"Being Absorbed in That Environment…It’s Just So Beneficial” – The Experiences of Physiotherapy Students in a Situated Learning Pilot Study

In this article, we aim to add to the existing literature on practice-based education. First, we will present a form of situated learning, which involved piloting a new teaching and learning relationship between the university and healthcare setting. Second, we will examine how students made sense of this perspective of practice. Using a phenomenologically oriented approach, this pilot study explored the experiences of entry-level physiotherapy students learning in a classroom environment, facilitated by clinicians, and located on a healthcare partner’s site. Twenty students completed two concurrent, theoretically oriented subjects that did not involve traditional clinical practicum experience. Two individual semi-structured interviews were conducted with students. Data was thematically analysed using an inductive approach. Three inter-related themes emerged. First, meaning-making is enhanced by the relevance and authenticity afforded by immersion in a practice-oriented classroom environment where clinicians facilitate learning. Second, learning from those ‘in practice’ challenges students’ professional and academic accountability. Finally, new educational infrastructures influenced students’ agency in unanticipated ways. This work highlights that students valued contextual learning. While meaning-making was enhanced by the development of key new relationships with others and the environment, these relationships also influenced student agency. Recommendations for health professional curricula are discussed, and include: capitalising on learning with peers, bringing the hidden curriculum into view and creating opportunities for students to navigate uncertainty and change

Betwixt and Between: A Pilot Study Exploring the Experiences of Clinical Educators Teaching in a Dispersed Model of Entry-Level Physiotherapy Curriculum

Education of the future healthcare workforce has long been a partnership between university and healthcare sectors, with students learning under the shared guidance of academics and clinicians. Traditionally, academics have taught in the classroom and clinicians have engaged students at the patient bedside. Using a phenomenologically-oriented approach, this pilot project explored the experiences of clinicians who team-taught a theoretical subject in a classroom environment. Purposeful sampling of physiotherapy staff within a metropolitan healthcare organisation was used. Six clinicians were recruited and, prior to teaching, completed a blended educational program about higher education teaching and learning. The clinicians taught classes of twenty students within new classroom spaces co-located at the healthcare organisation, with curricula provided by the university. Two semi-structured interviews were conducted with each clinician at the beginning and end of the allocated teaching period. Transcripts from the semi-structured interviews were analysed and four themes emerged. First, physiotherapists initially identified as clinicians not teachers, but their perceptions later broadened. Second, the intention of teaching was patient-focused. Third, the balancing of multiple roles resulted in challenges for the clinicians; and fourth, the experience involved new immersion in digital media. This work explores a different form of educator role – likened to a pracademic – and supports the need for considered approaches to teaching and links between theory/education and practice to meet the demands of modern healthcare and university learning

Ability of verbal autopsy data to detect deaths due to uncontrolled hyperglycaemia:testing existing methods and development and validation of a novel weighted score

Objectives: Verbal autopsy (VA) is a useful tool to ascertain cause of death where no other mechanisms exist. We aimed to assess the utility of VA data to ascertain deaths due to uncontrolled hyperglycaemia and to develop a weighted score (WS) to specifically identify cases. Cases were identified by a study or site physician with training in diabetes. These diagnoses were also compared with diagnoses produced by a standard computer algorithm (InterVA-4). Setting: This study was done using VA data from the Health and Demographic Survey sites in Agincourt in rural South Africa. Validation of the WS was done using VA data from Karonga in Malawi. Participants: All deaths from ages 1 to 49 years between 1992 and 2015 and between 2002 and 2016 from Agincourt and Karonga, respectively. There were 8699 relevant deaths in Agincourt and 1663 in Karonga. Results: Of the Agincourt deaths, there were 77 study physician classified cases and 58 computer algorithm classified cases. Agreement between study physician classified cases and computer algorithm classified cases was poor (Cohen’s kappa 0.14). Our WS produced a receiver operator curve with area under the curve of 0.952 (95% CI 0.920 to 0.985). However, positive predictive value (PPV) was below 50% when the WS was applied to the development set and the score was dominated by the necessity for a premortem diagnosis of diabetes. Independent validation showed the WS performed reasonably against site physician classified cases with sensitivity of 86%, specificity of 99%, PPV of 60% and negative predictive value of 99%. Conclusion: Our results suggest that widely used VA methodologies may be missing deaths due to uncontrolled hyperglycaemia. Our WS may offer improved ability to detect deaths due to uncontrolled hyperglycaemia in large populations studies where no other means exist

Protecting and restoring Europe's waters:an analysis of the future development needs of the Water Framework Directive

