In order to study early human development while avoiding the burdens associated with human embryo research, scientists are redirecting their efforts towards so-called human embryo-like structures (hELS). hELS are created from clusters of human pluripotent stem cells and seem capable of mimicking early human development with increasing accuracy. Notwithstanding, hELS research finds itself at the intersection of historically controversial fields, and the expectation that it might be received as similarly sensitive is prompting proactive law reform in many jurisdictions, including the Netherlands. However, studies on the public perception of hELS research remain scarce. To help guide policymakers and fill this gap in the literature, we conducted an explorative qualitative study aimed at mapping the range of perspectives in the Netherlands on the creation and research use of hELS. This article reports on a subset of our findings, namely those pertaining to (the degrees of and requirements for) confidence in research with hELS and its regulation. Despite commonly found disparities in confidence on emerging biotechnologies, we also found wide consensus regarding the requirements for having (more) confidence in hELS research. We conclude by reflecting on how these findings could be relevant to researchers and (Dutch) policymakers when interpreted within the context of their limitations.

BACKGROUND: The COVID-19 pandemic increased the likelihood of child maltreatment and made already difficult circumstances for children and their families much worse. This increased the significance of the child protection system\'s role in responding to child maltreatment and ensuring children\'s rights, including their right to a safe life without violence. Unfortunately, accumulating evidence has indicated that the rates of child maltreatment increased during the pandemic.
OBJECTIVE: The current study sought to identify the gaps within child protection responses in various countries during the COVID-19 pandemic and to discover how we can respond to crises in the future while preserving children\'s rights, including their right to protection from maltreatment.
METHODS: Five focus groups with a total of 47 professionals working with children from various countries were conducted via Zoom and analyzed using a thematic approach.
RESULTS: Three main themes were identified: 1) gaps in policies, 2) gaps in practice, and 3) professionals\' messages to improve policy and practice.
CONCLUSIONS: This study emphasizes what was missed in child protection policy and practice, highlighting the continuous neglect of children\'s needs and voices within policies, practices and guidelines worldwide during the pandemic. Professionals\' recommendations for policy and practice are also discussed.

Pathology in the GDR was firmly rooted in the tradition of German pathology. Further training imparted sound morphological knowledge. Until the late 1970s, it was primarily autopsy pathology. Scientific relations with the West-with centers where the discipline was developing dynamically-were severely hampered for political reasons; normal conference attendance was reserved for a few selected cadres. The inefficiency of the planned economy led to increasing material bottlenecks. GDR pathology had become a relic by the end of the GDR regime.
UNASSIGNED: Die Pathologie in der DDR stand fest in der Tradition der deutschen Pathologie. Die Weiterbildung vermittelte fundierte morphologische Kenntnisse. Bis in die späten 1970er-Jahre war sie in erster Linie Obuktionspathologie. Wissenschaftliche Beziehungen mit dem Westen – vor allem mit Zentren, wo sich das Fach dynamisch entwickelte – waren aus politischen Gründen stark behindert; normale Tagungsbesuche waren nur wenigfen ausgewählten Kadern möglich. Die ineffiziente Planwirtschaft führte zu zunehmenden materiellen Engpässen. Am Ende des DDR-Regimes wurde die Pathologie zum Relikt.

Over-the-counter hearing aids have been available to consumers in the US since 17 October 2022 following a ruling by the Food and Drug Administration. However, their reception by hearing healthcare professionals (HHP) has been mixed, and concerns have been expressed by many HHPs. The aim of this study was to examine the concerns that HHPs have towards over-the-counter (OTC) hearing aids. The study used a retrospective survey design. The survey data of HHPs (n = 730) was obtained from Hearing Tracker. A 22-item structured questionnaire was administered using a Question Scout platform. Descriptive analyses examined reported areas of concern and a Fisher\'s exact test examined the relationship between demographics and responses. A cluster analysis with partitioning around medoids (PAM) was used to identify a sub-group of participants based on responses. Nearly half of HHPs who participated reported that they will support patients with OTC hearing aids purchased elsewhere, whereas a quarter reported that they will sell OTC hearing aids in their clinic or website. HHPs expressed over 70% agreement in \'concern\' statements in 14 of the 17 items. Issues about safety, counseling, and audiological care were the key concerns expressed by HHPs about OTC hearing aids. Some demographics (i.e., profession, primary position) were associated with responses to some statements. Two groups were identified based on the responses to concern statements. The HHPs in the first cluster \'OTC averse\' (51%) agreed on all the 17 concern statements, whereas the second cluster \'OTC apprehensive\' (49%) had some items rated as disagree (i.e., consumers will give up on amplification) and neither agree nor disagree (i.e., do not provide good value, warranties and return periods will be worse), and remaining items were rated as agree. OTC hearing aids were initiated to improve affordability, accessibility, and hearing aid uptake and are currently a rapidly emerging category of hearing devices. Overall, the results of the current study indicate that HHPs have serious concerns about OTC hearing aids. HHP concerns cited in this study provide useful feedback to stakeholders (e.g., HHP professional agencies, FDA, industry, and insurance payers) involved in improving OTC hearing aid implementation.

