University of the West of England

Increasingly, adult Indigenous language learners are being identified as the “missing generation” of learners who hold great potential to contribute to the revival of Indigenous languages by acting as the middle ground between Elders, children and youth within their communities. Our research project NEȾOLṈEW̱ ‘one mind, one people’ investigated adult Indigenous language learning through the popular Mentor-Apprentice Program (MAP) method (Leanne Hinton, 2001). Over the course of 14 months, our team conducted 133 interviews with four groups of participants involved in MAP. The participants were current and past apprentices, mentors, and administrators of MAP programs in British Columbia, Canada. Our primary interest was to learn about the successes and challenges of MAP for language learning, but we also included interview questions that gave participants space to share how participating in MAP may have affected them. During thematic analysis of the interviews (Braun & Clarke, 2006, 2014) we noticed repeating comments across all four participant groups on how their involvement with MAP impacted their own and their community’s wellbeing. Six exploratory themes were identified: • Language loss negatively impacts the wellbeing of Indigenous people: “[the word] doesn’t just mean a bad, misbehaving child, it also means a poor child that has been uprooted […] and is disconnected from their culture” • The relationship between burden and wellbeing among participants in MAP: “there’s so much to be done. […] that’s the exhausting part of it. It’s trying to learn and teach at the same time” • Strengthening MAP apprentices to become future community leaders: “it brings a huge sense of pride […] and helps me be an inspiration to anyone else” • Elder’s healing through becoming language mentors: “we once again have that believe in ourselves where we can feel free” • Cultural and spiritual health and healing: “I am keeping something very precious alive by speaking my language” • Health outcomes: “it was […] the language that... pushed me to sobriety, […] it gave me... a sense of who I was”. Although studies have reported protective effects of Indigenous language use on health (Ball & Moselle, 2013; Hallett, Chandler, & Lalonde, 2007; McIvor, 2013), health-related outcomes of language revitalization efforts, including MAP, remain underexplored (Whalen, Moss, & Baldwin, 2016). In addition to discussing the six exploratory themes from our study, our paper also proposes that these themes can inform future research in the area of language revitalization and wellbeing. References Ball, J., & Moselle, K. (2013). Contributions of culture and language in aboriginal head start in urban and northern communities to children’s health outcomes: A review of theory and research. Prepared for Division of Children, Seniors & Healthy Development, Health Promotion and Chronic Disease Prevention Branch. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101. http://doi.org/10.1191/1478088706qp063oa Braun, V., & Clarke, V. (2014). What can “thematic analysis” offer health and wellbeing researchers? International Journal of Qualitative Studies on Health and Well-Being, 9, 26152. http://doi.org/10.3402/qhw.v9.26152 Hallett, D., Chandler, M. J., & Lalonde, C. E. (2007). Aboriginal language knowledge and youth suicide. Cognitive Development, 22(3), 392–399. http://doi.org/10.1016/j.cogdev.2007.02.001 Hinton, L. (2001). The master-apprentice language learning program. In L. Hinton & K. Hale (Eds.), The green book of language revitalization in practice (pp. 217–226). San Diego, CA: Academic Press. McIvor, O. (2013). Protective effects of language learning, use and culture on the health and well-being of Indigenous people in Canada. In Proceedings of the 17th FEL Conference, FEL XVII: Endangered Languages Beyond Boundaries: Community Connections, Collaborative Approaches and Cross-Disciplinary Research (pp. 123–131). Foundation for Endangered Languages in association with the University of Carleton. Whalen, D. H., Moss, M., & Baldwin, D. (2016). Healing through language: Positive physical health effects of indigenous language use. F1000Research, 5(852). http://doi.org/10.12688/f1000research.8656.1

Since initially writing on thematic analysis in 2006, the popularity of the method we outlined has exploded, the variety of TA approaches have expanded, and, not least, our thinking has developed and shifted. In this reflexive commentary, we look back at some of the unspoken assumptions that informed how we wrote our 2006 paper. We connect some of these un-identified assumptions, and developments in the method over the years, with some conceptual mismatches and confusions we see in published TA studies. In order to facilitate better TA practice, we reflect on how our thinking has evolved – and in some cases sedimented – since the publication of our 2006 paper, and clarify and revise some of the ways we phrased or conceptualised TA, and the elements of, and processes around, a method we now prefer to call reflexive TA.

