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Incubators have been studied extensively in the private sector, such as those that engage in technological innovation or growing small businesses. The scholarship has not sufficiently explored the efforts of incubators in the non-profit sector that help create programs supporting, mentoring, and cultivating social entrepreneurs. There are numerous documented cases of non-profit organisations establishing initiatives that help motivated entrepreneurs achieve social change; but research is lagging in developing a systematic understanding of these effort's impact, and the factors associated with the success of non-profit initiatives that support social entrepreneurs. This paper seeks to understand the nature of non-profit organisations that support and cultivate social entrepreneurs. We rely on a unique data set from survey research on non-profit initiatives across three U.S. Census Regions. Results indicate that the characteristics of non-profit organisations vary in their reliance on a variety of revenue resources and governance arrangements, as well as in their diverse policy focus. They also provide an extensive and diverse set of services that supports the ideas and efforts of social entrepreneurs. [ABSTRACT FROM AUTHOR]

Background: Research evidence suggests that a lack of engagement with palliative care and advance care planning could be attributed to a lack of knowledge, presence of misconceptions and stigma within the general public. However, the importance of how death, dying and bereavement are viewed and experienced has been highlighted as an important aspect in enabling public health approaches to palliative care. Therefore, research which explores the public views on strategies to facilitate engagement with palliative care and advance care planning is required. Methods: Exploratory, qualitative design, utilising purposive random sampling from a database of participants involved in a larger mixed methods study. Online semi-structured interviews were conducted (n = 28) and analysed using reflexive thematic analysis. Thematic findings were mapped to the social-ecological model framework to provide a holistic understanding of public behaviours in relation to palliative care and advance care planning engagement. Results: Three themes were generated from the data: "Visibility and relatability"; "Embedding opportunities for engagement into everyday life"; "Societal and cultural barriers to open discussion". Evidence of interaction across all five social ecological model levels was identified across the themes, suggesting a multi-level public health approach incorporating individual, social, structural and cultural aspects is required for effective public engagement. Conclusions: Public views around potential strategies for effective engagement in palliative care and advance care planning services were found to be multifaceted. Participants suggested an increase in visibility within the public domain to be a significant area of consideration. Additionally, enhancing opportunities for the public to engage in palliative care and advance care planning within everyday life, such as education within schools, is suggested to improve death literacy and reduce stigma. For effective communication, socio-cultural aspects need to be explored when developing strategies for engagement with all members of society. [ABSTRACT FROM AUTHOR]

Quasilinear theories have been shown to well describe a range of transport phenomena in magnetospheric, space, astrophysical and laboratory plasma "weak turbulence" scenarios. It is well known that the resonant diffusion quasilinear theory for the case of a uniform background field may formally describe particle dynamics when the electromagnetic wave amplitude and growth rates are sufficiently "small", and the bandwidth is sufficiently "large". However, it is important to note that for a given wave spectrum that would be expected to give rise to quasilinear transport, the quasilinear theory may indeed apply for given range of resonant pitch-angles and energies, but may not apply for some smaller, or larger, values of resonant pitch-angle and energy. That is to say that the applicability of the quasilinear theory can be pitch-angle dependent, even in the case of a uniform background magnetic field. If indeed the quasilinear theory does apply, the motion of particles with different pitch-angles are still characterised by different timescales. Using a high-performance test-particle code, we present a detailed analysis of the applicability of quasilinear theory to a range of different wave spectra that would otherwise "appear quasilinear" if presented by e.g., satellite survey-mode data. We present these analyses as a function of wave amplitude, wave coherence and resonant particle velocities (energies and pitch-angles), and contextualise the results using theory of resonant overlap and small amplitude criteria. In doing so, we identify and classify five different transport regimes that are a function of particle pitch-angle. The results in our paper demonstrate that there can be a significant variety of particle responses (as a function of pitch-angle) for very similar looking survey-mode electromagnetic wave products, even if they appear to satisfy all appropriate quasilinear criteria. In recent years there have been a sequence of very interesting and important results in this domain, and we argue in favour of continuing efforts on: (i) the development of new transport theories to understand the importance of these, and other, diverse electron responses; (ii) which are informed by statistical analyses of the relationship between burst-and survey-mode spacecraft data. [ABSTRACT FROM AUTHOR]

