The Development of the Attachment Defenses Questionnaire (ADQ-50): A Preliminary Examination of Reliability, Validity, and Factor Structure.

This paper marks the initial phase in the development of the Attachment Defenses Questionnaire (ADQ-50), a self-report tool crafted to assess defense mechanisms associated with attachment processes, catering to both clinical and research contexts. Anchored in the theoretical framework of attachment theory, the ADQ posits that an individual's internalized attachment style plays a influential role in predicting their defense mechanisms. The paper outlines the comprehensive development and refinement process of the ADQ-50. In Study 1 a preliminary 176-item version of the ADQ was examined. Data was collected online drawing from participants sourced from Prolific and undergraduate students (N = 1994). Study 2 further refined the ADQ, evaluating its initial convergent validity with a diverse participant pool (N = 726), including undergraduates, Prolific contributors, general practice medical patients, and individuals from social media. Exploratory factor analysis revealed a robust ten-factor structure, resulting in a 50-item scale aligning with theoretical expectations and demonstrating good psychometric properties. Findings, limitations, strengths and future research directions are discussed. We posit that the ADQ holds great potential to deepen our comprehension of defense mechanisms linked to attachment, with wide-ranging implications for clinical practices.

Implementation of a clinical practice guideline for assessment and management of renal colic in the emergency department.

INTRODUCTION: Renal colic is a common emergency department (ED) presentation. Variations in assessment and management of suspected renal colic may have significant implications on patient and hospital outcomes. We developed a clinical practice guideline to standardize the assessment and management of renal colic in the ED. We subsequently compared outcomes before and after guideline implementation. METHODS: The guideline standardizes the analgesia regimen, urology consult criteria, imaging modality, patient education, and followup instructions. This is a single-center, observational cohort study of patients presenting to the ED with renal colic prospectively collected after guideline implementation (December 2018 to May 2019) compared to a control group retrospectively collected before guideline implementation (December 2017 to May 2018). A total of 528 patients (pre-guideline n=283, post-guideline n=245) were included. Statistical analysis was performed with SPSS using multivariate linear regression. RESULTS: ED length of stay (LOS) was significantly shorter after guideline implementation (pre-guideline 295.82±178.8 minutes vs. post-guideline 253.2±118.2 minutes, p=0.017). The number of computed tomography (CT) scans patients received was significantly less after guideline implementation (pre guideline 1.35±1.34 vs. post-guideline 1.00±0.68, p=0.034). Patients discharged for conservative management had a lower re-presentation rate in the post-guideline group (12.6%) than the pre-guideline group (17.2%); however, this did not reach statistical significance (p=0.18). CONCLUSIONS: Implementation of a clinical practice guideline for ureteric stones reduces the ED LOS and the total number of CT scan in patients who present with renal colic. Standardizing assessment and management of ureteric stones can potentially improve patient and hospital outcomes without compromising the quality of care.

Informing the development of a mobile application for the physical activity guidelines in multiple sclerosis: a qualitative, pluralistic approach.

PURPOSE: The uptake of Physical Activity Guidelines (PAGs) for adults with multiple sclerosis (MS) may be facilitated through mHealth solutions such as a mobile app. To date, there is limited information regarding preferred features of an app for people with MS. We explored desired features for an app that supports physical activity behaviour among persons with MS. MATERIALS AND METHODS: Using a pluralistic analytical approach, we conducted a secondary qualitative analysis on a portion of data collected from an earlier study to explore (i) what persons with MS wanted in an app based on the PAGs and (ii) how the PAG-based app should facilitate behaviour change. The data were subjected to deductive, content analysis to identify populous mentions of desired PAG-based app elements. We then used inductive, semantic reflexive thematic analysis to further explore the opinions and evaluations of participants. RESULTS: Participants (n = 16) perceived features such as activity tracking, incentives for completing milestones, and customization as both triggers for doing PA and supporting engagement with the app. Participants desired a personalized PA prescription based on mobility and fitness level, expert feedback based on data entered in the app, and an exercise library with a range of evidence-based content. Participants insisted the app be backed by a solid scientific foundation and that accessibility of personal data be controlled by the user. CONCLUSIONS: This study identifies several design considerations for an app based on the PAGs. The results suggest a simple, trustworthy, and evidence-based app that focuses on helping persons with MS reach the PAGs.

