University of Southampton

This paper aims to conceptualise and operationalise an Employability Capital Growth Model (ECGM) via a systematic literature review of 42,558 manuscripts from Web of Science and Scopus databases published between 2016 and 2022 from the fields of graduate employability and career development incorporating applied psychology, business, education, and management. Two research questions are addressed. (1) How can literature addressing various forms of capital in the context of preparing university graduates for the labour market be integrated to offer a new ECGM? (2) How can various actors, i.e. (a) students and graduates, (b) educators, (c) careers and employability professionals, and (d) graduate employers, operationalise the ECGM? The systematic literature review resulted in a final corpus of 94 manuscripts for qualitative content analysis. Findings led to the construction of a new ECGM comprising nine forms of employability capital (social capital, cultural capital, psychological capital, personal identity capital, health capital, scholastic capital, market-value capital, career identity capital, and economic capital), external factors, and personal outcomes. Twenty-three opportunities for the operationalisation of the ECGM were also identified. The theoretical and conceptual contribution comes from constructing a new ECGM to bridge the fields of graduate employability and career development in the context of preparing individuals for the transition from university into the labour market. The practical contribution comes from operationalising the ECGM at the education-employment nexus. Consequently, developing various forms of capital and an awareness of external factors and personal outcomes can improve students’ and graduates’ employability, benefitting all actors operating in a career ecosystem.

This paper proposes a Modified model reference adaptive controller and observer (MMRACO) for unknown linear time‐invariant (LTI) systems. The recent literature, and in particular the so‐called MRACO approach, has demonstrated how some deficiencies in standard model reference adaptive control can be overcome by using a combination of modified reference models and observers, but this is done at the expense of knowing bounds on certain unknown parameters. Here, a novel adaptive observer/controller combination is presented which removes the need to know the above bounds but preserves the other desirable features of the MRACO approach. A Lyapunov analysis of the closed‐loop system ensures asymptotic convergence of both tracking and observer errors, with uniform boundedness of parameter estimation errors. A key advantage of the scheme is that the design involves only solutions of two Lyapunov equations (or linear matrix inequalities) and does not require the selection of a “high gain” parameter. The effectiveness of the approach is illustrated in some numerical examples.