Objectives To determine long-term (20 year) survival in RA patients enrolled in the Australian Rheumatology Association Database (ARAD). Methods ARAD patients with RA and data linkage consent who were diagnosed from 1995 onwards were included. Death data were obtained through linkage to the Australian National Death Index. Results were compared with age-, gender- and calendar year–matched Australian population mortality rates. Analysis included both the standardized mortality ratio (SMR) and relative survival models. Restricted mean survival time (RMST) at 20 years was calculated as a measure of life lost. Cause-specific SMRs (CS-SMRs) were estimated for International Classification of Diseases, Tenth Revision cause of death classifications. Results A total of 1895 RA patients were included; 74% were female, baseline median age 50 years (interquartile range 41–58), with 204 deaths. There was no increase in mortality over the first 10 years of follow up, but at 20 years the SMR was 1.49 (95% CI 1.30, 1.71) and the relative survival was 94% (95% CI 91, 97). The difference between observed (18.41 years) and expected (18.68 years) RMST was 4 months. Respiratory conditions were an important underlying cause of death in RA, primarily attributable to pneumonia [CS-SMR 5.2 (95% CI 2.3, 10.3)] and interstitial lung disease [CS-SMR 7.6 (95% CI 3.0, 14.7)], however, coronary heart disease [CS-SMR 0.82 (95% CI 0.42, 1.4)] and neoplasms [CS-SMR 1.2 (95% CI 0.89, 1.5)] were not. Conclusion Mortality risk in this RA cohort accrues over time and is moderately increased at 20 years of follow-up. Respiratory diseases may have supplanted cardiovascular diseases as a major contributor to this mortality gap. [ABSTRACT FROM AUTHOR]

Objectives Glucocorticoids (GCs) ('steroids') are used to treat rheumatic diseases but adverse effects are common. We aimed to explore the impact of GC therapy on health-related quality of life (HRQoL), to inform the development of a treatment-specific patient-reported outcome measure (PROM) for use in clinical trials and practice. Methods Semi-structured qualitative interviews were conducted with patients from the UK, USA and Australia, treated for a rheumatic condition with GCs in the last 2 years. Purposive sampling was used to select participants with a range of demographic and disease features. An initial conceptual framework informed interview prompts and cues. Interviews elicited GC-related physical and psychological symptoms and salient aspects of HRQoL in relation to GC therapy. Interview data were analysed inductively to develop initial individual themes and domains. Candidate questionnaire items were developed and refined. Results Sixty semi-structured qualitative interviews were conducted (UK n  = 34, USA n  = 10, Australia n  = 16). The mean age was 58 years; 39/60 were female; and 18 rheumatic diseases were represented. Some 126 individual themes were identified and organized into six domains: physical symptoms; psychological symptoms; psychological impact of steroids; impact of steroids on participation; impact of steroids on relationships; and benefits of steroids. Candidate questionnaire items were tested and refined by piloting with patient research partners, iterative rounds of cognitive interviews and linguistic translatability assessment, informing a draft questionnaire. Conclusion We describe an international qualitative study to develop candidate items for a treatment-specific PROM for patients with rheumatic diseases. A future survey will enable the validation of a final version of the PROM. [ABSTRACT FROM AUTHOR]

Objective People with rheumatic diseases are frequent, long-term attenders of health-care services. Their care experiences are central to improving services. The aim of this study was to explore real-world experiences and priorities of people attending outpatient rheumatology care and those of health-care professionals (HCPs) providing care. Methods This qualitative study consisted of five semi-structured focus groups. Participants included rheumatology outpatients (n  = 16) of two tertiary teaching hospitals and HCPs (n  = 14; rheumatologists, rheumatology trainees, physiotherapists, a specialty nurse and a pharmacist). Participants explored priorities when attending outpatient services, real experiences and aspirations for improving future care. Transcripts were coded using inductive and deductive thematic analysis. Results Seven key themes were identified: smooth flow of technical processes, care coordination, individualized care, information sharing, clinical excellence, patient empowerment and comprehensive care. The findings were aligned conceptually with quality standards in Australia and worldwide. Different sub-themes and prioritization of concerns emerged from patient and HCP subgroups. Highly prioritized themes for patients pertained to processes and technical aspects of care. HCPs focused on themes relating to non-technical aspects of service provision: information sharing, individualization of care, patient advocacy and empowerment. Conclusion This study captured valuable insights into the current experience of outpatient rheumatology care from the perspective of patients and HCPs. It informs a collective understanding of differing and shared priorities, positives of current care and areas requiring change. Themes derived from the study data can be conceptualized in terms of the process, content and impact of care. Such domains can be measured longitudinally by routine implementation of validated patient-reported experience measures in rheumatology. [ABSTRACT FROM AUTHOR]

Objectives To determine COVID-19 vaccine hesitancy rates in inflammatory arthritis patients and identify factors associated with changing vaccine hesitancy over time. Methods This investigation was a prospective cohort study of inflammatory arthritis patients from community and public hospital outpatient rheumatology clinics enrolled in the Australian Rheumatology Association Database (ARAD). Two surveys were conducted, one immediately prior to (pre-pandemic) and another approximately 1 year after the start of the pandemic (follow-up). Coronavirus disease 2019 (COVID-19) vaccine hesitancy was measured at follow-up, and general vaccine hesitancy was inferred pre-pandemic; these were used to identify factors associated with fixed and changing vaccine beliefs, including sources of information and broader beliefs about medication. Results Of the 594 participants who completed both surveys, 74 (12%) were COVID-19 vaccine hesitant. This was associated with pre-pandemic beliefs about medications being harmful (P  < 0.001) and overused (P  = 0.002), with stronger beliefs resulting in vaccine hesitancy persistent over two time points (P  = 0.008, P  = 0.005). For those not vaccine hesitant pre-pandemic, the development of COVID-19 vaccine hesitancy was associated with a lower likelihood of seeking out vaccine information from health-care professionals (P  < 0.001). COVID-19 vaccine hesitancy was not associated with new influenza vaccine hesitancy (P  = 0.138). Conclusion In this study of vaccine beliefs before and during the COVID-19 pandemic, factors associated with COVID-19 vaccine hesitancy in inflammatory arthritis patients varied, depending on vaccine attitudes immediately prior to the start of the pandemic. Fixed beliefs reflected broader views about medications, while fluid beliefs were highly influenced by whether they sought out information from health-care professionals, including rheumatologists. [ABSTRACT FROM AUTHOR]

