Citizen scientists filling knowledge gaps of phosphate pollution dynamics in rural areas.

In situ monitoring is fundamental to manage eutrophication in rivers and streams. However, in recent decades, the frequency and spatial coverage of regulatory monitoring have often been reduced due to funding and infrastructure limitations. This reduction has made it impossible to provide adequate coverage for most water bodies. In this study, trained citizen scientists filled spatial and temporal gaps in agency monitoring across a major catchment in rural England. By integrating data from citizen scientists, regulatory agencies, and the local water company, it was possible to demonstrate the opportunities for hypothesis-based citizen scientist monitoring to identify continuous and event-driven sources of phosphate pollution. Local citizen scientists effectively covered important spatial gaps, investigating river conditions both upstream and downstream of suspected pollution point sources, improving the identification of their temporal dynamics. When combined with long-term monitoring data from regulatory agencies, it became possible to identify areas within the catchment that exhibited increased phosphate concentrations during periods of low river discharge (summer). Inter-annual trends and anomaly detection suggested that continuous pollution sources dominated over event-driven sources in many sub-basins, allowing for the prioritisation of mitigation actions. This study highlights the opportunity for citizen scientists to fill gaps in regulatory monitoring efforts and contribute to the improved management of eutrophication in rural catchments.

Reducing LGBTQ+ adolescent mental health inequalities: a realist review of school-based interventions.

BACKGROUND: LGBTQ+ young people have elevated rates of poor mental health in comparison to their cisgender heterosexual peers. School environment is a key risk factor and consistently associated with negative mental health outcomes for LGBTQ+ adolescents. AIMS: To examine how, why, for whom and in what context school-based interventions prevent or reduce mental health problems in LGBTQ+ adolescents. METHODS: A realist review methodology was utilised and focused on all types of school-based interventions and study designs. A Youth Advisory Group were part of the research team. Multiple search strategies were used to locate relevant evidence. Studies were subject to inclusion criteria and quality appraisal, and included studies were synthesised to produce a programme theory. Seventeen studies were included in the review. RESULTS: Eight intervention components were necessary to address LGBTQ+ pupils mental health: affirmative visual displays; external signposting to LGBTQ+ support; stand-alone input; school-based LGBTQ support groups; curriculum-based delivery; staff training; inclusion policies; trusted adult. Few school-based interventions for this population group were identified. CONCLUSIONS: The programme theory indicates that "to work" school-based interventions must have a "whole-school" approach that addresses specifically the dominant cis-heteronormative school environment and hence the marginalisation, silence, and victimisation that LGBTQ+ pupils can experience.

Understanding How School-Based Interventions Can Tackle LGBTQ+ Youth Mental Health Inequality: A Realist Approach.

Globally, research indicates that LGBTQ+ young people have elevated rates of poor mental health in comparison with their cisgender heterosexual peers. The school environment is a major risk factor and is consistently associated with negative mental health outcomes for LGBTQ+ young people. The aim of this UK study was to develop a programme theory that explained how, why, for whom, and in what context school-based interventions prevent or reduce mental health problems in LGBTQ+ young people, through participation with key stakeholders. Online realist interviews were conducted in the UK with (1) LGBTQ+ young people aged between 13-18 years attending secondary schools (N = 10); (2) intervention practitioners (N = 9); and (3) school staff (N = 3). A realist retroductive data analysis strategy was employed to identify causal pathways across different interventions that improved mental health outcomes. The programme theory we produced explains how school-based interventions that directly tackle dominant cisgender and heterosexual norms can improve LGBTQ+ pupils' mental health. We found that context factors such as a 'whole-school approach' and 'collaborative leadership' were crucial to the delivery of successful interventions. Our theory posits three causal pathways that might improve mental health: (1) interventions that promote LGBTQ+ visibility and facilitate usualising, school belonging, and recognition; (2) interventions for talking and support that develop safety and coping; and (3) interventions that address institutional school culture (staff training and inclusion polices) that foster school belonging, empowerment, recognition, and safety. Our theoretical model suggests that providing a school environment that affirms and usualises LGBTQ+ identities and promotes school safety and belonging can improve mental health outcomes for LGBTQ+ pupils.

Social media use among bisexuals and pansexuals: connection, harassment and mental health.

Analysing survey data from 1,304 LGBTQ + young people in Australia collected in 2016, this paper considers key distinctions between the experiences of bisexual and pansexual participants, and lesbian and gay participants in relation to social media use and aspects of connection, harassment and mental health. Presenting quantitative data, illustrated by qualitative extracts, we found broad similarities in motivations for using social media and how participants connected to peers and communities. There were some statistically significant differences, however, in respondents' motivations for using social media and who they connected with on these platforms. Importantly, bisexual and pansexual participants reported more negative experiences of harassment and exclusion across all major social media platforms when compared to their lesbian and gay peers. Bisexual and pansexual respondents also reported poorer mental health experiences. These findings speak to the different impacts of discrimination and oppression that young people experience in everyday life. There is a need for focused attention on bisexual and pansexual young people in academic, policy and youth-work domains. Young people will benefit from more substantial school-based education on LGBTQ + identities - beyond the experiences of gay and lesbian people - to 'usualise' varieties of difference in gender and sexual identity.

Staying "One Step Ahead of a Racist": Expanding Understandings of the Experiences of the Covid-19 Pandemic Among People From Minoritized Ethnic Groups Living in Britain.

