This national pre-pandemic survey compared demand and capacity of adult community eating disorder services (ACEDS) with NHS England (NHSE) commissioning guidance.

Thirteen services in England and Scotland responded (covering 10.7 million population). Between 2016–2017 and 2019–2020 mean referral rates increased by 18.8%, from 378 to 449/million population. Only 3.7% of referrals were from child and adolescent eating disorder services (CEDS-CYP), but 46% of patients were aged 18–25 and 54% were aged >25. Most ACEDS had waiting lists and rationed access. Many could not provide full medical monitoring, adapt treatment for comorbidities, offer assertive outreach or provide seamless transitions. For patient volume, the ACEDS workforce budget was 15%, compared with the NHSE workforce calculator recommendations for CEDS-CYP. Parity required £7 million investment/million population for the ACEDS.

This study highlights the severe pressure in ACEDS, which has increased since the COVID-19 pandemic. Substantial investment is required to ensure NHS ACEDS meet national guidance, offer evidence-based treatment, reduce risk and preventable deaths, and achieve parity with CEDS-CYP.

In general, models for thermal effects of nuclear weapons are not as well developed as models for blast and radiation effects, yet casualties resulting from fires and burns in a nuclear detonation would significantly impact civil defense and emergency healthcare. Previous studies have conducted in-depth analysis of the various atmospheric conditions that affect the thermal radiation transmissivity. However, such models have yet to consider the role that buildings play in the urban environment to estimate the casualties from the thermal effect more accurately.

A three-dimensional model of the area within a three-mile radius of the detonation site in Atlanta, Georgia, USA was created in Blender. To represent the thermal energy resulting from a 15 kiloton, near-surface burst, a point light was created with a power of 96,725 gigawatts and a radius of 81 meters. Using the Cycles render engine, the resulting light/shadow was orthographically captured directly above the scene.

The rendered model demonstrated the attenuating effects of the built, urban environment. Nearly half (46.82%) of the pixels in the resulting raster were black, or regions that were not exposed to any thermal energy. Slightly less than a quarter (22.32%) of the pixels were white or light gray, or regions that received mostly direct thermal energy. The remaining regions (30.86% of the pixels) were dark gray, or regions that were initially in shadow from the thermal pulse but received thermal energy via reflection from nearby buildings.

As the thermal pulse travels at the speed of light, it arrives at a location before the blast wave. As such, the built urban environment offers protection from the thermal energy released during a nuclear detonation. Future studies that incorporate this thermal model may more accurately determine the quantity and geospatial distribution of burn casualties in the aftermath of a nuclear detonation.

Weather significantly affects the distribution of fallout radiation resulting from a nuclear detonation. Prior nuclear detonation models have either utilized a “typical” day for the city of interest or have chosen conditions that optimize fallout radiation. However, models that aid emergency planners should utilize representative weather conditions to capture the most likely distribution of fallout radiation for the region of interest.

Fallout radiation resulting from an improvised nuclear device detonation in Atlanta, Georgia, USA was simulated for each day in 2019 using the Hazard Prediction and Assessment Capability (HPAC) software and weather from Modern-Era Retrospective analysis for Research and Applications, Version 2 (MERRA-2). A partition around medoids cluster analysis was conducted, based on the characteristics of the plumes, population at risk, and estimated proportion of fatalities. A multinomial logistic regression, a decision tree, and a random forest model were then used to predict the cluster from surface-level weather data.

On average, the fallout plume was 160.25km long, had an area of 3,174.44 km2, and was angled 83.5° from due north. The plume on average contained 3,668,173 individuals at risk for exposure and caused 416,8908 casualties. Four clusters were identified to represent the distribution of fallout radiation. The random forest model was best able to predict the cluster using surface-level weather data, with an average accuracy of 57.24% (kappa = 0.385). The variable importance plot suggests north-westerly winds, cloud coverage at detonation, whether it is summer, and average temperature are among the most important variables for classification.

