Search Results (392)

Background: Iron deficiency (ID) is common among people with chronic kidney disease (CKD) and/or heart failure (HF). Despite the additional burden ID causes among people with CKD and HF, there is considerable uncertainty surrounding the best way to diagnose it and, subsequently, identify who is most likely to benefit from receiving iron therapy. Methods: This manuscript reports the markers and thresholds used in ID diagnosis, treatment, and management in the UK by nephrologists and cardiologists who manage people with chronic kidney disease or heart failure, as well as investigating future challenges and questions that remain unanswered. The research involved three stages: an online questionnaire, individual interviews, and a panel meeting, which discussed the findings from the first two stages. Results: The panel concluded that there is no robust definition of iron deficiency that can be applied to chronic kidney disease and heart failure. Existing methods of diagnosing iron deficiency come with various problems; a transferrin saturation of <20% is the most popular, but it is not regarded as a perfect solution. Transferrin saturation is also the most popular way of assessing the success of iron deficiency treatment. Clinicians generally do not vary treatment regimens based on severity or subgroups. There are large variations in monitoring and the ability to administer iron therapy in secondary care. Conclusions: There is a clear need to consolidate current approaches to diagnosing and treating iron deficiency in people with chronic kidney disease and/or heart failure. Simple markers and thresholds, and simple strategies to implement them are required. Full article

There is great interest in school leadership models, with their potential to explain and interpret leadership structures and processes. Models developed in the Global North, notably in the UK and USA, are now widely cited by scholars, policy-makers, and practitioners in many countries, including in the Global South. This article reviews the origins and development of these models, and their application in African and Asian contexts. It also examines the emergence of indigenous models, notably Ubuntu, Confucianism, and Islamic theory. The problem under scrutiny is why indigenous models appear to be neglected in the Global South, in favour of international models. These specific approaches are chosen because they have wide applicability, beyond nation-states. The paper stresses the importance of context and offers links between global and indigenous models. The topic is important and relevant given the growing concern about post-colonial influences in many Global South countries. Full article

Species of the genus Phytophthora are among the most detrimental plant pathogens globally, representing a significant threat to global agriculture, horticulture, and forestry. These zoosporic oomycetes have historically caused devastating outbreaks, including, just to mention a few, late blight of potato in Ireland; jarrah dieback of eucalyptus in Western Australia; ink disease of chestnut in Europe; sudden oak death and sudden larch death of coast live oak and tanoak in the Western US, and of Japanese larch in the UK. The environmental and ecological impacts of the diseases they cause result in significant economic costs that often have social repercussions. With the acceleration of globalization, enhancing the movement of plant material, in particular with the global live plant trade, the spread of Phytophthora to new, uncontaminated territories has intensified. Nurseries play a key role in the movement of these pathogens, the trade of contaminated stocks representing their major dissemination route. However valuable, conventional detection techniques, including baiting and direct isolation, are too slow and labour-intensive to meet current diagnostic requirements, particularly given the huge volumes of plants traded globally. This problem becomes even more acute when large volumes of potentially infectious plant material need to be processed in a short time frame, as it is often necessary to provide accurate and timely responses to interested parties. Early and precise detection is thus vital to avert outbreaks and mitigate long-term consequences. This review evaluates and contrasts the efficacy of novel detection methods against traditional approaches, emphasizing their significance in managing the escalating threat posed by Phytophthora spp. worldwide. Despite technological advances, critical challenges remain that limit the reliability and large-scale adoption of new diagnostic methods. Research still needs to bridge the gap between the laboratory and the field in terms of accuracy, sensitivity and diagnostic costs. Recent innovations focus on sensor technology and point-of-care (POC) devices for faster, more sensitive, and low-cost specific detection of Phytophthora spp. in plant matrices, water and soil. Enhancing diagnostic capabilities through these tools is crucial for protecting agricultural productivity, local economies, and natural ecosystems. Full article