The Water Framework Directive (WFD) is a pioneering piece of legislation that aims to protect and enhance aquatic ecosystems and promote sustainable water use across Europe. There is growing concern that the objective of good status, or higher, in all EU waters by 2027 is a long way from being achieved in many countries. Through questionnaire analysis of almost 100 experts, we provide recommendations to enhance WFD monitoring and assessment systems, improve programmes of measures and further integrate with other sectoral policies. Our analysis highlights that there is great potential to enhance assessment schemes through strategic design of monitoring networks and innovation, such as earth observation. New diagnostic tools that use existing WFD monitoring data, but incorporate novel statistical and trait-based approaches could be used more widely to diagnose the cause of deterioration under conditions of multiple pressures and deliver a hierarchy of solutions for more evidence-driven decisions in river basin management. There is also a growing recognition that measures undertaken in river basin management should deliver multiple benefits across sectors, such as reduced flood risk, and there needs to be robust demonstration studies that evaluate these. Continued efforts in ‘mainstreaming’ water policy into other policy sectors is clearly needed to deliver wider success with WFD goals, particularly with agricultural policy. Other key policy areas where a need for stronger integration with water policy was recognised included urban planning (waste water treatment), flooding, climate and energy (hydropower). Having a deadline for attaining the policy objective of good status is important, but even more essential is to have a permanent framework for river basin management that addresses the delays in implementation of measures. This requires a long-term perspective, far beyond the current deadline of 2027

Animal-related factors associated with moderate-to-severe diarrhea in children younger than five years in western Kenya: A matched case-control study

Background Diarrheal disease remains among the leading causes of global mortality in children younger than 5 years. Exposure to domestic animals may be a risk factor for diarrheal disease. The objectives of this study were to identify animal-related exposures associated with cases of moderate-to-severe diarrhea (MSD) in children in rural western Kenya, and to identify the major zoonotic enteric pathogens present in domestic animals residing in the homesteads of case and control children. Methodology/Principal findings We characterized animal-related exposures in a subset of case and control children (n = 73 pairs matched on age, sex and location) with reported animal presence at home enrolled in the Global Enteric Multicenter Study in western Kenya, and analysed these for an association with MSD. We identified potentially zoonotic enteric pathogens in pooled fecal specimens collected from domestic animals resident at children’s homesteads. Variables that were associated with decreased risk of MSD were washing hands after animal contact (matched odds ratio [MOR] = 0.2; 95% CI 0.08–0.7), and presence of adult sheep that were not confined in a pen overnight (MOR = 0.1; 0.02–0.5). Variables that were associated with increased risk of MSD were increasing number of sheep owned (MOR = 1.2; 1.0–1.5), frequent observation of fresh rodent excreta (feces/urine) outside the house (MOR = 7.5; 1.5–37.2), and participation of the child in providing water to chickens (MOR = 3.8; 1.2–12.2). Of 691 pooled specimens collected from 2,174 domestic animals, 159 pools (23%) tested positive for one or more potentially zoonotic enteric pathogens (Campylobacter jejuni, C. coli, non-typhoidal Salmonella, diarrheagenic E. coli, Giardia, Cryptosporidium, or rotavirus). We did not find any association between the presence of particular pathogens in household animals, and MSD in children. Conclusions and significance Public health agencies should continue to promote frequent hand washing, including after animal contact, to reduce the risk of MSD. Future studies should address specific causal relations of MSD with sheep and chicken husbandry practices, and with the presence of rodents

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

La plainte de discrimination devant le Tribunal canadien des droits de la personne portant sur les services d’aide à l’enfance aux enfants des Premières Nations et le Principe de Jordan

Il y a aujourd’hui plus d’enfants des Premières Nations placés en famille d’accueil qu’il y a jamais eu d’élèves autochtones fréquentant les pensionnats. Il est de plus en plus évident que ce problème est causé par les structures de financement inéquitables et déficientes du gouvernement fédéral pour les services d’aide à l’enfance. En 2007, la Société de soutien à l’enfance et à la famille des Premières Nations du Canada (la Société de soutien) et l’Assemblée des Premières Nations (APN) ont déposé une plainte qui mettait de l’avant deux allégations de discrimination. La première allégation portait sur les conflits de compétence entre les gouvernements fédéral et provinciaux, qui font en sorte que les enfants des Premières Nations sont souvent laissés en attente de services dont ils ont désespérément besoin ou se voient même refuser des services qui sont offerts aux autres enfants. La deuxième allégation de discrimination concernait le traitement défavorable de 163 000 enfants des Premières Nations dans le cadre du système de protection de l’enfance offert sur les réserves. Dans les deux cas, il était allégué que ces traitements constituaient des actes discriminatoires prohibés par la Loi canadienne sur les droits de la personne (LCDP). Au cours des six années suivantes, le gouvernement canadien a dépensé des millions de dollars dans une multitude de tentatives infructueuses pour faire avorter la poursuite. L’audience a néanmoins commencé en février 2013 devant le Tribunal des droits de la personne (TCDP). Pour la première fois dans l’histoire du Canada, la responsabilité du gouvernement fédéral quant à des allégations de discrimination envers les enfants des Premières Nations a été évaluée par un organisme pouvant rendre des décisions judiciairement contraignantes et des ordonnances réparatrices. Au cours de l’année suivante, le Tribunal a entendu plus de 25 témoins et a examiné plus de 500 documents mis en preuve. Les documents internes fédéraux déposés ont révélé une discrimination constante et systématique envers les enfants des Premières Nations ainsi que l’échec du gouvernement fédéral à résoudre le problème même si les solutions étaient connues. Alors même que le procès se déroulait devant le Tribunal, plusieurs auteurs de doctrine et membres des Premières Nations établissaient un parallèle entre la réaction du gouvernement fédéral dans ce dossier et d’autres cas de discrimination quant à l’accès à des services tels que l’éducation, la police, la santé et le logement dans les communautés autochtones. Cet article est écrit du point de vue des trois auteures, qui étaient étroitement impliquées dans la cause, deux à titre d’avocates et l’autre à titre de témoin et plaignante. Il offre d’abord une vue d’ensemble des principales questions juridiques soulevées par ce dossier avant d’analyser la preuve documentaire et testimoniale. La nécessité de redresser la situation dans d’autres sphères de services gouvernementaux pour les Premières Nations sera aussi abordée.More First Nations children today are being placed in foster care than the number of students who ever attended residential schools. It is becoming increasingly clear that this problem is caused by inequitable and insufficient federal government funding for child welfare services. In 2007, the First Nations Child & Family Caring Society of Canada (the Caring Society) and the Assembly of First Nations filed a complaint concerning two allegations of discrimination. The first allegation concerned a conflict of jurisdiction between the federal and provincial governments that resulted in First Nations children often having to wait to receive vital services or even refused services provided to other children. The second allegation of discrimination concerned the unfair treatment of 163,000 First Nations children in the child welfare system provided on reserves. In both cases, it was alleged that these treatments constituted discriminatory acts prohibited under the Canada Human Rights Act. Over the next six years, the Canadian government spent millions of dollars on numerous unsuccessful attempts to derail the case. The case was nevertheless brought before the Human Rights Tribunal in February 2013; for the first time in Canadian history, the federal government’s liability regarding allegations of discrimination toward First Nations children was examined by a body that could make legally binding decisions and remedial orders. Over the year that followed, the Tribunal heard from over 25 witnesses and examined over 500 evidentiary documents. Internal federal documents that were submitted revealed consistent and systematic discrimination against First Nations children, along with a failure to resolve the problem, even with known solutions at hand. Even while the case was still before the Tribunal, a number of academics and members of First Nations began making parallels between the federal government’s reaction in this case and other cases of discrimination in access to services such as education, policing, health, and housing in Indigenous communities. This article expresses the perspectives of three authors who were closely involved in the case: two as lawyers and the other as a witness and complainant. It first provides an overview of the main legal issues raised in the case and then analyses the documentary and testimonial evidence. The need to correct the situation in other spheres of governmental services for First Nations people is also discussed

Commentary: Association of American Geographers - Recreation, Tourism and Sport Specialty Group - Student Paper Award Sustainable Tourism Indicators in Scotland: What Should We Be Considering?

This paper explores the interconnections and relative importance of seven determinants implicit in the development of sustainable tourism indicators. These determinants provide a framework for understanding the process of indicator selection for sustainable tourism. This research has suggested that some of the implicit determinants may be interconnected and some may be more important than others. The paper reports findings from twelve stakeholder groups in two Scottish National Parks which are engaged in developing sustainable tourism indicators. It is important for park authorities to be aware of the different views of stakeholder groups on the issues surrounding indicator selection and development and this research provided an opportunity for such groups to be consulted. The paper will examine the relative importance each group placed on the implicit determinants and consider possible reasons for between-group differences. Analysis will also focus on the existence of linkages between individual implicit determinants. The paper concludes that different typologies of stakeholder groups exist, affecting both the interpretation of, and importance attributed to, the determinants and that the framework as a whole serves to be more than the sum of its parts

Commentary: Association of American Geographers - Recreation, Tourism and Sport Specialty Group - Student Paper Award Sustainable Tourism Indicators in Scotland: What Should We Be Considering?

This paper explores the interconnections and relative importance of seven determinants implicit in the development of sustainable tourism indicators. These determinants provide a framework for understanding the process of indicator selection for sustainable tourism. This research has suggested that some of the implicit determinants may be interconnected and some may be more important than others. The paper reports findings from twelve stakeholder groups in two Scottish National Parks which are engaged in developing sustainable tourism indicators. It is important for park authorities to be aware of the different views of stakeholder groups on the issues surrounding indicator selection and development and this research provided an opportunity for such groups to be consulted. The paper will examine the relative importance each group placed on the implicit determinants and consider possible reasons for between-group differences. Analysis will also focus on the existence of linkages between individual implicit determinants. The paper concludes that different typologies of stakeholder groups exist, affecting both the interpretation of, and importance attributed to, the determinants and that the framework as a whole serves to be more than the sum of its parts