Towards a clearer understanding of student disadvantage in higher education: problematising deficit thinking

The combination of massification and increased diversity in student body pose particular challenges to higher education. The paper attempts to contribute to conversations around one of the ‘silences’ in higher education research – the uncritical use of ‘disadvantage’ discourse and its effect on pedagogic processes. It explores some of the challenges of coping with student diversity, with particular reference to a South African higher education context. Students enter higher education institutions with a variety of educational backgrounds, not all of which is considered to be sufficient preparation for the demands of higher education. The dominant thinking in higher education attempts to understand student difficulty by framing students and their families of origin as lacking some of the academic and cultural resources necessary to succeed in what is presumed to be a fair and open society. This constitutes a deficit thinking model: it focuses on the inadequacies of the student, and ‘fixing’ this problem. In the process the impact of structural issues is often ignored or minimised. Employing a deficit mindset to frame student difficulties acts to perpetuate stereotypes, alienate students from higher education and disregards the role of higher education in the barriers to student success. In the process universities replicate the educational stratification of societies. This paper suggests that we need to find more suitable responses to diversity in the student body. These require a change in our way of thinking: we need to thoughtfully consider the readiness of higher education institutions to respond to students, and cultivate the will to learn in our students. We need to find ways to research the full texture of the student experience and to value the pre-higher education context of students. In addition the notion of ‘at risk’ students could be helpful, and the original sense of the concept needs to be reclaimed

Coping in pandemic times: bricolage employed by first-generation engineering students

First-generation students have been a focus in higher education research over the past ten years. However, limited attention has been paid to engineering students who are the first in their generation to enter university. The paper reports on data collected as part of a longitudinal study of first-generation engineering students at a South African university during the early stages of the pandemic. First-generation students, who already face multiple difficulties in their educational journey, were confronted with a juxtaposition during the lockdown. As engineering students, they are inducted into technical approaches to problem-solving via systematic and analytical exploration. Levi-Srauss contrasts this notion of the ingenieur, grounded in the Enlightenment belief in the superiority of rational scientific reasoning, with the bricoleur, who finds solutions by “doing things with whatever is at hand”. With the lockdown period being less amenable to structured problem-solving, students often had to resort to more improvised approaches to accommodate their studies and their shifted precarious everyday routines. The study not only adds to literature on firstgeneration engineering students, but also provides insight into the ways in which these students cope with obstacles over which they have little control. In the process a picture of resilient agency emerges that challenges a narrow deficit view of students with limited resources

Flatland

Flatland is a project of VCDE233 TYPOGRAPHY II and VCDI223 DESIGN AND PRE-PRESS PRODUCTION, both courses in the Design Studies diploma program at MacEwan University. Students were asked to translate an assigned section of the Victorian novella, Flatland: A Romance of Many Dimensions by Edwin A. Abbott (1884), into a two-page layout that treats the text in a way that is visually appealing, readable, and appropriate to the content. They were encouraged to challenge conventions by exploring alternative grids, objective and expressive type, and text and image relationships. VCDE233 Typography II (Constanza Pacher) and VCDI223 Design and Pre-Press Production (Jess Dupuis

Quantifiable plasma tenofovir among South African women using daily oral pre-exposure prophylaxis during the ECHO trial