Background Respiratory viral infections (RVIs) are major drivers of chronic obstructive pulmonary disease (COPD) exacerbations. Interferon beta (IFN-β) is key in host defence against viruses but can be suppressed by virus or host factors locally at the site of infection. Inhalation of SNG001 (IFN-β-1a nebuliser solution) aims to restore lung IFN-β levels. SG015 (NCT03570359) was a randomized, placebo-controlled Phase 2 clinical study of inhaled SNG001 conducted in COPD patients. Here we describe lung antiviral biomarker and sputum viral clearance data from Part 2 of the study which was conducted in patients with a confirmed RVI. Methods 109 COPD patients with worsening symptoms and a positive respiratory viral test were randomized 1:1 to SNG001 or placebo once-daily for 14 days in two Groups: A (no moderate exacerbation); B (moderate COPD exacerbation [i.e.,acute worsening of respiratory symptoms treated with antibiotics and/or oral corticosteroids]). Sputum samples were collected on days 1, 4, 7, 10, 13, 17 and 28 for analysis of lung antiviral biomarker responses (interferon-stimulated genes (ISGs): Mx1, OAS1 and CXCL10) and lung viral load by RT-qPCR. Results Mx1 and OAS1 sputum cell gene expression were significantly upregulated on day 7, 10 and 13 (p< 0.05) overall and in Groups A and B with SNG001 treatment compared to placebo. CXCL10 sputum cell gene expression was significantly upregulated in the overall population with SNG001 treatment compared to placebo on days 7 and 10, in Group B on days 7, 10 and 13, and there was no significant difference in Group A. Patients had a broad range of RVIs, the most common being human rhinovirus. A post-hoc analysis was therefore conducted in the subgroup of patients who had detectable rhinovirus viral load in sputum. By Day 4 the proportion of patients receiving SNG001 who had detectable rhinovirus reduced to 40.0% (compared to 94.7% of patients receiving placebo; p=0.052), with a further reduction to 20.0% on Day 7 (versus 89.5% receiving placebo; p=0.014). Conclusion Inhaled SNG001 upregulated lung antiviral defenses as assessed using sputum cell biomarker responses and accelerated viral clearance, supporting the proposed mechanism of action as an antiviral treatment for severe viral lung infections. Disclosures Phillip D. Monk, PhD, Synairgen Research Plc: Employee of Synairgen Research Plc and has options on shares|Synairgen Research Plc: Stocks/Bonds Jody L. Brookes, BSc, Synairgen Research Ltd: Share options Victoria J. Tear, PhD, Synairgen Research Ltd.: Stocks/Bonds Marcin Mankowski, MD MFPM (Dis), Multiple companies: Advisor/Consultant|Synairgen: Advisor/Consultant Michael G. Crooks, MBChB (hons), MD, FRCP, AstraZeneca: Advisor/Consultant|AstraZeneca: Grant/Research Support|AstraZeneca: Honoraria|Chiesi: Advisor/Consultant|Chiesi: Honoraria|Gilead: Honoraria|Synairgen: Advisor/Consultant Dave Singh, MD, AstraZeneca: Advisor/Consultant|Chiesi: Advisor/Consultant|gsk: Advisor/Consultant|Novartis: Advisor/Consultant|Orion: Advisor/Consultant|Pulmatrix: Advisor/Consultant|Sanofi: Advisor/Consultant|Synairgen: Advisor/Consultant|Synairgen: Grant/Research Support|Therevance: Advisor/Consultant Rekha Chaudhuri, MD, AstraZeneca: Grant/Research Support|AstraZeneca: Honoraria|Chiesi: Honoraria|GSK: Honoraria|Novartis: Honoraria|Sanofi: Honoraria|Teva: Honoraria Sarah Dudley, N/A, PhD, Synairgen Plc: Employed by Synairgen Research Ltd which is a subsidiary of Synairgen Plc|Synairgen Plc: Stocks/Bonds Felicity Gabbay, MbChb, Synairgen: Board Member Stephen T. Holgate, FMedSci, MD, Synairgen Research Plc: Board Member|Synairgen Research Plc: Stocks/Bonds Ratko Djukanovic, MD, GlaxoSmithKline: Advisor/Consultant|GlaxoSmithKline: Honoraria|KyMab: Advisor/Consultant|Sanofi: Advisor/Consultant|Synairgen: Advisor/Consultant|Synairgen: Stocks/Bonds Tom Wilkinson, PhD, PhD, Synairgen: Advisor/Consultant|Synairgen: Grant/Research Support|Synairgen: Honoraria

Background RSV is an extremely common respiratory pathogen and a leading cause of infant hospitalisation. An estimated 1 in 7 infants will develop an RSV lower respiratory tract infection (LRTI) requiring medical attention. The majority of infants hospitalised have no comorbidities and were born at term. Nirsevimab is the only preventative option designed to provide protection to all infants from RSV LRTI, from the start of their first RSV season, for the duration of that season. In the HARMONIE trial conducted in the UK, France, and Germany (EudraCT 2022-000099-20), we evaluated the impact of nirsevimab on all cause LRTI hospitalisations, as well as RSV LRTI specifically. Analyses looked at the efficacy of nirsevimab across subgroups that constitute the all infant population, all of whom are vulnerable throughout their first RSV season. Methods Individually randomised infants (≥29 weeks gestational age) received a single intramuscular injection of nirsevimab (< 5 kg 50 mg; ≥5 kg 100 mg), or no intervention (standard of care) before or during the RSV season. Following a single physical visit participants were monitored remotely for all cause LRTI hospitalisation (secondary endpoint, defined as treating physician decision to admit to in-patient care for >24 hours). Efficacy was evaluated through the RSV season. Adverse events (AEs) continue to be monitored for 365 days. Results 8058 infants were randomized, 4037 to the nirsevimab group and 4021 to the no intervention group. Efficacy against RSV LRTI was 83.21% (CI 67.77-92.04%) across all countries. Efficacy was consistent across infant subgroups, in those born at term (≥ 37 weeks: 84.41% (CI 64.92-94.10%)) or prematurely (< 37 weeks: 78.31% (CI 33.49-94.69%)) and not impacted by infant weight at randomisation (< 5kg: 82.12% CI 59.14-93.30% and ≥ 5kg 85.16% CI 57.01-96.25%). Efficacy against all cause LRTI hospitalisation was 58.04% (39.693- 71.19). Conclusion A single dose of nirsevimab given before or during the RSV season demonstrated a significant and sustained impact on RSV LRTI hospitalisations for the entire RSV season. Consistent efficacy was shown across subgroups comprising the all infant population.The potential impact of nirsevimab was reinforced by a reduction in all cause LRTI hospitalisations. Disclosures Saul N. Faust, FRCPCH PhD, AstraZeneca, Janssen, Pfizer, Moderna, GlaxoSmithKline, Novavax, Sanofi, Seqirus, Medimmune, Merck, MSD, Iliad and Valneva: Advisor/Consultant|AstraZeneca, Janssen, Pfizer, Moderna, GlaxoSmithKline, Novavax, Sanofi, Seqirus, Medimmune, Merck, MSD, Iliad and Valneva: Investigator Katrina Cathie, MBE, FRCPCH, AstraZeneca: Advisor/Consultant|GSK: Advisor/Consultant|Iliad: Advisor/Consultant|Janssen: Advisor/Consultant|MedImmune: Advisor/Consultant|Merck: Advisor/Consultant|Pfizer: Advisor/Consultant|Sanofi: Advisor/Consultant|Valneva: Advisor/Consultant SB Drysdale, FRCPCH, PhD, AstraZeneca: Advisor/Consultant|iLiAD: Advisor/Consultant|Janssen: Advisor/Consultant|Moderna: Advisor/Consultant|MSD: Advisor/Consultant|Pfizer: Advisor/Consultant|Sanofi: Advisor/Consultant|Valneva: Advisor/Consultant S Royal, FRCGP, Sanofi: Advisor/Consultant C Felter, MD, Sanofi: Employee NC Vassilouthis, MD, Sanofi: Employee Mathieu Bangert, PhD, Sanofi: Staff member K Mari, PhD, Sanofi: Employee R Nteene, MD, Sanofi: Employee M Roberts, MD, Sanofi: Employee P Tissieres, MD, Baxter: Advisor/Consultant|PAion: Advisor/Consultant|Sanofi: Advisor/Consultant|Sedana: Advisor/Consultant