mHealth technologies could be an empowering and inclusive method of supporting physical activity uptake among persons with multiple sclerosis (MS).Knowledge is currently lacking regarding how mHealth technologies, such as mobile apps, can facilitate uptake of Physical Activity Guidelines for Adults with MS (PAGs).People with MS (N = 16) desired an app grounded in a solid scientific foundation, but then translated into simple, accessible, personalized physical activity guidelines that focused on achieving activity goals.Motivational, functional, and personalization strategies should be included in the development of an app based on the PAGs.

Sex as a determinant of disease severity and clinical outcome in febrile children under five presenting to a regional referral hospital in Uganda.

Sex and gender are well-established determinants of health in adult and adolescent populations in low resource settings. There are limited data on sex as a determinant of host response to disease and clinical outcome in febrile children in sub-Saharan Africa, where the risk of infection-related mortality is greatest. We examined sex differences and gender biases in health-seeking behavior, clinical care, biological response to infection, or outcome in a prospective observational cohort of febrile children under 5 years of age presenting to a regional referral hospital in Jinja, Uganda. Main outcomes (stratified by sex) were disease severity at presentation measured by clinical and biological parameters, clinical management (e.g., time to see a physician, treatment by diagnosis), and disease outcome (e.g., mortality). Clinical measures of disease severity included Lambaréné Organ Dysfunction Score (LODS), Signs of Inflammation in Children that Kill (SICK), and the Pediatric Early Death Index for Africa (PEDIA). Biological measures of disease severity were assessed using circulating markers of immune and endothelial activation associated with severe and fatal infections. Differences in outcome by sex were analyzed using bivariate analyses with Bonferroni correction for multiple comparisons. In this cohort of febrile patients admitted to hospital (n = 2049), malaria infection was common (59.2%). 15.9% of children presented with severe disease (LODS score ≥ 2). 97 children (4.7%) died, and most deaths (n = 83) occurred within 48 hours of hospital admission. Clinical measures of disease severity at presentation, clinical management, and outcome (e.g., mortality) did not differ by sex in children under five years of age. Host response to infection, as determined by endothelial and inflammatory mediators (e.g., sTREM1, Ang-2) quantified at hospital presentation, did not differ by sex. In this cohort of children under the age of five, sex was not a principal determinant of disease severity at hospital presentation, clinical management, disease outcome, or biological response to infection (p-values not significant for all comparisons, after Bonferroni correction). The results suggest that health seeking behavior by caregivers and clinical care in the hospital setting did not reflect a gender bias in this cohort.

Lost in machine translation: The promises and pitfalls of machine translation for multilingual group work in global health education.

The rapid adoption of online technologies to deliver postsecondary education amid the COVID-19 pandemic has highlighted the potential for online learning, as well as important equity gaps to be addressed. For over ten years, McMaster University has delivered graduate global health education through a blended-learning approach. In partnership with universities in the Netherlands, India, Thailand, Norway, Colombia, and Sudan, experts from across the Consortium deliver lectures online to students around the world. In 2020, two courses were piloted with small groups of students from Canada and Colombia using machine translation supported by bilingual tutors. Students met weekly via video conferencing software, speaking in English and Spanish and relying on machine translation software to transcribe and translate for group members. Qualitative semi-structured interviews were conducted with students, tutors, and instructors to explore how artificial intelligence can be harnessed to integrate multilingual group work into course offerings, challenging the dominant use of English as the principal language of instruction in global health education. Findings highlight the potential for machine translation to bridge language divides, while also underscoring several key limitations of currently available technology. Further research is needed to investigate the potential for machine translation in facilitating multilingual online education as a pathway to more equitable and inclusive online learning environments.

