A PARTNERSHIP’S CAPACITY for COMMUNITY IMPACT UNDERSTOOD THROUGH NEOLIBERAL TECHNOLOGIES OF RISK and RESPONSIBILIZATION: A LOOK at WORCESTER MASSACHUSETTS’ SENATOR CHARLES E. SHANNON JR. COMMUNITY SAFETY INITIATIVE PARTNERSHIP

Since 2006, the Charles E. Shannon Jr. Community Safety Initiative has sought to reduce youth and gang violence in multiple Massachusetts cities through partnerships of community organizations, research institutions and police departments. Worcester, Massachusetts was an original recipient of Shannon funding due to its historic and increasing problem of youth and gang violence. Using a framework of governmentality, one of the ways crime is problematized and controlled is through the use of neoliberal technologies of risk and responsibilization, underscoring neoliberalism’s emphasis on personal responsibility. When risk is used to govern and assigned to individuals and groups of people living in relegated spaces, interventions become structurally blind. The framework of governmentality and risk and responsibilization was helpful in understanding Shannon’s capacity for a community impact in Worcester that would address structural barriers to equality and de-individualize interventions. Interviews and documentary analysis were conducted to understand the capacity of Worcester’s Shannon partnership. The findings revealed successes in increasing awareness of youth violence and inter-agency communication. However, because the Shannon Partnership in Worcester continues to be responsive to neoliberal technologies of risk and responsibilization, espousing a narrow interpretation of the Comprehensive Gang Model (CGM), and lacking community participation and voice, the partnership has not, and will not, move beyond individual programmatic responses to more structural responses to youth and gang violence, further maintaining the status quo. In Worcester, Massachusetts, a post-industrial gateway city, the disadvantaged ecological context of many youth’s lives disallows progress to be made solely through programmatic services provided by the partnership’s strategy

Navigating the Boundaries of Youth Violence Prevention and Reduction: Reflections on Power in Community Engaged Scholarship

Community-engaged scholars grapple with power asymmetries in community-university partnerships, generally working from the assumption that deliberate practices are required to moderate the researchers’ power vis-a-vis that of the community. In this article, we suggest that this dyadic framing masks the complexity of power dynamics within communities, of which the university is just one part, and examine how power is negotiated in the boundary zones of a partnership. We use Third Generation Cultural Historical Activity Theory (CHAT) as a conceptual framework to analyse the structural and cultural dimensions of the boundary zone in which research, learning and action in our partnership occurred (Engeström 1996). A brief story sheds light on our boundary work which uses research and data to span, broker and shake institutional boundaries for the purpose of youth violence prevention and intervention. Our analysis illuminates the potential and limitations of our power to foster transformational change. It also allows us to show that underestimating power differentials and the diversity of values and cultures within an organisation and between a university and a community partner, and certainly across multiple institutions in the case of a cross-sector partnership, can slow down and even thwart work to address societal problems

Development and validation of a pregnancy symptoms inventory

Background: Physical symptoms are common in pregnancy and are predominantly associated with normal physiological changes. These symptoms have a social and economic cost, leading to absenteeism from work and additional medical interventions. There is currently no simple method for identifying common pregnancy related problems in the antenatal period. A validated tool, for use by pregnancy care providers would be useful. The aim of this study was to develop and validate a Pregnancy Symptoms Inventory for use by health professionals. Methods: A list of symptoms was generated via expert consultation with health professionals. Focus groups were conducted with pregnant women. The inventory was tested for face validity and piloted for readability and comprehension. For test-re-test reliability, the tool was administered to the same women 2 to 3 days apart. Finally, midwives trialled the inventory for 1 month and rated its usefulness on a 10cm visual analogue scale (VAS). Results: A 41-item Likert inventory assessing how often symptoms occurred and what effect they had, was developed. Individual item test re-test reliability was between .51 to 1, the majority (34 items) scoring ≥0.70. The top four " often" reported symptoms were urinary frequency (52.2%), tiredness (45.5%), poor sleep (27.5%) and back pain (19.5%). Among the women surveyed, 16.2% claimed to sometimes or often be incontinent. Referrals to the incontinence nurse increased > 8 fold during the study period. Conclusions: The PSI provides a comprehensive inventory of pregnancy related symptoms, with a mechanism for assessing their effect on function. It was robustly developed, with good test re-test reliability, face validity, comprehension and readability. This provides a validated tool for assessing the impact of interventions in pregnancy

A Modified Surface on Titanium Deposited by a Blasting Process

Abstract : Hydroxyapatite (HA) coating of hard tissue implants is widely employed for its biocompatible and osteoconductive properties as well as its improved mechanical properties. Plasma technology is the principal deposition process for coating HA on bioactive metals for this application. However, thermal decomposition of HA can occur during the plasma deposition process, resulting in coating variability in terms of purity, uniformity and crystallinity, which can lead to implant failure caused by aseptic loosening. In this study, CoBlast™, a novel blasting process has been used to successfully modify a titanium (V) substrate with a HA treatment using a dopant/abrasive regime. The impact of a series of apatitic abrasives under the trade name MCD, was investigated to determine the effect of abrasive particle size on the surface properties of both microblast (abrasive only) and CoBlast (HA/abrasive) treatments. The resultant HA treated substrates were compared to substrates treated with abrasive only (microblasted) and an untreated Ti. The HA powder, apatitic abrasives and the treated substrates were characterized for chemical composition, coating coverage, crystallinity and topography including surface roughness. The results show that the surface roughness of the HA blasted modification was affected by the particle size of the apatitic abrasives used. The CoBlast process did not alter the chemistry of the crystalline HA during deposition. Cell proliferation on the HA surface was also assessed, which demonstrated enhanced osteo-viability compared to the microblast and blank Ti. This study demonstrates the ability of the CoBlast process to deposit HA coatings with a range of surface properties onto Ti substrates. The ability of the CoBlast technology to offer diversity in modifying surface topography offers exciting new prospects in tailoring the properties of medical devices for applications ranging from dental to orthopedic settings

Soothing dementia carers: a pilot evaluation of an imagery-based wellbeing app feature to support family carers of people with dementia during the COVID-19 pandemic

Background: The COVID-19 pandemic has presented unprecedented risks to the health of people living with dementia. Confinement to their homes and extra pressure on the health and social care system, left people with dementia and their carers with reduced access to care services. Accordingly, family carers assumed more caring responsibilities and faced a greater risk of social isolation and loneliness, negatively affecting their mental wellbeing. In response, we developed a new imagery-based feature called Project Soothe within an existing app, CogniCare, which aimed to support the wellbeing of family carers looking after someone with dementia at home. Methods: This new feature aimed to test the utility of our previous research which has shown that viewing soothing images has positive mood benefits on users. In this pilot, we examined the usage of the Project Soothe feature over a one-year period. Results: Our results indicate the feasibility of the imagery-based app feature as we found that most users found viewing the soothing images to have a positive influence on their mood. Conclusions: This finding illustrates feasibility of this imagery-based wellbeing app in this population of interest, and suggests that, upon further replication and research, the Project Soothe feature within the CogniCare app has potential to be developed as a digital wellbeing tool for family carers of people with dementia

Cost minimization analysis of intravenous or subcutaneous trastuzumab treatment in patients with HER2-positive breast cancer in Ireland

Background: Two large acute Irish University teaching hospitals changed the manner in which they treated human epidermal growth factor receptor (HER)2-positive breast cancer patients by implementing the administration of trastuzumab via the subcutaneous (SC) route into their clinical practice. The study objective is to compare the trastuzumab SC and trastuzuamb intravenous (IV) treatment pathways in both hospitals and assess which route is more cost-effective and time saving in relation to active health care professional (HCP) time. Materials and Methods: A prospective observational study in the form of cost minimization analysis constituted the study design. Active HCP time for trastuzumab SC- and IV-related tasks were recorded. Staff costs were calculated using fully loaded salary costs. Loss of productivity costs for patients were calculated using the human capital method. Results: On average, the total HCP time saved per trastuzumab SC treatment cycle relative to trastuzumab IV treatment cycle was 59.21 minutes. Time savings in favor of trastuzumab SC resulted from quicker drug reconstitution, no IV catheter installation/removal, and less HCP monitoring. Over a full treatment course of 17 cycles, average HCP time saved accumulates to 16.78 hours, with an estimated direct cost saving of â ¬1609.99. Loss of productivity for patients receiving trastuzumab IV (2.15 days) was greater than that of trastuzumab SC (0.60 days) for a full treatment course. Conclusion: Trastuzumab SC treatment has proven to be a more cost-effective option than trastuzumab IV treatment that generated greater HCP time savings in both study sites. Healthcare policymakers should consider replacing trastuzumab IV with trastuzumab SC treatment in all eligible patients

Using behavioural science to enhance use of core outcome sets in trials: protocol.

BackgroundCore outcome sets (COS) represent agreed-upon sets of outcomes, which are the minimum that should be measured and reported in all trials in specific health areas. Use of COS can reduce outcome heterogeneity, selective outcome reporting, and research waste, and can facilitate evidence syntheses. Despite benefits of using COS, current use of COS in trials is low. COS use can be understood as a behaviour, in that it is something trialists do, or not do, adequately. The aim of this study is to identify strategies, informed by behaviour change theory, to increase COS use in trials.MethodsThe project will be conducted in two stages, informed by the behaviour change wheel (BCW). The BCW is a theoretically based framework that can be used to classify, identify, and develop behaviour change strategies. In Stage 1, barriers and enablers to COS use will be extracted from published studies that examined trialist's use of COS. Barriers and facilitators will be mapped to the components of COM-B model (capability, opportunity, and motivation), which forms part of the BCW framework. Stage 2 will build on Stage 1 findings to identify and select intervention functions and behaviour change techniques to enhance COS use in trials.DiscussionThe findings of this study will provide an understanding of the behavioural factors that influence COS use in trials and what strategies might be used to target these factors to increase COS use in trials

Exorcising Grice’s ghost : an empirical approach to studying intentional communication in animals

Language’s intentional nature has been highlighted as a crucial feature distinguishing it from other communication systems. Specifically, language is often thought to depend on highly structured intentional action and mutual mindreading by a communicator and recipient. Whilst similar abilities in animals can shed light on the evolution of intentionality, they remain challenging to detect unambiguously. We revisit animal intentional communication and suggest that progress in identifying analogous capacities has been complicated by (i) the assumption that intentional (that is, voluntary) production of communicative acts requires mental-state attribution, and (ii) variation in approaches investigating communication across sensory modalities. To move forward, we argue that a framework fusing research across modalities and species is required. We structure intentional communication into a series of requirements, each of which can be operationalised, investigated empirically, and must be met for purposive, intentionally communicative acts to be demonstrated. Our unified approach helps elucidate the distribution of animal intentional communication and subsequently serves to clarify what is meant by attributions of intentional communication in animals and humans

Exercise in obese pregnant women: The role of social factors, lifestyle and pregnancy symptoms

Background Physical activity may reduce the risk of adverse maternal outcomes, yet there are very few studies that have examined the correlates of exercise amongst obese women during pregnancy. We examined which relevant sociodemographic, obstetric, and health behaviour variables and pregnancy symptoms were associated with exercise in a small sample of obese pregnant women. Methods This was a secondary analysis using data from an exercise intervention for the prevention of gestational diabetes in obese pregnant women. Using the Pregnancy Physical Activity Questionnaire (PPAQ), 50 obese pregnant women were classified as "Exercisers" if they achieved ≥900 kcal/wk of exercise and "Non-Exercisers" if they did not meet this criterion. Analyses examined which relevant variables were associated with exercise status at 12, 20, 28 and 36 weeks gestation. Results Obese pregnant women with a history of miscarriage; who had children living at home; who had a lower pre-pregnancy weight; reported no nausea and vomiting; and who had no lower back pain, were those women who were most likely to have exercised in early pregnancy. Exercise in late pregnancy was most common among tertiary educated women. Conclusions Offering greater support to women from disadvantaged backgrounds and closely monitoring women who report persistent nausea and vomiting or lower back pain in early pregnancy may be important. The findings may be particularly useful for other interventions aimed at reducing or controlling weight gain in obese pregnant women