Objective: To determine vaccination rates, perceptions, and information sources in people with inflammatory arthritis. Methods: Participants enrolled in the Australian Rheumatology Association Database were invited to participate in an online questionnaire, conducted in January 2020, prior to the COVID‐19 pandemic. Included questions were about vaccination history, modified World Health Organization Vaccination Hesitancy Scale, views of the information sources consulted, the Beliefs About Medicines Questionnaire, education, and the Single‐Item Health Literacy Screener. Results: Response rate was 994 of 1498 (66%). The median age of participants was 62 years, with 67% female. Self‐reported adherence was 83% for the influenza vaccine. Participants generally expressed positive vaccination views, particularly regarding safety, efficacy, and access. However, only 43% knew which vaccines were recommended for them. Vaccine hesitancy was primarily attributable to uncertainty and a perceived lack of information about which vaccines were recommended. Participants consulted multiple vaccination information sources (median 3, interquartile range 2‐7). General practitioners (89%) and rheumatologists (76%) were the most frequently used information sources and were most likely to yield positive views. Negative views of vaccination were most often from internet chatrooms, social media, and mainstream media. Factors of younger age, male gender, and having more concerns about the harms and overuse of medicines in general were associated with lower adherence and greater uncertainty about vaccinations, whereas education and self‐reported literacy were not. Conclusion: Participants with inflammatory arthritis generally held positive views about vaccination, although there was considerable uncertainty as to which vaccinations were recommended for them. This study highlights the need for improved consumer information about vaccination recommendations for people with inflammatory arthritis. [ABSTRACT FROM AUTHOR]

Objective: Socioeconomic status (SES) influences disease outcomes in rheumatoid arthritis (RA) patients. Differences in medication use may partly explain this association. A scoping review was used to identify research conducted on this topic and determine what knowledge gaps remain. Methods: Medline, Embase, and PsychInfo were searched from their inception until February 2022 for studies that assessed SES and medication use as an outcome variable. Data was extracted on the use of specific SES measures, medication use, and whether differences in SES variables were associated with differences in medication use. Results: We identified 2,103 studies, of which 81 were selected for inclusion. Included studies originated most frequently from the US (42%); the mean ± SD age of participants was 55.9 ± 6.8 years, and most were female (75%). Studies measured a median of 4 SES variables (interquartile range 3–6), with educational, area‐level SES, and income being the most frequent measurements used. Patients' race and/or ethnicity were documented by 34 studies. Studies primarily assessed the likelihood of prescription of disease‐modifying antirheumatic drugs or dispensation, medication adherence, or treatment delays. A majority of studies documented at least 1 SES measure associated with a difference in medication use. Conclusion: There is some evidence that SES affects use of medications in patients with RA; however, multiple definitions of SES have been utilized, making comparisons between studies difficult. Prospective studies with consistently defined SES will be needed to determine whether differences in medication use accounts for the poorer outcomes experienced by patients of lower SES. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic highlighted the weaknesses of the U.S. national food system, with grocery store shelves emptied in March and April 2020 and COVID outbreaks reported throughout the summer of 2020 at meat processing plants across the country. Fleetingly, Americans turned to local farms to ensure they could access food safely in a time of uncertainty. This paper examines the economies of community that formed around local farms and how direct engagements between consumers and producers in the face of the pandemic deepened these economic structures that often put community well-being above profits. Within a capitalist system that prioritizes efficient mass production, economies of community illustrate that solidarity can improve local food system resilience. Based on qualitative and quantitative research carried out in the summer of 2020 in New London County in southeastern Connecticut, this research draws on ethnographic interviews with small-scale farmers who developed innovative ways to feed some of their community's most vulnerable members. Community economies show that we should not only depend on standardized large-scale farms and giant retail distribution; the American food system needs to continue to cultivate smallscale local production in order to improve resilience and food access. At present, the sustainability of producing and distributing food occurs at the farmer's expense. The government needs to support local food producers so they can continue to play an integral part in community well-being. [ABSTRACT FROM AUTHOR]

