Search

Limited qualitative research has examined teachers' understanding of Attention Deficit/Hyperactivity Disorder (ADHD), their attitudes towards the inclusion of children with ADHD in mainstream schools and how they support such learners. To address this, the current study used qualitative methodology to examine teachers' understanding of ADHD, their attitudes towards inclusion and their inclusive behaviours for children with ADHD. Semi-structured interviews were conducted with teachers (n = 10) working in 10 Scottish schools. A thematic analysis identified four themes: "ADHD Existence and Importance; Girls Go Under the Radar; The Impact of Limited Training; Working Inclusively." Teachers' perceptions may impact upon ADHD diagnosis and successful inclusion. The findings suggest the need for training to educate teachers about the causes of ADHD and the role of gender in symptoms. Classroom teachers should have access to more support to help them work successfully with children with ADHD. The study provides recommendations for teacher education and professional development surrounding ADHD.

Inclusion of autistic pupils into mainstream schools is common practice and staff should have adequate knowledge on teaching and managing classroom behaviour. However, autism knowledge among teaching staff may be inconsistent. A mixed-methods design examined differences between school staff in autism knowledge, perceived barriers to inclusion and required support. 138 early years staff, school teachers and pupil support assistants took part. Knowledge and experience were assessed using Knowledge about Childhood Autism among Health Workers questionnaire (KCAHW; [Bakare, M. O., P. O. Ebigbo, A. O. Agomoh, and N. C. Menkiti. 2008. Knowledge about childhood autism among health workers (KCAHW) questionnaire: description, reliability and internal consistency. Clinical Practice and Epidemiology in Mental Health 4 (1): 17]). Qualitative measures addressed perceived barriers to inclusion and recommended supports. Significant differences in the knowledge of autism scores were shown.. Similar themes were identified across all staff, with five themes reflecting barriers to inclusion (Knowledge, Support, Training, Management of ASC features and Parent involvement) and four themes relating to required support (Individualising educational experience, Changes to learning spaces, Opportunities to learn about ASC and Communication). Government inclusion policy should take a whole school approach and consider staffs' actual and perceived barriers to inclusion of autistic children.

Abstract Background Around 6,000 revision knee replacement procedures are performed in the United Kingdom each year. Three-quarters of procedures are for aseptic, elective reasons, such as progressive osteoarthritis, prosthesis loosening/wear, or instability. Our understanding of how we can best support these patients undergoing revision knee replacement procedures is limited. This study aimed to explore patients’ experiences of having a problematic knee replacement and the impact of undergoing knee revision surgery for aseptic, elective reasons. Methods Qualitative semi structured interviews with 15 patients (8 women, 7 men; mean age 70 years: range 54–81) who had undergone revision knee surgery for a range of aseptic, elective indications in the last 12 months at an NHS Major Revision Knee Centre. Interviews were audio-recorded, transcribed, de-identified and analysed using reflexive thematic analysis. Results We developed six themes: Soldiering on; The challenge of navigating the health system; I am the expert in my own knee; Shift in what I expected from surgery; I am not the person I used to be; Lingering uncertainty. Conclusions Living with a problematic knee replacement and undergoing knee revision surgery has significant impact on all aspects of patients’ lives. Our findings highlight the need for patients with problematic knee replacements to be supported to access care and assessment, and for long-term psychological and rehabilitation support before and after revision surgery.

Summary: Background: Excessive antimicrobial exposure is associated with an increase in neonatal mortality, morbidities and adverse neurodevelopment. Canadian Neonatal Network has been promoting judicious antimicrobial use through the Evidence-based Practice for Improving Quality processes. Our objective was to evaluate the antimicrobial consumption among neonates in tertiary neonatal intensive care units (NICU) in Canada in the recent decade. Methods: This is a retrospective cohort study including data from very preterm infants (born at

