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Failure is seen as a problem in education. From failing schools, to failing students to rankings of universities, literacy or numeracy, the perception that one has failed to compete or to compare favourably with others has led to a series of policy initiatives internationally designed to ensure ‘success for all’. But when success is measured in comparison with others or against benchmarks or standards, then it is impossible to see how all could be successful given the parameters laid down. What are the implications of a culture that values success and achievement? How difficult is it to become the kind of individual who is flourishing, autonomous and becomes ‘all she can be’, in particular under the precarious conditions of contemporary capitalism? Samuel Beckett was sceptical of the quest for progress, production and prestige. His philosophy invites another way of thinking about failure, not as something one is, but rather as something one does: the pain and fear of inadequacy that can mark educational relations and experiences is alleviated by a more renunciative, gentle philosophy of education. There are two interwoven strands in this article. One questions the emphasis on competition and achievement in contemporary education and explores its implications for our relationship to failure. The second, strongly influenced by Beckett, explores ways of reimagining our relationship to failure in such a way that allows us to reflect on what matters in life.

Post-exertional symptom exacerbation (PESE) is a characteristic symptom of post-COVID syndrome (PCS). This prospective study investigated the effect of a 6-week structured World Health Organization (WHO) Borg CR-10 5-phase pacing protocol on PESE episodes and quality of life in a cohort of individuals with long-standing PCS (average duration of symptoms was 17 months). Participants received weekly telephone calls with a clinician to complete the Leeds PESE questionnaire (LPQ) and identify the appropriate phase of the pacing protocol. EQ-5D 5L was completed at the intervention's beginning and end to measure overall health. Thirty-one participants completed the 6-week protocol, with a statistically and clinically significant reduction in the average number of PESE episodes (from 3.4 episodes in Week 1 to 1.1 in Week 6), with an average decrease of 16% (95% CI: 9%−24%; p < 0.001) each week, and reduction across all three exertional triggers (physical, cognitive, and emotional). Physical activity levels showed moderate improvements during the intervention period. Mean EQ-5D 5L scores improved from 51.4 to 60.6 points (paired difference of 9.2 points, 95% CI: 3.2−15.2 points; p = 0.004). A structured pacing protocol significantly reduces PESE episodes and improves overall health in PCS.

The slow response of volume housebuilders to changes in demand has been cited as a contributing cause of a global crisis of housing affordability and allegations of land banking have persistently dogged the industry. This article reviews the supply responsiveness of speculative housebuilders in the United Kingdom and Australia through the neglected Marxian analytic category of absolute rent. Absolute rent directs attention to the relationship between the value of land and the cost of housing and models a market in which landowners may withdraw land from supply to inflate prices. Through the lens of absolute rent, the real estate practices of the housebuilding industry can be understood as a strategy of artificial scarcity straddling land and housing markets. The findings of this investigation demonstrate the insights to be gained by a return to absolute rent that will valuably expand the current debate on the supply and cost of housing.

Background: Depression and obesity are two of the most highly prevalent global public health concerns. Obesity and poor mental health are strongly associated, and it is likely that mental health needs are common in people seeking weight management services. Aims: To identify what psychological support is provided and required in tier 2 adult weight management services (T2 WMS). Methods: Online survey: quantitative data was summarised, and open-ended free-text questions were coded and thematically analysed. Results: Participants were current or recent service users with self-reported mental health needs (n = 27), commissioners (n = 9) or providers (n = 17). Over half of service users did not feel their mental health needs were met and 60% said they would like additional psychological support within T2 WMS. Findings highlight the lack of psychological and emotional support. Psychological support and behaviour change techniques are conflated, with a lack of clear understanding or definition of what psychological support is, either between or within service users, providers, and commissioners. Conclusions: Moving towards more person-centred care, better identification and triaging of those living with mental health issues, together with improved resources and training of providers, is crucial to improve outcomes for people living with obesity and poor mental health.

AIM: People living with ulcerative colitis (UC) have two broad treatment avenues, namely medical or surgical therapy. The choice between these can depend on patient preference as well as the receipt of relevant information. The aim of this study was to define the informational needs of patients with UC. METHOD: A postal survey was designed to capture respondent demographics, treatment experienced within the previous 12 months and informational preferences by rating a long list of items. It was delivered through two hospitals that provide tertiary inflammatory bowel disease services. Descriptive analyses were performed to describe demographics and experiences. Principal component analysis was carried out using a varimax rotation to investigate informational needs. RESULTS: A total of 101 responses were returned (20.1% response rate). The median age of respondents was 45 years and the median time since diagnosis was 10 years. Control preferences skewed towards shared (42.6%) or patient-led but clinician-informed (35.6%). Decision regret was low for the population (median 12.5/100, range 0-100). Key informational needs related to medical therapy were benefits and risks of long-term therapy, burden of hospital attendance, reproductive health, need for steroid treatment and impact on personal life. For surgery, these were stoma information, effect on daily life, effect on sexual and reproductive health, risks and benefits and disruption of life due to surgery. CONCLUSION: This study has identified key areas for discussion when counselling patients about treatment decisions around medical therapy and surgery for UC.

