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Voices from Laos: navigating the transition from a twice daily to multiple daily insulin regimen in a resource-limited setting
Get PDFBackground Before 2016, no Laotian child was known to have survived type 1 diabetes (T1D) into adulthood. There is an ongoing need for action. Our study explored, in supported youth, the impact of transitioning from a twice to multiple daily injection (MDI) regimen on glycaemic control, and their views/perceptions around how the switch affected their T1D management/quality of life. Methods Data were obtained from medical records/semi-structured interviews; participants recruited as they switched to an MDI regimen. Quantitative data were stratified into glycated haemoglobin (HbA1c) 6/12 months before/after the switch, and male/female sex; associations examined using t-tests. Qualitative data were analysed using Gibb’s framework. Results Overall, 24 youth (62.5% female) changed regimens. Mean±SD HbA1c 6/12-month periods before the switch were 8.8±2.3% (73.0 mmol/mol)/8.3±2.2% (67.0 mmol/mol), respectively. In the same periods after the switch, HbA1c improved to 7.6±2.7% (60.0 mmol/mol)/7.7±2.1% (61.0 mmol/mol), respectively. No differences were observed between sexes. Interviews were conducted with 15 youth (73.3% female); mean ages at T1D diagnosis/the switch time were 10.6 and 14.3 years, respectively. Describing how transitioning to an MDI regimen affected T1D management/quality of life, three themes emerged: pragmatism; empowerment and agency; and foundations of success. Conclusions The study provides valuable insights that will guide future work in supporting youth with T1D
The direct costs of violent crime in Local Labour Systems
No full textAt what point is the night? The reference to Shakespeare's Macbeth is a way of reading the evolution of crime in Sardinia, in particular those forms that use violence as a tool to satisfy impulses of control and illicit enrichment. The connection is risky, but it is useful to remember that there are always those who use violence to stop with blood anyone who stands in the way or constitutes an obstacle.At what point is Sardinian crime? For twenty years, the Social Observatory on Development and Crime in Sardinia (OSCRIM) has been monitoring the changes and has reported on them from time to time in the volumes published from 2006 until today, without forgetting that the flourishing drug market has now become the material support on which the major Sardinian criminal expressions are based, so much so that it has led OSCRIM to dedicate a trilogy to it - Drugs and criminal organizations in Sardinia (2021), The Underground Island (2022), Happiness no longer lives here (2023).It is in a twilight Sardinia, so to speak, that the different types of criminal violence are placed, also because they continue to characterize many of the criminal phenomena of the island in continuity with the past, albeit with many new elements.The volume is divided into four chapters and focuses attention on murders (by Daniele Pulino), robberies (by Sara Spanu) and attacks (by Daniele Pulino), the fourth chapter is dedicated to the latter two crimes which reports the study of the relative economic costs (by Anna Bussu, Domenica Dettori, Maria Gabriela Ladu, Manuela Pulina). The introductory essay (by Antonietta Mazzette) offers a possible way of reading the evolution of criminal violence in Sardinia.Antonietta Mazzette is an urban sociologist and scientific director of OSCRIM. His works include: The right to the city fifty years later (SUR, no. 127, 2018); Dualism in Sardinia (cur. Angeli 2019); Urban metamorphoses in times of pandemic (SUR, no. 127, 2022); with Daniele Pulino and Sara Spanu, City and territory in times of pandemic (Angeli 2021); Safety, Mobility and Sociality in Urban Spaces during the Health Emergency in Italy (Fuori Luogo, vol. 19, 2024)
Cultural reproduction of knowledge and identity:Impact of a competency-based curriculum on knowledge engagement and identity construction in second year undergraduate nursing students in England – A constructivist grounded theory study
Get PDFBackgroundNursing knowledge is neither fixed nor uncomplicated but outcomes driven and competency-based standards underpinning nurse education can result in the dilution of pedagogical principles and a prescriptive and cultural reproduction of knowledge in nursing students. AimTo examine how student nurses navigate the second year of an undergraduate degree programme in the UK and how different learning environments (practice and university) and previous experiences influence their perceptions, meanings and identity.DesignLongitudinal constructivist grounded theory design underpinned by symbolic interactionism and social realism using focus groups and individual interviews.SettingOne Higher Education Institution in Northwest England.ParticipantsYear 2 BSc Nursing students (n = 11)FindingsA substantive theory, ‘Navigating the second-year landscape: How student nurses construct an identity and engage with knowledge in the second year of an undergraduate degree’ was underpinned by six categories: (1) the perceived identity of year two; (2) re-evaluating past, present, future; (3) constructing and balancing identities; (4) engaging with knowledge; (5) reference groups: significant others and the generalized other; and (6) the hidden curriculum: professional socialisation.ConclusionsStudents place importance on and seek familiarity in the clinical environment and this can constrain opportunities for deeper critical engagement and hinder the development of autonomous practitioners capable of independent, reflective and critical thinking. Year two marks a pivotal stage in professional identity development and students seek knowledge and guidance from ‘significant others’ - typically their peers. Informal and hidden elements of the curriculum can influence students' learning and professional identity formation. Findings may have wider implications for opening international discourse on competency-based education including potential transferability to other practice-based professions
