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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]

Simple Summary: Horse sports are popular worldwide, providing spectator enjoyment, benefiting human health, and contributing substantially to national economies. Training and management practices used to care for sporthorses are generally based on tradition rather than science; this combined with the high-risk nature of equestrian activities led to the public questioning if sporthorse health and welfare are being compromised. To understand better how sporthorses are being managed, experts, actively involved with national and international horse sports (dressage, showjumping, and eventing) were consulted across four rounds of a Delphi study. This approach allowed participants to interact to reach a point where everyone agreed on core areas (or domains) that they felt were essential to sporthorse management. Five areas were rated as essential: training management, competition management, young horse management, health status and veterinary management, and the horse–human relationship. Stable and environmental management, and welfare assessment were rated as important but not essential, as most experts felt that these areas were already managed well. Experts called for increased education and research to support riders, trainers, and federations. A welfare charter and evidence-based guidelines to inform management practices were advised to ensure sporthorses have a good life and to safeguard the future of equestrian sports. The public is increasingly questioning equestrianism's social license to operate. While the focus historically centered on horseracing, increased scrutiny is now being placed on how dressage, showjumping, and eventing are addressing equine management and welfare concerns. Nominated equestrian federation and equestrian organization experts (n = 104) directly involved in international and/or national-level horse sports took part in a four-stage, iterative Delphi to obtain consensus on what factors should be considered essential to manage sporthorse health and welfare. Five core domains were agreed as essential: training management, competition management, young horse management, health status and veterinary management, and the horse–human relationship. Two further domains: stable and environmental management, and welfare assessment were rated as important but not essential, as most respondents felt that these areas were already managed well. Participants felt increased education and guidance combined with further policy development and regulation are needed to support stakeholders to optimize sporthorse management. An appetite to engage with research to generate evidence that promotes sporthorse welfare was evident. The development of a sporthorse welfare charter and evidence-based guidelines to inform the management and monitoring of sporthorses' health and welfare are recommended to provide horses with a good life and to safeguard the future of equestrian sports. [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 explores how complaint investigations undertaken by health ombudsman contribute to the improvement of the healthcare system. Using a qualitative case-study approach, semi-structured interviews were conducted with participants form the Scottish Public Services Ombudsman (SPSO) and three health boards within its jurisdiction. Health board participants were frustrated by complaints process used by the SPSO, in particular the lack of communication during an SPSO investigation especially when there were differences in clinical judgment. Using Braithwaite's typologies of motivational postures and Hertogh's models of administrative control it was found that a sense of capitulation was the primary determinant in ensuring health board compliance with SPSO recommendations and that the relationship between SPSO and health boards was predominantly coercive in nature. For the SPSO to be more effective in contributing to system improvement requires it to review its role and means of conducting complaint investigations. [ABSTRACT FROM AUTHOR]

Background: Physical activity benefits physical and mental health. However, limited research investigates if physical activity can improve outcomes from the grieving process following the death of a parent. Methods: Semi-structured interviews were conducted with 14 individuals (n = 8 female; age M = 31.2 years), who had experienced the death of a parent when they were aged between 10 and 24 years old, using retrospective recall. Data were analysed inductively using thematic analysis. Results: Six themes were identified. Physical activity was seen as; 1) 'Therapeutic'; providing an 2) 'Emotional Outlet' and created a strong sense of 3) 'Social Support'. Alongside it 4) 'Builds Confidence', and led to 5) 'Finding Yourself' and 6) 'Improved Health and wellbeing' (physical and psychological). Conclusion: Physical activity has the potential to provide positive experiences following a parental bereavement. It can provide a sense of freedom and was seen to alleviate grief outcomes, build resilience, enable social support and create a stronger sense of self. Bereavement support services for young people who have experienced death of a parent should consider physical activity as a viable intervention to support the grieving process. [ABSTRACT FROM AUTHOR]

In their 2010 book, Lorna Weir and Eric Mykhalovskiy conceptualised the role of vigilance in unknown and emerging infectious disease threats. Theirs is a macro-level account which draws on empirical data to describe vigilance as a set of technical and political arrangements that govern collection, analysis, interpretation and communication of data as it pertains to unknown threats. In this paper we expand their work to detail a conceptual analysis of the role of vigilance at the micro-level during periods of high infectious disease threat. Our data are daily press conferences and associated non-discursive tools in New South Wales (NSW), Australia during times of heightened COVID-19 risk. This paper is a conceptual analysis that draws on theories of vigilance and related concepts to show how a key aspect of vigilance is making previously unseen threats visible or present. Communications formulated and encouraged three types of vigilance as a set of governing relations: institutional or authority-based; individual outward-facing; and individual inward-facing. We also describe the relationship between vigilance and related concepts that are used in response to anticipated public threats. Authority based vigilance involved contact tracing and policing of movement and behaviours. In individual outward facing vigilance people were asked to be alert to, analyse, and react to risk in their immediate environment. Inward facing vigilance required people to gather and react to information about their own behaviours and within their own bodies. There was a relationship between different types of vigilance; as risk increased and authority-based vigilance was less successful in containing the spread of infection, individual vigilance had a stronger role to play. This extension of vigilance at the micro-level sees some of the same unintended consequences as Weir and Mykhalovskiy describe at the global level, particularly in how burdens are inequitably distributed and experienced. • Citizens became an arm of vigilance apparatus during COVID-19 pandemic in Australia. • Vigilance was authority-based; individual outward facing; individual inward facing. • Disadvantaged populations carried higher vigilance burden. • Earlier conceptions of vigilance in infectious disease emergencies are extended. [ABSTRACT FROM AUTHOR]

Introduction: Patients with gastroparesis (Gp) have symptoms with or without a cyclic pattern. This retrospective study evaluates differences in cyclic vs. non-cyclic symptoms of Gp by analyzing mucosal electrogastrogram (mEG), familial dysautonomias, and response to gastric stimulation. Methods: 37 patients with drug refractory Gp, 7 male and 30 female, with a mean age of 41.4 years, were studied. 18 had diabetes mellitus, 25 had cyclic (Cyc), and 12 had a non-cyclic (NoCyc) pattern of symptoms. Patients underwent temporary mucosal gastric stimulator (tGES) placement, which was done as a trial before permanent stimulator (GES) placement. Electrogastrogram (EGG) by mucosal (mEG) measures, including frequency, amplitude, and frequency-amplitude ratio (FAR), were pre- and post-tGES. Patients' history of personal and familial dysautonomias, quality of life, and symptom scores were recorded. Baseline vs. follow-ups were compared by paired t tests and McNemar's tests. T tests contrasted symptom scores, gastric emptying tests (GET), and mEG measures, while chi-squared tests deciphered comorbidity differences between two groups and univariate and multivariate analyses. Results: There were significantly more patients with diabetes in the Cyc group vs. the NoCyc group. Using a 1 point in symptom outcome, 18 patients did not improve and 19 did improve with tGES. Using univariable analysis, with the cyclic pattern as a predictor, patients exhibiting a cyclic pattern had an odds ratio of 0.22 (95% CI 0.05–0.81, p = 0.054) for achieving an improvement of at least one unit in vomiting at follow-up from baseline. The mucosal electrogastrogram frequency to amplitude ratio (FAR) for the "not Improved" group was 19.6 [3.5, 33.6], whereas, for the "Improved" group, it was 54.3 [25.6, 72.5] with a p-value of 0.049. For multivariate logistic regression, accounting for sex and age squared, patients exhibiting a cyclic pattern had an adjusted odds ratio (OR) of 0.16 (95% CI 0.03–0.81, p = 0.027) for achieving an improvement of at least one unit in vomiting at follow-up from baseline. The two groups had no significant differences in the personal or inherited history of investigated familial patterns. Conclusion: This study shows differences in Gp patients with Cyc vs. NoCyc symptoms in several areas. Larger studies are needed to elicit further differences between the two groups about cycles of symptoms, EGG, findings, familial patterns, and response to mucosal GES. [ABSTRACT FROM AUTHOR]

Behavioural responses vary significantly within the Reptile Class when stressed, fearful or frustrated, making it very difficult to observe or measure their emotional state. Reptiles are not commonly seen in general veterinary practice which can mean that suitable accommodation is not always available, and as there is a huge variation in a reptile's ability, or lack of, to signal changes in emotional state, it can be challenging for veterinary nurses to identify and address the stress response. The veterinary practice can reduce negative behavioural responses by managing transportation, sampling and handling methods to improve the patient experience. This article refers to reptile species commonly kept as companion animals in the UK, including snakes, lizards and tortoises, which may be presented for veterinary treatment. It also examines possible routes to the identification of Reptile species as suitable pets, and indeed the suitability of Reptiles as pets at all. [ABSTRACT FROM AUTHOR]

Vaccination plays an important role in pandemic planning and response. The possibility of developing an effective vaccine for a novel pandemic virus is not assured. However, as we have seen with SARS-CoV-2 vaccine development, with sufficient resources and global focus, successful outcomes can be achieved in a relatively short period. However even when vaccine is available it will initially be scarce. When one becomes available, how should it be distributed? In this paper we explicate how ethical thinking that is carefully attuned to context is essential to decisions about how we should conduct vaccination in a pandemic where demand exceeds supply. We focus on two key issues. First, setting the aims for a pandemic vaccination programme. Second, thinking about the means of delivering a chosen aim. We outline how pandemic vaccine distribution strategies can be implemented with distinct aims, e.g. protecting groups at greater risk of harm, saving the most lives, or ensuring societal benefit. Each aim will result in a focus on a different priority population and each strategy will have a different benefit-harm profile. Once we have decided our aim, we still have choices to make about delivery. We may achieve at least some ends via direct or indirect strategies. Such policy decisions are not merely technical, but necessarily involve ethics. One important general issue is that such planning decisions about distribution will always be made under conditions of uncertainty about vaccine safety and effectiveness. However, planning how to distribute vaccine for SARS-CoV-2 is even harder because we understand relatively little about the virus, transmission, and its immunological impact in the short and long term. [ABSTRACT FROM AUTHOR]

