University of Bradford

Steel concrete composite structures are extensively adopted in construction practices owing to their attractive merits in structural behaviour, material employment and economic consideration etc. Steel concrete composite slim-floor beam system is an innovative, economical evolution from conventional composite system, it is used for multi-story high-rise buildings to increase storey effective net height. This paper presents a numerical simulation and analysis on the shear resistance of concrete dowel shear connector with reinforcing rebar for composite slim-floor beams. A finite element model was developed and validated against experimental results available from reference and good agreement achieved. A parametric study, covering important component parameters including concrete strength, diameter of concrete dowel and diameter of reinforcing rebar, was conducted to investigate the effect of these connector components on the structural behaviour of dowel shear connectors. The numerical simulation and analysis further highlighted the influence of connector components on the shear resistance and slip behavior of this type of shear connection adopted for composite slim-floor beams. Finally, a simple prediction method is proposed to calculate the shear resistance of dowel shear connector with reinforcing rebar. The simple prediction method may be used for design reference.

Background There’s a significant demand to link and analyse administrative and routine local hospital data for health research to improve treatments and understand disease and diagnosis. Involving patients and members of the public in how data are accessed for service improvement is crucial for developing an acceptable, ethical and information governance-compliant whole system data linkage. A key challenge is ensuring sustainable and genuine public engagement that fosters trust in data use. This study evaluates the early implementation of a Data Trust Committee (DTC) at a London hospital, assessing its impact on research efficiency and the experiences of key stakeholders, including patients, staff and researchers. Methods A rapid qualitative evaluation was conducted using semi-structured to assess the implementation and perceived impact of the DTC. Purposive sampling targeted DTC members (n = 8), attendees (n = 3), and researchers (n = 2). Thematic analysis, supported by RREAL sheets, identified key themes in stakeholders’ experiences and perceptions. Results Findings highlighted five key areas: (1) the programme theory, outlining the DTC’s role in data governance and responsible data access; (2) varying stakeholder perceptions of the DTC’s purpose and decision-making processes; (3) The DTC’s impact on research oversight, data access and approval processes; (4) challenges related to role clarification and communication; (5) the perceived effectiveness of the DTC in enhancing data quality, research oversight and approval speed. While participants recognised the DTC’s potential to enhance data quality and prioritising patient experiences, challenges related to the speed of applications, communication gaps, and technology barriers were identified. Conclusion The DTC played a pivotal role in reshaping research regulatory processes, and how this may benefit patients. However, balancing ethical risks with patient benefits remains an ongoing challenge. Addressing role clarity, communication strategies, and stakeholder engagement is essential for optimising future DTC implementation. Future research should expand to evaluate DTC models across diverse healthcare settings to enhance data sharing frameworks.

Aim The current management of interprofessional collaborations in social prescribing schemes remains unclear. This systematic review aims to explore published reports of social prescribing schemes to examine the ways in which interprofessional collaborations are managed and their influence on social prescribing schemes. Subjects and methods We searched CINAHL, Ovid MEDLINE, Embase, PsycINFO PubMed, Social Care Online, and Web of Science and grey literature The searches were conducted between August 2022 and April 2023. Two reviewers independently screened titles and abstracts and assessed the quality of included records and extracted the data. Results We included 20 records. All included studies used qualitative methods and seven of the studies utilised mixed methods. Three themes were identified (1) requirements for collaboration, (2) challenges to establishing collaboration, and (3) forms and values of collaboration. Conclusion Different models of social prescribing are in operation and mostly reported in the UK. There is a lack of uniformity in the definition of social prescribing and interprofessional collaboration in relation to social prescribing schemes. More inclusive models of social prescribing and co-production with all stakeholders are warranted to sustain social prescribing schemes after initial funding initiatives. The involvement and onboarding of multiple professions is essential to deliver person-centred care in community settings.

The ‘thickened liquid challenge’, where for a period of time health care staff are encouraged to consume only thickened liquids, and subsequent challenges where participants consume only pureed food, have been popular on social media for many years. The #challenges have played a valuable role in highlighting the impact that thickened liquid and modified texture diets have on people. We suggest that recent posts on these challenges, however well-intentioned, show a shift from the original intention of encouraging staff to reflect on the appropriateness of their use. Some seek to promote empathy and awareness; some seem primarily performative. Encouraging staff to try such diets still has a role as a teaching tool for students or for those who doubt the impact of modified diets on intake of food or liquid or on quality of life. However, this should not be an end in itself. Use of modified diets remains unnecessarily high. The real challenge is changing current practice.

