Addressing Bias in SLP Problem-Based Tutorials through Critical Reflexivity, Curriculum Development and Instructor Training

Racism is prevalent in the fields of healthcare and education in North America and speech-language pathology and audiology are no exception. Systemic and individual racism in educational, training, and clinical settings creates barriers for student entry and success, and negatively impacts client care. Although the ability to serve clients of diverse backgrounds is a crucial skill for students and clinicians, current educational curricula appears insufficient in supporting culturally diverse students and preparing all students to work with culturally diverse populations. This is, in part, due to a lack of diverse representation in education and clinical settings, bias experienced by SLP and audiology students in education programs, and problematic ways in which clinical information and race are presented in these educational programs. This paper aims to provide evidence informed guidance to SLP and audiology educators that will support their efforts to: 1. Develop students’ critical reflection and critical reflexivity skills. 2. Integrate racial and cultural diversity in the curricula. 3. Develop instructor competencies to create a safe learning environment. An example of a problem-based tutorial course in an SLP program is presented with a focus on clinical case development and small group learning experiences. Revision of curricula content with a focus on developing students’ lifelong skills in critical reflexivity may provide a foundation to equip SLPs and audiologists to address existing health disparities and improve client outcomes

Are you really doing ‘codesign’? Critical reflections when working with vulnerable populations

‘Codesign’ and associated terms such as ‘coproduction’ or ‘patient engagement’, are increasingly common in the health research literature, due to an increased emphasis on the importance of ensuring that research related to service/systems development is meaningful to end-users.  However, there continues to be a lack of clarity regarding the key principles and practices of codesign, and wide variation in the extent to which service users are meaningfully engaged in the process. These issues are particularly acute when end-users include populations who have significant health and healthcare disparities that are linked to a range of intersecting vulnerabilities (eg, poverty, language barriers, age, disability, minority status, stigmatised conditions).  The purpose of this paper is to prompt critical reflection on the nature of codesign research with vulnerable populations, including key issues to consider in the initial planning phases, the implementation process, and final outputs.  Risks and tensions will be identified in each phase of the process, followed by a tool to foster reflexivity in codesign processes to address these issues

Does Policy Impact Equitable Access to Services? A Critical Discourse Analysis of Discharge Policies in Paediatric Rehabilitation

Having the choice to access rehabilitation services is a right of disabled children. In Ontario, Canada, paediatric rehabilitation services are provided by Children’s Treatment Centres (CTCs), and many manage missed appointments using discharge policies. The impact of discharge policies on access to rehabilitation services is unknown. This study critically examined the language of policies around missed appointments and impacts on service access. Using qualitative critical discourse analysis, text from discharge policies was analysed, considering how marginalised groups (e.g., low-income families, culturally diverse families) may be affected by CTC discharge policies. Discourses of family-centred service, health equity and the perpetuation of established power relations within paediatric rehabilitation were represented in the language of policies. Current policies place the organisation in a position of power, de-value family choice and risk infringing on the right of disabled children to access paediatric rehabilitation services when desired

Co-designing solutions to enhance access and engagement in pediatric telerehabilitation

IntroductionPrior to the COVID-19 pandemic, children's therapy appointments provided by Ontario's publicly-funded Children's Treatment Centre (CTCs) primarily occurred in-person. With COVID-19 restrictions, CTCs offered services via telerehabilitation (e.g., video, phone), which remains a part of service delivery. CTC data shows that families experience barriers in attending telerehabilitation appointments and may need supports in place to ensure service accessibility. Our study aimed to co-design innovative solutions to enhance access and engagement in ambulatory pediatric telerehabilitation services. This manuscript reports the co-design process and findings related to solution development.MethodsThis research project used an experience based co-design (EBCD) approach, where caregivers, clinicians and CTC management worked together to improve experience with telerehabilitation services. Interview data were collected from 27 caregivers and 27 clinicians to gain an in-depth understanding of their barriers and successes with telerehabilitation. Next, 4 interactive co-design meetings were held with caregivers, clinicians and CTC management to address priorities identified during the interviews. Using qualitative content analysis, data from the interviews and co-design meetings were analyzed and findings related to the solutions developed are presented.FindingsFour topics were identified from the interview data that were selected as focii for the co-design meetings. Findings from the co-design meetings emphasized the importance of communication, consistency and connection (the 3C's) in experiences with telerehabilitation. The 3C's are represented in the co-designed solutions aimed at changing organizational processes and generating tools and resources for telerehabilitation services.DiscussionThe 3C's influence experiences with telerehabilitation services. By enhancing the experience with telerehabilitation, families will encounter fewer barriers to accessing and engaging in this service delivery model

