Wednesday, November 19, 2025

UK

Thousands of NHS doctors trapped in insecure “gig economy” contracts


Almost 9 in 10 trusts use contracts that deny doctors training and fair pay progression; Experts warn that the NHS is effectively “behaving like a gig economy employer”



BMJ Group





Thousands of locally employed doctors (LEDs) - many of them international graduates and from ethnic minority backgrounds - are trapped on insecure NHS contracts with no access to training, career progression, or national safeguards, reveals an investigation published by The BMJ today.

LEDs are the fastest growing group of doctors in the UK, driven mostly by those who graduated outside the UK. From 2019 to 2023, the number of LEDs in England and Wales rocketed by 75% to 36,831 doctors.

Freedom of Information (FoI) data obtained by The BMJ show that almost nine in 10 UK acute trusts use local contracts - some dating back as far as 2002 without safeguards introduced in 2016 - letting them set terms without guarantees on pay, hours, teaching, or supervision.

Although guidance states that doctors should spend no longer than two years on local contracts, The BMJ has found alarming evidence of senior doctors effectively stranded in these unsuitable contracts for 10 years or more.

Data gathered from FoI requests found that around one quarter of doctors on local contracts had been employed by their trust for more than two years. Doctors from ethnic minority backgrounds were more likely to be in this position, our data found.

One such doctor, a surgeon with a degree from South East Asia, told The BMJ that she had been on an LED contract for over 17 years. When she raised these issues with her line manager, she was told that she could either accept the situation or quit.

Another doctor working in plastic surgery in the North West on a trust grade registrar contract said: “This is a stagnant post—there is no scope for growth. That’s the problem with the locally employed doctors—the local trust, they have their own rules, and we’re just doing the gap filling role in the service delivery system here.”

Another doctor who has been on a local contract since 2016 said: “I’m kind of trapped in this LED contract. It’s been so annoying, and it’s been going on for years. It’s so unfair.”

And an international medical graduate from Pakistan, working in Yorkshire on a local contract for more than two years, said: “Many of our trust grades have not had appraisals for the past two years. The trainees do get their appraisals. We don’t have teaching opportunities, and we don’t have time for learning. We can’t be stuck like this.”

Many of these doctors feel unable to challenge their employment status due to factors such as family responsibilities, financial pressures, visa constraints, career progression concerns, and the fear of uncertainty.

The BMA’s deputy chair of council, Emma Runswick, describes The BMJ’s findings as “further stark evidence of the way that locally employed doctors are exploited in a contractual ‘wild west,’” with dire terms and conditions and a lack of clear development opportunities.

Others describe the situation as a “two tier system” for doctors in the NHS and warn that the NHS is effectively “behaving like a gig economy employer.”

Partha Kar, consultant endocrinologist and a Royal College of Physicians elected councillor, wants to see a national framework that holds trusts to account. There should be no such thing as a non-training doctor, he says, and everyone should have access to clinical and educational supervision and the ability to progress their career.

A spokesperson for the Department of Health and Social Care says that LEDs are “an integral and highly valued” part of the NHS and that it is aware of reports from doctors that “trusts are not appropriately treating staff . . . This is completely unacceptable, and we are committed to improving working conditions through the implementation of elements of the SAS pay deal.”

NHS Employers also says that LEDs are “valuable” to the NHS and should be supported to help develop their careers. But nationally agreed contracts, although recommended, are not always suitable, says its chief executive, Danny Mortimer.

Rob Fleming, specialist anaesthetist and member of a campaign group, the SAS Collective, says the NHS must be stopped from “behaving like a gig economy employer.” He concludes, “We believe that locally employed doctors should be offered the appropriate permanent SAS contract for their work. As well as employment rights, this would give these folks the professional identity they are currently being denied.”

Two thirds of women gain too much or too little weight in pregnancy: Global study



Monash University





Key points

  • Higher and lower than recommended gestational weight gain is associated with increased pregnancy complications
  • Support is needed to improve health for women across the globe
  • Findings may help inform global standards for healthy weight gain in pregnancy

Around two-thirds of pregnancies have weight gain that is more or less than recommended and is associated with complications such as preterm birth, large birth weight, and admission to intensive care.

