Inner-suburban neighbourhoods, activist research and the social space of the commercial street

This paper tracks the transition of “creative city” planning from the gentrified downtown to the disinvested inner-suburbs. It attends particularly to contradictory notions of community mobilized by proponents of inner-suburban revitalization and by residents and business owners who daily inhabit inner-suburban commercial streets where cultural planning interventions are typically targeted. It further argues that those contradictory notions indicate immanent displacement pressure. The argument builds around data gleaned from an action research project in Toronto’s Mount Dennis neighbourhood, a former manufacturing neighbourhood that is now home to a large number of precariously employed new immigrants. We contend that community engaged research not only allows for an analysis of the race and class dimensions of creative city planning, it consolidates marginalized perspectives and opens up alternative possibilities for planning and development. We also claim that the relational, exploratory and sometimes fraught process of sharing knowledge with community-based researchers enriches critical research on the exclusionary politics of redevelopment planning

Political Transformations: collaborative feminist scholarship in Nepal

Feminist theory has expanded the sphere within which politics is assumed to occur and thus can make significant contributions to research on state transition. This paper traces the development of a research project wherein we combined our expertise and feminist commitments to explore the current political transition in Nepal. The project conceptualized market formation and resource governance to be important sites of political contestation and the formation of citizen subjectivities. Within these sites, we sought to understand what ‘democracy’ looks like at different scales, especially where, when and how people make claims and build critical accounts of established social systems in its name. Here, we reflect how on our feminist political and intellectual commitments helped develop a collaborative methodology and approach to state transition that integrates ‘politics’ across scales. The insights include the role played by spaces of social reproduction in everyday processes of state and political transformation, and the analytical opportunities opened up when research collaborations take the form of a community of inquiry within the field itself. We found ourselves turning back to the long tradition of feminist scholarship to show how the household is the origin of inequalities and how such relations transmit into wider contestations over ‘democracy’

Exploring the role of Entrustable Professional Activities in assessing final year medical students

The concept of Entrustable Professional Activities (EPAs) has been introduced in postgraduate medical education to try to bridge the gap between theoretical aspects of competency-based education and real-life clinical care (ten Cate et al., 2010). EPAs have been described as tasks or responsibilities to be entrusted to the unsupervised execution by a trainee once they have attained sufficient specific competence (ten Cate, 2013). Progress towards this is described on a scale based on level of entrustment. This thesis aims to explore the use of EPAs for final year medical undergraduates. Using Kane’s framework, I present a validity argument for the use of EPAs in this context using mixed methods underpinned by the ontological framework of Critical Realism and an interpretivist epistemology. I conclude that EPAs may be used in the assessment of the undergraduate - but the context in which we use them is fundamental to their validity. And the way in which we interpret, and ultimately use, these results require further exploration. I then go on to consider the process of entrustment from the perspective of the clinical learner by performing a literature review and identify a lack of published research on this in medical education. I therefore employ a hermeneutic methodology to allow inferences to be drawn from other relevant domains. Ultimately, I propose a model for how the perception of clinical trust may impact the clinical learner and their self-efficacy. To address the paucity of literature to be found in the medical education domain, I subsequently present novel research on the impact of entrustment from the perspective of the clinical learner. An interview study was carried out with four newly qualified junior doctors to investigate their individual experiences of trust and mistrust using interpretative phenomenological analysis. This work demonstrates the reality of entrustment for these people in their context and the superordinate themes reveal important points which may be transferable to other learners including the importance of the use of explicit expressions of entrustment – such as those to be found in the EPA scale

Inner-suburban neighbourhoods, activist research and the social space of the commercial street

This paper tracks the transition of “creative city” planning from the gentrified downtown to the disinvested inner-suburbs. It attends particularly to contradictory notions of community mobilized by proponents of inner-suburban revitalization and by residents and business owners who daily inhabit inner-suburban commercial streets where cultural planning interventions are typically targeted. It further argues that those contradictory notions indicate immanent displacement pressure. The argument builds around data gleaned from an action research project in Toronto’s Mount Dennis neighbourhood, a former manufacturing neighbourhood that is now home to a large number of precariously employed new immigrants. We contend that community engaged research not only allows for an analysis of the race and class dimensions of creative city planning, it consolidates marginalized perspectives and opens up alternative possibilities for planning and development. We also claim that the relational, exploratory and sometimes fraught process of sharing knowledge with community-based researchers enriches critical research on the exclusionary politics of redevelopment planning

Roads and the politics of thought: Climate in India, democracy in Nepal

This chapter brings together two major research projects led respectively by Edward Simpson and Katharine Rankin: ‘Roads and the Politics of Thought: Ethnographic Approaches to Infrastructure Development in South Asia’ and ‘Infrastructures of Democracy: State Building as Everyday Practice in Nepal’s Agrarian Districts’. Simpson is an anthropologist, whose UK-based collaborative project worked comparatively across South Asia, but the contribution here is written with India centrally in mind. Rankin is a geographer trained in anthropology and planning, whose project works in partnership with Nepal-and Canada-based researchers and collaborators to explore road development in vernacular terms

Pre-adolescent children’s experiences of receiving diabetes-related support from friends and peers: a qualitative study

BackgroundWhile pre�adolescent children with type 1 diabetes receive most support from their parents/caregivers, others also contribute to their care. This study explored pre�adolescent children's experiences of receiving diabetes�related support from friends and peers. The objective was to identify how children could be better supported by their friends and peers to undertake diabetes self�management.MethodsIn�depth interviews with 24 children (aged 9�12 years) with type 1 diabetes. Data were analysed using an inductive, thematic approach.ResultsChildren gave mixed accounts of their experiences of speaking to their school/class about diabetes with some indicating that this had resulted in unwanted attention. Most individuals reported that other children had a limited understanding of diabetes and sometimes acted in insensitive ways or said things they found upsetting. Virtually all children described having a small number of close friends who were interested in learning about diabetes and provided them with support. These friends provided support in three overlapping ways, as �monitors and prompters,� �helpers� and �normalizers.� While some children described benefiting from meeting peers with type 1 diabetes, most indicated that they would prefer to develop friendships based on shared interests rather than a common disease status.Discussion and conclusionsFriends and peers provide several kinds of support to pre�adolescent children with diabetes. Health professionals could consider ways to assist small friendship groups to undertake monitoring and prompting, helping and normalizing roles. Parents, schools and health professionals could explore ways to normalize self�management practices to better support children with diabetes in school settings.</p

Barriers and facilitators to taking on diabetes self-management tasks in pre-adolescent children with type 1 diabetes: a qualitative study.

BACKGROUND: When children with type 1 diabetes approach adolescence, they are encouraged to become more involved in diabetes self-management. This study explored the challenges pre-adolescent children encounter when self-managing diabetes and the factors which motivate and enable them to take on new diabetes-related tasks. A key objective was to inform the support offered to pre-adolescent children. METHODS: In-depth interviews using age-appropriate questioning with 24 children (aged 9-12 years) with type 1 diabetes. Data were analysed using an inductive, thematic approach. RESULTS: Children reported several barriers to taking on self-management tasks. As well as seeking respite from managing diabetes, children described relying on their parents to: perform the complex maths involved in working out carbohydrate content in food; calculate insulin doses if they did not use a bolus advisor; and administer injections or insert a cannula in hard-to-reach locations. Children described being motivated to take on diabetes tasks in order to: minimise the pain experienced when others administered injections; alleviate the burden on their parents; and participate independently in activities with their peers. Several also discussed being motivated to take on diabetes-management responsibilities when they started secondary school. Children described being enabled to take on new responsibilities by using strategies which limited the need to perform complex maths. These included using labels on food packaging to determine carbohydrate contents, or choosing foods with carbohydrate values they could remember. Many children discussed using bolus advisors with pre-programmed ratios and entering carbohydrate on food labels or values provided by their parents to calculate insulin doses. Several also described using mobile phones to seek advice about carbohydrate contents in food. CONCLUSIONS: Our findings highlight several barriers which deter children from taking on diabetes self-management tasks, motivators which encourage them to take on new responsibilities, and strategies and technologies which enable them to become more autonomous. To limit the need to perform complex maths, children may benefit from using bolus advisors provided they receive regular review from healthcare professionals to determine and adjust pre-programmed insulin-to-carbohydrate ratios. Education and support should be age-specific to reflect children's changing involvement in self-managing diabetes

Listening to women: experiences of using closed-loop in type 1 diabetes pregnancy