Meaningful representation of the variation in the distribution of fallout radiation is imperative while creating nuclear detonation models. While an analysis of the fallout distribution throughout a calendar year provides important insight, future research may examine longer study periods to better understand the climatological impacts on fallout radiation.

To provide comprehensive population-level estimates of the burden of healthcare-associated influenza.

Retrospective cross-sectional study.

US Influenza Hospitalization Surveillance Network (FluSurv-NET) during 2012–2013 through 2018–2019 influenza seasons.

Laboratory-confirmed influenza-related hospitalizations in an 8-county catchment area in Tennessee.

The incidence of healthcare-associated influenza was determined using the traditional definition (ie, positive influenza test after hospital day 3) in addition to often underrecognized cases associated with recent post-acute care facility admission or a recent acute care hospitalization for a noninfluenza illness in the preceding 7 days.

Among the 5,904 laboratory-confirmed influenza-related hospitalizations, 147 (2.5%) had traditionally defined healthcare-associated influenza. When we included patients with a positive influenza test obtained in the first 3 days of hospitalization and who were either transferred to the hospital directly from a post-acute care facility or who were recently discharged from an acute care facility for a noninfluenza illness in the preceding 7 days, we identified an additional 1,031 cases (17.5% of all influenza-related hospitalizations).

Including influenza cases associated with preadmission healthcare exposures with traditionally defined cases resulted in an 8-fold higher incidence of healthcare-associated influenza. These results emphasize the importance of capturing other healthcare exposures that may serve as the initial site of viral transmission to provide more comprehensive estimates of the burden of healthcare-associated influenza and to inform improved infection prevention strategies.

Predeath grief conceptualizes complex feelings of loss experienced for someone who is still living and is linked to poor emotional well-being. The Road Less Travelled program aimed to help carers of people with rarer dementias identify and process predeath grief. This study evaluated the feasibility, acceptability, and preliminary effectiveness of this program.

Pre–post interventional mixed methods study.

Online videoconference group program for carers across the UK held in 2021.

Nine family carers of someone living with a rare form of dementia. Eight were female and one male (mean age 58) with two facilitators.

The Road Less Travelled is an online, facilitated, group-based program that aims to help carers of people with rarer dementias to explore and accept feelings of grief and loss. It involved six fortnightly 2-hour sessions.

We collected measures for a range of well-being outcomes at baseline (T1), post-intervention (T2), and 3 months post-intervention (T3). We conducted interviews with participants and facilitators at T2.

Participant attendance was 98% across all sessions. Findings from the semistructured interviews supported the acceptability of the program and identified improvements in carer well-being. Trends in the outcome measures suggested an improvement in quality of life and a reduction in depression.

The program was feasible to conduct and acceptable to participants. Qualitative reports and high attendance suggest perceived benefits to carers, including increased acceptance of grief, and support the need for a larger-scale pilot study to determine effectiveness.

Many male prisoners have significant mental health problems, including anxiety and depression. High proportions struggle with homelessness and substance misuse.

This study aims to evaluate whether the Engager intervention improves mental health outcomes following release.

The design is a parallel randomised superiority trial that was conducted in the North West and South West of England (ISRCTN11707331). Men serving a prison sentence of 2 years or less were individually allocated 1:1 to either the intervention (Engager plus usual care) or usual care alone. Engager included psychological and practical support in prison, on release and for 3–5 months in the community. The primary outcome was the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), 6 months after release. Primary analysis compared groups based on intention-to-treat (ITT).

In total, 280 men were randomised out of the 396 who were potentially eligible and agreed to participate; 105 did not meet the mental health inclusion criteria. There was no mean difference in the ITT complete case analysis between groups (92 in each arm) for change in the CORE-OM score (1.1, 95% CI –1.1 to 3.2, P = 0.325) or secondary analyses. There were no consistent clinically significant between-group differences for secondary outcomes. Full delivery was not achieved, with 77% (108/140) receiving community-based contact.

Engager is the first trial of a collaborative care intervention adapted for prison leavers. The intervention was not shown to be effective using standard outcome measures. Further testing of different support strategies for prison with mental health problems is needed.