Objective: Therapeutic hypothermia (TH) is the standard treatment for neonates with hypoxic-ischemic encephalopathy (HIE). Validated cost estimates are required to better evaluate the cost-effectiveness of additional interventions during TH. The goal of this study is to identify clinical factors associated with costs of care and validate the Canadian Neonatal Network (CNN) costing algorithm for neonates with HIE receiving TH. Study design: Single-center retrospective cohort study among neonates with HIE treated with TH in a tertiary neonatal intensive care unit from 2016 to 2018. Actual costs per patient were obtained from the hospital cost accounting system, Coût par Parcours de Soinset de Services, and linked to patient data. Estimated costs per patient were calculated using the CNN case-costing algorithm. Neonates were grouped into cost tertiles to identify characteristics of high resource users. Comparisons of actual costs and estimated costs were performed across 8 cost domains. Results: Among 98 neonates treated with TH, 77 (79%) had mild-moderate HIE and 21 (21%) had severe HIE on admission. Factors associated with higher costs were severity of HIE and other markers of disease severity (seizures, mechanical ventilation, length of stay, and presence of brain injury on magnetic resonance imaging). Total median cost per neonate was $24,692 [IQR: $17,466; $39,234], which highly correlated with the CNN algorithm (median: $28 558 [IQR: $23 644; $40 704]) (R = 0.93, P < .01). The mean difference in total costs between estimates was $5339 (95% CI: $2697, $7981). There was a moderate-to-strong correlation between actual and estimated costs in 5/8 cost domains (R range: 0.68-0.98). Conclusions: Severity of HIE and other markers of disease severity were associated with higher hospital costs. The CNN costing algorithm cost estimates for neonates with HIE treated with TH highly correlate with actual costs but overestimates the costs by approximately 15%.

Abstract The African buffalo (Syncerus caffer) is a wild bovid with a historical distribution across much of sub-Saharan Africa. Genomic analysis can provide insights into the evolutionary history of the species, and the key selective pressures shaping populations, including assessment of population level differentiation, population fragmentation, and population genetic structure. In this study we generated the highest quality de novo genome assembly (2.65 Gb, scaffold N50 69.17 Mb) of African buffalo to date, and sequenced a further 195 genomes from across the species distribution. Principal component and admixture analyses provided little support for the currently described four subspecies. Estimating Effective Migration Surfaces analysis suggested that geographical barriers have played a significant role in shaping gene flow and the population structure. Estimated effective population sizes indicated a substantial drop occurring in all populations 5-10,000 years ago, coinciding with the increase in human populations. Finally, signatures of selection were enriched for key genes associated with the immune response, suggesting infectious disease exert a substantial selective pressure upon the African buffalo. These findings have important implications for understanding bovid evolution, buffalo conservation and population management.

Abstract Background Neutrophils are granulocytes with essential antimicrobial effector functions and short lifespans. During infection or sterile inflammation, emergency granulopoiesis leads to release of immature neutrophils from the bone marrow, serving to boost circulating neutrophil counts. Steady state and emergency granulopoiesis are incompletely understood, partly due to a lack of genetically amenable models of neutrophil development. Methods We optimised a method for ex vivo production of human neutrophils from CD34+ haematopoietic progenitors. Using flow cytometry, we phenotypically compared cultured neutrophils with native neutrophils from donors experiencing emergency granulopoiesis, and steady state neutrophils from non-challenged donors. We carry out functional and proteomic characterisation of cultured neutrophils and establish genome editing of progenitors. Results We obtain high yields of ex vivo cultured neutrophils, which phenotypically resemble immature neutrophils released into the circulation during emergency granulopoiesis. Cultured neutrophils have similar rates of ROS production and bacterial killing but altered degranulation, cytokine release and antifungal activity compared to mature neutrophils isolated from peripheral blood. These differences are likely due to incomplete synthesis of granule proteins, as demonstrated by proteomic analysis. Conclusion Ex vivo cultured neutrophils are genetically tractable via genome editing of precursors and provide a powerful model system for investigating the properties and behaviour of immature neutrophils.

