At Bristol

ABSTRACT Circular supply chain management (CSCM) practices are seen as a solution for addressing society's many significant environmental challenges. Although existing studies recognise the importance of reverse engineering in combating poverty, there is limited knowledge about its effectiveness in shaping CSCM practices to address climate change and global warming. To fill this gap, this study uses the strategy tripod perspective to explore the impact of reverse engineering on CSCM practices through compositional capability and cooperative orientation, with the moderating roles of humane orientation and competition intensity. We tested our hypotheses using time‐lagged data from 250 local small and medium‐sized enterprises (SMEs) in Ghana, an emerging economy. The results from our structural equation modelling analyses show that local SMEs rely on cooperative orientation and compositional capability to convert reverse engineering into CSCM practices via serial mediation. Additionally, while humane orientation does not moderate this relationship, we find that competition intensity negatively influences how cooperative orientation and compositional capability affect the CSCM practices of local SMEs. Our novel findings not only advance CSCM literature but also provide practical and systematic support to local SMEs on how to leverage their capabilities and resources to tackle significant societal challenges.

The management of older adults with back pain in GP surgery practices is currently not well understood. We aimed to describe this and investigate if there are factors associated with variability in treatment. Using primary care records from UK Clinical Practice Research Datalink Aurum, we observed 594,559 adults aged 50 years and older with an index consultation for back pain between 1 January 2015 to 31 July 2018 over 18-months follow-up. Main outcome measures were time to first referral to (i) radiology, (ii) physiotherapy, (iii) exercise, physical activity programmes and musculoskeletal clinics and services, (iv) other clinics and services for further assessment, and (v) pain medication prescriptions. The majority of patients received pain medication prescriptions following a back pain diagnosis (n = 381,829; 64.2%), but not referrals to radiology (n = 23,712; 4.0%), physiotherapy (n = 2,856; 0.5%), exercise, physical activity programmes and musculoskeletal clinics and services (n = 22,182; 3.7%) or other clinics and services for further assessment (n = 20,755; 3.5%). The probability of referrals or prescriptions at index consultation were (i) 2.6%, (ii) 0.3%, (iii) 1.7%, (iv) 1.3% and (v) 56.4% respectively. Opioids in combination with paracetamol or ibuprofen were most commonly prescribed (n = 151,390, 25.5%), followed by non-topical non-steroidal anti-inflammatory drugs (n = 127,164, 21.4%) and non-combination opioids dosage forms (n = 101,713, 17.1%). We observed large variability in the management of back pain within practice regions, age groups and socioeconomic status for all outcomes with the exception of pain medication prescriptions which showed little variation within factors of interest. Older patients presenting to GP surgery practices with back pain are typically prescribed pain medications, with few referred for imaging, further therapy or assessment. Among non-pharmacological treatments, there exist differences by practice region, age, and socioeconomic status. Future work is needed to explore reasons for these differences, and to develop new clinical guidelines or tools to facilitate the standardisation of managing back pain in older adults within GP surgery practices in the UK.

Evidence regarding the dynamics of the longitudinal reciprocal associations between maternal and paternal depression over time is lacking. The current study examines reciprocal longitudinal associations between maternal and paternal depressive symptoms (DS) from pregnancy (18weeks-gestation) to 11years 2months (study child's age) to gain insights into the joint course of DS. The study sample comprised 6296 mothers and fathers from the UK-based birth cohort, the Avon Longitudinal Study of Parents and Children. Reciprocal longitudinal associations between maternal and paternal DS, assessed at nine time-points (Edinburgh Postnatal Depression Scale; continuous scores), were examined using random intercept cross-lagged panel models to differentiate between stable covariance (between-person differences in DS) and dynamic processes (within-person level). Analyses were adjusted for parental and socioeconomic confounders. There were strong correlations between random intercepts of maternal and paternal DS (β=0.305, SE=0.015, p≤0.001), suggesting positive associations between the overall mean levels of parental DS (i.e., a between-person association). There were strong stability effects for maternal and paternal DS across all nine measurement occasions (i.e., within-person associations), with larger effects evident for both maternal and paternal DS later in childhood (between ages 5 and 11years). There was evidence for bidirectional longitudinal within-person effects between maternal and paternal DS at some but not other measurement occasions. These findings have important implications for screening, prevention and intervention programmes. Depression in one parent may require screening efforts directed at the other parent, with prevention and intervention programmes focused on the family, rather than one parent.

