activity and an increase in sedentary behaviour among children following the easing of restrictions in the UK in latter half of 2021. This finding suggests that the pandemic has had a persistent impact on child physical activity behaviour. This paper explored the possible mechanisms behind these changes. Methods Interviews with parents (n = 21), members of school staff (n = 9) and focus groups with children aged 10–11 years (n = 47) were conducted between August and December 2021 to discuss the impact of the pandemic on child physical activity behaviour. The framework method was used for analysis. Results Five themes spanning two key stages of the pandemic were described. Three themes related to the period of lockdowns and fluctuating restrictions (March 2020 – April 2021). These included: Theme 1) Lockdown: A short-lived adventure; Theme 2) Access to facilities during restrictions; and Theme 3) The importance of the parent. A further two themes were identified related to the period following the gradual easing of restrictions in April 2021. These included: Theme 4) An overwhelming return to normal; and Theme 5) Reopening fatigue. Conclusions The analysis suggested that feelings of novelty experienced during the initial stages of lockdown waned as restrictions were prolonged, creating an increasingly challenging period for parents and their children. However, during periods of restrictions, the importance of parental encouragement and access to appropriate facilities in the local and home environment helped facilitate physical activity. Following the easing of COVID-19 restrictions, emotional overwhelm and physical fatigue among children, stemming from a sedentary and socially isolated life in lockdown and other restrictions, were key contributors to the decreased moderate to vigorous physical activity and increased sedentary behaviour that was observed in a related quantitative study.

Outcomes of 584 cattle caesarean sections performed in a UK first opinion practice.

This retrospective cohort study evaluated 584 cattle caesarean sections (C-sections) performed at a first opinion practice in Southwest England between 2015 and 2021. Outcomes were recorded contemporaneously, and procedures were followed up after 14 days. Thirty-one dams died within 14 days of undergoing a C-section (94.7% survival rate). Dam parity and purpose did not significantly impact mortality. Dams were at 2.7 times greater odds of dying within 14 days if they delivered a stillborn calf (p < 0.05, 95% confidence interval [CI] = 1.20‒6.13), and at 2.9 times greater odds of dying within 14 days if they were recumbent for some, or all, of the C-section (p < 0.05, 95% CI = 1.02‒8.2). Among the 428 procedures where calf outcomes were recorded, 32.9% (n = 141) were stillborn, reflecting previous studies reporting perinatal mortality. Uterine torsion was anecdotally listed as the reason for operating in 34 cases, and 58.1% (n = 18) of these C-sections resulted in a dead calf. Despite the large number of cases studied, all C-sections were carried out by a single veterinary practice. Individual operator(s) and farms were not recorded and could be undetected confounding variables. This study's results provide much needed relevant benchmarking for completing in-house practice audit cycles, ensuring improved clinical governance and outcomes.

Exploring the possibility of university students as charity trustees

The aim of this study is to examine the viewpoint of charities, as to how receptive they might be to having a university student on their board of trustees. A questionnaire was sent to charities in the South-West of England. 154 responses were received. 63% of respondents currently have vacancies for trustees. There is a heightened awareness among respondents of the importance of diversity of boards and a high level of interest in exploring whether, and how, students could be recruited as trustees. This paper extends previous work in exploring whether charities would be receptive to having a university student on their boards and raises awareness of one possible route that charities might pursue to increase the number and diversity of trustees.

The Genomic Signature and Transcriptional Response of Metal Tolerance in Brown Trout Inhabiting Metal-Polluted Rivers.

Industrial pollution is a major driver of ecosystem degradation, but it can also act as a driver of contemporary evolution. As a result of intense mining activity during the Industrial Revolution, several rivers across the southwest of England are polluted with high concentrations of metals. Despite the documented negative impacts of ongoing metal pollution, brown trout (Salmo trutta L.) survive and thrive in many of these metal-impacted rivers. We used population genomics, transcriptomics, and metal burdens to investigate the genomic and transcriptomic signatures of potential metal tolerance. RADseq analysis of six populations (originating from three metal-impacted and three control rivers) revealed strong genetic substructuring between impacted and control populations. We identified selection signatures at 122 loci, including genes related to metal homeostasis and oxidative stress. Trout sampled from metal-impacted rivers exhibited significantly higher tissue concentrations of cadmium, copper, nickel and zinc, which remained elevated after 11 days in metal-free water. After depuration, we used RNAseq to quantify gene expression differences between metal-impacted and control trout, identifying 2042 differentially expressed genes (DEGs) in the gill, and 311 DEGs in the liver. Transcriptomic signatures in the gill were enriched for genes involved in ion transport processes, metal homeostasis, oxidative stress, hypoxia, and response to xenobiotics. Our findings reveal shared genomic and transcriptomic pathways involved in detoxification, oxidative stress responses and ion regulation. Overall, our results demonstrate the diverse effects of metal pollution in shaping both neutral and adaptive genetic variation, whilst also highlighting the potential role of constitutive gene expression in promoting metal tolerance.

