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On Community Development Research and Practice: Towards a Reflexive Approach
Get PDFThe lack of an established policy framework by government in Northern Ireland for community development, within the contested objectives of an enforced coalition, mirrors theoretical perspectives that see community development as a contested concept. In contrast, a research programme working with community development organisations in Catholic and Protestant disadvantaged neighbourhoods in Belfast identified that community development practitioners did have a clear understanding of what constituted community development. Successful community development practice in Belfast involved both conflict and collaboration with government. Effective leadership that interpreted meanings between sometimes consensual, sometimes conflictual interpretations of the nature of inequality stood out as a factor in the success of the researched community development organisations. The research findings indicate that ethnographic research in situations of poverty cannot avoid examining the positionality of the researcher and the impact of a reflexive methodology. A framework for planning and evaluation that is rooted in the common values exhibited by community development practitioners is proposed as a method to deliver support to successful community development organisations as independent influencers of government policy. In essence, those values see the primacy of the experience of the individual as a starting point for collective endeavour; of recognising the difference individuals can make for themselves and the greater difference for themselves if they work together. They are values of collaboration through participative democratic means whilst recognising the integrity of the individual
The Effect of Different Algorithms on Prevalence of Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorder in secondary healthcare data in five European countries: A Contribution from the ConcePTION project
Get PDFTo assess the effect on prevalence estimates of using different algorithms to identify children with attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in healthcare data. Three algorithms were developed and run on administrative/research data in Finland, France (Haute Garonne), Italy (Emilia Romagna), Norway and Wales: (1) ≥ 1 ADHD or ASD diagnoses recorded in specialist settings, (2) ≥ 2 ADHD or ASD diagnoses recorded in primary care and (3) ≥ 1 prescription for medication to manage ADHD. Prevalence rates per 1000 children for each algorithm were calculated. 3,130,162 children (born 1996–2020) with 29,291,204 years of follow-up were included. ADHD prevalence per 1000 children in specialist settings ranged from 3.9 (Emilia Romagna) to 24.1 (Finland); and was 7.0 in primary care (Finland). Based on prescriptions, ADHD prevalence ranged from 0.1 (Emilia Romagna) to 9.9 (Haute Garonne). ASD prevalence in specialist settings ranged from 5.6 (Wales) to 9.7 (Finland), and in primary care from 1.0 (Finland) to 2.0 (Wales). Prevalence of ADHD and ASD was greater among children with longer follow-up. In Finland and Wales, 1.7% and 19.4% of children were diagnosed with ASD in primary care only respectively. The male: female ratio was 3–4:1. Whilst there was considerable geographical variation in the length of follow-up available, and prevalence of ADHD and ASD, specialist diagnoses recorded in healthcare data were key to identifying children with these disorders. These data sources can be complemented by using primary care diagnoses and prescription data to identify affected children more comprehensively
The VIP trial: a randomised controlled trial of the clinical effectiveness of a Victim Improvement Package (VIP) for the reduction of continued symptoms of depression or anxiety in older victims of community crime in an English city
Get PDFBackground: Older crime victims may be particularly vulnerable to psychological distress. Objectives: To compare the clinical effectiveness of a Victim Improvement Package (VIP) to treatment as usual (TAU) for reducing continued crime-associated distress. Design: A three-step parallel-group single-blind randomised controlled trial. Setting: Police-reported victims of community crime aged 65 and over were recruited from 12 local authority areas in a major urban city in England, UK. Participants: Selection criteria—inclusion: victims of community crime aged 65 years or more, with significant Generalised Anxiety Disorder (GAD-2) and Patient Health Questionnaire (PHQ-2) distress associated with the crime. Exclusion: type of crime, diagnosis, receipt of cognitive–behavioural therapy (CBT) in the last 6 months; an inability to participate in CBT; cognitive impairment. Participants were typical of our local authority population; 71% were female, 69% white, with the majority of crimes associated with burglary (35%) and theft (26%). 67% (88/131) of the randomised participants were included in the primary analysis. Interventions: TAU was compared with TAU plus up to 10 sessions of a cognitively-behaviourally informed VIP, delivered by a mental health charity over 12 weeks. Primary and secondary outcome measures: Timings are in relation to the crime; baseline (3 months), post-VIP intervention (6 months) and follow-up (9 months). The primary outcome was a composite of the Beck Anxiety and Beck Depression Inventories. The primary endpoint was 6 months. Results: 24% (4255/17 611) of reported crime victims were screened, 35% (1505/4255) were distressed. Of 60% (877/1505) rescreened at 3 months, 49% (427/877) remained distressed. Out of our target of 226, 131 participants were randomised; 65 to VIP and 66 to TAU alone. 