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IntroductionBRONCHUK is a multicentre, prospective, observational cohort study enrolling adults with radiologically confirmed bronchiectasis across secondary centres in the UK. The objectives of the study are to develop a multicentre bronchiectasis registry incorporating baseline data collection with annual follow-up data for at least 5 years and to describe treatment patterns across the UK.Polypharmacy is defined as the concurrent use of ≥5 medications and has been rarely documented in literature for bronchiectasis patients. Polypharmacy has been associated with increased risk of adverse drug reactions and increased treatment burden. The current BTS guidelines have not detailed the impact of polypharmacy in bronchiectasis patients.MethodsAdult patients with a clinical diagnosis of bronchiectasis supported by CT Thorax were recruited in the study across multiple centres in the UK. Patient data collected at baseline included demographics, aetiology testing, comorbidities, lung function, radiology, treatments, microbiology and quality of life. Both respiratory and non-respiratory medications were included in the database but are not exhaustive.Results1626 patients were included in the analysis [1000 females (61.5%); 626 males (38.5%)] with a mean age of 64.4±13.4 years. 611 (37.6%) patients had documented asthma, 255 (15.7%) COPD and 58 (3.6%) ABPA.The mean BSI score was 7.3±3.5.376 patients (23.1%) had ≥5 respiratory-related medications prescribed. 643 patients (39.5%) had documented polypharmacy (including non-respiratory medications).321 (36%) patients without co-existing asthma/COPD were prescribed ICS.A weak positive relationship was established between age and number of medications prescribed (r=0.126;p<0.001). Higher rates of polypharmacy were seen in male cohort (45.5% as compared to 37.1% in female cohort) (χ2 =11.360;p<0.001).A logistic regression analysis showed that with each 1-point increase in BSI score the odds of polypharmacy increased by 20% (OR = 1.197, p <.001).Abstract S39 Figure 1[Image Omitted. See PDF.]ConclusionPolypharmacy is a growing concern due to risks of cumulative harm. Since this database didn’t collect all medications prescribed to patients, the current polypharmacy rates are underreported. Polypharmacy was associated with gender and disease severity. LABA and ICS were the most frequently prescribed medications. As new therapies and precision medicine emerge in bronchiectasis minimising polypharmacy should be considered.

BackgroundBronchiectasis is a chronic respiratory disease that is increasingly recognised globally. However, research on its economic impact is scarce. The primary objective of this study is to document major healthcare resource use and associated costs in a U.K. patient population with a focus on exacerbationsMethodsWe used baseline and follow up data from the Bronchiectasis Observational Cohort and Biobank UK (BronchUK). The study includes a baseline cohort of 1,119 patients diagnosed with primary bronchiectasis, who are followed for a period of up to five years. We extracted data from the database and compared to centrally held NHS resources use data.ResultsThe average age of the cohort was 64 years, and 62% were female. The most common bronchiectasis aetiology was idiopathic or post-infectious. Over the five-year period, the average annual distribution of exacerbations was as follows: 32% of patients had no exacerbations, 21% had one, 17.5% had two, and 29% had more than two. Longitudinal data show that while a significant proportion of patients (32%) experienced no exacerbations, those who did were predominantly managed in primary care settings. Based on exacerbation frequency and type, and applying 2024/25 NHS reference costs, the estimated total healthcare costs for the study population ranged from £2 million to £3.2 million. Disaggregated estimates for the highest cost scenario include GP-only exacerbations (n=2,824; £479,945), outpatient-managed exacerbations (n=311; £260,126), and inpatient-managed exacerbations (n=680; £2,428,291). The average estimated cost per patient over the full period was £2,824, with the majority of costs attributable to inpatient-managed exacerbations.ConclusionBronchiectasis and associated exacerbations are a significant cost to the NHS. This study, based on the BronchUK cohort, is one of the first to provide a detailed analysis of healthcare utilisation and costs associated with bronchiectasis in the UK, particularly among patients at risk of exacerbation. The findings highlight the economic burden of the disease and the importance of targeted management strategies to reduce exacerbation rates and associated healthcare costs.

Objectives: To identify a generic set of face valid quality indicators for primary care mental health services which reflect a multi-stakeholder perspective and can be used for facilitating quality improvement. Design: Modified two-round postal Delphi questionnaire. Setting: Geographical spread across Great Britain. Participants: One hundred and fifteen panellists representing 11 different stakeholder groups within primary care mental health services (clinical psychologist, health and social care commissioner, community psychiatric nurse, counsellor, general practitioner, practice nurse/district nurse/health visitor, psychiatrist, social worker, carer, patient and voluntary organisations). Main outcome measures: Face validity (median rating of 8 or 9 on a nine point scale with agreement by all panels) for assessing quality of care. Results: A maximum of 334 indicators were rated by panels in the second round; 26% were rated valid by all panels. These indicators were categorised into 21 aspects of care, 11 relating to general practices and 10 relating to health authorities or primary care groups/trusts. There was variation in the total number of indicators rated valid across the different panels. Overall, GPs rated the lowest number of indicators as valid (41%, n=138) and carers rated the highest number valid (91%, n=304). Conclusions: The quality indicators represent consensus among key stakeholder groups in defining quality of care within primary care mental health services. These indicators could provide a guide for primary care organisations embarking on quality improvement initiatives in mental health care when addressing national targets and standards relating to primary care set out in the National Service Framework for Mental Health for England. Although many of the indicators relate to parochial issues in UK service delivery, the methodology used in the development of the indicators could be applied in other settings to produce locally relevant indicators.

