Background:Violence is a major public health issue. In the United Kingdom (UK), injuries resulting from interpersonal violence were estimated to cost the National Health Service (NHS) £2.9 billion annually. Hospital Violence Intervention Programmes (HVIPs), based in Emergency Departments (EDs), identify individuals (both perpetrators and victims) who may benefit from support for modifiable risk factors associated with exposure to violence. In this study we evaluate the cost-effectiveness of implementing an HVIP called the Violence Prevention Team (VPT) relative to standard care in Wales. Methods:We conducted a cost-effectiveness analysis of VPTs in ED relative to standard care. We included patients aged 11 years or older who attended ED with an assault-related injury between November 2019 and February 2024 in Wales. Participants exposed to the VPT or standard care were matched with a minimum 1:1 ratio. A hybrid decision tree-Markov model was created to follow patients attending ED for an initial assault-related attendance and to track any subsequent unplanned ED visits thereafter. Health outcomes were measured in quality-adjusted life years (QALYs), and costs (in 2023/2024 British pounds sterling) were estimated using a (a) health perspective and (b) societal perspective (including additional costs across the third sector) over a time horizon of 10 years. Routine data from the Secure Anonymised Information Linkage (SAIL) databank were used to inform model probability and healthcare cost estimates. QALYs were estimated using the literature. We estimated the incremental cost-effectiveness ratio (ICER), net monetary and net health benefits, and probability of being cost-decreasing and QALY-increasing. ICERs were interpreted against the UK Department for Health's cost effectiveness threshold of £15,000 per QALY and the National Institute for Health and Care Excellence (NICE) cost-effectiveness threshold of £20,000-£30,000 per QALY. This study is registered with ISRCTN (68945844). Findings:Our base case analysis suggested that implementing VPTs in ED was cost-saving and more effective relative to standard care, from both a health and societal perspective. At a NICE cost-effectiveness threshold of £20,000-£30,000 per QALY, there was 83% probability that VPTs in ED are considered cost-effective relative to standard care. At a threshold of £15,000 per QALY, the probability that VPTs in ED are considered cost-effective relative to standard care was 84%. When only including ED and associated inpatient admission costs and excluding primary care visit costs, VPTs remained cost-effective from a health perspective (£12,950 per QALY gained). Interpretation:VPTs in ED are strategically placed to intervene following injuries. They have the potential to reduce costs and improve health outcomes, and their implementation should be prioritised by the NHS. Funding:This study was funded by the National Institute for Health and Care Research, Public Health Research Board (NIHR134055).

BACKGROUND:Neurodiversity, including autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD) and learning difficulties, can increase vulnerability to violence. However, the epidemiology of violence-related Emergency Department (ED) attendance among neurodiverse patients remains unknown, as does the extent to which they engage with support services. Hospital-based Violence Intervention Programmes represent a potential strategic response, yet their need for and effectiveness in identifying and supporting neurodiverse patients is unexplored. METHODS:A whole-population cross-sectional exploratory study of 3 993 439 Welsh residents (2012-2024) using anonymised routine data. Data linkage identified violence-related ED attendances, neurodiversity diagnoses and comorbid conditions. Multivariable logistic regression models explored associations between neurodiversity and violence-related attendance. There were 9584 patients eligible for Violence Prevention Team (VPT) interventions at two intervention sites and exploratory analyses assessed patients acceptance of support. RESULTS:There were 73 222 ED violence-related attendances. ADHD (n=3511) and learning difficulty (n=1641) were each independently associated with increased violence-related attendance (ADHD, OR 1.67, 95% CI 1.61 to 1.74; mild learning difficulty, OR 1.33, 95% CI 1.25 to 1.40), whereas ASD (n=1148) was associated with a lower likelihood of violence-related attendance (OR 0.71, 95% CI 0.67 to 0.76). Of the eligible patients, VPTs contacted 4007 (41.8%); 2560 engaged with support while 1180 refused. Males and individuals with a history of alcohol misuse, substance misuse, or being a looked-after child were more likely to refuse support. In contrast, diagnoses of ASD, ADHD, and learning difficulties were not associated with support refusal. CONCLUSION:ADHD and learning difficulty are over-represented among violence-related ED attendees; however, neurodiversity does not predict unwillingness to engage with intervention services. Hospital-based violence prevention programmes are feasible within UK ED and can identify neurodiverse patients. Resource limitations currently restrict coverage. These findings support the need for sustained violence prevention services to optimise identification and support of vulnerable populations. TRIAL REGISTRATION NUMBER:ISRCTN68945844.

