Future Experiences: Sustainable Development and the Global South

The Sustainable Development and the Global South project was jointly conceived by the Innovation School at Glasgow School of Art in partnership with the Sustainable Futures in Africa Network (SFA), and the University of Glasgow. Graduating final year BDes Product Design students from the Innovation School were presented with a challenge-based project to produce a vision of the future based on current trends that relate to Sustainable Development work and the Global South. This project involved working closely with researchers, academics and professionals specialising in human geography, education, health, environment, engineering, cultural practice and community engagement who are part of the Sustainable Futures in Africa Network which includes a Scottish hub, led from the University of Glasgow. Included in the network was a representative from an NGO that builds schools in Malawi, an entrepreneur who runs an ethical clothing company that partners with producers in the Global South, a senior governance officer from the UK Government’s Department for International Development (DFID), a research network administrator, and international graduate students from Africa based at Scottish institutions. In addition to the SFA, external experts from design studio AndThen and GOODD design consultancy were engaged. The objective of this project was to investigate, in both analytical and speculative ways, future forms and functions of Sustainable Development work in relation to the Global South in ten years from now, to develop future scenarios and design the artefacts, services and the experiences associated with these future visions. On completion of the project and learning experience it was intended that the students would be able to recognise and articulate the impact and sustainability of their design propositions, consider the life-cycle of their proposals and the values these might create for the intended users, communities and contexts. The project was completed in January 2020, as the Covid-19 pandemic was just beginning its spread around the world. This unprecedented catastrophe reinforced the importance of supporting those most in need – the citizens of developing regions in the Global South. In April 2020, the heads of all the UN’s major agencies issued an open letter warning of the risks the virus posed to the world’s most vulnerable countries. It called on wealthier nations to increase funding and help to tackle issues such as the cessation of aid as a result of cancelled flights and disrupted supply routes. These and many other concerns highlighted during the crisis are among the topics explored in this project, which feels even more relevant and urgent than when it was initiated in the summer of 2019. One of the most significant societal shifts currently taking place within the field of sustainable development work is its transformation from being understood as a process of growth or, at its most benign, poverty alleviation, to one of community empowerment and civic participation. The public’s role is developing beyond once-passive community members and recipients of aid, into stakeholders valued for their local knowledge, lived experiences, participation in development projects, and contribution towards policy-making and decision-making. This new dynamic is changing the traditional North-South relationship and holds the potential to challenge the geopolitical hegemony of International Development. The impetus for this shift is a decolonial, collaborative approach to development, research and practice; increased local empowerment, and sustainable solutions to problems that are co-created in context with those affected by and affecting the issue in question. This project asked students to consider what happens in this global landscape ten years from now where Sustainable Development has evolved to the extent that new forms of work and communities of practice transform how people engage, learn and interact with each other, with stakeholders and with the global community around them. The brief gave students the opportunity to explore the underlying complexities regarding sustainable futures, the post-colonial dynamic between ‘norths’ and ‘souths’, post-capitalism and human agency, to envision a future world context, develop it as an experiential exhibit, and produce the designed products, services and experiences for the people who might live and work within it. The project was divided into two sections: The first was a collaborative stage where groups of students were assigned a specific domain to collectively research one aspect of the project challenge, these domains included; Health, Energy, Mobility, Economies, Education, Societal Structures and Environment. Each of these domains were examined through the lenses of Social, Technological, Economic, Ethical, Educational, Values, Political, Legal and Ecological (STEEEVPLE) and were tailored in use, as appropriate per domain. The groups focused on researching and exploring their specific domain and gathering as much information and understanding while working with the external experts to further their knowledge. This group stage culminated in a series of Future World exhibits which tangibly manifest the cohort’s collective knowledge and collaborative understanding of what the future could look like in 10 years from now, after exploring the possible consequences of current actions. The second stage saw students explore their individual response to the Future World that had been created in the first stage. Each student developed their own response to the research by iteratively creating a design outcome that was appropriate to the subject matter. This culminated in each student producing a designed product, service or system and a visual communication of the future experience which they had created. A visual summary of the journey and stages (Project Journey Map) is included within the repository and outlines the collaborative process of designing and the innovative nature of the project’s pedagogical model. The project aims to reveal and address the emerging possibilities collaboratively created by Sustainable Development professionals and designers interacting and learning from each other, to present preferable futures which reveal socio-ecological innovations in development work with the Global South in the near future. The deposited materials are arranged as follows: Readme files - two readme files relate to stage one and stage two of the project as outlined above. Project Journey Map - gives a visual overview of the pedagogical structure and timeline of the project. Data folders - the data folders for stage one of the project are named by the domains through which each group explored possible futures. The data folders for stage two of the project are named for the individual students who conducted the work

Demographic characteristics and ocular needs of children attending child eye clinics in Cross River State, Nigeria: a retrospective analysis of clinical records

OBJECTIVES: To describe the demographic characteristics and ocular needs of children attending four child eye clinics in Cross River State, Nigeria, to inform the development of a sustainable spectacle cross-subsidisation scheme. DESIGN: Retrospective analysis of clinic records. SETTING: Four child eye clinics in Calabar, Ogoja, Ikom and Ugep, Cross River State, Nigeria, from 1 May 2017 to 30 June 2019. PARTICIPANTS: Children who failed the vision screening in schools and visited assigned child eye clinics, and self-referred children from the community. MAIN OUTCOME MEASURES: Children’s age, sex, residence, diagnosis, disease management, presenting and corrected visual acuity, history of spectacle wear and magnitude of refractive errors in spherical equivalent in the worse eye. RESULTS: Of all the 3799 records reviewed, data were available for 3774 children (mean age 10.6±4.35 years; 61.6% girls; 69.1% from urban settings); 30.8% (n=1162) of them had vision impairment. Of those children, 71.2% (n=827) were diagnosed with refractive error. For management, 48.6% (n=1833) were prescribed spectacles and 40.5% (n=1527) were prescribed ocular medications. Children prescribed spectacles were significantly more likely to be girls (68.0%, p−0.25 DS to −3.00DS (39.7%, n=727). Non-refractive eye conditions such as cataract (33.3%) and corneal disorders (14.1%) contributed to almost half of the total blindness. CONCLUSION: The findings show that spectacles provisions and ocular medications are the primary and secondary needs for children who attended child eye clinics seeking eye care services. Further research is needed to understand parents’ willingness to pay for spectacles to set strategic multitier pricing for a sustainable cross-subsidisation scheme

Is repeat fine needle aspiration required in thyroid nodules with initial benign cytology? Results from a large Irish series

Background : Fine needle aspiration (FNA) cytology is the preferred method for assessing thyroid nodules for malignancy. Concern remains about the rate of false negative results. The primary aim of this study is to investigate the malignancy rate of thyroid nodules initially classified as benign (Thy 2). Methods: We retrospectively examined 658 nodules in 653 (429 female) patients between January 2013 to December 2017. All FNA biopsies (FNABs) were performed under ultrasound (US) guidance by a radiologist with expertise in thyroid pathology. Nodules were cytologically classified according to the UK Royal College of Pathologists guidelines. Decisions about further management were made at a regular thyroid multidisciplinary meeting. Follow up of the Thy 2 nodules was determined based on clinical and radiological criteria. Results: The mean age (± SD) was 53.2 (14.6) years. Five hundred out of 658 (76.0%) nodules were classified as Thy 2 (benign) after the first FNAB. Of these thyroid nodules initially classified as benign, 208 (41.6%) underwent repeat FNAB and 9 (1.8%) were surgically removed without repeat FNAB. The remainder were followed up clinically and/or radiologically. Seven (1.4%) of nodules initially classified as Thy 2 were later shown to be or to harbor malignancy after a follow-up of 74.5 (± 19.7) months. Papillary thyroid microcarcinomas were found co-incidentally in two thyroid glands of benign nodules, giving a true prevalence of 5/500 (1.0%). Conclusions: With a well targeted FNAB, the false negative rate of an initial benign thyroid FNA is very low thus routine second FNAB is not required in patients with a thyroid nodule initially deemed benign. Multidisciplinary input is imperative in informing decision making.</p

Beneficial effects of a 3-week course of intramuscular glucocorticoid injections in patients with very early inflammatory polyarthritis: Results of the STIVEA trial

OBJECTIVE: To evaluate whether treating patients with very early inflammatory polyarthritis (IP) with a 3-week course of intramuscular (IM) methylprednisolone acetate may postpone the need for disease-modifying antirheumatic drugs (DMARDs) and prevent IP from evolving into rheumatoid arthritis (RA). METHODS: Patients with very early IP (4-10 weeks' duration) were randomised to receive three injections of either 80 mg IM methylprednisolone acetate or placebo, given at weekly intervals. Assessments were monthly until 6 months after the first injection, and then concluded at 12 months. The primary outcome was the need to start DMARDs by the 6-month assessment. Secondary outcomes included disease activity and final clinical diagnosis by the rheumatologist at 12 months. RESULTS: Patients in the placebo group (76%) were more likely to need DMARDs during the first 6 months of the trial than patients in the glucocorticoid group (61%) (adjusted OR = 2.11, 95% CI 1.16 to 3.85, p = 0.015). Disease activity did not differ between the two groups at 12 months, probably because many patients in the placebo group started DMARDs early in the study. After 12 months, the arthritis had resolved without the need for DMARDs in 9.9% (11/111) of the patients in the placebo group and in 19.8% (22/111) in the glucocorticoid-treated group (adjusted OR = 0.42, 95% CI 0.18 to 0.99, p = 0.048). CONCLUSION: Treatment of patients with very early IP with IM methylprednisolone acetate appears to postpone the prescription of DMARDs and prevent one in 10 patients from progressing into RA

