Methods for the thematic synthesis of qualitative research in systematic reviews

<p>Abstract</p> <p>Background</p> <p>There is a growing recognition of the value of synthesising qualitative research in the evidence base in order to facilitate effective and appropriate health care. In response to this, methods for undertaking these syntheses are currently being developed. Thematic analysis is a method that is often used to analyse data in primary qualitative research. This paper reports on the use of this type of analysis in systematic reviews to bring together and integrate the findings of multiple qualitative studies.</p> <p>Methods</p> <p>We describe thematic synthesis, outline several steps for its conduct and illustrate the process and outcome of this approach using a completed review of health promotion research. Thematic synthesis has three stages: the coding of text 'line-by-line'; the development of 'descriptive themes'; and the generation of 'analytical themes'. While the development of descriptive themes remains 'close' to the primary studies, the analytical themes represent a stage of interpretation whereby the reviewers 'go beyond' the primary studies and generate new interpretive constructs, explanations or hypotheses. The use of computer software can facilitate this method of synthesis; detailed guidance is given on how this can be achieved.</p> <p>Results</p> <p>We used thematic synthesis to combine the studies of children's views and identified key themes to explore in the intervention studies. Most interventions were based in school and often combined learning about health benefits with 'hands-on' experience. The studies of children's views suggested that fruit and vegetables should be treated in different ways, and that messages should not focus on health warnings. Interventions that were in line with these suggestions tended to be more effective. Thematic synthesis enabled us to stay 'close' to the results of the primary studies, synthesising them in a transparent way, and facilitating the explicit production of new concepts and hypotheses.</p> <p>Conclusion</p> <p>We compare thematic synthesis to other methods for the synthesis of qualitative research, discussing issues of context and rigour. Thematic synthesis is presented as a tried and tested method that preserves an explicit and transparent link between conclusions and the text of primary studies; as such it preserves principles that have traditionally been important to systematic reviewing.</p

Understanding children’s constructions of meanings about other children: implications for inclusiveeducation

This paper explores the factors that influence the way children construct meanings about other children, and especially those who seem to experience marginalisation, within school contexts. The research involved an ethnographic study in a primary school in Cyprus over a period of 5 months. Qualitative methods were used, particularly participant observations and interviews with children. Interpretation of the data suggests that children's perceptions about other children, and especially those who come to experience marginalisation, are influenced by the following factors: other children and the interactions between them; adults’ way of behaving in the school; the existing structures within the school; and the cultures of the school and the wider educational context. Even though the most powerful factor was viewed to be the adults’ influence, it was rather the interweaving between different factors that seemed to lead to the creation of particular meanings for other children. In the end, it is argued that children's voices should be seen as an essential element within the process of developing inclusive practices.<br/

Tragedy revisited

“Freedom in a commons brings ruin to all.” So argued ecologist Garrett Hardin in “The Tragedy of the Commons” in the 13 December 1968 issue of Science (1). Hardin questioned society's ability to manage shared resources and avoid an environmentally and socially calamitous free-for-all. In the 50 years since, the essay has influenced discussions ranging from climate change (see page 1217) to evolution, from infectious disease to the internet, and has reached far beyond academic literature—but not without criticism. Considerable work, notably by Nobelist Elinor Ostrom (2), has challenged Hardin, particularly his emphasis on property rights and government regulatory leviathans as solutions. Instead, research has documented contexts, cases, and principles that reflect the ability of groups to collectively govern common resources. To mark this anniversary and celebrate the richness of research and practice around commons and cooperation, Science invited experts to share some contemporary views on such tragedies and how to avert them. —Brad Wibl

Eight urgent, fundamental and simultaneous steps needed to restore ocean health, and the consequences for humanity and the planet of inaction or delay

The ocean crisis is urgent and central to human wellbeing and life on Earth; past and current activities are damaging the planet's main life support system for future generations. We are witnessing an increase in ocean heat, disturbance, acidification, bio‐invasions and nutrients, and reducing oxygen levels. Several of these act like ratchets: once detrimental or negative changes have occurred, they may lock in place and may not be reversible, especially at gross ecological and ocean process scales. Each change may represent a loss to humanity of resources, ecosystem function, oxygen production and species. The longer we pursue unsuitable actions, the more we close the path to recovery and better ocean health and greater benefits for humanity in the future. We stand at a critical juncture and have identified eight priority issues that need to be addressed in unison to help avert a potential ecological disaster in the global ocean. They form a purposely ambitious agenda for global governance and are aimed at informing decision‐makers at a high level. They should also be of interest to the general public. Of all the themes, the highest priority is to rigorously address global warming and limit surface temperature rise to 1.5°C by 2100, as warming is the pre‐eminent factor driving change in the ocean. The other themes are establishing a robust and comprehensive High Seas Treaty, enforcing existing standards for Marine Protected Areas and expanding their coverage, especially in terms of high levels of protection, adopting a precautionary pause on deep‐sea mining, ending overfishing and destructive fishing practices, radically reducing marine pollution, putting in place a financing mechanism for ocean management and protection, and lastly, scaling up science/data gathering and facilitating data sharing. By implementing all eight measures in unison, as a coordinated strategy, we can build resilience to climate change, help sustain fisheries productivity, particularly for low‐income countries dependent on fisheries, protect coasts (e.g. via soft‐engineering/habitat‐based approaches), promote mitigation (e.g. carbon storage) and enable improved adaptation to rapid global change.The attached document is the author(’s’) final accepted/submitted version of the journal article. You are advised to consult the publisher’s version if you wish to cite from it

Mutational signatures in esophageal adenocarcinoma define etiologically distinct subgroups with therapeutic relevance

Esophageal adenocarcinoma (EAC) has a poor outcome, and targeted therapy trials have thus far been disappointing owing to a lack of robust stratification methods. Whole-genome sequencing (WGS) analysis of 129 cases demonstrated that this is a heterogeneous cancer dominated by copy number alterations with frequent large-scale rearrangements. Co-amplification of receptor tyrosine kinases (RTKs) and/or downstream mitogenic activation is almost ubiquitous; thus tailored combination RTK inhibitor (RTKi) therapy might be required, as we demonstrate in vitro. However, mutational signatures showed three distinct molecular subtypes with potential therapeutic relevance, which we verified in an independent cohort (n = 87): (i) enrichment for BRCA signature with prevalent defects in the homologous recombination pathway; (ii) dominant T>G mutational pattern associated with a high mutational load and neoantigen burden; and (iii) C>A/T mutational pattern with evidence of an aging imprint. These subtypes could be ascertained using a clinically applicable sequencing strategy (low coverage) as a basis for therapy selection

Multicentre cohort study to define and validate pathological assessment of response to neoadjuvant therapy in oesophagogastric adenocarcinoma

BACKGROUND: This multicentre cohort study sought to define a robust pathological indicator of clinically meaningful response to neoadjuvant chemotherapy in oesophageal adenocarcinoma. METHODS: A questionnaire was distributed to 11 UK upper gastrointestinal cancer centres to determine the use of assessment of response to neoadjuvant chemotherapy. Records of consecutive patients undergoing oesophagogastric resection at seven centres between January 2000 and December 2013 were reviewed. Pathological response to neoadjuvant chemotherapy was assessed using the Mandard Tumour Regression Grade (TRG) and lymph node downstaging. RESULTS: TRG (8 of 11 centres) was the most widely used system to assess response to neoadjuvant chemotherapy, but there was discordance on how it was used in practice. Of 1392 patients, 1293 had TRG assessment; data were available for clinical and pathological nodal status (cN and pN) in 981 patients, and TRG, cN and pN in 885. There was a significant difference in survival between responders (TRG 1–2; median overall survival (OS) not reached) and non-responders (TRG 3–5; median OS 2·22 (95 per cent c.i. 1·94 to 2·51) years; P < 0·001); the hazard ratio was 2·46 (95 per cent c.i. 1·22 to 4·95; P = 0·012). Among local non-responders, the presence of lymph node downstaging was associated with significantly improved OS compared with that of patients without lymph node downstaging (median OS not reached versus 1·92 (1·68 to 2·16) years; P < 0·001). CONCLUSION: A clinically meaningful local response to neoadjuvant chemotherapy was restricted to the small minority of patients (14·8 per cent) with TRG 1–2. Among local non-responders, a subset of patients (21·3 per cent) derived benefit from neoadjuvant chemotherapy by lymph node downstaging and their survival mirrored that of local responders

Authentication and characterisation of a new oesophageal adenocarcinoma cell line: MFD-1.

New biological tools are required to understand the functional significance of genetic events revealed by whole genome sequencing (WGS) studies in oesophageal adenocarcinoma (OAC). The MFD-1 cell line was isolated from a 55-year-old male with OAC without recombinant-DNA transformation. Somatic genetic variations from MFD-1, tumour, normal oesophagus, and leucocytes were analysed with SNP6. WGS was performed in tumour and leucocytes. RNAseq was performed in MFD-1, and two classic OAC cell lines FLO1 and OE33. Transposase-accessible chromatin sequencing (ATAC-seq) was performed in MFD-1, OE33, and non-neoplastic HET1A cells. Functional studies were performed. MFD-1 had a high SNP genotype concordance with matched germline/tumour. Parental tumour and MFD-1 carried four somatically acquired mutations in three recurrent mutated genes in OAC: TP53, ABCB1 and SEMA5A, not present in FLO-1 or OE33. MFD-1 displayed high expression of epithelial and glandular markers and a unique fingerprint of open chromatin. MFD-1 was tumorigenic in SCID mouse and proliferative and invasive in 3D cultures. The clinical utility of whole genome sequencing projects will be delivered using accurate model systems to develop molecular-phenotype therapeutics. We have described the first such system to arise from the oesophageal International Cancer Genome Consortium project.Cancer Research UK, Medical Research CouncilThis is the final version of the article. It first appeared from Nature Publishing Group via http://dx.doi.org/10.1038/srep3241

Social equity is key to sustainable ocean governance

Calls to address social equity in ocean governance are expanding. Yet ‘equity’ is seldom clearly defined. Here we present a framework to support contextually-informed assessment of equity in ocean governance. Guiding questions include: (1) Where and (2) Why is equity being examined? (3) Equity for or amongst Whom? (4) What is being distributed? (5) When is equity considered? And (6) How do governance structures impact equity? The framework supports consistent operationalization of equity, challenges oversimplification, and allows evaluation of progress. It is a step toward securing the equitable ocean governance already reflected in national and international commitments

Accelerating ocean species discovery and laying the foundations for the future of marine biodiversity research and monitoring

This is the final version. Available from Frontiers Media via the DOI in this record. Ocean Census is a new Large-Scale Strategic Science Mission aimed at accelerating the discovery and description of marine species. This mission addresses the knowledge gap of the diversity and distribution of marine life whereby of an estimated 1 million to 2 million species of marine life between 75% to 90% remain undescribed to date. Without improved knowledge of marine biodiversity, tackling the decline and eventual extinction of many marine species will not be possible. The marine biota has evolved over 4 billion years and includes many branches of the tree of life that do not exist on land or in freshwater. Understanding what is in the ocean and where it lives is fundamental science, which is required to understand how the ocean works, the direct and indirect benefits it provides to society and how human impacts can be reduced and managed to ensure marine ecosystems remain healthy. We describe a strategy to accelerate the rate of ocean species discovery by: 1) employing consistent standards for digitisation of species data to broaden access to biodiversity knowledge and enabling cybertaxonomy; 2) establishing new working practices and adopting advanced technologies to accelerate taxonomy; 3) building the capacity of stakeholders to undertake taxonomic and biodiversity research and capacity development, especially targeted at low- and middle-income countries (LMICs) so they can better assess and manage life in their waters and contribute to global biodiversity knowledge; and 4) increasing observational coverage on dedicated expeditions. Ocean Census, is conceived as a global open network of scientists anchored by Biodiversity Centres in developed countries and LMICs. Through a collaborative approach, including co-production of science with LMICs, and by working with funding partners, Ocean Census will focus and grow current efforts to discover ocean life globally, and permanently transform our ability to document, describe and safeguard marine species.Nippon Foundatio