Parkinson’s disease (PD) is a complex, progressive neurodegenerative disorder with high heterogeneity, making early diagnosis difficult. Early detection and intervention are crucial for slowing PD progression. Understanding PD’s diverse pathways and mechanisms is key to advancing knowledge. Recent advances in noninvasive imaging and multi-omics technologies have provided valuable insights into PD’s underlying causes and biological processes. However, integrating these diverse data sources remains challenging, especially when deriving meaningful low-level features that can serve as diagnostic indicators. This study developed and validated a novel integrative, multimodal predictive model for detecting PD based on features derived from multimodal data, including hematological information, proteomics, RNA sequencing, metabolomics, and dopamine transporter scan imaging, sourced from the Parkinson’s Progression Markers Initiative. Several model architectures were investigated and evaluated, including support vector machine, eXtreme Gradient Boosting, fully connected neural networks with concatenation and joint modeling (FCNN_C and FCNN_JM), and a multimodal encoder-based model with multi-head cross-attention (MMT_CA). The MMT_CA model demonstrated superior predictive performance, achieving a balanced classification accuracy of 97.7%, thus highlighting its ability to capture and leverage cross-modality inter-dependencies to aid predictive analytics. Furthermore, feature importance analysis using SHapley Additive exPlanations not only identified crucial diagnostic biomarkers to inform the predictive models in this study but also holds potential for future research aimed at integrated functional analyses of PD from a multi-omics perspective, ultimately revealing targets required for precision medicine approaches to aid treatment of PD aimed at slowing down its progression.

The significance of medicines lies not only in their medicinal value but also in their cost, emphasizing the importance of proper utilisation to reduce waste and optimise resource allocation. The transition to a circular economy, which entails shifting from the current ‘take-use-dispose’ model to a closed-loop system, emerges as a pragmatic approach to curbing waste generation. This study therefore aims to identify the enablers and barriers associated with adopting circular economy practices in the management of medicines waste within hospital pharmacies, examining practices in both the United Kingdom and Kuwait. Employing a mixed-methods approach, this research is validated using empirical data gathered through qualitative interviews (Phase one, n = 29) and quantitative questionnaires (Phase two, n = 86). Key themes were identified in the qualitative data and supported by quantitative results, these were: Barriers and Enablers (Cognitive, Structural and Cultural) and CE Practices (Circulation of products and Eliminating waste and pollution). 89% of the total sample confirmed that legislation was a key barrier to CE adoption. Sustainable design of products and packaging was considered a priority by a large proportion of the respondent sample (89%), but technology was seen to be unsupportive in advancing CE agendas (90% confirmation across both samples). The sharing of medication with other hospital pharmacies was deemed a sensible approach with 75% of the Kuwait sample favouring this. Sharing stock within UK NHS Trusts was practiced but not between Trusts. To maximise the use of products in circulation nearly half of UK participants said they repackaged medications to reduce wastage. Embracing circular economy principles in hospitals’ management of medicines waste presents a promising strategy that can not only enhance national eco-friendly supply chain management practices but also mitigate medicines waste, bolster sustainability efforts, and alleviate disposal costs. Frameworks are proposed to overcome barriers to CE and support pharmacy operational activity promoting higher levels of circular practice.

In addition to producing melanin to protect epidermal keratinocytes against DNA damage, melanocytes may have important roles in strengthening innate immunity against pathogens. We have developed a functional, pigmented, human full‐thickness 3D skin equivalent to determine whether the presence of melanocytes impacts epidermal bacterial growth and regulates the expression of genes involved in the immune response. We introduced primary epidermal melanocytes to construct a 3‐cell full‐thickness skin equivalent with primary dermal fibroblasts and epidermal keratinocytes. Immunohistochemistry verified the appropriate ratio and spatial organisation of melanocytes. Alpha‐MSH induced melanogenesis, confirming an appropriate physiological response. We compared this 3‐cell skin equivalent with the 2‐cell version without melanocytes in response to inoculation with 3 species of bacteria: Staphylococcus epidermidis , Corynebacterium striatum , and Cutibacterium acnes. There was a significant decrease in the colonisation of bacteria in the skin equivalents containing functional melanocytes. There was increased expression of immune‐response genes ( S100A9, DEFB4A, IL‐4R ) following microorganism exposure; however, there were marked differences between the unpigmented and pigmented skin equivalents. This physiologically relevant human 3D‐skin equivalent opens up new avenues for studying complex skin pigmentation disorders, melanoma, and UV damage, as well as the rapidly evolving field of the skin microbiome and the balance between commensal and pathogenic species.

