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Posttraumatic stress disorder (PTSD) and alcohol use are highly prevalent among military veteran populations. Several theories have been proposed to account for the comorbidity between PTSD and problematic alcohol use, but research examining the symptom‐level associations between the two is limited. The current study used network analysis to examine the associations between PTSD and problematic alcohol use. Data were collected through a cross‐sectional survey of veterans of the United Kingdom Armed Forces living in Northern Ireland. The sample comprised 511 (91.2% male) veterans with a history of trauma exposure and current alcohol use. A network consisting of PTSD symptoms from the PTSD Checklist for DSM‐5 (PCL‐5) and items from the Alcohol Use Disorders Identification Test (AUDIT) was constructed, and the bridge centrality of all items was estimated to identify items with the highest number of associations and the strongest associations between the two constructs. The PTSD symptom "reckless behavior" (2.43) had the highest bridge centrality values and thus the strongest connections and most connections to the alcohol use items. For the alcohol use items, "not being able to stop drinking" (2.31) and "number of drinks" (1.24) demonstrated the strongest bridge connections to the PTSD items. These results highlight the role of specific PTSD symptoms involved in the interaction between PTSD and problematic alcohol use.

Background The United Kingdom (UK) is currently experiencing a public health crisis of drug-related deaths. The government has rejected recommendations to open overdose prevention services, under the Misuse of Drugs Act 1971. To report on the operation and use of an unsanctioned overdose prevention service which operated in Glasgow city centre from September 2020 to May 2021. Methods Description of the service, with analysis of data collected on its use. Results The service operated for nine months without permission or funding from official sources. We report on the 894 injections supervised and recorded, and nine successful interventions with overdose events (seven opioid/two cocaine). Powder cocaine injection predominated either alone (60.6%) or with heroin (22.1%). Injection was mostly in the groin (68.0%) or arm (16.8%). More injections were recorded by males (70.1%). Around 65% of injection events featured an individual who was on a buprenorphine/methadone prescription. Conclusion It is feasible for an overdose prevention service to operate successfully in the UK without being shut down by the police or with negative consequences for the community. Future sites in the UK must tailor to the substances used by their potential clients, international trends (e.g. for fentanyl use) did not apply here. There is an urgent need and demand for these services in the UK to reduce harm, prevent and intervene during overdose, and provide vital psychosocial support for health and wellbeing in a highly marginalised population.

Background The oversight and conduct of a randomised controlled trial involves several stakeholders, including a Trial Steering Committee (TSC), Trial Management Group (TMG), Data Monitoring Committee (DMC), funder, and sponsor. We aimed to examine how the relationships between these stakeholders affect the trial oversight process and its rigour, to inform future revision of Good Clinical Practice guidelines. Methods Using an ethnographic study design, we observed the oversight processes of eight trials and conducted semi-structured interviews with members of the trials' TSCs and TMGs, plus other relevant informants, including sponsors and funders of trials. Data were analysed thematically, and findings triangulated and integrated to give a multi-perspective account of current oversight practices in the UK. Findings Eight TSC and six TMG meetings from eight trials were observed and audio-recorded, and 66 semi-structured interviews conducted with 52 purposively sampled key informants. Five themes are presented: Collaboration within the TMG and role of the CTU; Collaboration and conflict between oversight committees; Priorities; Communication between trial oversight groups; and Power and accountability. There was evidence of collaborative relationships, based on mutual respect, between CTUs, TMGs and TSCs, but also evidence of conflict. Relationships between trial oversight committees were influenced by stakeholders' priorities, both organisational and individual. Good communication following specific, recognised routes played a central role in ensuring relationships were productive and trial oversight efficient. Participants described the possession of power over trials as a shifting political landscape, and there was lack of clarity regarding the roles and accountability of each committee, the sponsor, and funder. Stakeholders' perceptions of their own power over a trial, and the power of others, influenced relationships between those involved in trial oversight. Conclusions Recent developments in trial design ...