OBJECTIVE: To examine interprofessional healthcare professionals\' perceptions of triggers and root causes of moral distress.
METHODS: Qualitative description of open-text comments written on the Moral Distress Scale-Revised survey.
METHODS: A subset of interprofessional providers from a parent study provided open-text comments that originated from four areas of the Moral Distress Scale-Revised, including the margins of the 21-item questionnaire, the designated open-text section, shared perceptions of team communication and dynamics affecting moral distress, and the section addressing an intent to leave a clinical position because of moral distress. Open-text comments were captured, coded, and divided into meaning units and themes using systematic text condensation.
METHODS: Twenty-eight of the 223 parent study participants completing the Moral Distress Scale-Revised shared comments on situations contributing to moral distress.
RESULTS: All 28 participants working in the four medical center intensive care units reported feelings of moral distress. Feelings of moral distress were associated with professional anguish over patient care decisions, team, and system-level factors. Professional-level contributors reflected clinician concerns of continuing life support measures perceived not in the patient\'s best interest. Team and unit-level factors were related to poor communication, bullying, and a lack of collegial collaboration. System-level factors included clinicians feeling unsupported by senior administration and institutional culpability as a result of healthcare processes and system constraints impeding reliable patient care delivery.
METHODS: Approval was obtained from the Institutional Review Board (IRB) of the University of Texas Health IRB and the organization in which the study was conducted.
CONCLUSIONS: Moral distress was associated with feelings of anguish, professional intimidation, and organizational factors that impacted the delivery of ethically based patient care. Participants expressed a sense of awareness that they may experience ethical dilemmas as a consequence of the changing reality of providing healthcare within complex healthcare systems. Strategies to combat moral distress should target team and system interventions designed to improve interprofessional collaboration and support professional ethical values and moral commitments of all healthcare providers.

OBJECTIVE: Adherence to adjuvant endocrine therapy (AET) is suboptimal, and a range of variables have been explored for understanding patients\' experiences and motivations for medication-taking. However, oncologists\' views on adherence are poorly understood. The aim of this study was to explore oncologists\' perspectives on adherence/non-adherence and their strategies to ensure patients continue with treatments to inform the development of potential modifiable interventions.
METHODS: A qualitative study using in-depth, semi-structured interviews with 16 oncologists was conducted in Argentina. A stratified purposive sampling was used to recruit female and male participants from 3 health subsystems (private, social security, and public). Data were analyzed using the Framework approach.
RESULTS: Oncologists believed patients\' adherence was overall high and associated it with good tolerance of AET in comparison to chemotherapy, information provided, and patients feeling reassured (fear of recurrence). Non-adherence was not perceived as a major source of concern, and it was related to rare cases of severe side effects, young age, refusing treatment, losing the insurance plan, lack of education, and social circumstances. Patients\' complaints of bothersome side effects were not identified as a main reason to discontinuation. Public and private sector patients, however, were perceived as having different attitudes toward side effects. Management strategies included medicine change, referral to support services, and a supportive relationship with the oncologist.
CONCLUSIONS: Oncologists\' perspectives on adherence/non-adherence to AET show similarities and significant differences with those in the literature based on patient-reported factors. Overall adherence was considered high, but the likelihood of unintentional non-adherence seems important in public sector patients. Information to patients should provide clear explanations on both severe and unpleasant side effects. Interventions to improve communication skills in oncologists and specialists responsible for survivorship care should be considered to strengthen patients\' self-efficacy and effective medication-taking. Reliable data on adherence are needed.

A fundamental requirement of a supportive language development for young children who need aided communication is that an aided communication system is made available and its use is supported. There is limited information about the age at which children are typically provided with a communication aid or about how aided communication is used in everyday situations. Using questionnaire-based interview data, this study investigated (a) the pattern of provision of communication aids to 84 children and adolescents, (b) parents\' and professionals\' evaluation of the quality of communication across contexts, and (c) availability and use of aided communication in these contexts. The age at which the participants received their first aided system varied considerably across the group; however, most were considerably older than the age at which children with typical development usually begin to speak. Parents and professionals rated most everyday situations as good communication situations but reported that the participants did not have their main form of expressive language available in many of these situations, or did not use it much. Parents rated their child\'s education in relation to aided language positively, but many professionals indicated that they had limited knowledge about the participant\'s use of aided communication outside of the school environment, or about the parents\' attitudes. The study gives insights into the language learning situation of children and adolescents who develop aided communication.

