Systematic r eview to evaluate the quality of the clinical practice guidelines (CPG) for rheumatoid arthritis (RA) management and to provide a synthesis of high-quality CPG recommendations, highlighting areas of consistency, and inconsistency. Electronic searches of five databases and four online guideline repositories were performed. RA management CPGs were eligible for inclusion if they were written in English and published between January 2015 and February 2022; focused on adults ≥ 18 years of age; met the criteria of a CPG as defined by the Institute of Medicine; and were rated as high quality on the Appraisal of Guidelines for Research and Evaluation II instrument. RA CPGs were excluded if they required additional payment to access; only addressed recommendations for the system/organization of care and did not include interventional management recommendations; and/or included other arthritic conditions. Of 27 CPGs identified, 13 CPGs met eligibility criteria and were included. Non-pharmacological care should include patient education, patient-centered care, shared decision-making, exercise, orthoses, and a multi-disciplinary approach to care. Pharmacological care should include conventional synthetic disease modifying anti-rheumatic drugs (DMARDs), with methotrexate as the first-line choice. If monotherapy conventional synthetic DMARDs fail to achieve a treatment target, this should be followed by combination therapy conventional synthetic DMARDs (leflunomide, sulfasalazine, hydroxychloroquine), biologic DMARDS and targeted synthetic DMARDS. Management should also include monitoring, pre-treatment investigations and vaccinations, and screening for tuberculosis and hepatitis. Surgical care should be recommended if non-surgical care fails. This synthesis offers clear guidance of evidence-based RA care to healthcare providers. Trial registration The protocol for this review was registered with Open Science Framework (https://doi.org/10.17605/OSF.IO/UB3Y7).

ObjectiveTo evaluate the quality of clinical practice guidelines (CPGs) for interventions in management of osteoarthritis (OA) and to provide a synthesis of high‐quality CPG recommendations.MethodsFive databases (OvidSP Medline, Cochrane, Cumulative Index to Nursing and Allied Health Literature [CINAHL], Embase, and the Physiotherapy Evidence Database [PEDro]) and 4 online guideline repositories were searched. CPGs for the management of OA were included if they were 1) written in English and published from January 2015 to February 2022, focused on adults age ≥18 years, and met the criteria of a CPG as defined by the Institute of Medicine; and 2) were rated as high quality on the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. CPGs for OA were excluded if they were available via institutional access only, only addressed recommendations for the system/organization of care and did not include interventional management recommendations, and/or included other arthritic conditions.ResultsOf 20 eligible CPGs, 11 were appraised as high quality and included in the synthesis. Of interest were the hip, knee, hand, and glenohumeral joints and/or polyarticular OA. Consistent recommendations were that care should be patient centered and include exercise, education, and weight loss (where appropriate). Nonsteroidal antiinflammatory drugs and surgical interventions were recommended for disabling OA that had not improved with nonsurgical care. Hand orthoses should be recommended for patients with hand OA.ConclusionThis synthesis of high‐quality CPGs for OA management offers health care providers with clear, simple guidance of recommended OA care to improve patient outcomes.

A fundamental objective of the National Atmospheric Deposition Program (NADP) is to provide scientific investigators worldwide with timely access to a long-term, highquality data base of atmospheric deposition information for research support in such areas as air quality, water quality, effects of deposition on agriculture, forest productivity, effects of deposition on materials, ecosystem studies, watershed studies, and human health. In support of this objective, all data and selected other network products and summaries are made available on the Internet. The purpose of this report is to provide insight to NADP program participants as to the quantity and range of uses for the data collected and to provide information to help them develop better products and services to meet customer needs. For the 13 months included in this report (May 13, 1998, to June 9, 1999, 15,372 data sets were downloaded by 2,835 individual data users, reflecting about a 1,400-percent increase compared to a 13-month period beginning November 27, 1995, and ending February 10, 1997. Federal and State agencies accounted for nearly 30 percent of the data users, whereas educational users (K-12 and higher education) accounted for 55 percent of the total. The private sector, research groups, and others accounted for the remainder of the data-base retrievals. The greatest number of retrievals was for 2,270 data sets retrieved from sites in New York; this reflects the State's strong interest in acid rain, its large population base, and its greater than average number of NADP stations. The second greatest number of retrievals was for data from sites in North Carolina, which also has an above-average number of NADP sites and where data use reflects a significant and growing research interest in nitrogen deposition and its effects. The commitment the Federal, State, and local governments have made in recent years to improving service to their many customers is borne out to some extent by the depth and breadth of response to the availability of this single data base. The cooperative nature of the NADP bears further witness to a customer-focused effort to ensure that the science information needs of everyone, from environmental consultants to grade school teachers, are being met.

Objective. The aim of this study was to understand and describe the lived experience of Aboriginal and Torres Strait Islander people with osteoarthritis.Methods. Qualitative study guided by cultural security, which ensures that research is conducted in a way that will not compromise the cultural values, beliefs, and expectations of Aboriginal and Torres Strait Islander people. Participants were purposively sampled through the networks of project staff. Research yarns (a cultural form of conversation used as a data gathering tool) were conducted with 25 Aboriginal and Torres Strait Islander adults with self-reported osteoarthritis in Western Australia and Victoria, Australia. Data were analyzed using a framework approach and presented through composite storytelling (hypothetical stories representing an amalgam of participants' experiences).Results. Two composite stories were constructed to reflect themes relating to beliefs and knowledge, impact, coping, and health care experiences. Common beliefs held by participants were that osteoarthritis is caused by previous physically active lifestyles. Many participants feared for their future, increasing disability and needing a wheelchair. Pain associated with osteoarthritis impacted daily activities, sleep, work, family, and social life and cultural activities. Multidimensional impacts were often experienced within complex health or life circumstances and associated with increased anxiety and depression. Most participants reported negative health care experiences, characterized by poor patient-provider communication.Conclusion. Our findings highlight that osteoarthritis is a multidimensional issue for Aboriginal and Torres Strait Islander people that permeates all aspects of life and highlights the need for integrated, multidisciplinary care that is culturally informed and individualized to patient need.higher than non-Aboriginal people (2). Common symptoms include joint pain, stiffness, and swelling (2). These symptoms are associated with activity avoidance and reduced physical activity, absenteeism, social withdrawal, and poor mental health, which negatively impact quality of life (3-5). Providing patientcentered, multidisciplinary care for osteoarthritis requires an understanding of the beliefs, knowledge, values, and preferences of those who experience the condition (4). No research has yet