I can't believe I missed that! How the fear of missing out impacts on alcohol behaviours.

BACKGROUND: The Fear of Missing Out (FoMO), which is often experienced over missing opportunities for social gains associated with drinking, has been linked to heavy episodic drinking and experiencing negative consequences. The UK Coronavirus (COVID-19)-related lockdown provided a unique context to study FoMO's ability to predict of alcohol consumption. The aim of the current study was to test if FoMO predicted alcohol consumption during a time of social restrictions. METHODS: One hundred and five UK adults (aged 18-30, 61% female) participated in a study using an ecological momentary assessment design. Surveys were completed on smartphones and assessed FoMO and drinking intentions, three time a day (morning, afternoon, evening) over three consecutive weekends (Friday, Saturday, Sunday). Alcohol consumption was recorded once per day, based on previous day consumption. RESULTS: Repeated mixed model analyses found FoMO significantly predicted quantity of alcohol consumption (b =.05, p =.01) and drinking intentions (b =.47, p <.001), but did not predict frequency of consumption. Being male (b = 2.93, p =.02) and higher intentions (b = 0.5, p <.001) predicted higher quantity of consumption. Drinking intentions was the only variable to predict frequency of consumption (b =.004, p <.001). CONCLUSIONS: The study showed FoMO can predict quantity of alcohol consumption and drinking intentions, which are linked to increased negative consequences. Future studies should assess FoMO against other predictive factors. Results provide an insight into how a social predictor influenced alcohol consumption during a time of restrictions.

Nitrous oxide and methane production and consumption at five full-size denitrifying bioreactors treating subsurface drainage water.

Nitrate (NO3-) removal in denitrifying bioreactors is influenced by flow, water chemistry, and design, but it is not known how these widely varying factors impact the production of nitrous oxide (N2O) or methane (CH4) across sites. Woodchip bioreactors link the hydrosphere and atmosphere in this respect, so five full-size bioreactors in Illinois, USA, were monitored for NO3-, N2O, and CH4 to better document where this water treatment technology resides along the pollution swapping to climate smart spectrum. Both surface fluxes and dissolved forms of N2O and CH4 were measured (n = 7-11 sampling campaigns per site) at bioreactors ranging from <1 to nearly 5 years old and treating subsurface drainage areas from between 6.9 and 29 ha. Across all sites, N2O surface and dissolved volumetric production rates averaged 1.0 ± 1.6 mg N2O-N/m3-d and 24 ± 62 mg dN2O-N/m3-d, respectively, and CH4 production rates averaged 6.0 ± 26 mg CH4-C/m3-d and 310 ± 520 mg dCH4-C/m3-d for surface and dissolved, respectively. However, N2O was consistently consumed at one bioreactor, and only three of the five sites produced notable CH4. Surface fluxes of CH4 were significantly reduced by the presence of a soil cover. Bioreactor denitrification was relatively efficient, with only 0.51 ± 3.5 % of removed nitrate emitted as N2O (n = 48). Modeled indirect N2O emissions factors were significantly lower when a bioreactor was present versus absent (EF5: 0.0055 versus 0.0062 kg N2O-N/kg NO3-N; p = 0.0011). While further greenhouse gas research on bioreactors is recommended, this should not be used as an excuse to slow adoption efforts. Bioreactors provide a practical option for voluntary water quality improvement in the heavily tile-drained US Midwest and elsewhere.

"We just don't have the resources": Supervisor perspectives on introducing workplace-based assessments into medical specialist training in South Africa.