Despite much interest in healthy, sustainable cities, currently they are often on the margins of urban planning and design, not the centre. Part of the reason for this is technical. Many planners are interested in designing healthier cities but wonder how to link their objectives with actions. This study develops 99 indicators for a healthy city. The basis for the development of indicators was the 11 objectives of a healthy city according to the World Health Organisation. Application of these indicators helps push healthy city objectives to the centre of urban planning and design in two ways: (I) the indicators can show gap with each objective; and (II) monitoring the indicators over time can show the performance of solutions for each objective. It is possible to explore synergies and trade-offs between the 11 objectives of healthy cities by examining the relationships between their 99 indicators. Trade-offs between healthy city objectives in some contexts might require local adjustment of these objectives. This, in turn, would require adjustment of their indicators. Thus, the set of 99 indicators can be used as a starting point in an iterative process of adapting healthy city objectives and indicators to local circumstances.

At both UK and global level, dietary consumption patterns need to change to address environmental, health and inequality challenges. Despite considerable policy interventions, the prevalence of overweight and obesity in the United Kingdom has continued to rise with obesity now a leading cause of mortality and morbidity. Obesity prevalence is greater among those on lower incomes and the current UK food system, including government policy, does not effectively address this. Current behavioural approaches, without the support of structural changes in the system, may even widen the inequalities gap. Hence, using behavioural insights from those living with obesity and food insecurity, the project will explore potential avenues that can be applied in the food system to promote healthier choices in the food retail environment. The National Food Strategy report recommends that the UK food system should ensure "safe, healthy, affordable food; regardless of where people live or how much they earn". However, the association between food insecurity and the development of obesity is not well understood in relation to purchasing behaviours in the UK retail food environment, nor is the potential effectiveness of interventions that seek to prevent and reduce the impact of diet-induced health harms. The FIO Food (Food insecurity in people living with obesity - improving sustainable and healthier food choices in the retail food environment) project provides a novel and multi-disciplinary collaborative approach with co-development at the heart to address these challenges. Using four interlinked work packages, the FIO Food project will combine our knowledge of large-scale population data with an understanding of lived experiences of food shopping for people living with obesity and food insecurity, to develop solutions to support more sustainable and healthier food choices in the UK retail food environment.

This qualitative case study explores the Human Resource Development (HRD) interventions utilised in respect of local eco-skills with one marginalised group, the Roma, in the City of Liverpool, UK, and responds to HRD research calls into the cause of cycles of inequality. The case study illustrates the challenges experienced by precarious workers in accessing education and training. Further, it shares the interventions taken to address inequalities that a Higher Education (HE) UK University and a local Non-Government Organisation (NGO) took between 2016 and 2019. Roma is among the UK and Europe's most disadvantaged and marginalised groups. Working in partnership, utilising Community-Based Participatory Research (CBPR), we developed three HRD interventions: Stakeholder groups (adult and young Roma), Motivational Interviewing and Employability/Education Events. The findings unpack an understudied experience and context: the inadequate attention paid to developing skills at a local level for marginalised precarious workers. We found that aspiration grew through focused community support and a partnership approach, and educational opportunities emerged, albeit at a relatively slow pace. This paper ends with a call for action for more Human Resource Development educators to work with those at the margins of society.

Background Androgenetic alopecia (AGA) practitioner care may be hampered by commercial biases and hair loss' omission from most medical curricula. Aim and Method Between November 2020 and September 2021, 34 AGA professionals (86% British; 62% trichologists), participated in a pilot, mixed-methods, survey. Practitioner views on: 1a–1j) AGA's commercial influences (e.g., participants were quantitatively assessed on their understanding of a popular, commercially-funded, AGA study) and 2a–2h) constraints on evidenced-based AGA responding (e.g., ethical dilemmas) were assessed. Quantitative responses are reported descriptively whilst qualitative responses are categorized alongside illustrative quotes. Results On average, (1a–1d) 42% of participants were misled by the popular AGA study and (1e) participants underestimated the extent of commercial biases in AGA research as 25%; (2a–2e). Participants also indicated that AGA treatment limitations and misinformation ethically challenged them (e.g., “[It's difficult to know when] to treat or not without being able to confirm the outcome”). (2c) Most (77%) indicated society played a powerful role in exacerbating AGA distress (e.g., “Society is hyper critical of appearance”) and 30% indicated greater “treatment” accessibility was needed: (e.g., “hair loss product [should] give clear indication of what the active ingredients are and how effective they are”). Conclusions Despite the limited sample size, these finding cohere with previous identified challenges of the AGA practitioner role. Evidence based guidance and research scrutiny tools would help practitioners overcome such challenges.