How Did Rituals Change with the Changing Ritual Places During the Second Millennium BC in Southwest England?

This study explores the transformation of ritual spaces in southwest England during the second millennium BC, focusing on the transition from monumental structures to residential settlements. Initially, ritual activities predominantly occurred within barrows and ring-cairns. By the Middle Bronze Age, however, these activities shifted towards houses and settlements, reflecting broader changes in architectural practices and social dynamics. This research examines the implications of these shifts through archaeological findings and literature review, highlighting how rituals became integrated into daily domestic spaces and the continuity of ritual practices through the reconfiguration of abandoned settlements into monument-like structures. The findings suggest that the evolution of ritual spaces was closely tied to the socio-spiritual landscape of the community, revealing significant insights into the cultural and social dynamics of prehistoric Europe.

Nature-based approaches: a mixed methods study of facilitators and barriers to implementation in CAMHS

BackgroundThere is growing evidence that spending time with or in nature can be beneficial for health and wellbeing. Emerging evidence suggests potential benefits for staff and service users in healthcare settings, yet little is known about how to put Nature-based approaches (NBAs) into practice within the Child and Adolescent Mental Health Services (CAMHS) setting. The CAMHS Goes Wild project in Southwest England aimed to explore the implementation of NBAs within CAMHS, examining staff attitudes and understanding to identify potential benefits and challenges through a mixed methods study.MethodsThe study involved three phases of data collection: an online survey with two waves, the first wave prior to the training, and the second four months post-training, and semi-structured interviews. Data collection was designed to fit around NatureWell training, attended by sixty-four CAMHS staff, which took place alongside the study. All participants were sampled from one NHS Trust and the study was open to both those who had attended the NatureWell training and those who had not. Data were synthesised to produce an understanding of staff attitudes towards NBAs and perceived barriers and facilitators to the implementation of this approach.ResultsNinety-seven staff responded to the wave 1 survey and 57 responded to the wave 2 survey. Fourteen staff members were interviewed. Data synthesis generated three themes: Tension between the culture of CAMHS and NBAs (Theme 1) and the need for buy-in and governance support (Theme 2). Theme three described the potential benefits of NBAs for staff and service users in CAMHS and is presented in a separate paper. The first two themes are presented in this paper.ConclusionsThe implementation of NBAs in mental health service settings for CYP presents both significant challenges and opportunities. Our findings suggest multiple barriers to implementation, often in the form of organisational or cultural factors, such as the risk averse nature of the service. Our work also elucidates several potential facilitators which may address or mitigate some of these barriers. These potential enablers, such as harnessing the role of firsthand experience, warrant further exploration in the implementation of NBAs in CAMHS.

Primary School Pupils' Perceptions and Experiences of Wearable Technologies.

Wearable technologies offer new opportunities to address in-school physical inactivity. However, children are often excluded from discussing issues which directly impact them, including the use of wearable technologies in a school setting. Thus, the aim of this study is to understand primary school pupils' experiences and perceptions of using wearable physical activity monitoring technologies within schools. Nine semi-structured focus groups were conducted with 41 Year 5 and 6 pupils (19 girls, 22 boys) from 5 primary schools in the South West of England. Focus group transcripts were analyzed using a reflective thematic approach. Pupils made valuable contributions to discussions around wearable technologies, considering both advantages and disadvantages. Most importantly, when discussing use in schools, pupils were mindful that while they wanted to see their own activity and saw benefit in teachers knowing their activity, they felt comparisons in classes could lead to negative emotions for some pupils. The findings from this study can contribute to a more detailed understanding of pupils' perspectives, which can help inform school-based interventions which aim to address physical inactivity and associated inequalities. Instead of using wearable devices for individual pupil ownership, schools should access data-insights with the intention of changing school practices.

