To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The analysis and understanding of multilingualism, and its relationship to identity in the face of globalization, migration and the increasing dominance of English as a lingua franca, makes it a complex and challenging problem that requires insights from a range of disciplines. With reference to a variety of languages and contexts, this book offers fascinating insights into multilingual identity from a team of world-renowned scholars, working from a range of different theoretical and methodological perspectives. Three overarching themes are explored – situatedness, identity practices, and investment – and detailed case studies from different linguistic and cultural contexts are included throughout. The chapter authors' consideration of 'multilingualism-as-resource' challenges the conception of 'multilingualism-as-problem', which has dogged so much political thinking in late modernity. The studies offer a critical lens on the types of linguistic repertoire that are celebrated and valued, and introduce the policy implications of their findings for education and wider social issues.
The rise of agrarian capitalism in Britain is usually told as a story about markets, land and wages. The Enclosure of Knowledge reveals that it was also about books, knowledge and expertise. It argues that during the early modern period, farming books were a key tool in the appropriation of the traditional art of husbandry possessed by farm workers of all kinds. It challenges the dominant narrative of an agricultural 'enlightenment', in which books merely spread useful knowledge, by showing how codified knowledge was used to assert greater managerial control over land and labour. The proliferation of printed books helped divide mental and manual labour to facilitate emerging social divisions between labourers, managers and landowners. The cumulative effect was the slow enclosure of customary knowledge. By synthesising diverse theoretical insights, this study opens up a new social history of agricultural knowledge and reinvigorates long-term histories of knowledge under capitalism.
The transition between Core Psychiatry Training (CPT) and Psychiatry HTs is often anxiously anticipated by trainee psychiatrists, in view of the heightened responsibility and increased demand faced by trainees. The author wrote and delivered a one-day simulation induction course for newly appointed CAMHS HTs across London. The aim of this course was to improve participant's confidence, skills and knowledge in managing a range of conditions and challenging scenarios in children and young people (CYP) presenting to CAMHS. The course was also designed to improve HT's confidence in supporting junior colleagues and in managing conflict resolution. There was also an overarching aim of increasing human factor skills by focusing on these within the scenarios and debriefs.
The simulation training was delivered online and consisted of five scenarios commonly faced by CAMHS SPRs based in a variety of settings. Themes within the scenarios included eating disorders and deliberate self-harm, as well as managing risk, multiple demands, and the psychosocial factors contributing to mental illness. Professional actors, plants and virtual backgrounds were used to enhance fidelity of the scenarios. Platform orientation and an introduction to simulation were initially provided followed by “ice breaker” activities, which were used to promote psychological safety amongst participants. Each scenario lasted approximately 10 minutes. Following each scenario, participants were supported to engage in a debrief using the Maudsley Debrief model. Pre- and post-course evaluation questionnaires were given to participants to complete and comparative analysis was conducted.
Seven participants completed both the pre- and post- course evaluation questionnaires. The mean sum score for course specific questions was 51.86 (SD = 9.56) pre course, and 68.00 (SD = 10.08) post course, showing a 31.12% increase in knowledge, skills, and confidence across the course specific domains.
The mean sum score for the Human Factors Skills for Healthcare Instrument (HFSHI) was 76.67 (SD = 17.26) pre course, and 86.50 (SD = 16.54) post course, showing a 12.82% increase in human factors skills.
This simulation course demonstrated it is an effective and innovative way to help with induction for HT, resulting in an increase in knowledge, skills and confidence in trainees transitioning from CPT to HT, both in terms of factors specific to managing CYP's care and in relation to broader human factor skills.
Experiential learning, such as simulation-based training, is widely used in health education. Dramatic self-expression adds another layer through enacted perspective taking, and embodied self-exploration of interaction with others, to foster situated learning. We describe the evaluation of an innovative drama-based experiential learning project involving collaboration between multidisciplinary mental healthcare staff and people with lived experience of mental illness. The programme was facilitated at East London NHS Foundation Trust by a theatre company experienced in delivering workshops with service users. A weekly group programme took place online over 8 weeks during the COVID-19 pandemic and included activities of improvisation, embodied enactments and debriefing. The programme led to co-production of a drama piece that was filmed and distributed online. It was hypothesised that the experiential learning might result in individual benefits for all participants, such as improved well-being and increased mutual understanding of each other's experience of mental health care. The project aimed to improve relationships between healthcare disciplines, and between staff and service users. Additionally, aims were to empower service users, and support staff to practice core interpersonal skills. Objectives of the evaluation were to study the impact of the experiential learning, understand participants’ experience, and explore challenges and benefits.