Background: multiple sclerosis (MS) is associated with reduced bone and muscle strength and function. We aimed to investigate the effectiveness of a 24-week intervention in a 57-year-old frail female with MS. Methods: the participant completed a 2x/week exercise intervention and ingested 2x/day a supplement containing 7.5 g essential amino acids and 500IU cholecalciferol. Body composition, 6-m gait speed (GS), handgrip strength (HGS), 30-sec arm-curl test (30ACT), 6-min walking test (6MWT), 30-sec chair-stand test (30CST), and plasma concentrations of 25-hydroxyvitamin D3 [25(OH)D3], insulin-like growth factor 1 (IGF-1), and amino acids were assessed at baseline, and at weeks 12 and 24. Results: plasma 25(OH)D3 increased from 23.2 to 41.3ng/mL and IGF-1 from 131.6 to 140.7ng/mL from baseline to post-intervention. BMI, total lean tissue mass (LTM), fat mass, bone mineral content, and the sum of 17 amino acids increased by 3.8, 1.0, 3.5, 0.2, and 19% respectively at week 24. There were clinically significant increases in regional LTM (6.9% arms and 6.3% legs) and large increases in GS (67.3%), dominant HGS (31.5%), non-dominant HGS (11.8%), dominant 30ACT (100%), non-dominant 30ACT (116.7%), 6MWT (125.6%), and 30CST (44.4%). Conclusions: the current intervention was effective in improving components of physical fitness and body composition in a female with MS.

The centennial response of land-terminating glaciers in Greenland to climate change is largely unknown. Yet, such information is important to understand ongoing changes and for projecting the future evolution of Arctic subpolar glaciers, meltwater runoff, and sediment fluxes. This paper analyses the topography, geomorphology, and sedimentology of prominent moraine ridges and the proglacial areas of ice cap outlet glaciers on the Qaanaaq peninsula (Piulip Nunaa). We determine geometric changes of glaciers since the neoglacial maximum; the Little Ice Age (LIA), and we compare glacier behaviour during the LIA with that of the present day. There has been very little change in the rate of volume loss of each outlet glacier since the LIA compared with the rate between 2000 and 2019. However, the percentage of each glacier that is likely composed of cold-based ice has increased since the LIA, typically by 20%. The LIA moraines comprise subrounded, striated, and faceted clasts that evidence subglacial transport, and outwash plains, flutes, kames, and eskers that evidence subglacial motion and meltwater within temperate ice. Contrastingly, contemporary ice margins and their convex ice surfaces comprise pronounced primary foliation, ephemeral supraglacial drainage, sediment drapes from thrust plane fractures, and an absence of open crevasses and moulins. These calculations and observations together lead us to interpret that these outlet glaciers have transitioned towards an increasingly cold-based thermal regime despite a warming regional climate. Thermal regime transitions control glacier dynamics and therefore should be incorporated into glacier evolution models, especially where polythermal glaciers prevail and where climate is changing rapidly.

Background Observational tools can support understanding of the complex needs of older people with dementia and aid delivery of person-centred care. However, existing tools are complex and resource intensive to use. Aim To develop and evaluate the acceptability and feasibility of a low-resource, observational tool to support staff reflection and practice development. Method Intervention development of the Person-Centred Observation and Reflection Tool (PORT) and acceptability and feasibility study, using surveys and focus groups in the UK, Norway and Spain. Findings PORT was reported as easy, accessible and acceptable to use. Observation was identified as powerful for individual staff development and provided an evidence-based source for underpinning individualised care planning. Potential time challenges associated with implementation were identified. Conclusion Initial evaluation indicates PORT is an acceptable and feasible tool for use in health and social care settings for older people. Further research is needed on implementation models and impacts of use.

