This study aims to investigate the lived experiences of civilians in Lahore during the 2025 India–Pakistan conflict, focusing on psychological distress, social disruption, coping mechanisms and perceptions of national response and preparedness.

The study employs an exploratory phenomenological approach.

The study has been conducted in Lahore, the capital city of Punjab, the largest by population province of Pakistan. Lahore was selected as a research site due to its historical, strategic and political significance in Indo-Pak conflicts.

Data were collected from 10 participants aged 18 or above years, who lived in Lahore between April and May 2025, and were willing to discuss personal, social or psychological experiences related to the conflict. In-depth, semistructured interviews were conducted in Urdu, transcribed, and were thematically analysed using both manual and NVivo V.12 software-supported coding.

Seven inter-related themes were identified. Participants reported intense anxiety, hypervigilance and insomnia driven by hybrid warfare tactics, including misinformation, drone sightings and media sensationalism. Social life was disrupted through withdrawal from public, religious and communal activities. Coping strategies included religious faith, family cohesion, humour and expressions of national solidarity. Notably, many participants experienced psychosomatic symptoms such as palpitations, gastrointestinal distress and stress-induced fever. A prominent finding was the absence of civilian preparedness guidance, which amplified fear and uncertainty during the escalation.

The conflicts, although short lived and geographical restrained, casts a long psychological and social on civilians, marked by fear, uncertainty, social disruption and dissatisfaction with institutional preparedness. While some coping and resilience were evident, the findings highlight the need to strengthen civilian-focused public health responses during periods of conflict escalation, including mental health awareness, media literacy and community-level support within Pakistan’s emergency response frameworks.

The development of the target trial emulation (TTE) methodology has enhanced the conduct of non-randomised studies. By leveraging readily available routinely collected data, TTEs offer opportunities for complementing randomised controlled trials (RCTs), providing more precise estimates and improving the external validity of RCTs. To explore this potential, we selected a successfully completed RCT as a case study. In the FIRST-line support for Assistance in Breathing in Children (FIRST-ABC) step-up RCT, high flow nasal cannula (HFNC) was found to be non-inferior to continuous positive airway pressure (CPAP) in terms of time to liberation from respiratory support in the paediatric critical care setting. We will emulate the FIRST-ABC step-up trial using routinely collected data from the Paediatric Intensive Care Audit Network (PICANet) database.

This is a protocol for a TTE that will use longitudinally collected data from the PICANet database. The study aims to emulate the FIRST-ABC step-up RCT using an observational study design in a frequentist framework. We will benchmark the results against the published trial. The study will apply a new-user design by selecting children admitted to paediatric intensive care units that started HFNC or non-invasive ventilatory support (as a surrogate for CPAP). The eligibility criteria and selected outcomes will reflect those of FIRST-ABC within the constraints of the available routinely collected data. We will use advanced quantitative doubly robust methods to minimise the impact of confounding by indication and allow for heterogeneity according to child characteristics. The analysis will be repeated using a Bayesian approach for follow-up research.

The research received ethics approval from the London School of Hygiene & Tropical Medicine Research Ethics Committee. This study will expand the findings from the FIRST-ABC step-up RCT, providing additional insight from a large representative sample using real-world data. The frequentist and Bayesian approaches will enable a discussion about the advantages and drawbacks of the two strategies. The results will be disseminated to the research and clinical community and made accessible to the public. In addition, the study results will be used in future research, which aims to supplement RCTs with additional evidence from a TTE.

An increasing number of teenagers and young adults (TYA) with chronic conditions and complex needs are transitioning from paediatric to adult services, including admission to intensive care units (ICUs). As these services are often ill-equipped to care for TYA, there is a risk of compromised care. Despite recent guidelines from the UK Paediatric Critical Care and Intensive Care Societies highlighting the importance and urgency of improving ICU transition, current recommendations are not evidence-based and established pathways for ICU transition remain limited.

This mixed-methods research study aims to generate evidence to underpin national policy on transition from paediatric to adult ICUs that will improve clinical care and patient experience. To do this, we will: (1) link and analyse UK national data (years 2017–2024) on paediatric and adult ICU admissions, hospital inpatient, outpatient and emergency care visits and survival status, to determine the clinical characteristics and healthcare resource utilisation from teenage years to early adulthood of people admitted to an ICU as a young person (admission aged 14 and 15), and how these relate to ICU admissions after age 16; (2) conduct semistructured interviews, online forums and surveys with TYA patients, carers and health professionals to understand their experience of transition in ICU services; and (3) synthesise these strands of evidence and use a structured process of stakeholder engagement to propose potential targeted improvements as appropriate.

This study was approved by the East of England - Cambridge South Research Ethics Committee on 1 August 2024 (research ethics committee number 24/EE/0108), and the Health Research Authority Confidentiality Advisory Group (CAG) on 7 October 2024 (CAG number 24/CAG/0068). Study results will be actively disseminated through peer-reviewed journals, conference presentations and accessible lay texts and graphic summaries for the use of charities and patients including those with learning disabilities and neurodevelopmental disorders.