Covid-19 has had a disproportionate impact on those in minoritized ethnic groups. Considerable attention has been given to evidence of ethnic inequalities in rates of infection, hospitalisation, and death. But other ways in which the pandemic experience has been affected by ethnicity have received less consideration. This paper explores the lived experiences of people in different minoritized ethnic groups living in South West England, during the United Kingdom's first pandemic lockdown, using qualitative data collected from interviews and comments provided on a survey. Perceived positive opportunities for growth were offset by anxiety and stress, which were themselves compounded by an awareness of the additional risks they experienced as members of racialised groups, and a sense that this was being ignored-or intentionally exacerbated-by the British authorities. Frustration with an incompetent and corrupt national Government was intensified by concerns regarding their racist motives. Racism in wider society undermined confidence in key public institutions, such as the NHS and the police, while also producing barriers to informal local-community pandemic responses. Only through recognition of the particular ways in which the pandemic affected those in minoritized ethnic groups, including the multiple and compounding effects of current and historical racism, will it be possible to identify avenues for transformative systemic policy change and opportunities to rebuild trust and a better post-pandemic society for all.

A mixed-methods study to evaluate a patient-designed tool to reduce harm from cancer-associated thrombosis: The EMPOWER study.

INTRODUCTION: Venous thromboembolism (VTE) is a common and serious complication of systemic anticancer therapies. Delays in presentation increase risk of death or long-term morbidity. BACKGROUND: A patient charity developed an information video for patients receiving systemic anticancer therapy including what to do if they developed symptoms of VTE. This was introduced into clinical practice in a regional cancer center and its impact compared with a district general hospital where the video was not used. METHODS: A mixed-methods approach was used, comprising clinical audit data, patient surveys, and key informant interviews. The time between development of VTE symptoms and seeking medical evaluation was routinely recorded on patients attending a regional cancer-associated thrombosis service with systemic anticancer therapy-provoked VTE. The video was then embedded into clinical practice at the regional cancer center for 3 months. The primary outcome was the difference in time to presentation with VTE symptoms, between patients attending the regional cancer center and the district general hospital (which acted as control). Other outcomes included impact on radiology resources, patient knowledge, and perspectives of chemotherapy nurses. RESULTS: Addition of the video was associated with a lower mean time to presentation from 8.9 to 2.9 days (0.33 hazard ratio; 95% confidence interval, 4.5-7.4; P < .0001). This may reflect greater awareness of VTE, resulting in earlier clinical presentation when they developed attributable symptoms. CONCLUSION: The video was associated with reduced delays in diagnosis of systemic anticancer therapy-associated VTE by 6 days, thereby reducing long-term complications.

The Politics of LGBT+ Health Inequality: Conclusions from a UK Scoping Review.

This scoping review of UK evidence aimed to describe what is known about Lesbian, Gay, Bisexual, and Trans (LGBT+) health inequalities in relation to cancer, mental health, and palliative care to inform research, policy and public health interventions. Using a scoping review methodology, we identified studies from database searches, citation tracking, and expert consultation. The in/exclusion criteria was based on the PICOS framework. The data were charted and then summarised to map the theoretical approaches and the main types of evidence and identify knowledge gaps. In total, 279 articles were screened and 83 were included in the final review. We found that there is limited UK research examining LGBT+ health inequality in cancer, mental health and palliative care. We would argue that this thin evidence base is partly due to national policy discussions of LGBT+ health inequality that are framed within a depoliticised 'it's getting better' narrative, and an unwillingness to adequately acknowledge the unjust social and economic relations that produce LGBT+ health inequality. In addition, LGBT+ health inequality is depoliticised by existing public health explanatory theories, models and frameworks that exclude sexual orientation and gender diversity as dimensions of power that interlock with those of socio-economic, race and ethnicity. This is a barrier to developing public health interventions that can successfully tackle LGBT+ health inequality.

Patient understanding and acceptability of an early lung cancer diagnosis trial: a qualitative study.

BACKGROUND: The ELCID (Early Lung Cancer Investigation and Diagnosis) trial was a feasibility randomised controlled trial examining the effect on lung cancer diagnosis of lowering the threshold for referral for urgent chest x-ray for smokers and recent ex-smokers, aged over 60 years with new chest symptoms. The qualitative component aimed to explore the feasibility of individually randomising patients to an urgent chest x-ray or not and to investigate any barriers to patient recruitment and participation. We integrated this within the feasibility trial to inform the design of any future definitive trial, particularly in view of the lack of research exploring symptomatic patients' experiences of participating in diagnostic trials for possible/suspected lung cancer. Although previous studies contributed valuable information concerning screening for lung cancer and patient participation in trials, this paper is the first to explore issues relating to this specific patient group. METHODS: Qualitative interviews were conducted with 21 patients, comprising 9 who had been randomised to receive an immediate chest x-ray, 10 who were randomised to receive the standard treatment according to the National Institute for Health and Care Excellence guidelines, and 2 who chose not to participate in the trial. Interviews were analysed using a framework approach. RESULTS: The findings of this analysis showed that altruism, personal benefit and the reassurance of not having lung cancer were important factors in patient participation. However, patients largely believed that being in the intervention arm was more beneficial, highlighting a lack of understanding of clinical equipoise. Disincentives to participation in the trial included the stigmatisation of patients who smoked (given the inclusion criteria). Although the majority of patients reported that they were happy with the trial design, there was evidence of poor understanding. Last, for several patients, placing trust in health professionals was preferred to understanding the trial processes. CONCLUSIONS: The integration of a qualitative study focusing on participant experience as a secondary outcome of a feasibility trial enabled exploration of patient response to participation and recruitment. The study demonstrated that although it is feasible to recruit patients to the ELCID trial, more work needs to be done to ensure an understanding of study principles and also of smoking stigmatisation. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01344005 . Registered on 27 April 2011.