To explore longer-term health-related quality of life (HRQoL) and participation outcomes and goals of children and young people (CYP) with acquired brain injuries (ABI) and their families in a region of the UK and the impact of the COVID-19 pandemic. Cross-sectional survey of (5-18 CYP) and their parent-carers 12–43 months following ABI. Included measures of HRQoL, participation, family function and parental wellbeing and demographic and free text questions. Ninety-five responses (30% response) were received. 67% of CYP were at risk of impaired HRQoL, 72% had severely impaired participation. 53% of parent-carers reported reduced HRQoL and family functioning, 37% of parent-carers screened positive for anxiety/depression. Relationships exist between CYP participation and HRQoL and parental HRQoL and family functioning. Goals were overwhelmingly activity and participation focused. Participants described the global impact of an ABI on the CYP and family as well as the additional impact of the COVID-19 pandemic on CYP and family wellbeing. ABI significantly impacts CYP participation and both CYP and parent-carer wellbeing in the long-term, potentially further impacted by the COVID-19 pandemic. Rehabilitation interventions should address both participation and the psychological wellbeing of CYP with ABI and their parent-carers. [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]

In Australia, the growing assisted reproductive technologies (ART) industry has recently received some public criticism. Much of this criticism centres on the concern that doctors are increasingly motivated by profit, rather than patient interests. These concerns appear to suggest that the growing business of ART generates conflicts of interest (COI) for clinicians. While media reports may be rhetorically compelling, claims that ART practice is distorted by COI must be supported by empirical evidence. This preliminary study sought to engage with people involved with the ART industry and map out their concerns related to COI in ART. A small convenience sample of eight professionals was interviewed. Here, we present the major themes uncovered, including a richer understanding of the 'interests' of various parties involved in Australian ART. We then propose a strategy for how this topic could be constructively explored. [ABSTRACT FROM AUTHOR]

Aim: With a number of qualified community practitioner nurse prescribers (CPNPs) not prescribing, this research aimed to understand what influences this behaviour. Design: A qualitative research design. Methods: Semi‐structured interviews, based on the theoretical domains framework (TDF) were conducted with 20 CPNPs. Data collection took place between March‐July 2018 and continued until data saturation was reached. Results: Nine themes inductively explained prescribing behaviour: 1) 'Knowledge and experience'; 2) 'Consultation and communication skills'; 3) 'Professional confidence and identity'; 4) 'Wanting the best outcome'; 5) 'NHS versus patient cost'; 6) 'Emotion‐led decisions'; 7) 'Time allocation'; 8) 'Formulary access' and 9) 'Supporting environment for patient‐centred care'. Themes were then deductively mapped to the TDF and COM‐B. Conclusion: There is an ongoing need to support community practitioner nurse prescribers' 'Capability' to prescribe in terms of knowledge and aquired skills; 'Opportunity' to make prescribing easier, such as access to a wider and up to date nurse formulary alongside effective clinical support; and 'Motivation' to feel confident in prescribing behaviour, highlighting positive patient outcomes while reducing perceived issues such as cost and non‐adherence. Impact: Findings show that Capability, Opportunity and Motivation all influence the decision to prescribe. Those responsible for professional regulation and training should ensure community practitioner nurse prescribers have access to the relevant knowledge, skills and formulary to facilitate their prescribing behaviour. Professional confidence and identity as a prescriber should be encouraged, with acknowledgment of influences such as cost and emotion. An environment that allows for patient‐centred care and the best outcome should be supported, this may mean increasing time allocated to consultations. [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]

Over the past decade ‘social egg freezing’ has emerged as a technology of hope that purports to empower women by enabling them to continue their careers or find the right partner without the fear of jeopardising their fertility. This technology has been promoted and celebrated by fertility companies, bioethicists, clinicians, and multi-national corporations such as Apple and Facebook. While critical questions have been raised, they tend to focus on ethical and legal issues, such as informed consent and patient autonomy. This paper uses Foucault’s notion ofdispositifas analytic lens to examine the entanglement of the commercial arrangements of fertility companies, the discursive use of hope in promoting these services, and effects on professional medical care. Drawing on socio-political analyses of hope, this paper examines the potential financial conflicts of interest facing clinicians and the way discourses of hope might mask problematic financial relations and lack of evidence of effectiveness. [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]

This paper aims to interrogate the potential and challenges in interdisciplinary working across disciplinary boundaries by examining a longitudinal partnership designed to research student experiences of digital technologies in undergraduate medicine established by the authors of this paper (one from Education and the other from Medical Education). The paper is situated in current methodological trends including the changing value of replicability and evidence-based methods and increases in qualitative and mixed methods studies in medical education, whilst education research has seen growing encouragement for randomized controlled trials and large-scale quantitative studies. A critical analysis of the partnership interactions is framed by Holland’s positional and imagined identities, negotiated across ‘figured’ worlds and the concept of epistemic games that guide knowledge construction. We consider social, political and cultural challenges; and how ‘in-between’ sites of knowledge were established where the academic identity of each was shaped by engaging with the other and new theoretical, methodological and ethical understandings were co-constructed. The paper concludes that despite the ongoing challenges, ‘bottom-up’ partnerships can contribute to a growth in interdisciplinarity which might itself be understood as a boundary object. Interdisciplinarity necessitates improvisation and boundary crossing and can, therefore, always be considered a matter of negotiation, creativity and collaboration. [ABSTRACT FROM AUTHOR]

Equestrianism is popular worldwide, with millions of horses and riders participating in competitive horse sports and non-competitive leisure riding. Riders have a duty of care or responsibility for their horses and should aim to optimise their health and welfare. Despite this, limited research has explored the effectiveness and impact of equitation practice, equine management and training techniques on equine performance and welfare. The International Society for Equitation Science promotes enhanced equine welfare through an objective and evidence based approach to equine management and training, via education and research. This review explores the impact of the rider on equitation practice and how rider education could inform equine management and training regimens to promote health, welfare and performance. The experience of the rider will influence their riding capabilities, decision-making and their horse’s ridden performance. Matching the personality and experience of horses and riders can create a positive partnership. Riding is a physical activity; therefore rider fitness can also influence the horse’s performance and physical capacity. An unbalanced rider will not be able to give clear and consistent aids to the horse therefore affecting their behaviour when ridden. The horse will have to adapt their locomotion to account for the moving weight of the unbalanced rider which increases the physiological demands of exercise. Psychological influences can also change the way a rider interacts with their horse. Therefore the informed rider will ensure they are physically and psychologically prepared to ride. Decision making is a key part of rider responsibility. Riders, owners and keepers of horses will determine training and management regimens, which should be designed to support the workload expected of the horse. Similarly, riders should be capable of identifying potential risks of injury and be able to recognise pain and the physical representation of injury in the horse. Such knowledge should then be applied to adapt management and exercise regimes accordingly. To safeguard the horse, the responsible rider needs to be educated and informed, to make them aware of the impact of decisions they make, on their equine partner. Further research within equitation science is required to build an evidence base to support the development of educated and responsible riders. The horse-rider relationship is complex. The inability of the horse to verbalise its emotions and pain places significant responsibility on the rider to ensure that the animal’s health and welfare is optimised through informed management and riding. The responsible rider should exert a positive impact upon the horse and the partnership, applying scientific principles when training and managing their horse to promote health, welfare and performance to achieve a positive horse-rider relationship. [ABSTRACT FROM AUTHOR]

Variation in equine hoof conformation between farriery interventions lacks research, despite associations with distal limb injuries. This study aimed to determine linear and angular hoof variations pre- and post-farriery within a four to six week shoeing/trimming interval. Seventeen hoof and distal limb measurements were drawn from lateral and anterior digital photographs from 26 horses pre- and post-farriery. Most lateral view variables changed significantly. Reductions of the dorsal wall, and weight bearing and coronary band lengths resulted in an increased vertical orientation of the hoof. The increased dorsal hoof wall angle, heel angle, and heel height illustrated this further, improving dorsopalmar alignment. Mediolateral measurements of coronary band and weight bearing lengths reduced, whilst medial and lateral wall lengths from the 2D images increased, indicating an increased vertical hoof alignment. Additionally, dorsopalmar balance improved. However, the results demonstrated that a four to six week interval is sufficient for a palmer shift in the centre of pressure, increasing the loading on acutely inclined heels, altering DIP angulation, and increasing the load on susceptible structures (e.g., DDFT). Mediolateral variable asymmetries suit the lateral hoof landing and unrollment pattern of the foot during landing. The results support regular (four to six week) farriery intervals for the optimal prevention of excess loading of palmar limb structures, reducing long-term injury risks through cumulative, excessive loading. [ABSTRACT FROM AUTHOR]

This article draws on an empirical investigation of how Australia's cervical screening program came to be the way it is. The study was carried out using grounded theory methodology and primarily uses interviews with experts involved in establishing, updating or administering the program. We found strong differences in experts' normative evaluations of the program and beliefs about optimal ways of achieving the same basic outcome: a reduction in morbidity and mortality caused by invasive cervical cancer. Our analysis demonstrates how variations in values and preferences associated with key concepts underpinning public health such as benefit, harm and burden led to different perspectives on the purpose of an organized cervical screening program. These variations were largely driven by different bases of professional experience. Differently conceived purposes in turn led to conflict over how the program should be operationalized. Following Frith's model of empirical bioethics, the results of the study both draw on and inform the existing public health and screening ethics literature. [ABSTRACT FROM AUTHOR]

Chemotherapy is a commonly integrated treatment option within human and animal oncology regimes. Limited research has investigated pet owners' treatment decision-making in animals diagnosed with malignant neoplasia. Dog and cat owners were asked to complete an online questionnaire to elucidate factors which are key to the decision making process. Seventy-eight respondents completed the questionnaire in full. Fifty-eight percent of pet owners would not elect to treat pets with chemotherapy due to the negative impact of the associated side effects. Seventy-two percent of respondents over estimated pet survival time post chemotherapy, indicating a general perception that it would lead to remission or a cure. Vomiting was considered an acceptable side effect but inappetence, weight loss and depression were considered unacceptable. Owners did expect animals' to be less active, sleep more and play less, but common side effects were not rated as acceptable despite the potential benefits of chemotherapy. Based on the results, veterinary teams involved with oncology consultations should establish if clients have prior experience of cancer treatments and their expectations of survival time. Quality of life assessments should also be implemented during initial oncology consultations and conducted regularly during chemotherapy courses to inform client decision making and to safe guard animal welfare. [ABSTRACT FROM AUTHOR]