In the UK, one consequence of neoliberalism has been the development of test cultures in schools and standardised assessment strategies used to judge all pupils against within and across curriculum subjects. Few studies to date have explored the influence of this on assessing the learning of pupils with special educational needs and disabilities (SEND), and none have centred physical education (PE). This study used the concept of ableism and semi-structured interviews to explore mainstream secondary school PE teachers’ views and experiences of assessing the learning of pupils with SEND. Based on the findings, we discuss the importance of schools disrupting hegemonic, ableist modes of thinking that cast pupils with SEND as being of inferior ability when compared with their peers and thus being disadvantaged by standardised, normative assessment practices. Specifically, we identify a need for senior leaders and teachers in schools to recognise the needs and capabilities of pupils with SEND, through more holistic assessment approaches that focus on social, affective, cognitive and physical learning and development. We end by discussing the significance of initial teacher education and teacher networks to support this endeavour and advocating for the amplification of the voices of pupils with SEND, given that they have expert knowledge about the perceived inclusivity of assessment in PE because they can draw upon their lived and embodied experiences.

Allied Health Professionals (AHPs) have the capacity to promote healthy behaviours in young children through routine ‘contact points’, as well as structured weight management programmes. This scoping review aims to evaluate the impact of AHPs in the prevention of obesity in young children. Databases were searched for relevant evidence between 1st January 2000 and 17th January 2022. Eligibility criteria included primary evidence (including, but not limited to; randomized controlled trials, observational studies, service evaluations) evaluating the impact of AHPs on the primary and secondary prevention of obesity in young children (mean age under 5 years old). AHP-related interventions typically demonstrated improvements in outcomes such as nutritional behaviour (e.g. lower sweetened drink intake), with some reductions in screen time. However, changes in weight outcomes (e.g. body mass index (BMI) z-score, BMI) in response to an AHP intervention were inconsistent. There was insufficient data to determine moderating effects, however tentative evidence suggests that those with a lower socioeconomic status or living in an underprivileged area may be more likely to lose weight following an AHP intervention. There was no evidence identified evaluating how AHPs use routine ‘contact points’ in the prevention of obesity in young children. AHP interventions could be effective in optimizing weight and nutritional outcomes in young children. However, more research is required to determine how routine AHP contact points, across the range of professional groups may be used in the prevention of obesity in young children.

Many Senior Leadership Teams (SLTs) are engaging in professional development to nurture explicitly anti-racist practice. Teachers' knowledge gaps about racism, its traumatic, lasting impact and how racism is generated through schooling persist within a cloak of silence. This small-scale study explores interview data from senior leaders in English schools, questioning legacies of colour-evasion and breaking silences to understand the role ‘race’ plays in their schools, appearing exigent due to Black Lives Matter (BLM) movements and the inescapable reality of racism seen in George Floyd's horrific murder. Using Critical Race Theory (CRT) and Critical Whiteness Studies (CWS) as theoretical tools, we explore negotiations and challenges of leading anti-racist work in systems favouring whiteness as the norm. Findings show senior leaders undertaking the Anti-Racist School Award (ARSA) and/or Race, Identity and School Leadership (RISL) programme are novice ‘race’ practitioners, despite their seniority, wrestling to recognise whiteness and to connect their own ‘race’(d) identities to role-enactment and policy. They must negotiate and make the case for anti-racist leadership to colleagues trained not to notice, and mitigate wider external systems operationalising whiteness, blocking the development of anti-racist practice. We examine resistances to anti-racist work in English school systems that (re)centre whiteness.

Fostering the growth, development, health, and wellbeing of children is a global priority. The early childhood period presents a critical window to influence lifelong trajectories, however urgent multisectoral action is needed to ensure that families are adequately supported to nurture their children's growth and development. With a shared vision to give every child the best start in life, thus helping them reach their full developmental potential, we have formed the International Healthy Eating Active Living Matters (HEALing Matters) Alliance. Together, we form a global network of academics and practitioners working across child health and development, and who are dedicated to improving health equity for children and their families. Our goal is to ensure that all families are free from structural inequality and oppression and are empowered to nurture their children's growth and development through healthy eating and physical activity within the context of responsive emotional support, safety and security, and opportunities for early learning. To date, there have been disparate approaches to promoting these objectives across the health, community service, and education sectors. The crucial importance of our collective work is to bring these priorities for early childhood together through multisectoral interventions, and in so doing tackle head on siloed approaches. In this Policy paper, we draw upon extensive research and call for collective action to promote equity and foster positive developmental trajectories for all children. We call for the delivery of evidence-based programs, policies, and services that are co-designed to meet the needs of all children and families and address structural and systemic inequalities. Moving beyond the “what” is needed to foster the best start to life for all children, we provide recommendations of “how” we can do this. Such collective impact will facilitate intergenerational progression that builds human capital in future generat