Objectives To investigate the knowledge and beliefs of Australian patients with inflammatory arthritis regarding biologic/targeted synthetic DMARDs (b/tsDMARDs) and biosimilars and their sources of information. Methods Participants enrolled in the Australian Rheumatology Association Database (ARAD) with RA, PsA and axial SpA were sent an online survey. They were asked about information sources for b/tsDMARDs and how positive or negative this information was. The Beliefs about Medicine Questionnaire (BMQ) was used to measure beliefs about b/tsDMARDs with scores ranging from 1 (strongly disagree) to 5 (strongly agree). Participants were asked about their knowledge of biosimilars and willingness to switch to biosimilar. Results There was a response rate of 66% (994/1498; 67% female, median age 62 years). Participants currently taking b/tsDMARDs (n  = 794) had a high b/tsDMARD-specific BMQ 'necessity' score {median 4.2 [interquartile range (IQR) 3.6–4.8]}, with a lower specific 'concerns' score [median 2.4 (IQR 2.0– 3.0)]. Participants consulted multiple information sources [median 3 (IQR 2–5)]. Positive sources were rheumatologists and educational websites and negative were chat rooms and social media. Only 18% were familiar with biosimilars, with half knowing of availability in Australia. Following a short paragraph describing biosimilars, 75% (744) of participants indicated they would consider switching if recommended by their rheumatologist, with nearly half identifying safety and efficacy of biosimilars as an important concern. Conclusion Australian patients have positive attitudes towards b/tsDMARDs overall, although little knowledge of biosimilars specifically. They have a high degree of trust in their rheumatologist regarding treatment decisions, even if they are unfamiliar with the medication recommended. [ABSTRACT FROM AUTHOR]

Objectives There is a growing acceptance of the need for routine implementation of patient-reported experience measures (PREMs) in health care. Rheumatology patients, as frequent and long-term users of care, stand to benefit from collection of experience-related data. The aim of this study was to perform a systematic review to identify and critically appraise the development and psychometric validation of PREMs in rheumatology. Methods Six databases were searched systematically from inception to 14 December 2020: MEDLINE, EMBASE, PsycINFO, SCOPUS, Cochrane and Google Scholar. We included articles in English that described the use or development of PREMs, with results of psychometric testing, in an adult outpatient rheumatology context. This study is registered with PROSPERO (CRD42021233819). Articles were appraised using the COnsensus Based Standards for the selection of health status Measurement Instruments (COSMIN) (i) Risk of Bias checklist and (ii) criteria for good measurement properties. Results The search yielded 3809 publications, and six studies met inclusion criteria. All the included studies on PREM development fulfilled COSMIN standards for 'doubtful' or 'inadequate' quality of instrument development. One study fulfilled a 'sufficient' rating for content validity, and the remainder fulfilled 'inconsistent' ratings. During validity testing, studies fulfilled between one and four of the eight COSMIN checklist criteria for good measurement properties. Conclusion Methodological concerns regarding instrument development and validation limit the generalizability of the existing six validated PREMs in use in rheumatology contexts. There is a need for further well-designed studies to validate existing and new PREMs in this area. [ABSTRACT FROM AUTHOR]

Community restrictions due to COVID‐19 have changed healthcare, including increased telehealth use. During the early pandemic phase, a cohort of Australian patients with inflammatory arthritis was surveyed. Self‐reported access to healthcare was maintained and physical health was more likely to be self‐rated poorly than mental health. There was a high level of support for telehealth during and after the pandemic. [ABSTRACT FROM AUTHOR]

Objective: Prednisolone is an effective oral glucocorticoid for managing symptoms of rheumatoid arthritis (RA) but has predictable and common adverse effects. We explored patient perspectives of prednisolone use in RA. Methods: Patients with RA registered with the Australian Rheumatology Association Database (ARAD) who had completed an ARAD questionnaire in the preceding 12 months were invited to participate in an online survey. Responses were linked to already collected respondent demographics, medication use, and patient‐reported outcome measures. The Beliefs about Medicine Questionnaire (BMQ) measured patient beliefs on medication necessity and concerns. Free‐text responses outlining reasons for stopping or declining prednisolone underwent thematic analysis using NVivo 12. Results: The survey response rate was 79.6% (804/1010), including 251 (31.2%) reporting current prednisolone use and 432 (53.7%) reporting previous use. Compared with previous users, current users were older (P = 0.0002) and had worse self‐reported pain, disease activity, health‐related quality of life, and function (all P < 0.001). Current users had higher BMQ scores for prednisolone‐specific necessity (3.6 versus 1.7; P <0.001) and concerns (2.7 versus 2.3; P <0.001). In previous prednisolone users (n = 432), the most frequent themes identified in free‐text responses for cessation were adequate disease control (30.3%), adverse effects (25.2%), and predetermined short courses (21.3%). Of respondents citing adverse effects for cessation (n = 131), weight gain (27.5%), osteoporosis (14.7%), and neuropsychiatric issues (13.8%) were most frequent. Conclusions: In our cohort, patients with RA taking prednisolone believed it was necessary yet remained concerned about its use. Adequate disease control and adverse effects were important considerations for patients using prednisolone. [ABSTRACT FROM AUTHOR]