Desired Resources for Changing Diet Among Persons With Multiple Sclerosis: Qualitative Inquiry Informing Future Dietary Interventions.

BACKGROUND: There are approximately 1 million adults in the United States with multiple sclerosis (MS). Persons with MS are interested in diet as a second-line therapy for improving MS symptoms and disease progression. Examination of desired resources regarding diet among persons with MS is necessary for supporting behavior change. METHODS: Twenty-five adults with MS completed 1-on-1, online semistructured interviews. An inductive, 6-phase, semantic thematic analysis was applied to identify themes associated with participant preferences for dietary behavior change. RESULTS: The research team crafted 4 key themes from the data that encompassed participants' desired resources for dietary behavior change. Theme 1, MS-specific evidence, involved the need for clear information about the impact of diet regimens or specific foods on MS. Theme 2, dietary guidelines, was related to guidelines provided by a reliable source such as a registered dietitian. Theme 3, behavioral supports, underscored the need for support for behavior change, including accountability, self-monitoring, motivation, habituation, and incremental changes. Theme 4, diet resources, highlighted tangible resources for supporting dietary change, including recipes, food lists, meal services, or games. CONCLUSIONS: This study provides a foundation for guiding dietary interventions for persons with MS that incorporates their needs and preferences and could improve their overall health. Such dietary change can be facilitated by theory-based behavioral interventions that incorporate behavior change techniques such as self-monitoring and goal setting for supporting behavior change.

The renal lineage factor PAX8 controls oncogenic signalling in kidney cancer.

Large-scale human genetic data1-3 have shown that cancer mutations display strong tissue-selectivity, but how this selectivity arises remains unclear. Here, using experimental models, functional genomics and analyses of patient samples, we demonstrate that the lineage transcription factor paired box 8 (PAX8) is required for oncogenic signalling by two common genetic alterations that cause clear cell renal cell carcinoma (ccRCC) in humans: the germline variant rs7948643 at 11q13.3 and somatic inactivation of the von Hippel-Lindau tumour suppressor (VHL)4-6. VHL loss, which is observed in about 90% of ccRCCs, can lead to hypoxia-inducible factor 2α (HIF2A) stabilization6,7. We show that HIF2A is preferentially recruited to PAX8-bound transcriptional enhancers, including a pro-tumorigenic cyclin D1 (CCND1) enhancer that is controlled by PAX8 and HIF2A. The ccRCC-protective allele C at rs7948643 inhibits PAX8 binding at this enhancer and downstream activation of CCND1 expression. Co-option of a PAX8-dependent physiological programme that supports the proliferation of normal renal epithelial cells is also required for MYC expression from the ccRCC metastasis-associated amplicons at 8q21.3-q24.3 (ref. 8). These results demonstrate that transcriptional lineage factors are essential for oncogenic signalling and that they mediate tissue-specific cancer risk associated with somatic and inherited genetic variants.

'Working relationships' across difference - a realist review of community engagement with malaria research.