As many countries experience population aging, patients with cancer are becoming older and have more preexisting comorbidities, which include prevalent, age-related, chronic conditions such as dementia. People living with dementia (PLWD) are vulnerable to health disparities, and dementia has high potential to complicate and adversely affect care and outcomes across the cancer trajectory. This report offers an overview of dementia and its prevalence among patients with cancer and a summary of the research literature examining cancer care for PLWD. The reviewed research indicates that PLWD are more likely to have cancer diagnosed at an advanced stage, receive no or less extensive cancer treatment, and have poorer survival after a cancer diagnosis. These cancer disparities do not necessarily signify inappropriately later diagnosis or lower treatment of people with dementia as a group, and they are arguably less feasible and appropriate targets for care optimization. The reviewed research indicates that PLWD also have an increased risk of cancer-related emergency presentations, lower quality processes of cancer-related decision making, accessibility-related barriers to cancer investigations and treatment, higher experienced treatment burden and higher caregiver burden for families, and undertreated cancer-related pain. The authors propose that optimal cancer care for PLWD should focus on proactively minimizing these risk areas and thus must be highly person-centered, with holistic decision making, individualized reasonable adjustments to practice, and strong inclusion and support of family carers. Comprehensive recommendations are made for clinical practice and future research to help clinicians and providers deliver best and equitable cancer care for PLWD and their families.

Radical action against the political system may have substantial negative implications for society. However, little research so far has examined this form of radical engagement. In the present study, we drew on psychological theories of system justification and radicalization, and cultural theories of power distance to propose, for the first time, the existence of a dependency-counterdependency dynamic in individuals’ radical intentions against the political system. Specifically, we proposed that individuals’ system justification tendencies and radical intentions against the system would be negatively associated at lower levels of power distance orientation, that is when individuals feel dependent on a system perceived as malleable (dependency hypothesis). Conversely, system justification tendencies and radical intentions would be positively associated at higher levels of power distance orientation, reflecting dependency on a system that is perceived as fixed (counterdependency hypothesis). We tested the hypotheses using a multi-group latent structural equation model and samples from four democratic societies (NTotal = 2502) characterized by different macro-cultural and political profiles, South Korea, Italy, the UK and the US. Consistent with the hypothesized dynamic, results showed a significant latent interaction between system justification tendencies and power distance orientation. Theoretical implications of the findings, limitations and future research directions are discussed.

Whilst the link between young people's well-being and the creative arts is strengthening, there is a lack of research which focuses on the roles that artists play to help teachers and parents engage young people in the creative arts. This paper explores the benefits of and barriers to artists working in education in six European countries (England, Iceland, Germany, Greece, Italy and Austria). Using the ‘5A's model of creativity’ and a view of professional development taking place within ‘landscapes of practice’, the data were analysed in order to explain how creativity is operationalised in the different contexts. Our study highlights the need for policy at a national and transnational level to value the creative arts in order to help teachers cross boundaries and utilise the full potential of the creative arts in schools. Our study also highlights that further research is needed into how artists shape teaching and curriculum and how schools engage parents in the creative arts in order to build an evidence-base relating to young people's positive mental health that can affect policy at these levels.

Background Phonetic transcription is recognized in regulatory standards as an essential skill for Speech and Language Therapists (SLTs) in the assessment, diagnosis and management of clients with speech difficulties. Previous research has identified that approaches to phonetic transcription vary, and that SLTs often lack confidence in transcribing. However, SLTs’ views and working practices have not been investigated in detail, particularly in terms of whole service approaches and following the recent increase in telehealth. Aims To investigate SLTs’ views about phonetic transcription, their working practices at both individual and service levels, and the factors that influence these. Methods & Procedures A total of 19 SLTs from the UK were recruited to online focus groups via social media and local networks. Participants discussed their views of, and practices in, phonetic transcription. Themes were identified using reflexive thematic analysis. Outcomes & Results Three broad themes were generated division and unity; one small part of a big job; and fit for purpose. SLTs were uniformly proud of their ability to phonetically transcribe and viewed this as a unique skill, but clear differences existed between different groups of SLTs in their views and practices. Investing in phonetic transcription was not always a priority for SLTs or services, and although many felt under-confident in their skills they considered these to be adequate for the populations they usually encounter. SLTs make an early judgement about possible therapy targets, which influences the level of detail used in their phonetic transcription. Practical barriers are often not addressed at service level, and assessment via telehealth poses some specific challenges. Conclusions & Implications SLTs and services would benefit from increased investment in phonetic transcription in terms of time, opportunities for continuing professional development (CPD) and initiatives such as electronic patient records

