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As speech and language therapists, we explored theories of communication and voice that are familiar to our profession and found them an inadequate basis on which to generate deep and rich analysis of the qualitative data from people who have communication difficulties and who use augmentative and alternative communication. Expanding our conceptual toolkit to include the work of John Shotter allowed us to reconceptualise voice and where it is emergent in dialogue. Reimaging voice will inform clinical and research praxis with people who have communication difficulties as it allows practitioners to attend more closely to the complexity and nuance inherent in interactions with this population. Our proposition is exemplified with excerpts from a single participant who has communication difficulties to illustrate the value of dialogic theory in praxis. This article presents a provocation for the wider academy of qualitative health research; do we have the concepts and tools to develop meaning with people whose lived experiences may also be hard to voice in monologues?

Developments in qualitative research methods recognize the benefits of working with material objects to evoke memories, stories, and reflections on specific topics. Through engagement with materialist theory and methods, our research demonstrates that more than simply eliciting storied responses, self-chosen material objects can in fact co-tell stories in novel ways. This article draws on our storied experiences as a group of women who took part in a four-day residential storying retreat. Our qualitatively driven research employed a range of multi-modal methodologies; however, this article focuses on a particular method that involved co-telling personal stories with the aid of self-selected objects. This method embodies the emotive and co-constitutive power, relational materiality, and reflective potency of object-centered storying. The article builds on and extends qualitative methodologies that value more-than-rational ways of researching.

The debate on citizenship in the Constituent Assembly was overshadowed by the partition of India, which created difficulties in making constitutional provision for citizenship on certain defined criteria. However, it was quite clear to most of the members of the Constituent Assembly that the criteria of citizenship could not be fixed beforehand, as it was not possible to anticipate future developments. Thus, the Constitution empowered the parliament to define citizenship from time to time in the light of changing conditions. Thus began the process of enactments revising the provisions for citizenship, which ultimately culminated into the violation of the Constitution through enactment.

Objective: Despite the availability of high-paying, high-demand careers, few women and students from underrepresented racial and ethnic minorities enter undergraduate programs understanding what the geosciences are and associated available career opportunities. This problem is compounded for students from backgrounds underrepresented in the United States. High-impact practices, such as mentoring, internships, undergraduate research experiences, and cohort-building, increase recruitment and retention of underrepresented students in science, technology, engineering, and math at 4-year institutions. What is not yet clear is the impact these interventions have on underrepresented students at two-year colleges, where the STEM pathway has become a main postsecondary school entry point for these students due to the affordability, flexibility, and academic support provided. Therefore, we designed, implemented, and researched a year-long program providing underrepresented students at a two-year college exposure to several of these experiences. Methods: We interviewed program participants about their perceptions and experiences in the program. Analysis proceeded using constant comparison. Results: Participants reported benefits from networking opportunities, gains in confidence, and gains in job skills, while some reported challenges for participation such as communication and time expectation conflicts; participants also struggled to balance the program with employment needs on top of school requirements. Different aspects of the program benefited different students, suggesting that all of these experiences could support recruitment and foster interest in geoscience for underrepresented students at two-year colleges. Conclusion: We conclude with implications for future research, program enhancements, and time constraint and mentoring needs related to characteristics of two-year college students.

Background: Young adult cancer survivors have significant work-related challenges, including interruptions to education and employment milestones, which may affect work-related goals (WRGs). The study purpose was to explore posttreatment perspectives of WRGs in a sample of young adult hematologic cancer survivors. Methods: This qualitative descriptive study used social media to recruit eligible cancer survivors (young adults working or in school at the time of cancer diagnosis). Data were collected through telephone semi-structured interviews and analyzed using directed content analysis, followed by thematic content analysis to identify themes. Findings: The sample ( N = 40) were mostly female (63.5%), White (75%), and diagnosed with Hodgkin lymphoma (57.5%); most worked in professional (40%) or health care (23%) roles. The overarching theme, “Survivors’ Dilemma,” highlights a changed perspective on work-related fulfillment and financial obligations, capturing survivors’ decision-making process regarding work. Three subthemes illustrated questions that participants contemplated as they examined how their WRGs had changed: (a) Self-identity: Do I want to do this work? (b) Perceived health and work ability: Can I do this work? and (c) Financial toxicity: Can I afford to/not to do this work? Conclusions/Application to Practice: Participants experienced a state of dilemma around their WRGs, weighing areas around self-identity, perceived health and work ability, and financial toxicity. Findings suggest occupational health nurses should be aware of challenges surrounding WRGs, including how goals may change following a cancer diagnosis and treatment, and the potential stressors involved in the Survivors’ Dilemma. Occupational health nurses should assess for these issues and refer young survivors to employee and financial assistance programs, as necessary.