Background:Emergency Department (ED) care of people injured in violence is increasingly seen as an opportunity to address patients' psychosocial vulnerabilities as well as their treatment. These vulnerabilities include alcohol, drug use, mental health and social vulnerabilities that are also associated with high levels of unplanned ED attendances for reasons other than violent injury. Since evidence of the effectiveness of interventions designed to reduce these risks is weak, we evaluated the impact of nurse-led Hospital Violence Intervention Programmes (HVIPs) across two sites in Wales, United Kingdom, on subsequent unplanned ED attendance. Methods:We used anonymised country-wide electronic health and administrative data to identify a cohort of patients, from 2019 to 2024, injured in violence who attended EDs in Wales, United Kingdom. We matched the characteristics of patients who engaged with the HVIP to control patients in the same cohort. We estimated the unadjusted hazard ratio (HR) for subsequent unplanned ED attendances for patients, and adjusted HRs to determine HVIP effectiveness overall and for sub-groups based on age and gender. This study is registered with ISRCTN (68945844). Findings:For patients who engaged with the intervention (n = 2068; representing 3580 attendances), the frequency of subsequent ED attendances was lower than control patients (n = 6196; 12,174 attendances; HR = 0.95, 95% CI 0.91-0.99). The intervention was more effective for female patients (HR = 0.86, 95% CI 0.80-0.92) and those aged 11-17 (HR = 0.88, 95% CI 0.82-0.92) and 18 to 30 (HR = 0.86, 95% CI 0.80-0.92) years of age. Interpretation:If risk factors associated with violence related injury are identified and addressed as part of ED care, ED attendances can be reduced. Funding:This study is funded by the National Institute for Health and Care Research, Public Health Research Programme (NIHR134055).

OBJECTIVES:Patients visiting an Emergency Department (ED) due to violence who are unable or unwilling to disclose that their injury is violence-related are unlikely to receive support for associated psychosocial vulnerabilities. Nurse-led hospital-based violence intervention programmes (HVIPs) are an additional resource in ED providing support to patients exposed to violence. Our objective was to determine whether HVIPs can overcome barriers to disclosure and what patient characteristics are associated with non-disclosure under usual care. STUDY DESIGN:A natural longitudinal experiment, including routine health data from 2012 to 2024, comparing intervention EDs with HVIPs to control EDs. METHODS:Multi-level logistic difference-in-difference models with unplanned visits clustered by patient on the probability that a visit (N = 6,724,446) was recorded as violence-related in ED or subsequently in HVIP data from Wales, UK: nine control EDs without an HVIP were compared with two intervention sites with nurse-led HVIPs. Secondary analyses assessed the characteristics of patients disclosing to the HVIP, but not under usual care by age, gender, ethnicity, and residential deprivation. RESULTS:The probability that a visit was designated as assault-related increased in intervention EDs following HVIP implementation (Cardiff β = 0.37, 95 % CI 0.31 to 0.44; Swansea β = 0.19, 95 % CI 0.14 to 0.25). Male, younger, those residing in deprived neighbourhoods, and black or mixed ethnicity patients were more likely to be missed under usual care. CONCLUSIONS:Non-disclosure is a significant barrier in provisioning support to those who are psychosocially vulnerable and likely to revisit ED. Nurse-led HVIPs can overcome inequalities in ED, reaching patient groups that are not otherwise able or willing to disclose their exposure to violence. HVIPs offer the prospect of reducing inequality in patients' visiting ED due to violence. ISRCTN Registration: 68945844 (12 August 2022).

