An Immersive Virtual Reality Curriculum for Pediatric Hematology Clinicians on Shared Decision-making for Hydroxyurea in Sickle Cell Anemia

Although hydroxyurea (HU) is an effective treatment for sickle cell anemia, uptake remains low. Shared decision-making (SDM) is a recommended strategy for HU initiation to elicit family preferences; however, clinicians lack SDM training. We implemented an immersive virtual reality (VR) curriculum at 8 pediatric institutions to train clinicians on SDM that included counseling virtual patients. Clinicians’ self-reported confidence significantly improved following the VR simulations on all communication skills assessed, including asking open-ended questions, eliciting specific concerns, and confirming understanding (Ps≤0.01 for all). VR may be an effective method for educating clinicians to engage in SDM for HU

Single Pilot Workload Management During Cruise in Entry Level Jets

Advanced technologies and automation are important facilitators of single pilot operations, but they also contribute to the workload management challenges faced by the pilot. We examined task completion, workload management, and automation use in an entry level jet (ELJ) flown by single pilots. Thirteen certificated Cessna Citation Mustang (C510-S) pilots flew an instrument flight rules (IFR) experimental flight in a Cessna Citation Mustang simulator. At one point participants had to descend to meet a crossing restriction prior to a waypoint and prepare for an instrument approach into an un-towered field while facilitating communication from a lost pilot who was flying too low for ATC to hear. Four participants experienced some sort of difficulty with regard to meeting the crossing restriction and almost half (n=6) had problems associated with the instrument approach. Additional errors were also observed including eight participants landing at the airport with an incorrect altimeter setting

The agreement between parent-reported and directly measured child language and parenting behaviors

Parenting behaviors are commonly targeted in early interventions to improve children\u27s language development. Accurate measurement of both parenting behaviors and children\u27s language outcomes is thus crucial for sensitive assessment of intervention outcomes. To date, only a small number of studies have compared parent-reported and directly measured behaviors, and these have been hampered by small sample sizes and inaccurate statistical techniques, such as correlations. The Bland-Altman Method and Reduced Major Axis regression represent more reliable alternatives because they allow us to quantify fixed and proportional bias between measures. In this study, we draw on data from two Australian early childhood cohorts (N = 201 parents and slow-to-talk toddlers aged 24 months; and N = 218 parents and children aged 6-36 months experiencing social adversity) to (1) examine agreement and quantify bias between parent-reported and direct measures, and (2) to determine socio-demographic predictors of the differences between parent-reported and direct measures. Measures of child language and parenting behaviors were collected from parents and their children. Our findings support the utility of the Bland-Altman Method and Reduced Major Axis regression in comparing measurement methods. Results indicated stronger agreement between parent-reported and directly measured child language, and poorer agreement between measures of parenting behaviors. Child age was associated with difference scores for child language; however, the direction varied for each cohort. Parents who rated their child\u27s temperament as more difficult tended to report lower language scores on the parent questionnaire, compared to the directly measured scores. Older parents tended to report lower parenting responsiveness on the parent questionnaire, compared to directly measured scores. Finally, speaking a language other than English was associated with less responsive parenting behaviors on the videotaped observation compared to the parent questionnaire. Variation in patterns of agreement across the distribution of scores highlighted the importance of assessing agreement comprehensively, providing strong evidence that simple correlations are grossly insufficient for method comparisons. We discuss implications for researchers and clinicians, including guidance for measurement selection, and the potential to reduce financial and time-related expenses and improve data quality. Further research is required to determine whether findings described here are reflected in more representative populations

Creating spatial synergies around food in cities

This paper focusses on the phenomenon of multifunctional urban food initiatives (MUFIs) and how, using food as a vehicle, they provide integrative solutions for a number of social, environmental and economic problems in European cities. Through an in-depth investigation of three MUFIs in the UK, Latvia and Belgium, the paper aims to increase understanding on how different activities are combined within MUFIs, leading to the creation and strengthening of synergies: both internal, between the different activities performed within MUFIs, and external synergies between the MUFI and the (peri-) urban environment in which it operates. The three cases illustrate that the dense and complex urban environment in which they are situated provides possibilities to create a wide, diverse network around food, leading to a high potential for synergies to occur. In this way, MUFIs can respond to specific urban needs, which are not addressed by the state, and therefore have an important signalling function. For the MUFIs themselves, although being multifunctional increases opportunities, it is also a challenge to find the right balance between the different functions and not to lose sight of the economic side of the business. Local governments can support MUFIs by providing space for them, room to experiment, adapting regulations to get MUFIs out of the “grey zones” of legislation, and by starting to strategically think about food in their city region

Branding the City: The Democratic Legitimacy of a New Mode of Governance

__Abstract__ Place branding has been used to influence ideas concerning communities and districts, especially in regeneration programmes. This article approaches branding as a new governance strategy for managing perceptions. Considering the popular criticism that branding is a form of spin that prevents the public from gaining a proper understanding of their government's policies, this article focuses on the democratic legitimacy of branding in urban governance. The branding of two urban communities in the Netherlands is examined empirically in terms of input legitimacy, throughput legitimacy and output legitimacy. The research shows how the democratic legitimacy of branding varies in the two cases. In one case, branding largely excluded citizens, whereas in the other case there was limited citizen participation. The article indicates that, although branding can potentially be a participatory process in which the feelings and emotions of citizens are included, this potential is not always fully realised in practice

Law, necropolitics and the stop and search of young people

Stop and search can harm young people, damage relations between police and the community and alienate ethnic and racial minorities. In Mohidin and another v Commissioner of the Police of the Metropolis and others, a group of minors who had been stopped, searched and, in some cases, falsely imprisoned, assaulted and racially abused by officers, were awarded damages for the distress and pain suffered. In this article, the case will be read not for the tortious legal consequences of police actions towards youth, or members of the public in general, nor for the culpability of any of the parties concerned, but for how the use of ‘lawful’ police powers on young people was framed and justified by both officers and the courts. It is argued that the punitive function of such powers has been underexplored by criminologists, and that the authorization and legitimization of such tactics, routinely defended as a ‘necessary’ crime prevention tool, can be understood as an instantiation of ‘necropolitics’

EHLS at school: school-age follow-up of the early home learning study cluster randomized controlled trial

BACKGROUND: Targeted interventions during early childhood can assist families in providing strong foundations that promote children\u27s health and wellbeing across the life course. There is growing recognition that longer follow-up times are necessary to assess intervention outcomes, as effects may change as children develop. The Early Home Learning Study, or \u27EHLS\u27, comprised two cluster randomized controlled superiority trials of a brief parenting intervention, smalltalk, aimed at supporting parents to strengthen the early childhood home learning environment of infants (6-12 months) or toddlers (12-36 months). Results showed sustained improvements in parent-child interactions and the home environment at the 32 week follow-up for the toddler but not the infant trial. The current study will therefore follow up the EHLS toddler cohort to primary school age, with the aim of addressing a gap in literature concerning long-term effects of early childhood interventions focused on improving school readiness and later developmental outcomes. METHODS: \u27EHLS at School\u27 is a school-aged follow-up study of the toddler cluster randomized controlled trial (n = 1226). Data will be collected by parent-, child- and teacher-report questionnaires, recorded observations of parent-child interactions, and direct child assessment when children are aged 7.5 years old. Data linkage will provide additional data on child health and academic functioning at ages 5, 8 and 10 years. Child outcomes will be compared for families allocated to standard/usual care (control) versus those allocated to the smalltalk program (group program only or group program with additional home coaching). DISCUSSION: Findings from The Early Home Learning Study provided evidence of the benefits of the smalltalk intervention delivered via facilitated playgroups for parents of toddlers. The EHLS at School Study aims to examine the long-term outcomes of this initiative to determine whether improvements in the quality of the parent-child relationship persist over time and translate into benefits for children\u27s social, academic and behavioral skills that last into the school years

What influences parental engagement in early intervention? Parent, program and community predictors of enrolment, retention and involvement

Poor participant engagement undermines individual and public health benefits of early intervention programs. This study assessed the extent to which three types of engagement (participant enrolment, retention and involvement) were influenced by individual, program and contextual factors. Data were from a cluster randomised controlled trial (N = 1447) of a community-based parenting program, delivered at two levels of intensity (group sessions with and without individualised home coaching) conducted in Victoria, Australia. Individual (parent and family) factors and program factors were assessed by parent report and administrative records, and contextual factors by area-level population statistics. Data were analysed using multilevel logistic or linear regression models. Individual and contextual factors predicted enrolment, while family and program factors were more influential on program retention and parents’ active involvement. Provision of individualised support was important to all forms of engagement, particularly for families experiencing the greatest barriers to participation. These findings indicate that different strategies are required to effectively support families in the processes of enrolling, continuing to attend and actively participating in early intervention program

Hamburg's Spaces of Danger: Race, Violence and Memory in a Contemporary Global City

Germany today is experiencing the strongest upsurge of right-wing populism since the second world war, most notably with the rise of Pegida and Alternative für Deutschland. Yet wealthy global cities like Hamburg continue to present themselves as the gatekeepers of liberal progress and cosmopolitan openness. This article argues that Hamburg’s urban boosterism relies on, while simultaneously obscuring, the same structures of racial violence that embolden reactionary movements. Drawing on the work of Walter Benjamin and Allan Pred, we present an archaeology of Hamburg’s landscape, uncovering some of its ‘spaces of danger’––sites layered with histories of violence, many of which lie buried and forgotten. We find that these spaces, when they become visible, threaten to undermine Hamburg’s cosmopolitan narrative. They must, as a result, be continually erased or downplayed in order to secure the city as an attractive site for capital investment. To illustrate this argument, we give three historical examples: Hamburg’s role in the Hanseatic League during the medieval and early modern period; the city under the Nazi regime; and the recent treatment of Black African refugees. The article’s main contribution is to better situate issues of historical landscape, collective memory and racialized violence within the political economy of today’s global city