Background: Peri-implantitis treatments are mainly based on protocols for teeth but have not shown favorable outcomes for implants. The potential role of titanium dissolution products in peri-implantitis necessitate the consideration of material properties in devising treatment protocols. We assessed implant cleaning interventions on (1) bacterial removal from Ti-bound biofilms, (2) Ti surface alterations and related Ti particle dissolution, and (3) cytocompatibility.Methods: Acid-etched Ti discs were inoculated with human peri-implant plaque biofilms and mechanical antimicrobial interventions were applied on the Ti-bound biofilms for 30 seconds each: (1) rotary nylon brush; (2) Ti brush; (3) water-jet on high and (4) low, and compared to sterile, untreated and Chlorhexidine-treated controls. We assessed colony forming units (CFU) counts, biofilm removal, surface changes via scanning electron microscopy (SEM) and atomic force microscopy (AFM), and Ti dissolution via light microscopy and Inductively-coupled Mass Spectrometry (ICP-MS). Biological effects of Ti particles and surfaces changes were assessed using NIH/3T3 fibroblasts and MG-63 osteoblastic cell lines, respectively.Results: Sequencing revealed that the human biofilm model supported a diverse biofilm including known peri-implant pathogens. WJ and Nylon brush were most effective in reducing CFU counts (P < 0.01 versus control), whereas Chlorhexidine was least effective; biofilm imaging results were confirmatory. Ti brushes led to visible streaks on the treated surfaces, reduced corrosion resistance and increased Ti dissolution over 30 days of material aging as compared to controls, which increase was amplified in the presence of bacteria (all P-val < 0.05). Ti particles exerted cytotoxic effects against fibroblasts, whereas surfaces altered by Ti brushes exhibited reduced osteoconductivity versus controls (P < 0.05).Conclusions: Present findings support that mechanical treatment strategies selected for implant biofilm removal may lead to Ti dissolution. Ti dissolution should become an important consideration in the clinical selection of peri-implantitis treatments and a necessary criterion for the regulatory approval of instruments for implant hygiene. [ABSTRACT FROM AUTHOR]

Background: Current guidelines recommend methotrexate (MTX) as a glucocorticoid‐sparing agent in patients with polymyalgia rheumatica (PMR) who relapse or suffer glucocorticoid adverse effects, although there is no level 1 evidence to support this recommendation. Aims: To review the effect of MTX in PMR on inflammation and glucocorticoid dose. Methods: Patients with PMR from rheumatology outpatient clinics at two tertiary centres were identified. A structured case note review was conducted for patient characteristics at diagnosis and medications including glucocorticoid and MTX use. Results: There were 70 patients, 61% female; mean (range) age of 70 (51–87) years. At the time of diagnosis, median (±interquartile range) erythrocyte sedimentation rate (ESR) was 38.5 (26–74) mm/h and C‐reactive protein (CRP) 34.5 (6–74 mg/L) with median initiating prednisolone dose of 15 mg (range 5–60 mg). MTX was prescribed in 22 (31%) patients. Mean disease duration at MTX initiation was 2.5 years (1–7 years), with median (range) MTX dose of 10 mg (5–20 mg). At MTX initiation, median (interquartile range) (±standard deviation) ESR was 33 (13–60 mm/h) and CRP 19 (8–42 mg/L). Reasons for commencing MTX were disease relapse (34%) or inability to wean prednisolone dose (66%). Six months after MTX initiation, there was significant reduction in ESR (P = 0.012), CRP (P = 0.0003) and prednisolone dose (P < 0.0001). Eleven (50%) patients stopped MTX, five due to controlled PMR, and six due to adverse effects. Conclusions: In this study of PMR patients in tertiary care, 31% were co‐prescribed MTX, after prolonged disease duration. MTX was associated with improved inflammatory activity and reduced prednisolone dose, with a relatively high risk of adverse events. [ABSTRACT FROM AUTHOR]

Objective: This paper investigates the experiences of women using a social media Facebook group for breastfeeding support and attempts to explore whether it has aided in extended breastfeeding success. In addition, it aims to explore the value of social cognitive theory (SCT) in explaining these experiences.Design: Exploratory, deductive approach.Methods: Qualitative, audio-recorded, semi-structured interviews were conducted from eight women who were members of a private Facebook group'. Data were analysed using theoretical thematic analysis, and SCT was used as a theoretical lens through which the data were interrogated.Results: A number of themes were identified from the women's experiences, with analysis uncovering the superordinate theme 'increased self-efficacy' which provided an understanding of how the group impacted women's experiences and aided them in breastfeeding success. The sub-themes of education, accessibility, online community, normalization, and extended goals provided a more detailed understanding of how self-efficacy was increased through group membership.Conclusion: The symbiotic relationship between members of a social media group facilitates greater breastfeeding success and a longer duration of breastfeeding through the central concept of the SCT: reciprocal determinism. Therefore, it is posited that the SCT is a suitable theory of behaviour change which can potentially be used to develop interventions aiming to increase breastfeeding rates and duration. [ABSTRACT FROM AUTHOR]