BACKGROUND: South Africa (SA) is on the brink of implementing workplace-based assessments (WBA) in all medical specialist training programmes in the country. Despite the fact that competency-based medical education (CBME) has been in place for about two decades, WBA offers new and interesting challenges. The literature indicates that WBA has resource, regulatory, educational and social complexities. Implementing WBA would therefore require a careful approach to this complex challenge. To date, insufficient exploration of WBA practices, experiences, perceptions, and aspirations in healthcare have been undertaken in South Africa or Africa. The aim of this study was to identify factors that could impact WBA implementation from the perspectives of medical specialist educators. The outcomes being reported are themes derived from reported potential barriers and enablers to WBA implementation in the SA context. METHODS: This paper reports on the qualitative data generated from a mixed methods study that employed a parallel convergent design, utilising a self-administered online questionnaire to collect data from participants. Data was analysed thematically and inductively. RESULTS: The themes that emerged were: Structural readiness for WBA; staff capacity to implement WBA; quality assurance; and the social dynamics of WBA. CONCLUSIONS: Participants demonstrated impressive levels of insight into their respective working environments, producing an extensive list of barriers and enablers. Despite significant structural and social barriers, this cohort perceives the impending implementation of WBA to be a positive development in registrar training in South Africa. We make recommendations for future research, and to the medical specialist educational leaders in SA.

Exploring barriers to switching "on time" to second-line antiretroviral therapy among nurses in primary health care facilities, Ekurhuleni Health District, South Africa.

BACKGROUND: Ensuring that all HIV-infected people receive antiretroviral therapy (ART) and achieve viral suppression are key South African strategies to end the AIDS epidemic in the country. National HIV treatment guidelines recommend an immediate switch to second-line ART following virological failure with first-line ART. Nurses based in district health facilities are at the forefront of implementing this recommendation. While there are often delays in switching and in some instances no switch, the reasons for and barriers to delayed switching are not well understood at the primary care level. AIM: To explore the views of frontline nursing staff about factors contributing to delayed switching of patients who have failed first-line ART regimen in Ekurhuleni district, South Africa. METHODS: A qualitative study was conducted among 21 purposively sampled nurses who provide HIV treatment and care to patients in 12 primary health care (PHC) facilities in Ekurhuleni Health District, Gauteng Province, South Africa. Individual in-depth interviews explored nurses' experiences regarding their recognition of virological failure and understanding of "on time" switching to second-line ART. Interviews probed the circumstances contributing to delays in switching. After digital audio recording and transcription, manual inductive thematic analysis was used to analyse the data. FINDINGS: Multiple barriers were identified: 1) Healthcare provider factors included a lack of knowledge and confidence coupled with demotivation in the workplace; 2) Patient issues similarly comprised a lack of knowledge as well as resistance to being switched to another drug regimen and loss to follow up; 3) Systems factors were poor facility leadership, shortages of medication, staffing constraints, and the inability to trace laboratory results, especially for migrant patients. CONCLUSION: Reasons for delayed switching of patients to second-line ART are multifactorial and require integrated interventions at health provider, patient and health system levels.

Developing entrustable professional activities for family medicine training in South Africa.

Workplace-based assessment (WPBA) is becoming part of high-stake assessments in specialist training. Entrustable professional activities (EPAs) are a recent addition to WPBA. This is the first South African publication on developing EPAs for postgraduate family medicine training. An EPA is a unit of practice, observable in the workplace, constituting several tasks with underlying knowledge, skills and professional behaviours. Entrustable professional activities allow for entrustable decisions regarding competence in a described work context. A national workgroup representing all nine postgraduate training programmes in South Africa has developed 19 EPAs. This new concept needs change management to understand the theory and practice of EPAs. Family medicine departments with large clinical workloads are small, necessitating navigating logistical issues to develop EPAs. It has unmasked existing workplace learning and assessment challenges.Contribution: This article contributes new thinking to developing EPAs for family medicine in an effort to understand more authentic WPBA nationally.

Catch-Up Growth in Infants and Young Children With Faltering Growth: Expert Opinion to Guide General Clinicians.

Faltering growth (FG) is a problem regularly seen by clinicians in infants and young children (<2 years of age). It can occur due to non-disease-related and disease-related causes and is associated with a wide range of adverse outcomes, including shorter-term effects such as impaired immune responses and increased length of hospital stay, and longer-term consequences, including an impact on schooling and cognitive achievements, short stature, and socioeconomic outcomes. It is essential to detect FG, address underlying causes and support catch-up growth where this is indicated. However, anecdotal reports suggest misplaced fear of promoting accelerated (too rapid) growth may deter some clinicians from adequately addressing FG. An invited international group of experts in pediatric nutrition and growth reviewed the available evidence and guidelines on FG resulting from disease-related and non-disease-related effects on nutritional status in healthy term and small for gestational age infants and children up to the age of 2 years in low-, middle-, and high-income countries. Using a modified Delphi process, we developed practical consensus recommendations to provide clarity and practical recommendations for general clinicians on how FG should be defined in different young child populations at risk, how FG should be assessed and managed, and the role of catch-up growth after a period of FG. We also suggested areas where further research is needed to answer remaining questions on this important issue.

Experiences of primary health care practitioners dealing with emergencies - 'We are on our own'.

BACKGROUND: Primary health care (PHC) focuses on health promotion and disease prevention; however, acute episodes and emergencies still occur at this level of care. The World Health Organization (WHO) proposes strengthening emergency care at a PHC level as a way of lessening the burden of disease on the overall health system. It is not known how health care practitioners at the PHC level experience management of emergencies. AIM: To explore and describe the experiences of PHC practitioners dealing with emergencies at PHC facilities in Gauteng, South Africa. SETTING: The study was conducted in the District Health Services of Gauteng province in South Africa, including clinics, community health care centres and district hospitals. METHODS: Using a qualitative approach, semi-structured interviews were conducted with a purposively selected sample of professional nurses and doctors from various levels of the district health care system. Data were transcribed and analysed using qualitative thematic analysis. RESULTS: Various themes were identified related to the individual confidence and competence of the PHC practitioner, the team approach, the process of role and task allocation and the need for training. CONCLUSION: The study provided a voice for the needs of health care practitioners dealing with emergencies at the PHC level. The designing of a targeted and contextually appropriate approach to emergency care training of health care practitioners in the PHC setting that improves team dynamics and team performance, is recommended.Contribution: The insights of PHC practitioners dealing with emergencies contribute contextual relevance to any strategic improvement of care at this level.

Designing complex interventions: A description of the development of an intervention to reduce inequalities in planned dental visiting.

There are multifaceted reasons for a social gradient in planned dental visiting involving various psycho-social variables that interact with each other and the environment. Interventions in this area are therefore inevitably complex interventions. While guidance recommends undertaking theory and modelling work before experimental work is done, there is a shortage of descriptions of how this is done, especially in the field of oral health. OBJECTIVES: To describe theory, qualitative and public engagement work, and identification of behaviour change techniques (BCTs) to define features of an opportunistic dental visiting intervention for adult users of urgent dental care services. METHODS: A systematic review and synthesis of theory, qualitative and quantitative work, along with expert input, generated a list of psycho-social determinants linked to planned dental visiting intentions. Modelling involved ethnographic work in urgent dental care settings and work with members of the community from the targeted demographic. This enabled verification, in the context of their idiosyncratic expression for the target population in question, of behavioural determinants (BDs) identified in the theory phase. It also facilitated generating intervention material which was infused with the identity of the end user. BDs identified were then mapped to BCTs using an accepted BCT taxonomy and an intervention prototype developed. The prototype then underwent iterative testing with target users before it was ready for a feasibility trial. RESULTS: Theory and modelling identified five key intervention focuses: affordable resources (time/ cost), the importance of oral health, trust in dentists, embarrassment of having poor oral health and dental anxiety. Short videos were developed to incorporate role modelling which were well received. Prototype testing resulted in shifting from 'if-then' plans to action planning. CONCLUSIONS: Complex intervention development involves an iterative rather than sequential process of combining theory, empirical work and user involvement, of which the article provides an example.

Understandings and practices: Towards socially responsive curricula for the health professions.

