IntroductionKnee osteoarthritis (KOA) is a highly prevalent disabling joint disease. Intra-articular stem cell therapy is increasingly being used for treating KOA with little high-quality evidence to support its use. The aim of this study is to investigate the efficacy, safety and cost-effectiveness of allogeneic mesenchymal stem cells (Cymerus MSCs) for treating symptomatic tibiofemoral KOA and improving knee structure over 24 months.Methods and analysisThe Stem Cell injections for symptomatic relief and strUctural improvement in people with Tibiofemoral knee OsteoaRthritis study is a phase III, multi-centre, parallel, superiority, randomised, double-blind, placebo-controlled trial, which will be conducted in Sydney and Hobart, Australia. 440 participants (220 per arm) aged over 40 years with painful KOA and mild to moderate structural change on X-ray (Kellgren and Lawrence grade 2 or 3) with medial minimum joint space width between 1 and 4 mm in the study knee will be recruited from the community and randomly allocated to receive either intra-articular MSCs or saline at baseline, week 3 and week 52. The coprimary outcomes will be the proportion of participants achieving patient-acceptable symptom state for knee pain at 24 months and quantitative central medial femorotibial compartment cartilage thickness change from baseline to 24 months. Main secondary outcomes include change in knee pain, Patient Global Assessment, physical function, quality of life and other structural changes. Additional data for cost-effectiveness analysis will also be recorded. Adverse events will be monitored throughout the study. The primary analysis will be conducted using modified intention-to-treat.Ethics and disseminationThis protocol has been approved by The University of Sydney (USYD) Human Research Ethics Committee (HREC) #: 2020/119 and The University of Tasmania (UTAS) HREC #: H0021868. All participants will be required to provide informed consent. Dissemination will occur through conferences, social media, and scientific publications.Trial registration numbersAustralian New Zealand Clinical Trials Registry (ACTRN12620000870954); U1111-1234-4897.

This study looked at the impact of Widening Participation interventions on the attitudes of young people towards higher education. A total of 2731 adolescents aged 13-16 years completed a self-report measure of their attitudes to higher education, general and academic self concept and identification with school, family and peers. This was matched with data on the students' academic attainment and social backgrounds. As expected, attainment scores were significantly positively correlated with take up of Widening Participation activities aimed at increasing participation in higher education, attitudes towards going to university and academic motivation. However, attainment was negatively correlated with perceptions of family attending university and identification with family. Regression analyses found that perceptions of family views about attending university were not a predictor of taking part in Widening Participation activities but were a predictor of attitudes towards higher education. Students in Year 10 aged 14-15 were significantly more negative on most factors than either older or younger students.

Reflective practice is an essential competency in clinical psychology training and practice. However, evidence is limited to support the role of reflection in clinical practice. This study investigated the lived experiences of clinical psychologists' use of reflective practice in the context of their clinical work. Seven clinical psychologists completed reflective diaries and semi-structured interviews to facilitate in-depth reflections on clinical events. Interview transcripts were analyzed using interpretative phenomenological analysis. Three superordinate themes and six subthemes were developed from the data: Exploratory Questioning (gaining a different perspective, new insight and opening new possibilities), Containment of own Thoughts and Feelings in Practice, and Human Survival (managing the emotional impact, self-sustaining and leaving work at work). Consideration of these findings suggested that reflective practice plays a key role in clinical psychologists' perspective-taking abilities; allowing them to maintain an open and curious clinical perspective. Reflective practice enables containment, which impacts the building and maintaining of therapeutic relationships. Reflective practice relieves discomfort and promotes personal resilience. Further research on clinician use of reflective practice can contribute to understanding this core competency which is highly relevant to the training and ongoing development of clinical psychologists.

No abstract

No abstract