An other(ed) handmaid\u27s tale : Child care workers: seen but not heard

Child care workers seem to have been forever assigned the lowest rung on the career ladder. Their low status has been attributed to several intractable factors: the socially devalued \u27caring\u27 nature of the role; the relatively small, disparate and non-hierarchically structured workplace; intimate association with an increasingly more marginalized group - children in their early childhoods; and an assumed complicity with a pseudo-surrogacy role of mother rendering them transgressors within a pro-natalist landscape. The institution of exclusive maternal care, for children prior to school, holds fast against the inexorable call for women to paid work. This dilemma resonates strongly within \u27skills starved\u27 economies facing diminishing birth rates. Whilst undeniably denigrating views of child care work persist in a sector buffeted by competing economic and cultural imperatives for child care provision, the voice of the predominantly female (97%) child care worker herself remains mute. This research seeks to explain how the voice of the child care worker lies baffled under a layered mantle of discourses. Uncovering how she has been named and marginalised provokes emancipatory imaginings of being heard and reinscribed. A feminist autoethnographic approach is adopted to investigate and interpret the researcher\u27s experience of working within this fraught role. A metaphor of a handmaid subject-hood, constituted by a dissident relationship to motherhood and sisterhood within an ostensibly post-patriarchal state is appropriated to frame a disruptive analysis of the child care worker\u27s occupation in (re) productive work for broader society

Diluting education? An ethnographic study of change in an Australian Ministry of Education

This ethnographic study captures the processes that led to change in an Australian public education system. The changes were driven by strong neo-liberal discourses which resulted in a shift from a shared understanding about leading educational change in schools by knowledge transfer to managing educational change as a process, in other words, allowing the schools to decide how to change. Inside an Australian state education bureaucracy at a time when the organisation was restructured and services decentralised, this study helps show some of the disturbing trends resulting from the further entrenchment of neo-liberal strategies. Although control was re-centralised by legitimising performance mechanisms, in the form of national testing, there are indications that the focus on national tests may have alarming consequences for the content and context of education. I argue that the complexities of learning and fundamental pedagogies are being lost in preference for an over reliance on data systems that are based on a shallow and narrow set of standardised measures

Hybrid self‐assembling peptide/gelatin methacrylate (gelma) bioink blend for improved bioprintability and primary myoblast response

Organ fabrication as the solution to renewable donor demands requires the ability to spatially deposit viable cells into biologically relevant constructs necessitating reliable and effective cell deposition through bioprinting and the subsequent ability to mature. However, effective bioink development demands advances in both printability and control of cellular response. Effective bioinks are designed to retain shape fidelity, influence cellular behavior, having bioactive morphologies stiffness and highly hydrated environment. Hybrid hydrogels are promising candidates as they reduce the need to re‐engineer materials for tissue‐specific properties, with each component offering beneficial properties. Herein, a multicomponent bioink is developed whereby gelatin methacrylate (GelMA) and fluorenylmethoxycarbonyprotected self‐assembling peptides (Fmoc‐SAPs) undergo coassembly to yield a tuneable bioink. This study shows that the reported fibronectin‐inspired fmoc‐SAPs present cell attachment epitopes RGD and PHSRN in the form of bioactive nanofibers and that the GelMA enables superior printability, stability in media, and controlled mechanical properties. Importantly, when in the hybrid format, no disruption to either the methacrylate crosslinking of GelMA, or self‐assembled peptide fibril formation is observed. Finally, studies with primary myoblasts show over 98% viability at 72 h and differentiation into fused myotubes at one and two weeks demonstrate the utility of the material as a functional bioink for muscle engineering. In this work, muscle tissue is 3D‐bioprinted with a novel bioink formulation. The bioink presents fibrous bioactive properties of the body's native scaffold, while also improving biofabrication outcomes. Self‐assembling peptides are combined with GelMA creating a hybrid bioink. This work sets the stage for future hybrid bioinks for muscle biofabrication

Cost and economic evidence for asset-based approaches to health improvement and their evaluation methods: a systematic review