Creative processes in co-designing a co-design hub: towards system change in health and social services in collaboration with structurally vulnerable populations.

Background: Co-design is an approach to engaging stakeholders in health and social system change that is rapidly gaining traction, yet there are also questions about the extent to which there is meaningful engagement of structurally vulnerable communities and whether co-design leads to lasting system change. The McMaster University Co-Design Hub with Vulnerable Populations Hub (‘the Hub’) is a three-year interdisciplinary project with the goal of facilitating partnerships, advancing methods of co-design with vulnerable populations, and mobilising knowledge. Aims and objectives: A developmental evaluation approach inspired by experience-based co-design was used to co-produce a theory of change to understand how the co-design process could be used to creatively co-design a co-design hub with structurally vulnerable populations. Methods: Twelve community stakeholders with experience participating in a co-design project were invited to participate in two online visioning events to co-develop the goals, priorities, and objectives of the Hub. Qualitative data were analysed using a thematic content analysis approach. Findings: A theory of change framework was co-developed that outlines a future vision for the Hub and strategies to achieve this, and a visual graphic is presented. Discussion and conclusions: Through critical reflection on the work of the Hub, we focus on the co-creative methods that were applied when co-designing the Hub’s theory of change. Moreover, we illustrate how co-creative processes can be applied to embrace the complexity and vulnerability of all stakeholders and plan for system change with structurally vulnerable populations