Biopsychosocial pain assessment and management in paediatric inflammatory vs non-inflammatory musculoskeletal conditions: a vignette study
Get PDFObjectives There is no research evidence about how healthcare professionals prioritise assessment and management of pain in different paediatric chronic musculoskeletal conditions (e.g. inflammatory or non-inflammatory). This study investigated and compared paediatric rheumatology healthcare professionals’ pain assessment/management priorities in inflammatory and non-inflammatory chronic musculoskeletal conditions and explored perceived barriers to implementation of prioritised pain assessment/management approaches. Methods Participants were presented with online vignettes describing a young person with an inflammatory (juvenile idiopathic arthritis) or non-inflammatory (diffuse idiopathic pain) chronic musculoskeletal condition. Participants completed closed questions on pain assessment/management priorities and open questions on perceived barriers to implementation of these priorities in clinical practice. Data were analysed using within-subjects bivariate statistical analysis and content analysis. Results Results from 56 healthcare professionals (11 countries) found that broadly similar pain assessments were selected for both conditions. Biomedical management approaches were more frequently selected for the inflammatory condition whereas psychosocial approaches were primarily selected for the non-inflammatory condition. Barriers to implementation of assessment/management approaches included: limited time, resources, knowledge and skillset, and healthcare professionals’ habits and beliefs about pain care (e.g. limiting access to components of biopsychosocial pain management due to preconceived beliefs about the musculoskeletal condition). Conclusion Paediatric rheumatology healthcare professionals generally prioritise similar pain assessments for inflammatory and non-inflammatory chronic musculoskeletal conditions. However, some healthcare professionals perceive psychosocial pain management approaches as less important for managing pain in inflammatory conditions. Importantly, pain is always biopsychosocial in nature and clinical guidelines (which emphasise the biopsychosocial perspective) should ideally be followed regardless of condition-type
AI in the Curator’s Loop: Designing Transparent and Trustworthy Metadata Displays under the EU AI Act
No full textMuseums are increasingly exploring how artificial intelligence could assist with largescale metadata enrichment, yet few have implemented such systems beyond small research pilots. Concerns about hallucinations, bias, transparency, and the erosion of curatorial authority have made many institutions cautious about operational use. This paper introduces Project SPOT, a research-led framework and AI-assisted tool developed to operate within the curator’s loop, ensuring that AI generated suggestions support rather than supersede and replace curatorial knowledge and judgement. SPOT identifies sub-objects within artefact images and produces candidate metadata that are subsequently reviewed, amended, or rejected by curators, maintaining clear human authorship throughout the process.Forthcoming transparency obligations under the EU AI Act add urgency to these discussions. The Act requires public disclosure when content has been generated or influenced by AI, raising new design questions for museums that wish to display AIassisted information online. Using SPOT as a case study, this paper examines strategies for integrating AI-generated, curator-verified data into artefact webpages while remaining compliant with the Act. It considers both interface-level and metadatalevel approaches for signalling AI involvement and analyses how these might affect user trust in institutions long regarded as sources of reliable knowledge.By framing AI as a transparent, curator-controlled partner in the creation of cultural data, the paper contributes to current debates on human–machine interaction, digital provenance, and the museum as an epistemic actor in the digital public sphere
Enhancing emergency front-of-neck airway training: a mixed methods study on the impact of external noise and startle stressors:Stress and Startle
No full textIntroduction: Our aim was to investigate whether emergency front-of-neck airway training utilising low-fidelity manikins in a ‘tea-trolley’ format could be improved by the incorporation of stress inoculation training. This would be an important advance as clinicians report that cognitive overload impairs performance during real emergencies. We hypothesised that environmental noise and simulated blood splatter would result in a heightened stress experience. Methods: Thirteen anaesthetic residents completed the study, performing emergency front-of-neck access first under non-stressed conditions and later with the addition of noise and startle stressors. The primary outcome was a change in salivary cortisol, measured before and after each training session. Secondary outcomes included participant proficiency; time to perform the procedure; and perceived stress and utility of the training. Semi-structured interviews explored participant perceptions of the training. Results: Environmental noise and simulated blood splatter resulted in a quantitatively and qualitatively heightened stressful experience for the participants in paired comparisons. There was no significant change in median (IQR [range]) salivary cortisol levels after participants completed the non-stressed training: 6.4 (4.3–8.1 [3.3–16.2]) nmol.l -1 vs. 9.2 (5.8–11.3 [3.8–14.1]) nmol.l -1, respectively (p = 0.133). There were, however, significant changes following stressed training: 4.9 (4.3–11.6 [1.1–11.6]) mol.l -1 vs. 9.2 (8.0–12.1 [4.4–20.1]) nmol.l -1, respectively (p = 0.005). Participants' semi-structured interviews and questionnaire results evidenced that the adaptations created a more stressful yet valuable training experience. Discussion: Environmental noise and simulated blood splatter increased participant stress. Participants performed emergency front-of-neck access equally well in both sessions, suggesting this technical skill is stored in their stress-resistant long-term memory. These relatively low-cost adaptations could enhance emergency front-of-neck airway tea-trolley training by facilitating stress inoculation training and so better prepare clinicians for real-world emergencies.</p