Sexual experiences and behaviours of the parents in the Avon Longitudinal Study of Parents and Childhood (ALSPAC)

The aim of this data note is to describe the sexual experiences, functioning and behaviour data collected from the parent cohorts of the Avon Longitudinal Study of Parents and Children (ALSPAC) occurring during their childhoods and up to 19 years after the birth of the index child. ALSPAC is an ongoing birth cohort which enrolled 14,541 pregnant women living in Avon, an area of southwest England, with expected dates of delivery between April 1991 and December 1992 inclusive. It continues collecting data on these mothers (age range at delivery &lt;16–41 years), their partners (age range at delivery &lt;16–65), and their offspring, so far resulting in 100,000+ phenotype variables. During the index pregnancy the mothers were asked (and at 8 months post-delivery for partners) about their early sexual experiences to identify sexual abuse, the age at which an event first occurred, along with the type of perpetrator (e.g. stranger, relatives, boy/girlfriend). There are also data on these parents’ experiences of sexual assault as adults. Both parents were asked also about sexual abuse within a battery of questions identifying Adverse Childhood Events (ACEs). Further longitudinal data described here includes satisfaction with sexual and non-sexual sides of their relationship; sexual functioning; and at seven years post-delivery, both parents were asked to describe their sexual orientation as well as the sex of their partners. These data provide the ability to compare generational differences between parental sexual experiences and behaviours with those of their offspring, as well as allowing comparisons with other longitudinal surveys where similar (or identical) information has been collected such as the National Survey of Sexual Attitudes and Lifestyles (NATSAL-3). This paper forms a companion to a further data note describing similar data collected on the offspring cohort.

Understanding the risk factors for student attrition across pre-registration nursing and midwifery programmes in a United Kingdom university: A sequential explanatory mixed methods study

BackgroundThe World Health Organization estimates a global shortage of 4.5 million nurses and 0.31 million midwives by 2030, which presents a significant problem for workforce planning. Despite aspirational United Kingdom (UK) government policy targets and ongoing efforts, the number of nursing and midwifery vacancies continues to increase. One contributing factor is student nurse and midwife attrition.AimTo identify risk factors that contribute to nursing and midwifery students interrupting or withdrawing from pre-registration programmes. DesignSequential explanatory mixed-methods design. SettingA University School of Nursing and Midwifery in the Southwest of England. Participants534 pre-registration nursing and midwifery student survey respondents and 8 focus group participants. MethodsStudents' perspectives of attrition risk factors were evaluated using a Likert scale with free text questions used to capture additional factors affecting interruption or withdrawal. Students were also invited to take part in focus group discussions. Survey data were coded and analysed utilising SPSS (Version 25) software. Survey free text narrative and focus group data were analysed using reflexive thematic analysis. ResultsSurvey results revealed 55 students had interrupted and returned and 281 students had considered leaving or interrupting their programme. Survey descriptive statistics data were grouped into top attrition risk factors. Free text narratives and focus group data identified four themes: multiple and overlapping challenges; the threats and opportunities of clinical placements; the availability of the right support at the right time and investing for a better future for myself and others. ConclusionNursing and Midwifery students reported challenges across their pre-registration programmes resulting in risk factors that might lead to students interrupting or withdrawing. Optimal cooperation between higher education institutions (HEI) and clinical stakeholders is of paramount importance to address these challenges as is government and Nursing and Midwifery Council (NMC) acknowledgement and consideration of the identified risks linked to attrition; specifically relating to national funding arrangements and the clinical practice hours required for registration within the UK. This may also resonate with professional programmes internationally, faced with similar staffing shortages.

Untangling Circularity: Transitioning to a Regional Circular Economy in the Clothing and Textile Sector in England

The transition to a Circular Economy (CE) presents a paradigm shift, emphasizing sustainability, resource efficiency, and waste reduction. The existing literature extensively covers the principles and benefits of CE, but there is a notable gap in understanding how these practices are implemented at a local level. Specifically, there is a lack of detailed insights into the localized challenges, adaptation processes, and contextual factors influencing the adoption of circular practices. Additionally, the implications for different types of stakeholders and the effectiveness of localized strategies remain underexplored. By employing causal loop diagrams to depict system dynamics, interactions, and connections inherent in the transition to a CE, this research delves into the significance of understanding the complexities of circularity within a specific localized context. We draw qualitative data from semi-structured interviews and workshops with participants from key stakeholders within the textile and clothing sector in the Southwest of England. We find that legislation has a different impact on multinational corporations (MNCs) and small and medium-sized enterprises (SMEs) in their CE engagement. We also find that, while the flow of materials from MNCs to SMEs fosters regional innovation and knowledge-sharing, it does not always facilitate inter-organizational learning. Finally, both MNCs and SMEs recognize the CE’s potential for job creation, which highlights the need for more effective knowledge exchange strategies between businesses of different sizes. The study concludes that balancing CE principles with profit-driven pressures remains a significant challenge for both those founded on circular principles and those who are gradually incorporating CE principles into their organisation.