Self-management of chronic disease and related symptoms provides a framework for understanding the contextual factors that influence self-management knowledge and skills that patients and families require to manage their condition on a day-to-day basis. The management of cancer pain is a significant issue for patients and families, and their experience can provide insight on cancer pain self-management support needs and preferences. A meta-synthesis of 20 qualitative research articles on self-management of cancer pain was conducted to gain a deeper understanding of the self-management support needs of patients with cancer pain. Noblit and Hare’s meta-ethnographic model was used. The meta-synthesis resulted in increased understanding of the needs and preferences for self-management support of cancer pain and the role of the health care practitioner. Practical implications are presented.

Objective: International standards of end-of-life care (EOLC) intend to guide the delivery of safe and high-quality EOLC. Adequately documented care is conducive to higher quality of care, but the extent to which EOLC standards are documented in hospital medical records is unknown. Assessing which EOLC standards are documented in patients’ medical records can help identify areas that are performed well and areas where improvements are needed. This study assessed cancer decedents’ EOLC documentation in hospital settings. Methods: Medical records of 240 cancer decedents were retrospectively evaluated. Data were collected across six Australian hospitals between 1/01/2019 and 31/12/2019. EOLC documentation related to Advance Care Planning (ACP), resuscitation planning, care of the dying person, and grief and bereavement care was reviewed. Chi-square tests assessed associations between EOLC documentation and patient characteristics, and hospital settings (specialist palliative care unit, sub-acute/rehabilitation care settings, acute care wards, and intensive care units). Results: Decedents’ mean age was 75.3 years (SD 11.8), 52.0% (n = 125) were female, and 73.7% lived with other adults or carers. All patients (n = 240; 100%) had documentation for resuscitation planning, 97.6% (n = 235) for Care for the Dying Person, 40.0% for grief and bereavement care (n = 96), and 30.4% (n = 73) for ACP. Patients living with other adults or carers were less likely to have a documented ACP than those living alone or with dependents (OR 0.48; 95% CI 0.26-0.89). EOLC documentation was significantly greater in specialist palliative care settings than that in other hospital settings ( P

In this study, we aimed to identify processes that enabled the involvement of a person with complex speech and motor disorders and the parent of a young person with these disorders as co-researchers in a U.K. research project. Semi-structured individual and focus group interviews explored participants’ experiences and perceptions of public involvement (PI). Sixteen participants were recruited, with representation from (a) the interdisciplinary project team; (b) academics engaged in discrete project activities; (c) individuals providing organizational and operational project support; and (d) the project’s two advisory groups. Data were analyzed using Framework Analysis. Five themes were generated: (a) the challenge of defining the co-researcher role; (b) power relations in PI; (c) resources used to enable PI; (d) perceived benefits of PI; and (e) facilitators of successful PI. Our findings provide new evidence about how inclusive research teams can support people with complex speech and motor disorders to contribute meaningfully to co-produced research.

During a shot put, there are different finite variables that can be controlled by the thrower, including release angle, release height, release direction, and release velocity. Previous studies have determined thresholds of release velocity necessary for achieving certain distances, and this case study sought to expand upon that concept. Conclusions from key biomechanical data can make a significant difference in the performance of athletes in the shot put if properly understood by coaches. By utilizing this scientific approach to the shot put event, the throws coach will be able to determine more accurate adjustments and devise training stimuli to better accommodate the athlete. In this case study, researchers and the coach attempted to bridge the gap in the approach to teaching and coaching the glide shot put by using a physics-based equation regarding projectile motion in tandem with biomechanical analyses. The use of immediate feedback via video analysis was an essential part the coaching and teaching system. The athlete’s release angles decreased, and her maximum release velocities increased from 12.5 m/s in 2015 to 13.1 m/s in 2016. This USATF coaching education shot put project is an example in which the cooperation between sport science and coaching helped to produce an Olympic berth (19.24 m) by Felisha Johnson in the women’s shot put in 2016.