Background: Community engagement (CE) is increasingly accepted as a critical aspect of health research, because of its potential to make research more ethical, relevant and well implemented. While CE activities linked to health research have proliferated in Low and Middle Income Countries (LMICs), and are increasingly described in published literature, there is a lack of conceptual clarity around how engagement is understood to 'work', and the aims and purposes of engagement are varied and often not made explicit. Ultimately, the evidence base for engagement remains underdeveloped. Methods: To develop explanations for how and why CE with health research contributes to the pattern of outcomes observed in published literature , we conducted a realist review of CE with malaria research - a theory driven approach to evidence synthesis. Results: We found that community engagement relies on the development of provisional 'working relationships' across differences, primarily of wealth, power and culture. These relationships are rooted in interactions that are experienced as relatively responsive and respectful, and that bring tangible research related benefits. Contextual factors affecting development of working relationships include the facilitating influence of research organisation commitment to and resources for engagement, and constraining factors linked to the prevailing 'dominant health research paradigm context', such as: differences of wealth and power between research centres and local populations and health systems; histories of colonialism and vertical health interventions; and external funding and control of health research. Conclusions: The development of working relationships contributes to greater acceptance and participation in research by local stakeholders, who are particularly interested in research related access to health care and other benefits. At the same time, such relationships may involve an accommodation of some ethically problematic characteristics of the dominant health research paradigm, and thereby reproduce this paradigm rather than challenge it with a different logic of collaborative partnership.

Exercise experiences among persons with multiple sclerosis living in the southeast of the United States.

PURPOSE: Exercise is one of the best behavioral approaches for improving health and wellbeing among persons with multiple sclerosis. The environment is a key influencer regarding engagement in this health enhancing activity among those with multiple sclerosis, yet existing research has often been restricted amongst Caucasian samples residing in the midwest and northwest of the United States, Europe and New Zealand. This study explored experiences of exercise among persons with multiple sclerosis from the southeast of the United States. MATERIALS AND METHODS: We interviewed 32 persons with multiple sclerosis from the southeast of the United States regarding exercise experiences, and then undertook an inductive, semantic thematic analysis. RESULTS: The racially diverse sample of persons with multiple sclerosis in the southeast of the United States permitted a crafting of five themes that reflected lived experiences of exercise; (i) exercise is a therapeutic strategy, (ii) facilitators of exercise, (iii) barriers of exercise, (iv) ineffective exercise promotion, and (v) necessities for improved exercise promotion. CONCLUSION: Experiences of exercise in multiple sclerosis are transferable up to a point, but exercise interventions should be contextually specific depending on the geographic area and culture of persons with multiple sclerosis.Implications for RehabilitationExercise is one of the only strategies that improves symptoms of multiple sclerosis and improves quality of life.Cultural and geographic climate may significantly influence exercise experiences, and subsequent engagement of exercise among persons with multiple sclerosis.Practitioners working with persons with MS in the southeast of the US should consider designing exercise programs that take into account the oppressive climate of this area.Persons' with MS cultural and geographic backgrounds should be considered when designing exercise programs to ensure more individualized and appropriate application.

Models and materials for exercise promotion in comprehensive multiple sclerosis care: completion of the 'exercise in medicine' development process.

PURPOSE: Health care providers have highlighted the need for tools and resources that support promotion of exercise behavior within comprehensive multiple sclerosis (MS) care. This study involved a final quality improvement evaluation of exercise promotion models and materials for inclusion within this setting. METHODS AND MATERIALS: Our research team distributed a paper-based survey containing Likert scales, open answer questions, and copies of the models for editing. We distributed this survey among health care providers across the United States. We conducted a novel mixed-methods analysis evaluating quantitative, qualitative, and creative data. RESULTS: We received completed surveys from 13 health care providers who strongly rated the clarity and applicability of the models and materials, and reported that no major improvements were necessary. The minor improvements were specific per comprehensive MS care center. The feedback indicated that the "Exercise in Medicine" models and materials are guides such that the processes should be integrated into real world practice by amending roles and responsibilities with the team members and structure per comprehensive MS care center. CONCLUSION: This paper presents finalized models and materials for exercise promotion within comprehensive MS care that are ready to be tested for feasibility and efficacy in a clinical trial.IMPLICATIONS FOR REHABILITATIONHealth care providers require support to promote exercise within the context of comprehensive MS care.The practice models in this article provide guides regarding how to promote exercise in this context.Implementing these exercise promotion guides can reduce the burden of neurologists, and ensure patients receive exercise support from appropriate providers.These guides should be implemented within the context of each individual care center, and not as an explicit step by step guide as each care center is unique.