A new procolophonid with complex dentition from the Late Triassic of southwest England

AbstractFissure fill deposits from the Late Triassic to Early Jurassic of England and Wales preserve a diverse small tetrapod fauna including procolophonids, an important group of Permian and Triassic parareptiles that radiated across Pangaea following the end‐Permian extinction event. Procolophonids are currently known from two fissure fill sites: incomplete and isolated remains from Ruthin Quarry (Wales) and type and referred material of Hwiccewyrm trispiculum from Cromhall Quarry (southwest England). The age of the Cromhall fissure deposits has been debated but recent radiometric dating suggests a Carnian age for at least some of the fossil assemblages. Here, we present material from several fissure assemblages at Cromhall, which are interpreted as stratigraphically older than the assemblage that yielded Hwiccewyrm. We describe a new species of leptopleuronine procolophonid based on partial remains with unique tooth morphology. Threordatoth chasmatos gen. et sp. nov. is characterized by maxillae with a reduced number of complex tricuspid teeth along with dentaries that bear labiolingually compressed monocuspid teeth and in some cases have a peculiar edentulous tip. These distinct tooth morphologies occlude closely, perhaps facilitated by a flexible dentary symphyseal connection. This unique combination of characters may suggest a high degree of oral food processing of a mode unlike other procolophonids, occurring among the broader leptopleuronine adaptation towards diets of high‐fibre herbivory/omnivory and insectivory. Phylogenetic analysis places the remains of Threordatoth as a derived leptopleuronine, sister taxon to Hwiccewyrm, in a clade with taxa including Soturnia, Hypsognathus, Libognathus and two unnamed leptopleuronines from the southwest USA.

A practical risk score for prediction of 6-month mortality in patients with acute heart failure: CHAM2P2

Abstract Background Admission with acute heart failure carries a poor prognosis. Multiple predictive risk scores exist in heart failure presentation, however the utility of these scores in acute heart failure setting among older adults is limited. Aim The purpose of this study was to develop a practical risk score to predict 6-month mortality in patients presenting with acute heart failure. Methods Between January-August 2020, 474 consecutive patients (mean age 80 ± 11 years) admitted with acute heart failure to a large tertiary hospital in the South-West of England were identified. Data was retrospectively collected on admission bloods, comorbidities, imaging, echocardiography and post discharge mortality. Prediction modelling with multivariate Cox regression was then used to identify clinically relevant predictors of six-month mortality. Continuous variables were dichotomised around the mean/median for simplification. Variables were assigned points proportional to hazard ratios on Cox regression. Results Mortality at six months was 34% (161/474). Cox regression identified five significant (p&amp;lt;0.05) predictors of mortality: C: Clinical Frailty Score&amp;gt;5, H: hospital stay &amp;gt;10 days, A: age &amp;gt;80yrs, M: malignancy (current or previous) history and P: NT pro-BNP&amp;gt;4500pg/ml. In our final model, malignancy and NT pro-BNP were assigned two points with the remainder being assigned one. In total, 304 patients had data available to generate CHAM2P2 scores. Mortality increased sequentially from 16.0% in patients with CHAM2P2 0-2, 44.4% in patients with CHAM2P2 scores of 3-5 and 94.1% in patients with CHAM2P2 scores of 6 or 7 (log rank &amp;lt;0.01). AUC demonstrated good discriminatory value of the CHAM2P2 score in predicting six-month mortality (AUC 0.74). Conclusion The CHAM2P2 score is a readily available and simple tool to predict 6-month mortality in patients admitted with acute heart failure.

An evaluation of oral surgery referrals to aid development of an integrated service in South West England.

Introduction The number of oral surgery referrals from primary to secondary care has increased, resulting in longer waiting times. A study suggests two-thirds of patients referred to secondary care for oral surgery could be treated by dentists with enhanced skills.Aims To help inform the development of an integrated oral surgery service in South West England by assessing the proportion of inappropriate referrals to Bristol Dental Hospital.Methods A total of 100 non-consecutive written referrals to oral surgery were analysed. Multiple variables were collected, including the complexity of the treatment requested (Level 1, 2 or 3) and patient and referrer locations.Results In total, 94 referrals were included in the analysis: 17% were Level 1 complexity, 35% Level 2, and 48% Level 3. Additionally, 17% of referrals were inappropriate. Almost half (52%) (Levels 1 and 2) could have been treated in primary care. Many referrals had missing clinical details or unacceptable-quality radiographs.Conclusion An effective integrated oral surgery managed clinical network in South West England could reduce waiting times in secondary care and potentially improve patient experience. An electronic referral management system could also improve the quality of referral information.

