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Childhood obesity levels continue to rise, with significant impact on individuals and the NHS. The ‘Complications of Excess Weight’ (CEW) clinics provide support to young people with complications of their weight. Our objective was to co-develop, with young people, a new intervention; AIM2Change, to enable young people to develop their intrinsic motivation to manage weight, using Acceptance and Commitment Therapy (ACT), with a person-centred approach. Young people from the Care of Childhood Obesity (CoCO) clinic in Bristol, UK, were recruited to co-develop this intervention. The study was registered on ISRCTN (ISRCTN16607863). The seven-session, ACT-based intervention was delivered one-to-one, securely online. Qualitative interviews were conducted after each intervention session was delivered. Qualitative data were coded and reviewed regularly to make iterative changes to individual sessions and the overall programme. Fourteen co-developers were recruited, of whom nine completed the co-development process (female = 4; median age (IQR)=15(1.5); 4 with a parent; Indices of Multiple Deprivation (IMD) median = 3.5, range = 1–10). Iterative changes made during co-development included introducing an earlier focus on eating behaviour and body image, with more practical activities to increase engagement. Thematic analysis of co-developer feedback identified four themes: theoretical understanding; delivery and receipt of therapy; view of strategies and engagement; real world benefits of co-development process. Framework analysis was conducted to map data pertaining to these themes into matrices according to each participant and session. Insights from the co-development process have shaped AIM2Change to optimise the intervention’s value, relevance and acceptability. Findings suggest that AIM2Change meets an unmet need in delivery of current childhood weight management services.

ObjectivesThis paper provides an in-depth account of general practitioners’ (GPs) experiences of living and working with mental illness and distress, as part of a wider study reporting the barriers and facilitators to help-seeking for mental illness and burn-out, and sources of stress/distress for GP participants.DesignQualitative study using in-depth interviews with 47 GP participants. The interviews were audio recorded, transcribed, anonymised and imported into NVivo V.11 to facilitate data management. Data were analysed using a thematic analysis employing the constant comparative method.SettingEngland.ParticipantsA purposive sample of GP participants who self-identified as: (1) currently living with mental distress, (2) returning to work following treatment, (3) off sick or retired early as a result of mental distress or (4) without experience of mental distress. Interviews were conducted face to face or over the telephone.ResultsThe findings report GP participants’ in-depth experiences of distress and mental illness with many recollecting their distressing experiences and significant psychological and physical symptoms relating to chronic stress, anxiety, depression and/or burn-out, and a quarter articulating thoughts of suicide. Many talked about their shame, humiliation and embarrassment at their perceived inability to cope with the stresses of their job and/or their symptoms of mental illness.ConclusionsThese findings paint a concerning picture of the situation affecting primary care doctors, with participants’ accounts suggesting there is a considerable degree of mental ill health and reduced well-being among GPs. The solutions are complex and lie in prevention and provision. There needs to be greater recognition of the components and cumulative effect of occupational stressors for doctors, such as the increasing workload and the clinical and emotional demands of the job, as well as the need for a culture shift within medicine to more supportive and compassionate work environments.

Background Resource-use measurement is integral for assessing cost-effectiveness within trial-based economic evaluations. Methods for gathering resource-use data from participants are not well developed, with questionnaires typically produced for each trial and rarely validated. The healthcare module of a generic, modular resource-use measure, designed for collecting self-report resource-utilisation data, has recently been developed in the UK. The objective of this research is to identify and prioritise items for new, bolt-on modules, covering informal care, social care and personal expenses incurred due to health and care needs. Methods Identification and prioritisation, conducted between April and December 2021, involved a rapid review of questionnaires included in the Database of Instruments for Resource Use Measurement and economic evaluations published from 2011 to 2021 to identify candidate items, an online survey of UK-based social care professionals to identify omitted social care items and focus groups with UK-based health economists and UK-based people who access social care services either for themselves or as carers to prioritise items. Results The review identified 203 items. Over half of the 24 survey respondents reported no missing items. Five academic health economists and four people who access social care services participated in focus groups. Feedback shaped the social and informal care modules and indicated that no specific personal expenses were essential to collect in all trials. Aids/adaptations were highlighted as costly personal expenses when relevant; therefore, the personal expenses module was narrowed to aids/adaptations only. Conclusion Draft informal care, social care and aids/adaptations modules were developed, ready for further testing.