State of the climate in 2018

In 2018, the dominant greenhouse gases released into Earth’s atmosphere—carbon dioxide, methane, and nitrous oxide—continued their increase. The annual global average carbon dioxide concentration at Earth’s surface was 407.4 ± 0.1 ppm, the highest in the modern instrumental record and in ice core records dating back 800 000 years. Combined, greenhouse gases and several halogenated gases contribute just over 3 W m−2 to radiative forcing and represent a nearly 43% increase since 1990. Carbon dioxide is responsible for about 65% of this radiative forcing. With a weak La Niña in early 2018 transitioning to a weak El Niño by the year’s end, the global surface (land and ocean) temperature was the fourth highest on record, with only 2015 through 2017 being warmer. Several European countries reported record high annual temperatures. There were also more high, and fewer low, temperature extremes than in nearly all of the 68-year extremes record. Madagascar recorded a record daily temperature of 40.5°C in Morondava in March, while South Korea set its record high of 41.0°C in August in Hongcheon. Nawabshah, Pakistan, recorded its highest temperature of 50.2°C, which may be a new daily world record for April. Globally, the annual lower troposphere temperature was third to seventh highest, depending on the dataset analyzed. The lower stratospheric temperature was approximately fifth lowest. The 2018 Arctic land surface temperature was 1.2°C above the 1981–2010 average, tying for third highest in the 118-year record, following 2016 and 2017. June’s Arctic snow cover extent was almost half of what it was 35 years ago. Across Greenland, however, regional summer temperatures were generally below or near average. Additionally, a satellite survey of 47 glaciers in Greenland indicated a net increase in area for the first time since records began in 1999. Increasing permafrost temperatures were reported at most observation sites in the Arctic, with the overall increase of 0.1°–0.2°C between 2017 and 2018 being comparable to the highest rate of warming ever observed in the region. On 17 March, Arctic sea ice extent marked the second smallest annual maximum in the 38-year record, larger than only 2017. The minimum extent in 2018 was reached on 19 September and again on 23 September, tying 2008 and 2010 for the sixth lowest extent on record. The 23 September date tied 1997 as the latest sea ice minimum date on record. First-year ice now dominates the ice cover, comprising 77% of the March 2018 ice pack compared to 55% during the 1980s. Because thinner, younger ice is more vulnerable to melting out in summer, this shift in sea ice age has contributed to the decreasing trend in minimum ice extent. Regionally, Bering Sea ice extent was at record lows for almost the entire 2017/18 ice season. For the Antarctic continent as a whole, 2018 was warmer than average. On the highest points of the Antarctic Plateau, the automatic weather station Relay (74°S) broke or tied six monthly temperature records throughout the year, with August breaking its record by nearly 8°C. However, cool conditions in the western Bellingshausen Sea and Amundsen Sea sector contributed to a low melt season overall for 2017/18. High SSTs contributed to low summer sea ice extent in the Ross and Weddell Seas in 2018, underpinning the second lowest Antarctic summer minimum sea ice extent on record. Despite conducive conditions for its formation, the ozone hole at its maximum extent in September was near the 2000–18 mean, likely due to an ongoing slow decline in stratospheric chlorine monoxide concentration. Across the oceans, globally averaged SST decreased slightly since the record El Niño year of 2016 but was still far above the climatological mean. On average, SST is increasing at a rate of 0.10° ± 0.01°C decade−1 since 1950. The warming appeared largest in the tropical Indian Ocean and smallest in the North Pacific. The deeper ocean continues to warm year after year. For the seventh consecutive year, global annual mean sea level became the highest in the 26-year record, rising to 81 mm above the 1993 average. As anticipated in a warming climate, the hydrological cycle over the ocean is accelerating: dry regions are becoming drier and wet regions rainier. Closer to the equator, 95 named tropical storms were observed during 2018, well above the 1981–2010 average of 82. Eleven tropical cyclones reached Saffir–Simpson scale Category 5 intensity. North Atlantic Major Hurricane Michael’s landfall intensity of 140 kt was the fourth strongest for any continental U.S. hurricane landfall in the 168-year record. Michael caused more than 30 fatalities and $25 billion (U.S. dollars) in damages. In the western North Pacific, Super Typhoon Mangkhut led to 160 fatalities and$6 billion (U.S. dollars) in damages across the Philippines, Hong Kong, Macau, mainland China, Guam, and the Northern Mariana Islands. Tropical Storm Son-Tinh was responsible for 170 fatalities in Vietnam and Laos. Nearly all the islands of Micronesia experienced at least moderate impacts from various tropical cyclones. Across land, many areas around the globe received copious precipitation, notable at different time scales. Rodrigues and Réunion Island near southern Africa each reported their third wettest year on record. In Hawaii, 1262 mm precipitation at Waipā Gardens (Kauai) on 14–15 April set a new U.S. record for 24-h precipitation. In Brazil, the city of Belo Horizonte received nearly 75 mm of rain in just 20 minutes, nearly half its monthly average. Globally, fire activity during 2018 was the lowest since the start of the record in 1997, with a combined burned area of about 500 million hectares. This reinforced the long-term downward trend in fire emissions driven by changes in land use in frequently burning savannas. However, wildfires burned 3.5 million hectares across the United States, well above the 2000–10 average of 2.7 million hectares. Combined, U.S. wildfire damages for the 2017 and 2018 wildfire seasons exceeded $40 billion (U.S. dollars)