Feasibility study of hospital antimicrobial stewardship analytics using electronic health records.

BACKGROUND: Hospital antimicrobial stewardship (AMS) programmes are multidisciplinary initiatives to optimize antimicrobial use. Most hospitals depend on time-consuming manual audits to monitor clinicians' prescribing. But much of the information needed could be sourced from electronic health records (EHRs). OBJECTIVES: To develop an informatics methodology to analyse characteristics of hospital AMS practice using routine electronic prescribing and laboratory records. METHODS: Feasibility study using electronic prescribing, laboratory and clinical coding records from adult patients admitted to six specialities at Queen Elizabeth Hospital, Birmingham, UK (September 2017-August 2018). The study involved: (i) a review of AMS standards of care; (ii) their translation into concepts measurable from commonly available EHRs; and (iii) a pilot application in an EHR cohort study (n = 61679 admissions). RESULTS: We developed data modelling methods to characterize antimicrobial use (antimicrobial therapy episode linkage methods, therapy table, therapy changes). Prescriptions were linked into antimicrobial therapy episodes (mean 2.4 prescriptions/episode; mean length of therapy 5.8 days), enabling several actionable findings. For example, 22% of therapy episodes for low-severity community-acquired pneumonia were congruent with prescribing guidelines, with a tendency to use broader-spectrum antibiotics. Analysis of therapy changes revealed IV to oral therapy switching was delayed by an average 3.6 days (95% CI: 3.4-3.7). Microbial cultures were performed prior to treatment initiation in just 22% of antibacterial prescriptions. The proposed methods enabled fine-grained monitoring of AMS practice down to specialities, wards and individual clinical teams by case mix, enabling more meaningful peer comparison. CONCLUSIONS: It is feasible to use hospital EHRs to construct rapid, meaningful measures of prescribing quality with potential to support quality improvement interventions (audit/feedback to prescribers), engagement with front-line clinicians on optimizing prescribing, and AMS impact evaluation studies.

Fitness for all: how do non-disabled people respond to inclusive fitness centres?

BACKGROUND: Representation of people with disabilities in fitness centres is lacking, despite initiatives to promote inclusion mainly in the UK and USA. Success creating these inclusive spaces is mixed and few were crafted taking into account attitudes and biases of non-disabled co-members. Inclusive fitness centres have not gained much attention in Denmark, and the campaign 'Fitness for All - fitness for people with physical disabilities' was initiated. The aim of this study was shaped by two key questions; 1) what is the ideal fitness space from the perception of non-disabled fitness users? and 2) how might their dis/ableist attitudes negate inclusion in three future pilot inclusive fitness centres across Denmark? METHOD: Three focus groups involving 5-7 (total n = 18) adult non-disabled participants were conducted. Aged ranged between 19 and 75 years, both men and women were involved, with fitness centre experiences ranging from 0 to 20+ years. Interviews were transcribed and analysed using Malterud's four-step method of systematic text condensation. RESULTS: Of most importance was a pleasant atmosphere which should make them feel welcome and comfortable. Good social relations within the space were also highly valued. Participants welcomed people with physical disabilities but predicted many challenges with an inclusive fitness centre and expressed unconscious ableist attitudes. CONCLUSION: The current study adds essential knowledge regarding how non-disabled people perceive the ideal inclusive fitness centre. A welcoming and inviting atmosphere is essential whereas social skills, ableism, ignorance, and preconceptions are important barriers that may hinder inclusion of participants with disabilities in inclusive fitness centres.

Only two out of five articles by New Zealand researchers are free-to-access: a multiple API study of access, citations, cost of Article Processing Charges (APC), and the potential to increase the proportion of open access.