Disease activity, smoking, and reproductive-related predictors of poor prognosis in patients with very early inflammatory polyarthritis

OBJECTIVE: To identify disease activity, smoking, and reproductive-related predictors of a poor prognosis in patients with very early inflammatory polyarthritis (IP). METHODS: Patients with very early IP (symptom duration 4-11 weeks) included in our study were participants in the STIVEA (Steroids In Very Early Arthritis) randomized placebo-controlled trial. At baseline, disease-related variables were measured and patients were asked to complete a questionnaire covering smoking status and reproductive questions. Baseline predictors of poor prognosis [i.e., the need to start disease-modifying antirheumatic drug (DMARD) therapy by 6 months or the clinical diagnosis of rheumatoid arthritis (RA) at 12 months] were identified, applying logistic regression analyses adjusted for treatment group. RESULTS: Rheumatoid factor (RF) positivity was one of the strongest clinical predictors of a poor prognosis: OR for DMARD therapy at 6 months, 4.00 (95% CI 2.00-8.00) and OR for a diagnosis of RA at 12 months, 9.48 (95% CI 4.48-20.07). There was a significant association between current smoking at baseline compared to never smoking and a diagnosis of RA at 12 months (OR 3.15, 95% CI 1.16-8.56). CONCLUSION: About 6 in 7 patients with very early RF-positive IP were diagnosed with RA 1 year later. In addition, 1 in 4 IP patients who smoke will develop RA later. It is recommended to treat RF-positive patients who have IP with DMARD at presentation and to advise patients to stop smoking

Chlamydia Screening in Ireland: a pilot study of opportunistic screening for genital Chlamydia trachomatis infection in Ireland (2007-2009). Pre-screening Report

Summary A series of background studies in 18 to 29 year olds were conducted in a range of primary care settings in Dublin and Galway, 2007-09, to assess the acceptability and feasibility of opportunistic screening for chlamydia: - semi-structured interviews with 35 women who had never been tested for a sexually transmitted infection (STI) - similar interviews with 30 men and women who had had a STI test - a questionnaire survey of 5685 students and 400 primary care patients - four focus group discussions with university students - semi-structured interviews with eight doctors and 10 practice nurses. The most important barrier to seeking or taking a STI test was the stigma young Irish men and women associated with chlamydia and other STIs, and the fear of being seen doing this. This fear was greater among young women. Young people, especially women, were aware that chlamydia infection was often asymptomatic and were conscious of the danger of complications such as infertility and the consequences of transmitting chlamydia to other women. Factors that would encourage acceptance of a chlamydia screening test, which were common to women and men, were: - normalising STI testing, by portraying it as a responsible practice that adults should engage in - not being asked questions by staff about their sexual history - being offered screening by younger non-judgmental female healthcare professionals - being offered screening in private or general health care settings, where others would not be aware that they were getting an STI test There was a high level of acceptance of chlamydia screening among young people: 95% said it would be acceptable to be offered a test, and 90% of health facility attendees and 75% of students said they would accept a test if offered. The most acceptable setting for chlamydia screening was a General Practice where respondents were most comfortable with being offered screening by a doctor or nurse. Other primary care settings were also acceptable, whereas pharmacies were not because they were seen as public settings. 80% said they would inform their current partner if they tested positive for chlamydia, though this fell to 55-60% in the case of previous partners. Health care providers (doctors and nurses) viewed chlamydia screening as a priority, because young people are sexually active and are at high risk because of alcohol. Providers anticipated high chlamydia test offers and uptake rates. Providers viewed chlamydia testing as a core activity to undertake in primary care, but they would need support for partner notification and easy access to laboratory tests, especially urine-based ones. Conclusion: Most 18-29 year old men and women would respond positively if offered a test for chlamydia, when attending a health care facility for other reasons. They recognise the risks and the importance of their sexual contacts being tested, if they themselves test positive for chlamydia. However, sexual health services in Ireland need to minimise stigma and ensure the confidentiality and acceptability of STI testing of young people.</p