Hubungan Hiperglikemia Dengan Retinopati Pada Bayi Prematur

Retinopati pada bayi prematur (retinopathy of prematurity/ROP) adalah penyakit neovaskularisasi iskemik pada bayi prematur yang dapat menyebabkan terbentuknya jaringan parut hingga ablasio retina. ROP sendiri merupakan penyebab kebutaan pada 15% bayi di negara berkembang. Ada beberapa kemungkinan faktor risiko ROP yaitu usia gestasi, berat lahir, faktor maternal, stress oksidatif, kondisi hipoksia dan hiperoksia, proteinuria, dan hiperglikemia. Dikarenakan hiperglikemia merupakan salah satu faktor resiko yang berpotensi untuk dimodifikasi maka dilakukan penelitian ini dengan tujuan untuk mengetahui insidensi retinopati pada bayi prematur dengan hiperglikemia. Penelitian ini dilakukan dengan metode literature review menggunakan kata-kata kunci hiperglikemia neonatal (neonatal hyperglycemia), retinopati (retinopathy), dan bayi prematur (preterm infant). Penulis mencari kumpulan tinjauan Pustaka dari berbagai sumber terpercaya dan didapatkan sebanyak 15 jurnal yang digunakan setelah proses seleksi dengan kriteria akses terbuka. Batasan hiperglikemia neonatal adalah kadar gula darah di atas 150 mg/dL atau 8,5 mmol/L. Didapatkan hubungan antara hiperglikemia neonatal dengan ROP dikarenakan kadar insulin growth factor (IGF)-1 yang rendah pada bayi prematur. Kadar IGF-1 berbanding terbalik dengan vascular endothelial growth factor (VEGF), hal mana yang berperan dalam fase progresivitas ROP. Studi literatur ini membahas hubungan antara hiperglikemia neonatal dengan insidensi ROP serta penelitian yang mendukungnya.Retinopathy in premature infants (retinopathy of prematurity/ROP) is an ischemic neovascularization disease in premature infants which may cause the formation of scar tissue to retinal detachment. ROP itself is the cause of blindness in 15% of babies in developing countries. There are several possible risk factors for ROP, namely gestational age, birth weight, maternal factors, oxidative stress, conditions of hypoxia and hyperoxia, proteinuria, and hyperglycemia. Since hyperglycemia is a risk factor that could be modified, this study was conducted with the aim of determining the incidence of retinopathy in premature infants with hyperglycemia. This study was conducted using the literature review method using the key words neonatal hyperglycemia, retinopathy, and premature infants. The author looked for a collection of literature reviews from various reliable sources and 15 journals were chosen from the selection process with the open access criteria. The cut-off point of neonatal hyperglycemia is blood sugar levels above 150 mg/dL or 8.5 mmol/L. A relationship was found between neonatal hyperglycemia and ROP due to low levels of Insulin Growth Factor (IGF)-1 in premature infants. IGF-1 levels are inversely related to vascular endothelial growth factor (VEGF), which plays a role in the progressive phase of ROP. This literature study discusses the relationship between neonatal hyperglycemia and the incidence of ROP and the research that supports it