The findings are part of a Monash University-led systematic review of data from 1.6 million women, published by The BMJ.

Gaining too much or too little weight during pregnancy, known as gestational weight gain or GWG, represents combined growth of mother and baby, and is associated with increased risks to both mother and child.

Each year 130 million births occur globally in total, in the context of increasingly unhealthy and processed food supply and environmental drivers, causing an epidemic of excess GWG.

First author Dr Rebecca Goldstein, from the Monash Centre for Health Research and Implementation (MCHRI), said the study’s results underlined the need for international action.

“These findings reinforce the need for international reference standards for healthy GWG alongside lifestyle support and public health measures to improve outcomes for mothers and babies worldwide,” Dr Goldstein said.

Most countries rely on Institute of Medicine GWG guidelines*, but these are based on data from predominantly Caucasian women in high income countries in the 1980s, so they don’t reflect ethnically diverse populations across low, middle and high-income settings, or changes in food supply and environment that are driving global trends such as rising weight (BMI).

In response, the World Health Organization (WHO) has launched an initiative to develop global healthy GWG standards aimed at defining optimal GWG recommendations across diverse settings.

To support this initiative, Monash University researchers and collaborators from the WHO analysed data from 40 observational studies involving 1.6 million women aged 18 and over from five of the six WHO defined world regions that reported pregnancy outcomes according to BMI and GWG from 2009 to 2024. Of these 40 studies, 36 were considered to be high quality.

Around half (53 per cent) of study participants had a healthy pre-pregnancy BMI, with others classified as below (6 per cent), above (19 per cent), or well above healthy weight (obese) (22 per cent). Only a third (32 per cent) had GWG within recommended ranges, with 23 per cent gaining below and 45 per cent gaining above recommended.

Based on WHO BMI criteria, the research study found that GWG below the recommended range was associated with: lower risk of caesarean delivery; a large for gestational age infant; and high birth weight (macrosomia) but higher risk of preterm birth; a small for gestational age infant; low birth weight; and respiratory distress.

Conversely, GWG above the recommended range was associated with: a higher birth weight and a higher risk of caesarean delivery; hypertensive disorders of pregnancy; a large for gestational age infant (macrosomia), and admission to a neonatal intensive care unit; and a lower risk of preterm birth and a small for gestational age infant.

Similar patterns were apparent when Asian BMI categories were used in studies conducted in this world region.

The researchers point to some limitations, such as variations in BMI and GWG classifications, and note that few studies from low income countries met their inclusion criteria, limiting diversity. Nor can they rule out the possibility that other unmeasured factors, such as smoking status, age and ethnicity, may have influenced their results.

However, Senior author Professor Helena Teede, who is Director of the Monash Centre for Health Research and Implementation, and an Endocrinologist at Monash Health, said the study supported the need for a global approach.

“Our findings inform and support the need for optimised, evidence-based WHO international GWG reference standards based on individual patient data, applicable to contemporary and diverse global populations,” Professor Teede said. “This work builds on and improves current recommendations and highlights the need for multi-level support to improve the health of mothers and babies worldwide.

“Whilst this work supports guidance on healthy GWG, it will need to be incorporated into individualised care to meet the needs of those in pregnancy, limiting stigma and optimising healthy outcomes for women and the next generation. Ultimately, the burden of health impacts shown here mandate action to support women across policy, healthcare and individual level solutions for the health of mothers and babies.”

Read the research paper in The BMJ: Gestational weight gain and risk of adverse maternal and neonatal outcomes in observational data from 1.6 million women: systematic review and meta-analysis
DOI: 10.1136/bmj-2025-085710

This study involved researchers from Monash University, Monash Health, the World Health Organization’s Department of Nutrition and Food Safety, the National Institute of Perinatology in Mexico, Universidade Federal do Rio de Janeiro (UFRJ) in Brazil and California Polytechnic State University.