Current classificatory systems recognize that the features of separation anxiety disorder can have their onset across the life course, it no longer being necessary to establish that the characteristic symptoms first emerged during childhood or adolescence, to make the diagnosis in an adult. Adult-onset separation anxiety disorder is a common and distressing condition, associated with considerable distress and impairment in functioning, and is frequently comorbid. It has some features similar to those of other anxiety disorders, especially panic disorder and generalized anxiety disorder, and distinguishing between these conditions can sometimes be challenging. We review the clinical features and sometimes blurred margins of adult separation anxiety disorder and suggest how it may be distinguished from other conditions in which ‘separation anxiety’ can also be prominent, illustrating some of the challenges with an accompanying clinical vignette.

Novel fundamental notions helping in the interpretation of the complex dynamics of nonlinear systems are essential to our understanding and ability to exploit them. In this work we predict and demonstrate experimentally a fundamental property of Kerr-nonlinear media, which we name mode rejection and takes place when two intense counter-propagating beams interact in a multimode waveguide. In stark contrast to mode attraction phenomena, mode rejection leads to the selective suppression of a spatial mode in the forward beam, which is controlled via the counter-propagating backward beam. Starting from this observation we generalise the ideas of attraction and rejection in nonlinear multimode systems of arbitrary dimension, which paves the way towards a more general idea of all-optical mode control. These ideas represent universal tools to explore novel dynamics and applications in a variety of optical and non-optical nonlinear systems. Coherent beam combination in polarisation-maintaining multicore fibres is demonstrated as example.