Hubungan Hiperglikemia Dengan Retinopati Pada Bayi Prematur

Retinopati pada bayi prematur (retinopathy of prematurity/ROP) adalah penyakit neovaskularisasi iskemik pada bayi prematur yang dapat menyebabkan terbentuknya jaringan parut hingga ablasio retina. ROP sendiri merupakan penyebab kebutaan pada 15% bayi di negara berkembang. Ada beberapa kemungkinan faktor risiko ROP yaitu usia gestasi, berat lahir, faktor maternal, stress oksidatif, kondisi hipoksia dan hiperoksia, proteinuria, dan hiperglikemia. Dikarenakan hiperglikemia merupakan salah satu faktor resiko yang berpotensi untuk dimodifikasi maka dilakukan penelitian ini dengan tujuan untuk mengetahui insidensi retinopati pada bayi prematur dengan hiperglikemia. Penelitian ini dilakukan dengan metode literature review menggunakan kata-kata kunci hiperglikemia neonatal (neonatal hyperglycemia), retinopati (retinopathy), dan bayi prematur (preterm infant). Penulis mencari kumpulan tinjauan Pustaka dari berbagai sumber terpercaya dan didapatkan sebanyak 15 jurnal yang digunakan setelah proses seleksi dengan kriteria akses terbuka. Batasan hiperglikemia neonatal adalah kadar gula darah di atas 150 mg/dL atau 8,5 mmol/L. Didapatkan hubungan antara hiperglikemia neonatal dengan ROP dikarenakan kadar insulin growth factor (IGF)-1 yang rendah pada bayi prematur. Kadar IGF-1 berbanding terbalik dengan vascular endothelial growth factor (VEGF), hal mana yang berperan dalam fase progresivitas ROP. Studi literatur ini membahas hubungan antara hiperglikemia neonatal dengan insidensi ROP serta penelitian yang mendukungnya.Retinopathy in premature infants (retinopathy of prematurity/ROP) is an ischemic neovascularization disease in premature infants which may cause the formation of scar tissue to retinal detachment. ROP itself is the cause of blindness in 15% of babies in developing countries. There are several possible risk factors for ROP, namely gestational age, birth weight, maternal factors, oxidative stress, conditions of hypoxia and hyperoxia, proteinuria, and hyperglycemia. Since hyperglycemia is a risk factor that could be modified, this study was conducted with the aim of determining the incidence of retinopathy in premature infants with hyperglycemia. This study was conducted using the literature review method using the key words neonatal hyperglycemia, retinopathy, and premature infants. The author looked for a collection of literature reviews from various reliable sources and 15 journals were chosen from the selection process with the open access criteria. The cut-off point of neonatal hyperglycemia is blood sugar levels above 150 mg/dL or 8.5 mmol/L. A relationship was found between neonatal hyperglycemia and ROP due to low levels of Insulin Growth Factor (IGF)-1 in premature infants. IGF-1 levels are inversely related to vascular endothelial growth factor (VEGF), which plays a role in the progressive phase of ROP. This literature study discusses the relationship between neonatal hyperglycemia and the incidence of ROP and the research that supports it

Establishing and sustaining authentic organizational partnerships in childhood disability research: lessons learned

Abstract There is an increased interest from both researchers and knowledge users to partner in research to generate meaningful research ideas, implement research projects, and disseminate research findings. There is accumulating research evidence to suggest the benefits of engaging children/youth with disabilities and their parents/families in research partnerships; however, less is known about the benefits of, and challenges to, engaging organizations as partners in research. The purpose of this commentary is to reflect on successful organizational partnership experiences from the perspectives of researchers at an internationally-recognized childhood disability research centre (CanChild), and to identify and share key ingredients for developing partnerships between organizations and academic institutions. A companion study is underway to examine partnership experiences with CanChild from the partners’ perspective. Four CanChild researchers and two co-facilitators participated in a collaborative auto-ethnography approach to share experiences with organizational research partnerships and to reflect, interpret, and synthesize common themes and lessons learned. The researchers and facilitators met virtually via Zoom for 105 min. Researchers were asked to discuss the following: the formation of their organizational partnerships; if/how partnerships evolved over time; if/how partnerships were sustained; and lessons learned about benefits and challenges to building research partnerships with organizations. The meeting was recorded, transcribed verbatim, and analyzed by the facilitators to identify and synthesize common experiences and reflections. Multiple rounds of asynchronous reflection and feedback supported refinement of the final set of analytic themes. Researchers agreed that partnerships with organizations should be formed through a mutual interest, and that partnerships evolved by branching to include new organizations and researchers, while also involving trainees. Researchers identified the importance of defining roles and responsibilities of key individuals within each partnering group to sustain the partnership. Lessons learned from organizational partnerships included reciprocity between the partnering organization and academic institution, leveraging small pockets of funds to sustain a partnership over time, and building a strong rapport with individuals in a partnership. This commentary summarized lessons-learned and provided recommendations for researchers and organizations to consider when forming, growing, and sustaining research partnerships over time