Predicting pharmaceutical concentrations and assessing risks in the aquatic environment using PERK: A case study of a catchment area in South-West England

The aim of this study was to introduce a model to predict pharmaceuticals concentrations in the aquatic environment and their environmental impacts using the Risk Quotient (RQ) approach. The model was trained using: (i) high resolution dataset on pharmaceuticals’ concentration in wastewater and receiving environment in a river catchment, (ii) understanding of pharmaceuticals’ discharge points in the catchment, (iii) fate of pharmaceuticals during wastewater treatment and in the receiving environment, (iv) high resolution per-postcode pharmaceutical prescription data. A total of 41 pharmaceuticals were evaluated, with successful predictions achieved for concentrations falling within the range of 0.7 (influent: 37 %, effluent: 39 %, river: 29 %) to 1 % (influent: 56 %, effluent: 58 %, river: 48 %) of the measured values. Importantly, our risk assessment demonstrates significant environmental risks associated with specific pharmaceuticals, with strong alignment (86 %) between assessments based on predicted and measured data, underscoring the reliability of our model in assessing environmental risks. The observed variability in predicted and measured concentrations underscores the necessity for ongoing model refinement, particularly in regions with notable discrepancies such as wastewater treatment plant (WWTP) C. Overall, our study illustrates the intricate dynamics of pharmaceutical contamination in aquatic ecosystems, emphasizing the crucial need for continued research in this field.

Personal care products use during SARS-CoV-2 pandemic: Environmental and public health impact assessment using wastewater-based epidemiology

The recent SARS-CoV-2 pandemic had profound consequences on people's wellbeing, societies and economy worldwide. This manuscript discusses public exposure to chemicals of concern in personal care products (parabens and benzophenones) during SARS-CoV-2 pandemic. These were monitored for two years in four catchments (two cities and two towns) in South West England accounting for >1 million people. Results showed slightly higher usage of personal care products in small towns than big cities. Major changes in usage of parabens (p values < 0.05) were observed during national lockdowns (NLs). This is likely due to increased awareness towards personal hygiene. In contrast, benzophenones showed seasonal trends; there were higher correlations with sunshine prevalence and temperature rather than NLs reflecting their usage in sunscreen products. Estimation of per capita intake of parabens and benzophenones using WBE revealed lower intake than the Acceptable Daily Intake (ADI) established by the EFSA; however, the metabolism factor used was considered putative due to the lack of pharmacokinetic studies. Prediction of environmental exposure revealed peaks of higher impact during NLs and first year of pandemic, nevertheless the overall predicted values were below Predicted No Effect Concentrations (PNEC).

A qualitative study exploring the experiences of advanced clinical practitioner training in emergency care in the South West of England, United Kingdom

BackgroundAttempting to improve emergency care (EC) advanced clinical practitioner (ACP) training, Health Education England (HEE) South West (SW) implemented a pilot, whereby emergency departments (ED) were provided with enhanced funding...

Comparison of manual and automated body condition scoring of commercial dairy cattle.

Body condition scoring of dairy cows estimates their body reserves. Automation allows increased data availability and reduced labour costs. The aim of this study was to compare an automated (AUT) body condition score (BCS) system to manual observers on a single commercial dairy farm in south-west England. Three practising veterinary surgeons performed body condition scoring of 315 dairy cows using the agriculture and horticulture development board (AHDB) Body Condition Scorecard. AUT BCSs were obtained from two 3D cameras and compared to the BCSs recorded by the three operators. The AUT system only agreed with manual scorers at a BCS of 3. The system failed to detect cows classified as underconditioned (BCS ≤ 2.25) by any of the operators (sensitivity 0%). It also systematically underestimated the BCS of cows classified as overconditioned (BCS ≥ 3.5) by the operators. For overconditioned cows, the sensitivity of the AUT system ranged from 30.7% to 48.8% when compared with the manual operators. The AUT system also had weaker agreement with operators for Jersey cows, with Cohen's weighted kappa values of 0.28 for Jersey animals and 0.40 for Holsteins. This study used a convenience sample of animals on a single farmat a single time point, so the extent to which the findings can be more widely generalised is unclear. The AUT system failed to detect animals classified as underconditioned by the operators and underestimated the condition of cows classified as overconditioned by the operators. Currently, without improvements to the algorithm, the clinical usefulness of such an AUT system for body condition scoring is limited.