Aim Dalbavancin is a lipoglycopeptide with a half-life of 14 days (range 6.1 to 18.4), significantly longer than other antimicrobials, which avoids the need for daily antibiotic dosing. This multi-centre observational study aims to describe the use of dalbavancin to facilitate discharge in treating bone and joint infections. Method All adult patients treated with dalbavancin from January 2017 to September 2022 in four UK bone infection units were included. Data collected through a standardised data collection form included: Clinical and microbiological characteristics. Hospital length of stay. Complications. Patient suitability for hypothetical treatment options, such as Outpatient Parenteral Antibiotic Team (OPAT) Clinical outcome. Treatment-related costs were calculated for dalbavancin and the preferred hypothetical treatment option that would have been administered for the same duration. The costs were subtracted to calculate the cost difference. Clinical success was defined as the absence of definite failure in accordance with the OVIVA Trial protocol. Results Thirty-six patients were included: 20 males and 16 females, with a median age of 53 (IQR 43–73): Thirteen were septic arthritis, twelve were prosthetic joints, seven were spondylodiscitis and five were other orthopaedic-related implant infections. In twenty cases the infecting organism was Staphylococcus aureus, fourteen were due to coagulase-negative staphylococci and two no cultured organism. Reasons for dalbavancin The reasons for choosing dalbavancin over alternatives were due to either: Necessity due to poor adherence (21), or lack of viable OPAT options due to antibiotic resistance or intolerance (7) OR Convenience to avoid the need for OPAT (8) Dalbavancin was initiated at 1500mg after a median of 12 days (IQR 6–17) of in-hospital antimicrobial therapy. Subsequent dalbavancin doses were based on clinical decisions and ranged from 1000mg to 1500mg. Healthcare benefits Switching to dalbavancin reduced treatment costs by a median of £3526 (IQR 1118 - 6251) compared with the preferred theoretical alternatives. A median of 31 hospital days (IQR 23–47) was avoided among patients who would have required a prolonged inpatient stay. Outcome Overall, 20 patients (55.6%) were successfully treated after a median follow-up of 8 months (IQR, 5.8 – 18.4). No patients developed an adverse drug reaction. Conclusions Dalbavancin can safely facilitate outpatient treatment in patients with limited oral options and in whom OPAT is unsuitable. Dalbavancin is cost-effective compared with the alternative of an inpatient stay.

The increased complexity of high-consequence digital system designs with intricate interactions between numerous components has placed a greater need on ensuring that the design satisfies its intended requirements. This digital assurance can only come about through rigorous mathematical analysis of the design. This manuscript provides a detailed description of a formal language semantics that can be used for modeling and verification of systems. We use Event-B to build a formalized semantics that supports the construction of triggered enable statecharts with a run-to-completion scheduling. Rodin has previously been used to develop and analyse models using this semantics.

Aim Brain SPECT can detect early changes in perfusion to support the diagnosis of dementia. Amyloid Beta (Aβ) plaque deposits and aggregation of hyperphosphorylated tau in neurofibrillary tangles are hallmark pathologies of Alzheimer disease (AD). The aim of this study was to identify changes in brain perfusion patterns (neuroimaging signatures) with CSF amyloid and tau. Materials and Methods 91 participants’ SPECT scans and CSF samples from a heterogenous clinical cohort were analysed. AD biomarkers including Aβ42 and pTau were measured using a chemiluminescent enzyme immunoassay. Statistical Parametric Mapping (SPM) was used to quantify brain perfusion diffe- rences in SPECT scans in comparison to a database of healthy controls. Specifically, whole brain analysis was performed in SPM with Aβ42 and pTau added as covariates to univariate linear regression models Results Decreasing Aβ42 corresponds to significant reduction in perfusion in the parietal and temporal lobes, bilaterally (cluster centres in angular gyrus and medial temporal areas). Increasing pTau corresponds to reduction in brain perfusion medially in the parietal lobe (cluster centre in precuneus). Conclusion CSF Aβ42 and pTau showed distinct neuroimaging signatures in brain which could be pre- dictive of regional brain injury.

Background My Medical Record is an online patient portal developed by University Hospital Southamp- ton and used by over 80,000 patients. The benefits and challenges of using such a portal for people with long-term neurological conditions is unknown. Aims 1) To evaluate the use and perceived usefulness of an online patient portal for people with long-term neurological conditions 2) To identify the benefits and challenges of use. Method 60 patients completed an online survey on their use of the portal, its usefulness, and their sociode- mographic and health status. Results Of the 10 main functions offered by the portal, patients found test results, clinical letters and messaging the most useful, and diaries and health questionnaires the least. Patients with higher disease severity tended to find the portal more useful than those with lower disease severity. The research identi- fied benefits and challenges within the themes of functionality, navigation, accessibility, and responsivity. Sociodemographic factors such as educational attainment and income did not appear to affect use or perceived usefulness. Conclusion This study identified the benefits and challenges of an online patient portal for people with neurological conditions. The findings can help improve the design and implementation of digital tools for this population.