Developing a universal quality standard for thematic analysis (TA) is complicated by the existence of numerous iterations of TA that differ paradigmatically, philosophically and procedurally. This plurality in TA is often not recognised by editors, reviewers or authors, who promote ‘coding reliability measures’ as universal requirements of quality TA. Focusing particularly on our reflexive TA approach, we discuss quality in TA with reference to ten common problems we have identified in published TA research that cites or claims to follow our guidance. Many of the common problems are underpinned by an assumption of homogeneity in TA. We end by outlining guidelines for reviewers and editors – in the form of twenty critical questions – to support them in promoting high(er) standards in TA research, and more deliberative and reflexive engagement with TA as method and practice.

Recent years have seen a rapid proliferation of mass-market consumer software that takes inspiration from video games. Usually summarized as "gamification", this trend connects to a sizeable body of existing concepts and research in human-computer interaction and game studies, such as serious games, pervasive games, alternate reality games, or playful design. However, it is not clear how "gamification" relates to these, whether it denotes a novel phenomenon, and how to define it. Thus, in this paper we investigate "gamification" and the historical origins of the term in relation to precursors and similar concepts. It is suggested that "gamified" applications provide insight into novel, gameful phenomena complementary to playful phenomena. Based on our research, we propose a definition of "gamification" as the use of game design elements in non-game contexts.

BACKGROUND: A growing body of research identifies the harmful effects that adverse childhood experiences (ACEs; occurring during childhood or adolescence; eg, child maltreatment or exposure to domestic violence) have on health throughout life. Studies have quantified such effects for individual ACEs. However, ACEs frequently co-occur and no synthesis of findings from studies measuring the effect of multiple ACE types has been done. METHODS: In this systematic review and meta-analysis, we searched five electronic databases for cross-sectional, case-control, or cohort studies published up to May 6, 2016, reporting risks of health outcomes, consisting of substance use, sexual health, mental health, weight and physical exercise, violence, and physical health status and conditions, associated with multiple ACEs. We selected articles that presented risk estimates for individuals with at least four ACEs compared with those with none for outcomes with sufficient data for meta-analysis (at least four populations). Included studies also focused on adults aged at least 18 years with a sample size of at least 100. We excluded studies based on high-risk or clinical populations. We extracted data from published reports. We calculated pooled odds ratios (ORs) using a random-effects model. FINDINGS: of >75%) between estimates for almost half of the outcomes. INTERPRETATION: To have multiple ACEs is a major risk factor for many health conditions. The outcomes most strongly associated with multiple ACEs represent ACE risks for the next generation (eg, violence, mental illness, and substance use). To sustain improvements in public health requires a shift in focus to include prevention of ACEs, resilience building, and ACE-informed service provision. The Sustainable Development Goals provide a global platform to reduce ACEs and their life-course effect on health. FUNDING: Public Health Wales.

The concept of data saturation, defined as ‘information redundancy’ or the point at which no new themes or codes ‘emerge’ from data, is widely referenced in thematic analysis (TA) research in sport and exercise, and beyond. Several researchers have sought to ‘operationalise’ data saturation and provide concrete guidance on how many interviews, or focus groups, are enough to achieve some degree of data saturation in TA research. Our disagreement with such attempts to ‘capture’ data saturation for TA led us to this commentary. Here, we contribute to critical discussions of the saturation concept in qualitative research by interrogating the assumptions around the practice and procedures of TA that inform these data saturation ‘experiments’, and the conceptualisation of saturation as information redundancy. We argue that although the concepts of data-, thematic- or code-saturation, and even meaning-saturation, are coherent with the neo-positivist, discovery-oriented, meaning excavation project of coding reliability types of TA, they are not consistent with the values and assumptions of reflexive TA. We encourage sport and exercise and other researchers using reflexive TA to dwell with uncertainty and recognise that meaning is generated through interpretation of, not excavated from, data, and therefore judgements about ‘how many’ data items, and when to stop data collection, are inescapably situated and subjective, and cannot be determined (wholly) in advance of analysis.