Social media (SM) platforms are frequently used by pre-teen (8-12-year old) consumers for curating their self-identity, developing social relationships and for learning. This paper identifies the building blocks that drive pre-teen SM engagement. We use the Gioia method to analyse interview data collected from 32 pre-teens and parents, in France. Findings show that the primary building blocks are FoMO (Fear of Missing Out) and social inclusive experience, being noticed online, multiplicity, excessive use (without guidelines) and self-regulation. Identity constructs (self-identity and social-identity) are used to explain SM engagement – and to empirically define core conceptual building blocks (aggregate dimensions) that drive SM engagement. We contribute to consumer theory by developing a holistic research framework to examine pre-teen SM engagement. Self-identity and social-identity theories help explain the factors that drive pre-teen SM engagement and explain push/pull influences of parents and schools in encouraging or discouraging certain behaviour. We build on current research into SM usage, drawing from the fragmented existing literature, to reveal causes of both excessive screen-time and SM usage among pre-teen consumers, which may indicate antecedents of future adult behaviour. Practical and regulatory policy issues are considered and addressed.

This paper analyses policies and practices designed to support digital transformation in the tourism workforce in six OECD countries, namely Germany, Greece, Iceland, New Zealand, Switzerland, and the United Kingdom. Data for the project were gathered via a questionnaire survey, interviews with key informants and examination of various policy documents in 2021. Contrasting practice in relation to digital skills development is revealed. Significant deficiencies are evident in relation to the availability of high-quality data, evaluation, understanding, leadership, and infrastructure among the six countries. Ways in which effective policy development might emerge are suggested.

BACKGROUND: NHS England commissioned four independent service providers to pilot low-calorie diet programmes to drive weight loss, improve glycaemia and potentially achieve remission of Type 2 Diabetes across 10 localities. Intervention fidelity might contribute to programme success. Previous research has illustrated a drift in fidelity in the design and delivery of other national diabetes programmes. AIMS: (1) To describe and compare the programme designs across the four service providers; (2) To assess the fidelity of programme designs to the NHS England service specification. METHODS: The NHS England service specification documents and each provider's programme design documents were double-coded for key intervention content using the Template for Intervention Description and Replication Framework and the Behaviour Change Technique (BCT) Taxonomy. RESULTS: The four providers demonstrated fidelity to most but not all of the service parameters stipulated in the NHS England service specification. Providers included between 74% and 87% of the 23 BCTs identified in the NHS specification. Twelve of these BCTs were included by all four providers; two BCTs were consistently absent. An additional seven to 24 BCTs were included across providers. CONCLUSIONS: A loss of fidelity for some service parameters and BCTs was identified across the provider's designs; this may have important consequences for programme delivery and thus programme outcomes. Furthermore, there was a large degree of variation between providers in the presence and dosage of additional BCTs. How these findings relate to the fidelity of programme delivery and variation in programme outcomes and experiences across providers will be examined.

Purpose: To determine whether UK optometrists and ophthalmologists provide target refraction advice to patients prior to cataract surgery, and when this should first be discussed. Methods: Optometrists and ophthalmologists were asked to complete a survey of two clinical vignettes (both older patients with cataract; a pre-operative myope who routinely read without glasses and a patient using a monovision approach), plus multiple choice and short answer questions either using hard copy or online. Results: Responses were obtained from 437 optometrists and 50 ophthalmologists. Optometrists who reported they would provide target refraction advice were more experienced (median 22 years) than those who would leave this to the Hospital Eye Service (median 10 years). The former group reported it was in the patients’ best interest to make an informed decision as they had seen many myopic patients who read uncorrected pre-operatively, and were unhappy that they could no longer do so after surgery. Inexperienced optometrists reported that they did not want to overstep their authority and left the decision to the ophthalmologist. The ophthalmologists estimated their percentage of emmetropic target refractions over the last year to have been 90%. Conclusion: Currently, some long-term myopes become dissatisfied after cataract surgery due to an emmetropic target refraction that leaves them unable to read without glasses as they did prior to surgery. Although experienced optometrists are aware of this and attempt to discuss this issue with patients, less experienced optometrists tend not to. This suggests that target refraction needs greater exposure in university training and continuing professional development. To provide patients with the knowledge to make informed decisions regarding their surgery, we suggest an agreed protocol within funded direct referral schemes of initial target refraction discussions by optometrists to introduce the idea of refractive outcomes and outline o