To synthesize experiences of the patient complaints process for patients and health-care professionals to identify facilitators and barriers in the successful implementation of patient complaints processes. This will assist the development of cultural change programmes, enabling complaints managers to incorporate stakeholder perspectives into future care.
Systematic literature search and meta-ethnography, comprising reciprocal syntheses of \"patient\" and \"professional\" qualitative studies, combined to form a \"line-of-argument\" embodying both perspectives.
MEDLINE, CINAHL and PsycINFO (database inception to April 2015) were searched to identify international literature in primary and secondary health-care settings, involving qualitative data collection and analysis. Further studies were identified from hand-searching relevant journals, contacting authors, article reference lists and Google Scholar.
A total of 13 papers, reporting 9 studies from the United Kingdom, Sweden, Australia and New Zealand, were included in the synthesis. Facilitators and barriers to the successful implementation of patient complaints processes were identified across the perspectives of both patients and health-care professionals. Patients sought to individualize the complaints process by targeting specific professionals who engaged in practices that undermined the identity of patients. In contrast, professionals obscured their own individualism through maintaining a collective identity and withholding personal judgement in relation to patient complaints.
Complainants recognized health-care professionals as bearers of individual accountability for unsatisfactory care, in opposition to the stance of collective responsibility endorsed by professionals. Implementation of patient complaints processes must reconcile the need for individualized resolution, whilst striving to improve the future provision of health care through a collaborative approach between patients and professionals.

Healthcare professionals (HCPs) regularly face requests from parents for predictive genetic testing of children for adult-onset conditions. Little is known about how HCPs handle these test requests, given that guidelines recommend such testing is deferred to adulthood unless there is medical benefit to testing before that time. Our study explored the process of decision-making between HCPs and parents. Semi-structured interviews were conducted with 34 HCPs in 8 regional genetic services across the UK, and data were thematically analysed. We found that instead of saying \'yes\' or \'no\' to such requests, many HCPs framed the consultation as an opportunity to negotiate the optimal time of testing. This, they argued, facilitates parents\' considered decision-making, since parents\' eventual decisions after requesting a test was often to defer testing their child. In cases where parents\' requests remained a sustained wish, most HCPs said they would agree to test, concluding that not testing would not serve the child\'s wider best interest. As a strategy for determining the child\'s best interest and for facilitating shared decision-making, we recommend that HCPs re-frame requests for testing from parents as a discussion about the optimal time of testing for adult-onset disease.

The colonisation of Australia has been associated with traumatic consequences for Aboriginal health and wellbeing, including the breakdown of the traditional family unit and negative consequences for the mother/child relationship. Early-intervention programs have been developed to assist families to overcome disadvantage and strengthen mother/child attachment. However, there is no research examining Aboriginal women\'s subjective experiences and constructions of motherhood in the context of such programs, and no research on the perceived impact of such programs, from the perspective of Aboriginal mothers and healthcare workers (HCWs), with previous research focusing on child outcomes.
Researchers conducted participant observation of an early intervention program for Aboriginal mothers and young children over a 6 month period, one-to-one interviews and a focus group with 10 mothers, and interviews with nine HCWs, in order to examine their perspectives on motherhood and the intervention program.
Thematic analysis identified 2 major themes under which subthemes were clustered. Constructions of motherhood: \'The resilient mother: Coping with life trauma and social stress\' and \'The good mother: Transformation of self through motherhood\'; Perspectives on the intervention: \'\"Mothers come to life\": Transformation through therapy\'; and \'\"I know I\'m a good mum\": The need for connections, skills and time for self\'.
The mothers constructed themselves as being resilient \'good mothers\', whilst also acknowledging their own traumatic life experiences, predominantly valuing the peer support and time-out aspects of the program. HCWs positioned the mothers as \'traumatised\', yet also strong, and expressed the view that in order to improve mother/child attachment a therapeutic transformation is required. These results suggest that early interventions for Aboriginal mothers should acknowledge and strengthen constructions of the good and resilient mother. The differing perspectives of mothers and HCWs on the role and impact of the early intervention program reinforces the need for Aboriginal mothers to be involved in the design and implementation of services aimed at assisting their families.