This paper proposes a model for designing consumer dispute resolution (CDR) mechanisms (including conciliation, adjudication, arbitration and ombuds schemes). This field has expanded significantly in recent years, replacing courts as the primary forum of dispute resolution in some areas of consumer-to-business activity. This expansion has been ad hoc, with a lack of consistency in the design of CDR mechanisms and in the overall shape of the CDR landscape. In light of the recent implementation of the EU's Directive on Consumer Alternative Dispute Resolution and Regulation on Consumer Online Dispute Resolution, Dispute System Design (DSD) requires urgent attention to ensure that the design of future mechanisms is based on coherent principles. A failure to address this issue risks undermining the legitimacy of state-sanctioned dispute resolution. The model described in this paper proposes a systematic approach and aims to: synthesise existing DSD models; apply the concepts of DSD to the field of CDR; and provide a framework that may be of use in other disputing contexts. [ABSTRACT FROM AUTHOR]

The United Kingdom's four children's commissioners, established under separate legislation for Wales, Northern Ireland, Scotland and England, are amongst the best known of the public institutions created since the beginning of devolved government in 1999. Like many such offices around the world, they are the result of domestic political and social processes as well as the influence of the requirements of international human rights treaties, specifically the United Nations Convention on the Rights of the Child. Different processes in the four countries have produced differing remits and emphases, but each commissioner is in part a response to concerns about the vulnerability of children in difficult circumstances. The commissioners' activities include vigilance over the access of such children to support, in particular support for getting their voices heard. The commissioners have also developed prominence on the international stage as independent children's rights institutions and all have been active in promoting children's participation in social accountability for human rights implementation. This article explains the commissioners' different roles and remits and examines ways in which they contribute to accountability for human rights implementation in the political, administrative, legislative, judicial and social spheres. It concludes by suggesting that their status as both "children's champion" and independent children's rights institutions is likely to assure their long-term endurance in the still-evolving process of constitutional change in the UK. [ABSTRACT FROM AUTHOR]

Cancer screening is an important component of prevention and early detection in public health and clinical medicine. The evidence for cancer screening, however, is often contentious. A description and explanation of disagreements over the evidence for cervical, breast, and prostate screening may assist physicians, policymakers, and citizens faced with screening decisions and suggest directions for future screening research. There are particular issues to be aware of in the evidence base for each form of screening, which are summarized in this paper. Five tensions explain existing conflicts over the evidence: (1) data from differing contexts may not be comparable; (2) screening technologies affect evidence quality, and thus evidence must evolve with changing technologies; (3) the quality of evidence of benefit varies, and the implications are contested; (4) evidence about harm is relatively new, there are gaps in that evidence, and there is disagreement over what it means; and (5) evidence about outcomes is often poorly communicated. The following principles will assist people to evaluate and use the evidence: (1) attend closely to transferability; (2) consider the influence of technologies on the evidence base; (3) query the design of meta-analyses; (4) ensure harms are defined and measured; and (5) improve risk communication practices. More fundamentally, there is a need to question the purpose of cancer screening and the values that inform that purpose, recognizing that different stakeholders may value different things. If implemented, these strategies will improve the production and interpretation of the methodologically challenging and always-growing evidence for and against cancer screening. [ABSTRACT FROM AUTHOR]

Organised screening programmes have been remarkably successful in reducing incidence and mortality from cervical cancer, while opportunistic screening varies in its effectiveness. Experts recommend that cervical screening or HPV testing be carried out only in the context of an organised programme. We sought to answer the following study questions: What does it mean for a cervical screening programme to be organised? Is there a place for opportunistic screening (in an organised programme)? We reviewed 154 peer-reviewed papers on organised and opportunistic approaches to cervical screening published between 1970 and 2014 to understand how the term ‘organised’ is used, formally and in practice. We found that despite broad recognition of a prescriptive definition of organisation, in practice the meaning of organisation is much less clear. Our review revealed descriptions of organised programmes that differ significantly from prescribed norms and from each other, and a variety of ways that opportunistic and organised programmes intersect. We describe the breadth of the variation in cervical cancer screening programmes and examine the relationships and overlaps between organised and opportunistic screening. Implications emerging from the review include the need to better understand the breadth of organisation in practice, the drivers and impacts of opportunistic screening and the impact of opportunistic screening on population programme outcomes. Appreciation of the complexity of cervical screening programmes will benefit both screeners and women as programmes are changed to reflect a partially vaccinated population, new evidence and new technologies. [ABSTRACT FROM AUTHOR]