The following Key Messages comprise the salient findings of this study:1. Ambient energy (from sun, air, ground, and sky) can heat and cool buildings; provide hot water, ventilation, and daylighting; dry clothes; and cook food. These services account for about three-quarters of building energy consumption and a third of total US demand. Biophilic design (direct and indirect connections with nature) is an intrinsic adjunct to ambient energy systems, and improves wellness and human performance.2. The current strategy of electrification and energy efficiency for buildings will not meet our climate goals, because the transition to an all-renewable electric grid is too slow. Widespread adoption of ambient energy is needed. Solar-heated buildings also flatten the seasonal demand for electricity compared to all-electric buildings, reducing required production capacity and long-term energy storage. In addition, ambient-conditioned buildings improve resilience by remaining livable during power outages.3. National policies, incentives, and marketing should be enacted to promote ambient energy use. Federal administrative priorities should reflect the importance of ambient energy for buildings. Use of ambient energy should be encouraged through existing and new building codes and standards.4. Ambient energy system design tools are needed for architects, engineers, builders, building scientists, realtors, appraisers, and consumers. PVWatts is used over 100 million times per year for photovoltaic system design. A similar, simple, and accessible tool for ambient design is crucial.5. Training on ambient energy is needed throughout secondary, post-secondary, and continuing education for workforce development. Currently, only about 10% of colleges teach courses on passive heating and cooling systems.6. Ambient-conditioned buildings should be demonstrated in all US climate zones. Performance should be monitored and reported, with quantitative case studies made widely available.7. While current technology is sufficient to build high-performance ambient buildings now, research is needed to develop new technologies to harness ambient energy more effectively and more economically. Such advancements will facilitate adoption of ambient energy technologies in a wider range of buildings, including retrofits. Examples include windows with much lower thermal losses, use of the building shell for thermal storage, alternative light-weight thermal storage systems, sky-radiation cooling systems, automated controls for solar gains and passive cooling, and ground coupling.

BackgroundDegenerative cervical myelopathy (DCM) is a progressive neurological condition, characterized by spinal cord injury secondary to degenerative changes in the spine. Misdiagnosis in primary care forms part of a complex picture leading to an average diagnostic delay of 2 years. This leads to potentially preventable and permanent disability. A lack of awareness secondary to deficits in postgraduate education may contribute to these delays. ObjectiveThis study aims to assess the awareness of DCM in the setting of general practice. MethodsGeneral practitioners completed a quantitative web-based cross-sectional questionnaire. The 17-item questionnaire captured data regarding demographics, subjective awareness, and objective knowledge. The questionnaire was disseminated via professional networks, including via practice managers and senior practice partners. Incentivization was provided via a bespoke DCM fact sheet for those that completed the survey. ResultsA total of 54 general practitioners representing all 4 UK nations responded to the survey. General practitioners most commonly self-assessed that they had “limited awareness” of DCM (n=24, 51%). General practitioners felt most commonly “moderately able” to recognize a case of DCM (n=21, 46%). In total, 13% (n=6) of respondents reported that they would not be at all able to recognize a patient with DCM. Respondents most commonly reported that they were “moderately confident” in their ability to triage a patient with DCM (n=19, 41%). A quarter of respondents reported no prior introduction to DCM throughout their medical training (n=13, 25%). The mean score for knowledge-based questions was 42.6% (SD 3.96%) with the lowest performance observed in patient demographic and clinical recognition items. ConclusionsGeneral practitioners lack confidence in the recognition and management of DCM. These findings are consistent with the diagnostic delays previously described in the literature at the primary care level. Further work to develop and implement educational interventions to general practitioner practices is a crucial step to improving patient outcomes in DCM.

Abstract Optimal foraging theory predicts that animals maximise energy intake by consuming the most valuable foods available. When resources are limited, they may include lower-quality fallback foods in their diets. As seasonal herbivore diet switching is understudied, we evaluate its extent and effects across three Kenyan reserves each for Critically Endangered eastern black rhino (Diceros bicornis michaeli) and Grevy’s zebra (Equus grevyi), and its associations with habitat quality, microbiome variation, and reproductive performance. Black rhino diet breadth increases with vegetation productivity (NDVI), whereas zebra diet breadth peaks at intermediate NDVI. Black rhino diets associated with higher vegetation productivity have less acacia (Fabaceae: Vachellia and Senegalia spp.) and more grass suggesting that acacia are fallback foods, upending conventional assumptions. Larger dietary shifts are associated with longer calving intervals. Grevy’s zebra diets in high rainfall areas are consistently grass-dominated, whereas in arid areas they primarily consume legumes during low vegetation productivity periods. Whilst microbiome composition between individuals is affected by the environment, and diet composition in black rhino, seasonal dietary shifts do not drive commensurate microbiome shifts. Documenting diet shifts across ecological gradients can increase the effectiveness of conservation by informing habitat suitability models and improving understanding of responses to resource limitation.

Sewage sludge (SS), a byproduct of wastewater treatment plants, poses significant environmental and health risks if not properly handled. Conventional approaches for SS stabilization often involve costly and energy-consuming processes. This study investigated the effect of promoting native microalgae growth in SS on its stabilization, pathogen bacteria removal, and valuable biomass production. The effect on settleability, filterability, and extracellular polymeric substances (EPSs) was examined as well. Experiments were conducted in photobioreactors (PBRs) without O2 supply and CO2 release under controlled parameters. The results show a significant improvement in SS stabilization, with a reduction of volatile solids (VSs) by 47.55%. Additionally, fecal coliforms and E. coli were efficiently removed by 2.25 log and 6.72 log, respectively. Moreover, Salmonella spp. was not detected after 15 days of treatment. The settleability was improved by 71.42%. However, a worsening of the sludge filterability properties was observed, likely due to a decrease in floc size following the reduction of protein content in the tightly bound EPS fraction. Microalgae biomass production was 16.56 mg/L/day, with a mean biomass of 0.35 g/L at the end of the batch treatment, representing 10.35% of the total final biomass. These findings suggest that promoting native microalgal growth in SS could be sustainable and cost-effective for SS stabilization, microalgal biomass production, and the enhancement of sludge-settling characteristics, notwithstanding potential filtration-related considerations.

We argue that understanding the cognitive foundations of computational thinking will assist educators to improve children's learning in computing. We explain the conceptual relationship between executive functions and aspects of computational thinking. We present initial empirical data from 23 eleven year old learners which investigates the correlation between assessments of programming and debugging in the visual language Scratch and scores from the BRIEF2 assessment of executive functions. The initial data shows moderate to large correlations between assessments of debugging and programming with the BRIEF2 teachers' rating of executive function as manifested in classroom behaviour. Case studies from the empirical data are used to qualitatively illustrate how executive functions relate to a game making task. We discuss the implications of these findings for educators, and present suggestions for future work.

Abstract Taenia solium taeniasis/cysticercosis (TSTC) is a foodborne, zoonotic neglected tropical disease affecting predominately low- and middle-income countries. Humans are definitive hosts for T. solium, whereas pigs act as intermediate hosts. Taeniasis, i.e. intestinal infection with adult T. solium in the human host, occurs through ingestion of undercooked pork infected with the larval stage (porcine cysticercosis, PCC). Human cysticercosis occurs after humans ingest T. solium eggs, acting as accidental intermediate hosts. Migration of cysticerci to the human brain results in neurocysticercosis (NCC), manifesting in a variety of clinical symptoms, most notably epilepsy. NCC is the leading cause of acquired epilepsy cases in endemic areas. PCC results in reduced pork value because of condemnation or the risk of condemnation of the meat. Available serological diagnostic tests for porcine and human cysticercosis are characterized by low sensitivity and are not cost-effective. An effective vaccine for T. solium cysticercosis in pigs has been developed, although it is not yet commercially available in all endemic countries, and still no vaccine is available for use in humans. This primer highlights the recent development in the field of diagnostic tests and vaccine production and explores possible strategies for future control and eradication of T. solium. In the absence of highly specific diagnostic tests and human vaccines, treatment of infected pigs and tapeworm carriers and prevention of disease transmission remain the principal means to interrupt the zoonotic cycle of T. solium in endemic countries. Graphical abstract

The regulation of reactive oxygen species (ROS) in red blood cells (RBCs) is crucial for maintaining functionality and lifespan. Indeed, dysregulated ROS occurs in haematological diseases such as sickle cell disease and β-thalassaemia. In order to combat this, RBCs possess high levels of protective antioxidant enzymes. We aimed to further boost RBC antioxidant capacity by overexpressing peroxiredoxin (Prxs) and glutathione peroxidase (GPxs) enzymes. Multiple antioxidant enzyme cDNAs were individually overexpressed in expanding immortalised erythroblasts using lentivirus, including Prx isoforms 1, 2, and 6 and GPx isoforms 1 and 4. Enhancing Prx protein expression proved straightforward, but GPx overexpression required modifications. For GPx4, these modifications included adding a SECIS element in the 3’UTR, the removal of a mitochondrial-targeting sequence, and removing putative ubiquitination sites. Culture-derived reticulocytes exhibiting enhanced levels of Prx and GPx antioxidant proteins were successfully engineered, demonstrating a novel approach to improve RBC resilience to oxidative stress. Further work is needed to explore the activity of these proteins and their impact on RBC metabolism, but this strategy shows promise for improving RBC function in physiological and pathological contexts and during storage for transfusion. Enhancing the antioxidant capacity of reticulocytes has exciting promise for developing culture-derived RBCs with enhanced resistance to oxidative damage and offers new therapeutic interventions in diseases with elevated oxidative stress.