Childhood obesity levels continue to rise, with significant impact on individuals and the NHS. The 'Complications of Excess Weight' (CEW) clinics provide support to young people with complications of their weight. Our objective was to co-develop, with young people, a new intervention; AIM2Change, to enable young people to develop their intrinsic motivation to manage weight, using Acceptance and Commitment Therapy (ACT), with a person-centred approach. Young people from the Care of Childhood Obesity (CoCO) clinic in Bristol, UK, were recruited to co-develop this intervention. The study was registered on ISRCTN (ISRCTN16607863). The seven-session, ACT-based intervention was delivered one-to-one, securely online. Qualitative interviews were conducted after each intervention session was delivered. Qualitative data were coded and reviewed regularly to make iterative changes to individual sessions and the overall programme. Fourteen co-developers were recruited, of whom nine completed the co-development process (female = 4; median age (IQR)=15(1.5); 4 with a parent; Indices of Multiple Deprivation (IMD) median = 3.5, range = 1-10). Iterative changes made during co-development included introducing an earlier focus on eating behaviour and body image, with more practical activities to increase engagement. Thematic analysis of co-developer feedback identified four themes: theoretical understanding; delivery and receipt of therapy; view of strategies and engagement; real world benefits of co-development process. Framework analysis was conducted to map data pertaining to these themes into matrices according to each participant and session. Insights from the co-development process have shaped AIM2Change to optimise the intervention's value, relevance and acceptability. Findings suggest that AIM2Change meets an unmet need in delivery of current childhood weight management services.

The aerosol route has been a pathway for transmission of many viruses. Similarly, recent evidence has determined aerosol transmission for SARS-CoV-2 to be significant. Consequently, public health officials and professionals have sought data regarding the role of Heating, Ventilation, and Air Conditioning (HVAC) features as a means to mitigate transmission of viruses, particularly coronaviruses. Using international standards, a systematic review was conducted to comprehensively identify and synthesize research examining the effect of humidity on transmission of coronaviruses and influenza. The results from 24 relevant studies showed that: increasing from mid (40–60%) to high (>60%) relative humidity (RH) for SARS-CoV-2 was associated with decreased virus survival; although SARS-CoV-2 results appear consistent, coronaviruses do not all behave the same; increasing from low (<40%) to mid RH for influenza was associated with decreased persistence, infectivity, viability, and survival, however effects of increased humidity from mid to high for influenza were not consistent; and medium, temperature, and exposure time were associated with inconsistency in results for both coronaviruses and influenza. Adapting humidity to mitigate virus transmission is complex. When controlling humidity as an HVAC feature, practitioners should take into account virus type and temperature. Future research should also consider the impact of exposure time, temperature, and medium when designing experiments, while also working towards more standardized testing procedures. Clinical trial registration: PROSPERO 2020 CRD42020193968 .

Respiratory viruses are capable of transmitting via an aerosol route. Emerging evidence suggests that SARS-CoV-2 which causes COVID-19 can be spread through airborne transmission, particularly in indoor environments with poor ventilation. Heating, ventilation, and air conditioning (HVAC) systems can play a role in mitigating airborne virus transmission. Ultraviolet germicidal irradiation (UVGI), a feature that can be incorporated into HVAC systems, can be used to impede the ability of viruses to replicate and infect a host. We conducted a systematic review of the scientific literature examining the effectiveness of HVAC design features in reducing virus transmission—here we report results for ultraviolet (UV) radiation. We followed international standards for conducting systematic reviews and developed an a priori protocol. We conducted a comprehensive search to January 2021 of published and grey literature using Ovid MEDLINE, Compendex, and Web of Science Core. Two reviewers were involved in study selection, data extraction, and risk of bias assessments. We presented study characteristics and results in evidence tables, and synthesized results across studies narratively. We identified 32 relevant studies published between 1936 and 2020. Research demonstrates that: viruses and bacteriophages are inactivated by UV radiation; increasing UV dose is associated with decreasing survival fraction of viruses and bacteriophages; increasing relative humidity is associated with decreasing susceptibility to UV radiation; UV dose and corresponding survival fraction are affected by airflow pattern, air changes per hour, and UV device location; and UV radiation is associated with decreased transmission in both animal and human studies. While UV radiation has been shown to be effective in inactivating viruses and reducing disease transmission, practical implementation of UVGI in HVAC systems needs to consider airflow patterns, air changes per hour, and UV device location. The majority of the scientific literature is comprised of experimental, laboratory-based studies. Further, a variety of viruses have been examined; however, there are few studies of coronaviruses and none to date of SARS-CoV-2. Future field studies of UVGI systems could address an existing research gap and provide important information on system performance in real-world situations, particularly in the context of the current COVID-19 pandemic. This comprehensive synthesis of the scientific evidence examining the impact of UV radiation on virus transmission can be used to guide implementation of systems to mitigate airborne spread and identify priorities for future research. Trial registration PROSPERO 2020 CRD42020193968 .

