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Medication abortion has been established globally as safe and effective. This modality has increased accessibility and the opportunity to centre individual autonomy at the heart of abortion care, by facilitating self-managed abortion. Previous research has shown how self-managed abortion is beneficial in myriad settings ranging from problematic to (relatively) unproblematic contexts of access. In this paper we explore the relationship between self-management and sources of support (including health professionals, family, and friends); as well as considering issues of reproductive control and autonomy. Drawing on qualitative, experience-centred interviews, we utilise the concept of social connectedness to examine how supported self-managed abortion was experienced in the United Kingdom during the COVID-19 pandemic. Overall, self-management was welcomed, with participants speaking positively about managing their own abortion at home. However, a sense of connectedness was crucial in helping participants deal with difficult experiences; and functioned to support individual autonomy in self-care. This paper is the first to examine factors of connection, support, and isolation, as experienced by those undergoing self-managed abortion in the UK in detail. Our research suggests a continued need to advocate for high quality support for self-managed abortion, as well as for choice of abortion method, to support patient-centered care. [ABSTRACT FROM AUTHOR]

This article focuses on the interface between the formal learning associated with the curricula of school and college, and the personal knowledge and broader learning lives and identities of two young people as they move into and through their post-16 careers. The interviews reveal the complex interaction between the formal curriculum, contingent social, economic and cultural influences and dispositions, and everyday learning, inside and outside of school and college. Whilst we appreciate the value and contribution of the formal curriculum, where young people find their own meanings and understandings, we maintain that all young people would profit from a curriculum in school and college that is "catalytic," and more explicitly centred upon their knowledge conceptions, and their sense of themselves as learner and agent in all of the different dimensions of their lives. Such a curriculum would be empowering. It would challenge all young people to critique what is accepted as knowledge (its content, form and structure) and simultaneously encourage them to enlist their experiences and identities, in all the different spheres of their lives, for understanding. (Contains 5 notes.)

Interviews focused on the learning of two British young adults examined processes of identity transformation and transition to work. Their experiences suggest that technical/rational educational approaches fail to meet developmental needs and are inadequate for prevocational, vocational, and lifelong learning. Curriculum should focus on the agency of the learner as a driving force. (Contains 49 references.) (SK)

In most settings worldwide, abortion continues to be highly stigmatised. Whilst a considerable body of literature has addressed abortion stigma, what is less commonly examined are the ways in which those with experience of abortion describe it in non-negative terms which may resist or reject stigma. Drawing on qualitative secondary analysis of five UK datasets using a narrative inquiry approach, we explore: the use of non-negative language around abortion, potential components of a normalising narrative, and constraints on non-negativity. As such, we present the first empirical UK study to critically examine how a dominant negative abortion narrative might be disrupted. [ABSTRACT FROM AUTHOR]

Observational research has a history of controversy, particularly when the research is conducted in a clinical setting. Existing ethical approval processes focus on protecting participants and the researcher's responsibilities, in particular where vulnerable populations are concerned. In this study, the authors explored the less overt and often understated ethical challenges that can arise when conducting observational research in a clinical setting. Reflecting on two recent studies conducted in different clinical settings, the authors described the challenges of blurring role boundaries, the risk of collecting redundant data, and the impact of reverse power relationships between researchers, clinicians, and managers. From their experiences, the authors suggested that the preparatory work undertaken with clinicians and managers onsite, which typically focuses on how the researchers will maintain the ethical robustness of the research and protect the rights of participants and the vulnerable, should also highlight the sometimes overlooked ethical issues associated with participatory research. This can help ensure that participants and managers understand the scope and limitations of the research, and consider the ways in which the observed can influence the researcher and the findings. [ABSTRACT FROM AUTHOR]

Study design:A cross-sectional study.Objectives:To measure the change of structural and material properties at different sites of the tibia in spinal cord-injured patients using peripheral quantitative computerised tomography (pQCT).Setting:Orthopaedic research centre (UK).Methods:Thirty-one subjects were measured-eight with acute spinal cord injury (SCI), nine with chronic SCI and fourteen able-bodied controls. pQCT scans were performed at 2% (proximal), 34% (diaphyseal) and 96% (distal) along the tibia from the tibial plateau. Structural measures of bone were calculated, and volumetric bone mineral density (vBMD) was also measured at all three levels. Muscle cross-sectional area was measured at the diaphyseal level.Results:Structurally, there were changes in the cortical bone; in the diaphysis, the shape of the cross-section changed to offer less resistance to AP bending, and the cross-sectional area of the cortical shell decreased both proximally and distally. There were corresponding changes in vBMD in the anterior aspect of the cortical diaphysis, as well as proximal and distal trabecular bone. Changes in muscle occurred more rapidly than changes in bone.Conclusion:There were clear changes of both structure and material at all three levels of the tibia in chronic SCI patients. These changes were consistent with specific adaptations to reduced local mechanical loading conditions. To assess fracture risk in SCI and also to monitor the effect of therapeutic interventions, the structure of the bone should be considered in addition to trabecular bone mineral density. [ABSTRACT FROM AUTHOR]