A mixed methods approach was taken to evaluate the programme. Following completion of the project, participants were invited to complete a questionnaire utilising a Likert scale rating of overall satisfaction with the project, perceived benefit and impact on specific domains such as working with others. One-to-one semi-structured interviews were conducted according to a topic-guide, and qualitative data were analysed using open & axial coding for thematic analysis.
11 participants, including Psychiatrists, Occupational Therapists and current service users, completed the experiential learning and filming. Questionnaire data suggested participants were highly satisfied with the learning and felt it would be valuable to others. Themes include the positive experience of creativity, dismantling of hierarchy, improved empathy, confidence and connection. Potential challenges were digital inequality and lack of dedicated time for professional development.
A drama-based experiential learning group programme for healthcare staff and service users is a highly beneficial learning experience. Participants describe changes on a personal level as well as improved understanding of others’ perspectives. This form of experiential learning features collaborative working that aligns with principles of co-production and supports the development of interpersonal skills; the findings suggest that drama-based experiential learning is a useful method in health education to complement knowledge acquisition.
Background: The qualitative Degenerative Spondylolisthesis Instability Classification (DSIC) system defines pre-operative instability associated with degenerative lumbar spondylolisthesis (DLS) and facilitates surgical technique selection. Objectives: (1) propose a quantitative DSIC system; (2) compare objective measures to surgeon impressions of DLS-related instability. Methods: We conducted a multi-center prospective study of 408 adult patients undergoing surgery for DLS. Variables included in the quantitative classification were assigned point-values based on evidence quality. Scores were converted to DSIC Types: 0-2 points (“Stable”; Type I), 3 points (“Potentially Unstable”; Type II), 4-5 points (“Unstable”; Type III). Surgeons documented impressions of instability using the qualitative DSIC system. Results: Five variables were included in the quantitative DSIC: presence of facet effusion, preservation of disc height (<6.5mm), translation (>4mm), kyphotic or neutral disc angle in flexion, and presence of low back pain (LBP) (>5/10 intensity). Surgeons categorized higher degrees of instability than the preliminary quantitative DSIC system, in 130 patients (42%) (P < 0.001). Compared to procedures suggested by the quantitative DSIC system, more extensive surgical procedures were performed in 150 patients (57%) (P < 0.001). Conclusions: A quantitative DSIC system allowed DLS-related stability to be scored and categorized. Patients potentially received more extensive surgery than warranted based on quantitative assessments of stability.
Effective incident management is essential for coordinating efforts of multiple disciplines and stakeholders when responding to emergencies, including public health disasters such as the ongoing coronavirus disease 2019 (COVID-19) pandemic.
Existing research frameworks tend to focus on formal structures and doctrine (eg, ICS-NIMS); however, organizational processes that underlie incident management have not been systematically assessed and synthesized into a coherent conceptual framework.
The lack of a framework has hindered the development of measures of performance that could be used to further develop the evidence base and facilitate process improvement. To address this gap, we present a conceptual framework of incident management drawn from expert feedback and a review of literature on incident management and related fields. The framework features 23 measurement constructs grouped into 5 domains: (1) situational awareness and information sharing, (2) incident action and implementation planning, (3) resource management and mobilization, (4) coordination and collaboration, and (5) feedback and continuous quality improvement.
As such, the article provides a first step toward the development of robust measures for assessing the performance and effectiveness of incident management systems.
As online graduate programs in psychology continue to proliferate, it is important to understand the research addressing the effectiveness of online graduate education so as to advise stakeholders in these programs: applicants, students, faculty, and institutions. In this article, we examine the effectiveness of online education in psychology at two levels of analysis. First, we examine empirical evidence at the course level: Do online, hybrid, and face-to-face instruction lead to different effects at the level of course outcomes? Second, we examine empirical evidence at the program level: Do online and face-to-face graduate programs provide different academic experiences for their respective students, and how does program type influence the employability of graduates? We supplement these discussions with results from a survey of faculty who converted graduate courses to online delivery methods during the COVID-19 pandemic in spring of 2020. Finally, we provide practical considerations for administrators, educators, students, and applicant stakeholders of online programs. We also offer suggestions for optimizing learning and development in online environments. Our intent is to stimulate discussion on building effective learning environments and continuing to educate optimally effective industrial-organizational psychologists, regardless of delivery modality.
Between 2016 and 2021, we retrospectively identified 42 patients receiving ≥1 dose of dalbavancin for osteomyelitis, skin and soft-tissue infection, endocarditis or bacteremia, or septic arthritis. Median antibiotic duration prior to dalbavancin administration was 7 days. Within 90 days, 93% achieved clinical cure, 12% were readmitted, 12% developed hepatotoxicity, and 5% died.