Clinical studies have suggested an association between dyslipidemia and tendon injuries or chronic tendon pain; the mechanisms underlying this association are not yet known. The objectives of this study were (1) to evaluate the impact of a high fat diet on the function of load-bearing tendons and on the distribution in tendons of oxidized low density lipoprotein (oxLDL), and (2) to examine the effect of oxLDL on tendon fibroblast proliferation and gene expression. Gene expression (Mmp2, Tgfb1, Col1a1, Col3a1), fat content (Oil Red O staining), oxLDL levels (immunohistochemistry) and tendon biomechanical properties were examined in mice (C57Bl/6 or ApoE -/-) receiving a standard or a high fat diet. Human tendon fibroblast proliferation and gene expression (COL1A1, COL3A1, MMP2) were examined following oxLDL exposure. In both types of mice (C57Bl/6 or ApoE -/-), consumption of a high fat diet led to a marked increase in oxLDL deposition in the load-bearing extracellular matrix of the tendon. The consumption of a high fat diet also reduced the failure stress and load of the patellar tendon in both mouse types, and increased Mmp2 expression. ApoE -/- mice exhibited more pronounced reductions in tendon function than wild-type mice, and decreased expression of Col1a1 compared to wild type mice. Human tendon fibroblasts responded to oxLDL by increasing their proliferation and their mRNA levels of MMP2, while decreasing their mRNA levels for COL1A1 and COL3A1. The consumption of a high fat diet resulted in deleterious changes in tendon function, and these changes may be explained in part by the effects of oxLDL, which induced a proliferative, matrix-degrading phenotype in human tenocytes.

The most common surgical techniques for the treatment of recurrent anterior shoulder instability include the arthroscopic Bankart repair, the open Bankart repair and the open Latarjet procedure. The purpose of this study was to evaluate and compare the long-term outcomes following these procedures. A systematic review of modern procedures with a minimum follow-up of 5 years was completed. The objective outcome measures evaluated were post-operative dislocation and instability rate, the Rowe score, radiographic arthritis and complications. Twenty-eight studies with a total of 1652 repairs were analyzed. The estimated re-dislocation rate was 15.1% following arthroscopic Bankart repair, 7.7% following open Bankart repair and 2.7% following Latarjet repair, with the comparison between arthroscopic Bankart and open Latarjet reaching statistical significance ( <0.001). The rates of subjective instability and radiographic arthritis were consistently high across groups, with no statistical difference between groups. Estimated complication rates were statistically higher in the open Latarjet repair (9.4%) than in the arthroscopic Bankart (0%; =0.002). The open Latarjet procedure yields the most reliable method of stabilization but the highest complication rate. There are uniformly high rates of post-operative subjective instability symptoms and radiographic arthritis at 5 years regardless of procedure choice.

The aerosol route has been a pathway for transmission of many viruses. Similarly, recent evidence has determined aerosol transmission for SARS-CoV-2 to be significant. Consequently, public health officials and professionals have sought data regarding the role of Heating, Ventilation, and Air Conditioning (HVAC) features as a means to mitigate transmission of viruses, particularly coronaviruses. Using international standards, a systematic review was conducted to comprehensively identify and synthesize research examining the effect of humidity on transmission of coronaviruses and influenza. The results from 24 relevant studies showed that: increasing from mid (40-60%) to high (>60%) relative humidity (RH) for SARS-CoV-2 was associated with decreased virus survival; although SARS-CoV-2 results appear consistent, coronaviruses do not all behave the same; increasing from low (<40%) to mid RH for influenza was associated with decreased persistence, infectivity, viability, and survival, however effects of increased humidity from mid to high for influenza were not consistent; and medium, temperature, and exposure time were associated with inconsistency in results for both coronaviruses and influenza. Adapting humidity to mitigate virus transmission is complex. When controlling humidity as an HVAC feature, practitioners should take into account virus type and temperature. Future research should also consider the impact of exposure time, temperature, and medium when designing experiments, while also working towards more standardized testing procedures.

Vitrification inhibits crystallization of ice and may allow the mechanical properties of menisci to be preserved for transplantation without the damaging consequences of ice crystals formed during freezing. The primary objective of this study was to investigate the differences between fresh, frozen, and vitrified porcine lateral menisci examining tensile mechanical properties along the circumferential-peripheral, circumferential-central, longitudinal, and radial orientations. The secondary objective was to investigate the variations in the tensile mechanical properties of menisci comparing the circumferential-peripheral orientation to the three other orientations: circumferential-central, longitudinal, and radial. Quasi-static tensile testing was conducted to quantify the tensile mechanical properties of fresh, frozen and vitrified menisci. Ultimate tensile strength of frozen menisci were significantly decreased compared with fresh and vitrified menisci along three orientations: circumferential-peripheral, longitudinal, and radial. Along the circumferential-central orientation, tensile modulus of frozen menisci was significantly decreased compared with fresh menisci. The mechanical properties of vitrified menisci were comparable to fresh menisci along all four orientations. For all menisci (fresh, frozen and vitrified), ultimate tensile strength and failure strain along the circumferential-peripheral orientation were significantly increased compared with the three other orientations. Freezing was detrimental to the mechanical properties of menisci but vitrification likely avoided the negative effects of freezing thereby preserving mechanical properties that were comparable to fresh menisci. The findings of this study revealed that vitrification was superior to freezing for preserving mechanical properties of meniscal tissue; hence, vitrification is likely to be a competitive alternative to freezing for meniscal transplantation in the future.