AIMS/QUESTIONS: To explore the barriers and facilitators to nurses accessing clinical supervision; explore the barriers and facilitators to organizations implementing clinical supervision and capture what skills nurses require to facilitate clinical supervision. DESIGN: Scoping review of peer-reviewed research and grey literature. DATA SOURCES: CINAHL, Medline, PsychINFO and Scopus were searched for relevant papers published between 1990 and 2020. Google, Google Scholar, OpenGrey & EThOS were used to search for grey literature. REVIEW METHODS: PRISMA-ScR guidelines were used during the literature review process. Eighty-seven papers were included, and data were extracted from each paper using a standardized form. Data synthesis was undertaken using Seidel's analytical framework. RESULTS: Five themes were identified: Definitions and Models, (Mis) Trust and the Language of Supervision, Alternative Parallel Forums and Support Mechanisms, Time and Cost and Skills required. CONCLUSION: Since its inception in the 1990s, clinical supervision has long been regarded as a supportive platform for nurses to reflect on and develop their practice. However, this review highlights that despite an awareness of the skills required for nurses to undertake clinical supervision, and the facilitators for nurses to access and organizations to implement clinical supervision, there have been persistent barriers to implementation. This review identifies these persistent factors as 'barriers to overcoming the barriers' in the clinical supervision landscape. These require critical consideration to contribute towards moving clinical supervision forward in the spirit of its original intentions. IMPACT: This review progresses the debate on clinical supervision through critically analysing the barriers to overcoming the barriers. To this end, the review is designed to stimulate critical discussions amongst nurses in different clinical spaces and key stakeholders such as policy makers and regulatory

BACKGROUND: Adjectives are essential for communication, conceptual development and academic success. However, they are semantically and syntactically complex and can be particularly challenging for children with Developmental Language Disorder (DLD). Surprisingly, language interventions have not typically focused on this important word class. AIMS: (1) To provide a supportive and accessible primer on adjectives for practitioners; (2) to explore how the SHAPE CODINGTM system can be adapted to support adjective learning in DLD; and (3) to provide practical recommendations on how to support adjective learning in clinical practice and education. METHODS/PROCEDURE: We synthesise linguistic and psychological research on adjective semantics, clinical insights into DLD and pedagogical practice supporting this population. MAIN CONTRIBUTION: We address the lack of specific training in the nature and acquisition of adjectives for speech and language therapists (SLTs) by providing an accessible primer. We also provide an innovative guide detailing how an established metalinguistic intervention might be adapted to support adjective learning. CONCLUSIONS/IMPLICATIONS: Without targeted support for adjective learning, the communicative potential of children with DLD is compromised. Our recommendations can be used across a range of therapeutic and educational contexts to guide SLTs and teaching staff in developing practice in this area. WHAT THIS PAPER ADDS: What is already known on the subject Adjectives are an essential word class needed for effective communication. They are also vital to successfully achieve academic objectives across all curriculum areas. For example, most subjects require children to be able to describe, evaluate, compare and discriminate different events, objects or techniques. Children with Developmental Language Disorder (DLD) have deficits in various domains of language that can affect adjective learning and use. What this paper adds to existing knowledge D

This paper presents the findings of research about children's participation in child protection processes. Research was undertaken with young people who had recent involvement with safeguarding professionals. The study explored children's lived experience and perspectives and found that children feel capable of making a contribution, however, they are frustrated by experiences of exclusion and inequality and the limitations of their ability to influence process and outcomes. The study further explored the perspectives of practitioners. Whilst professional commitment to child-centred practice and effective safeguarding is unequivocal, the discourse of participation is characterised by ‘yes, but’. Insights emerged from the different voices and competing narratives of the central protagonists in the child protection process: children, social workers, chairs of case conferences and advocates. This paper examines how the child's right to involvement in safeguarding processes is understood and contributes to the evolving discourse about the importance of children's participation.

Aims To provide insight into the everyday realities facing care aides working in long-term residential care (LTRC), and how they perceive their role in society. Design A qualitative ethnographic case study. Methods Data were collected over. 10 months of fieldwork at one LTRC setting [September 2015 to June 2016] in Western Canada; semi-structured interviews (70 h) with 31 care aides; and naturalistic observation (170 h). Data were analysed using reflexive thematic analysis. Results The findings in this work highlight the underpinned ageism of society, the gendered work of body care, and the tension between the need for relational connections – which requires time and economic profit. Four themes were identified, each relating to the lack of training, support, and appreciation care aides felt about their role in LTRC. Conclusion Care aides remain an unsupported workforce that is essential to the provision of high-quality care in LTRC. To support the care aide role, suggestions include: (i) regulate and improve care aide training; (ii) strengthen care aides autonomy of their care delivery; and (iii) reduce stigma by increasing awareness of the care aide role. Impact What problem did the study address? The unsupportive working conditions care aides experience in LTRC and the subsequent poor quality of care often seen delivered in LTRC settings. What were the main findings? Although care aides express strong affection for the residents they care for, they experience insurmountable systemic and institutional barriers preventing them from delivering care. Where and on whom will the research have impact? Care aides, care aide educators, care aide supervisors and managers in LTRC, retirement communities, and home care settings.