Global health inequities have created an urgency for health professions education to transition towards responsive and contextually relevant curricula. Such transformation and renewal processes hold significant implications for those educators responsible for implementing the curriculum. Currently little is known about how health professions educators across disciplines understand a responsive curriculum and how this understanding might influence their practice. We looked at curricula that aim to deliver future health care professionals who are not only clinically competent but also critically conscious of the contexts in which they serve and the health care systems within which they practice. We conducted a qualitative study across six institutions in South Africa, using focus group discussions and in-depth individual interviews to explore (i) how do health professions educators understand the principles that underpin their health professions education curriculum; and (ii) how do these understandings of health professions educators shape their teaching practices? The transcripts were analysed thematically following multiple iterations of critical engagement to identify patterns of meaning across the entire dataset. The results reflected a range of understandings related to knowing, doing, and being and becoming; and a range of teaching practices that are explicit, intentionally designed, take learning to the community, embrace a holistic approach, encourage safe dialogic encounters, and foster reflective practice through a complex manner of interacting. This study contributes to the literature on health professions education as a force for social justice. It highlights the implications of transformative curriculum renewal and offers insights on how health professions educators embrace notions of social responsiveness and health equity to engage with these underlying principles within their teaching.

Consensus-based recommendations for strengthening emergency care at primary health care level: a Delphi study.

BACKGROUND: Emergency care at a primary health care (PHC) level must be strengthened to reduce overall mortality and morbidity in any country. Developing recommendations for improvement in this area should take into consideration the context and nuances of the current emergency care system and primary health care context. Contribution to policy from the experts in the cross-cutting fields of PHC and emergency care is lacking. OBJECTIVES: This study aims to evaluate the strengths and weaknesses of emergency care in primary health settings and develop consensus-based recommendations for the strengthening of emergency care at this level. METHODS: Using a modified Delphi technique, data were collected from various data sources to evaluate the strengths and weaknesses of emergency care at PHC level, from which recommendation statements were developed. These recommendations were proposed to a panel of experts using a Delphi survey to build consensus on 14 recommendations to strengthen emergency care at PHC level. RESULTS: Ten experts were recruited to participate (n = 10) with a response rate of 90% in round II and 80% in round III of Delphi. Recommendations broadly addressed the areas of education and training in emergency care, the role and placement of various actors, leadership in emergency care and the development of a national plan for emergency care. Consensus was reached in round II for 97.61% of the statements and after modification based on open-ended comments, 98.21% consensus was reached in round III. CONCLUSION: Strengthening emergency care at primary and subsequent levels of health care requires a coordinated effort and mandate from authority in order to effect real change.

Effectiveness of denitrification bioreactors with woodchips, corn stover, and phosphate-sorbing media for simultaneous removal of drainage water N and P in a corn-soybean system.

Millions of acres of farmland in the midwestern United States (US) are artificially drained, and this contributes to the export of nitrogen (N) and phosphorus (P) from agricultural land to surface water. Using a 36-acre tile-drained farm field, effects of P-sorbing media in combination with a denitrifying bioreactor system constructed with woodchips (WC) and corn stover (CS) on reducing nutrient export in drainage water were tested for 3 cropping years (2018-2020). The field was divided into three subfields as replicates. In each subfield, the drainage water was divided and separately channeled into three bioreactors, each of which contains one of the three different substrates: WC, CS, and CS-WC (1:1 v/v mixture of CS and WC), randomly assigned. The outlet of each compartment contained a 2.25 L flow-through chamber filled with activated iron (Fe) filings as P-sorbing material. Both WC and CS bioreactors were effective in removing drainage NO3 - with a 77% (WC), 86% (CS), and 89% (CS-WC) reduction in mean NO3 - -N concentration. For the three cropping years, the WC bioreactor reduced the total drainage inorganic N (NO3 - -N + NH4 + -N) load by 72%, but the CS bioreactor increased the total inorganic N load in the drainage water due to the substantial release of NH4 + with the decomposition of CS. The breakdown of CS also increased drainage P. The NH4 + and P release decreased with the decrease in the proportion of CS; thus, not more than 10% of CS is recommended for blending with WC to enhance the performance of a bioreactor. The P-sorbing Fe filing media reduced the P loads in drainage by an average of 19% during the 2-year study.

Calling time on responsible drinking: A qualitative study of perceptions of information on alcohol product labels.

OBJECTIVES: This study aimed to explore (a) how people interpret responsible drinking messages on alcohol product labels, and (b) the acceptability of including health information on labels. DESIGN: Qualitative interviews. METHODS: Face-to-face semi-structured interviews were conducted with 20 people aged 21-63; 18 were classified risky drinkers using AUDIT-C. They were shown three sets of alcohol product labels: one including three responsible drinking messages (drink responsibly), one with three positively worded health messages (drinking less reduces risks) and one with three negatively worded health messages (drinking more increases risks). Health messages included information about cancer, liver and heart disease. RESULTS: Thematic analysis identified three themes: ambiguity about alcohol labelling; identifying oneself as responsible; and acceptability of enhanced product labelling. Participants were critical of responsible drinking messages and wary of conflicting health information in the media. They positioned themselves as responsible, knowledgeable drinkers and distanced themselves from problem drinkers. They did not appear to support the inclusion of health information on labels; however, novel information was considered more impactful. CONCLUSIONS: Responsible drinking messages were seen by our sample as an alcohol industry ploy. Although health messages about cancer were seen as potentially impactful, the ability of consumers to position themselves as unproblematic drinkers means that they may not see the information on the label as relevant to themselves. Understanding factors that increase the personal relevance of messages is needed, alongside an exploration of a wider range of methods for alcohol health communication.

The effect of forming implementation intentions on alcohol consumption: A systematic review and meta-analysis.

ISSUES: Meta-analysis was used to estimate the effect of forming implementation intentions (i.e., if-then plans) on weekly alcohol consumption and heavy episodic drinking (HED). Sample type, mode of delivery, intervention format and timeframe were tested as moderator variables. APPROACH: Cochrane, EThOS, Google Scholar, PsychArticles, PubMed and Web of Science were searched for relevant publications to 31 March 2021. Random-effects meta-analysis was used to estimate the effect size difference (d) between individuals forming versus not forming implementation intentions on weekly consumption and HED. KEY FINDINGS: Sixteen studies were included in meta-analyses. The effect size difference for forming implementation intentions on weekly alcohol consumption was d+  = -0.14 confidence interval (CI) [-0.24; -0.03]. Moderator analyses highlighted stronger effects for: (i) community (d+  = -0.38, CI [-0.58; -0.18]) versus university (d+  = -0.04, CI [-0.13; 0.05]) samples; (ii) paper (d+  = -0.26, CI [-0.43; -0.09]) versus online (d+  = -0.04, CI [-0.14; 0.06]) mode of delivery; and (iii) volitional help sheet (d+  = -0.34, CI [-0.60; -0.07]) versus implementation intention format (d+  = -0.07, CI [-0.16; 0.02]). In addition, effects diminished over time (B = 0.02, SE = 0.01, CI [0.03; 0.01]). Forming implementation intentions had a null effect on HED, d+  = -0.01 CI [-0.10; 0.08]. IMPLICATIONS: Forming implementation intentions reduces weekly consumption but has no effect on HED. CONCLUSION: This review identifies boundary conditions on the effectiveness of implementation intentions to reduce alcohol consumption. Future research should focus on increasing the effectiveness of online-delivered interventions and integrating implementation intention and motivational interventions.

How Health Care Practitioners experience emergencies at Primary Health Care facilities - Kinks in the chain of survival.

