NHS Grampian

Access to cross-border clinical trials may represent the sole therapeutic option for children living with rare diseases for which no approved medicines exist. Many children are excluded from participation in trials due to language restrictions. There are insufficient comprehensive analyses of the experiences and preferences of parents across Europe concerning participation and exclusion of their child in international clinical trials, particularly regarding language support during enrollment in cross-border clinical research studies. An anonymous online survey was designed and translated into 22 official European languages to collect data from parents of children living with a disease across Europe. The survey included five sections: (1) sociodemographic information; (2) experience participating in a clinical trial; (3) experience in cases where the patient was unable to take part in a study abroad; (4) experience participating in a clinical trial abroad; and (5) preferences regarding decentralized trial options. 1,436 responses were analyzed from parents across 34 European countries. 55.7% of the parents reported being able to communicate in English. 10.7% had prior clinical trial experience, of whom 30.1% traveled abroad to enable their child to participate. Among those reporting being excluded from cross-border trials, 34.7% cited language barriers or country of residence as the reason. Most families expressed a strong willingness to accept decentralized trial options, regardless of where the study may be conducted. Accommodating language translation to permit participation in a clinical trial abroad is feasible. While a significant percentage of caregivers of pediatric patients in Europe could communicate in English, approximately one-third of those excluded from clinical trials cited language barriers or country of residence as the reason. When translation was required, the most commonly offered solution was the use of professional interpreters, an accommodation that could enable broader patient participation in essential research.

Coastal western Scotland lies directly under the core of the modern North Atlantic winter storm track, yet long winter-sensitive terrestrial archives of storminess are rare. We present a new 2,500-year (~600 BCE–1981 CE), high-resolution speleothem record from a sea cave on the Isle of Islay, a uniquely winter-dominated site that captures past changes in storm activity, moisture pathways, and North Atlantic hydroclimate. This multiproxy record, comprising stable isotopes (δ¹⁸O, δ¹³C) and marine aerosol-related elements (Na, S), reflects the combined influence of Atlantic westerlies, sea-spray transport, and seasonal recharge.Islay δ¹⁸O and δ¹³C reflect changes in the pathway and hydrological processing of Atlantic winter moisture. Lower values occur during intervals with enhanced effective recharge and stronger Atlantic influence, such as the Roman and Medieval Warm Periods. In contrast, higher values reflect reduced recharge and colder circulation regimes during the Dark Age Cold Period and Little Ice Age. Sodium concentrations rise during these cold intervals, indicating enhanced sea-spray delivery and intensified winter storminess, while sulphur reflects mixed sea-salt and non-sea-salt marine aerosol inputs.Comparison with Greenland ice core data shows that Islay Na covaries with Greenland Na⁺, and that major volcanic events (e.g., 1257 CE) produce synchronous S maximum in both regions. These teleconnected responses demonstrate that coastal Scotland and Greenland share common winter storm generation processes and Arctic–Atlantic moisture variability. This study provides the first long-term speleothem–ice-core teleconnection framework for reconstructing North Atlantic winter storm-track behaviour over the past 2,500 years.

Abstract Background: Mammographic screening programmes reduce breast cancer mortality but detect many small good-prognosis tumours which may not progress. Screen-detected cancers are currently treated with standard surgery and adjuvant therapies, with associated morbidities. There is a need to reduce overtreatment of good prognosis tumours and numerous studies are evaluating omission of radiotherapy in low-risk disease. However, there is little evidence for surgical de-escalation, although percutaneous minimally invasive treatment approaches have been described. Vacuum-assisted excision (VAE) is in widespread use for management of lesions of uncertain malignant potential and benign lesions. SMALL (ISRCTN 12240119) aims to determine the feasibility of using this approach to treat small invasive tumours detected within the UK NHS Breast Screening Programme. Methods: SMALL is a phase III multicentre RCT comparing standard surgery with VAE for screen-detected cancers. Main eligibility criteria are age ≥47 years, unifocal grade 1 tumours with maximum diameter 15mm, strongly ER/PR+ve and HER2-ve, with negative axillary staging. Patients are randomised 2:1 to VAE or surgery, with no axillary surgery in the VAE arm. Completeness of excision is assessed radiologically, and if excision is incomplete, patients undergo surgery. Adjuvant radiotherapy and endocrine therapy are mandated in the VAE arm but may be omitted following surgery. Co-primary end-points are1. Non-inferiority comparison of the requirement for a second procedure following excision2. Single arm analysis of local recurrence (LR) at 5 years following VAE Recruitment of 800 patients will permit demonstration of 10% non-inferiority of VAE for requirement of a second procedure. This ensures sufficient patients for single arm analysis of LR rates, where expected LR free survival is 99% at 5 years, with an undesirable survival probability after VAE of 97%. To ensure that the trial as a whole only has 5% alpha, the significance level for each co-primary outcome is set at 2.5% with 90% power. The Data Monitoring Committee will monitor LR events to ensure these do not exceed 3% per year. Secondary outcome measures include time to ipsilateral recurrence, overall survival, complications, quality of life and health economic analysis. A novel feature of SMALL is integration of a QuinteT Recruitment Intervention (QRI), which aims to optimise recruitment to the study. Recruitment challenges are identified by analysing recruiter/patient interviews and audio-recordings of trial discussions, and by review of trial screening logs, eligibility and recruitment data and study documentation. Solutions to address these are developed collaboratively, including individual/group recruiter feedback and recruitment tips documents. Results: SMALL opened in December 2019. Recruitment halted in 2020 for 5 months due to COVID-19. At 9th July 2025, 49 centres are open, with 640 patients randomised. The randomisation rate is approximately 45%, and per site recruitment rate is 0.4-0.5 patients/month. Drawing from QRI findings and insights from patient representatives, a recruitment tips document has been circulated (on providing balanced information about treatments, encouraging recruiters to engage with patient preferences, and explaining randomisation). Individual recruiter feedback is ongoing, and wider feedback is being delivered across sites via recruitment training workshops. Patient interviews are ongoing to explore patient views and experiences of the trial. Conclusion: SMALL continues to have excellent recruitment, is expected to complete recruitment in 2026 and have a global impact on treatment of breast cancer within mammographic screening programmes. SMALL is funded by the UK NIHR HTA programme award 17/42/32 Citation Format: S. McIntosh, C. Coles, D. Dodwell, K. Elder, B. Elsberger, J. Foster, C. Gaunt, J. Henderson, C. Mabena, J. Morgan, Z. Nabi, I. Lyburn, S. Paramasivan, S. Pinder, S. Pirrie, S. Potter, T. Roberts, N. Sharma, E. Southgate, H. Stobart, A. Talwalkar, S. Taylor-Phillips, W. Teh, E. Turner, M. Wallis, D. Rea. Small: open surgery versus minimally invasive vacuum-assisted excision for small screen-detected breast cancer - a UK phase III randomised multi-centre trial [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-09-12.