As far back as the industrial revolution, significant development in technical innovation has succeeded in transforming numerous manual tasks and processes that had been in existence for decades where humans had reached the limits of physical capacity. Artificial Intelligence (AI) offers this same transformative potential for the augmentation and potential replacement of human tasks and activities within a wide range of industrial, intellectual and social applications. The pace of change for this new AI technological age is staggering, with new breakthroughs in algorithmic machine learning and autonomous decision-making, engendering new opportunities for continued innovation. The impact of AI could be significant, with industries ranging from: finance, healthcare, manufacturing, retail, supply chain, logistics and utilities, all potentially disrupted by the onset of AI technologies. The study brings together the collective insight from a number of leading expert contributors to highlight the significant opportunities, realistic assessment of impact, challenges and potential research agenda posed by the rapid emergence of AI within a number of domains: business and management, government, public sector, and science and technology. This research offers significant and timely insight to AI technology and its impact on the future of industry and society in general, whilst recognising the societal and industrial influence on pace and direction of AI development.

The field of health and wellbeing scholarship has a strong tradition of qualitative research*and rightly so. Qualitative research offers rich and compelling insights into the real worlds, experiences, and perspectives of patients and health care professionals in ways that are completely different to, but also sometimes complimentary to, the knowledge we can obtain through quantitative methods. (Published: 16 October 2014) Citation: Int J Qualitative Stud Health Well-being 2014, 9 : 26152 - http://dx.doi.org/10.3402/qhw.v9.26152

Abstract Thematic analysis methods, including the reflexive approach we have developed, are widely used in counselling and psychotherapy research, as are other approaches that seek to develop ‘patterns’ (themes, categories) across cases. Without a thorough grounding in the conceptual foundations of a wide variety of across‐case analytic approaches, and qualitative research more broadly—something rarely offered in counselling training—it can be difficult to understand how these differ, where they overlap, and which might be appropriate for a particular research project. Our aim in this paper is to support researchers in counselling and psychotherapy to select an appropriate across‐case approach for their research, and to justify their choice, by discussing conceptual and procedural differences and similarities between reflexive thematic analysis (TA) and four other across‐case approaches. Three of these are also widely used in counselling and psychotherapy research—qualitative content analysis, interpretative phenomenological analysis and grounded theory. The fourth—discourse analysis—is less widely used but importantly exemplifies the critical qualitative research tradition. We contextualise our comparative approach by highlighting the diversity within TA. TA is best thought of as a spectrum of methods—from types that prioritise coding accuracy and reliability to reflexive approaches like ours that emphasise the inescapable subjectivity of data interpretation. Although reflexive TA provides the point of comparison for our discussion of other across‐case approaches, our aim is not to promote reflexive TA as ‘best’. Rather, we encourage the knowing selection and use of analytic methods and methodologies in counselling and psychotherapy research.

autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field.

The human impact on life on Earth has increased sharply since the 1970s, driven by the demands of a growing population with rising average per capita income. Nature is currently supplying more materials than ever before, but this has come at the high cost of unprecedented global declines in the extent and integrity of ecosystems, distinctness of local ecological communities, abundance and number of wild species, and the number of local domesticated varieties. Such changes reduce vital benefits that people receive from nature and threaten the quality of life of future generations. Both the benefits of an expanding economy and the costs of reducing nature's benefits are unequally distributed. The fabric of life on which we all depend-nature and its contributions to people-is unravelling rapidly. Despite the severity of the threats and lack of enough progress in tackling them to date, opportunities exist to change future trajectories through transformative action. Such action must begin immediately, however, and address the root economic, social, and technological causes of nature's deterioration.

"Gamification" is an informal umbrella term for the use of video game elements in non-gaming systems to improve user experience (UX) and user engagement. The recent introduction of 'gamified' applications to large audiences promises new additions to the existing rich and diverse research on the heuristics, design patterns and dynamics of games and the positive UX they provide. However, what is lacking for a next step forward is the integration of this precise diversity of research endeavors. Therefore, this workshop brings together practitioners and researchers to develop a shared understanding of existing approaches and findings around the gamification of information systems, and identify key synergies, opportunities, and questions for future research.