Background*

In 1990 the USA’s Institute of Medicine (IOM), now known as the National Academy of Medicine  generated gestational weight gain guidelines based on a modest sized population of predominantly white women from 1980 in the US, with a mean body mass index (BMI) of 24 and age of 26 years, focusing on the outcome of low birth weight. The 2009 IOM guideline update incorporated WHO BMI categories and broader outcomes, varying recommended GWG by maternal BMI. These guidelines have since provided an important international reference point. However, the evidence underpinning them reflects the population and priorities of that era, characterised by lower maternal age and BMI, with limited ethnic diversity and a narrow high income setting.
 

 

School accountability yields long-term gains for students




University of California - Riverside
Ozkan Eren 

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Ozkan Eren

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Credit: Stan Lim/UC Riverside




A University of California, Riverside-led study shows that holding underperforming schools accountable can yield life-changing benefits for their most vulnerable students.

The research, led by UCR economist and professor Ozkan Eren, found that when high schools receive the state’s lowest performance rating—and are subsequently compelled to make changes—students are significantly less likely to have run-ins with law enforcement later in life.

“In terms of long-run criminal involvement, we find that if the school has a lower rating, students are less likely to be arrested and less likely to be incarcerated,” said Eren, a professor of economics in UCR’s College of Humanities, Arts, and Social Sciences.

The study tracked more than 54,000 South Carolina students who entered ninth grade between 2000 and 2005. Researchers followed the students into their early 30s, linking education records with data on arrests, incarceration, and participation in social welfare programs.

Students who attended schools rated “unsatisfactory” were nearly 3 percentage points less likely to be arrested in adulthood than peers in slightly higher-rated schools, resulting in an overall 12% reduction in arrests. Incarceration rates also declined, though those results were less precise. The study found no significant impact on enrollment in public assistance programs such as food aid or the federal Temporary Assistance for Needy Families program.

Eren said the changes stem from accountability pressure triggered by poor ratings, which carry the threat of sanctions such as leadership changes or even state takeover. In response, schools often make internal reforms that improve the learning environment.

“Even in the short run, we see that there is a change in the school climate,” Eren said. “Those improvements in school climate, in the long run, translate into lower criminal involvement.”

Eren and his colleagues examined data from South Carolina’s school accountability system, which rates public schools from “excellent” to “unsatisfactory” based on graduation rates, test scores, and eligibility for merit-based scholarships. Schools with lower ratings are required to submit improvement plans and are subject to oversight.

What sets this study apart is its focus on long-term outcomes and its use of a robust research method called regression discontinuity. This technique isolates the causal effect of receiving a failing grade by comparing schools just above and just below the threshold for an “unsatisfactory” rating.

“When we compare these two sets of schools, we see that F-rated schools, because of the accountability pressure, perform better than D-rated schools,” Eren said. “That kind of pressure does not exist, let’s say, for B- and A-rated schools.”

While the study does not identify specific school-level interventions, it found that the improvements occurred without significant increases in spending, teacher turnover, or principal replacements. Instead, shifts in school culture and student engagement likely drove the changes.

Eren cautioned that the findings apply specifically to schools at the bottom of the performance scale and may not translate to all accountability systems.

“Can we say this is a general policy prescription? I’m not sure,” he said. “But what we can say with confidence is that accountability pressure helps schools at the bottom of the ratings distribution perform better.”

The study, titled “School Accountability, Long-Run Criminal Activity, and Self-Sufficiency,” was co-authored with David Figlio of the University of Rochester, Naci Mocan of Louisiana State University, and Orgul Ozturk of the University of South Carolina. It was published in the Journal of Human Resources.

 

New study reveals how China can cut nitrogen pollution while safeguarding national food security



Biochar Editorial Office, Shenyang Agricultural University

Minimizing nitrogen-related environmental harm while achieving food security in China 

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Minimizing nitrogen-related environmental harm while achieving food security in China

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Credit: Xuejun Liu, Wim de Vries, Ying Zhang, Lei Liu5, Lin Ma, Zhenling Cui, Qichao Zhu, Hao Ying, Mingsheng Fan, Weifeng Zhang, Keith Goulding, Tom Misselbrook, Dave Chadwick, Jie Zhang & Fusuo Zhang





A new study published in Nitrogen Cycling presents the most comprehensive assessment to date of how China can reduce nationwide nitrogen pollution while continuing to meet the rising food demands of its population. The research analyzes nearly six decades of data and concludes that smarter nitrogen management could reduce fertilizer use by more than one third, significantly improving air and water quality without compromising crop yields.