BACKGROUND:EDs can address modifiable risks of patients attending due to violence. Hospital-based violence intervention programmes (HVIPs) can reduce patients' exposure to violence but can place additional burdens on staff. We explored practitioners' views on two nurse-led HVIPs' design and delivery, response to patient need, engagement with ED health professionals, adaptation to local context and analysed documents relevant to these objectives. METHODS:This was a qualitative process evaluation, from January to September 2023, of two nurse-led HVIPs implemented in a major trauma centre and a large urban hospital in the UK. Interview participants (N=49) were involved with the commission and implementation of the HVIPs, or worked within the broader violence-prevention ecology. We gathered perspectives on intervention implementation and undertook documentary analysis on local and national policies, and guidance relating to HVIPs development, implementation and delivery (N=46). Documentary data were subject to thematic and content analyses, interview data to thematic analysis. RESULTS:HVIPs were developed in response to a perceived under-provision of services for patients attending EDs due to violence. The HVIP nurses had access to clinical records facilitating the identification of eligible patients. They provided patient-centred care, addressing needs through referrals into health and community-based services. Over 60% of eligible patients engaged. The nurses were seen as credible champions working towards a minimally burdensome service that supported and trained ED staff. Embedding HVIPs into usual care took time and was limited by the perceived short-term nature of the intervention. CONCLUSION:The implementation of nurse-led HVIPs enables access to clinical records, facilitating patient engagement, and can provide an additional service aligned to usual emergency care, supporting both patients and ED staff. PRE-REGISTRATION:The protocol was pre-registered (ISRCTN 15286575; March 13, 2023) and published before data collection was complete.

The Crime and Disorder Act (1998) requires the police, local authorities, NHS, and other organisations to share intelligence and collectively work to reduce violent crime. This paper aimed to explore opinions on linking police data with other agency data. Interviews were undertaken with individuals from police forces in Wales, UK. Barriers to sharing data with other organisations involve differences in the systems used to store police data and uncertainties around what is allowed to be shared. Overcoming barriers would allow data linkage across organisations leading to deeper insights into the causes of violence, and therefore intelligence that supports crime prevention. Background The Crime and Disorder Act of 1998 requires the police, local authorities, the NHS, and other organisations to work together on collective approaches to reduce crime and to analyse shared data to inform resource allocation decisions. Data sharing has been conducted on a per-project basis, but it is rare for whole population data to be linked across organisations. The purpose of this study was to investigate the feasibility of linking national data from the police with national data from other agencies including health data from General Practitioners, hospitals, and Emergency Departments (EDs). In addition, this study explored the views and opinions from police service areas in Wales on using a single software system to cover all police service areas for public protection purposes and to facilitate sharing data with other agencies. Methods Semi-structured interviews were conducted with 36 individuals from the 4 police services in Wales along with representatives from the Violence Prevention Unit (VPU) and the Police Liaison Unit (PLU). The interviews were analysed using codebook thematic analysis to generate key themes from qualitative responses. Results Two key themes and seven sub-themes were developed from the qualitative data. The key themes include the following: (1) Opinions on the systems used in the police for public protection including thoughts on the current system and moving to using one system. (2) Opinions on data sharing including what data should be shared, benefits of data sharing, barriers to data sharing (within the police and across organisations), and overcoming barriers to data sharing. Interviewees identified that a proprietary relational database, Niche, was the most used system for public protection, was highly regarded, and individuals felt that if all forces moved to the same system this would be a positive development. However, work needs to be undertaken to ensure there is a minimum dataset entered in each area as there is high variability in data quality. Barriers included not knowing what was possible to share and fear of sharing. An unambiguous framework endorsed at a high level of what data should and shouldn’t be shared was recommended to overcome this. Conclusions The main barriers to shared police data included a lack of clarity around data governance and what is appropriate to share. It was felt that sharing should be the default position and with support these barriers could be removed. Data sharing between agencies would require high-level support and unambiguous guidelines as to what data can be shared, with whom, and in what format.

Introduction Hospital-based violence intervention programmes (HVIPs), based in Emergency Departments (EDs) have been proposed as a public health response to violence. These programmes address the underlying reasons why patients are exposed to violence. In addressing any underlying modifiable risks and vulnerabilities HVIPs can reduce patients’ exposure to violence and therefore subsequent unplanned attendance into ED. Methods and Analysis ED patients are eligible for inclusion in the evaluation if they are normally resident in Wales, United Kingdom (UK), aged 11 years and older. A controlled longitudinal natural experiment will be undertaken. The primary outcome is derived from the Emergency Department Dataset, routinely collected for all EDs in Wales, and is subsequent unplanned ED attendance. Case patients will be matched to control patients attending EDs without an HVIP. Analysis will derive the hazard rate for subsequent unplanned ED attendances using recurrent event analysis. The total monthly count of patients identified as attending because of violence in intervention EDs will be compared to the total count of Welsh control EDs in an interrupted time series analysis to determine whether HVIPS increase violence ascertainment. To determine whether referral, versus no referral, to the HVIP represents value for money, we will undertake a cost-effectiveness analysis from the perspective of the National Health Service. Ethics and Dissemination The approval to access and analyse data housed in the Secure Anonymised Information Linkage (SAIL) databank, an ISO 27001 certified and UK Statistics Authority accredited secure data environment, was granted by the SAIL independent Information Governance Review Panel (Ref: 1421). Findings will be presented at local, national, and international conferences and disseminated by peer-review publication. ISRCTN Registration: 41868 (12 August 2022)

ObjectiveThe UK Government increasingly emphasises a comprehensive, multi-agency approach to tackling crime. This pilot study explores the feasibility of integrating police data with routine health data to develop a holistic understanding of the predictors of domestic abuse (DA). ApproachThe study encompasses three work-packages a) coding the narrative data from Domestic Abuse, Stalking and Harassment (DASH) risk assessment report from Public Protection Notifications (PPNs), which are information-sharing documents recording safeguarding concerns and shared with partner agencies b) exploring to identify what works to harmonise different software systems within police data-sharing approach, c) constructing a case study by linking PPN DASH data with routine health and administrative records. These efforts illustrate the potential of national data-sharing initiatives. Results a) Text mining methods successfully identified and coded (with over 95% accuracy) 17 refereed/involved agencies from the PPN DASH data. b) Barriers to data sharing were attributed to a lack of clarity and consensus regarding appropriate information sharing, rather than technical obstacles. This barrier can be overcome by an unambiguous framework, endorsed at an elevated level, highlighting which data should be shared. c) The data-linkage study revealed that victims of DA had prior interactions with healthcare services before their initial PPN, and younger pregnant victims had higher risk of future healthcare emergency visits. Conclusion and ImplicationPolice and health data integration enhances evidence-based prevention and early identification of vulnerable individuals by both law enforcement and public health services.

The interaction between auxin and cytokinin is important in many aspects of plant development. Experimental measurements of both auxin and cytokinin concentration and reporter gene expression clearly show the coexistence of auxin and cytokinin concentration patterning in Arabidopsis root development. However, in the context of crosstalk among auxin, cytokinin, and ethylene, little is known about how auxin and cytokinin concentration patterns simultaneously emerge and how they regulate each other in the Arabidopsis root. This work utilizes a wide range of experimental observations to propose a mechanism for simultaneous patterning of auxin and cytokinin concentrations. In addition to revealing the regulatory relationships between auxin and cytokinin, this mechanism shows that ethylene signaling is an important factor in achieving simultaneous auxin and cytokinin patterning, while also predicting other experimental observations. Combining the mechanism with a realistic in silico root model reproduces experimental observations of both auxin and cytokinin patterning. Predictions made by the mechanism can be compared with a variety of experimental observations, including those obtained by our group and other independent experiments reported by other groups. Examples of these predictions include patterning of auxin biosynthesis rate, changes in PIN1 and PIN2 patterns in pin3,4,7 mutants, changes in cytokinin patterning in the pls mutant, PLS patterning, and various trends in different mutants. This research reveals a plausible mechanism for simultaneous patterning of auxin and cytokinin concentrations in Arabidopsis root development and suggests a key role for ethylene pattern integration.

BackgroundAddressing violence related harm is a global public health priority. While violence is primarily managed in the criminal justice system, healthcare supports and manages those injured by violence. Emergency Departments (EDs), the primary destination for those seriously injured, have emerged as a candidate location for violence prevention initiatives. There is limited evaluation of ED-based violence prevention, and a lack of guidance for the implementation and delivery of them. Nurse-led Violence Prevention Teams (VPTs) have been developed and implemented in two EDs in Wales, UK. This protocol describes methods used in the process evaluation of these VPTs.AimTo understand how VPTs function, how they were implemented, and mechanisms of impact, as well as the exploration of wider contextual factors influencing their function.MethodsAdopting a critical realist approach and informed by the Medical Research Council (MRC) guidance for process evaluations, the process evaluation will employ qualitative methods to collect and analyse data: a scoping review of evidence of effectiveness that considers the causal mechanisms underpinning violence; a documentary analysis to determine operational considerations concerning the development, implementation and delivery of the VPTs; a descriptive analysis of routine ED data to characterise the prevalence of violence-related attendances in each ED; interviews with professional stakeholders (N = 60) from the violence prevention ecologies in which the VPTs are embedded.DiscussionThis protocol outlines a process evaluation of a novel, nurse led violence prevention intervention. Findings will be used to inform policy makers' decision making on whether and how VPTs should be used in practice in other EDs across the UK, and the extent that a single operational model should be adjusted to address the local characteristic of violence. To the authors knowledge, this is the first process evaluation of a UK-based, nurse led Emergency Department Violence Prevention Team.Trial registrationProtocol registration ISRCTN: 15286575. Registered 13th March, 2023.