Aim To identify what aspects of health clinicians target when working with children with neurodisability, and which might be appropriate to assess the performance of health services. Method Health professionals were recruited through child development teams and professional societies in England. Professionals participated in four rounds of an online Delphi survey. Open questions were used to elicit aspects of health; these were coded using the WHO International Classification of Functioning, Disability and Health for Children and Youth. Then, participants were asked to rate their agreement with statements to prioritise outcomes identified. Results Responses to all four rounds were, respectively: 233/276 (84.4%), 232/286 (81.1%), 227/285 (79.6%) and 191/284 (67.3%). The key outcome domains identified were: mental health, confidence/emotional stability, anxiety/attention, sleep, pain, toileting, movement ability, manual ability, acquiring skills, communication, mobility, self-care, recreation and leisure. Participants rated both functioning and wellbeing in these aspects of health as equally important. Interpretation This Delphi survey identified nine key domains that provide a professional perspective on a core set of outcomes for evaluating services for children and young people with neurodisability. [ABSTRACT FROM AUTHOR]

Simple Summary: In the U.S., thousands of pigs had to be destroyed on the farms when illness caused by COVID-19 greatly reduced pork slaughter plant capacity. Some of the methods used to destroy pigs on the farms severely compromised animal welfare. Reliance on a few large slaughter plants created a fragile supply chain. Animal welfare auditing conducted by large meat buyers was also hindered by COVID-19. Many live in-person audits were stopped and replaced by a combination of stationary video cameras and live streamed videos from mobile phones. To insure high standards of animal welfare, video methods should never completely replace in-person visits. In the U.S., the most severe animal welfare problems caused by COViD-19 were in the pork industry. Thousands of pigs had to be destroyed on the farm due to reduced slaughter capacity caused by ill workers. In the future, both short-term and long-term remedies will be needed. In the short-term, a portable electrocution unit that uses scientifically validated electrical parameters for inducing instantaneous unconsciousness, would be preferable to some of the poor killing methods. A second alternative would be converting the slaughter houses to carcass production. This would require fewer people to process the same number of pigs. The pandemic revealed the fragility of large centralized supply chains. A more distributed supply chain with smaller abattoirs would be more robust and less prone to disruption, but the cost of pork would be greater. Small abattoirs can coexist with large slaughter facilities if they process pigs for specialized premium markets such as high welfare pork. The pandemic also had a detrimental effect on animal welfare inspection and third party auditing programs run by large meat buyers. Most in-person audits in the slaughter plants were cancelled and audits were done by video. Video audits should never completely replace in-person audits. [ABSTRACT FROM AUTHOR]

Simple Summary: On 11 March 2020, the World Health Organization declared coronavirus disease (COVID-19) outbreak a global pandemic and an ongoing public health emergency. In the United Kingdom, quarantine and social distancing measures were implemented with immediate effect on 17 March 2020, resulting in a rapid change to the way owners managed and interacted with their horses. We surveyed 6259 horse owners to evaluate the impact of COVID-19 on themselves and their horses. The majority of horse owners were visiting and riding their horses less, with increased restrictions experienced by owners who kept their horse at private livery yards. Whilst social distancing and visiting restrictions were in place at livery yards, nearly half were not providing hand sanitization or disinfection protocols for shared areas/equipment to prevent the spread of the virus between owners. Horse owners expressed concern that equine health and welfare would be negatively affected by the restrictions put in place and of financial consequences as a result of the pandemic. The majority of respondents also felt their own mental health and wellbeing was being adversely affected by not being able to visit/interact as they normally would with their horses. Equestrian influencers and national bodies should engage with increased communication and education to support horse owners through the pandemic in the short, medium, and long-term. COVID-19 was declared a global pandemic on 11 March 2020; the United Kingdom (UK) implemented quarantine measures shortly afterward, resulting in rapid changes in how owners managed and interacted with their horses. This study provides a rapid analysis of the initial impact of the COVID-19 outbreak on the management of UK leisure and competition horses. A 17 question online survey was distributed via equestrian social media sites to ascertain the impact of COVID-19 on horse and yard management and on human–horse interactions. Frequency analysis combined with Chi-squared and thematic analyses identified the impact of COVID-19 on UK horse owners. Major changes within horse management and horse–human interactions were reported for the majority of horse owners (>65%), regardless of the establishment type or region. Social distancing and visiting restrictions were implemented at most yards, but nearly half were not providing hand sanitization or disinfection protocols for the shared areas/equipment to prevent cross-contamination between users. The financial impact of the pandemic combined with restricted access to veterinary professionals resulted in owners expressing concerns that horse health and welfare may be compromised as a result. Horse owners also felt that the reduced opportunities for horse–human interactions were negatively affecting their mental health and wellbeing. [ABSTRACT FROM AUTHOR]

In this paper, we show that over the next few decades, the natural variability of mid-latitude storm systems is likely to be a more important driver of coastal extreme sea levels than either mean sea level rise or climatically induced changes to storminess. Due to their episodic nature, the variability of local sea level response, and our short observational record, understanding the natural variability of storm surges is at least as important as understanding projected long-term mean sea level changes due to global warming. Using the December 2013 North Atlantic Storm Xaver as a baseline, we used a meteorological forecast modification tool to create "grey swan" events, whilst maintaining key physical properties of the storm system. Here we define "grey swan" to mean an event which is expected on the grounds of natural variability but is not within the observational record. For each of these synthesised storm events, we simulated storm tides and waves in the North Sea using hydrodynamic models that are routinely used in operational forecasting systems. The grey swan storms produced storm surges that were consistently higher than those experienced during the December 2013 event at all analysed tide gauge locations along the UK east coast. The additional storm surge elevations obtained in our simulations are comparable to high-end projected mean sea level rises for the year 2100 for the European coastline. Our results indicate strongly that mid-latitude storms, capable of generating more extreme storm surges and waves than ever observed, are likely due to natural variability. We confirmed previous observations that more extreme storm surges in semi-enclosed basins can be caused by slowing down the speed of movement of the storm, and we provide a novel explanation in terms of slower storm propagation allowing the dynamical response to approach equilibrium. We did not find any significant changes to maximum wave heights at the coast, with changes largely confined to deeper water. Many other regions of the world experience storm surges driven by mid-latitude weather systems. Our approach could therefore be adopted more widely to identify physically plausible, low probability, potentially catastrophic coastal flood events and to assist with major incident planning. [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]

Background: Recent deliberations by Australian public health researchers and practitioners produced an ethical framework of how decisions should be made to distribute pandemic influenza vaccine. The outcome of the deliberations was that the population should be considered in two categories, Level 1 and Level 2, with Level 1 groups being offered access to the pandemic influenza vaccine before other groups. However, the public health researchers and practitioners recognised the importance of making space for public opinion and sought to understand citizens values and preferences, especially First Nations peoples. Methods: We conducted First Nations Community Panels in two Australian locations in 2019 to assess First Nations people's informed views through a deliberative process on pandemic influenza vaccination distribution strategies. Panels were asked to make decisions on priority levels, coverage and vaccine doses. Results: Two panels were conducted with eighteen First Nations participants from a range of ages who were purposively recruited through local community networks. Panels heard presentations from public health experts, cross-examined expert presenters and deliberated on the issues. Both panels agreed that First Nations peoples be assigned Level 1 priority, be offered pandemic influenza vaccination before other groups, and be offered two doses of vaccine. Reasons for this decision included First Nations people's lives, culture and families are important; are at-risk of severe health outcomes; and experience barriers and challenges to accessing safe, quality and culturally appropriate healthcare. We found that communication strategies, utilising and upskilling the First Nations health workforce, and targeted vaccination strategies are important elements in pandemic preparedness and response with First Nations peoples. Conclusions: First Nations Community Panels supported prioritising First Nations peoples for pandemic influenza vaccination distribution and offering greater protection by using a two-dose full course to fewer people if there are initial supply limitations, instead of one dose to more people, during the initial phase of the vaccine roll out. The methodology and findings can help inform efforts in planning for future pandemic vaccination strategies for First Nations peoples in Australia. [ABSTRACT FROM AUTHOR]

Simple Summary: Employee mental health is a strategic initiative for global organizations and maintaining staff wellbeing is a key focus for British horseracing. Workforce wellbeing is increasingly linked to employee recruitment, retention, and productivity, challenges currently facing the horseracing sector. Improving staff wellbeing is paramount to maintaining high standards of equine welfare, ensuring the industry's social license to operate is upheld. Research in horseracing has identified a range of factors influencing staff wellbeing; however, the role of injury in anxiety and depression scores is unknown for this population. Over two thirds of injured staff were experiencing anxiety and over half were experiencing depression. Anxiety and depression scores were related to employment status, working hours, and type of injury. Higher anxiety and depression scores were negatively associated with help-seeking and pain management behaviors during injury, as well as increased risk of using alcohol as a coping method, both for pain-relief at work and socially. The findings from this study may provide opportunities to influence mental health post-injury within horseracing, through the development of educational resources aimed at reducing stigma, improving mental health literacy, and developing industry-wide early screening protocols for mental health in injured staff. Horseracing has identified several factors influencing staff wellbeing; however, the relationship between injury, anxiety, and depression is yet to be established. This study investigated anxiety and depression scores and their association to pain management, coping, and help-seeking behaviour in injured British horseracing staff. An online retrospective survey was completed by 175 participants, identifying injury prevalence, coping strategies, occupational risk factors, and Hospital Anxiety and Depression Scale (HADS) scores. Analysis identified 65.14% (n = 114) of staff reported anxiety scores above the threshold (≥8) and 59.52% (n = 104) of staff reported depression scores ≥8. Median anxiety and depression scores were higher for staff who viewed their employer as unhelpful (anxiety p = 0.001; depression p = 0.020). Heightened anxiety and depression were associated with an increased likelihood to use pain medication to manage at work, including non-steroidal anti-inflammatory drugs (NSAID's), alcohol, nicotine, and prescription drugs (p < 0.05). Implications for staff wellbeing is evident; anxiety and depression risks are high following injury, which may influence help-seeking behaviour, perceived job security, and coping mechanisms. This paper suggests it is vital to continue to investigate poor mental health and injury in racing staff and the implications for equine welfare. [ABSTRACT FROM AUTHOR]