Objective: To understand the effects of glucocorticoids (GC), which are of importance to patients.Methods: The results of 2 literature reviews, a patient survey, and a qualitative study were presented.Results: No validated instrument exists to evaluate GC effect on patients. Survey data revealed skin thinning/bruising, sleep disturbance, and weight gain as the most frequent adverse effects. The qualitative research yielded rich data covering rapid benefits and physical and emotional consequences of GC.Conclusion: It was agreed that a patient-reported outcome to measure GC effect was required and a research agenda was developed for this goal. [ABSTRACT FROM AUTHOR]

Objective: To describe the experience of the first OMERACT Emerging Leaders Program (ELP).Methods: A Delphi process identified positive aspects, areas for improvement, and future directions. Core items were defined as essential if they received ≥ 70% ratings.Results: Participants valued relatable/accessible mentors (100%), including an OMERACT Executive mentor (100%), and a support network of peers (90%). Key items for future development were funding support (100%) and developing knowledge about OMERACT processes (90%) and politics (80%).Conclusion: The ELP has the potential to provide targeted training for early career researchers to develop relevant skills for future leadership roles within OMERACT. [ABSTRACT FROM AUTHOR]

Objective: Glucocorticoids (GCs) are often used to treat Rheumatoid Arthritis (RA) despite their many side effects and the availability of other effective therapies. Cataract and glaucoma are known side effects of GCs but the risk of them developing in the setting of GC use for RA is unknown. The aim was to perform a systematic review and meta-analysis to determine the association between GCs and the risk of developing cataract and/or glaucoma in RA. Methods: A systematic search was carried out using MEDLINE, EMBASE, and Web of Science. All RCTs comparing GC use to non-use in RA populations were sought. Observational studies reporting cataract and/or glaucoma amongst GC users and non-users were also included. Data extracted included incidence/prevalence of cataract and/or glaucoma in each arm, dose and duration of therapy. Two independent reviewers performed quality assessment. Results: 28 RCTs met eligibility criteria, however only 3 reported cataracts and glaucoma, suggesting significant under-reporting. An association between GC use and the development of cataracts in RA patients was seen in observational studies but not RCTs. There was no statistically significant association between GC use and the development of glaucoma, although data were sparse. There were insufficient data to determine the impact of dose and duration of therapy. Conclusion: The current literature suggests a possible association between GC use and the development of cataract. However, this risk cannot be accurately quantified in RA from the available evidence. RCTs have not adequately captured these outcomes and well-designed observational research is required. [ABSTRACT FROM AUTHOR]

In the article, the authors discuss their programs to help maintain a healthy work environment and reduce compassion fatigue among staff of their 30-bed pediatric intensive care unit (PICU), particularly the PICU Family Day. Other topics include the support of the hospital's executive leadership team to the program, and the effectiveness of the initiative as a support structure to staff.

This article reviews the literature pertaining to the changing value of the child in England since the 19th century, highlighting the relative policy neglect of contemporary sick and dying children. The review discusses the relationship between the value of the child, social constructions of childhood and social policy. The review demonstrates how the value of the child has altered from one of utility to a contemporary position of sacralisation, illustrated by mortality statistics as a measure of associated policy impact. However, large reductions in mortality rates conceal the more complex picture of contemporary child health. Children die each year from life-limiting and life-threatening disorders. Moreover, technological developments increasingly allow children to live longer with such conditions, albeit with ever more complex ill health. Such children are therefore dying over protracted periods of time. However, they are largely absent from policy, which tends towards standardised outcome measures which may not reflect the needs of this minority group. Therefore, although contemporary constructions of childhood focus upon sacralisation, reflecting psychological value to parents and society, the most vulnerable child members of society remain neglected in policy and service provision. [ABSTRACT FROM AUTHOR]

Aim The exact diagnostic role of temporal artery ultrasound ( TAU) remains unclear. The aim of this study was to determine the sensitivity and specificity of a positive halo sign in patients undergoing TAU in a clinical setting, and to perform a review of existing evidence. Method Patients who had undergone TAU at a single centre in Australia were included in the study. The presence or absence of a halo sign and whether it was unilateral or bilateral was determined retrospectively from radiology reports. Pathology results were used to determine which patients underwent a temporal artery biopsy and if the biopsy was positive or negative. A case note review was performed to determine presenting clinical features and if a clinical diagnosis of giant cell arteritis was made. The sensitivity, specificity and likelihood ratios of TAU compared to both biopsy and clinical diagnosis were calculated. Results Fifty patients were identified as having had a TAU (28% male, mean age 69). When compared to biopsy-proven cases, the sensitivity of a halo sign was 40%, specificity 81%, positive likelihood ratio 2.1 and negative likelihood ratio 0.7. When compared to clinical diagnosis, the sensitivity was 42%, specificity 94%, positive likelihood ratio 7.1 and negative likelihood 0.6. Conclusions Sensitivity and specificity results were comparable to the literature. A halo sign may preclude the need for biopsy in cases of high clinical suspicion and contraindications to surgery. Biopsy remains necessary in most cases, irrespective of whether a halo sign is present. [ABSTRACT FROM AUTHOR]

