Power and rights in the community: paralegals as leaders in women's legal empowerment in Tanzania

What can an analysis of power in local communities contribute to debates on women’s legal empowerment and the role of paralegals in Africa? Drawing upon theories of power and rights, and research on legal empowerment in African plural legal systems, this article explores the challenges for paralegals in facilitating women’s access to justice in Tanzania, which gave statutory recognition to paralegals in the Legal Aid Act 2017. Land conflicts represent the single-biggest source of local legal disputes in Tanzania and are often embedded in gendered land tenure relations. This article argues that paralegals can be effective actors in women’s legal empowerment where they are able to work as leaders, negotiating power relations and resisting the forms of violence that women encounter as obstacles to justice. Paralegals’ authority will be realised when their role is situated within community leadership structures, confirming their authority while preserving their independence

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

A New Look at Performance on Theory-of-Mind Tasks by Adolescents With Autism Spectrum Disorder

Purpose: A hallmark of autistic spectrum disorder (ASD) is disruption in theory-of-mind development, including the understanding of false beliefs. Previous studies have typically assessed the development of first- and second-order false belief concepts in ASD, with tasks primarily emphasizing physical causality and logical inferencing. The present study investigated how preadolescents and adolescents with ASD performed on false belief tasks that included social inferencing of psychological states as well as logical inferencing of physical states. Method: Two categories of tasks were administered: four traditional logical inferencing tasks and four social inferencing tasks specifically developed for this study. In addition, a prompt hierarchy was included to ascertain if performance on both task types improved. Participants were 45 children and adolescents primarily selected from three urban school districts: 15 adolescents with a previous diagnosis of ASD (ASD group); 15 typically developing children matched for age, gender, and ethnicity (CA group); and 15 typically developing children matched for language age, gender, and ethnicity (LA group). Results: Three findings were pertinent. First, the CA group performed at higher levels than did the LA group and the ASD group on both task sets. Second, although the CA and the LA groups performed equally well on both the logical and the social inferencing tasks, the ASD group performed better on the social inferencing tasks. Finally, the prompt hierarchy significantly improved overall task performance for the ASD and LA groups. Clinical Implications: These findings indicate that task type, variations in vocabulary ability, and the provision of support influenced performance on the false belief tasks

A New Look at Performance on Theory-of-Mind Tasks by Adolescents With Autism Spectrum Disorder

Purpose: A hallmark of autistic spectrum disorder (ASD) is disruption in theory-of-mind development, including the understanding of false beliefs. Previous studies have typically assessed the development of first- and second-order false belief concepts in ASD, with tasks primarily emphasizing physical causality and logical inferencing. The present study investigated how preadolescents and adolescents with ASD performed on false belief tasks that included social inferencing of psychological states as well as logical inferencing of physical states. Method: Two categories of tasks were administered: four traditional logical inferencing tasks and four social inferencing tasks specifically developed for this study. In addition, a prompt hierarchy was included to ascertain if performance on both task types improved. Participants were 45 children and adolescents primarily selected from three urban school districts: 15 adolescents with a previous diagnosis of ASD (ASD group); 15 typically developing children matched for age, gender, and ethnicity (CA group); and 15 typically developing children matched for language age, gender, and ethnicity (LA group). Results: Three findings were pertinent. First, the CA group performed at higher levels than did the LA group and the ASD group on both task sets. Second, although the CA and the LA groups performed equally well on both the logical and the social inferencing tasks, the ASD group performed better on the social inferencing tasks. Finally, the prompt hierarchy significantly improved overall task performance for the ASD and LA groups. Clinical Implications: These findings indicate that task type, variations in vocabulary ability, and the provision of support influenced performance on the false belief tasks

Evidence-Based Systematic Review: Effects of Different Service Delivery Models on Communication Outcomes for Elementary School–Age Children

Purpose: The purpose of this investigation was to conduct an evidence-based systematic review (EBSR) of peer-reviewed articles from the last 30 years about the effect of different service delivery models on speech-language intervention outcomes for elementary school–age students. Method: A computer search of electronic databases was conducted to identify studies that addressed any of 16 research questions. Structured review procedures were used to select and evaluate data-based studies that used experimental designs of the following types: randomized clinical trial, nonrandomized comparison study, and single-subject design study. Results: The EBSR revealed a total of 5 studies that met the review criteria and addressed questions of the effectiveness of pullout, classroom-based, and indirect–consultative service delivery models with elementary school–age children. Some evidence suggests that classroom-based direct services are at least as effective as pullout intervention for some intervention goals, and that highly trained speech-language pathology assistants, using manuals prepared by speech-language pathologists to guide intervention, can provide effective services for some children with language problems. Conclusion: Lacking adequate research-based evidence, clinicians must rely on reason-based practice and their own data until more data become available concerning which service delivery models are most effective. Recommendations are made for an expanded research agenda

Evidence-Based Systematic Review: Effects of Different Service Delivery Models on Communication Outcomes for Elementary School–Age Children

Purpose: The purpose of this investigation was to conduct an evidence-based systematic review (EBSR) of peer-reviewed articles from the last 30 years about the effect of different service delivery models on speech-language intervention outcomes for elementary school–age students. Method: A computer search of electronic databases was conducted to identify studies that addressed any of 16 research questions. Structured review procedures were used to select and evaluate data-based studies that used experimental designs of the following types: randomized clinical trial, nonrandomized comparison study, and single-subject design study. Results: The EBSR revealed a total of 5 studies that met the review criteria and addressed questions of the effectiveness of pullout, classroom-based, and indirect–consultative service delivery models with elementary school–age children. Some evidence suggests that classroom-based direct services are at least as effective as pullout intervention for some intervention goals, and that highly trained speech-language pathology assistants, using manuals prepared by speech-language pathologists to guide intervention, can provide effective services for some children with language problems. Conclusion: Lacking adequate research-based evidence, clinicians must rely on reason-based practice and their own data until more data become available concerning which service delivery models are most effective. Recommendations are made for an expanded research agenda