Despite advances in facial beauty prediction, how specific facial regions contribute to perceptions of attractiveness remains largely unexplored, highlighting a critical interpretability gap in this domain. This study addresses the interpretability gap in facial beauty prediction (FBP) models by introducing a novel framework that combines global and local interpretability methods. We introduce Region Attribution, a technique that aggregates XRAI (eXplanation with Ranked Area Integrals) saliency maps across predefined facial regions to quantify their relative importance in individual predictions. Two global approaches complement this local interpretability: permutation feature importance, which systematically explores individual facial regions across the dataset to measure performance degradation, and individual feature prediction, where separate CNN models are trained on isolated facial regions to assess their independent predictive power. Using the SCUT-FBP5500 and MEBeauty datasets, we train convolutional neural networks on both full faces and individual facial features. While our findings reveal slight variations in feature rankings across the three methods, they consistently identify the eyes and nose regions as crucial determinants in facial beauty prediction. Thus, this study demonstrates the value of a multi-method approach in understanding the complex interplay of facial features in beauty prediction machine learning models.

Oil reservoir formation damage is a significant issue in secondary and tertiary oil recovery operations. Enhanced oil recovery (EOR) approaches can address these issues while increasing production rates and resource recovery. However, challenges include chemical degradation, high chemical volumes, and high costs. Nanotechnologies can improve oil recovery by improving subsurface porous media and pore fluids, separating fluid phases, and introducing influencing coatings. Cobalt oxide-based materials have been extensively evaluated for their amphiphilic properties, thermal stability, and high reactivity, which can modify physicochemical properties and improve crude oil recovery. CoO nanoparticles were characterized using various techniques, including Fourier Transform Infrared Spectroscopy (FTIR), Raman spectroscopy, X-ray photoelectronic spectrometry, and Field Emission Scanning Electron Microscope (FSEM). Results showed that CoO nanofluid positively affects reservoir minerals with electromagnetic fields and improves oil recovery. It also improves thermal stability, promotes stable emulsion formation, decreases the interfacial tension (IFT) up to 15% for the light-crude-oil/water system at concentrations of 0.5 wt% nanofluid, and can improve thermal stability with respect to CoO in a wide range of temperatures, favouring the formation of stable emulsions.

Carbon dioxide (CO 2 ) storage serves as a greenhouse gas mitigation strategy employed by numerous nations. This study aims to explore the feasibility of CO 2 storage in the Rio del Rey Basin, Gulf of Guinea region. We employ a compositional flow model, which has been validated using data from a Subsurface interpretation project in Cameroon.This work is aimed at conducting compositional numerical simulations to investigate the impact of geochemistry on CO 2 aquifer storage. A conceptual development CO 2 storage study has been considered for a deep aquifer reservoir formation Miocene Rio del Rey Basin, Cameroon Gulf of Guinea. The reservoir formations in this basin are set to have very good petrophysical and geological properties for it to be considered as a storage system.The aquifer formation contains various amounts of minerals which in turn would alter the injection of CO 2 as the chemical and geological properties of the storage system change. Some of the chemicals would alter the CO 2 fluid and rock properties and consequently the reservoir injection and storage rates and quantities of injected and stored CO 2 due to minerals precipitation and vaporization phenomena within the storage system. This presents a major concern as the impact of geochemistry on CO 2 injection and storage is not well understood to date which means that the development and operational strategies and costs of such a project are not fully understood and present significant deployment risk and uncertainties.The simulation results show that aquifer geochemistry strongly affects CO 2 brine water storage efficiency at different scales.

Introduction: Use of mobile devices with high-quality cameras has expanded medical photography. We investigate the impact of different devices and conditions on photograph quality in a surgical setting. Methods: Fourteen surgeons across six centres scored photograph quality of kidneys donated for transplantation. Images were captured using an iPhone, iPad, or DSLR camera on automatic modes under varying lighting conditions. In blinded A/B testing, surgeons selected the image perceived more clinically useful for remote organ quality assessment and rated each on a 5-point Likert scale. Quality was objectively analysed using two computer vision referenceless quality assessment tools (BRISQUE & NIMA). Results: Of 369 photographs, mobile device images were rated higher quality by surgeons (78.4%) compared to DSLR (9.4%, p < 0.001). Multilevel regression using BRISQUE showed higher quality for iPhones (β = -5.86, p < 0.001) and iPads (β = -3.90, p < 0.001) versus DSLR. Room lighting improved quality over direct overhead illumination with theatre lights (β = 17.87, p < 0.001). Inter-rater (Gwet AC = 0.78) and intra-rater (Cohen's κ = 0.86) agreements were high. Discussion: Smartphones can produce high quality photographs. These findings should reassure clinicians that smartphone devices do not compromise photograph quality and support their use in clinical practice and image analysis research.