Studies on links between Oral Health-Related Quality of Life (OHRQoL) and use of dental services among UK children are lacking. This study aimed to assess the relationship between OHRQoL and dental attendance in 12- and 15-year-old children in the UK using secondary data from the UK Child Dental Health Survey (CDHS, 2013). Methods: OHRQoL was measured as the exposure using the Child-OIDP (Oral Impacts on Daily Performances), and dental attendance was the outcome in this analysis. Dental attendance was measured by asking children whether they visited the dentist regularly, only when in trouble, or never. Logistic regression models analysed the relationship between OHRQoL and dental attendance accounting for potential confounding factors such as socio-demographic characteristics, health behaviours, and anxiety. Results: Data from 4136 children aged 12 and 15 years found that the prevalence of dental attendance ‘only when in trouble or never’ was 20.5% among children who reported at least one impact, compared to 13.6% among children reporting no impacts. A social gradient was apparent, as 28% of children living in deprived areas exhibited problem-oriented dental attendance compared with 8.6% in affluent areas. Logistic regression unadjusted estimates of children who reported at least one impact on QoL had 1.64 times greater likelihood of visiting the dentist ‘only when in trouble or never’ compared to children reporting no impacts (OR: 1.64, 95%CI: 1.24, 2.17). Adjusting for confounders reduced this to OR 1.39 (95% CI: 1.10, 1.77). Furthermore, the greater the number of negative impacts that were reported, the higher the odds of visiting a ‘dentist only when in trouble or never’. In the fully adjusted model, children who reported either two or more impacts had higher odds of visiting the dentist ‘only when in trouble’. Children who reported only one impact were as likely to seek dental treatment ‘only when in trouble’ as children reporting no impacts. Conclusions: Both poorer OHRQoL and problem-oriented attendance were more evident in children from lower-socio-economic backgrounds. Barriers to regular dental attendance affecting children from disadvantaged backgrounds should be addressed and dental care prioritised. Full article

Firefighters are exposed not only to predictable fire effluents and fuels released during combustion, but also to novel man-made chemicals intentionally added to consumer products. In this paper, policies, processes and regulations adopted to recognize the diseases created by these hazards within the UK and internationally are examined and the problems and solutions illustrated. Diseases include but are not restricted to occupational cancers. Many diseases remain unrecognized in the UK industrial disease prescription system and may not have been detected because of a lack of health surveillance and screening. Hence, assessing the impact of firefighters’ exposures requires active surveillance for the expected and the unexpected. Comprehensive health monitoring and health surveillance with a preventive focus is needed. The broadest range of available tools should be considered to better establish exposures and their consequences, including risks to both male and female firefighters. The paper identifies some recent positive global approaches to firefighter health surveillance, monitoring and disease recognition that could and should be adopted in the UK. Full article

Housing stock is observed to be associated with high carbon emissions, high fuel poverty and low comfort levels in the UK. Retrofitting the housing stock is one of the best solutions to address these problems. This paper directly corresponds with human and planetary health in terms of climate change, human health and mental health by addressing the challenges of housing retrofit at scale. Retrofitting houses can also contribute to social equity, reduced use of planetary resources and better financial and physical comfort. Despite the availability of the right technology, government grants and the potential to acquire supply chain and skilled labour, the progress of retrofit is extremely poor. Importantly, the UK is off track to achieve net zero by 2050, and the housing stock contributes 18.72% of the total emissions. The problem is further exacerbated by the 30.4 million units of housing stock. Robust strategies are required to retrofit the housing stock at scale. The study uses a qualitative modelling method under the diffusion of innovations theory to formulate a retrofit-at-scale strategy for the UK. Findings recommend focusing on skill development, show homes, research and innovation, supply chain development, business models, government grants and regulatory tools in a trajectory from 2025 to 2050. The proposed strategy is aligned with the segments of the diffusion of innovation theory. Although the analysis was performed with reference to the UK, the findings are transferable, considering the broader and urgent concerns related to human and planetary health. Full article