Background: The National University Hospital (NUH) is a 1,200 bed tertiary-care hospital with no documented nosocomial transmission of COVID-19 among patients for the first year and a half of the pandemic, despite 65% of the patients being housed in 4- to 8-bedded open cubicles with shared bathrooms. However, this arrangement changed in late September 2021 with large community clusters including in healthcare institutions nationally associated with the spread of the δ (delta) variant of SARS-CoV-2. We conducted a retrospective review of hospital epidemiology data to determine risk factors for SARS-COV-2 transmission during this period. Methods: Index patients were defined as the first patient in an open cubicle with a confirmed positive SARS-CoV-2 PCR test. Contacts were defined as being in the same cubicle as a patient before isolation from 2 days before symptom onset, up to 7 days from positive test if asymptomatic. Clinical and patient movement data were obtained manually from routine clinical records. Proximity of the contact from the index was classified as within, or more than, 2 m away, according to the prevailing definition from the Singapore Ministry of Health. A univariate analysis was performed to identify risk factors for nosocomial acquisition of SARS-CoV-2. The analysis was deemed exempt from ethics review (reference no. NHG-DSRB-2021/01026). Results: From October 1 to November 30, 2021, 30 index cases occurred in open cubicles identified (median, 9 days after admission; IQR, 19 days). Contact tracing yielded 211 contacts, of whom 10 (4.7%) were infected. Linear regression analysis found the duration of contact for each hour spent in the same room as the index case was the only statistically significant risk variable for contracting COVID-19, with an odds ratio 1.02 (Table 1). Conclusions: Patients in open cubicles are at risk for nosocomial transmission of COVID-19 and other infections. The duration of contact appeared to be more important than vaccination status of index or ward ventilation status. Larger multicentered studies are needed to validate this finding, which has significant implications for infection prevention strategies and pandemic planning.
Arsenic, lead and mercury are common environmental contaminants in low- and middle-income countries. We investigated the association between child toxicant exposure and growth and development and determined if this association was mitigated by selenium concentration.
Toxicant concentrations in fingernail samples, anthropometry, and Bayley’s Scales of Infant Development, 3rd edition (BSID) domains were assessed in 36-month-old children whose mothers had been part of a randomised controlled trial in rural Vietnam. Multivariable regression analyses were performed to estimate the effect of toxicant exposure on clinical outcomes with adjustments for potential confounders and interaction with fingernail selenium concentration.
We analysed 658 children who had data for at least one physical or developmental outcome, and at least one toxicant measurement, and each of the covariates. Fingernail arsenic concentration was negatively associated with language (estimate per 10% increase in arsenic: −0.19, 95% CI: [−0.32, −0.05]). Lead was negatively associated with cognition (estimate per 10% increase in lead: −0.08 [−0.15, −0.02]), language (estimate per 10% increase in lead: −0.18 [−0.28, −0.10]), and motor skills (estimate per 10% increase in lead: −0.12 [−0.24, 0.00]). Mercury was negatively associated with cognition (estimate per 10% increase in mercury: −0.48, [−0.72, −0.23]) and language (estimate per 10% increase in mercury −0.51, [−0.88, −0.13]) when selenium concentration was set at zero in the model. As selenium concentration increased, the negative associations between mercury and both cognition and language scores were attenuated. There was no association between toxicant concentration and growth.
Arsenic, lead and mercury concentrations in fingernails of 3-year-old children were associated with lower child development scores. The negative association between mercury and neurological development was reduced in magnitude with increasing selenium concentration. Selenium status should be considered when assessing heavy metal toxicants in children and their impact on neurodevelopmental outcomes.
This chapter examines the New York Times’ representation of the Elián González custody case in 1999 within the broader context of the conflict between the United States and Cuba. The central question that frames this work is the extent to which the ideas that underpin the conflict can be shown to influence the Times’ coverage of this specific episode – i.e., the extent to which the coverage of an episode can be influential on the broader conflict. The results point to support for the hypotheses that the discourses represented by the New York Times in its coverage of the González case corresponded with the themes of the broader conflict between the United States and Cuba and that American sources represented in the coverage exemplified predictable attitudes about Cuba and Communism.
Bloodstream infections (BSIs) are a frequent cause of morbidity in patients with acute myeloid leukemia (AML), due in part to the presence of central venous access devices (CVADs) required to deliver therapy.
To determine the differential risk of bacterial BSI during neutropenia by CVAD type in pediatric patients with AML.
We performed a secondary analysis in a cohort of 560 pediatric patients (1,828 chemotherapy courses) receiving frontline AML chemotherapy at 17 US centers. The exposure was CVAD type at course start: tunneled externalized catheter (TEC), peripherally inserted central catheter (PICC), or totally implanted catheter (TIC). The primary outcome was course-specific incident bacterial BSI; secondary outcomes included mucosal barrier injury (MBI)-BSI and non-MBI BSI. Poisson regression was used to compute adjusted rate ratios comparing BSI occurrence during neutropenia by line type, controlling for demographic, clinical, and hospital-level characteristics.
The rate of BSI did not differ by CVAD type: 11 BSIs per 1,000 neutropenic days for TECs, 13.7 for PICCs, and 10.7 for TICs. After adjustment, there was no statistically significant association between CVAD type and BSI: PICC incident rate ratio [IRR] = 1.00 (95% confidence interval [CI], 0.75–1.32) and TIC IRR = 0.83 (95% CI, 0.49–1.41) compared to TEC. When MBI and non-MBI were examined separately, results were similar.
In this large, multicenter cohort of pediatric AML patients, we found no difference in the rate of BSI during neutropenia by CVAD type. This may be due to a risk-profile for BSI that is unique to AML patients.
Many triage algorithms exist for use in mass-casualty incidents (MCIs) involving pediatric patients. Most of these algorithms have not been validated for reliability across users.
Investigators sought to compare inter-rater reliability (IRR) and agreement among five MCI algorithms used in the pediatric population.
A dataset of 253 pediatric (<14 years of age) trauma activations from a Level I trauma center was used to obtain prehospital information and demographics. Three raters were trained on five MCI triage algorithms: Simple Triage and Rapid Treatment (START) and JumpSTART, as appropriate for age (combined as J-START); Sort Assess Life-Saving Intervention Treatment (SALT); Pediatric Triage Tape (PTT); CareFlight (CF); and Sacco Triage Method (STM). Patient outcomes were collected but not available to raters. Each rater triaged the full set of patients into Green, Yellow, Red, or Black categories with each of the five MCI algorithms. The IRR was reported as weighted kappa scores with 95% confidence intervals (CI). Descriptive statistics were used to describe inter-rater and inter-MCI algorithm agreement.
Of the 253 patients, 247 had complete triage assignments among the five algorithms and were included in the study. The IRR was excellent for a majority of the algorithms; however, J-START and CF had the highest reliability with a kappa 0.94 or higher (0.9-1.0, 95% CI for overall weighted kappa). The greatest variability was in SALT among Green and Yellow patients. Overall, J-START and CF had the highest inter-rater and inter-MCI algorithm agreements.
The IRR was excellent for a majority of the algorithms. The SALT algorithm, which contains subjective components, had the lowest IRR when applied to this dataset of pediatric trauma patients. Both J-START and CF demonstrated the best overall reliability and agreement.
OBJECTIVES/GOALS: Well-appearing febrile infants are a model for exploring communication, bias, and health disparities in the pediatric emergency department (ED). Using mixed methods, we will perform an in-depth analysis of disparities and shared decision making, a potentially modifiable driver of inequities. METHODS/STUDY POPULATION: We will conduct a multicenter cross-sectional chart review study of well-appearing febrile infants 29-60 days old treated in the ED and apply multivariable logistic regression to assess the association between 1) race/ethnicity and 2) limited English proficiency with the primary outcome, discharge to home without lumbar puncture and without antibiotics (standard of care). We will concurrently perform an interpretive study using purposive sampling to conduct interviews with: 1) minority parents of febrile infants and 2) ED physicians. By capturing dyadic data, we will triangulate perspectives to elucidate disparities and bias that can emerge in the shared decision making process. RESULTS/ANTICIPATED RESULTS: Forty member institutions of the Pediatric Emergency Medicine Collaborative Research Committee are participating, providing a projected cohort of 3000 infants. In the 6 months since site recruitment, 235 eligible infants have been entered into the dataset (43% minority race/ethnicity, 6% language other than English), 61% of whom received the primary outcome. Chart review has the benefits of 1) ensuring exclusion of ill infants, 2) providing data on interpreter use that is unavailable in administrative datasets, and 3) allowing an analysis of shared decision making. These findings will inform an interpretive study of parent and provider experiences of bias in shared decision making. DISCUSSION/SIGNIFICANCE: We demonstrate the feasibility of a large-scale manual chart review to analyze disparities within a shared decision making context. Partnered with qualitative scholarship, this research will support the development of communication interventions to mitigate implicit bias in the clinical encounter.