The traditionally regulated financial industry has been disrupted by the innovative and liberalised use of financial technology (FinTech) in the cyberspace. While innovations can foster economic development, we argue in this chapter that a liberalised use of FinTech without responsible management is akin to a double-edged sword that can both rescue and destroy humanity. Although FinTech can be used as a saviour of financial inclusion, it can also reduce security to vulnerability in the cyberspace. This chapter highlights the implications and unintended consequences of FinTech activities on human security by reflecting on real-life examples and findings of related studies in this field. Considering the concerns outlined here and elsewhere regarding the downside risks of FinTech, ‘Responsible FinTech’ agenda is formally introduced in this chapter to inspire a critical discourse for the public interest. This chapter navigates the definition and scope of the agenda from an ethical and interdisciplinary perspective to offer a balanced approach in shaping a FinTech space. It concludes that the use of FinTech must be responsibly managed and governed to help human race towards achieving the United Nations’ Sustainable Development Goals (SDGs).

We began this volume by highlighting the role of the upcoming Fourth International Conference on Financing for Development (FfD4) (More details are available at https://sdg.iisd.org/events/fourth-international-conference-on-financing-for-development-ffd4/) in 2025 of closing the gap between ‘aspiration and financing’. To fulfil the aspiration, we will need a pearl of collective wisdom to overcome the key challenges in financing many of the SDGs as outlined in the 2030 Agenda. This will be particularly important for the developing economies as they will need to mobilize money by involving both the public and the private sectors to work together at scale. But more so, the challenge is fundamentally related to promoting effective governance as it warrants the re-orientation of how public and private actors (including the third sector) interact with each other in a system that achieves results in all the dimensions of sustainable development: environmental, social, and economic. In this final chapter, we consider both academic and practitioner perspectives to delve into both the challenges and opportunities in financing sustainable development. The overriding conclusion is to recognise that while innovative financing solutions are imminent in dealing with the rising challenges such as climate change and achieving SDGs, it needs to be achieved by taking into account the risks, transparency, and voice of the developing countries.

Optimal infant nutrition is crucial for good health and survival. HIV-exposed infants have a greater incidence of low birthweight than HIV-unexposed infants, predisposing them to malnutrition and a greater risk of HIV infection. A 12-month longitudinal study was conducted on 166 HIV-exposed infants, assessing nutritional status at 6 weeks, 6 months, and 12 months. Fisher’s test and logistic regression analysed the data using WHO growth standards. Ethical approval was obtained (KEMRI/SERU/CPHR/002/3525). Results: Wasting: Younger maternal age (18–24 years) presented higher odds of infant wasting across all timepoints: 6 weeks aOR 4.31 (CI: 1.11, 1.83), 6 months aOR 4.49 (CI: 1.09, 27.34), and 12 months aOR 5.49 (CI: 1.41, 32.97). Stunting: At 6 months, infants of underweight mothers and those on second-line antiretroviral therapy (ART) regimens had higher odds of stunting aOR 4.76 (CI: 1.36, 16.65) and aOR 5.49 (CI: 1.64, 18.38), respectively. At 12 months, poor maternal ART adherence aOR 4.11 (CI: 1.14, 14.82) and mothers on second-line ART regimens aOR 3.68 (CI: 1.09, 12.49) had increased odds of infant stunting. Underweight: At 6 weeks, high maternal viral load aOR 6.33 (CI: 2.31, 17.36) was associated with higher odds underweight infants, whereas employed mothers had lower odds of underweight infants at 6 and 12 months aOR 0.10 (CI: 0.03, 0.32) and aOR 0.22 (CI: 0.09, 0.59) respectively. The results highlight maternal nutrition and ART adherence’s influence on infant nutritional status and HIV vertical transmission risk. The study recommended integrating comprehensive nutritional care into HIV policies and enhancing ART counselling to reduce vertical transmission risk and poor infant growth.