Lean implementations often deploy tools in isolation, leaving gaps in how abnormalities are exposed, resolved at the root cause, escalated when needed, and converted into organisational learning. This study proposes a five-stage closed-loop routine for daily factory management that integrates problem visibility, standardised shop-floor cadence, disciplined problem-solving, and tiered escalation within a single operating logic. The novelty lies not in the individual Lean tools, but in the specification of cadence, triggers, accountable roles, and verification steps that connect them into a replicable end-to-end routine. The model was evaluated through a 19-month longitudinal, single-site field intervention (quasi-experimental before–and–after) on the bottleneck production line of a pharmaceutical plant in Hengoed, Wales (UK). Line OEE increased by over 50% in relative terms. At factory level, total output increased by 20% year-on-year in 2024 (context indicator), alongside qualitative field observations of shorter time-to-resolution and improved cross-functional coordination. As a single-site study, external validity is context-dependent; nevertheless, the paper provides a specified closed-loop routine and field evidence on the operational effects of embedding an integrated Lean cycle into daily management. Practically, the study provides a specified routine that practitioners can replicate and adapt; academically, it contributes to Lean implementation research by showing how tool bundles can be operationalised as an end-to-end daily management routine with observable performance effects. Full article

Transnational higher education programs in engineering face persistent challenges in sustaining student motivation, engagement, and learning outcomes. Cultural norms, linguistic barriers, and traditional pedagogies often reinforce teacher-centred instruction, limiting active participation. This mixed-methods action research investigates how problem-based learning (PBL) supported by interactive handouts affects students’ motivation, engagement, and perceived learning outcomes in civil engineering programs, delivered in a Sino–UK university context. Drawing upon socio-cultural constructivism, Self-Determination Theory (SDT), and the multidimensional framework of student engagement, the study repositions motivation and engagement as central drivers of learning. Quantitative data from student surveys (N = 49) and qualitative responses from open-ended questions were analysed to identify patterns of perceived improvement and underlying mechanisms. Findings reveal that the scaffolded PBL and interactive tasks enhanced students’ intrinsic motivation, collaborative engagement, and self-reported understanding of key concepts. Students described the activities as “more interesting,” “interactive,” and “helpful for exam preparation.” In total, 92% agreed that the handouts improved their understanding of core concepts, while 78% of students reported being more motivated to participate in class, and 92% of students expressed that the handouts enhanced the learning environment. While self-reported perceptions limit causal claims, the findings contribute to a growing body of evidence advocating for learner-centred, motivationally informed pedagogies in transnational engineering education. Full article

Background: Foster children exhibit higher rates of psychiatric and physical disorders than children living with their biological families. This places a high burden on the parenting skills of foster parents and potentially increases the risk of placement failure. One possibility to increase foster carers’ parenting skills and to reduce child problems is through parent training. In this study, the feasibility and effectiveness of the German-translated version of Fostering Changes, a parent training programme for foster parents, was investigated. The aims of Fostering Changes are the reduction in child behavioural problems, supporting children’s affect regulation, and improving the quality of the foster parent–child relationship through the promotion of foster parents’ sensitivity and parenting skills. Methods: We conducted six Fostering Changes courses in 2022 and 2023, with a total of 33 foster carers (i.e., foster parents) participating. Child behavioural problems (Carer-Defined Problems Scale; primary outcome), child psychopathology (Strengths and Difficulties Questionnaire), carer–child relationship quality (Child Relationship Behavior Inventory, Quality of Attachment Relationship Questionnaire), foster carers’ stress (Parental Stress Scale), and foster carers’ parenting strategies (Parenting Scale) were assessed at the start (t0) and end of each course (t1) and three months after course completion (t2). To examine the effect of training participation, mixed linear models and generalised estimating equations were applied. Additionally, effect sizes (Cohen’s d) were calculated. Results: When comparing t0 with t1 scores, there was a significant reduction in child behavioural problems (d = 1.87) and child psychopathology (d = 0.70), and improvement in foster carers’ parenting skills (d = 0.76) and the quality of the foster parent–child relationship (CRBI: d = 0.77, QUARQ: d = 0.72). Effect sizes for changes in the abovementioned variables between t0 and t2 were also moderate to large, with the exception of child psychopathology (d = 0.44). Conclusions: The results of this feasibility study, which is the first trial of Fostering Changes outside the UK, suggest that the German version of Fostering Changes could be an effective intervention for foster families. The largely comparable results for the periods t0–t1 and t0–t2 suggest constancy of the observed changes three months after course completion. Trial registration: DRKS-ID: DRKS00029014; date of registration: 23 May 2022. Full article