Nitrogen fertilizers have played a central role in feeding China since the 1960s, supporting dramatic increases in crop production. Yet the overuse of nitrogen has also created widespread environmental challenges. Excess reactive nitrogen enters the atmosphere as ammonia or reaches groundwater as nitrate, contributing to particulate pollution, acidification of soils, eutrophication of water bodies, biodiversity loss, and risks to human health.

To understand how China can reverse these trends, the research team compiled a national nitrogen budget covering the years 1961 to 2018. They tracked nitrogen inputs from fertilizers, manure, deposition, irrigation, and biological fixation and compared them with crop uptake and losses to air and water. The study also calculated the nitrogen input required to meet national food needs and the critical nitrogen threshold necessary to protect environmental and public health.

The findings reveal acute imbalances. China’s nitrogen inputs rose from 4 Tg per year in 1961 to 48 Tg per year in 2018. Since 1980, actual nitrogen inputs have exceeded the amounts needed for food security. Since 2000, they have also exceeded the environmental safety limits set by acceptable ammonia emissions and nitrate leaching. By 2018, China was using 18 to 20 Tg more nitrogen each year than either food security or environmental protection required.

The study identifies three major sources of nitrogen losses: ammonia emissions, nitrate leaching, and denitrification processes. Together they account for up to 39 percent of total nitrogen inputs. In greenhouse vegetable systems in particular, nitrogen use efficiency can fall as low as 4 percent, with substantial losses to the environment.

Despite these challenges, the researchers outline a feasible path forward. They propose a three step strategy that could reduce total nitrogen inputs from 48 to approximately 31 Tg per year. The first step is to increase recycling of livestock manure. China produces 15.4 Tg of manure nitrogen annually, but less than half currently returns to croplands. Achieving an 80 percent manure recycling rate would reduce fertilizer demand by more than 4 Tg per year.

The second step is to balance fertilizer applications with nitrogen supplied by manure and environmental sources. This adjustment alone could cut fertilizer use by 30 to 35 percent without reducing crop yields.

The third step is to adopt integrated soil and crop management practices, including improved crop varieties, optimal rotations, precision fertilization guided by the 4R principles, and enhanced soil productivity. These improvements could further reduce nitrogen fertilizer use by 20 percent and raise national nitrogen use efficiency to levels comparable with those of Europe.

If implemented together, these actions would not only bring China’s nitrogen input within safe environmental limits but also generate substantial economic benefits. The study estimates that reduced fertilizer purchases would save farmers approximately EUR 14 billion annually. Additional savings of nearly EUR 18 billion could result from improved water quality, reduced health costs, and environmental restoration.

The authors emphasize that achieving these benefits will require coordinated national policy, investments in manure management infrastructure, and widespread adoption of advanced farming practices. They conclude that China now has both the scientific insight and the technological capacity to reconcile food production with ecological safety, creating a model for sustainable agriculture worldwide.

 

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Journal Reference: Liu X, de Vries W, Zhang Y, Liu L, Ma L, et al. 2025. Minimizing nitrogen-related environmental harm while achieving food security in China. Nitrogen Cycling 1: e010  

https://www.maxapress.com/article/doi/10.48130/nc-0025-0010  

 

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About Nitrogen Cycling:
Nitrogen Cycling is a multidisciplinary platform for communicating advances in fundamental and applied research on the nitrogen cycle. It is dedicated to serving as an innovative, efficient, and professional platform for researchers in the field of nitrogen cycling worldwide to deliver findings from this rapidly expanding field of science.

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Dissolved organic matter: Climate change’s double-edged player in global carbon and pollution cycles





Biochar Editorial Office, Shenyang Agricultural University

The double-edged environmental effect of dissolved organic matter in global climate change 

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The double-edged environmental effect of dissolved organic matter in global climate change

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Credit: Jing Zhao, Qiusheng Yuan, Xin Lei, Thora Lieke, Yang Liu, Christian E.W. Steinberg, Bo Pan, & Baoshan Xing




As global temperatures climb, a critical but often-overlooked component of our ecosystems is stepping into the spotlight: dissolved organic matter, or DOM. Found everywhere from river water to forest soils, DOM acts as a powerful mover of carbon, nutrients, and pollutants. A new review led by scientists from Kunming University of Science & Technology and international partners finds DOM to be both a buffer and a potential accelerator of climate change, playing a surprisingly complex role in the planet’s environmental balance.