Background Asset-based approaches (ABAs) tackle health inequalities by empowering people in more disadvantaged communities, or targeted populations, to better utilise pre-existing local community-based resources. Using existing resources supports individuals to better manage their own health and its determinants, potentially at low cost. Targeting individuals disengaged with traditional service delivery methods offers further potential for meaningful cost-savings, since these people often require costly care. Thus, improving prevention, and management, of ill-health in these groups may have considerable cost implications. Aim To systematically review the extent of current cost and economic evidence on ABAs, and methods used to develop it. Methods Search strategy terms encompassed: i) costing; ii) intervention detail; and iii) locality. Databases searched: Medline, CENTRAL and Wed of Science. Researchers screened 9,116 articles. Risk of bias was assessed using the Critical Appraisal Skills Programme (CASP) tool. Narrative synthesis summarised findings. Results Twelve papers met inclusion criteria, representing eleven different ABAs. Within studies, methods varied widely, not only in design and comparators, but also in terms of included costs and outcome measures. Studies suggested economic efficiency, but lack of suitable comparators made more definitive conclusions difficult. Conclusion Economic evidence around ABAs is limited. ABAs may be a promising way to engage underserved or minority groups, that may have lower net costs compared to alternative health and wellbeing improvement approaches. ABAs, an example of embedded services, suffer in the context of economic evaluation, which typically consider services as mutually exclusive alternatives. Economics of the surrounding services, mechanisms of information sharing, and collaboration underpin the success of assets and ABAs. The economic evidence, and evaluations in general, would benefit from increased context and detail to help ensure more nuanced and sophisticated understanding of the economics of ABAs. Further evidence is needed to reach conclusions about cost-effectiveness of ABAs

Who am I? : Representing the self offline and in different online contexts

The present paper examines the extent to which self-presentation may be affected by the context in which is it undertaken. Individuals were asked to complete the Twenty Statements Test both privately and publicly, but were given an opportunity to withhold any of their personal information before it was made public. Four contexts were examined: an offline context (face-to-face), an un-contextualized general online context, or two specific online contexts (dating or job-seeking). The results suggested that participants were willing to disclose substantially less personal information online than offline. Moreover, disclosure decreased as the online context became more specific, and those in the job-seeking context disclosed the least amount of information. Surprisingly, individual differences in personality did not predict disclosure behavior. Instead, the results are set in the context of audience visibility and social norms, and implications for self-presentation in digital contexts are discussed

Patients with positive malaria tests not given artemisinin-based combination therapies: a research synthesis describing under-prescription of antimalarial medicines in Africa.

BACKGROUND: There has been a successful push towards parasitological diagnosis of malaria in Africa, mainly with rapid diagnostic tests (mRDTs), which has reduced over-prescribing of artemisinin-based combination therapies (ACT) to malaria test-negative patients. The effect on prescribing for test-positive patients has received much less attention. Malaria infection in endemic Africa is often most dangerous for young children and those in low-transmission settings. This study examined non-prescription of antimalarials for patients with malaria infection demonstrated by positive mRDT results, and in particular these groups who are most vulnerable to poor outcomes if antimalarials are not given. METHODS: Analysis of data from 562,762 patients in 8 studies co-designed as part of the ACT Consortium, conducted 2007-2013 in children and adults, in Cameroon, Ghana, Nigeria, Tanzania, and Uganda, in a variety of public and private health care sector settings, and across a range of malaria endemic zones. RESULTS: Of 106,039 patients with positive mRDT results (median age 6 years), 7426 (7.0%) were not prescribed an ACT antimalarial. The proportion of mRDT-positive patients not prescribed ACT ranged across sites from 1.3 to 37.1%. For patients under age 5 years, 3473/44,539 (7.8%) were not prescribed an ACT, compared with 3833/60,043 (6.4%) of those aged ≥ 5 years. The proportion of < 5-year-olds not prescribed ACT ranged up to 41.8% across sites. The odds of not being prescribed an ACT were 2-32 times higher for patients in settings with lower-transmission intensity (using test positivity as a proxy) compared to areas of higher transmission. mRDT-positive children in low-transmission settings were especially likely not to be prescribed ACT, with proportions untreated up to 70%. Of the 7426 mRDT-positive patients not prescribed an ACT, 4121 (55.5%) were prescribed other, non-recommended non-ACT antimalarial medications, and the remainder (44.5%) were prescribed no antimalarial. CONCLUSIONS: In eight studies of mRDT implementation in five African countries, substantial proportions of patients testing mRDT-positive were not prescribed an ACT antimalarial, and many were not prescribed an antimalarial at all. Patients most vulnerable to serious outcomes, children < 5 years and those in low-transmission settings, were most likely to not be prescribed antimalarials, and young children in low-transmission settings were least likely to be treated for malaria. This major public health risk must be addressed in training and practice. TRIAL REGISTRATION: Reported in individual primary studies