68% (89/131) completed the primary outcome (post-intervention). The VIP showed no overall benefit; mean VIP −0.41 (SD 0.89) vs mean TAU −0.19 (SD 1.11); standardised mean difference −0.039; 95% CI (−0.39, 0.31), although stratified analyses suggested an effect in burglary victims (n=27, standardised mean difference −0.61; 95% CI (−1.22, –0.002), p=0.049). Conclusions: Community crime had long-lasting impacts. The police are ideally placed to screen for distress, present in 35% of victims, but only 58% of participants were recruited and the cognitive–behavioural therapy was not delivered competently. Further research on victim care and improving the delivery and quality of therapy is required. Trial registration number: All procedures were approved by the University College London (UCL) Research Ethics Committee on 17 March 2016 (6960/001). International Standard Randomised Controlled Trial Number is ISRCTN16929670: https://doi.org/10.1186/ISRCTN16929670
Evaluating the Economic Impact of Diabetes Mellitus: A Hospital-Centric Cost Analysis in Hail, Saudi Arabia
Get PDFBackgroundDiabetes mellitus (DM) is a chronic non-communicable disease (NCD) that imposes a significant economic burden on healthcare systems and households. This study aimed to estimate the direct medical costs associated with diabetes care from a hospital perspective in Hail, Saudi Arabia.MethodsA retrospective, hospital-based study was conducted using data from hospital records of diabetic patients treated at King Khalid Hospital (KKH) and King Salman Specialized Hospital (KSSH) in Hail. The study employed a top-down approach to estimate direct medical costs, including consultation, lab tests, medications, admissions, and annual check-ups. Costs were adjusted to US dollars (1 USD = 3.75 SAR). Ethical approval was obtained from the Hail Health Cluster (IRB Log Number: 2023-44).ResultsA total of 377 diabetic patients were included in the study. The mean age was 58.02 years (SD = 18.80), with 53.3% male and 46.7% female patients. The average total annual cost per patient was US2686.0 ± 3373.0). The total estimated cost for all patients combined was approximately US$2.52 million. Older age, female gender, DM complications, and treatment at KSSH were significantly associated with higher direct costs.ConclusionThe economic burden of diabetes is substantial and continues to rise annually. Policymakers should prioritize cost-effective interventions and improve data collection across hospitals to better understand and mitigate the financial impact of diabetes
AI-assisted script concordance tests: Enhancing feasibility with customized ChatGPT
Get PDFThe Script Concordance Test (SCT) assesses clinical reasoning by evaluating responses to uncertain scenarios against expert clinician panels. Unlike traditional multiple-choice questions (MCQs), SCTs measure how examinees structure their knowledge in complex, evolving contexts. Grounded in script theory, SCTs capture the cognitive networks clinicians develop through experience, allowing assessment of real-world decision-making. Developing SCTs presents challenges, including crafting clinically relevant scenarios with appropriate ambiguity and ensuring expert panel reliability. Scoring depends on concordance with expert panels, requiring careful recruitment of 15-20 experts for validity. These logistical demands complicate SCT implementation, particularly in high-stakes assessments. To address these challenges, we leveraged artificial intelligence (AI), utilizing ChatGPT to generate and score SCTs in ophthalmology. We refined prompts to emulate medical educators, producing SCT vignettes aligned with curricular blueprints. A customized ChatGPT system was trained to assist SCT development, incorporating expert-derived scoring keys. We created one SCT test composed of 10 questions, each with three items assessed through a 5-point Likert scale. ChatGPT-generated SCTs effectively simulate clinical scenarios, structure scoring, and analyze response patterns. Future work will expand AI-assisted SCTs to other specialties, creating an archive of validated vignettes
AI Across Borders:Exploring Perceptions and Interactions in Higher Education
Get PDFThis study investigates students’ perceptions of Generative Artificial Intelligence (GenAI), with a focus on Higher Education institutions in Northern Ireland and India. We collect quantitative Likert ratings and qualitative comments from 1211 students on their awareness and perceptions of AI and investigate variations in attitudes toward AI across institutions and subject areas, as well as interactions between these variables with demographic variables (focusing on gender). We found the following: (a) while perceptions varied across institutions, responses for Computer Sciences students were similar, both in terms of topics and degree of positivity; and (b) after controlling for institution and subject area, we observed no effect of gender. These results are consistent with previous studies, which find that students’ perceptions are predicted by prior experience; crucially, however, the results of this study contribute to the literature by identifying important interactions between key factors that can influence experience, revealing a more nuanced picture of students’ perceptions and the role of experience. We consider the implications of these relations, and further considerations for the role of experience
