‘I enjoyed it because … you could do whatever you wanted and be creative’: three principles for participatory research and pedagogy

The complexity of many children’s lives can result in their ideas being neither understood nor included in mainstream opportunities for learning, particularly children who are living with disadvantage. With a focus on developing ethical and inclusive principles for participatory research and pedagogy, this paper reports on a pilot project where we worked with young, hard-to-reach individuals across four sites in England to enable them to design and carry out research about their experiences and views of disadvantage. Here, we present snapshots of the young participants’ choices of research topics and methods, which reflected their own lives and interests, and led to powerful visualizations of the complexity of child and youth disadvantage. Reflecting back on the project, we discuss effective ways to initiate and sustain participatory research that can enable young researchers to be involved as active and empowered agents at every stage of the research process. We also consider the implications for developing participatory pedagogy, with researchers working alongside educators to create school cultures that foster belonging and genuinely support all students’ expertise and ways of knowing by looking beyond the school buildings and into their lives in the wider community

Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents.

BACKGROUND: Overweight and obesity are increasing worldwide. To help assess their relevance to mortality in different populations we conducted individual-participant data meta-analyses of prospective studies of body-mass index (BMI), limiting confounding and reverse causality by restricting analyses to never-smokers and excluding pre-existing disease and the first 5 years of follow-up. METHODS: Of 10 625 411 participants in Asia, Australia and New Zealand, Europe, and North America from 239 prospective studies (median follow-up 13·7 years, IQR 11·4-14·7), 3 951 455 people in 189 studies were never-smokers without chronic diseases at recruitment who survived 5 years, of whom 385 879 died. The primary analyses are of these deaths, and study, age, and sex adjusted hazard ratios (HRs), relative to BMI 22·5-<25·0 kg/m(2). FINDINGS: All-cause mortality was minimal at 20·0-25·0 kg/m(2) (HR 1·00, 95% CI 0·98-1·02 for BMI 20·0-<22·5 kg/m(2); 1·00, 0·99-1·01 for BMI 22·5-<25·0 kg/m(2)), and increased significantly both just below this range (1·13, 1·09-1·17 for BMI 18·5-<20·0 kg/m(2); 1·51, 1·43-1·59 for BMI 15·0-<18·5) and throughout the overweight range (1·07, 1·07-1·08 for BMI 25·0-<27·5 kg/m(2); 1·20, 1·18-1·22 for BMI 27·5-<30·0 kg/m(2)). The HR for obesity grade 1 (BMI 30·0-<35·0 kg/m(2)) was 1·45, 95% CI 1·41-1·48; the HR for obesity grade 2 (35·0-<40·0 kg/m(2)) was 1·94, 1·87-2·01; and the HR for obesity grade 3 (40·0-<60·0 kg/m(2)) was 2·76, 2·60-2·92. For BMI over 25·0 kg/m(2), mortality increased approximately log-linearly with BMI; the HR per 5 kg/m(2) units higher BMI was 1·39 (1·34-1·43) in Europe, 1·29 (1·26-1·32) in North America, 1·39 (1·34-1·44) in east Asia, and 1·31 (1·27-1·35) in Australia and New Zealand. This HR per 5 kg/m(2) units higher BMI (for BMI over 25 kg/m(2)) was greater in younger than older people (1·52, 95% CI 1·47-1·56, for BMI measured at 35-49 years vs 1·21, 1·17-1·25, for BMI measured at 70-89 years; pheterogeneity<0·0001), greater in men than women (1·51, 1·46-1·56, vs 1·30, 1·26-1·33; pheterogeneity<0·0001), but similar in studies with self-reported and measured BMI. INTERPRETATION: The associations of both overweight and obesity with higher all-cause mortality were broadly consistent in four continents. This finding supports strategies to combat the entire spectrum of excess adiposity in many populations. FUNDING: UK Medical Research Council, British Heart Foundation, National Institute for Health Research, US National Institutes of Health.UK MRC, BHF, NIHR; US NIHThis is the final version of the article. It first appeared from Elsevier via http://dx.doi.org/10.1016/S0140-6736(16)30175-

Clinical outcomes and response to treatment of patients receiving topical treatments for pyoderma gangrenosum: a prospective cohort study