Measurements of muscle-tendon unit passive mechanical properties are often used to illustrate acute and chronic responses to a training stimulus. The purpose of this study was to quantify the inter-session repeatability of triceps surae passive stiffness measurements in athletic and non-athletic populations, with the view to discussing its usefulness both as a muscle-tendon profiling tool and a control measure for studies with multiple data collection sessions. The study also aimed to observe the effects of quiet standing on passive stiffness parameters. Twenty-nine men (10 cyclists, nine triathletes, 10 controls) visited the laboratory on three separate occasions, where passive stiffness tests were carried out using an isokinetic dynamometer and B-mode ultrasound. Participants were fully rested on two of the sessions and subjected to 20 min of quiet standing in the other. The passive stiffness assessment generally showed only moderate inter-session repeatability but was still able to detect inter-group differences, with triathletes showing higher passive stiffness than cyclists (p < 0.05). Furthermore, quiet standing impacted passive stiffness by causing a reduction in ankle joint range of motion, although mechanical resistance to stretch in the muscle-tendon unit at a given joint angle was relatively unaffected. These findings show that passive stiffness assessment is appropriate for detecting inter-group differences in the triceps surae and even the effects of a low-intensity task such as quiet standing, despite showing some inter-session variation. However, the inter-session variation suggests that passive stiffness testing might not be suitable as a control measure when testing participants on multiple sessions.

The aim of this systematic review and meta-analysis was to examine the effectiveness of e health interventions for the treatment of children and adolescents with overweight or obesity. Databases were searched up to November 2020. Studies were randomised controlled trials where interventions were delivered via e-health (e.g. computers, tablets, smartphones, but not phone calls). Studies should target the treatment of overweight or obesity in children or their agent of changes and report BMI or BMI-z score. A meta-analysis using a random-effects model was conducted. Nineteen studies met the inclusion criteria, and 60% were of high quality. The narrative review revealed variation in behaviour change strategies and modes of delivery. The pooled mean reduction in BMI or BMI z-score showed evidence for a non-zero effect (standardised mean difference = -0.31, 95% confidence interval -0.49 to -0.13), with moderately high heterogeneity between studies (I2 = 74%, p<0.001). Subgroup analysis revealed high heterogeneity in studies with a high or unclear risk of bias. E-health interventions can be effective in treating children and adolescents with overweight and obesity and should be considered by practitioners and policymakers. However, an understanding of the most effective and acceptable intervention components, long-term benefits and sustainability should be further studied.

CONTEXT: Being involved in one's care is prioritised within UK healthcare policy to improve care quality and safety. However, research suggests that many older people struggle with this. DESIGN: We present focused ethnographic research exploring older peoples' involvement in healthcare from hospital to home. RESULTS: We propose that being involved in care is a dynamic form of labour, which we call 'involvement work' (IW). In hospital, many patients 'entrust' IW to others; indeed, when desired, maintaining control, or being actively involved, was challenging. Patient and professionals' expectations, alongside hospital processes, promoted delegation; staff frequently did IW on patients' behalf. Many people wanted to resume IW postdischarge, but struggled because they were out of practice. DISCUSSION: Preference and capacity for involvement was dynamic, fluctuating over time, according to context and resource accessibility. The challenges of resuming IW were frequently underestimated by patients and care providers, increasing dependence on others post-discharge and negatively affecting peoples' sense and experience of (in)dependence. CONCLUSIONS: A balance needs to be struck between respecting peoples' desire/capacity for non-involvement in hospital while recognising that 'delegating' IW can be detrimental. Increasing involvement will require patient and staff roles to be reframed, though this must be done acknowledging the limits of patient desire, capability,and resources. Hospital work should be (re)organised to maximise involvement where possible and desired. PATIENT/PUBLIC CONTRIBUTION: Our Patient and Public Involvement and Engagement Panel contributed to research design, especially developing interview guides and patient-facing documentation. Patients were key participants within the study; it is their experiences represented.

AIM: This article describes the development and implementation of a virtual consensus development project to address current challenges in adult nursing care in the UK. DESIGN: This is a Consensus Development Project (CDP). METHODS: The five stages of this CDP were: develop questions (informed by PPI representatives and a documentary review), generate evidence reviews, recruit and orient the lay panel, host consensus seminars, and consult with panel members and stakeholders. RESULTS: To the best of our knowledge, a CDP has not previously been conducted in a UK nursing context, and this is the first of its kind to be hosted virtually. This article contributes a detailed outline of the consensus development methodology and constructive commentary to support future consensus development projects. Learning points include reflections on the impact of hosting this event virtually, the relationship between the project coordinator and chair, and the composition of the lay panel.