We studied journal articles published by researchers at all eight New Zealand universities in 2017 to determine how many were freely accessible on the web. We wrote software code to harvest data from multiple sources, code that we now share to enable others to reproduce our work on their own sample set. In May 2019, we ran our code to determine which of the 2017 articles were open at that time and by what method; where those articles would have incurred an Article Processing Charge (APC) we calculated the cost if those charges had been paid. Where articles were not freely available we determined whether the policies of publishers in each case would have allowed deposit in a non-commercial repository (Green open access). We also examined citation rates for different types of access. We found that, of our 2017 sample set, about two out of every five articles were freely accessible without payment or subscription (41%). Where research was explicitly said to be funded by New Zealand's major research funding agencies, the proportion was slightly higher at 45%. Where open articles would have incurred an APC we estimated an average cost per article of USD1,682 (for publications where all articles require an APC, that is, Gold open access) and USD2,558 (where APC payment is optional, Hybrid open access) at a total estimated cost of USD1.45m. Of the paid options, Gold is by far more common for New Zealand researchers (82% Gold, 18% Hybrid). In terms of citations, our analysis aligned with previous studies that suggest a correlation between publications being freely accessible and, on balance, slightly higher rates of citation. This is not seen across all types of open access, however, with Diamond OA achieving the lowest rates. Where articles were not freely accessible we found that a very large majority of them (88% or 3089 publications) could have been legally deposited in an institutional repository. Similarly, only in a very small number of cases had a version deposited in the repository of a New Zealand university made the difference between the publication being freely accessible or not (125 publications). Given that most New Zealand researchers support research being open, there is clearly a large gap between belief and practice in New Zealand's research ecosystem.

Using Quality Improvement for Refining Program Materials for Exercise Promotion in Comprehensive Multiple Sclerosis Care.

INTRODUCTION: There is a gap between evidence-based knowledge of exercise benefits and the translation of these benefits among persons with multiple sclerosis within clinical practice. This study represents the second cycle of a Plan-Do-Study-Act ramp to assess and improve three exercise promotion practice models and a screening process for use by healthcare providers to bridge the knowledge-translation gap within comprehensive multiple sclerosis care. METHODS: Using a quality improvement design, our research team created an online survey for evaluating program materials by healthcare providers (i.e., neurologists, nurses, physical therapists, and occupational therapists). Participants provided written comments and suggestions for improvement regarding roles and responsibilities and clarity and relatability of these tools within a real-world setting. RESULTS: Healthcare providers submitted 13 suggestions for improvement. Responses informed four specific improvements regarding program materials (i.e., patient screening, current exercise behavior, referrals, and provider checklists), thereby prompting the research team to adapt and further test the change idea. CONCLUSIONS: This article provides a step forward in a line of research focused on developing a systems-based process for integrating exercise promotion as part of comprehensive multiple sclerosis care.

Unveiling the composition of historical plastics through non-invasive reflection FT-IR spectroscopy in the extended near- and mid-Infrared spectral range.

The present research exploits the strengths of external reflection FT-IR spectroscopy to non-invasively study heritage plastic objects through inspection, for the first time, of the wide spectral range including the near- and mid-IR (12500-350 cm-1). Unlike most of previous works on historical plastic objects, reflection-mode spectra were not corrected for the unfamiliar surface reflection profiles to the more recognizable absorption-like band shapes. This avoided data misinterpretation due to ill-suited Kramers Krönig correction when volume reflection is also present or when highly absorbing IR compounds generate Reststrahlen bands. The inspection of the enlarged spectral range allowed the detection of fundamental, combination and overtone bands which provided reliable identification and semi-quantitative characterization of different polystyrene-based co-polymers. Furthermore the variation of the plastic optical properties across the explored spectral range allowed us to sample the plastic materials to different depths in the mid- and near-IR regions, so as to probe the chemistry at the surface and in the plastic bulk, respectively, in a non-invasive manner. This proved particularly useful to observe spectral markers of surface degradation occurring in historical ABS-based polymers.