The United Kingdom’s (UK) retrofit revolution is at a crossroads and the efficacy of retrofit interventions is not solely a function of insulation thickness. To truly slash emissions and lift households out of fuel poverty, we must solve the persistent problem of thermal bridging (TB), i.e., the hidden flaws that cause heat to escape, dampness to form, and well-intentioned retrofits to fail. This review moves beyond basic principles to spotlight the emerging tools and transformative strategies to make a difference. We explore the role of advanced modelling techniques, including finite element analysis (FEA), in pinpointing thermal and moisture-related risks, and how emerging materials like vacuum-insulated panels (VIPs) offer high-performance solutions in tight spaces. Crucially, we demonstrate how an integrated fabric-first approach, guided by standards like PAS 2035, is essential to manage moisture, ensure durability, and deliver the comfortable, low-energy homes the UK desperately needs. Therefore, achieving net-zero targets is critically dependent on the systematic upgrade of the building envelope, with the mitigation of TB representing a fundamental prerequisite. The EnerPHit approach applies a rigorous fabric-first methodology to eliminate TB and significantly reduce the building’s overall heat demand. This reduction enables the use of a compact heating system that can be efficiently powered by renewable energy sources, such as solar photovoltaic (PV). Moreover, this review employs a systematic literature synthesis to critically evaluate the integration of TB mitigation within the PAS 2035 framework, identifying key technical interdependencies and research gaps in whole-house retrofit methodology. This article provides a comprehensive review of established FEA modelling methodologies, rather than presenting results from original simulations. Full article

(1) Background: Medication shortages have become increasingly common in the UK. However, there is limited evidence regarding the experiences of people with epilepsy and their caregivers during these shortages. The aim of this study is to explore the extent and impact of ASM shortages on people with epilepsy and their caregivers across the UK. (2) Methods: A cross-sectional online survey was distributed between January and April, 2024 by epilepsy charities. Participants included people with epilepsy and caregivers. The survey collected demographic information, types of ASM respondents were prescribed, experiences of shortages, and the impact of shortages. Data were analysed descriptively, and subgroup analyses were conducted by medication type. (3) Results: A total of 1549 responded, of whom 1312 were people with epilepsy and their carers who were included in the analysis with a mean age of 43 years. A total of 941 respondents (71.7%) reported difficulty obtaining their prescribed ASM in the past year. Shortages were most frequently reported for sodium valproate (60.8%), lamotrigine (65.2%), carbamazepine (92.6%), clobazam (82.6%), topiramate (81.5%), zonisamide (74.0%), levetiracetam (62.8%), lacosamide (71.0%), and brivaracetam (70.5%). A total of 529 (40.4%) of the participants reported that stress and/or anxiety caused by medication shortages was associated with recurrent seizures. We did not ask whether patients missed medications because of these difficulties. (4) Conclusions: ASM shortages are a widespread issue for people with epilepsy in the UK, leading to treatment disruptions and psychological distress. Addressing supply change limitations and identifying effective approaches to preventing the substitution of ASMs brands by clinicians may potentially reduce this problem. Full article

The research aims to evaluate financial instruments on household uptake of energy efficiency and renewable energy towards different risk scenarios. The study addresses the problem of behavioral response to financial incentives when technological, financial, or institutional risks are perceived as continuous. Two sophisticated models were used for the analysis to quantify the effect of subsidies, green loans, personal income, energy costs, and governmental support for energy efficiency and renewable energy uptake. The research data came from the UK, Estonia, Germany, Poland, and Ukraine between 2022 and 2024. The results suggest that countries experiencing drops in risk indices with strong institutional support, such as Germany and the UK, had maximum improvement in energy efficiency (as high as 598.72 kWh saved a year) and renewable energy implementation rates (above 30%). Countries posing high risk, like Ukraine, require more potent and custom-made strategies to achieve comparable advances compared to a less-risky environment. The evidence indicates that even financial mechanisms are most fruitful if they are complemented by risk management tactics. With these results, policymakers can proceed with useful information in formulating economically appropriate strategies that rely on realistic assumptions of behavior. Full article