Immunotherapeutics targeting immune checkpoint receptors or their ligands (i.e., immune checkpoint inhibitors), have been groundbreaking in the field of oncology, radically changing the approach to treatment and improving the clinical outcomes of an ever-expanding list of solid tumors and hematological malignancies. However, immune checkpoint inhibitors (ICI) are not devoid of side effects, collectively regarded as immune-related adverse events (irAE); they are not easily uncovered in preclinical immunotoxicological investigations and are often due to the very low expression of their targets in immunologically-unchallenged non-clinical species. We have characterized expression of a broad range of immune checkpoint receptors in peripheral blood mononuclear cell (PBMC) subpopulations from cynomolgus monkeys and healthy human volunteers, under resting and T-cell stimulatory conditions by multicolor flow cytometry to inform appropriate species selection for modeling potential irAE in immunotherapeutic preclinical research. Focusing on the response of the main lymphocyte populations to interleukin (IL)-2 alone, or in combination with anti-CD3 and anti-CD28 antibodies, checkpoints with shared similarities and key differences between the two species were identified. The results of this first study provide a database for the expression and response to stimulation for immune checkpoint receptors and can help guide future model selection in the design of preclinical studies involving immunotherapeutics directed against these targets.

Introduction Medication safety in healthcare settings is a persistent problem, and children may be at greater risk of harm than adults. Most existing research examining medication safety for hospitalised children is from the perspective of healthcare professionals and organisations. This study aimed to ethnographically explore parent and staff perspectives on the role of parents in medication safety in the paediatric hospital setting. Methods 230 h of ethnographic observation and 19 semi‐structured interviews with clinical staff and parents were conducted over paediatric wards in three acute hospitals in Northern England between October 2020 and May 2022. Data was organised and coded using NVivo and analysed thematically. Results Three main themes were identified: (1) Capacity and Capability: Parents were often assumed to be incompetent by organisational policies and managers but at the same time were co‐opted to undertake medication processes to meet operational needs. Parental experience was often ignored or judged negatively. When things went wrong parents were sometimes blamed. (2) Communication: parents were seldom meaningfully involved in decisions about their children's medication or provided with appropriate information unless requested. Parental medication histories were treated with suspicion and validated against inaccurate records. (3) Agency and Autonomy: parents often wanted to participate in their child's care but were expected to be passive observers. Conclusions Medication safety for children is a social phenomenon involving healthcare professionals and parents. However, parents are often relegated to a passive role by healthcare staff. We posit that this represents an example of epistemic injustice in the way parents are assumed to be incompetent outsiders with no understanding of the medical care of their children, despite them offering resilience for medicines safety. We recommend further exploration of how parents contribute to resilience and safety for children in hospital and the barriers to this, and how health services can safely support increased engagement and involvement of parents in the care of their children while in hospital. Patient or Public Contribution Parents contributed to the analysis and interpretation of the data collection and have contributed to the preparation of the manuscript.

Introduction Dignity Therapy (DT) is a psycho-therapeutic end-of-life intervention supporting life review, meaning making and legacy leaving. DT is well-established with adults, impacting positively on mental well-being. Evidence and consultation work suggests young people (YP) with life-limiting conditions (LLCs) would welcome a tailored digital DT based intervention. Aim To co-design a digital DT based intervention, called DIGNISPACE, for YP with LLCs. Methods Qualitative methods included focus groups with health professionals (n=23), semi-structured interviews with YP with LLCs (n=13) and family carers (n=12). Data were analysed using framework approach. Participants were recruited from hospices in the North of England. An advisory group of YP with LLC and carers supported the study and content of the DIGNISPACE prototype. Results Three themes were derived from the data: 1) Intervention purpose including amendments to the DT question protocol; 2) App components, content, and delivery; 3) Networks and support systems. Findings informed a model of dignity in YP with LLCs and the DIGNISPACE prototype, a digital time capsule of memories, thoughts, and creative activities personal to the user. DIGNISPACE enables YP to review their lives, talk about memories and leave a legacy. DIGNISPACE helps them address issues challenging to them and can be used alone, or with trained DIGNISPACE supporters, friends, and family. When shared the content will provide comfort for the bereaved. Conclusions DIGNISPACE is a co-created psycho-therapeutic digital intervention aimed at supporting the psycho-spiritual well-being needs of YP with LLCs. DIGNISPACE includes tenets of the model of dignity for YP in its content and delivery. Further research is required to explore DIGNISPACE feasibility. Impact We have created a new model of dignity for young people to shape future interventions. DIGNISPACE is a tool to support individuals’ psycho-spiritual and conversational needs - helping health professionals work more sensitively with young people and families.