Background: pyoderma gangrenosum (PG) is an uncommon dermatosis with a limited evidence base for treatment. Objective: to estimate the effectiveness of topical therapies in the treatment of PG. Methods: prospective cohort study of UK secondary care patients with a clinical diagnosis of PG suitable for topical treatment (recruited July 2009 to June 2012). Participants received topical therapy following normal clinical practice (mainly Class I-III topical corticosteroids, tacrolimus 0.03% or 0.1%). Primary outcome: speed of healing at 6 weeks. Secondary outcomes: proportion healed by 6 months; time to healing; global assessment; inflammation; pain; quality-of-life; treatment failure and recurrence. Results: Sixty-six patients (22 to 85 years) were enrolled. Clobetasol propionate 0.05% was the most commonly prescribed therapy. Overall, 28/66 (43.8%) of ulcers healed by 6 months. Median time-to-healing was 145 days (95% CI: 96 days, ∞). Initial ulcer size was a significant predictor of time-to-healing (hazard ratio 0.94 (0.88;80 1.00); p = 0.043). Four patients (15%) had a recurrence. Limitations: No randomised comparator Conclusion: Topical therapy is potentially an effective first-line treatment for PG that avoids possible side effects associated with systemic therapy. It remains unclear whether more severe disease will respond adequately to topical therapy alone

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Perceptions of Creativity among Faculty in Higher Education

Higher education instructors do not sufficiently incorporate creativity in the teaching and learning environments within which they operate. While there is a great deal of research available regarding creativity and primary or secondary education, there is little research available regarding creativity and higher education. This study contributes to that gap of knowledge by surveying faculty members in one institution of higher education in order to understand their perspectives regarding creativity, both as it relates to being a creative individual and to teaching others to be creative themselves. There were 358 faculty members who participated in the online survey designed specifically for this study. Those participants were tenured, tenure-track, visiting, and affiliate faculty from eight different academic units at both the graduate and undergraduate levels. The survey instrument asked participants to answer six demographic questions, eleven Likert scale statements, and two short answer questions. The results of the surveys were gathered and organized by response, allowing the researcher to identify similarities and tabulate percentages of responses. The majority of faculty participants believed creativity to be a positive concept that should be incorporated in higher education. However, when asked if they believed their faculty peers engaged in creative action, most participants did not perceive that to be the case. Several barriers to creativity, along with factors that could potentially promote creativity, were identified in this survey as well. The results have important implications for institutions of higher education if they are seeking to incorporate creativity. There is still a significant amount of research needed that could further promote this field of knowledge

The red-vented bulbul (Pycnonotus cafer) : serious pest or understudied invader?

International audienceRecently, debate has flourished about inadequacies in the simplistic ''worst invasive spe-cies'' approach and its global scale. Here we investigate the status of the red-vented bulbul (Pycnonotus cafer), an Asian passerine bird. This species has been introduced widely across Pacific islands and is commonly blamed for its impacts on agriculture and biodiversity via dispersal of invasive plant seeds and competition with native fauna. This case study evaluates all available data on the impacts and management of this invasive species and identifies priorities for future research. We reviewed the scientific literature and information from three databases (ABBA, GAVIA, eBird) and highlight that the attention paid to this species by scientists and managers varied considerably between islands and contexts and was globally lower than the attention paid to other species on the IUCN-ISSG list. The red-vented bulbul has now established on 37 islands and in seven continental locations outside its native range. We show that three categories of effects are associated with this species: plant damage, seed dispersal and disturbance of fauna. We compiled lists of 110 plant species consumed, 33 plant species dispersed, and 15 species of bird that this bulbul interacts with. However, these lists were mainly made of opportunistic observations rather than specific assessments. Research outputs that focus on better ways to prevent or quantify the impacts of the red-vented bulbul remain scarce. We found very few references exploring potential positive impacts of this species, and only two examples of management actions undertaken against it. The latter are required to inform management actions, especially on sensitive tropical islands where invasions and dispersal of the red-vented bulbul are ongoing. Our analysis of the literature found no clear support for considering this species to be one of the ''world's worst'' invasive alien species