Introduction: Recent high-profile calls have emphasized that women's experiences should be considered in maternity care provisioning. We explored women's experiences of using closed-loop during type 1 diabetes (T1D) pregnancy to inform decision-making about antenatal rollout and guidance and support given to future users. Methods: We interviewed 23 closed-loop participants in the Automated insulin Delivery Among Pregnant women with T1D (AiDAPT) trial after randomization to closed-loop and ∼20 weeks later. Data were analyzed thematically. Results: Women described how closed-loop lessened the physical and mental demands of diabetes management, enabling them to feel more normal and sleep better. By virtue of spending increased time-in-range, women also worried less about risks to their baby and being judged negatively by health care professionals. Most noted that intensive input and support during early pregnancy had been crucial to adjusting to, and developing confidence in, the technology. Women emphasized that attaining pregnancy glucose targets still required ongoing effort from themselves and the health care team. Women described needing education to help them determine when, and how, to intervene and when to allow the closed-loop to operate without interference. All women reported more enjoyable pregnancy experiences as a result of using closed-loop; some also noted being able to remain longer in paid employment. Conclusions: Study findings endorse closed-loop use in T1D pregnancy by highlighting how the technology can facilitate positive pregnancy experiences. To realize fully the benefits of closed-loop, pregnant women would benefit from initial intensive oversight and support together with closed-loop specific education and training. Clinical Trial Registration number: NCT04938557

Automated closed-loop insulin delivery for the management of type 1 diabetes during pregnancy: the AiDAPT RCT

Background There are over 2000 pregnancies annually in women with type 1 diabetes in the UK. Despite recent improvements in diabetes technology, most women cannot achieve and maintain the recommended pregnancy glucose targets. Thus, one in two babies experience complications requiring neonatal care unit admission. Recent studies demonstrate that hybrid closed-loop therapy, in which algorithms adjust insulin delivery according to continuous glucose measurements, is effective for managing type 1 diabetes outside of pregnancy, but efficacy during pregnancy is unclear. Objective To examine the clinical efficacy of hybrid closed-loop compared to standard insulin therapy in pregnant women with type 1 diabetes. Design A multicentre, parallel-group, open-label, randomised, controlled trial in pregnant women with type 1 diabetes. Setting Nine antenatal diabetes clinics in England, Scotland and Northern Ireland. Participants Pregnant women with type 1 diabetes and above-target glucose levels, defined as glycated haemoglobin A1c of ≥ 48 mmol/mol (6.5%) in early pregnancy. Interventions A hybrid closed-loop system compared to standard insulin delivery (via insulin pump or multiple daily injections) with continuous glucose monitoring. Outcome measures The primary outcome is the difference between the intervention and control groups in percentage time spent in the pregnancy glucose target range (3.5–7.8 mmol/l) as measured by continuous glucose monitoring from 16 weeks’ gestation until delivery. Secondary outcomes include overnight time in range, time above range (> 7.8 mmol/l), glycated haemoglobin A1c, safety outcomes (diabetic ketoacidosis, severe hypoglycaemia, adverse device events), psychosocial functioning obstetric and neonatal outcomes. Results The percentage of time that maternal glucose levels were within target range was higher with closed-loop than standard insulin therapy: 68.2 ± 10.5 in closed-loop and 55.6 ± 12.5 in the control group (mean‑adjusted difference 10.5 percentage points, 95% confidence interval 7.0 to 14.0; p < 0.001). Results were consistent in secondary outcomes, with less time above range (−10.2%, 95% confidence interval −13.8 to −6.6%; p < 0.001), higher overnight time in range (12.3%, 95% confidence interval 8.3 to 16.2%; p < 0.001) and lower glycated haemoglobin A1c (−0.31%, 95% confidence interval −0.50 to −0.12%; p < 0.002) all favouring closed-loop. The treatment effect was apparent from early pregnancy and consistent across clinical sites, maternal glycated haemoglobin A1c categories and previous insulin regimen. Maternal glucose improvements were achieved with 3.7 kg less gestational weight gain and without additional hypoglycaemia or total daily insulin dose. There were no unanticipated safety problems (six vs. five severe hypoglycaemia cases, one diabetic ketoacidosis per group) and seven device-related adverse events associated with closed-loop. There were no between-group differences in patient-reported outcomes. There was one shoulder dystocia in the closed-loop group and four serious birth injuries, including one neonatal death in the standard care group. Limitations Our results cannot be extrapolated to closed-loop systems with higher glucose targets, and our sample size did not provide definitive data on maternal and neonatal outcomes. Conclusions Hybrid closed-loop therapy significantly improved maternal glycaemia during type 1 diabetes pregnancy. Our results support National Institute for Health and Care Excellence guideline recommendations that hybrid closed-loop therapy should be offered to all pregnant women with type 1 diabetes. Future work Future trials should examine the effectiveness of hybrid closed-loop started before pregnancy, or as soon as possible after pregnancy confirmation