Summary: Background: Exposure to domestic abuse can lead to long-term negative impacts on the victim's physical and psychological wellbeing. The 1998 Crime and Disorder Act requires agencies to collaborate on crime reduction strategies, including data sharing. Although data sharing is feasible for individuals, rarely are whole-agency data linked. This study aimed to examine the knowledge obtained by integrating information from police and health-care datasets through data linkage and analyse associated risk factor clusters. Methods: This retrospective cohort study analyses data from residents of South Wales who were victims of domestic abuse resulting in a Public Protection Notification (PPN) submission between Aug 12, 2015 and March 31, 2020. The study links these data with the victims’ health records, collated within the Secure Anonymised Information Linkage databank, to examine factors associated with the outcome of an Emergency Department attendance, emergency hospital admission, or death within 12 months of the PPN submission. To assess the time to outcome for domestic abuse victims after the index PPN submission, we used Kaplan-Meier survival analysis. We used multivariable Cox regression models to identify which factors contributed the highest risk of experiencing an outcome after the index PPN submission. Finally, we created decision trees to describe specific groups of individuals who are at risk of experiencing a domestic abuse incident and subsequent outcome. Findings: After excluding individuals with multiple PPN records, duplicates, and records with a poor matching score or missing fields, the resulting clean dataset consisted of 8709 domestic abuse victims, of whom 6257 (71·8%) were female. Within a year of a domestic abuse incident, 3650 (41·9%) individuals had an outcome. Factors associated with experiencing an outcome within 12 months of the PPN included younger victim age (hazard ratio 1·183 [95% CI 1·053–1·329], p=0·0048), further PPN submissions after the initial referral (1·383 [1·295–1·476]; p<0·0001), injury at the scene (1·484 [1·368–1·609]; p<0·0001), assessed high risk (1·600 [1·444–1·773]; p<0·0001), referral to other agencies (1·518 [1·358–1·697]; p<0·0001), history of violence (1·229 [1·134–1·333]; p<0·0001), attempted strangulation (1·311 [1·148–1·497]; p<0·0001), and pregnancy (1·372 [1·142–1·648]; p=0·0007). Health-care data before the index PPN established that previous Emergency Department and hospital admissions, smoking, smoking cessation advice, obstetric codes, and prescription of antidepressants and antibiotics were associated with having a future outcome following a domestic abuse incident. Interpretation: The results indicate that vulnerable individuals are detectable in multiple datasets before and after involvement of the police. Operationalising these findings could reduce police callouts and future Emergency Department or hospital admissions, and improve outcomes for those who are vulnerable. Strategies include querying previous Emergency Department and hospital admissions, giving a high-risk assessment for a pregnant victim, and facilitating data linkage to identify vulnerable individuals. Funding: National Institute for Health Research.