Being active in Ghana: facilitators, barriers and preferences for being physically active in community settings among Ghanaian adults
Get PDFIntroduction Physical inactivity remains a major risk factor for the development of non-communicable diseases. This study investigated physical activity behaviours, as well as barriers, facilitators and preferences that influence participation in a range of community-based physical activity interventions among Ghanaian adults.Methods Adults living in six regions of Ghana completed a cross-sectional survey. Participants were recruited using a multi-stage sampling technique. Data were collected using a researcher-developed structured questionnaire, administered to participants using Kobo Toolbox, with data reported descriptively and analysed using binary logistic regression.Results A total of 1122 out of 1164 participants completed the survey (mean age±SD=31.0±12.0; women=621). Overall, 648 (60.1%) participants engaged in ≥150 min of moderate-to-vigorous intensity physical activity (MVPA)/week, while 375 (33.4%) participants completed muscle-strengthening exercises≥twice/week. About a quarter of respondents (n=301, 26.8%) were knowledgeable about the guidelines for physical activity. Six out of ten participants expressed that social media is an effective way to encourage regular physical activity among Ghanaian adults. Over half of the participants (n=624, 55.6%) reported they would take part in physical activity interventions if offered by their place of worship and about half (n=443, 45.6%) indicated they would attend gyms/fitness centres regularly if they were more accessible and affordable in Ghana. Being male (adjusted odds ratios (AOR) 1.92, 95% CI 1.48 to 2.50), having a basic level of education (AOR 2.44, 95% CI 1.29 to 4.63) and being knowledgeable about guidelines for physical activity (AOR 1.86, 95% CI 1.37 to 2.53) were associated with higher odds of engaging in ≥150 min of MVPA per week as per guidance. These findings suggest that social media and faith-based settings may be effective contexts for promoting physical activity in Ghana. Improving accessibility and affordability of gyms/fitness centres may also increase engagement in structured and unstructured physical activity.Conclusion This study found that a large percentage of participants were not meeting the guidance for daily physical activity. Knowledge about the guidelines for physical activity was very low and concerning. Participants expressed a strong preference for physical activity interventions to be delivered through social media channels, by healthcare professionals and in places of worship. These findings highlight the importance of leveraging these settings for promoting physical activity in Ghana
Revealing Privacy Needs During Life’s Significant Transitions
No full textPeople experience transitional events during their lives that are significant, disruptive, and potentially challenging to navigate. Emotions usually run high, and the central actor may seek personalised support from ‘others’ who are often identified online. An increased online presence, however, can also exacerbate vulnerabilities, making it challenging for individuals to preserve their privacy. Privacy Enhancing Technologies (PETs) can support people undergoing transitions to have more control over their online identity and related disclosures. Nevertheless, available tools of this kind do not explicitly cater to the needs of such populations, leading to low uptake.To inform the development of bespoke Privacy Enhancing Technologies, we carried out a survey to understand the population characteristics and online behaviours of four transition groups: (1) leaving the Armed Forces; (2) Relationship Breakdown (Romantic); (3) Serious Illness (Cancer); and (4) LGBTQ+ (‘coming out’ or gender transition). Our findings suggest that bespoke Privacy Enhancing Technologies should engender resilience and a sense of control over what is shared online via the identification, creation, and maintenance of ‘safe spaces’ in which network members are restricted to trusted others who are deemed supportive of the actor’s transitio
‘We are different, but we are not really that different’:An insight into the challenges encountered by career leaders when supporting disabled students in English mainstream and specialist classrooms
Get PDFFor over 10 years, schools have been responsible for providing career support to all young people. In order for schools to be able to deliver career support in the classroom, the career leader role was introduced as part of the Education Act 2011. With increasing numbers of disabled students attending mainstream school, a key challenge encountered is ensuring that the support provided is inclusive and accessible to all young people. This article provides an overview of a case study which brought together eight educational professionals working across mainstream and specialist provisions. It was hoped that by providing space for these educational practitioners to share practice, they could both reflect on their own experiences and identify ways to develop more inclusive practice when providing career support to young disabled people. As with many of the professionals working within the current English education system, the career leaders demonstrated their commitment to ensuring all young people have opportunities to successfully transition from school; however, they find themselves constrained by a system that is not working. This article therefore highlights some key recommendations for addressing the barriers that are encountered when supporting young people to successfully transition from school