Background: The oversight and conduct of a randomised controlled trial involves several stakeholders, including a Trial Steering Committee (TSC), Trial Management Group (TMG), Data Monitoring Committee (DMC), funder, and sponsor. We aimed to examine how the relationships between these stakeholders affect the trial oversight process and its rigour, to inform future revision of Good Clinical Practice guidelines. Methods: Using an ethnographic study design, we observed the oversight processes of eight trials and conducted semi-structured interviews with members of the trials' TSCs and TMGs, plus other relevant informants, including sponsors and funders of trials. Data were analysed thematically, and findings triangulated and integrated to give a multi-perspective account of current oversight practices in the UK. Findings Eight TSC and six TMG meetings from eight trials were observed and audio-recorded, and 66 semistructured interviews conducted with 52 purposively sampled key informants. Five themes are presented: Collaboration within the TMG and role of the CTU; Collaboration and conflict between oversight committees; Priorities; Communication between trial oversight groups; and Power and accountability. There was evidence of collaborative relationships, based on mutual respect, between CTUs, TMGs and TSCs, but also evidence of conflict. Relationships between trial oversight committees were influenced by stakeholders' priorities, both organisational and individual. Good communication following specific, recognised routes played a central role in ensuring relationships were productive and trial oversight efficient. Participants described the possession of power over trials as a shifting political landscape, and there was lack of clarity regarding the roles and accountability of each committee, the sponsor, and funder. Stakeholders' perceptions of their own power over a trial, and the power of others, influenced relationships between those involved in trial oversight. Conclusions: Recent developments in trial design and conduct have been accompanied by changes in roles and relationships between trial oversight groups. Recognising and respecting the value of differing priorities among those involved in running trials is key to successful relationships between committees, funders and sponsors. Clarity regarding appropriate lines of communication, roles, and accountability is needed. We present 10 evidence-based recommendations to inform updates to international trial guidance, particularly the Medical Research Council guidelines

This guidance offers recommendations for interventions that can be used to encourage and enable physical distancing. The target behaviour for this guidance document is physical distancing, defined as staying 1–2 metres (depending on national guidance)apart from people in the same location. We are using the term 'physical distancing' as opposed to 'social distancing', in line with the World Health Organization and our earlier guidance. Physical distancing is important when viruses are airborne, such as the virus that causes Covid-19. Remaining at a physical distance from others reduces the risk of aerosols and droplets entering the eyes, nose or mouth and therefore reduces the risk of spreading infection, particularly with physical distancing of 1 metre or more3. Many governments and health agencies have recommended people adhere to a physical distance of between1 metre4 to 2 metres5 from people who are not in their household or 'bubble'. In general, people typically stand a little less than 1 metre away from familiar people and 1.3 metre away from others6. Whilst many people have started to physically distance, standing metres away requires breaking strong habits. Even where regulations do not require physical distancing, people might still be encouraged to distance where possible, in regions where transmission rates are rising or high. This guidance is based on a systematic review of the evidence for interventions to encourage physical distancing and summarises the approaches that are effective in helping people to maintain physical distance from others. This included six papers, reporting 14 interventions with over 5500 people. There may be other approaches that could be effective but at present there is no evidence for or against them. It is important to note that some of the evidence reports influences on intention to distance physically rather than the action of physical distancing itself.

BACKGROUND Digital contact tracing apps have been proposed as a method of controlling the spread of Covid-19. The effectiveness of this tool depends largely on adequate levels of uptake (e.g. whether the user downloads and registers on the application) and engagement (e.g. the extent of usage of the application or its components over time). It has been estimated that approximately 60% of the population would need to use the NHSX application in order for it to be effective in reducing the spread of COVID-19. It is therefore crucial that we understand the level of, and factors influencing, uptake and engagement with digital tracing applications in order to put appropriate measures in place to mitigate those issues. AIMS 1. To quantify the current data on COVID-19 digital contact tracing applications a. Uptake and engagement of COVID-19 digital contact tracing applications b. Examine whether uptake differs between countries c. Identify any predictors or correlates of uptake and engagement 2. To conduct two scoping reviews to identify key barriers and facilitators influencing engagement and uptake of a. COVID-19 digital contact tracing applications b. Health behaviour change applications, including government approved applications, from academic literature and behaviour change guidelines CONCLUSIONS • There is no evidence on the level of uptake and engagement with COVID-19 digital contact tracing applications. • There is a dearth of evidence regarding the barriers and facilitators to uptake and engagement with COVID-19 digital contact tracing applications. • The health behaviour change literature suggests a number of barriers and facilitators associated with uptake and engagement with applications.

While researchers work to develop an effective COVID-19 vaccination, government and healthcare agencies across the world are developing and testing new 'digital contact tracing' technologies to help support the transition from emergency lockdown measures. During this transition phase, it is proposed that people will be able to move more freely, whilst ensuring continual monitoring and rapid action to tackle any new outbreaks of the COVID-19 virus.