Adolescents' experiences of living with HIV and AIDS.

A growing body of research exists that examines the nature of i n tervent ions aimed at educa ting adolescents in t e rms of HIV and AIDS (Campbell, 2003; Campbell & McPhail, 2002; Van Dyk, 2001). However, there appears to be a grave pauci ty of l i t e rature that explor es the impact of HIV and AIDS on adolescents’ psychological and emotional functioning. Adolescents who live in the af t e rmath following the death of a parent, or parents often have to deal with rejection from thei r community, and are often confronted with significant emo t ional, educa tional and psycho-social challenges. These cha llenges continue to pose enormous threat to the development of a healthy s e lf-concept (Foster & Germann, 2002). These adolescents continue to be marginalized as their voices remain largely s i l e n t in contemporar y research . Using a combination of Art therapy, and narr ative creation, twenty-eight adolescents participated in a group intervention intended to facilitate, empower and encourage meaning making processes, and to f ac i l i t at e both oral and wr i t ten communica tion about the i r exper iences of living wi th HIV and AIDS. Findings suggest that while adolescents living with HIV and AIDS continue to have significant emotional, physiological, and social cha l lenges on a daily basis, their stories espouse great hope, determination and resilience

Exploring Teachers’ Phenomenological Experiences of a Principal’s Change Initiative

Educational change has traditionally been viewed as an objective and rational process. From this perspective, school leaders have been dependent on solving the infuriatingly elusive effective change process puzzle by trying to “finetune the plan to ensure it incorporated every essential piece of the jigsaw” (Branson, 2010, p. 18). Despite educators seeking to explain events and control processes for change for many decades, effective educational change remains an elusive outcome. By striving to objectify the process, people can overlook the subjective influence that a change initiative may have on the behaviour and attitudes of those involved in enacting change. For this research, the term ‘phenomenology’ is used to refer to a person’s subjective emotional dimension and this is distinct from its use in a research methodology sense. In recent times, there is an emerging realisation that leaders of change within schools need to be more relational and to consider how a change initiative influences the subjectivity of those involved. To do this, school leaders need to move beyond conceptualising change as a series of processes and/or practices that are often imposed onto teachers, who are then expected to enact these in a ‘one-size-fits-all’ manner (Wheatley, 2006). A relational school leader acknowledges that enacting change involves teachers experiencing some sense of loss for the practices and processes that they consider define their identity as a professional. A teacher’s sense of professionalism and professional identity are couched in the way they individually ‘craft’ their practice (Crow, Day & Moller, 2016; Kelchtermans, 2005). Thus, a relational school leader should be reflective and monitor the effect that a change initiative has on teachers’ sense of subjectivity as they need to realise that this can influence the extent to which teachers engage in processes for teaching and learning. This is particularly pertinent in light of the teacher quality agenda that underscores the current political context. Within the current Australian educational context, teacher quality is being viewed as a key factor in shaping the economic fabric of this nation now and into the future. As a consequence of this perspective, the Australian government has introduced a suite of reforms into education that seek to address the perceived paucity in teacher quality (Australian Council for Assessment and Reporting Authority [ACARA], 2012; Council of Australian Governments, 2008a; Education Services Australia, 2011a, 2012a, 2012b, 2013). The Australian Institute for Teaching and School Leadership [AITSL], a government-endorsed body, has played an instrumental role in the development and promulgation of educational reforms in this nation. These reforms have been premised on the view that teaching is an objective and rational process, and they have sought to embed a culture of control, consistency, and accountability with regard to the way that teaching and learning occur in Australian schools. It is unlikely that viewing education from this perspective and embedding a culture of compliance, and its associated control and accountability measures, will result in an elevation in teacher quality (Hursh, 2011, 2013; Hursh & Henderson, 2011). The research problem emanates from the perspective that subjectivity, arguably, has a critical role to play in shaping the way that teachers embrace opportunities for learning and the way that teachers implement pedagogical practice at the classroom level. However, this continues to be overlooked in the current educational context. In light of this problem, this research will explore the phenomenological responses that teachers in a single-school context have regarding the implementation of a principal’s change initiative. Consistent with a broader body of scholarship concerned with educational change, this research is guided by an interpretivist paradigm through which educators’ constructions of the principal’s change initiative are elucidated. Within a school, teachers constantly interpret their experiences and construct multiple views of reality. The way that each teacher enacts their professional role is shaped by their individual perception of reality and the meaningful social interactions that they have with the people they interact with. Case-study methodology enables a detailed exploration of an experience, and for this research it is the implementation of the principal’s change initiative. Perceptions of this particular change initiative are gathered from the principal, the change facilitator, and the teachers from a Catholic primary school in the State of Queensland, Australia. All teachers at the research school completed an electronic survey to share their perceptions of the change initiative implemented at this school. Individual semi-structured interviews were also conducted with the principal, the change facilitator, and 16 of the teachers at the research school. It is argued in this thesis that imposing a change initiative on teachers can result in them expressing negative phenomenological responses towards the focus area of change which reinforces their reluctance, if not resistance, towards continuing to enact the change. Furthermore, it supports the understanding that a planned educational change strategy is significantly deficient if it does not incorporate a means for ascertaining, and positively responding to, the ongoing phenomenological responses to the change processes from those involved in bringing about the change. This implies that those who are overseeing the change need to not only be effective managers of the change process, but they also need to have the dispositional characteristics to be effective leaders of people

Embedding Guides Where Students Learn: Do Design Choices and Librarian Behavior Make a Difference?

This study investigated whether library guides embedded in a university’s learning management system fulfill their mission to promote library resources and maintain a librarian presence in the online course environment. Specifically, the study examined whether design elements, promotional practices, or other behaviors influenced guide use. It questioned whether students located the library guides and, if so, did students find the guides helpful. Results confirmed that students who used library guides found the guides helpful. Select faculty and librarian behaviors may also influence student use of library guides. Promotion and marketing practices, however, are not the only factors encouraging students to use library guides.Publisher allows immediate open acces

Joining the dots: measuring the effects of a national quality improvement collaborative in ambulance services

Context: We undertook a national collaborative to improve cardiovascular care by frontline clinicians in 12 English Ambulance Services. Data were collected by clinical audit staff and submitted centrally where they were collated and analysed. Problem: Cardiovascular disease is the commonest cause of death in the United Kingdom (UK). Acute Myocardial Infarction (AMI) causes 250,000 deaths per year and 1 in 3 heart attack victims die before reaching hospital. There are approximately 152,000 strokes per year causing more than 49,000 deaths. Early and effective treatment decreases death rates for AMI and stroke, improves long-term health and reduces future disability. National guidelines for ambulance clinicians are based on evidence for best clinical practice for AMI and stroke care by ambulance services as defined in the National Service Framework for CHD and National Stroke Strategy. Whilst ambulance clinicians were good at delivering specific aspects of care they were less effective at delivering whole bundles of care. Assessment of problem and analysis of its causes: The process of care delivered by English ambulance services is now assessed using National Clinical Performance Indicators (nCPIs) which include measures of complete bundles of care. The care bundle for AMI is: administration of aspirin and GTN, pain score recorded before and after treatment and administration of analgesia. The stroke care bundle consists of recording of FAST, blood glucose and blood pressure. A key project aim was to produce a sustained improvement in the national rate of care bundle delivery for AMI from 43% (range 26.2%-90.32%) to 90% and for stroke from 83.1% (range 39.4 %– 97.6%) to 90% within 2 years. Intervention: Frontline clinicians identified barriers and facilitators to delivery of care bundles and designed and tested new processes using quality improvement (QI) methods after being trained in process mapping, root cause analysis and Plan Do Study Act cycles. The effects of interventions were tracked using annotated control charts. Strategy for change: Quality Improvement Teams and Fellows were appointed in each service to form QI collaboratives. Collaboratives were responsible for developing and trialling localised interventions and spreading successful interventions more widely within Trusts. QI Fellows were to meet regularly to share learning. Measurement of improvement: Statistical Process control (SPC) methods were utilised to measure the effectiveness and sustainability of interventions. Effects of changes: With 6 months of the project left to run, the nCPIs have shown improvements in the care bundle for STEMI (mean 58.8%) and Stroke (mean 89.8%) with significant improvements in some trusts. There is evidence in some Trusts that interventions (particularly those affecting a whole Trust) are being reflected in the data although more data is needed to see whether these changes will be sustained. Lessons learnt: Small sample sizes sometimes made local level measurement of change problematic and ways of overcoming this were developed. Barriers in service reconfiguration caused delays in starting collaboratives or trialling interventions; this highlighted the importance o f ensuring that corporate bodies clearly understood the scale and purpose of the collaboratives. Baseline and prospective data collection took longer than expected and resources for this were stretched, particularly in Trusts without electronic systems. If running similar projects on a similar scale greater clarity about roles and expectations around resourcing data collection would be needed from the outset. Annotation of the control charts proved invaluable in monitoring the effects of interventions and their sustainability. Message for others: Annotated control charts were a powerful tool in determining whether and to what extent interventions led to improvements in care. This enabled an evidence base for spreading intervention within and beyond ambulance services on a national scale

Education, Covid-19 and care : social inequality and social relations of value in the South Africa and the United States

Abstract:Education has not been spared during the Covid-19 pandemic that has exposed deep inequalities across the world along lines of ‘race’, class, gender and geography, as well as the digital divide. However, many of the policy responses and solutions proffered to mitigate the crisis fail to address the generative structures that made public education institutions so vulnerable to shocks in the first place. Using the work of Nancy Fraser and Social Reproduction Theory (Bhattacharya, 2017), we argue that understanding the prevailing capitalist social institutional order, and the relations it generates between spheres of production and spheres of reproduction (including education), is fundamental to theories of change that not only respond to the Covid-19 moment justly, but also avoid reproducing and deepening the conditions that made Covid so cataclysmic to begin with. By analysing the conditions of public education across South Africa and the United States comparatively, a case is built for distinguishing between affirmative responses that leave inequitable structures intact and transformative responses that seek to address the root causes of injustice and violence amplified by the pandemic

Learning from Escaped Prescribed Fire Reviews Workshop Discussion Summary

This Joint Fire Science funded project seeks to understand individual and organizational learning from prescribed fire operations, particularly how existing review processes do or might promote capture and transfer of lessons from prescribed fire escapes. We seek to understand what aspects of current reviews (processes, venues/formats, timing, and distribution techniques) are most effective in promoting organizational learning

Effect of case management on neonatal mortality due to sepsis and pneumonia.

BACKGROUND: Each year almost one million newborns die from infections, mostly in low-income countries. Timely case management would save many lives but the relative mortality effect of varying strategies is unknown. We have estimated the effect of providing oral, or injectable antibiotics at home or in first-level facilities, and of in-patient hospital care on neonatal mortality from pneumonia and sepsis for use in the Lives Saved Tool (LiST). METHODS: We conducted systematic searches of multiple databases to identify relevant studies with mortality data. Standardized abstraction tables were used and study quality assessed by adapted GRADE criteria. Meta-analyses were undertaken where appropriate. For interventions with biological plausibility but low quality evidence, a Delphi process was undertaken to estimate effectiveness. RESULTS: Searches of 2876 titles identified 7 studies. Among these, 4 evaluated oral antibiotics for neonatal pneumonia in non-randomised, concurrently controlled designs. Meta-analysis suggested reductions in all-cause neonatal mortality (RR 0.75 95% CI 0.64- 0.89; 4 studies) and neonatal pneumonia-specific mortality (RR 0.58 95% CI 0.41- 0.82; 3 studies). Two studies (1 RCT, 1 observational study), evaluated community-based neonatal care packages including injectable antibiotics and reported mortality reductions of 44% (RR = 0.56, 95% CI 0.41-0.77) and 34% (RR = 0.66, 95% CI 0.47-0.93), but the interpretation of these results is complicated by co-interventions. A third, clinic-based, study reported a case-fatality ratio of 3.3% among neonates treated with injectable antibiotics as outpatients. No studies were identified evaluating injectable antibiotics alone for neonatal pneumonia. Delphi consensus (median from 20 respondents) effects on sepsis-specific mortality were 30% reduction for oral antibiotics, 65% for injectable antibiotics and 75% for injectable antibiotics on pneumonia-specific mortality. No trials were identified assessing effect of hospital management for neonatal infections and Delphi consensus suggested 80%, and 90% reductions for sepsis and pneumonia-specific mortality respectively. CONCLUSION: Oral antibiotics administered in the community are effective for neonatal pneumonia mortality reduction based on a meta-analysis, but expert opinion suggests much higher impact from injectable antibiotics in the community or primary care level and even higher for facility-based care. Despite feasibility and low cost, these interventions are not widely available in many low income countries. FUNDING: This work was supported by the Bill & Melinda Gates Foundation through a grant to the US Fund for UNICEF, and to Saving Newborn Lives Save the Children, through Save the Children US