Young people as co-researchers in schools: a collaborative research methodology which benefits young people and school culture

The voice of young people in schools is often tokenistic. They are asked to contribute to surveys for OFSTED or are part of an adult-led school council. Rarely are they asked to work with adults to create new knowledge for school improvement. Returning to my previous school to conduct research resulted in developing an inclusive and collaborative methodology. Whilst initially intending to use a participative action research (PAR) process, I synthesised this with Critical Communicative Methodology (CCM) to create Youth Participative Dialogic Action Research (YPDAR). This approach created a research power dynamic where responsibility was shared more equally between the young people and the researcher. The results of this approach were unexpected. As the process developed, the young people’s confidence grew, their trust in the school developed, and they felt empowered to act. This paper explores the processes involved and how YPDAR could be used as a school improvement model with the potential not only to transform young people’s lives, but also the culture of the school

Young researchers in schools: a participative action research study into the efficacy of a whole school mental health strategy

In England between April and June of 2021, 190,271 young people were referred to mental health services, an increase of 134% since June 2020 (Local Government Association, 2022). Since 2014, schools have been expected to support young people’s mental health needs (Department for Education, 2014). This qualitative work critically explores the efficacy of a whole school mental health strategy, in a comprehensive academy in England. As participative action research (PAR), this approach involved self-selecting young people aged 16-18 years old to collaborate with me as a young research team (YRT). They worked closely with the study participants, aged 12-15 years, who volunteered from the pupil premium cohort (The Department for Education, 2022). A weekly cycle of meetings between myself, the YRT and participants took place, providing qualitative data. This research focuses on a school mental health strategy and new approaches to young people’s participation in school decision-making. My findings and contributions to knowledge are divided into two sections. Firstly, I present findings that indicate a school mental health strategy requires trusting staff / young people relationships to be successful. As a further contribution, I suggest relationships are viewed through a nanosystems lens (Rudasill et al., 2018), so schools can start to address this issue. My second area contributing to new knowledge is how this unique methodology has enabled the development of youth participative dialogic action research (YPDAR). I have discovered how using YPDAR can positively impact young people and school character. YPDAR benefits young people as attachment-like relationships may develop between young researchers and participants. In addition to improving young people’s socio-emotional skills, this research can boost their confidence, empowerment, agency and trust in the school. School character also benefits, as YPDAR requires a power shift from school to young people, strengthening relationships and the development of trust between them

Healing through YPAR transportation projects

Rationale: In Denver, Colorado, the streets aren’t safe and youth have been noticing and taking action in response. Eighthgrader Emilleo, for example, often spent his lunch meeting with his peers and even grilling city council members as part of a research project aimed at making a deadly local street safer. Ash, a high school senior, led her classmates in another transportation-related research project: an examination of the lack of school and city bus routes serving the growing school. In both cases, the transportation focus, emerging from youth participatory action research (YPAR) proved to be generative and healing for students. The more they understood how local transportation services oppressed them, the more they could devise solutions and actions that eventually proved empowering and healing. Theoretical perspective: Unlike other papers in this symposium, these projects did not set out to explicitly implement healing practices. Instead, we focused on implementing YPAR, an emergent epistemological approach that positions youth to name problems, conduct their own research around them, develop equitable policy solutions, and work with adults to implement them (Ozer & Douglas, 2015; Fox & Fine, 2013). In this case, both youth teams implemented YPAR projects that dealt with transportation inequities. Emilleo’s class launched their YPAR project after their teacher’s friend was hit and killed by a car while crossing a notoriously dangerous street. Ash’s class explored their past negative lived experiences with transportation to and from school. Through later individual and collective reflection with university researchers—via writing, video testimonials, and online group discussions and presentations—youth described the YPAR work as healing. Methods: After completing the projects, the youth met online with a group of university researchers to develop a reflection process. The intergenerational group, with members ranging from 13 to 64 years old in the US, United Kingdom, and Greece, developed two research questions. The first looked at what external changes the youth made. By external, we meant “outside of yourself,” like using YPAR to change school lunch offerings. The second examined internal changes or shifts occurring in students’ “heads or hearts.” Students, and one teacher, wrote and filmed video responses to those prompts, and the intergenerational group collectively analyzed the findings and engaged in regular online video discussions about their implications. Findings: In terms of external changes, the young people noted the tangible things they had achieved. Emilleo’s group had worked with elected officials to reduce lanes of traffic on a street from four to three and pilot pedestrian-only hours. Ash’s group secured the promise of a city bus line to their school. Progress is underway but not complete. In terms of internal changes, intergenerational analysis revealed a pattern of healing outcomes. The youth felt safer, more powerful, and able to use YPAR to mediate problems inside and outside of schools. Specifically, they described interactions with powerful adults as important. The young people in these cases interacted with adults ranging from school district administrators to the state’s governor, who listened, gave feedback, and even enacted some level of change. The youth said this political progress helped alleviate the immediate anguish of the transportation problems they faced and actually induced pride. “It was so healing to have adults sit down and be like ‘Wow, you’re passionate and committed,’” Ash said. Discussion: The two YPAR projects, while not explicitly designed with a healing justice framework, proved generative and reparative for young people. The transportation focus allowed young people to do the “both/and” work that Ginwright (2015) described: finding collective well-being in their school-based groups while also working to alleviate social oppression, in this case, the transformation of local transportation systems