Background Neurological conditions and neurodegenerative diseases can negatively impact the well-be- ing and quality of life of patients and informal caregivers. The use of digital health technology to promote self-management and the delivery of post-diagnostic care may help improve this. Aim Identify digital tools used in self-management and care delivery, to investigate how they support users, and highlight pertinent clinical and psychosocial outcomes. Methods Six databases were searched using free text and equivalent database-controlled vocabulary terms. Results For neurological conditions, 27 articles were identified, reporting 17 self-management digital tools aimed at patients. These promoted self-management through five main functions: knowledge and under- standing, behaviour modification, self-management support, facilitating communication, and recording condition characteristics. Salient clinical outcomes included improvements in self-management, self-ef- ficacy, coping, depression, and fatigue.For neurodegenerative diseases, 26 articles were identified, reporting 21 digital tools focused mainly on caregivers. These promoted self-management and support through five main functions: psychoeduca- tion and self-help, competency and ability, sustaining and promoting well-being, behaviour change and motivation, and facilitating contact and communication with healthcare professionals and other users. Conclusion There is limited-to-mixed evidence to support a positive influence of digital tools on mental health, burden, quality of life, and caregiver perceived ability. Greater understanding is needed around their accessibility, uptake, sustained use, and integration within care pathways and routine clinical care.

Background The Covid-19 pandemic hastened the use of remote and digital care delivery in neurology outpatient services. If we are to understand the effect of this transformation on care quality, we must first understand the individual value components of a neurology outpatient appointment that might be affected. Aim 1) To identify the value components of a neurology outpatient appointment from a patient and carer perspective. 2) To identify potential changes in quality or considerations when moving the value component to remote or digital delivery. Method 40 patients and 9 carers participated in interviews, focus groups and an online forum. Transcripts of the interviews and focus groups and comments from the online forum were analysed using inductive thematic analysis. Results We identified 18 value components, which were grouped into themes including ‘interaction with clinician’, ‘diagnosis’, ‘treatment’, ‘patient/carer knowledge’, ‘support and self-management’ and ‘well-being’. Considerations when moving each value component to remote or digital delivery were then identified, with patients and carers identifying potential benefits and challenges for quality. Conclusion This study determined the value components of outpatient appointments from a patient and carer perspective and potential implications and considerations in moving each of these value components to remote or digital care.

There are two mandatory features added sequentially en route to classical follicular lymphoma (FL): first the t(14;18) translocation which upregulates BCL2; second the introduction of sequence motifs into the antigen-binding sites of the B-cell receptor (BCR), where oligomannose-type glycan is added. Further processing of the glycan is blocked by complementarity-determining-region (CDR)-specific steric hindrance, leading to exposure of mannosylated Ig to the microenvironment. This allows interaction with the local lectin, DC-SIGN, expressed by tissue macrophages and follicular dendritic cells. The major function of DC-SIGN is to engage pathogens, but this is subverted by FL cells. DC-SIGN induces tumor-specific low-level BCR signaling in FL cells and promotes membrane changes with increased adhesion to VCAM-1 via proximal kinases and actin regulators , but, in contrast to engagement by anti-Ig, avoids endocytosis and apoptosis. These interactions appear mandatory for early development of FL prior to acquisition of other accelerating mutations. BCR-associated mannosylation can be found in a subset of germinal-center B-cell-like DLBCL (GCB-DLBCL) with t(14;18), tracking those cases back to FL. This category was associated with more aggressive behavior, and both FL and transformed cases, and potentially a significant number of cases of Burkitt's lymphoma which also have sites for N-glycan addition, could benefit from antibody-mediated blockade of the interaction with DC-SIGN.

Background Vestibular rehabilitation is a safe and effective exercise-based treatment for patients with chronic vestibular symptoms. However, it is underused in general practice. Internet-based vestibular rehabilitation (Vertigo Training), which has proven to be effective as well, was developed to increase uptake. We now aim to improve the quality of care for patients with vestibular symptoms by carrying out a nationwide implementation of Vertigo Training. We will evaluate the effect of this implementation on primary care. Methods Our implementation study consists of three successive phases: 1) We will perform a retrospective observational cohort study and a qualitative interview study to evaluate the current management of patients with vestibular symptoms in primary care, in particular anti-vertigo drug prescriptions, and identify areas for improvement. We will use the results of this phase to tailor our implementation strategy to the needs of general practitioners (GPs) and patients. 2) This phase entails the implementation of Vertigo Training using a multicomponent implementation strategy, containing: guideline adaptations; marketing strategy; pharmacotherapeutic audit and feedback meetings; education; clinical decision support; and local champions. 3) In this phase, we will evaluate the effect of the implementation in three ways. a. Interrupted time series. We will use routine primary care data from adult patients with vestibular symptoms to compare the number of GP consultations for vestibular symptoms, referrals for vestibular rehabilitation, prescriptions for anti-vertigo drugs, and referrals to physiotherapy and secondary care before and after implementation. b. Prospective observational cohort study. We will extract data from Vertigo Training to investigate the usage and the characteristics of participants. We will also determine whether these characteristics are associated with successful treatment. c. Qualitative interview study. We will conduct interviews with GPs to explore their experiences with the implementation. Discussion This is one of the first studies to evaluate the effect of a nationwide implementation of an innovative treatment on Dutch primary care. Implementation strategies have been researched before, but it remains unclear which ones are the most effective and under what conditions. We therefore expect to gain relevant insights for future projects that aim to implement innovations in primary care.

Objectives :To determine how muscle strength, power, mass, and density ( i.e . quality) differ between children living with HIV (CWH) and those uninfected, and whether antiretroviral therapy (ART) regime is associated with muscle quality. Design :A cross-sectional study in Harare, Zimbabwe. Methods :The study recruited CWH aged 8–16years, taking ART for ≥2years, from HIV clinics, and HIV-uninfected children from local schools. Muscle outcomes comprised grip strength measured by hand-held Jamar dynamometer, lower-limb power measured by standing long-jump distance, lean mass measured by dual-energy X-ray absorptiometry, and muscle density (reflecting intramuscular fat) by peripheral quantitative computed tomography. Linear regression calculated adjusted mean differences (aMD) by HIV status. Results :Overall, 303 CWH and 306 without HIV, had mean(SD) age 12.5(2.5) years, BMI 17.5(2.8), with 50% female. Height and fat mass were lower in CWH, mean differences(SE) 7.4(1.1)cm and 2.7(0.4)kgs, respectively. Male CWH had lower grip strength (aMD 2.5[1.1,3.9]kg, P < 0.001), long-jump distance (7.1[1.8,12.5]cm, P = 0.006), muscle density (0.58[0.12,1.05]mg/cm ³ , P = 0.018, but not lean mass 0.06[-1.08,1.21]kg, P = 0.891) versus boys without HIV; differences were consistent but smaller in females. Mediation analysis suggested the negative effect of HIV on jumping power in males was partially mediated by muscle density ( P = 0.032). CWH taking tenofovir disoproxil fumarate (TDF) had lower muscle density (0.56[0.00,1.13]mg/cm ³ , P = 0.049) independent of fat mass, than CWH on other ART. Conclusions :Perinatally-acquired HIV is associated, particularly in males, with reduced upper and lower-limb muscle function, not mass. Intra-muscular fat (poorer muscle quality) partially explained reductions in lower-limb function. TDF is a novel risk factor for impaired muscle quality.

Microbial fuel cells (MFCs) have been gaining attention as a promising technology for sustainable energy production through the metabolic processes of microorganisms. The materials traditionally employed in this field have fallen short in facilitating efficient microbial-electron transfer and subsequent current generation, posing significant challenges for practical applications. To overcome this hurdle, the integration of nanomaterials into MFC components has emerged as a promising avenue, capitalizing on their unique physical and chemical properties to drive iterative advancements. In this review article, we explore the importance of nanomaterials in MFCs, highlighting their exceptional attributes such as high surface area-to-volume ratio, stability, durability, and selectivity. These advancements could hold the key to accelerating the recognition of MFCs as a powerful platform technology.

Objectives To gain a consensus among therapists for reasons why a person who had a stroke may not receive the Royal College of Physicians’ recommended minimum of 45 min of daily therapy. Design Three-round remote e-Delphi study. Setting National study, based in the UK. Participants Occupational therapists and physiotherapists with experience of delivering therapy after stroke and awareness of the 45 min guideline. Results Forty-five therapists consented to participate in the study. Thirty-five (78%) completed round one, 29 of 35 (83%) completed round 2 and 26 of 29 (90%) completed round three. A consensus (75%) was reached for 32 statements. Reasons why a person may not receive 45 min were related to the suitability of the guideline for the individual (based on factors like therapy tolerance or medical status) or the capability of the service to provide the intervention. In addition to the statements for which there was a consensus, 32 concepts did not reach a consensus. Specifically, there was a lack of consensus concerning the suitability of the guideline for people receiving Early Supported Discharge (ESD) services and a lack of agreement about whether people who need more than 45 min of therapy actually receive it. Conclusion Some people do not receive 45 min of therapy as they are considered unsuitable for it and some do not receive it due to services’ inability to provide it. It is unclear which reasons for guideline non-achievement are most common. Future research should focus on why the guideline is not achieved in ESD, and why people who require more than 45 min may not receive it. This could contribute to practical guidance for therapists to optimise therapy delivery for people after stroke.