Collaborating with Wheat Producers in Demonstrating Areawide Integrated Pest Management

Focus groups were used to initiate collaborative relationships with wheat producers while learning about their farming history and decision-making. Focus group transcripts illustrate that producers were less confident in evaluating insect management problems compared to weed management. Producers do rely on Cooperative Extension in managing insect problems. Extension educators continue to play an important role in increasing producer\u27s knowledge of simplified field scouting and insect identification technology

Microbial control of diatom bloom dynamics in the open ocean

Diatom blooms play a central role in supporting foodwebs and sequestering biogenic carbon to depth. Oceanic conditions set bloom initiation, whereas both environmental and ecological factors determine bloom magnitude and longevity. Our study reveals another fundamental determinant of bloom dynamics. A diatom spring bloom in offshore New Zealand waters was likely terminated by iron limitation, even though diatoms consumed <1/3 of the mixed-layer dissolved iron inventory. Thus, bloom duration and magnitude were primarily set by competition for dissolved iron between microbes and small phytoplankton versus diatoms. Significantly, such a microbial mode of control probably relies both upon out-competing diatoms for iron (i.e., K-strategy), and having high iron requirements (i.e., r-strategy). Such resource competition for iron has implications for carbon biogeochemistry, as, blooming diatoms fixed three-fold more carbon per unit iron than resident non-blooming microbes. Microbial sequestration of iron has major ramifications for determining the biogeochemical imprint of oceanic diatom blooms. Citation: Boyd, P. W., et al. (2012), Microbial control of diatom bloom dynamics in the open ocean, Geophys. Res. Lett., 39, L18601

Prevalence of sleep disordered breathing in a population of Canadian grainworkers