Sleep is increasingly acknowledged as a cornerstone of public health, with chronic sleep loss implicated in preventable injury and deaths. Obstructive sleep apnea (OSA) affects over one billion people worldwide but remains widely under-diagnosed due to dependence on polysomnography (PSG), an overnight, hospital-based intrusive procedure. As an adjunct to the clinical diagnosis of OSA, this paper presents a low-cost, smartphone-based Generative AI agent framework for sleep apnea detection and sleep coaching at the bedside. Powered by an on=device Generative AI model, the four agents of this framework include a classifier, an analyser, a visualiser, and a sleep coach. The key agent activities performed are sleep apnea detection, sleep data management, data analysis, and natural language sleep coaching. The framework was empirically evaluated on a subject-independent hold-out set drawn from a dataset of 500 clinician annotated clips collected from 10 clinically diagnosed OSA patients. Sleep apnea detection achieved an accuracy of 0.89, precision of 0.91, and recall of 0.88, with nightly Apnea–Hypopnea Index (AHI) estimates strongly correlated with PSG-based clinical scores. The framework was further assessed on the performance metrics of computation, latency, memory, and energy usage. The results of these experiments confirm the feasibility of the proposed framework for large-scale, low-cost OSA screening, with pathways for future work in federated learning, noise robustness, and broad clinical validation.

Co-creation is recognised as a promising methodology for addressing complex public health issues by leveraging the collective intelligence of multiple stakeholders to develop tailored solutions. However, there is a lack of clarity and significant fragmentation in the concept. This study aims to define the fundamental attributes and guiding principles of co-creation to establish it as a rigorous, evidence-based, and trustworthy methodology. A participatory concept mapping process based on the Differentiae Principle was employed. The study consisted of four stages: 1) systematic extraction of attributes and their definition from traditional scientific and participatory research methodological literature, 2) screening, 3) semantic analysis and clustering into principles using Natural Language Processing and Large Language Models and 4) selection of a final set of attributes and development of principles. The study involved 50 participants with diverse backgrounds within and outside the Health CASCADE Network over 18 months. The study identified 105 candidate attributes. A set of 38 was selected from which 10 key principles were derived (open access, recognised contribution, ethics and legal, transparency, rigorous evaluation, clear problem, plural evidence, critical reflection, diversity, and structured and flexible processes) across three domains: Governance, Scientific and Methodological Rigour, and Collective Intelligence Processes. The attributes and guiding principles provide a comprehensive foundations for evidence-based co-creation, enhancing its trustworthiness, transparency, reliability, and impact in public health and other fields. Future research and practice should use these principles and attributes to refine and implement co-creation effectively.

Background: Healthcare and academic institutions face growing challenges in strategic planning due to rapid advances in medicine and technology, alongside fiscal and workforce constraints that limit traditional consultation. Participatory approaches offer a way to integrate diverse stakeholder perspectives under these constraints, generating contextually relevant strategies that can indicate whether current directions are appropriate or whether priorities have been overlooked. Methods: A structured participatory workshop was conducted at the 10th Grampian Research Conference (June 2025). One hundred seventy-eight participants including National Health Service (NHS) staff, academics, industry partners, patients, and public contributors, engaged in 14 parallel roundtable discussions. Contributions were captured using posters and Post-it notes, collecting 148 written annotations. Data were analysed using thematic and content analysis, supplemented by strategic frameworks including Strengths, Weaknesses, Opportunities and Threats (SWOT/TOWS), and Easy Wins, to identify and prioritise actionable strategies. Results: Five core themes emerged: (1) access to healthcare and services, (2) patient and public involvement and engagement, (3) digital health and service delivery innovation, (4) data access, integration, and governance, and (5) workforce development and culture. SWOT analysis identified strengths in telemedicine, interdisciplinary student training, and patient and public involvement, alongside weaknesses in fragmented data, referral tracking, and workforce pressures. TOWS matrix produced strategy-oriented recommendations such as AI-enabled scheduling, remote monitoring, and transparent referral systems. Easy Wins framework assessment highlighted immediate, low-cost improvements including identifiable NHS caller identification, automated text message reminders, updated informational videos and multilingual materials. Conclusion: By combining participatory outputs with structured strategy tools, this approach demonstrated a resource-efficient model for adaptive planning. The findings align with and extend current national health policy frameworks, offering a replicable approach for institutions aiming to obtain meaningful stakeholder engagement despite fiscal and temporal constraints.