In the past 10-15 years, the microbial fuel cell (MFC) technology has captured the attention of the scientific community for the possibility of transforming organic waste directly into electricity through microbially catalyzed anodic, and microbial/enzymatic/abiotic cathodic electrochemical reactions. In this review, several aspects of the technology are considered. Firstly, a brief history of abiotic to biological fuel cells and subsequently, microbial fuel cells is presented. Secondly, the development of the concept of microbial fuel cell into a wider range of derivative technologies, called bioelectrochemical systems, is described introducing briefly microbial electrolysis cells, microbial desalination cells and microbial electrosynthesis cells. The focus is then shifted to electroactive biofilms and electron transfer mechanisms involved with solid electrodes. Carbonaceous and metallic anode materials are then introduced, followed by an explanation of the electro catalysis of the oxygen reduction reaction and its behavior in neutral media, from recent studies. Cathode catalysts based on carbonaceous, platinum-group metal and platinum-group-metal-free materials are presented, along with membrane materials with a view to future directions. Finally, microbial fuel cell practical implementation, through the utilization of energy output for practical applications, is described.

Ethylene is a plant hormone that regulates many aspects of growth and development. Despite the well-known association between ethylene and stress signalling, its effects on stomatal movements are largely unexplored. Here, genetic and physiological data are provided that position ethylene into the Arabidopsis guard cell signalling network, and demonstrate a functional link between ethylene and hydrogen peroxide (H(2)O(2)). In wild-type leaves, ethylene induces stomatal closure that is dependent on H(2)O(2) production in guard cells, generated by the nicotinamide adenine dinucleotide phosphate hydrogen (NADPH) oxidase AtrbohF. Ethylene-induced closure is inhibited by the ethylene antagonists 1-MCP and silver. The ethylene receptor mutants etr1-1 and etr1-3 are insensitive to ethylene in terms of stomatal closure and H(2)O(2) production. Stomata of the ethylene signalling ein2-1 and arr2 mutants do not close in response to either ethylene or H(2)O(2) but do generate H(2)O(2) following ethylene challenge. Thus, the data indicate that ethylene and H(2)O(2) signalling in guard cells are mediated by ETR1 via EIN2 and ARR2-dependent pathway(s), and identify AtrbohF as a key mediator of stomatal responses to ethylene.

Fully qualitative surveys, which prioritise qualitative research values, and harness the rich potential of qualitative data, have much to offer qualitative researchers, especially given online delivery options. Yet the method remains underutilised, and there is little in the way of methodological discussion of qualitative surveys. Underutilisation and limited methodological discussion perhaps reflect the dominance of interviewing in qualitative research, and (misplaced) assumptions about qualitative survey data lacking depth. By discussing our experiences of developing online surveys as a tool for qualitative research, we seek to challenge preconceptions about qualitative surveys, and to demonstrate that qualitative surveys are an exciting, flexible method with numerous applications, and advantages for researchers and participants alike. We offer an overview and practical design information, illustrated with examples from some of our studies.

