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Introduction: Transition from primary school to high school can be a time of significant stress for young people. Social connection may mitigate the stress experienced by young people, yet their play activities, which are a key source of connection and friendship, have not been examined. The aim of the study was to capture the play behaviours of children in outdoor school environments. Methods: Children's play behaviours in their final year of primary school and those in their first year of high school were captured using a standardised tool (Tool for Observing Play Outdoors). Observations occurred in school outdoor environments during break times in the South Australian autumn of 2021. Frequencies and types of play were compared between year levels using descriptive statistics and contingency tables. Data were collected from four schools (two metropolitan and two regional), which were all from a similar level on the Index of Educational Disadvantage. Four observation sessions were held at each school. Results: Parents of 42 (16 girls) primary school students and 85 (33 girls) high school students gave permission for their children to participate. Physical play was the most frequent activity observed in both primary school and high school followed by expressive play. Year level was significantly associated with the type of play engaged in. Conclusion: Findings demonstrate children in the first year of high school continue to engage in physical and social play albeit less than those in the final year of primary school. Further research is needed to determine whether the physical and social environment or onset of puberty is more influential on changes in children's play. [ABSTRACT FROM AUTHOR]

In the past decade, numerous ethical frameworks have been developed to support public health decision‐making in challenging areas. Before the COVID‐19 pandemic began, members of the authorship team were involved in research programmes, in which the development of ethical frameworks was planned, to guide (a) the use of new technologies for emerging infectious disease surveillance; and (b) the allocation of scarce supplies of pandemic influenza vaccine. However, as the pandemic evolved, significant practical challenges emerged that led to our questioning the value of these frameworks. We now believe that a normative instrument, such as a framework, cannot adequately or reliably provide the ethical guidance that needs to be incorporated into public health decision‐making during natural disasters or infectious disease emergencies. Recently it has been suggested that there are potentially more dynamic, flexible, and effective ways to navigate decisions involving complex considerations entailed in policies and practices during a public health emergency. In this paper, we first outline the key functions of a public health ethics framework, before describing why we believe it would not be fit for purpose during a crisis. We end by considering whether proposed alternative methods to promote ethical public health decision‐making goals have the potential to meet these objectives. [ABSTRACT FROM AUTHOR]

This article argues that an analytic framework based on participation is useful for analysing consumer experiences of alternative dispute resolution (ADR), providing a complementary approach to analyses drawing on procedural justice theory. The argument is developed by applying McKeever's 'ladder of legal participation' (LLP)1 to a qualitative data set consisting of interviews with United Kingdom consumers. The article concludes that applying the LLP in the consumer ADR context results in novel empirical and theoretical insights. Empirically, it demonstrates that – even in low‐value and transactional disputes – consumers expect high levels of participation from ADR. Theoretically, it argues that the LLP complements existing approaches by providing an unifying lens through which to study consumer experiences by emphasizing the importance of participation, not only as a process value but also in shaping outcomes highlighting the distinction between genuine and tokenistic provision of ADR. [ABSTRACT FROM AUTHOR]

Abstract: Aim: This paper reports on the findings from 6 focus groups conducted with Australian medical students. The focus groups sought students' perspectives on how the influence of commercial interests on medical practice and education could be managed. Method: We conducted 6 focus groups with medical students in New South Wales, Australia. Participants were recruited via student‐run medical society and faculty e‐mail lists. Forty‐nine students from 6 medical schools in New South Wales participated. The research team reflected on the extent to which students uncritically appealed to science in the abstract as a management solution for conflicts of interest. Data analysis was largely inductive, looking for uses of scientific terminology, EBM, and appeals to “science” in the management of COI and applied theoretical analyses of scientism. Results: The students in our study suggested that science and evidence‐based medicine, rather than ethics or professionalism, were the best tools to deal with undue influence and bias. This paper uses philosophy of science literature to critically examine these scientistic appeals to science and EBM as a means of managing the influence of pharmaceutical reps and commercial interests. We argue that a scientistic style of reasoning is reinforced through medical curricula and that students need to be made aware of the epistemological assumptions that underpin science, medicine, and EBM to address the ethical challenges associated with commercialised health care. Conclusion: More work is needed to structure medical curricula to reflect the complexities of practice and realities of science. However, curricula change alone will not sufficiently address issues associated with commercial interests in medicine. For real change to occur, there needs to be a broader social and professional debate about the ways in which medicine and industry interact, and structural changes that restrict or mitigate commercial influences in educational, research, and policy settings. [ABSTRACT FROM AUTHOR]

Context Conflicts of interest (CoIs) are considered to be ubiquitous in health care and biomedicine. The disclosure of relevant interests is a first step in managing conflicts, although its usefulness is contested. Although several countries have mandated the public disclosure of doctors' financial relationships with the pharmaceutical industry, little is known about medical students' understanding of mandatory public disclosure. Methods Six 90-minute focus groups were conducted with medical students in New South Wales, Australia. Participants ranged from first- to final-year students. Students were asked about their understanding and experiences of CoIs and, more specifically, for their views on and experiences of disclosure in medical education, mandatory disclosure and public registers. Qualitative data analysis was based on a framework approach. Results Participants were generally not supportive of mandatory public disclosure of financial relationships with industry, principally because of concerns about privacy, control over disclosure, and others' (mis)interpretations of disclosures. Further, they did not know how to assess the disclosures presented to them as part of their medical education and described a wide range of reactions to disclosed information. Conclusions This study suggests that students are currently not well prepared for mandatory public disclosure of CoIs. The subsequent discussion draws on Bourdieu's doxa to highlight assumptions of altruism in medicine, assumptions that are potentially in tension with recent events that have exposed doctors to moral scrutiny by the public. Medical students could be better prepared for future obligations by encouraging disclosures, and contextualising and helping students to interpret them. Disclosure as a box-ticking exercise is unlikely to achieve goals implied by transparency, but a more reflective approach may assist both scrutinisers and the scrutinised. [ABSTRACT FROM AUTHOR]

Conflicts of interest ( COI) are considered ubiquitous in many healthcare arrangements,1 but there is disagreement on how COI should be defined, whether non-financial conflicts deserve attention and the relationship between COI and harm. We conducted a study of Australian healthcare professionals and students to gain a better understanding of the way that COI are understood in practice. In this paper, we outline an empirically derived taxonomy of the understanding of, and attitudes towards, COI. We carried out 25 semistructured interviews with clinicians working in several fields across Australia and held six focus group discussions with medical students in New South Wales. Interviewees and focus groups followed similar question routes investigating participants' understanding of COI and views of management. All data were compared and analysed using a matrix of pre-determined questions. There were, broadly, two views of COI: that COI were potentially harmful and morally compromising and another that saw COI as less serious and easily managed through existing structures. Definitions of COI varied widely and were both financial and non-financial. Causes of COI were, variously, systemic, individual and/or relational. Some participants associated COI with moral wrongdoing, and a variety of potential harms was identified. Views on how COI should be managed were similarly varied. We found considerable heterogeneity in how COI are understood in practice. This has implications for management systems that are currently in place, and we suggest a more sophisticated system for considering and mitigating COI. [ABSTRACT FROM AUTHOR]

Aim: To evaluate an innovative paediatric neurorehabilitation model in relation to improving quality of neurorehabilitation and reducing length of stay (LOS) for children with acquired brain injury.Method: A process evaluation approach was conducted in line with Medical Research Council evaluation of complex interventions guidance. Analysis was conducted on routinely collected patient data from 2017 to 2018, including LOS and family feedback. Descriptive and inferential statistics were used for quantitative analysis and qualitative data was analysed thematically.Results: Outcomes for 70 children (0-16y, median age 5y, IQR 1-11y, 46 males, 24 females) referred to the service indicated improved function and reduced complexity of need. The mean LOS was 10.6 days compared to baseline mean LOS of 41 days (2011-2012). High satisfaction from the families was recorded; however, ongoing needs and service gaps regarding long-term support were identified.Interpretation: This service model is effective in delivering quality paediatric neurorehabilitation, demonstrating a sustained impact on LOS, and positive patient outcome data and family feedback for this group of patients. What this paper adds Investment in early intensive neurorehabilitation and supported discharge impacts length of stay (LOS) for children with acquired brain injury. Early intensive neurorehabilitation and supported discharge is effective. This is demonstrated by a sustained reduction in LOS, positive patient outcomes, and family feedback. [ABSTRACT FROM AUTHOR]

This commentary is on the original article by Jystad et al. on pages 1174–1180 of this issue. [ABSTRACT FROM AUTHOR]

Objectives: Imaging methods to measure the human pelvis in vivo provide opportunities to better understand pelvic variation and adaptation. Magnetic resonance imaging (MRI) provides high‐resolution images, but is more expensive than dual‐energy X‐ray absorptiometry (DXA). We sought to compare pelvic breadth measurements collected from the same individuals using both methods, to investigate if there are systematic differences in pelvic measurement between these imaging methods. Methods: Three pelvic breadth dimensions (bi‐iliac breadth, bi‐acetabular breadth, medio‐lateral inlet breadth) were collected from MRI and DXA scans of a cross‐sectional sample of healthy, nulliparous adult women of South Asian ancestry (n = 63). Measurements of MRI and DXA pelvic dimensions were collected four times in total, with one baseline data collection session and three replications. Data collected from these sessions were averaged, used to calculate technical error of measurement and entered into a Bland–Altman analysis. Linear regression models were fitted with a given MRI pelvic measurement regressed on the same measurement collected from DXA scans, as well as MRI mean bias regressed on DXA mean bias. Results: Technical error of measurement was higher in DXA measurements of bi‐iliac breadth and medio‐lateral pelvic inlet breadth and higher for MRI measurements of bi‐acetabular breadth. Bland Altman analyses showed no statistically significant relationship between the mean bias of MRI and DXA, and the differences between MRI and DXA pelvic measurements. Conclusions: DXA measurements of pelvic breadth are comparable to MRI measurements of pelvic breadth. DXA is a less costly imaging technique than MRI and can be used to collect measurements of skeletal elements in living people. [ABSTRACT FROM AUTHOR]