Compare the diagnostic accuracy of measuring gingival recession (GR) using a digital ruler on intraoral scans with clinical measurements using a UNC-15 probe. A prospective, observational, examiner-blinded, single-arm, cross-sectional, single-site study in adults aged 18+ with minimum of 20 teeth. All participants underwent an intraoral scan. Clinical GR was recorded on 6-sites (non-molar teeth) and 8-sites (molar teeth) by the principal examiner. Anonymised scans were assessed by the principal examiner twice (Ex1a, 1b) and two additional examiners (Ex2 and 3). 109 participants were assessed; all had at least one site of buccal GR. Ex1a on-scan measurements compared to clinical measurements showed 66.9% sensitivity and 92.5% specificity. There were considerable differences between central and proximal sites, central sites showed greater sensitivity 77.0% and specificity 81.4% compared to proximal sites 38.5% and 97.2% respectively. Diagnostic precision was robust, agreement for intra-examiner variability (Examiner-1a vs 1b) was 98.5% (95% CI 98.1%-98.8%). Inter-examiner variability was 78.9% (95% CI, 77.0%-80.6%) for Ex-1a-Ex-2 and 86.2% (95% CI, 84.8%-87.5%) for Ex-1a-Ex-3. Intraoral scan measurements are reproducible and can be utilised with accuracy. Measuring GR clinically is the current gold standard despite the limitations, intraoral scans can be utilised to overcome these limitations.

Sensory and consumer researchers are often required to identify clusters of consumers based on product liking. A widespread, if informally held, belief is that many studies contain a group of consumers whose data differ from the product means in their assigned cluster. The implication could be less discrimination between samples within a cluster, leading to poorer decision-making. This research presents a variant of existing cluster analysis methods to potentially improve insights by excluding subjects with non-typical response behaviour. The approach is intuitive, easy to implement, and cluster algorithm agnostic. After removing non-discriminators (i.e., those who like all samples equally), the principle is to conduct cluster analysis and then calculate the correlation of each subject's liking ratings with the mean in their assigned cluster, setting a fixed “trim out” threshold for the correlation coefficient. Consumers with correlations below the threshold are classified as non-typical and excluded. After introducing cluster trimming in a case study, the method is applied to another 29 data sets representing category appraisal and product optimisation applications. On average, the cluster-trimming process resulted in around 1/3 of study participants being “trimmed out.” These consumers tended to discriminate less between samples than the participants who were retained following cluster trimming. While cluster trimming was found to add some value regarding product discrimination, this benefit was somewhat obscured by the reduction in cluster size. Exploring within-cluster heterogeneity, made possible by examining histograms of correlation coefficients (r-values), is recommended. Because the cluster trimming approach is correlational, it should not be used in product studies with too few samples ( n < 6). • A correlational approach for refinement of consumer segments based on liking. • Subjects are retained or trimmed out based on similarity with the cluster product means. • Improves cluster homogeneity but has little impact on sample discrimination. • Cluster trimming is easy to perform and does not bias mean liking ratings.