What is Next for Universal Design for Learning?:UDL 3.0 and Implications for Diverse Settings
Get PDFThe Universal Design for Learning (UDL) framework guides educators and instructional designers in planning for learner diversity as a core facet of curricular design. Following an extensive four-year process, a revised UDL 3.0 framework was released in 2024 that expanded considerations for learner diversity and attended to exclusionary systemic biases. This refresh of UDL brought marked changes in guideline language that incorporated complex concepts such as learner identity, intersectionality, learner-centeredness, and interdependence. Through a conversation cafe during the International Conference on Education Quality, global educators dialogued about how they interpret these changes in terms of their understanding of UDL and its implications for inclusive education practice in their local contexts. Participant feedback on the revised framework revealed varied perceptions of the strengths of the UDL 3.0 language and applications for practice in differing settings, such as early years, formal school settings, tertiary education, and alternative education contexts, and potential challenges related to cultural and linguistic differences
What are the most salient visuoperceptual reading symptoms to identify visual stress in adults? Using exploratory factor analysis to develop the Ulster visual stress questionnaire
Get PDFVisual Stress (VS) is a reading disorder characterised by visuoperceptual distortion symptoms experienced when reading. VS diagnosis is on an ad-hoc basis, with symptomology and diagnostic criteria poorly understood. This study investigated reading symptoms in adults to develop a clinically useful questionnaire for VS diagnosis. A comprehensive 17-item questionnaire was developed probing reading symptoms derived from the existing literature. 1248 undergraduate students (aged 18–50 years) completed the questionnaire and pattern glare test. 294 participants (23.6 %) exhibited pattern glare (scores > 3 on a mid-spatial frequency pattern glare test) which was used as an indirect measure of cortical hyperexcitation. After exclusion of diagnosed migraineurs, data from 247 participants were analysed. Parallel analysis determined the number of distinct factors and exploratory factor analysis assigned symptoms to these factors. To ensure symptoms mapped to a single factor, retained items needed to satisfy three conditions: (i) load onto their primary factor if >0.40, (ii) cross-load onto alternative factors by <0.30 and (iii) exhibit a difference in item primary factor and subsequent factor loadings of >0.20. Five factors were identified and mapped well to aetiological theories proposed to explain visual stress: 1) Magnocellular Pathway Deficits 2) Cortical Hyperexcitability 3) Eye Movement/Tracking Issues 4) Aversion to High Temporal Frequency ‘Flicker’ and 5) Concurrent Pathologies associated with Visual Stress. Post-hoc item analysis reduced questionnaire content to ten items. Exploratory factor analysis enabled systematic creation of a robust 10-item questionnaire to aid visual stress diagnosis. The questionnaire will be applied in a clinical context and among different ages for validation purposes
Statistical Power in Musculoskeletal Research: A Meta-Review of 266 Randomised Controlled Trials
Get PDFBackgroundUnderpowered study designs undermine the reliability of experimental research, with growing concerns regarding randomised controlled trials (RCTs) informing musculoskeletal injury management. We assessed the statistical power and sample size calculations of such RCTs.MethodsElectronic searches (MEDLINE and PEDro searched up to March 2024) identified meta-analyses of RCTs comparing conservative interventions for musculoskeletal injury, without restrictions on demographics, injury type, or outcome. Statistical power was estimated using two approaches: (1) meta-analytic—the RCT’s power to detect the summary effect of the meta-analysis it contributed to, and (2) conventional—the RCT’s power to detect Cohen’s small (d = 0.2), medium (d = 0.5), and large (d = 0.8) effect sizes. The RCTs’ manuscripts and registry entries were screened for sample size planning details.ResultsThe search identified 4737 articles, with 41 eligible meta-analyses of 266 RCTs. The median power was 42% (54% among RCTs within statistically significant meta-analyses). Less than 1 in 3 RCTs from statistically significant meta-analyses had ≥ 80% power to detect the corresponding summary effect. The number of RCTs with ≥ 80% power to detect small, medium, and large effects was 0%, 7.9%, and 37.6%, respectively. One in four RCTs reported sample size calculations; 80% expected larger effects than they observed. RCTs not reporting sample size calculations were smaller and reported larger effects.ConclusionLow statistical power permeates musculoskeletal injury research, limiting the clinical utility of many RCTs. The underlying causes of low power in this field are multifactorial and extend beyond sample size calculation alone. Enhancing study power requires methodological improvements, including robust planning, stronger theoretical frameworks, multi-center collaboration, data sharing, and the use of valid, reliable outcome measures