Aims: To pilot prospective data collection by paediatricians at the point of care across England using a defined terminology set; demonstrate feasibility of data collection and utility of data outputs; and confirm that counting the number of needs per child is valid for quantifying complexity.Method: Paediatricians in 16 hospital and community settings collected and anonymized data. Participants completed a survey regarding the process. Data were analysed using R version 3.1.2.Results: Overall, 8117 needs captured from 1224 consultations were recorded. Sixteen clinicians responded positively about the process and utility of data collection. The sum of needs varied significantly (p<0.01) by level of gross motor function ascertained using the Gross Motor Function Classification System for children with cerebral palsy; epilepsy severity as defined by level of expertise required to manage it; and by severity of intellectual disability.Interpretation: Prospective data collection at the point of clinical care proved possible without disrupting clinics, even for those with the most complex needs, and took the least time when done electronically. Counting the number of needs was easy to do, and quantified complexity in a way that informed clinical care for individuals and related directly to validated scales of functioning. Data outputs could inform more appropriate design and commissioning of quality services. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives This study sets out to investigate the intergenerational associations between the body mass index (BMI) of parents and the body composition of their offspring. Methods The cross-sectional data were analyzed for 511 parent-offspring trios from London and south-east England. The offspring were aged 5-21 years. Parental BMI was obtained by recall and offspring fat mass and lean mass were obtained using the four-component model. Multivariable regression analysis, with multiple imputation for missing paternal values was used. Sensitivity analyses for levels of non-paternity were conducted. Results A positive association was seen between parental BMI and offspring BMI, fat mass index (FMI), and lean mass index (LMI). The mother's BMI was positively associated with the BMI, FMI, and LMI z-scores of both daughters and sons and of a similar magnitude for both sexes. The father's BMI showed similar associations to the mother's BMI, with his son's BMI, FMI, and LMI z-scores, but no association with his daughter. Sensitivity tests for non-paternity showed that maternal coefficients remained greater than paternal coefficients throughout but there was no statistical difference at greater levels of non-paternity. Conclusions We found variable associations between parental BMI and offspring body composition. Associations were generally stronger for maternal than paternal BMI, and paternal associations appeared to differ between sons and daughters. In this cohort, the mother's BMI was statistically significantly associated with her child's body composition but the father's BMI was only associated with the body composition of his sons. Am. J. Hum. Biol. 28:524-533, 2016. © 2016 The Authors American Journal of Human Biology Published by Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Aims: To develop a Disabilities Terminology Set and quantify the multifaceted needs of disabled children and their families in a district disability clinic population.Method: Data from structured electronic clinic letters of children attending paediatric disability clinics from June 2007 to May 2012 in Sunderland, north-east England collected at the point of clinical care were analysed to determine appropriate terms for consistent recording of each need and issue. Terms were collated to count the number of needs per child.Results: A Systemized Nomenclature of Medicine - Clinical Terms subset of 296 terms was identified and published, and 8392 consultations for 1999 children were reviewed. The required number of clinic appointments correlated strongly with the number of needs identified. Children with intellectual disabilities in addition to cerebral palsy and epilepsy had more than double the number of conditions, technology dependencies, and family-reported issues than those without. Disabled children who subsequently died had the highest burden of needs (p=0.007).Interpretation: Detailed data about needs generated outputs useful for local care pathway development and service planning. Sufficient evidence was provided for successful business cases leading to the appointment of additional paediatric disability consultants. Counting numbers of needs and issues quantifies complexity in a straightforward way. This could underpin needs-based commissioning of services. [ABSTRACT FROM AUTHOR]

Background As the health care education landscape in the UK changes rapidly and dramatically, collaboration across institutions bridging undergraduate and postgraduate fields is increasingly necessary. Collaboration entails both risks and benefits. There is a paucity of advice on how to ensure collaborative projects in medical education are effective. Context In 2011 three medical schools began a collaborative project along with NHS Education for Scotland (NES) to modify, develop and deliver a medical school version of the NES foundation programme ePortfolio, called UMeP. The underlying principal was the introduction of an authentic ePortfolio early in undergraduate life. The challenge of three diverse medical schools with significantly different curricula and assessment approaches working together with a single postgraduate ePortfolio was complex and demanding. Discussion We reveal the complexities of collaboration on education projects and draw on our experiences to provide illustrative examples of collaboration. Despite the increased complexity and need for compromise, we argue that successful collaborative partnerships are key to maximising the circumstances in which education innovation can be successful, and create the potential for robust evaluation and research. [ABSTRACT FROM AUTHOR]