OBJECTIVES: To determine the prevalence of sleep disordered breathing (SDB) in a Canadian population of industrial workers (grainworkers). To determine the clinical features that are predictive of SDB and the validity of self-reported snoring. DESIGN: Cross-sectional, interviewer-administered questionnaire with selective recruitment of subjects for home sleep monitoring. SETTING: Community setting, Vancouver, British Columbia. PARTICIPANTS: All male grainworkers at grain elevators in Vancouver were approached for completion of a questionnaire. Eighty-three per cent of 524 subjects completed the questionnaire and were divided by presumed risk for SDB into four groups. All subjects in the highest risk group (group 1-frequent snoring and witnessed apneas) and a random sample of 40 subjects in the other three groups (group 2 -frequent snoring without witnessed apneas; group 3 -infrequent snoring rare; group 4 -nonsnoring) were approached for home sleep monitoring and 42% consented. INTERVENTIONS: Interviewer-administered questionnaire and home sleep monitoring. RESULTS: The overall prevalence of SDB in this relatively overweight group was estimated to be 25%, with a stepwise increase from group 4 to group 1 (7%, 29%, 40%, 60%). Presence of snoring and witnessed apneas, a greater body-mass index and a larger neck circumference were associated with SDB. Self-reported snoring was not found to be predictive. CONCLUSIONS: This first study of the prevalence of SDB in Canada suggests that SDB is at least as prevalent in Canada as in other industrialized nations and may actually be more common than previously thought. Further studies are required to determine the morbidity, mortality and economic loss associated with SDB in industrial workers. Key Words: Home monitoring, Obstructive sleep apnea, Screening, Self-reported snoring, Sleep disordered breathing Prévalence des troubles respiratoires du sommeil dans une population de travailleurs du grain OBJECTIFS : Déterminer la prévalence des troubles respiratoires du sommeil dans une population canadienne de travailleurs de l&apos;industrie du grain. Déterminer les caractéristiques cliniques prédictives des troubles respiratoires du sommeil et la validité du ronflement signalé par les sujets eux-mêmes. MODÈLE : Questionnaire transversal rempli par un intervieweur et recrutement sélectif de sujets pour mener des études du sommeil à domicile. CONTEXTE : Dans la communauté de Vancouver en Colombie-Britannique. PARTICIPANTS : On a demandé à tous les sujets de sexe masculin travaillant dans les silos à grains de répondre à un questionnaire. Quatre-vingt-trois pour cent des 524 sujets ont complété le questionnaire ; ils étaient divisés en quatre groupes selon le risque présumé de troubles respiratoires du sommeil. On a demandé à tous les sujets du groupe à risque le plus élevé (groupe 1 -ronflement fréquent et apnées observées) et un échantillon aléatoire de 40 sujets dans les trois autres groupes (groupe 2 -ronflement fréquent sans apnées observées ; groupe 3 -rare ronflement occasionnel ; groupe 4 -aucun ronflement) de subir des études de sommeil à domicile. Quarante-deux pour cent des sujets ont consenti à subir de telles études. INTERVENTIONS : Questionnaire rempli par un intervieweur et études du sommeil à domicile. RÉSULTATS : La prévalence globale des troubles respiratoires du sommeil dans cette population relativement obèse a été estimée à 25 %, avec une augmentation par paliers du groupe 4 jusqu&apos;au groupe 1 (7 %, 29 %, 40 %, 60 %). Le ronflement et les apnées observées, un index de masse corporelle plus élevé et un tour du cou plus grand étaient associés à des troubles respiratoires du sommeil. voir page suivante S leep disordered breathing (SDB), including obstructive sleep apnea and obstructive sleep hypopnea, is associated with significant mortality (1,2) and morbidity (3). SDB is most common in middle-aged men, but its true prevalence in this group is still being determined. While early studies estimated the prevalence of SDB to be 0.9% and 1.3%, (4,5) more recent studies from the United States and Australia (6-8) have reported prevalence rates of SDB in middle-aged men to be in the range of 10% to 15%. To date there have been no published studies of the prevalence of SDB in Canada. The main objective of this study was to obtain an estimate of the prevalence of SDB in industrial workers, using a population of men working at grain elevators in Vancouver, British Columbia as a model. To achieve this objective we studied subjects with all levels of risk for SDB. A secondary objective was to determine which clinical features and anthropometric data were predictive of SDB. We also examined the relationship between self-reported snoring and recorded snoring. PATIENTS AND METHODS Subjects: The target population was men working in grain terminals. The sample frame, for the purpose of this study, consisted of men working at the grain terminals in the Vancouver area. Questionnaire administration: Subjects completed a questionnaire administered by trained interviewers that included questions concerning demographic data, sleep disturbance (snoring, witnessed apneas, daytime sleepiness), smoking history and included the American Thoracic Society Respiratory Disease Questionnaire (9). All subjects had their height, weight, blood pressure and neck circumference measured. The subjects were divided into four groups based on the reported presence of snoring and witnessed apneas: group 1, frequent snoring and witnessed apneas; group 2, frequent snoring without witnessed apneas; group 3, infrequent snoring or rare; group 4, nonsnoring. All subjects in group 1 and a random sample of 40 subjects in groups 2 to 4 were approached about overnight home sleep monitoring. Subjects who consented formed the sample population for determining SDB prevalence. Home sleep monitoring: Home sleep was monitored using the Mesam 4 (Madaus Medizin Elektronik, Freiburg, Germany) (10). The Mesam 4 is a four-channel digital recording device. The Mesam system has been validated in two previous studies (10,11). A polysomnographic technologist, trained in the use of the Mesam 4, set up the device at the subject&apos;s home on the study night and retrieved it the next morning. Heart rate was monitored through a single-lead electrocardiogram (modified V2) and R-R intervals were measured in milliseconds. Snoring sounds were monitored through an electric subminiature microphone, type MCE 2,000 (frequency range, 30 to 20,000 cycles/s ± 2dB, sensitivity 0.6 mV/microbar at 1000 cycles/s ± 4 dB; Conrad Electronics, Hirschau, Germany), taped above the larynx. Arterial oxygen saturation was measured continuously with a finger probe. The body position sensor, a flat cylinder 18 mm high with a diameter of 50 mm, was placed on the lower part of the sternum. Automated scoring software is available with the Mesam that provides a respiratory disturbance index. However, previous research has shown that hand scoring provides results that are more closely related to the results of simultaneous polysomnography than the automated analysis results (11). The Mesam recordings were therefore hand scored in 5 min epochs. This was done independently and in a blinded fashion by two physicians trained in SDB and familiar with the Mesam 4. Interobserver variability was determined using the Kappa statistic (12). Snoring was scored as absent, present during less than 50% of the recording, or present during 50% or more of the recording. A respiratory event was scored if at least two of the following three parameters were present: pauses in snoring of at least 10 s; heart rate deceleration and acceleration of at least 10 beats/min; and an associated arterial oxygen desaturation of at least 2%. If recurrent episodes were present during the majority of a 5 min epoch, the epoch was defined as positive for SDB. The subjects&apos; records were then classified based on the following criteria: normalevents less than 10% of the recording; possible SDB -events 10% to 30% of the recording; definite SDB -events greater than 30% of the recording. The Mesam 4 does not record sleep; therefore, the total study time is not equivalent to a total sleep time. Using a total study time rather than a total sleep time tends to underestimate the degree of SDB. This approach was adopted to avoid concerns that the prevalence of SDB would be overestimated in this population. Calculation of prevalence: The prevalence of both suspected and definite SDB was calculated but the conservative latter definition was used for the primary analysis. The prevalence of SDB was calculated in each sample group by the equation: Prevalence = (number of subjects with definite SDB × 100%)/ total number of subjects To estimate the overall prevalence of definite SDB in the entire group of grainworkers the prevalence obtained from each sample groups was projected to their respective total groups. Overall prevalence = [(sample group 1)(number of subjects in total group 1) + (sample group 2)(number of subjects in total group 2) + (sample group 3)(number of subjects in total group 3) + (sample group 4)(number of subjects in total group 4)] × 100%/total number of grainworkers Can Respir J Vol 5 No 3 May/June 1998 185 Prevalence of SDB in grainworkers Le ronflement signalé par les sujets eux-mêmes ne représentait pas un facteur prédictif. CONCLUSIONS : Cette première étude sur la prévalence des troubles respiratoires du sommeil au Canada permet de croire qu&apos;ils sont aussi fréquents dans ce pays que dans les autres pays industrialisés mais aussi que leur incidence serait en fait plus importante que celle présumée antérieurement. D&apos;autres études sont nécessaires pour déterminer la morbidité, la mortalité et la perte économique associées aux troubles respiratoires du sommeil chez les travailleurs industriels. where sample group refers to the prevalance of SDB in the sample group specificed. Before this calculation, subjects approached for home sleep monitoring who did not participate (refused or could not be contacted) were compared with their respective total groups in terms of age, body mass index (BMI) and neck circumference. If no significant difference was found between the sample group and total group, then the previously described formula was used to calculate prevalence. If a significant difference was found between a sample group and either those who did not participate or the group as a whole then the above formula was modified such that the respective group prevalence was multiplied by only the number of subjects in the sample group and not by the entire total group. Statistics: One-way ANOVA was used to to compare the anthropometric data and a c 2 test was used to compare the questionnaire data (categorical) among the four total groups and among the three home sleep monitoring derived diagnostic groups (normal, possible SDB, definite SDB). The sample groups and the total groups were compared by an unpaired Student&apos;s t test. Prevalence was calculated as described above, and the interobserver variability was calculated using the Kappa statistic (a Kappa score greater than 0.7 is indicative of minimal interobserver variability). RESULTS Questionnaire data: Four hundred and thirty-seven men of the 524 men approached completed the questionnaire and had a limited physical examination (83% response rate). Nineteen (4.3%) admitted to snoring often and had a history of witnessed apneas (group 1), 98 (22.3%) snored often without witnessed apneas (group 2), 185 (42.3%) snored sometimes or rarely (group 3) and 135 (31.1%) were nonsnorers (group 4). These groups differed significantly in the distribution of neck circumference (P&lt;0.0001), BMI (P&lt;0.0001) and age (P&lt;0.05) ( The distribution of diagnoses from home sleep monitoring differed among the four groups By projecting the prevalence of definite SDB found in the four sample groups to their respective total group the overall prevalence of SDB was estimated to be 25% in this group of grainworkers: In group 1 the prevalence of the sample group was multiplied by the number of subjects in the sample group rather than the total group. There was a significant difference in BMI between those studied (heavier) and those who were not studied (P&lt;0.02, Table 2), although those who were studied were similar to the total group. There were no significant differences between those subjects studied and those that did not participate in sample groups 2 to 4 (P&gt;0.05, Figure 1) Prevalence of definite sleep disordered breathing in the sample groups and the total population There were no differences among the total groups and their respective sample groups in age, BMI or neck circumference. The two physicians scoring the Mesam studies agreed on categorization of the studies 85% of the time. In the studies in which there was not complete agreement, the two physicians were never more than one category removed. The interobserver variability, as calculated by the Kappa statistic, was 0.7. Factors associated with SDB: Among grainworkers who underwent home sleep monitoring, the presence of snoring (P&lt;0.005) and witnessed apneas (P&lt;0.04), a greater BMI (P&lt;0.040) and a larger neck circumference (P&lt;0.02) were found to be predictive of definite SDB. However, the presence of daytime sleepiness, history of hypertension (patient reported) and smoking history were not associated with the presence of SDB. There was no difference in measured blood pressure between the patients with and those without SDB. The relatively small sample size in each group may limit the power to detect true differences among the groups. Validity of self-reported snoring: Fifty-eight subjects underwent home sleep monitoring. Fourteen of these subjects denied snoring but home sleep monitoring revealed that five did not snore, five snored for less than 50% of the night and four snored for more than 50% of the night DISCUSSION In this first study of the prevalence of SDB in Canada, we found that 25% of a population of male grainworkers had SDB. The known risk factors of male sex and higher than average BMI in the study population are probably responsible for a higher prevalence of SDB than previously reported. A history of snoring and witnessed apneas as well as greater BMI and larger neck circumference were found to be useful predictors of SDB, a finding consistent with previous studies (6,13-15). Smoking was more common in subjects who re- ported snoring (with or without witnessed apneas) but we did not find a previously reported association between smoking history and SDB (7). Furthermore, self-reported snoring was not found to be a reliable guide to the presence of recorded snoring. A number of factors could have contributed to our finding of a greater prevalence of SDB in our study than that reported by others. Certain assumptions were made in previous prevalence studies, the most common of which is that self-reported snoring and daytime sleepiness were reliable symptoms of SDB The recognition of obstructive breathing associated with neurological arousal without accompanying arterial oxygen desaturation has expanded the definition of SDB. It is now apparent that there is a continuum of SDB associated with progressively more clinical consequences, from chronic snoring to obstructive sleep hypopnea to severe obstructive sleep apnea. The diagnostic threshold to define SDB within this continuum directly affects the measured prevalence. For example, the initial study by Lavie (4) used a diagnostic threshold of an apnea index greater than 10/h; however, if one uses an apnea index more than five/h the prevalence moves from 1% to nearly 16% in a group of male industrial workers. The use of home oximetry to define cases of SDB, a less sensitive monitoring system than conventional overnight, in-hospital polysomnography, has also contributed to the underestimation of prevalence rates. Stradling and Crosby (17) studied 893 men with overnight oximetry and found that 45 (5%) had more than five desaturations of 4% per hour. Thirty-one of these men had overnight polysomnography, and three had severe, nonpositional SDB (0.3%) and 18 had mild to moderate, positional apnea (2.4%). Men with clinically significant SDB with apneas and hypopneas without associated desaturations of 4% would have been missed using this methodology. More recent studies conducted in the United States and Australia using expanded definitions of SDB have found prevalence rates similar to our study (10% to 20%). In a recent study from the United States, 40% of middle-aged men and 30% of middle-aged women were found to be habitual snorers (6). Significant SDB was defined as the presence of an apnea-hypopnea index (AHI) greater than five/h (from polysomnography) and symptoms of excessive daytime sleepiness. About 4% of middle-aged men and 2% of middle-aged women met these criteria. When they defined SDB based only on AHI, 24% of middle-aged men had an AHI greater than five/h, 15% had an AHI greater than 10 per hour, and 9% had an AHI greater than 15/h. These prevalence rates are similar to those found in our study. Bearpark and colleagues Obesity is a significant risk factor for SDB. We examined a relatively healthy, nonhypertensive population of middleaged, working men who had a higher average BMI (29±5 kg/m

Clinical characteristics, sepsis interventions and outcomes in the obese patients with septic shock: an international multicenter cohort study

La calidad educativa de los centros de hoy depende del nivel de competencias adquirido por sus educadores (Perrenoud, 2002). En este sentido, debemos apostar por un equipo humano formado por sujetos que sepan superarse permanentemente, aptos para ejercer tareas dinámicas y cambiantes y que compartan alternativas para crecer en todos los sentidos. Más todavía, debemos apostar por profesionales capaces de identificar y dominar los procesos que se deben realizar actuando con decisión y responsabilidad. La adquisición de competencias comporta aptitud y actitud para utilizar conocimientos, más concretamente, habilidades y valores, de manera interdisciplinaria, transversal e interactiva en contextos y situaciones que requieren la intervención de contenidos vinculados a las diferentes áreas del currículum (Lleixà, 2007), sin exclusividad, en este caso, del área de Educación Física. Presentamos una propuesta metodológica, el «Paradigma Estratégico para el desarrollo de habilidades competenciales», cuya ejecución implica comprensión, reflexión y discernimiento, teniendo en cuenta la dimensión social de cada situación. El estudio se ha llevado a cabo en la Universidad de Lleida con 40 alumnos de tercer curso de la asignatura «Educación Física y su didáctica». Se pretende valorar el impacto que provoca la implementación del programa «Paradigma estratégico para la adquisición de habilidades competenciales» sobre sus propias percepciones competenciales intrapersonales, antes y después de la aplicación de dicho programa