Objective. To determine the relationship between FCGR3B gene copy number variation (CNV) and biopsy proven giant cell arteritis (GCA). Methods. FCGR3B CNV was determined in 139 Australian biopsy proven GCA patients and 162 population matched controls, using a duplex qPCR assay and RNase P as the reference gene. Copy number was determined using Copy Caller software (v.1.0, Applied Biosystems, USA). CNV genotypes were classified into 3 groups (<2, 2, 3+) for analysis purposes, and analysis was performed using logistic regression. Results. All GCA patients had a positive temporal artery biopsy, and the most common presenting symptoms were visual disturbance and temporal headache. The mean age of patients at biopsy was 74 years (range 51.94) and 88/139 (63%) were female. The frequency of low (<2) FCGR3B copy number was comparable between GCA patients (9/139 = 6.5%) and controls (10/162 = 6.2%), as was the frequency of high (3+) FCGR3B copy number (15/130 (10.8%) in GCA patients versus 13/162 (8.0%) in controls). Overall there was no evidence that FCGR3B CNV frequencies differed between GCA patients and controls (χ² = 0.75, df = 2, P = 0.69). Conclusion. FCGR3B CNV is not associated with GCA; however, replicate studies are required. [ABSTRACT FROM AUTHOR]

Introduction: Despite clinical advances in neonatal and paediatric palliative care, there is limited educational provision to underpin practice. To develop appropriate educational content, the needs of staff working in this area must be identified. Aim: To explore the educational needs of staff working with families with palliative or end-of-life care requirements. Methods: A training needs analysis (TNA) explored the perceived knowledge, confidence, and support of neonatal and paediatric health professionals in a tertiary children's hospital in London. Results: An online Likert scale TNA was completed by 111 participants. The results indicated that the staff did not feel educationally prepared in their working areas, despite having regular contact with families with palliative or end-of-life care issues. Discussion: Understanding the educational needs of staff can underpin the development of appropriate educational interventions. These modules require evaluation to determine their impact on health professionals' knowledge and confidence. [ABSTRACT FROM AUTHOR]

Introduction: Despite clinical advances in neonatal and paediatric palliative care, there is limited educational provision to underpin practice. To develop appropriate educational content, the needs of staff working in this area must be identified. Aim: To explore the educational needs of staff working with families with palliative or end-of-life care requirements. Methods: A training needs analysis (TNA) explored the perceived knowledge, confidence, and support of neonatal and paediatric health professionals in a tertiary children's hospital in London. Results: An online Likert scale TNA was completed by 111 participants. The results indicated that the staff did not feel educationally prepared in their working areas, despite having regular contact with families with palliative or end-of-life care issues. Discussion: Understanding the educational needs of staff can underpin the development of appropriate educational interventions. These modules require evaluation to determine their impact on health professionals' knowledge and confidence. [ABSTRACT FROM AUTHOR]

Behçet's disease (BD) is an immune-mediated systemic vasculitis associated with HLAB51. Other gene associations are likely and may provide further insight into the pathogenesis of this disease. Fc-gamma receptors play an important role in regulating immune function. Copy number variation (CNV) of the Fc-gamma receptor 3B (FCGR3B) gene is associated with other inflammatory conditions and may also play a role in BD. The aim of this study was to determine whether CNV of the FCGR3B gene is associated with BD or its clinical features. FCGR3B copy number was determined for 187 Iranian patients and 178 ethnicity-matched controls using quantitative real-time PCR. The genotype frequencies were comparable in both BD patients and controls. The odds ratio for low copy number (<2CN) was 0.6 (P = 0.16) and the odds ratio for high copy number (>2CN) was 0.75 (P = 0.50). There was no association found between high or low CN of the FCGR3B gene and BD or its clinical features in this Iranian population. We are the first to report this finding which, when looked at in the context of other genetic studies, gives us further insight into the complex pathogenesis of BD. [ABSTRACT FROM AUTHOR]

New and effective treatment for acute kidney injury remains a challenge. Here, we induced mouse hematopoietic stem and progenitor cells (HSPC) to differentiate into cells that partially resemble a renal cell phenotype and tested their therapeutic potential. We sequentially treated HSPC with a combination of protein factors for 1 wk to generate a large number of cells that expressed renal developmentally regulated genes and protein. Cell fate conversion was associated with increased histone acetylation on promoters of renal-related genes. Further treatment of the cells with a histone deacetylase inhibitor improved the efficiency of cell conversion by sixfold. Treated cells formed tubular structures in three-dimensional cultures and were integrated into tubules of embryonic kidney organ cultures. When injected under the renal capsule, they integrated into renal tubules of postischemic kidneys and expressed the epithelial marker E-cadherin. No teratoma formation was detected 2 and 6 mo after cell injection, supporting the safety of using these cells. Furthermore, intravenous injection of the cells into mice with renal ischemic injury improved kidney function and morphology by increasing endogenous renal repair and decreasing tubular cell death. The cells produced biologically effective concentrations of renotrophic factors including VEGF, IGF-1, and HGF to stimulate epithelial proliferation and tubular repair. Our study indicates that hematopoietic stem and progenitor cells can be converted to a large number of renal-like cells within a short period for potential treatment of acute kidney injury. [ABSTRACT FROM AUTHOR]