Background: While mental health is a core part of primary care, there are few validated quality measures and little relevant internationally published research. Consensus panel methods are a useful means of developing quality measures where evidence is sparse and/or opinions are diverse. However, little is known about the dynamics of consensus techniques and the factors that influence the judgements and ratings of panels and individual panellists. Objectives: (1) To describe differences in panel ratings on the quality of primary mental health care services by patient, carer, professional and managerial panels within a Delphi procedure; and (2) to explore why different panels and panellists rate quality indicators of primary mental health care differently. Design: Two round postal Delphi technique and exploratory semi-structured interviews. Participants: 115 panellists across 11 panels. Eleven panellists were subsequently interviewed. Results: 87 of 334 indicators (26%) were rated face valid by all 11 panels. There was little disagreement within panel ratings but significant differences between panels. The GP panel rated the least number of indicators valid (n = 138, 41%) and carers the most (n = 304, 91%). The way in which panellists interpreted and conceptualised the indicators and their definition of quality of mental health care affected the way in which participants made their ratings. Conclusions: Stakeholders in primary mental health care have diverse views of quality of care and these differences translate into how they rate quality indicators. Exploratory interviews suggest that ratings are influenced by past experience, expectations, definitions of quality of care, and perceived power relationships between stakeholders.

Online: https://www.smartbrief.com/ sigmaxi/index.jsp Global Map of Forest Changes A publicly available, high-resolution map of forest cover-created by researchers at the University of Maryland, working with the Google Earth Engine-provides a powerful tool for forest researchers and environmental policy makers. According to Higgsogenesis, an asymmetry between the Higgs boson and its antiparticle could have triggered a corresponding asymmetry between matter and antimatter, explaining why matter dominates the universe.

The connection between the local rotation tensor and the strain tensor is investigated. Expressions for the derivatives of the components of the rotation tensor are derived, and they lead to new forms for the compatibility relations for finite strain. For two-dimensional deformations, it is shown that the rotation and the deformation field can be determined directly from the strains through line integrals.

The stress-strain law for an ideal soil formulated in a recent paper [1]3^{3} is applied here to obtain the velocity equations referred to the stress characteristic lines in plane strain problems. Simple velocity fields associated with families of straight characteristic lines are then examined, together with discontinuities in the velocity field. The results are applied to obtain the incipient velocity field for the indentation of a semi-infinite mass of material by a flat punch or footing, and to solve the problem of indentation by a lubricated wedge.

This paper is concerned with the axially symmetric plastic flow of a rigid-plastic nonhardening material which obeys the Tresca yield criterion of constant maximum shearing stress and the associated flow rule. A general discussion of the basic equations is given. The discussion shows that the hypothesis of Haar and von Kármán is likely to be of great importance in the solution of axially symmetric problems. This conclusion is substantiated by the remainder of the work which considers problems in which the hypothesis is satisfied, i.e. problems in which the circumferential stress is equal to one of the principal stresses in the meridional planes. Possible plastic velocity fields in a circular cylindrical bar stressed to yielding in compression or tension are obtained in §3. Section 4 examines plastic stress fields in the neighbourhood of stress-free conical surfaces. In the final sections of the paper, the plastic stress field and a permissible deformation mode for the problem of the indentation of the plane surface of a semi-infinite body by a circular flat-ended rigid punch are obtained. It is shown that the plastic stress field near the punch can be extended into the rigid region without violating the yield criterion.

Upper and lower bounds for the average pressure in the indentation by a flat, smooth punch of the plane surface of a layer of elastic-perfectly plastic material resting on a rough, rigid base are obtained by the application of the limit-design theorems. The material of the layer is assumed to obey Tresca's yield criterion of constant maximum shearing stress during plastic deformation. The square punch problem is considered in detail for layers whose thickness is greater than one-fourteenth of the width of the punch. For thinner layers, reasonably close upper and lower bounds for the average pressure over the square punch are obtained as functions of the relative thickness of the layer. The circular punch is considered briefly, and the bounds obtained determine the indentation force with sufficient accuracy for layers which are not too thick compared with the width of the punch.