Access to data from the ECHO study may be requested through submission of a research concept to ude.wu@crci. The concept must include the research question, data requested, analytic methods, and steps taken to ensure ethical use of the data. Access will be granted if the concept is evaluated to have scientific merit and if sufficient data protections are in place. As of the time of publication, data access applications are in process with the governing institutional review boards of the ECHO study to make deidentified data publicly available.BACKGROUND : HIV endpoint–driven clinical trials provide oral pre-exposure prophylaxis (PrEP) as HIV prevention standard of care. We evaluated quantifiable plasma tenofovir among South African women who used oral PrEP during the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial. METHODS : ECHO, a randomized trial conducted in 4 African countries between 2015 and 2018, assessed HIV incidence among HIV-uninfected women, aged 16–35 years, randomized to 1 of 3 contraceptives. Oral PrEP was offered onsite as part of the HIV prevention package at the South African trial sites. We measured tenofovir in plasma samples collected at the final trial visit among women reporting ongoing PrEP use. We used bivariate and multivariate logistical regression to assess demographic and sexual risk factors associated with plasma tenofovir quantification. RESULTS : Of 260 women included, 52% were ≤24 years and 22% had Chlamydia trachomatis at enrollment. At PrEP initiation, 68% reported inconsistent/nonuse of condoms. The median duration of PrEP use was 90 days (IQR: 83–104). Tenofovir was quantified in 36% (n = 94) of samples. Women >24 years had twice the odds of having tenofovir quantified vs younger women (OR = 2.12; 95% confidence interval = 1.27 to 3.56). Women who reported inconsistent/nonuse of condoms had lower odds of tenofovir quantification (age-adjusted OR = 0.47; 95% confidence interval = 0.26 to 0.83). CONCLUSIONS : Over a third of women initiating PrEP and reporting ongoing use at the final trial visit had evidence of recent drug exposure. Clinical trials may serve as an entry point for PrEP initiation among women at substantial risk for HIV infection with referral to local facilities for ongoing access at trial end. CLINICAL TRIAL NUMBER : NCT02550067.The Bill & Melinda Gates Foundation, the American people through the United States Agency for International Development, the Swedish International Development Cooperation Agency, the South Africa Medical Research Council, and the United Nations Population Fund. Contraceptive supplies were donated by the Government of South Africa and US Agency for International Development.http://journals.lww.com/jaidshj2023Family MedicineMedical Microbiolog

Integrating oral PrEP delivery among African women in a large HIV endpoint-driven clinical trial

INTRODUCTION : Global guidelines emphasize the ethical obligation of investigators to help participants in HIV-endpoint trials reduce HIV risk by offering an optimal HIV prevention package. Oral pre-exposure prophylaxis (PrEP) has increasingly become part of state-of-the-art HIV prevention. Here we describe the process of integrating oral PrEP delivery into the HIV prevention package of the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial. METHODS : ECHO was an open-label randomized clinical trial that compared HIV incidence among women randomized to one of three effective contraceptives. In total, 7830 women aged 16 to 35 years from 12 sites in four African countries (Eswatini, Kenya, South Africa and Zambia) were enrolled and followed for 12 to 18 months, from 2015 to 2018. Part-way through the course of the trial, oral PrEP was provided to study participants either off-site via referral or on site via trained trial staff. PrEP uptake was compared between different contraceptive users using Chi-squared tests or t-tests. HIV seroincidence rates were compared between participants who never versus ever initiated PrEP using exact Poisson regression. RESULTS : PrEP access in ECHO began through public availability in Kenya in May 2017 and was available at all sites by June 2018. When PrEP became available, 3626 (46.3%) eligible women were still in follow-up in the study, and of these, 622 (17.2%) initiated PrEP. Women initiating PrEP were slightly older; more likely to be unmarried, not living with their partner, having multiple partners; and less likely to be earning their own income and receiving financial support from partners (all p < 0.05). PrEP initiation did not differ across study randomized groups (p = 0.7). Two-thirds of PrEP users were continuing PrEP at study exit. CONCLUSIONS : There is a need for improved HIV prevention services in clinical trials with HIV endpoints, especially trials among African women. PrEP as a component of a comprehensive HIV prevention package provided to women in a large clinical trial is practical and feasible. Provision of PrEP within clinical trials with HIV outcomes should be standard of prevention.The ECHO Trial was funded by Bill & Melinda Gates Foundation, US Agency for International Development and the President’s Emergency Plan for AIDS Relief, Swedish International Development Cooperation Agency, South African Medical Research Council and UN Population Fund. Contraceptive supplies were donated by the Government of South Africa and US Agency for International Development. IB received funding from the South African Medical Research Council under the SAMRC Clinician Researcher MD PhD Development Programme.https://onlinelibrary.wiley.com/journal/17582652am2020Family Medicin

High levels of pretreatment HIV-1 drug resistance mutations among South African women who acquired HIV during a prospective study

