Sociomateriality in medical practice and learning: Attuning to what matters

CONTEXT In current debates about professional practice, learning and education, increasing emphasis is being placed on understanding learning as ongoing participation rather than as acquiring knowledge and skills. Close attention is paid to the sociocultural context as well as to cognition. While this general sociocultural view is important and useful, issues have emerged in studies of practice-based learning that point to certain oversights. METHOD Three issues are described here: (1) the general lack of attention to the importance of materiality – objects, technologies, nature etc – in questions of learning; (2) the human-centric view of challenges and complexities in practice that fail to note the transformational entanglements among social and material forces; and (3) the conflicts between ideals of evidence-based standardized models and the sociomaterial contingencies of clinical practice.    DISCUSSION It is argued here that a sociomaterial approach to learning and practice offers important insights for medical education. This view joins a growing field of research in the materiality of practice and everyday life, which embraces wide-ranging theoretical families that can only be briefly mentioned in this short introduction. The main premise they share is that social and material forces, culture, nature and technology, are enmeshed in everyday practice. Objects and humans act upon one another in ways that mutually transform their characteristics and activity. Examples from research in medical practice show how materials actively influence clinical practice, how learning itself is a material matter, how protocols are in fact temporary sociomaterial achievements, and how practices form unique and sometimes conflicting sociomaterial worlds, with diverse diagnostic and treatment approaches for the same thing.   CONCLUSIONS The article concludes with implications for learning in practice. The shift is from sole emphasis on acquiring knowledge representations to learning how to participate more wisely in particular situations. Focus is on learning how to attune to minor material fluctuations and surprises, how to track one’s own and other’s effects on the ‘intra-actions’ and emerging effects, and how to improvise solutions

Geographical Distribution of Intestinal Schistosomiasis and Soil-Transmitted Helminthiasis and Preventive Chemotherapy Strategies in Sierra Leone

The common intestinal roundworm, whipworm and hookworm (together known as soil-transmitted helminthes - STHs) together with schistosomes or bilharzia are responsible for extensive ill health, reduced life expectancy and death in sub-Saharan Africa. These diseases are transmitted in areas of poor water supply and sanitation. In order to implement an appropriate national control program, knowledge of the prevalence and geographical distribution of these diseases is required. A national survey was performed in Sierra Leone in 2008. Overall prevalence of intestinal schistosomiasis was 18.4% and that of STHs was 39.1%. Intestinal schistosomiasis was mainly prevalent in the northern and eastern regions while STH is widespread in the country. The results justify routine de-worming for pre-school children, school age children, women of childbearing age, and adults at high risk twice a year. The results also justify using anti-schistosomiasis drug (praziquantel) in school age children, all women of childbearing age, and adults at high risk annually or biennially depending upon the prevalence in the areas

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Local perspectives of the ability of HIA stakeholder engagement to capture and reflect factors that impact Alaska Native health

Background: Health impact assessment (HIA) is a process used to inform planning and decision making in a range of sectors by identifying potential positive and negative health effects of proposed projects, programs, or policies. Stakeholder engagement is an integral component of HIA and requires careful consideration of participant diversity and appropriate methodologies. Ensuring that the engagement process is able to capture and address Indigenous worldviews and definitions of health is important where Indigenous populations are impacted, particularly in northern regions experiencing increases in natural resource development activities on Indigenous lands. Objective: Investigate local participant perspectives of an HIA of a proposed Alaska coal mine, with a focus on the ability of the HIA process to capture, reflect, and address health concerns communicated by Alaska Native participants. Design: A qualitative approach guided by semi-structured interviews with purposeful sampling to select key informants who participated in the coal mine HIA stakeholder engagement process. Results: Qualitative data identified three key themes as important from the perspective of Alaska Native participants in the Alaska coal mine HIA stakeholder engagement process: (i) the inability of the engagement process to recognize an Indigenous way of sharing or gathering information; (ii) the lack of recognizing traditional knowledge and its use for identifying health impacts and status; and (iii) the inability of the engagement process to register the relationship Indigenous people have with the environment in which they live. Issues of trust in the HIA process and of the HIA findings were expressed within each theme. Conclusions: Recommendations derived from the research identify the need to acknowledge and incorporate the history of colonialism and assimilation policies in an HIA when assessing health impacts of resource development on or near Indigenous lands. These historical contexts must be included in baseline conditions to understand particular vulnerabilities and potential health risks and impacts. Further, HIA practitioners should recognize the range of definitions for “health” and demonstrate this recognition throughout the stakeholder engagement process, as well as in the HIA recommendations and suggested mitigations

Discovering the Literacy Gap: A Systematic Review of Reading and Writing Theories In Research

Research is failing to consistently report theoretical frameworks, increasing the gap between research and practice, and increasing the difficulty teachers face in effectively matching interventions with student needs. However, this lack of theoretical understanding has not been well documented in the current literature. The purpose of this systematic review is to determine the literacy theories used in published articles within the Journal of Adolescent and Adult Literacy (JAAL). JAAL is a peer-reviewed literacy journal that focuses on providing research-based practices for teachers. The present study includes an overview of published theories of reading and writing and the results of coding for these theories within a sample of ninety-four published intervention articles. Through this review, we have uncovered several areas for future research: (1) clarification of the differences between sociocultural and sociocognitive theories, (2) an increased emphasis on the mutual impact of reading and writing, and (3) a need to diversify theories used for reading and writing instruction