This paper draws on a longitudinal study of young people studying in further education in England to explore contradictions between the complex reasons why a small number of the sample dropped out without completing their courses and qualifications, and the simplistic funding and policy assumptions about such 'failures'. Current English policy assumes that retention and qualification achievement rates are appropriate measures of learning and of educational provision. Yet the stories presented here demonstrate that many of the factors influencing non-completion lie beyond the control of both the educational providers and the learners. Furthermore, from the perspective of the learner, there is little difference between changing educational or career intentions during or at the end of a course. Yet policy assumes that the former is dysfunctional and the latter unproblematic. Based upon our data, we argue that the causes of dropping out can best be explained in the context of an individual's learning career, which involves a complex combination of social and economic factors, individual preferences and beliefs, and contingency. Not only do current English policy approaches ignore this complexity; they also risk making things worse for a significant minority of students. The failure to acknowledge that dropping out is normal and appropriate for some, means that those who do drop out receive no help or support, except to stay on. Furthermore, there is a risk that educational providers will refuse to recruit students in 'at risk' categories, for fear that they will be judged adversely, should some of them eventually fail to complete. Finally, the audit obsession with retention and achievement rates blames either the individual student or the education and guidance providers for failure, thus rendering deeper inequalities, based on class, gender and ethnicity, invisible and harder to address. [ABSTRACT FROM AUTHOR]

Background Increasing use of teledermatology should be based on demonstration of favourable accuracy and cost–benefit analysis for the different methods of use of this technique. Objectives To evaluate the clinical efficacy and cost-effectiveness of real-time and store-and-forward teledermatology. Methods Patients attended their own health centre and in the company of a general practitioner (GP) were seen by a hospital dermatologist over the videolink (real-time). Before the videolink consultation commenced, the GP took instant photographs of the skin lesion and posted them along with a standard referral letter to a different hospital dermatologist (store-and-forward). In total, 96 patients were seen by both real-time and store-and-forward teledermatology. Comparative diagnoses, clinical management plans, clinical outcomes and associated costs were made between the two types of teledermatology consultation. Results There was agreement between the videolink diagnosis and the still image diagnosis in 51% of cases. The same or similar management plan was recommended at both types of consultation in 44% of cases. Following the store-and-forward consultation the dermatologist recommended that 69% of patients required at least one hospital appointment compared with 45% of those patients seen in real-time. The net societal cost of the initial real-time consultation was £132·10 per patient compared with &;pound26·90 per patient for the initial store-and-forward consultation. Conclusions The store-and-forward consultation was cheaper, but less clinically efficient, compared with the real-time consultation. The absence of interaction in a store-and-forward consultation limits the dermatologist’s ability to obtain clinically useful information in order to diagnose and manage a patient satisfactorily. [ABSTRACT FROM AUTHOR]

The paediatric CF unit at the RVI in Newcastle upon Tyne has 176 children who attend for full care from throughout the Northern region of the UK. Children are reviewed in clinic every 6 weeks, between clinics the CF team rely on parents/carers to report any increase in respiratory symptoms by telephone. Telephone triage, with particular reference to respiratory exacerbation, is a recognised service provided by most, if not all Paediatric CF centres within the UK. Documentation of this care episode was inadequate and not recorded in the patients’ medical notes. This was identified as a potential risk. A review of current practice in UK CF centres identified an absence of a structured assessment triage tool. Various methods to record and report symptoms were described, however it was evident that there was a distinct lack of a consistent clinical approach to this area of care. Therefore a telephone triage tool was developed in October 2013 to enable the CF nurses to assess children using a symptom based protocol. The proforma enables the nurses to identify a respiratory exacerbation, it utilises a systematic approach which identifies the presenting problems and moves through a series of prompts which aid the nurse make a decision. The outcomes are determined by the information gathered. A retrospective review covering a period of 12 months has indicated that the tool is working effectively. The review has highlighted some areas for development such as an early warning/traffic light system. Few such tools have been developed that are particular to CF respiratory symptoms and it is envisaged that following further development, it may be implemented by other CF MDT members. [ABSTRACT FROM AUTHOR]