OBJECTIVE:Globally, 20 million children are born with a birth weight below 2500 g every year, which is considered as a low birthweight (LBW) baby. This study investigates the contribution of modifiable risk factors in a nationally representative Welsh e-cohort of children and their mothers to inform opportunities to reduce LBW prevalence. DESIGN:A longitudinal cohort study based on anonymously linked, routinely collected multiple administrative data sets. PARTICIPANTS:The cohort, (N=693 377) comprising of children born between 1 January 1998 and 31 December 2018 in Wales, was selected from the National Community Child Health Database. OUTCOME MEASURES:The risk factors associated with a binary LBW (outcome) variable were investigated with multivariable logistic regression (MLR) and decision tree (DT) models. RESULTS:The MLR model showed that non-singleton children had the highest risk of LBW (adjusted OR 21.74 (95% CI 21.09 to 22.40)), followed by pregnancy interval less than 1 year (2.92 (95% CI 2.70 to 3.15)), maternal physical and mental health conditions including diabetes (2.03 (1.81 to 2.28)), anaemia (1.26 (95% CI 1.16 to 1.36)), depression (1.58 (95% CI 1.43 to 1.75)), serious mental illness (1.46 (95% CI 1.04 to 2.05)), anxiety (1.22 (95% CI 1.08 to 1.38)) and use of antidepressant medication during pregnancy (1.92 (95% CI 1.20 to 3.07)). Additional maternal risk factors include smoking (1.80 (95% CI 1.76 to 1.84)), alcohol-related hospital admission (1.60 (95% CI 1.30 to 1.97)), substance misuse (1.35 (95% CI 1.29 to 1.41)) and evidence of domestic abuse (1.98 (95% CI 1.39 to 2.81)). Living in less deprived area has lower risk of LBW (0.70 (95% CI 0.67 to 0.72)). The most important risk factors from the DT models include maternal factors such as smoking, maternal weight, substance misuse record, maternal age along with deprivation-Welsh Index of Multiple Deprivation score, pregnancy interval and birth order of the child. CONCLUSION:Resources to reduce the prevalence of LBW should focus on improving maternal health, reducing preterm births, increasing awareness of what is a sufficient pregnancy interval, and to provide adequate support for mothers' mental health and well-being.

OBJECTIVE: To estimate the prevalence and socio-economic determinants of energy drink (ED) consumption and related health outcomes in Riyadh, Saudi Arabia. METHODS: A self-report survey was used to collect data from 2,024 students (aged 13-20 years). Logistic regression was used to determine the relationship between ED consumption, diet and health-related outcomes. RESULTS: In total, 54% of young people reported ED consumption at least once and 25.5% at least weekly. The most common (38.65%) reason for ED consumption was the enjoyable flavour. Male students reported higher ED consumption compared to females (OR = 1.26, 95% CI 1.08 to 1.46). ED consumption was associated with an unhealthy diet (OR = 1.69, 95% CI 1.53 to 1.87), tobacco use (OR = 5.91, 95% CI 3.47 to 10.07), poor quality sleep (OR = 0.73, 95% CI 0.47 to 0.99). Those who regularly ate breakfast were less likely to report ED consumption (OR = 0.89, 95% CI 0.83 to 0.95). CONCLUSION: More than 1 in 2 young people reported ED consumption among a sample of Riyadh-based students. Consumption was found to be associated with a poor-quality diet and negative health outcomes. Findings suggest that there is a public health need to reduce the consumption of EDs among this population.

Black beech (Fuscospora solandri) seedlings were planted in randomly located plots on Motuareronui (Adele Island) to assess whether survival was sufficient for applied nucleation to be used as a restoration method on parts of the adjacent mainland. The long-term goal of this project is to re-establish black beech as a keystone canopy species on ridges and headlands that lost their primary forest cover as a result of fires by the middle of last century. One hundred and sixty-four of 199 beech seedlings (82%) planted in 2014 survived to 2019. Survival was higher in plots that had a low to moderate canopy density, or when plots had either low or moderate canopy density, when seedlings had higher levels of ambient light. There was weak evidence of a negative relationship between seedling growth and the amount of ambient light, attributable to apical dieback in some seedlings.

Abstract Background Increasing the price of alcohol reduces alcohol consumption and harm. The role of food complementarity, transaction costs and inflation on alcohol demand are determined and discussed in relation to alcohol price policies. Methods UK Biobank (N = 502,628) was linked by region to retail price quotes for the years 2007 to 2010. The log residual food and alcohol prices, and alcohol availability were regressed onto log daily alcohol consumption. Model standard errors were adjusted for clustering by region. Results Associations with alcohol consumption were found for alcohol price (β = −0.56, 95% CI, −0.92 to −0.20) and availability (β = 0.06, 95% CI, 0.04 to 0.07). Introducing, food price reduced the alcohol price consumption association (β = −0.26, 95% CI, −0.50 to −0.03). Alcohol (B = 0.001, 95% CI, 0.0004 to 0.001) and food (B = 0.001, 95% CI, 0.0005 to 0.0006) price increased with time and were associated (ρ = 0.57, P < 0.001). Conclusion Alcohol and food are complements, and the price elasticity of alcohol reduces when the effect of food price is accounted for. Transaction costs did not affect the alcohol price consumption relationship. Fixed alcohol price policies are susceptible to inflation.

Introduction Early alcohol use has significant association with poor health outcomes. Individual risk factors around early alcohol use have been identified, but a holistic, data-driven investigation into health and household environmental factors on early alcohol use is yet to be undertaken. Objectives This study aims to investigate the relationship between preceding health events, household exposures and early alcohol use during adolescence using a two-stage data-driven approach. Methods In stage one, a study population (N = 1,072) were derived from the Millennium Cohort Study (MCS) Wales (born between 2000-2002). MCS data were first linked with electronic-health records. Factors associated with early (<= eleven years old) alcohol use were identified using feature selection and stepwise logistic regression. In stage two, analogous risk factors from MCS were recreated for whole population (N = 59,231) of children (born between 1998-2002 in the Welsh Demographic Service Dataset) using routine data to predict the alcohol-related health events in hospital or GP records. Results Significant risk factors from stage two included poor maternal mental (adjusted odds ratio [aOR] = 1.31) and physical health (aOR = 1.25), living with someone with alcohol-related problem (aOR = 2.16), single-adult household (aOR = 1.45), ever in deprivation (aOR = 1.66), child's high hyperactivity (aOR = 3.57), and conduct disorder (aOR = 3.26). Children with health events, whose health needs are supported (e.g., are taken to the doctor), are at lower risk of early alcohol use. Conclusion Health events of the family members and the child can act as modifiable exposures and may therefore inform the development of prevention initiatives. Families with known alcohol problems, living in deprivation, experiencing child behavioural problems and those who are not taken to the doctor are at higher risk of early drinking behaviour and should be prioritised for early years support and interventions to target problem drinking in young people.

Background: The characteristics of night-time environments (NTEs) in which alcohol is consumed and that contribute to violence are poorly described. We explore competing explanations for violence in the NTE, with a particular focus on the number of patrons and its association with assault-related visits to a hospital emergency department. Other environmental features including the weather and notable events were also considered. The primary aim was to stimulate debate around the causal mechanisms responsible for violence. Methods: Assault-related ED visits occurring between 8 pm and 4 am were recorded at the University Hospital of Wales, the single Emergency Department (ED) serving Cardiff, Wales, United Kingdom. Footfall was derived from the total number of unique MAC addresses recorded per hour collected from ten wireless fidelity monitoring tools located in the city centre. A narrative review of the literature concerning alcohol and violence informed exploratory analyses into the association between night-time footfall, sporting events, the weather, and other potential predictors of assault-related visits to the ED. We developed analytic methods from formal accounts of queueing. Results: International rugby matches at home, the weather (temperature), national holidays, the day of the week, and number of patrons in the NTE predicted assault-related injury (R2 = 0.70), with footfall yielding a positive non-linear exponential association consistent with predictions derived from mathematical models of queueing. Discussion: Assault-related visits to the ED have a non-linear association with the number of people socialising in the night-time environment and are further influenced by the weather and notable events. Opportunities for further research that might inform policy and interventions aimed at better managing NTEs are discussed.

Polyamines (PAs) dramatically affect root architecture and development, mainly by unknown mechanisms; however, accumulating evidence points to hormone signaling and reactive oxygen species (ROS) as candidate mechanisms. To test this hypothesis, PA levels were modified by progressively reducing ADC1/2 activity and Put levels, and then changes in root meristematic zone (MZ) size, ROS, and auxin and cytokinin (CK) signaling were investigated. Decreasing putrescine resulted in an interesting inverted-U-trend in primary root growth and a similar trend in MZ size, and differential changes in putrescine (Put), spermidine (Spd), and combined spermine (Spm) plus thermospermine (Tspm) levels. At low Put concentrations, ROS accumulation increased coincidently with decreasing MZ size, and treatment with ROS scavenger KI partially rescued this phenotype. Analysis of double AtrbohD/F loss-of-function mutants indicated that NADPH oxidases were not involved in H2O2 accumulation and that elevated ROS levels were due to changes in PA back-conversion, terminal catabolism, PA ROS scavenging, or another pathway. Decreasing Put resulted in a non-linear trend in auxin signaling, whereas CK signaling decreased, re-balancing auxin and CK signaling. Different levels of Put modulated the expression of PIN1 and PIN2 auxin transporters, indicating changes to auxin distribution. These data strongly suggest that PAs modulate MZ size through both hormone signaling and ROS accumulation in Arabidopsis.