DOM is a diverse mixture of molecules released from decomposed plants, microorganisms, and even plastics. When temperatures rise and rainfall patterns shift, DOM’s molecular structure changes, altering its environmental behavior and biological effects. According to the researchers, climate-induced changes are making DOM both a concern and a solution in the face of global warming.

“Our work highlights how global warming can push DOM to act as a carbon source, fueling greenhouse gas emissions, or as a carbon sink, capturing carbon for long periods,” says lead author Dr. Jing Zhao. “What’s more, these processes are shaped by climate-driven events like droughts, floods, wildfires, and permafrost thaw.”​

Key Findings

  • Global warming increases the aromaticity and carboxyl content of DOM, resulting in molecules with either higher stability or higher reactivity. The fate of these molecules helps determine whether DOM stores carbon or releases it to the atmosphere.​

  • Changes in DOM affect how heavy metals, organic chemicals, and microplastics move and transform in the environment. New forms of DOM can enhance pollutant binding or, under some conditions, boost pollutant mobility and ecological risks.

  • Biological effects of DOM shift with its amount and structure. It can act as a nutrient and protective barrier for organisms, but excessive or chemically altered DOM may stress organisms by increasing reactive oxygen species or disrupting nutrient uptake.

  • DOM has a feedback relationship with climate change. Positive feedbacks, like increased CO2 and methane emissions from thawed permafrost, can intensify warming. Negative feedbacks, like long-term carbon storage in peatland DOM, can help offset emissions.​

Broader Impacts for Public and Environment

The researchers found that DOM’s double-edged role extends to pollutant regulation. Structural changes in DOM can both reduce and intensify the bioavailability of toxic substances such as mercury, pharmaceuticals, and microplastics. For instance, as drought and warming make DOM more aromatic, its ability to bind to pollutants often grows. However, these same changes may turn DOM from a protective shield into a vector for toxins, especially in increasingly polluted and plastic-contaminated waters.

Climate change also increases DOM’s interaction with pollutants and living organisms. DOM can shield aquatic life from some stresses but can also increase pollutant uptake or trigger oxidative stress, depending on its concentration and molecular quality. Researchers urge caution in assuming all DOM changes benefit ecosystems.

Policy Implications and Future Directions

The authors call for governments and research institutions to enhance monitoring of DOM quality in the environment, including key chemical ratios and redox potential. They recommend establishing long-term observational networks to track DOM dynamics across ecosystems and guide climate change mitigation efforts.

“Dissolved organic matter is at the intersection of climate, water chemistry, and ecology,” says Dr. Baoshan Xing, co-author and professor at the University of Massachusetts Amherst. “Understanding DOM’s shifting impact is essential for protecting ecosystems and human well-being in a warming and increasingly complex world.”​

The study emphasizes the urgent need for interdisciplinary collaboration to improve analytical methods for DOM and to quantify its multiple environmental roles. Such efforts can help build robust policies aimed at climate adaptation, pollution reduction, and biodiversity conservation.

About the Study
This research was supported by the National Natural Science Foundation of China and the Yunnan Provincial Scientific and Technological Projects. For media inquiries, please contact Dr. Bo Pan at Kunming University of Science & Technology. 

 

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Journal reference: Zhao J, Yuan Q, Lei X, Lieke T, Liu Y, et al. 2025. The double-edged environmental effect of dissolved organic matter in global climate change. Environmental and Biogeochemical Processes 1: e009  

https://www.maxapress.com/article/doi/10.48130/ebp-0025-0009  

 

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About the Journal:

Environmental and Biogeochemical Processes is a multidisciplinary platform for communicating advances in fundamental and applied research on the interactions and processes involving the cycling of elements and compounds between the biological, geological, and chemical components of the environment. 

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