Abstract Background Urogynaecological conditions, such as pelvic organ prolapse, urinary incontinence, and urinary tract infection, can have a profound impact on people’s lives. The Independent Medicines and Medical Devices Safety Review highlights missed opportunities to prevent harm when patient voices are not incorporated into healthcare policy and practice. This resonates with the Women’s Health Strategy for England. The National Institute for Health and Care Research (NIHR) Policy Research Programme funded this in-depth qualitative exploration of people’s experiences of living with urogynaecological conditions, and of seeking healthcare treatment, to inform health and social care improvements in the UK. Methods We conducted in-depth interviews online or by telephone (April 2021-December 2021) and used reflexive thematic analysis to develop themes that cut across urogynaecological conditions. Results We spoke to seventy-four adults aged 22–84 across a range of backgrounds and lived experiences of urogynaecological conditions, including pelvic organ prolapse, urinary incontinence and persistent or recurring urinary tract infection. Eight themes were developed: [1] I get no respite from my own body; [2] I feel confined and separated; [3] I can no longer be ‘me’; [4] I am constrained by stigma, shame and silence; [5] I feel fragmented and lost in the healthcare system; [6] I need to be heard, believed, and valued; [7] I need respect as an equal partner in healthcare; and [8] (Re)connected to a more open community. Conclusions High quality care focuses on the whole person rather than their body parts. Openness and candour support a shared decision-making model of care. A culture of shame can have a negative impact on access to health care and recovery.

Abstract Background Adolescent idiopathic scoliosis (AIS) is a common spinal deformity with physical and psychosocial implications for adolescents. The aim of this qualitative evidence synthesis (QES) was to systematically search for, identify, and synthesise qualitative research in order to improve our understanding of what it is like to live with AIS and to facilitate empathetic and effective healthcare. Methods We systematically searched 4 databases (Medline, EMBASE, PsycINFO and CINAHL) and used the 7 phases of meta-ethnography to synthesise qualitative evidence including studies with children and adolescents, and additional viewpoints from parents about the experience of AIS. Results We distilled 7 themes. (1) Diagnosis turned time on its head revolves around the AIS diagnosis and the uncertainty of the future that accompanied it. (2) Usual activities no longer the same explores how activities and participation in everyday life are impacted by AIS. (3) Hiding my body describes the pervasive struggle with self-image and appearance. (4) I want to feel normal again explores adolescents’ desire to return to ‘normality’ and challenges of feeling different. (5) Balancing isolation and support considers the relationships in the adolescents’ lives alongside their feelings of isolation. (6) Trying to keep control of treatment decisions explores how adolescents and their parents strive to feel in control. (7) Fearing surgery yet feeling hopeful focused on the apprehension and fear around spinal surgery and the beacon of hope it represented. Conclusions Our QES contributes to the understanding of the adolescent experience of living with AIS. From our findings, clinicians can better understand the physical and psychosocial obstacles and the challenges faced throughout the journey of AIS to inform their clinical interactions with these patients.

Plasmodium falciparum invasion of the red blood cell is reliant upon the essential interaction of PfRh5 with the host receptor protein basigin. Basigin exists as part of one or more multiprotein complexes, most notably through interaction with the monocarboxylate transporter MCT1. However, the potential requirement for basigin association with MCT1 and the wider role of basigin host membrane context and lateral protein associations during merozoite invasion has not been established. Using genetically manipulated in vitro derived reticulocytes, we demonstrate the ability to uncouple basigin ectodomain presentation from its transmembrane domain-mediated interactions, including with MCT1. Merozoite invasion of reticulocytes is unaffected by disruption of basigin-MCT1 interaction and by removal or replacement of the basigin transmembrane helix. Therefore, presentation of the basigin ectodomain at the red blood cell surface, independent of its native association with MCT1 or other interactions mediated by the transmembrane domain, is sufficient to facilitate merozoite invasion.

Abstract Background Understanding the variation between well and poorly adapted cattle breeds to local environments and pathogens is essential for breeding cattle with improved climate and disease-resistant phenotypes. Although considerable progress has been made towards identifying genetic differences between breeds, variation at the epigenetic and chromatin levels remains poorly characterized. Here, we generate, sequence and analyse over 150 libraries at base-pair resolution to explore the dynamics of DNA methylation and chromatin accessibility of the bovine immune system across three distinct cattle lineages. Results We find extensive epigenetic divergence between the taurine and indicine cattle breeds across immune cell types, which is linked to the levels of local DNA sequence divergence between the two cattle sub-species. The unique cell type profiles enable the deconvolution of complex cellular mixtures using digital cytometry approaches. Finally, we show distinct sub-categories of CpG islands based on their chromatin and methylation profiles that discriminate between classes of distal and gene proximal islands linked to discrete transcriptional states. Conclusions Our study provides a comprehensive resource of DNA methylation, chromatin accessibility and RNA expression profiles of three diverse cattle populations. The findings have important implications, from understanding how genetic editing across breeds, and consequently regulatory backgrounds, may have distinct impacts to designing effective cattle epigenome-wide association studies in non-European breeds.

Nigeria’s independence ushered in an era of university creation. Four new universities were established by 1962, just two years after attaining self-rule. Twenty-five years later, they each commissioned and published a book that documented their histories. This article employs a textual analysis of these publications within the context of contemporary research on university architecture in 20th-century Nigeria. It examines these books as a historical source for tracing the universities’ architectural histories. It further explores the ways they documented their built environment through their accounts of academic development, institutional changes, and nation-building goals. Finally, it reflects on the relevance of their sources, narratives, and limitations in reimagining the architectural history of Nigeria’s first universities.

Thomas et al. test 6 ELISAs detecting IgA and IgG antibodies to whole SARS-CoV-2 spike protein, to its receptor binding domain region and to nucleocapsid protein in saliva. Across 20 household outbreaks, antibody responses are heterogeneous, but a reliable indicator of recent infection.

In this article we examine the complex relationship between care experience, mental health and exclusion from school and how young people (YP) negotiate these different experiences and identities. The study is a secondary analysis, informed by symbolic interactionist theory, of interviews conducted with 19 care experienced YP in Scotland. Not all of the YP were excluded and not all had a formal mental health diagnosis, as such our study design allows interrogation of the contexts and relationships which not only facilitate but also disrupt pathways to exclusion. It also allows reconsideration of assumptions of vulnerability which are often applied to care experienced YP. Our findings suggest that these YP are moving beyond 'role playing' the identities ascribed to them and actively seek out relationships which enable them to construct alternative identities.

Measurement(s) Optical Mapping Technology Type(s) Optical Mapping Factor Type(s) Structural variants Sample Characteristic - Organism Bos taurus Sample Characteristic - Location United Kingdom • Kenya • Zambia • Uganda • Brazil • Nigeria

Abstract Objectives The paper presents insights from the Community based Rehabilitation after Knee Arthroplasty (CORKA) trial. We aimed to explore physiotherapists and physiotherapy assistants’ experiences of delivering a home-base exercise intervention following knee replacement surgery. We were particularly interested in the feasibility, potential benefits and barriers of a community-based exercise programme from the perspective of physiotherapists and physiotherapy assistants and to understand any constraints or training needs that arose. Design Qualitative thematic analysis of semi-structured interviews. Setting The Community based Rehabilitation after Knee Arthroplasty (CORKA) trial. Participants Five physiotherapists and six physiotherapy assistants with a range of clinical experience. Methods Interviews were digitally recorded and transcribed verbatim. We used the stages of reflexive thematic analysis suggested by Braun and Clarke. One researcher conducted the interviewers whilst three researchers with experience in qualitative research methods contributed to the coding and analysis of data. Results We developed seven themes that help to understand the benefits and challenges of delivering treatment interventions in a person’s home: seeing the person in their own world; thinking outside the cubicle;developing people skills; enjoying the above and beyond; treading a fine line between patient and friend; feeling outside my comfort zone; needing a support network. Conclusions Treating people in their own homes facilitates a holistic approach. Our findings highlight areas for clinical education: (1) how do we help clinicians to tread the fine line between friend and professional (2) how do we balance the need to provide support and structure with the freedom to work creatively and independently?

Objective: Osteoarthritis is the most common joint disease with treatment involving a multidisciplinary approach with pharmacological, physical therapies and surgery as options. Qualitative research can help us to understand the complexity of managing health conditions and this understanding plays a role in good clinical practice. We aimed to systematically search for, identify, and synthesise qualitative research exploring the experience of living with osteoarthritis, including decision making about joint replacement. Methods: We comprehensively searched 4 bibliographic databases and used the methods of meta-ethnography to synthesise qualitative research findings. We screened 10 ​123 titles, 548 abstracts, and 139 full texts. We included findings from 118 reports (105 unique samples) of at least 2534 adults living with osteoarthritis around the world. Results: We developed 7 themes: Becoming your own expert can be hard work; Living has become a careful balancing act; Medication is a double-edged sword; I have other things in my life to consider; You have to weigh up the odds of surgery; Surgery is the only effective option; and Surgery will give me a chance to live now. These findings have been drawn into a conceptual model reflecting a complex balancing act with tensions underpinning treatment decision making. Conclusions: Osteoarthritis is framed as a world where patients become their own expert about their management and healthcare choices. Our conceptual model highlights key tensions underpinning treatment decision-making. These findings provide clinicians with insight of the complex nature of these decisions and how they can help patients through shared decision making.

Summary: Background: The UK's ‘First do no harm’ report highlighted missed opportunities to prevent harm and emphasised the need to incorporate patient voices into healthcare. Due to concerns about, and the subsequent suspension, of vaginal mesh for urinary incontinence thousands of women face the decision about mesh removal surgery. The aim of this study was to explore and understand the experience of living with complications attributed to vaginal mesh surgery so that this knowledge can contribute to improvements in care for those considering mesh, or mesh removal, surgery. Methods: This study was embedded in the ‘PURSUE’ study which explored the experiences of 74 people with urogynaecological conditions in the UK (30th April 2021–17th December 2021). Of these 74 people, fifteen women reported complications that they attributed to vaginal mesh surgery. We used the six stages of reflexive thematic analysis to conceptualise these fifteen accounts. Findings: Our conceptual model anchors eight themes around two dualities: (1) body parts versus body whole, (2) dominant discourse versus marginal discourse. Our themes indicate that trust can be established through: (1) embodied healthcare that focuses on connecting with patients’ lived experience, (2) dialectic communication that recognises patient experiences and remains open to alternative perspectives. Interpretation: This study raises some important issues for education and practice. Our findings can translate to other health settings where treatments aimed to provide care have caused harm. Funding: NIHR Policy Research Programme (NIHR202450).

Abstract Introduction Although several outcomes are commonly measured to assess the effect of surgery for young people with cerebral palsy (CP), these are selected mainly by health professionals and researchers. Including the perspectives of a broader range of stakeholders is an essential step towards determining important outcomes for assessment. This qualitative study involves the development of a core outcome set (COS) for lower limb orthopaedic surgery for ambulant children with CP. Objective This study aimed to identify outcomes that matter to children and young people with CP, their parents and healthcare professionals following lower limb orthopaedic surgery. Methods Semi‐structured interviews were conducted with 10 healthcare professionals, 10 children and young people with CP and 8 parents. Interview data were analysed by content analysis supported by the International Classification of Functioning, Disability and Health (ICF‐CY) supplemented by thematic analysis. Findings Thirty‐one outcomes were identified in total, which were linked to eleven second‐level ICF‐CY categories. There were differences between stakeholder groups in preferences and expectations from surgical outcomes. Healthcare professionals and children with their parents identified 31 and 25 outcomes, respectively. Health outcomes valued by participants were lower limb alignment and symmetry, flexibility and muscle strength, mental health, fatigue, pain, function in life, mobility, participation, being independent, quality of life and adverse events. Compared to previous published trials, 10 new outcomes were revealed by this study. Conclusion The researchers identified outcomes that are important to all stakeholders following lower limb orthopaedic surgery for ambulant CP. Including these outcomes in future studies would promote patient‐centred care for children and young adults with CP. Findings will be used to inform an international Delphi survey and develop a COS in this field. Patient and Public Contribution This study was informed by an advisory group including a young adult with CP and a parent of a child with CP. This group engaged in the design of the study and the information material to support the interview (information sheet and interview topic guide).