Simple Summary: In the sport of Para dressage, the combined performance of the Para athlete and the horse is judged subjectively. To provide a level playing field for athletes with a wide range of impairments, Para dressage athletes are classified based on the degree to which their impairment impacts sports performance. This study aimed to evaluate the effects of impairment on objective performance measures in Para athletes as a step towards developing an evidence-based classification system. Two groups of athletes comprising twenty-one elite Para athletes (classified grades I to V) and eleven non-disabled athletes (competing at Prix St. Georges or Grand Prix) were measured while performing a 2 min custom dressage test on a riding simulator and clinically assessed using a battery of impairment assessment tools. Statistical analysis considered the extent to which performance could be predicted from impairment measures. Impairment assessment tools related to sitting function could predict the impact of impairment on performance in Para athletes but not in non-disabled athletes. These findings provide evidence of sport-specific impairment assessments that could be used to enhance athlete classification. These findings pave the way for further studies using similar approaches to enhance the objectivity of classification between grades. This study follows a previously defined framework to investigate the impact of impairment on performance in Para dressage athletes. Twenty-one elite Para dressage athletes (grades I to V) and eleven non-disabled dressage athletes (competing at Prix St. Georges or Grand Prix) participated. Data were collected in two phases: performing a two minute custom dressage test on a riding simulator while kinematic data were synchronously collected using inertial measurement units (2000 Hz) and optical motion capture (100 Hz), and clinically assessed using a battery of impairment assessment tools administered by qualified therapists. Impairment and performance measures were compared between Para and non-disabled athletes. Significant differences between athlete groups were found for all impairment measures and two performance measures: simulator trunk harmonics (p = 0.027) and athlete trunk dynamic symmetry (p < 0.001). Impairment assessments of sitting function and muscle tone could predict 19 to 35% of the impact of impairment on performance in Para athletes but not in non-disabled athletes. These findings provide the basis for a robust, scientific evidence base, which can be used to aid in the refinement of the current classification system for Para dressage, to ensure that it is in line with the International Paralympic Committee's mandate for evidence-based systems of classification. [ABSTRACT FROM AUTHOR]

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

Few socially recognized death customs are available for bereaved pet owners, who may experience adverse mental health as a result of disenfranchisement and other complications surrounding pet loss. Additionally, pet owners can experience complex grief when the death is by euthanasia. When a human loved one dies, societal infrastructures allow mourners to express loss through death rites. Such customs often include a eulogy; a traditional testimony of praise which serves a number of functions in human bereavement, allowing the mourner to celebrate the life of the deceased, publicly validating their loss, and facilitating a "letting go." This study assessed the value of eulogy writing as a therapeutic memorial device for bereaved pet owners. The text of 19 human-style pet eulogies, provided by professional celebrants, was investigated using inductive thematic analysis and emerging themes revealed two higher order categories: Structural Content and Emotional Content. Lower-order Structural Content themes included references to "biographical detail" of the pet, "relationships," "spirituality," and "death." Lower-order Emotional Content themes included the strong presence of "love" and "joy/happiness," as well as "sadness" and "guilt" around euthanasia. Similarities in content and structure were found between pet and human eulogies: praising the deceased and describing fond memories and happy times spent together. This suggests that human and pet eulogies may also share similar therapeutic benefits: allowing mourners to "let go," providing validation, and a means of retaining a remembrance bond with the pet. We suggest that eulogy writing could offer a powerful tool to allow bereaved owners to process their loss within a positive framework, and recommend that supporting professionals, like veterinarians, social workers and bereavement counsellors, should consider exploring the use of eulogy writing as a coping-strategy option for vulnerable bereaved clients. [ABSTRACT FROM AUTHOR]

The ethical principles of avoiding harm and supporting autonomy are relevant to cancer-screening policy. We argue that more attention needs to be given to implementing them. Cancer screening may deliver excessive harms due to low-value or outdated screening programs and from poorly communicated screening options that leave people with heavy burdens of decision-making. Autonomy is inadequately supported due to limited opportunities for people to understand downsides of screening and because of institutional and societal pressures in favour of screening. Members of screening policy committees may have differing ideas about the goals of screening or have conflicts of interest that prevent them from addressing policy questions in a neutral way. We recommend the following: 1. Committees should be required to discern and discuss the values of individual members and the wider public; 2. Committee membership and voting procedures should be more carefully constructed to reduce the likelihood that committee members' interests are placed above public interests; 3. Committees should explain their policy decisions with reference to values as well as evidence, so that values considered in decision-making can be interrogated and challenged if necessary. These changes would increase the likelihood that cancer-screening policy decisions are in keeping with public views about what is important. [ABSTRACT FROM AUTHOR]

The governance of healthcare organizations is becoming more complex and is prompting changes in board structure and membership. The presence and contributions of nurses on governance structures will favorably influence the future of health care. The essentials of baccalaureate nursing education, along with the general education curriculum, provide learning opportunities that result in nursing students developing the leadership skills needed to serve on hospital and healthcare boards. The purpose of this article is to present the perspective that graduates of baccalaureate nursing programs possess the foundation to participate as members of hospital and healthcare boards. This perspective is supported by the results of a survey of nursing faculty, many who have served or currently serve on healthcare boards and who provided overwhelming agreement that the foundational skills required for board participation are provided by the nursing curriculum. [ABSTRACT FROM AUTHOR]