Introduction Patient public involvement and engagement (PPIE), a requirement of planning and delivering health research, must not be tokenistic to meet funding body requirement. The perceived vulnerability of people towards the end-of-life, particularly young people (YP) with life-limiting conditions (LLCs) may result in exclusion form participating in research. Our co-designed psycho-therapeutic (DIGNISPACE) intervention drew extensively on PPIE methods but was not without challenges. Aim Drawing on our experience of co-designing DIGNISPACE, the café will debate how to ensure meaningful PPIE in research, using the questions below: • What are the challenges of involving YP with LLCs in research? • What strategies can ensure YP’s involvement & engagement is not tokenistic? • How can YP be involved in research from initial conception to grant co-applicant and thereafter? Methods Our participatory activities have included workshops, a range of social media activities including Twitter (now X) chats and Facebook group discussions, TRELLO virtual discussion board, consultation on coding and interface design, in addition to traditional steering group meetings. Results Lower levels of engagement were used to consult at the initial stage of the research, primarily PPIE forums and health professional meetings. YP / family steering group advised on study materials, data collection methods and data analysis reviews. YP advisor was part of the research team and co-applicants on a successful research grant, and lead author on two publications. The involvement of YP with LLCs, across PPIE activities, was challenging, most significantly the death and health deterioration of contributors and peers. Conclusions The patient voice must remain the focus of the research. The successful co-design of DIGNISPACE was rewarding and challenging both practically and emotionally for the research team. Impact Our research approach allowed substantial input from YPs with LLCs, family carers and healthcare professionals: the resultant DIGNISPACE prototype is truly co-designed. References • Watts L, Rodriguez A, Tatterton M, Mc Sherry W, Smith J. Stakeholder perceptions of dignity therapy for children and young people with life-limiting conditions study. Integrative Therapies in Palliative Care 2020; 5 (1). • Watts L, Rodriguez A, Tatterton M, Smith J. Meaning making and generativity in children and young people with life limiting conditions. Evidence-Based Nursing 2019; 22 (2):33–35 • Rodriguez A, Smith J, McDermid K. Dignity therapy interventions for young people in palliative care: a rapid structured evidence review. International Journal of Palliative Nursing 2018; 24 (7):112–121

Purpose Little is known about the quality of optometrists' referrals to secondary care for neovascular age‐related macular degeneration (nAMD), despite the need for timely intervention. We analysed the content and accuracy of optometrists' referrals for nAMD. Adherence to UK National Institute for Health and Care Excellence (NICE) guidelines and the impact of the COVID‐19 pandemic were assessed as secondary measures. Methods Optometric referrals to a specialist macular treatment centre in Bradford, United Kingdom, between March 2019 and March 2021 were retrospectively analysed and compared with subsequent electronic medical records. Data were extracted on legibility, reason for referral, patient and optometrist demographics, visual acuity, reported signs and symptoms, patient diagnosis and patient outcomes. Binomial logistic regression models were constructed to determine whether signs or symptoms noted in the referral were associated with subsequent nAMD diagnosis in secondary care and whether optometrist gender or experience influenced nAMD referral accuracy. Results Across all 394 referrals analysed, 256 were for nAMD. Referral accuracy for nAMD was 39.8% (95% CI [34.0%, 45.9%]), with the most common reason for misdiagnosis being dry AMD. However, 76.8% of patients referred for suspected nAMD were either treated in secondary care or observed over multiple visits. 20% of suspected nAMD patients were seen within the NICE recommended 14‐day window pre‐COVID, dropping to 5% during the pandemic ( p < 0.001). Visual acuity was most strongly associated with nAMD diagnosis (χ ² (1) = 13.71, p < 0.001) followed by macular haemorrhage (χ ² (1) = 5.89, p = 0.02). Neither optometrist gender nor experience was significantly associated with confirmed nAMD. Legibility of referrals was 91–95% for patient details and 94–97% for the referring optometrist. Conclusions Although the overall quality and legibility of optometrists' macular referrals to secondary care were of a high standard, the diagnostic accuracy of nAMD was below 40%. Referred visual acuity was the main sign/symptom associated with confirmed nAMD diagnosis.