Wean Earlier and Automatically with New technology (the WEAN study): a protocol of a multicentre, pilot randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Weaning is the process during which mechanical ventilation is withdrawn and the work of breathing is transferred from the ventilator back to the patient. Prolonged weaning is associated with development of ventilator-related complications and longer stays in the Intensive Care Unit (ICU). Computerized or Automated Weaning is a novel weaning strategy that continuously measures and adapts ventilator support (by frequently measuring and averaging three breathing parameters) and automatically conducts Spontaneous Breathing Trials to ascertain whether patients can resume autonomous breathing. Automated Weaning holds promise as a strategy to reduce the time spent on the ventilator, decrease ICU length of stay, and improve clinically important outcomes.</p> <p>Methods/Design</p> <p>A pilot weaning randomized controlled trial (RCT) is underway in the ICUs of 8 Canadian hospitals. We will randomize 90 critically ill adults requiring invasive ventilation for at least 24 hours and identified at an early stage of the weaning process to either Automated Weaning (SmartCare™) or Protocolized Weaning. The results of a National Weaning Survey informed the design of the Protocolized Weaning arm. Both weaning protocols are operationalized in Pressure Support mode, include opportunities for Spontaneous Breathing Trials, and share a common sedation protocol, oxygen titration parameters, and extubation and reintubation criteria. The primary outcome of the WEAN study is to evaluate compliance with the proposed weaning and sedation protocols. A key secondary outcome of the pilot RCT is to evaluate clinician acceptance of the weaning and sedation protocols. Prior to initiating the WEAN Study, we conducted a run-in phase, involving two patients per centre (randomizing the first participant to either weaning strategy and assigning the second patient to the alternate strategy) to ensure that participating centres could implement the weaning and sedation protocols and complete the detailed case report forms.</p> <p>Discussion</p> <p>Mechanical ventilation studies are difficult to implement; requiring protocols to be operationalized continuously and entailing detailed daily data collection. As the first multicentre weaning RCT in Canada, the WEAN Study seeks to determine the feasibility of conducting a large scale future weaning trial and to establish a collaborative network of ICU clinicians dedicated to advancing the science of weaning.</p> <p>Trial Registration Number</p> <p>ISRCTN43760151</p