The Neurologist as an Agent of Exercise Rehabilitation in Multiple Sclerosis.

This review hypothesizes that the neurologist represents the linchpin of exercise behavior change within comprehensive multiple sclerosis (MS) care settings. This is based on a series of recent articles that developed actionable practice models for accomplishing such behavior change through the neurologist as the primary agent. This provides tangible, next steps for exercise promotion in MS.

"Kicking and Screaming" or "Gracefully Conceding": Creative Nonfiction Stories of Aging With Multiple Sclerosis.

Aging with multiple sclerosis (MS) is a complex phenomenon. Some individuals report physical and cognitive dysfunctions regarding these combined experiences, whereas others report perceived improvements in quality of life. Beyond this, little is known regarding how people make sense of, and come to embody, negative or positive experiences of MS. Thus, our objectives were to (a) explore how people made sense of aging with MS and (b) present this in an artful, engaging, transformative way. To achieve this, we conducted 40 semi-structured interviews with older adults who had MS, analyzed data using pluralistic narrative analyses, and presented results through two creative nonfictions. We detail our process of creating the nonfictions before presenting the different stories of aging with MS, namely "Kicking and Screaming" and "Gracefully Conceding." We then offer recommendations and implications for using these stories as knowledge translation devices, and further critique the limitations of these stories in practice.

"How Come You Sent Me the Canadian One?" Application and Uptake of the Canadian Physical Activity Guidelines for Adults With Multiple Sclerosis in the United States.

The uptake and benefits of the Canadian Physical Activity Guidelines for Adults with Multiple Sclerosis (PAGs) have been validated, but there is limited understanding regarding the knowledge, needs, and preferences of people with multiple sclerosis (MS) for implementing the PAGs outside of clinical research. The authors conducted online, semistructured interviews with 40 persons with MS from across the United States seeking information on awareness of and potential approaches for increasing the uptake of the PAGs. They identified first impressions and potential approaches for increasing the uptake of the PAGs through inductive, semantic thematic analysis. Participants perceived the PAGs as a good introduction for structured exercise but desired more information on how to meet the PAGs. Participants further believed that modifying the PAGs for inclusivity and applying a multifaceted approach for dissemination and implementation may increase uptake of exercise behavior. Physical activity research in MS should include both analyzing the effects of exercise and the unique challenges faced by persons with MS in putting the PAGs into practice.

Informing the design of exercise programs for persons with multiple sclerosis who use wheelchairs: a qualitative inquiry of perceived components.

PURPOSE: We investigated the perceptions of persons with multiple sclerosis (MS) who use wheelchairs regarding preferences for the design of exercise programs. MATERIALS AND METHODS: We conducted online, semi-structured interviews with 20 persons with MS who use wheelchairs regarding preferences for exercise programs. We identified perceived necessary and desired components of exercise programs through deductive content analysis. RESULTS: Participants articulated preferences for "what", "when", "where", and "who" of exercise programs for persons with MS who use wheelchairs. The majority of participants expressed an interest in aerobic and strength training, possibly supported by rehabilitation therapies (what). The frequency was 2-7 times per week with a duration of 15-30 minutes (when). The locations included home-, Internet-, or community-based exercise (where), supported through autonomous, one-on-one, and group delivery (who). CONCLUSIONS: Persons with MS who use wheelchairs were interested in exercise, but need resources for engagement in regular exercise programs that yield meaningful health benefits. This study provided guidance for creating personalized, structured exercise programs for persons with MS who use wheelchairs that may improve overall wellness, independence, and quality of life.Implications for rehabilitationExercise training programs often do not account for the unique needs and wants of persons with multiple sclerosis (MS) who use a wheelchair.Personalized, structured exercise programs for persons with MS who use wheelchairs may improve outcomes including independence and quality of life.The proposed exercise guidelines provide initial guidance for persons with MS who use wheelchairs regarding engagement in exercise for improving MS symptoms and quality of life.