To investigate and compare the extent of shared decision making (SDM) in orthodontics from the perspective of patients, clinicians and independent observers.
 
  A cross-sectional, observational study.
 
  NHS teaching hospital.
 
  A total of 31 adult patients and their treating clinicians were included in the study.
 
  The extent of SDM in new patient orthodontic consultations was measured using three versions of a validated instrument the self-administered patient dyadic-OPTION scale; the self-administered clinician dyadic-OPTION scale; and an independent observer-rated OPTION
  scale. Patients and clinicians completed the 12-item dyadic-OPTION questionnaire independently at the end of the consultation to rate their perceived levels of SDM. The consultations were also audio-recorded and two calibrated raters independently rated the extent of SDM in these consultations using the OPTION
  scale.
 
  There was excellent inter-rater reliability between the two independent raters using the OPTION
  scale (intraclass correlation coefficient (ICC) = 0.909). The mean patient, clinician and independent observer OPTION scores for SDM were 90.4% (SD 9.1%, range 70.8% to 100%), 76.2% (SD 8.95%, range 62.5% to 95.8%) and 42.6% (SD 17.4%, range 13.5% to 68.8%), respectively. There was no significant correlation between the OPTION scores for the three groups (ICC = -0.323).
 
  The results showed that generally high levels of SDM were perceived by patients and clinicians but lower levels of SDM were scored by the independent observers. However, it could be argued that the patient's perception of SDM is the most important measure as it is their care that is affected by their involvement.
 The results showed that generally high levels of SDM were perceived by patients and clinicians but lower levels of SDM were scored by the independent observers. However, it could be argued that the patient's perception of SDM is the most important measure as it is their care that is affected by their involvement.IntroductionCurrent challenges to successful clinical translation of therapeutic nanomedicine have discouraged many stakeholders, including patients. Significant effort has been devoted to uncovering the reasons behind the less-than-expected success, beyond failures or ineffectiveness, of therapeutic nanomedicine products (e.g. cancer nanomedicine). Until we understand and address the factors that limit the safety and efficacy of NPs, both individually and in combination, successful clinical development will lag.Areas coveredThis review highlights the critical roles of interdependent factors affecting the safety and therapeutic efficacy of therapeutic NPs for drug delivery applications.Expert opinionDeep analysis of the current nanomedical literature reveals ahistory of unanticipated complexity by awide range of stakeholders including researchers. In the manufacture of nanomedicines themselves, there have been persistent difficulties with reproducibility and batch-to-batch variation. The unanticipated complexity and interdependency of nano-bio parameters has delayed our recognition of important factors affecting the safety and therapeutic efficacy of nanomedicine products. These missteps have had many factors including our lack of understanding of the interdependency of various factors affecting the biological identity and fate of NPs and biased interpretation of data. All these issues could raise significant concern regarding the reproducibility- or even the validity- of past publications that in turn formed the basis of many clinical trials of therapeutic nanomedicines. Therefore, the individual and combined effects of previously overlooked factors on the safety and therapeutic efficacy of NPs need to be fully considered in nanomedicine reports and product development.
  Excessive adversity in childhood can have long-term consequences on health and well-being. One group of children that may be at risk are those who grow up with a parent with Huntington's disease (HD). Despite this, there is little knowledge about how these children are impacted by adversity. We aimed to explore adverse childhood experiences (ACEs) of individuals who grew up with a parent with HD and their perceptions of caregiver support.
 
  Semi-structured qualitative interviews of 36 adults and adolescents were analysed using interpretative phenomenological analysis (IPA).
 
  First, the analysis revealed a range of frequent adverse events during participants' childhoods, leading to feelings of uncertainty, loss, fear, and a lack of care. Next, how the presence or absence of support had impacted participants' perceptions of these experiences was analysed. Results showed that participants without support were often overwhelmed by feelings of stress, whereas participants with support tolerated adversity better.
 
  Findings suggest that children in families with HD can be exposed to a range of adverse experiences. Findings also suggest that sufficient support from a caregiver without HD can buffer or protect against negative consequences of these experiences.
 Findings suggest that children in families with HD can be exposed to a range of adverse experiences. Findings also suggest that sufficient support from a caregiver without HD can buffer or protect against negative consequences of these experiences.The National Institute of Environmental Health Sciences Worker Training Program piloted an Opioids and the Workplace Prevention and Response training tool and program in 2019. The pilot trainees (N = 97) were surveyed (n = 27) and interviewed (n = 6) six months posttraining, and those who downloaded the training tool from the Worker Training Program website (n = 87) were surveyed (n = 19) and interviewed (n = 1) two to six months postdownload, to evaluate the impact of the training program. Workplace policy and program-level actions were reported less frequently than individual-level actions by trainees, except for planning and conducting training and education. Barriers to taking actions included not being able to make changes on their own without supervisor support and lack of upper management support and approval.  https://www.selleckchem.com/products/Nolvadex.html  We found some evidence that the Opioids in the Workplace training program and materials contributed to helping workers introduce policies and programs related to opioids within their workplace or union.