STEM learning communities promote friendships but risk academic segmentation.

Universities are increasingly using learning communities (LCs) to promote the academic and social integration of entering students, especially within STEM majors. Examining the causal effect of LCs on student networks is necessary to understand the nature and scope of their impact. This study combines a regression discontinuity design with social network analysis to estimate the effect of a simple LC design on the size, strength, structure, and composition of friendship networks among students within the same biological sciences freshman cohort. Results of the quasi-experimental analysis indicate that LC participants acquired one additional friend in the major and increased their share of friends in the LC by 54 percentage-points. Exponential random-graph models that test mediation and alternative friendship mechanisms provide support for the theoretical argument that the LC promoted friendship development by structuring opportunities for interaction through block-registration into courses. Thus, this study shows that even simple LCs can shape the development of friendships through relatively low-cost administrative means. The increased access to resources and support facilitated by the LC is likely beneficial for participating students. However, there is a potential downside when eligibility for participation is determined using academic metrics that separate the student population into distinct classroom environments

An international observational study to assess the impact of the Omicron variant emergence on the clinical epidemiology of COVID-19 in hospitalised patients

Background: Whilst timely clinical characterisation of infections caused by novel SARS-CoV-2 variants is necessary for evidence-based policy response, individual-level data on infecting variants are typically only available for a minority of patients and settings. Methods: Here, we propose an innovative approach to study changes in COVID-19 hospital presentation and outcomes after the Omicron variant emergence using publicly available population-level data on variant relative frequency to infer SARS-CoV-2 variants likely responsible for clinical cases. We apply this method to data collected by a large international clinical consortium before and after the emergence of the Omicron variant in different countries. Results: Our analysis, that includes more than 100,000 patients from 28 countries, suggests that in many settings patients hospitalised with Omicron variant infection less often presented with commonly reported symptoms compared to patients infected with pre-Omicron variants. Patients with COVID-19 admitted to hospital after Omicron variant emergence had lower mortality compared to patients admitted during the period when Omicron variant was responsible for only a minority of infections (odds ratio in a mixed-effects logistic regression adjusted for likely confounders, 0.67 [95% confidence interval 0.61-0.75]). Qualitatively similar findings were observed in sensitivity analyses with different assumptions on population-level Omicron variant relative frequencies, and in analyses using available individual-level data on infecting variant for a subset of the study population. Conclusions: Although clinical studies with matching viral genomic information should remain a priority, our approach combining publicly available data on variant frequency and a multi-country clinical characterisation dataset with more than 100,000 records allowed analysis of data from a wide range of settings and novel insights on real-world heterogeneity of COVID-19 presentation and clinical outcome

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Introduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population. Methods: This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay. Results: Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity. Conclusions: AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable