ObjectivesGender inequity has persisted in academic medicine. Yet equity is vital for countries to achieve their full potential in terms of translational research and patient benefit. This study sought to understand how the gender equity programme, Athena SWAN, can be enabled and constrained by interactions between the programme and the context it is implemented into, and whether these interactions might produce unintended consequences.DesignMultimethod qualitative case studies using a realist evaluation approach.Setting5 departments from a university medical school hosting a Translational Research Organisation.Participants25 hours of observations of gender equality committee meetings, 16 in-depth interviews with Heads of Departments, Committee Leads and key personnel involved in the initiative. 4 focus groups with 15 postdoctoral researchers, lecturers and senior lecturers.ResultsThe implementation of Athena SWAN principles was reported to have created social space to address gender inequity and to have highlighted problematic practices to staff. However, a number of factors reduced the programme's potential to impact gender inequity. Gender inequity was reproduced in the programme's enactment as female staff was undertaking a disproportionate amount of Athena SWAN work, with potential negative impacts on individual women's career progression. Early career researchers experienced problems accessing Athena SWAN initiatives. Furthermore, the impact of the programme was perceived to be undermined by wider institutional practices, national policies and societal norms, which are beyond the programme's remit.ConclusionsGender equity programmes have the potential to address inequity. However, paradoxically, they can also unintentionally reproduce and reinforce gender inequity through their enactment. Potential programme impacts may be undermined by barriers to staff availing of career development and training initiatives, and by wider institutional practices, national policies and societal norms.

Implications for rehabilitation-Hip fracture was perceived as a potential tipping point in the loss of independence, contributing to the wider disruption of advancing age and co-existing conditions.-Participants expressed uncertainty over their ability to recover their previous identity in the absence of professional support and/or social capital.-Healthcare professionals need to educate and empower older adults to take charge of their own recovery.-For successful implementation of the UK standards for acute physiotherapy, there is a need to contextualize goal setting to empower patients to define a fresh narrative of self.

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The Crime Scene Investigator (CSI) has a distinct professional profile within the police. It is the CSI who is tasked with identifying trace at crime scenes in order to inform police investigations. Despite this significant role, little is known sociologically about the CSI's routine work. This paper draws on ethnographic fieldwork completed at the National Policing Improvement Agency's Forensic Centre, observation of CSIs at real crime scenes and interview data to consider the CSI's practices surrounding trace at volume crime scenes. It foregrounds the work that take place in transforming crime scene trace into admissible evidence or objects for laboratory analysis and the processes of identifying meaningful trace, central to CSI claims of unique expertise. Yet beyond the crime scene and police environment, it is the CSI's ability to record their adherence to prescriptive contamination avoidance procedures which is of paramount importance. This paper demonstrates the agency involved in making sense of crime scenes and the differing ways the CSI and CSI work are understood across police and courtroom environments.

Background Clinical research has been central to the global response to COVID-19, and the United Kingdom (UK), with its research system embedded within the National Health Service (NHS), has been singled out globally for the scale and speed of its COVID-19 research response. This paper explores the impacts of COVID-19 on clinical research in an NHS Trust and how the embedded research system was adapted and repurposed to support the COVID-19 response. Methods and findings Using a multi-method qualitative case study of a research-intensive NHS Trust in London UK, we collected data through a questionnaire (n = 170) and semi-structured interviews (n = 24) with research staff working in four areas: research governance; research leadership; research delivery; and patient and public involvement. We also observed key NHS Trust research prioritisation meetings (40 hours) and PPI activity (4.5 hours) and analysed documents produced by the Trust and national organisation relating to COVID-19 research. Data were analysed for a descriptive account of the Trust’s COVID-19 research response and research staff’s experiences. Data were then analysed thematically. Our analysis identifies three core themes: centralisation; pace of work; and new (temporary) work practices. By centralising research prioritisation at both national and Trust levels, halting non-COVID-19 research and redeploying research staff, an increased pace in the setup and delivery of COVID-19-related research was possible. National and Trust-level responses also led to widescale changes in working practices by adapting protocols and developing local processes to maintain and deliver research. These were effective practical solutions borne out of necessity and point to how the research system was able to adapt to the requirements of the pandemic. Conclusion The Trust and national COVID-19 response entailed a rapid large-scale reorganisation of research staff, research infrastructures and research priorities. The Trust’s local processes that enabled them to enact national policy prioritising COVID-19 research worked well, especially in managing finite resources, and also demonstrate the importance and adaptability of the research workforce. Such findings are useful as we consider how to adapt our healthcare delivery and research practices both at the national and global level for the future. However, as the pandemic continues, research leaders and policymakers must also take into account the short and long term impact of COVID-19 prioritisation on non-COVID-19 health research and the toll of the emergency response on research staff.

Objective to determine the extent to which equity factors contributed to eligibility criteria of trials of rehabilitation interventions after hip fracture. We define equity factors as those that stratify healthcare opportunities and outcomes. Design systematic search of MEDLINE, Embase, CINHAL, PEDro, Open Grey, BASE and ClinicalTrials.gov for randomised controlled trials of rehabilitation interventions after hip fracture published between 1 January 2008 and 30 May 2018. Trials not published in English, secondary prevention or new models of service delivery (e.g. orthogeriatric care pathway) were excluded. Duplicate screening for eligibility, risk of bias (Cochrane Risk of Bias Tool) and data extraction (Cochrane’s PROGRESS-Plus framework). Results twenty-three published, eight protocol, four registered ongoing randomised controlled trials (4,449 participants) were identified. A total of 69 equity factors contributed to eligibility criteria of the 35 trials. For more than 50% of trials, potential participants were excluded based on residency in a nursing home, cognitive impairment, mobility/functional impairment, minimum age and/or non-surgical candidacy. Where reported, this equated to the exclusion of 2,383 out of 8,736 (27.3%) potential participants based on equity factors. Residency in a nursing home and cognitive impairment were the main drivers of these exclusions. Conclusion the generalisability of trial results to the underlying population of frail older adults is limited. Yet, this is the evidence base underpinning current service design. Future trials should include participants with cognitive impairment and those admitted from nursing homes. For those excluded, an evidence-informed reasoning for the exclusion should be explicitly stated. PROSPERO CRD42018085930.

ObjectiveTo investigate how different lay and professional groups perceive and understand the use of routinely collected general practice patient data for research, public health, service evaluation and commissioning.Design, method, participants and settingWe conducted a multimethod, qualitative study. This entailed participant observation of the design and delivery of a series of deliberative engagement events about a local patient database made of routine primary care data. We also completed semistructured interviews with key professionals involved in the database. Qualitative data were thematically analysed. The research took place in an inner city borough in England.ResultsOf the community groups who participated in the six engagement events (111 individual citizens), five were health focused. It was difficult to recruit other types of organisations. Participants supported the uses of the database, but it was unclear how well they understood its scope and purpose. They had concerns about transparency, security and the potential misuse of data. Overall, they were more focused on the need for immediate investment in primary care capacity than data infrastructures to improve future health. The 10 interviewed professionals identified the purpose of the database in different ways, according to their interests. They emphasised the promise of the database as a resource in health research in its own right and in linking it to other datasets.ConclusionsFindings demonstrate positivity to the uses of this local database, but a disconnect between the long-term purposes of the database and participants’ short-term priorities for healthcare quality. Varying understandings of the database and the potential for it to be used in multiple different ways in the future cement a need for systematic and routine public engagement to develop and maintain public awareness. Problems recruiting community groups signal a need to consider how we engage wider audiences more effectively.

Purpose -The authors have developed an educational model that operates at the undergraduate level and aims to produce graduates who can comfortably operate in the gulf between the laboratory bench and the commercial marketplace. The purpose of the paper is to describe the course, approaches, activities and initial outcomes of the Bachelor of Biotechnology Innovation course at Queensland University of Technology. Design/methodology/approach -Students undertake "hard science" subjects and business subjects on entrepreneurship, innovation and market development. Synthesis of these disparate disciplines is driven through formation of virtual companies that serve to contextualize subject content and provide start-up company experience across the four-year course. Student companies design biotechnology products and processes and can progress their product through initial research and development phases or undertake an industry-based internship working as a team on initial concept projects. This focused, team-based approach to learning is contrary to traditional science courses that focus on the individual. Findings -Outcomes include graduates of high quality that have moved into positions associated with commercialization and technology transfer where previously a PhD and MBA were required qualifications. Other measures of course success include acceptance and promotion of the new course by business, academia and government. Originality/value -Postgraduate courses provide the most common pathway for assisted self-development of entrepreneurial skills in science and engineering graduates. In contrast, this model aims to train entrepreneurs in technological disciplines at an undergraduate level in a framework where innovation and enterprising behaviour are embedded in the fabric of the degree.