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Medial longitudinal arch development of school children : The College of Podiatry Annual Conference 2015: meeting abstracts

Background Foot structure is often classified into flat foot, neutral and high arch type based on the variability of the Medial Longitudinal Arch (MLA). To date, the literature provided contrasting evidence on the age when MLA development stabilises in children. The influence of footwear on MLA development is also unknown. Aim This study aims to (i) clarify whether the MLA is still changing in children from age 7 to 9 years old and (ii) explore the relationship between footwear usage and MLA development, using a longitudinal approach. Methods We evaluated the MLA of 111 healthy school children [age = 6.9 (0.3) years] using three parameters [arch index (AI), midfoot peak pressure (PP) and maximum force (MF: % of body weight)] extracted from dynamic foot loading measurements at baseline, 10-month and 22-month follow-up. Information on the type of footwear worn was collected using survey question. Linear mixed modelling was used to test for differences in the MLA over time. Results Insignificant changes in all MLA parameters were observed over time [AI: P = .15; PP: P = .84; MF: P = .91]. When gender was considered, the AI of boys decreased with age [P = .02]. Boys also displayed a flatter MLA than girls at age 6.9 years [AI: mean difference = 0.02 (0.01, 0.04); P = .02]. At baseline, subjects who wore close-toe shoes displayed the lowest MLA overall [AI/PP/MF: P < .05]. Subjects who used slippers when commencing footwear use experienced higher PP than those who wore sandals [mean difference = 31.60 (1.44, 61.75) kPa; post-hoc P = .04]. Discussion and conclusion Our findings suggested that the MLA of children remained stable from 7 to 9 years old, while gender and the type of footwear worn during childhood may influence MLA development. Clinicians may choose to commence therapy when a child presents with painful flexible flat foot at age 7 years, and may discourage younger children from wearing slippers when they commence using footwear

Climate controls over ecosystem metabolism: insights from a fifteen-year inductive artificial neural network synthesis for a subalpine forest

Eddy covariance (EC) datasets have provided insight into climate determinants of net ecosystem productivity (NEP) and evapotranspiration (ET) in natural ecosystems for decades, but most EC studies were published in serial fashion such that one study's result became the following study's hypothesis. This approach reflects the hypothetico-deductive process by focusing on previously derived hypotheses. A synthesis of this type of sequential inference reiterates subjective biases and may amplify past assumptions about the role, and relative importance, of controls over ecosystem metabolism. Long-term EC datasets facilitate an alternative approach to synthesis: the use of inductive data-based analyses to re-examine past deductive studies of the same ecosystem. Here we examined the seasonal climate determinants of NEP and ET by analyzing a 15-year EC time-series from a subalpine forest using an ensemble of Artificial Neural Networks (ANNs) at the half-day (daytime/nighttime) time-step. We extracted relative rankings of climate drivers and driver-response relationships directly from the dataset with minimal a priori assumptions. The ANN analysis revealed temperature variables as primary climate drivers of NEP and daytime ET, when all seasons are considered, consistent with the assembly of past studies. New relations uncovered by the ANN approach include the role of soil moisture in driving daytime NEP during the snowmelt period, the nonlinear response of NEP to temperature across seasons, and the low relevance of summer rainfall for NEP or ET at the same daytime/nighttime time step. These new results offer a more complete perspective of climate-ecosystem interactions at this site than traditional deductive analyses alone

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes