Randomised controlled trials of complex interventions and large-scale transformation of services

Complex interventions and large-scale transformations of services are necessary to meet the health-care challenges of the 21st century. However, the evaluation of these types of interventions is challenging and requires methodological development. Innovations such as cluster randomised controlled trials, stepped-wedge designs, and non-randomised evaluations provide options to meet the needs of decision-makers. Adoption of theory and logic models can help clarify causal assumptions, and process evaluation can assist in understanding delivery in context. Issues of implementation must also be considered throughout intervention design and evaluation to ensure that results can be scaled for population benefit. Relevance requires evaluations conducted under real-world conditions, which in turn requires a pragmatic attitude to design. The increasing complexity of interventions and evaluations threatens the ability of researchers to meet the needs of decision-makers for rapid results. Improvements in efficiency are thus crucial, with electronic health records offering significant potential

Book sharing with young children: A study of book sharing in four Australian long day care centres

Research has consistently established the positive impact of sharing books with young children. Evidence suggests several important factors when evaluating book sharing with young children, including the quality of educator practice = and the nature of groupings, as well as the frequency and duration of book sharing sessions and access to books. Other evidence suggests book sharing may be particularly important for children from low ses backgrounds attending early learning settings. This paper reports on a larger study which investigated the factors and relationships influencing the use of children’s literature to support principles of diversity in kindergarten rooms of long day care centres. A mixed methods approach was adopted and a convergent design was employed to synthesise the qualitative and quantitative data and interpret significant relationships and their meanings. The quality of educator practice was measured through the Systematic Assessment of Book Reading (SABR) and Children’s engagement in book sharing was assessed using the Children’s Orientation to Book Reading Rating Scale. Detailed analysis of 148 video recorded book sharing sessions produced statistical representations of the frequency and duration of book sharing across the contexts and the nature of involvement of the children in the study. Twenty four educators and 110 children from four long day care centres in Western Australia participated. Data were collected through semi-structured interviews, video-based observations, field notes, document analysis and a book audit. The results showed that while the children in this study had a range of book sharing experiences, few of these were frequent or of high quality. Of great concern is the finding that the children in this study most likely to be considered at risk of educational disadvantage were those with the least exposure to book sharing in general, and, even less so, to high quality book sharing, raising concerns about equitable outcomes for them

The challenge of monoculturalism: What books are educators sharing with children and what messages do they send?

The importance of recognising, valuing and respecting a child’s family, culture, language and values is increasingly articulated in educational policy. Diversity and inclusion are central themes of the guiding principles of early childhood education and care in Australia. Children’s literature can be a powerful tool for extending children’s knowledge and understandings of themselves and others who may be different culturally, socially or historically. However, evidence suggests many settings provide monocultural book collections which are counterproductive to principles of diversity. This paper reports on a larger study investigating factors and relationships influencing the use of children’s literature to support principles of cultural diversity in the kindergarten rooms of long day care centres. The study was conducted within an ontological perspective of constructivism and an epistemological perspective of interpretivism informed by sociocultural theory. A mixed methods approach was adopted and convergent design was employed to interpret significant relationships and their meanings. Twenty-four educators and 110 children from four long day care centres in Western Australia participated. Data were collected through semi-structured interviews, video-based observations, field notes, document analysis and a book audit. This study identified that current book collections in these four kindergarten rooms of long day care centres promote monocultural viewpoints and ‘othering’ of minority groups through limited access to books portraying inclusive and authentic cultural diversity. These findings have important social justice implications. The outcomes of this study have implications for educators, policy makers, early childhood organisations and those providing higher education and training for early childhood educators

“Portray cultures other than ours”: How children’s literature is being used to support the diversity goals of the Australian Early Years Learning Framework

Catering for diversity within birth to 5-year-old settings continues to be an on-going concern for policy makers and educators worldwide. This research contributes to discussion on the value of children’s literature in achieving international principles of diversity and, in particular, the Principles, Practice and Outcomes outlined in the Australian Early Years Learning Framework. The article considers the selection and use of children’s literature related to diversity, as well as what influences these processes. Seventeen educators from five long day care centres located in or near the Perth metropolitan area participated in the study. Data were drawn from interviews and a book audit. The findings revealed educators had limited understandings of the role of literature in acknowledging and valuing diversity and rarely used it to promote the diversity-related outcomes of the EYLF. The key challenges which emerged from the findings concerned beliefs of educators, professional learning and the application of the EYLF in practice

Correction to: “Portray cultures other than ours”: How children’s literature is being used to support the diversity goals of the Australian Early Years Learning Framework

The article “Portray cultures other than ours”: How children’s literature is being used to support the diversity goals of the Australian Early Years Learning Framework, written by Helen Adam, Caroline Barratt-Pugh and Yvonne Haig, was originally published electronically on the publisher’s internet portal (currently Springer- Link) on 20 January 2019 without open access. With the author(s)’ decision to opt for Open Choice the copyright of the article changed on 30 August 2019 to © The Author(s) 2019 and the article is forthwith distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creat iveco mmons .org/licen ses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made. The original article has been corrected

Patient and public priorities regarding the organisation of emergency hospital care

Proposed changes to hospital services, such as the closure of Accident & Emergency departments (A&E), often create high profile, contentious debates. Whilst clinicians tend to focus on potential health gains for patients, public concerns may include non-clinical factors such as ease of access to services. Previous research has largely concentrated on policy issues and little is known about the priorities and preferences for emergency hospital care amongst the public at large. The first study in this thesis explored a process carried out to engage the local community with proposals to reconfigure hospital services in North London. This included mapping key areas of concern for the public and critically reviewing the impact of the methods used in the public engagement process. Study 1 demonstrated that the techniques currently used draw on traditional approaches aimed at improving the public understanding of science. This includes an apparent assumption of ‘public ignorance’ in matters of science and technology, and the belief that science offers a uniquely privileged view of the world. The second study involved a series of in-depth interviews examining priorities for emergency care in more detail. Interviews were conducted with four groups of participants: patients with a chronic condition; parents of young children; older people; patient representatives and community groups campaigning against service closures. Interviews were carried out in an area where a reconfiguration was being discussed and an area where it was not. The analysis drew on theories relating to risk perception and risk communication. It demonstrated the importance of the widespread belief that timely access is associated with better outcomes, as well as the way in which the public’s assessment of service quality influences their response to reconfiguration proposals

Involving the public in decision-making about large-scale changes to health services: a scoping review

BACKGROUND: Public involvement in large-scale changes (LSC) to health services is strongly promoted - and even mandated - in several health systems. This scoping review aimed to describe the evidence about how public involvement is conceptualised and conducted in LSC, with what impact, and how different stakeholders perceived this process. METHODS: After searching eight databases, 34 publications were included. Data were extracted and charted using a standardised form. Findings from the literature were discussed with frontline stakeholders. RESULTS: Public involvement remains poorly defined and its aims lack clarity in LSC. Public meetings are most often used to gather public views but raise the issue of representativeness. However, evidence in the literature is scarce about which involvement methods - informative and deliberative - are appropriate for the different stages of the LSC and with what impact. In several cases, the involved public felt they had no influence on decision-making regarding LSC proposals, sometimes leading to an environment of mistrust. In those instances, the public understood the technical arguments for change and actively questioned them, opposed LSC plans and sought alternative routes to voice their views. CONCLUSION: More research and consideration are needed regarding who should be involved, with what purpose and how. We argue that in practice two models of involvement, invited and uninvited participation, coexist and therefore interactions between the two should be given further consideration in LSC

Assisted Probe Positioning for Ultrasound Guided Radiotherapy Using Image Sequence Classification

Effective transperineal ultrasound image guidance in prostate external beam radiotherapy requires consistent alignment between probe and prostate at each session during patient set-up. Probe placement and ultrasound image inter-pretation are manual tasks contingent upon operator skill, leading to interoperator uncertainties that degrade radiotherapy precision. We demonstrate a method for ensuring accurate probe placement through joint classification of images and probe position data. Using a multi-input multi-task algorithm, spatial coordinate data from an optically tracked ultrasound probe is combined with an image clas-sifier using a recurrent neural network to generate two sets of predictions in real-time. The first set identifies relevant prostate anatomy visible in the field of view using the classes: outside prostate, prostate periphery, prostate centre. The second set recommends a probe angular adjustment to achieve alignment between the probe and prostate centre with the classes: move left, move right, stop. The algo-rithm was trained and tested on 9,743 clinical images from 61 treatment sessions across 32 patients. We evaluated classification accuracy against class labels de-rived from three experienced observers at 2/3 and 3/3 agreement thresholds. For images with unanimous consensus between observers, anatomical classification accuracy was 97.2% and probe adjustment accuracy was 94.9%. The algorithm identified optimal probe alignment within a mean (standard deviation) range of 3.7$^{\circ}$ (1.2$^{\circ}$) from angle labels with full observer consensus, comparable to the 2.8$^{\circ}$ (2.6$^{\circ}$) mean interobserver range. We propose such an algorithm could assist ra-diotherapy practitioners with limited experience of ultrasound image interpreta-tion by providing effective real-time feedback during patient set-up.Comment: Accepted to MICCAI 202

Just good enough data: Figuring data citizenships through air pollution sensing and data stories

Citizen sensing, or the use of low-cost and accessible digital technologies to monitor environments, has contributed to new types of environmental data and data practices. Through a discussion of participatory research into air pollution sensing with residents of northeastern Pennsylvania concerned about the effects of hydraulic fracturing, we examine how new technologies for generating environmental data also give rise to new problems for analysing and making sense of citizen-gathered data. After first outlining the citizen data practices we collaboratively developed with residents for monitoring air quality, we then describe the data stories that we created along with citizens as a method and technique for composing data. We further mobilise the concept of ‘just good enough data’ to discuss the ways in which citizen data gives rise to alternative ways of creating, valuing and interpreting datasets. We specifically consider how environmental data raises different concerns and possibilities in relation to Big Data, which can be distinct from security or social media studies. We then suggest ways in which citizen datasets could generate different practices and interpretive insights that go beyond the usual uses of environmental data for regulation, compliance and modelling to generate expanded data citizenships