Prosumer energy storage behavior alongside national rooftop photovoltaics (RTPV) penetration metrics is essential for decarbonization pathways in buildings. A research gap persists in quantitatively assessing storage strategies under varying regulatory frameworks that integrate both technical and financial dimensions while accounting for behavioral heterogeneity and policy feedback. This study introduces a novel degradation-aware, feedback-preserving framework that optimizes behind-the-meter storage design and operation, enabling realistic modeling of prosumer responses on large-scale RTPV adoption scenarios. Long Short-Term Memory (LSTM) and Compound Annual Growth (CAGR) models applied for the RTPV penetration rates projections in European urban contexts. The increasing rates in the Netherlands, Spain, and Italy respond to second-order regression behavior, with the former to emit signals of saturation and the latter to perform mixed anelastic and reverse elastic curves of elasticities. Accordingly, Germany, France, the United Kingdom (UK), and Greece remain in an inelastic area by 2030. The building RTPV energy storage arbitrage formulation is treated as a linear programming (LP) problem using a convex and piecewise linear cost function, a Model Predictive Control (MPC), Auto Regressive Moving Average (ARMA) and Auto Regressive Integrated Moving Average (ARIMA) statistical forecasts and rolling horizon in order to address the uncertainty of the load and the ratio κ of the sold to purchased electricity price. Weekly arbitrage gains may drop by up to 9.1% due to stochasticity, with maximized gains achieved at battery capacities between 1C and 2C. The weekly gain per cycle performs elastic, anelastic, and reverse behavior of the prosumer across the range of κ values responding to different regulatory mechanisms of pricing. The variability of economic incentives suggests the necessity of flexible energy management strategies. Full article

The UNHCR reported that over 123.2 million people were forcibly displaced worldwide by the end of 2024, with the mental health of refugees emerging as a critical issue. In the UK, asylum seekers and refugees make up around 13% of immigrants and the number is increasing year on year. The Immigration and Asylum Act 1999 aimed to ensure that most cases of asylum seekers would be decided fairly, and within six months. However, it has been argued that long wait times and systemic inequalities and inequities within the asylum system have contributed to heightened mental health problems among refugees even once they gain refugee status. The present study aimed to examine the factors that refugees perceive as limiting their ability and willingness to access mental health services in the UK. A systematic review of 15 relevant articles followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Results highlight intersecting perceived limitations to accessing mental health services, such as language difficulties, cultural disconnection regarding mental health including stigma and prejudice, mistrust of services as well as structural barriers including general service limitations and the involuntary transient nature of many refugees’ lives. Policy recommendations emphasize integrating ethnic minority organizations into services, developing culturally adapted services that take into consideration the views of refugees, and ensuring holistic approaches to address socio-economic determinants. Full article

Background: Ethnic minority groups are under-represented in their use of community mental health services in the UK. Online mental health forums could be a more appealing support option than traditional mental health services. Part one of this study investigated the level of online forum use in people from ethnic minority groups. Part two investigated the factors influencing online mental health forum use for people from ethnic minority groups. Methods: Part one involved comparing data from a range of pre-existing national datasets, and datasets local to Berkshire, UK (i.e., on the general population, people experiencing common mental health problems, users of mental health forums, and NHS Talking Therapies services). Part two involved interviewing 14 individuals from ethnic minority backgrounds who had used, or considered using, online mental health forums. Results: In part one, nationally, Asian, Black, and Mixed ethnic groups appeared over-represented in their online mental health forum use based on their reporting of common mental health problems. In Berkshire, people from Asian and Black ethnic groups were under-represented in their use of Berkshire NHS Trust’s online mental health forum based on their representation in the Berkshire population. In Part Two, three themes were identified as influencing forum use: (1) sense of community in the online and offline worlds, (2) trust is crucial, and (3) barriers to accessing online forums. Conclusion: People from ethnic minority groups vary in their use and experiences of mental health forums. Whilst forums can offer a valued accessible space for anonymous sharing of often stigmatised experiences, pathways to access require trusted figures to promote their availability, and forum designers and moderators to co-create culturally sensitive spaces with people from these target communities. Full article