BACKGROUND: The omicron variant (B.1.1.529) of SARS-CoV-2 has demonstrated partial vaccine escape and high transmissibility, with early studies indicating lower severity of infection than that of the delta variant (B.1.617.2). We aimed to better characterise omicron severity relative to delta by assessing the relative risk of hospital attendance, hospital admission, or death in a large national cohort. METHODS: Individual-level data on laboratory-confirmed COVID-19 cases resident in England between Nov 29, 2021, and Jan 9, 2022, were linked to routine datasets on vaccination status, hospital attendance and admission, and mortality. The relative risk of hospital attendance or admission within 14 days, or death within 28 days after confirmed infection, was estimated using proportional hazards regression. Analyses were stratified by test date, 10-year age band, ethnicity, residential region, and vaccination status, and were further adjusted for sex, index of multiple deprivation decile, evidence of a previous infection, and year of age within each age band. A secondary analysis estimated variant-specific and vaccine-specific vaccine effectiveness and the intrinsic relative severity of omicron infection compared with delta (ie, the relative risk in unvaccinated cases). FINDINGS: The adjusted hazard ratio (HR) of hospital attendance (not necessarily resulting in admission) with omicron compared with delta was 0·56 (95% CI 0·54-0·58); for hospital admission and death, HR estimates were 0·41 (0·39-0·43) and 0·31 (0·26-0·37), respectively. Omicron versus delta HR estimates varied with age for all endpoints examined. The adjusted HR for hospital admission was 1·10 (0·85-1·42) in those younger than 10 years, decreasing to 0·25 (0·21-0·30) in 60-69-year-olds, and then increasing to 0·47 (0·40-0·56) in those aged at least 80 years. For both variants, past infection gave some protection against death both in vaccinated (HR 0·47 [0·32-0·68]) and unvaccinated (0·18 [0·06-0·57]) cases. In vaccinated cases, past infection offered no additional protection against hospital admission beyond that provided by vaccination (HR 0·96 [0·88-1·04]); however, for unvaccinated cases, past infection gave moderate protection (HR 0·55 [0·48-0·63]). Omicron versus delta HR estimates were lower for hospital admission (0·30 [0·28-0·32]) in unvaccinated cases than the corresponding HR estimated for all cases in the primary analysis. Booster vaccination with an mRNA vaccine was highly protective against hospitalisation and death in omicron cases (HR for hospital admission 8-11 weeks post-booster vs unvaccinated: 0·22 [0·20-0·24]), with the protection afforded after a booster not being affected by the vaccine used for doses 1 and 2. INTERPRETATION: The risk of severe outcomes following SARS-CoV-2 infection is substantially lower for omicron than for delta, with higher reductions for more severe endpoints and significant variation with age. Underlying the observed risks is a larger reduction in intrinsic severity (in unvaccinated individuals) counterbalanced by a reduction in vaccine effectiveness. Documented previous SARS-CoV-2 infection offered some protection against hospitalisation and high protection against death in unvaccinated individuals, but only offered additional protection in vaccinated individuals for the death endpoint. Booster vaccination with mRNA vaccines maintains over 70% protection against hospitalisation and death in breakthrough confirmed omicron infections. FUNDING: Medical Research Council, UK Research and Innovation, Department of Health and Social Care, National Institute for Health Research, Community Jameel, and Engineering and Physical Sciences Research Council.

New Media: A Critical Introduction /i is a comprehensive introduction to the culture, technologies and history and theories of new media. Written especially for students, the authors consider the ways in which "new media" really are new, assess the claims that a media and technological revolution is underway and formulate new ways for media studies to respond to new technologies.Individual chapters introduce: Assessing the "newness" of new media; How to define the characteristics of new media; Film, photography and new forms of visual culture and entertainment; Social and political uses of new media and new communications; New media technologies, politics and globalization; Everyday life and new media; Cyborgs, cybernetics and cyberculture; Theories of interactivity; and The history of automata and artificial life. Illustrated with over seventy photographs, images, tables and line drawings, key features of this textbook include: A user's guide; A glossary of key terms and concepts; Boxed case studies andexamples; Key terms defined in the margins with extensive cross-referencing; and Extensive bibliographies and web resources to help with further study.

Abstract Objective: To determine whether nurse practitioners can provide care at first point of contact equivalent to doctors in a primary care setting. Design: Systematic review of randomised controlled trials and prospective observational studies. Data sources: Cochrane controlled trials register, specialist register of trials maintained by Cochrane Effective Practice and Organisation of Care Group, Medline, Embase, CINAHL, science citation index, database of abstracts of reviews of effectiveness, national research register, hand searches, and published bibliographies. Included studies: Randomised controlled trials and prospective observational studies comparing nurse practitioners and doctors providing care at first point of contact for patients with undifferentiated health problems in a primary care setting and providing data on one or more of the following outcomes: patient satisfaction, health status, costs, and process of care. Results: 11 trials and 23 observational studies met all the inclusion criteria. Patients were more satisfied with care by a nurse practitioner (standardised mean difference 0.27, 95% confidence interval 0.07 to 0.47). No differences in health status were found. Nurse practitioners had longer consultations (weighted mean difference 3.67 minutes, 2.05 to 5.29) and made more investigations (odds ratio 1.22, 1.02 to 1.46) than did doctors. No differences were found in prescriptions, return consultations, or referrals. Quality of care was in some ways better for nurse practitioner consultations. Conclusion: Increasing availability of nurse practitioners in primary care is likely to lead to high levels of patient satisfaction and high quality care. What is already known on this topic Nurse practitioners have existed in North America for many years An increasing number of such nurses are being employed in the United Kingdom in general practice, emergency departments, and other primary care settings Reviews suggest that nurse practitioners are equivalent to doctors on most variables studied, but the relevance of this in the context of the NHS is unclear What this study adds Patients are more satisfied with care from a nurse practitioner than from a doctor, with no difference in health outcomes Nurse practitioners provide longer consultations and carry out more investigations than doctors Most recent research has related to patients requesting same day appointments for minor illness, which is only a limited part of a doctor's role