Background: The 72nd World Health Assembly has recognised that emergency care at primary health care level is vital for reducing overall mortality and disability. The system of emergency care at this level is affected by various external factors. Little is known about these factors and how they shape the experiences of health care practitioners dealing with medical emergencies in Primary Health Care (PHC) settings. The objective of the study was to explore the experiences of health care practitioners in dealing with emergencies in PHC facilities in the Gauteng province of South Africa. Methods: A qualitative formative evaluation approach was used. Data were collected using semi structured interviews and analysed using qualitative content analysis to describe the experiences of health care practitioners dealing with emergencies at a primary health care level. Participants included health care practitioners from various levels of the district health system. Results: Major themes that emerged explored challenges faced by health care practitioners, the referral system and influential policy such as the ideal clinic movement.

Paired denitrifying bioreactors with wide orientation for increased drainage flow capacity.

Denitrifying bioreactors are a conservation drainage practice for reducing nitrate loads in subsurface agricultural drainage. Bioreactor hydraulic capacity is limited by cross-sectional area perpendicular to flow through the woodchip bed, with excess bypass flow untreated. Paired bioreactors with wide orientations were built in 2017 in Illinois, USA, to treat drainage from a relatively large 29 ha field. The paired design consisted of: a larger, Main bioreactor (LWD: 6.1 × 18.3 × 0.9 m) for treating base flow, and 2) a smaller, Booster bioreactor (7.8 × 13.1 × 0.9 m) receiving bypass flow from the Main bioreactor during periods of high flow. Over three years of monitoring, the paired bioreactor captured 84-92% of the annual drainage discharge which demonstrated an expanded cross-sectional area could improve bioreactor flow capture, even for a large drainage area. However, the paired bioreactors removed 6-28% of the annual N load leaving the field (1.8-5.6 kg N ha-1 removed; 52-161 kg N), which was not a notable improvement compared to bioreactors treating smaller drainage areas. The design operated as intended at low annual flow-weighted hydraulic retention times (HRTs) of usually ≤2 h, but these short HRTs ultimately limited bioreactor nitrate removal efficiency. Daily HRTs of <2 h often resulted in nitrate flushing. The Main bioreactor had higher hydraulic loading as intended and was responsible for the majority of flow captured in each year although not always the most nitrate mass removal. The Booster bioreactor provided better nitrate removal than the Main at HRTs of 3.0-11.9 h, possibly due to its drying cycles which may have liberated more available carbon. This new design approach tested at the field-scale illustrated tradeoffs between greater flow capacity (via increased bioreactor width) and longer HRT (via increased length), given a consistent bioreactor surface footprint.

Alcohol consumption and mental health conditions: Insights from a South Australian population survey to inform policy and practice.

OBJECTIVE: Among individuals with a mental health condition co-occurring alcohol use disorders are common, but less is known about alcohol consumption in excess of recommended drinking guidelines. This study investigated the prevalence of lifetime risky drinking (>2 drinks daily) and single occasion risky drinking (>4 drinks on one occasion) among individuals with mental health conditions of different severities. METHODS: Data from representative cross-sectional population surveys among South Australians aged ≥15 years (n=11,761) were utilised. Logistic regression models assessed associations between risky alcohol consumption, presence of a mental health condition and demographic characteristics. RESULTS: Prevalence of lifetime risky drinking was greater among both males and females with a mental health condition (p>0.001). Single occasion risky drinking was more prevalent among males with a severe mental health condition (p=0.01). Adjusted logistic regressions showed that only females with a mental health condition had greater odds of exceeding lifetime risky drinking levels (OR=1.39, CI 1.11 to1.75). CONCLUSIONS: There are sex-specific relationships between risky alcohol consumption and mental health conditions. IMPLICATIONS FOR PUBLIC HEALTH: Risky alcohol consumption, in excess of guidelines, is of concern among those with a mental health condition and requires attention at an individual and population level.

Saturated buffer design flow and performance in Illinois.

There are few peer-reviewed studies documenting saturated buffer annual nitrate (NO3 ) removal or that have assessed the federal practice standard design criteria. Drainage flow, NO3 , and dissolved reactive phosphorus (DRP) were monitored at three saturated buffers in Illinois, USA, for a combined 10 site-years. Nitrate loss reduction averaged 48 ± 19% with removals of 3.5-25.2 kg NO3 -N ha-1 annually. Median DRP concentrations at all sampling locations were at the analytical detection limit of 0.01 mg L-1 . The current design paradigm (i.e., USDA practice standard) prescribes there should be no flow bypassing the saturated buffer at flow rates that are ≤5% of the peak drainage system flow rate. The drainage coefficient-based and Manning's equation-based peak flow estimates were higher and lower, respectively, than the observed annual peaks in all years. This illustrated inherent uncertainty introduced early in the design process, which can be further compounded by dynamic in-buffer hydrology. The percentage of the observed peak flow rate at which bypass initiated ranged across an order of magnitude between sites (4.4-8.1% of peak flow rate at one site and 42-49% of peak at another) despite the buffers providing relatively similar NO3 removal. Bypass at one site (SB2) was related to the concept of "antecedent buffer capacity filled," which was defined as the 5-d average water depth in the middle control structure chamber expressed as a relative percentage of the bypass stop log height. This design flow analysis serves as a call to further evaluate predictive relationships and design models for edge-of-field practices.

Core Ideas Three saturated buffers in Illinois provided an ≈50% annual reduction in NO3 load. Observed peak flow rates differed from estimation methods used for design purposes. Two sites had relatively similar nitrate removals but different bypass trends. "Antecedent buffer capacity filled" was the water depth in the middle chamber as a percent of stop log height.

Phosphorus removal in denitrifying woodchip bioreactors varies by wood type and water chemistry.

Denitrifying woodchip bioreactors are a practical nitrogen (N) mitigation technology but evaluating the potential for bioreactor phosphorus (P) removal is highly relevant given that (1) agricultural runoff often contains N and P, (2) very low P concentrations cause eutrophication, and (3) there are few options for removing dissolved P once it is in runoff. A series of batch tests evaluated P removal by woodchips that naturally contained a range of metals known to sorb P and then three design and environmental factors (water matrix, particle size, initial dissolved reactive phosphorus (DRP) concentration). Woodchips with the highest aluminum and iron content provided the most dissolved P removal (13±2.5 mg DRP removed/kg woodchip). However, poplar woodchips, which had low metals content, provided the second highest removal (12±0.4 mg/kg) when they were tested with P-dosed river water which had a relatively complex water matrix. Chemical P sorption due to woodchip elements may be possible, but it is likely one of a variety of P removal mechanisms in real-world bioreactor settings. Scaling the results indicated bioreactors could remove 0.40 to 13 g DRP/ha. Woodchip bioreactor dissolved P removal will likely be small in magnitude, but any such contribution is an added-value benefit of this denitrifying technology.

'You see the pictures the morning after and you're like I wish I was in them': an interpretative phenomenological analysis of university student's alcohol-related regrets.

OBJECTIVES: University students report experiencing regrettable health and social outcomes following excessive alcohol consumption. Students also report experiencing regret when they are unable to attend drinking events. This study explored how such experiences influence risk appraisals and decisions about future alcohol consumption. DESIGN AND MEASURES: Thirteen university students (69% female, 18-20 years old) discussed the interplay of regret with alcohol consumption, and nonattendance at drinking events, in one of three focus groups. Transcripts were analysed using Interpretative Phenomenological Analysis (IPA). RESULTS: IPA produced three super-ordinate themes: 'It's not something I would have done sober', 'Attitudes towards action regret' and 'Fear of Missing Out (FoMO)'. Participants reported regrettable experiences (e.g. alcohol poisoning, tattoos), and a gender difference in risk appraisals was apparent. Attitudes towards action regret affected risk appraisals and informed future drinking decisions. Participants reported experiencing FoMO when they were unable to attend drinking events. CONCLUSION: Regrettable incidents following excessive consumption were seen as common but did not affect risk appraisals or future drinking decisions. Students' reported they preferred the regrettable experiences that follow excessive consumption than the FoMO experienced when they were unable to attend drinking events, suggesting FoMO may drive attendance at future drinking events.