The importance of micronutrient status in human food choice remains a fundamental issue needing further investigation. The objectives of the present paper are to present and discuss historic and current research together with a general model incorporating this interaction and to suggest future research to address the questions this poses. By definition, essential nutrients must be consumed in sufficient amounts to meet an individual's requirements. While data indicate that complex neuroendocrine mechanisms provide negative-feedback control of energy and protein intake to support homeostasis, corresponding mechanisms controlling micronutrient intake are less well studied. In some contexts, they are explicitly assumed to be absent, specifically for models evaluating safety and risks of deficiencies. However, it may be hypothesized that for at least some micronutrients, mechanisms exist that aid attainment of requirements by altering preference for micronutrient-rich foods so as to increase ingestion of foods containing them, similar to how being thirsty increases the appeal of watermelon compared with dry food. If this hypothesis is correct, it may hold important implications for understanding the types and quantities of foods ingested. Greater appeal in foods richer in essential nutrients may reduce the risk of malnutrition. However, by extension, it may be posited that the use of supplements could confound the most healthful food choices. For example, obtaining vitamin C from supplements or fortified foods could then causally reduce the dietary intake of vegetables and fruits by reducing the appeal of these foods. The unintended consequence may be a lower intake of fiber, nitrate, and phytochemicals, food constituents that may contribute to health without being essential nutrients themselves. This hypothesis can and should be tested empirically, for example, through randomized placebo-controlled supplementation trials. If clear causal effects are documented, clinical and public health guidance will require critical evaluation and possible modification.

Background: Sleep disturbances are common in dementia and adversely affect both the person with dementia and their caregiver. Non-pharmacological options exist but are seldom dyadic or culturally tailored, limiting their reach and relevance across diverse communities. Objective: We aimed to co-develop DREAM (Dyadic Resilience, Engagement, Awareness & Mind-body intervention)-an 8-week dyadic mind-body programme (mindfulness + gentle Tai Chi) for improving sleep and wellbeing in people with dementia and their caregivers. Methods: The process was informed by Intervention Mapping (Stages 1-4) and underpinned by established behaviour change frameworks, including the Behaviour Change Wheel (BCW), the COM-B model (Capability, Opportunity, Motivation → Behaviour), and the Theoretical Domains Framework (TDF), to systematically identify determinants of engagement. Co-design involved dementia-caregiver dyads, Patient and Public Involvement (PPI) contributors, clinicians, mind-body practitioners, and community stakeholders. Results: The intervention was co-developed and culturally grounded through engagement with White British, Caribbean, Chinese, and South Asian communities. Participants reported high cultural resonance, endorsing DREAM's concise practices, caregiver-supported home routines, and delivery in trusted community venues. Behavioural insights highlighted the importance of motivational framing (perceived dyadic benefits, cultural meaning), practical enablement (simplified guidance, prompts/cues, environmental restructuring), and caregiver facilitation to support adherence. Conclusions: DREAM demonstrates the practicability of using Intervention Mapping to co-develop a culturally responsive, theory-informed dyadic mind-body intervention for people with dementia and their caregivers. This groundwork supports progression to a feasibility trial focused on implementation processes and preliminary sleep and wellbeing outcomes.

Abstract Background Antidepressants exert their therapeutic effects through ameliorating negative emotional biases that underpin depression. However, therapeutic gains may depend upon restructuring how emotional information is processed. This can be achieved through Cognitive Bias Modification (CBM), a technique for positively shifting recognition of emotional facial expressions. Here, we examined how CBM modifies emotional processing circuits in individuals with depression who were taking Selective Serotonin Reuptake Inhibitors (SSRIs). Methods A double-blind Randomised Controlled Trial was conducted in 84 participants with depression who had recently started SSRI medication. Participants received five sessions of ‘active’ or ‘sham’ CBM over one week before fMRI scanning where they viewed emotional faces (happy, fearful, sad). Results Across all emotional expressions, greater Blood Oxygen Level Dependent (BOLD) signal was observed in the inferior occipital gyrus for the active compared to sham CBM. Emotional-specific effects were observed in the medial Prefrontal Cortex (mPFC), with reduced BOLD signal in the active (compared to sham) group for viewing happy vs. fearful faces. Changes in BOLD signal were also associated with individual differences in response to CBM. Enhanced functional connectivity between mPFC and right Dorsolateral Prefrontal Cortex (rDLPFC) predicted improvement in depressive symptoms four weeks later. Conclusions These results indicate that CBM modifies the neural circuits involved in emotion processing in people with depression currently taking antidepressants. Converting these changes in emotional perception to improved depressive symptoms was related to changing mPFC-rDLPFC connectivity. Future trials are needed to test CBM’s clinical utility as a simple, affordable and accessible adjunct therapy for depression.