BACKGROUND: The omicron variant (B.1.1.529) of SARS-CoV-2 has demonstrated partial vaccine escape and high transmissibility, with early studies indicating lower severity of infection than that of the delta variant (B.1.617.2). We aimed to better characterise omicron severity relative to delta by assessing the relative risk of hospital attendance, hospital admission, or death in a large national cohort. METHODS: Individual-level data on laboratory-confirmed COVID-19 cases resident in England between Nov 29, 2021, and Jan 9, 2022, were linked to routine datasets on vaccination status, hospital attendance and admission, and mortality. The relative risk of hospital attendance or admission within 14 days, or death within 28 days after confirmed infection, was estimated using proportional hazards regression. Analyses were stratified by test date, 10-year age band, ethnicity, residential region, and vaccination status, and were further adjusted for sex, index of multiple deprivation decile, evidence of a previous infection, and year of age within each age band. A secondary analysis estimated variant-specific and vaccine-specific vaccine effectiveness and the intrinsic relative severity of omicron infection compared with delta (ie, the relative risk in unvaccinated cases). FINDINGS: The adjusted hazard ratio (HR) of hospital attendance (not necessarily resulting in admission) with omicron compared with delta was 0·56 (95% CI 0·54-0·58); for hospital admission and death, HR estimates were 0·41 (0·39-0·43) and 0·31 (0·26-0·37), respectively. Omicron versus delta HR estimates varied with age for all endpoints examined. The adjusted HR for hospital admission was 1·10 (0·85-1·42) in those younger than 10 years, decreasing to 0·25 (0·21-0·30) in 60-69-year-olds, and then increasing to 0·47 (0·40-0·56) in those aged at least 80 years. For both variants, past infection gave some protection against death both in vaccinated (HR 0·47 [0·32-0·68]) and unvaccinated (0·18 [0·06-0·57]) cases. In vaccinated cases, past infection offered no additional protection against hospital admission beyond that provided by vaccination (HR 0·96 [0·88-1·04]); however, for unvaccinated cases, past infection gave moderate protection (HR 0·55 [0·48-0·63]). Omicron versus delta HR estimates were lower for hospital admission (0·30 [0·28-0·32]) in unvaccinated cases than the corresponding HR estimated for all cases in the primary analysis. Booster vaccination with an mRNA vaccine was highly protective against hospitalisation and death in omicron cases (HR for hospital admission 8-11 weeks post-booster vs unvaccinated: 0·22 [0·20-0·24]), with the protection afforded after a booster not being affected by the vaccine used for doses 1 and 2. INTERPRETATION: The risk of severe outcomes following SARS-CoV-2 infection is substantially lower for omicron than for delta, with higher reductions for more severe endpoints and significant variation with age. Underlying the observed risks is a larger reduction in intrinsic severity (in unvaccinated individuals) counterbalanced by a reduction in vaccine effectiveness. Documented previous SARS-CoV-2 infection offered some protection against hospitalisation and high protection against death in unvaccinated individuals, but only offered additional protection in vaccinated individuals for the death endpoint. Booster vaccination with mRNA vaccines maintains over 70% protection against hospitalisation and death in breakthrough confirmed omicron infections. FUNDING: Medical Research Council, UK Research and Innovation, Department of Health and Social Care, National Institute for Health Research, Community Jameel, and Engineering and Physical Sciences Research Council.

OBJECTIVES: To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction. DESIGN: A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process. METHODS: The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, "in our practice" statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. RESULTS: The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 52 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, "in our practice" statements were provided. In addition, 49 research priorities were identified. CONCLUSIONS: A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research.