Access to data from the ECHO Study may be requested through submission of a research concept to [email protected]. The concept must include the research question, data requested, analytic methods, and steps taken to ensure ethical use of the data. Access will be granted if the concept is evaluated to have scientific merit and if sufficient data protections are in place. As of the time of publication, data access applications are in process with the governing institutional review boards of the ECHO Study to make de-identified data publicly available.BACKGROUND : Pretreatment HIV drug resistance (PDR) undermines individual treatment success and threatens the achievement of UNAIDS 95-95-95 targets. In many African countries, limited data are available on PDR as detection of recent HIV infection is uncommon and access to resistance testing is limited. We describe the prevalence of PDR among South African women with recent HIV infection from the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial. METHODS : HIV-uninfected, sexually active women, aged 18–35 years, and seeking contraception were enrolled in the ECHO Trial at sites in South Africa, from 2015 to 2018. HIV testing was done at trial entry and repeated quarterly. We tested stored plasma samples collected at HIV diagnosis from women who seroconverted during follow-up and had a viral load >1000 copies/mL for antiretroviral resistant mutations using a validated laboratory-developed population genotyping assay, which sequences the full protease and reverse transcriptase regions. Mutation profiles were determined using the Stanford Drug Resistance Database. RESULTS : We sequenced 275 samples. The median age was 23 years, and majority (98.9%, n = 272) were infected with HIV-1 subtype C. The prevalence of surveillance drug resistance mutations (SDRMs) was 13.5% (n = 37). Nonnucleoside reverse transcriptase inhibitor (NNRTI) mutations were found in 12.4% of women (n = 34). Few women had NRTI (1.8%, n = 5) and protease inhibitor (1.1%, n = 3) mutations. Five women had multiple NRTI and NNRTI SDRMs. CONCLUSIONS : The high levels of PDR, particularly to NNRTIs, strongly support the recent change to the South African national HIV treatment guidelines to transition to a first-line drug regimen that excludes NNRTIs.The Bill & Melinda Gates Foundation, the American people through the United States Agency for International Development, the Swedish International Development Cooperation Agency, the South Africa Medical Research Council, and the United Nations Population Fund.http://journals.lww.com/jaidshj2023Family MedicineMedical Microbiolog

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

Beyond the dichotomy of students-as-consumers and personal transformation : What students want from their degrees and their engagement with knowledge

There is widespread concern that students are increasingly becoming passive consumers of education who primarily attend university to obtain the credentials they need for the labour market. To interrogate this view, a longitudinal qualitative study examined what 47 students in three countries wanted to get out of studying for their degree (their personal projects) and how these developed over the course of their undergraduate studies. Our analysis showed that whilst most students had instrumental reasons for studying, they tended to be personally committed to the knowledge they were studying and had a clear sense of the role it would play in their future lives. Where students did not see knowledge as having a key role in helping them to realise their personal projects, they were less likely to value their studies. Also, students who were committed to the knowledge they were studying but did not have a sense of what they were trying to achieve personally with it, appeared to be uncertain about where they were going by the end of their degree. Based on this analysis, we argue that the dichotomy between students-as-consumers and personal transformation is false. Rather what is important is students being clear about how academic knowledge connects them to the world and helps them to shape their plans for the future

Exploring emerging engineering identities : The potential of possible selves

CONTEXT The theory of "possible selves", first proposed by Hazel Markus and Paula Nurius (1987), has been used in higher education as a way to understand how an imagined future impact on present behaviour. When future selves are embodied and personalised in identity, they have the potential to become powerful motivations for behaviour. While the concept has been widely used in higher education research, little work has been done in engineering education. PURPOSE There is growing interest in engineering education in the ways in which engineering identity is developed. However, sound theoretical and methodological approaches to researching identity formation are lacking in published research. In this paper we explore the potential of the lens of possible selves as an analytical tool for understanding the development of an emerging engineering identity. METHODOLOGY The paper draws on data collected from an international longitudinal study at six universities in three countries (UK, South Africa and the USA) over a period of four years. Semi-structured interviews, covering a range of topics, were conducted annually with chemical engineering students at each of the institutions, transcribed and initially coded into broad sets of categories, using qualitative software. For the work described in this paper, we returned to full transcripts to benefit from the longitudinal nature of the study. A qualitative analysis of themes linked to the theory of possible selves was conducted and links between themes were developed. OUTCOMES The conceptual framework of possible selves allows researchers to explore the varied ways in which engineering students clarify conceptualisation of their future professional roles. In addition, the theory enables consideration of a temporaI aspect of identity development: the notion of a welldeveloped future self has the potential to impact on current behaviour and make sense of the past. CONCLUSIONS Engineering education is about more than the transfer and acquisition of specialised knowledge and skills. In this study the theory of possible selves is applied to gain insight into chemical engineering students' development of an identity as an engineer over the course of their academic careers. We consider a recommendation concerning the potential impact of including intentional opportunities in the curriculum for students to reflect on aspirations for a future as an engineer, in addition to the technical knowledge and skills they gain