Over recent years there have been several political imperatives in the UK directed toward children's palliative care and ensuring that services are high-quality, coordinated, family-centred, and able to meet the needs of children with complex disabilities. In addition, in 2010 the health and social care regulation authority in England-the Care Quality Commission (CQC)-aligned hospices with regulation and inspection requirements. This context has acted as a driver for the creation of effective education and training to ensure a skilled and expert workforce. Against this backdrop, this paper describes a project to develop a learning and development strategy for Children's Hospices across London (CHaL). CHaL educators worked with a research team to develop a unified strategy that was based on evidence of good practice, embedded in required CQC outcomes, and validated with a wider audience. The resultant strategy contains a set of four key learning and development principles that are applicable and transferable across different hospices. [ABSTRACT FROM AUTHOR]

Over recent years there have been several political imperatives in the UK directed toward children's palliative care and ensuring that services are high-quality, coordinated, family-centred, and able to meet the needs of children with complex disabilities. In addition, in 2010 the health and social care regulation authority in England-the Care Quality Commission (CQC)-aligned hospices with regulation and inspection requirements. This context has acted as a driver for the creation of effective education and training to ensure a skilled and expert workforce. Against this backdrop, this paper describes a project to develop a learning and development strategy for Children's Hospices across London (CHaL). CHaL educators worked with a research team to develop a unified strategy that was based on evidence of good practice, embedded in required CQC outcomes, and validated with a wider audience. The resultant strategy contains a set of four key learning and development principles that are applicable and transferable across different hospices. [ABSTRACT FROM AUTHOR]

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Aim : To develop a model of why people seek professional treatment for drinking problems, grounded in what clients say about the process at treatment entry. Participants : Three sets of consecutive entrants to the UK Alcohol Treatment Trial, sets commencing at intervals during trial recruitment (total n = 98). Location : Statutory and non‐statutory alcohol problem treatment agencies in three areas of England and Wales. Data : Open‐ended interviews according to a brief interview guide, leading to 400–800‐word post‐interview reports used for analysis (tape recordings used for auditing the interview and analysis process). Analysis : Reports analysed by a team according to grounded theory principles, involving an iterative process with successive refinement of interviewing and analysis with each successive set of data. Findings : A model of professional treatment entry was developed, refined and “tested” with the last set of data. The process of seeking professional treatment was depicted in the model as involving a realization of worsening, accumulating and multiple problems related to drinking, especially in health and family domains; in conjunction with, in most cases (but not all), a trigger event and/or family or professional influence; combined with rejection of the possibility of unaided change or non‐professional help; leading to the seeking or accepting of professional help. Conclusions : The findings support conclusions already in the literature about the process of seeking professional help for a drinking problem, but provide further refinement of existing ideas: for example regarding the accumulation of drinking‐related problems, the ways in which a realization of those problems combines with triggers or pressure, and the complex role of the family and primary care professionals in assisting motivation to seek treatment. [ABSTRACT FROM AUTHOR]

Aim To develop a model of change during and following professional treatment for drinking problems, grounded in clients’ accounts. Participants Subsets of consecutively selected clients of the UK Alcohol Treatment Trial (UKATT), followed-up at 3 months ( n = 211) and 12 months ( n = 198) after randomization. Location Five statutory and non-statutory alcohol problems treatment agencies in three areas of England and Wales. Data Open-ended interviews conducted according to a brief interview guide, leading to 400–800-word post-interview reports used for analysis (tape-recordings used for auditing purposes). Analysis Reports analysed by a team according to grounded theory principles, involving an iterative process with successive refinement of interviewing and analysis with each successive batch of data. Findings A model of change from the clients’ perspective was developed. Treatment was seen by clients as facilitating various changes in ways of thinking and/or increased support of various kinds from family and friends, along with new ways of acting in relation to drinking or more generally. For many those changes had led to an appreciation of the benefits accruing to them. Treatment was seen as part of a broader treatment system which included pretreatment assessment, forms of help additional to the trial treatment, plus an element of self-directed change during and following treatment. Taken with awareness of worsening alcohol-related harms, triggering events and external influence to seek treatment (the catalyst system), to which clients continued to refer following treatment, the change process is depicted as a complex, ongoing set of systems in which a trial treatment is embedded. Conclusions Models of change should be broadened so that treatment is seen as a complex system of parts, facilitating a nexus of cognitive, social and behavioural changes, embedded within a broader system of events and processes catalysing change. Such a model helps explain the relative absence of between-treatments outcome differences in UKATT and in the alcohol problems treatment and more general psychotherapy research literatures. [ABSTRACT FROM AUTHOR]