With a focus on contemporary South Africa, and through the lens of queer identity and politics, the article critiques the limitations and possibilities for queerness and its futures in post-apartheid South Africa. From the advent of constitutional democracy and its ushering in of human rights, the article analyses developments in the politics of sexuality in the context of enduring systems of violence, rooted in colonial and apartheid histories. Discrimination against lesbian, gay, bisexual, transgender and intersex people – at the intersection with other forms of discrimination – has emerged as a focal point for political resistances in the post-apartheid period. These resistances are interrogated, including the paradoxes of rights struggles that they expose, and the contradictions between formal equality gains and present queer realities that they call attention to. With an emphasis on enduring inequalities within post-apartheid society, and on the racialisation of violence against queerness, the article explores various political formations of and for queer freedom. In navigating these dynamics of inequality and difference, the article urges a radical politics – both for relating as equals, and against the violent ends of othering.

Policy writing assessments are increasingly used as an alternative or supplementary method of assessment within the teaching of politics and policy. Such assessments, often referred to as ‘policy briefs’ or ‘briefing memos’, are often used to develop writing skills and to encourage active learning of policy-related topics among students. While they can be readily adapted to different teaching and learning contexts, it can be challenging to make appropriate design choices to implement policy writing assessments so that are able to meet the learning aims of students. This article sets out a heuristic framework, derived from the existing literature on policy writing assessments to help clarify these choices. It advocates for viewing assessment design as embedded within course design and emphasises the pedagogical and contextual aspects of assessment design. To illustrate how this heuristic framework can help those involved in course design, this article concludes with a reconstruction of the design process for a policy writing assessment in an undergraduate course on Global Energy Politics.

Desistance from crime involves nuanced consideration of external and internal theories of change and methodological challenges to accurately capture positive change. Although desistance is expected for adult offenders, the onset of change in adolescence has not received sufficient attention. The current study explores the potential impact of specific social bonding experiences, to school, parents, and peers, on desistance among juvenile offenders using the Pathways to Desistance study. Findings indicate that school socialization can facilitate positive change, as can maternal bonding and changes in peer networks. The study also creates opportunity to revisit how theoretical perspectives may be guided by age specific patterns of offending.

What are the consequences of lay beliefs about how things are made? In this article, we describe a Western folk theory of artifact creation, highlighting how intuitive dualism regarding mental and physical labor (i.e., folk psychology) can lead to the perceived transmission of properties from makers to material artifacts (i.e., folk physics), and affect people’s interactions with material artifacts. We show how this folk theory structures the conceptual domain of material artifacts by differentiating the contemporary lay concepts of art/craft and industrial production, and how it influences people’s evaluations of different types of artifacts and their makers. We propose that the folk theory and lay concepts of art/craft and industrial production are best understood within a specific sociohistorical context, and review potential sources of cross-cultural and cross-temporal variation. We conclude by making recommendations for future research and examining the implications for promoting environmental sustainability and social justice in production systems.

Coronavirus disease 2019 (COVID-19) has affected over 200 million patients worldwide. COVID-19 is transmitted through respiratory droplets from patient to patient or by touching a surface that has been contaminated by an infected patient. Many COVID-19 patients have other comorbidities, such as end-stage renal disease. Currently, management of COVID-19 in patients with end-stage renal disease is unclear. Some studies have shown improvement in this population with the use of tocilizumab, a humanized interleukin-6 monoclonal antibody, in addition to the standard therapy as per guidelines published by the National Institutes of Health. In this case report, we present a patient case where the use of remdesivir, tocilizumab, and pulse-dose methylprednisolone significantly improved symptoms and inflammatory biomarkers associated with COVID-19 in a patient with end-stage renal disease.

Few investigations have examined dementia training programs for rehabilitation professionals. To address this, the Leveraging Existing Abilities in Dementia (LEAD) program was developed and examined with a pilot study. LEAD addressed dementia knowledge; the Strength-Based Approach; strategies for communication, recognizing behaviors, and learning techniques; and documentation. Participants completed pre-program, post-program, and three-month follow-up questionnaires assessing confidence, practice patterns, and dementia knowledge. Confidence and use of treatment strategies increased through the three-month follow-up and dementia knowledge significantly increased following training. LEAD positively impacted rehabilitation professionals’ knowledge, confidence, and use of evidence-based treatment strategies. Implications of LEAD and future research are discussed.

Foreign body ingestion is a common indication for general surgery consultation in the emergency setting. We report a case of large esophageal foreign body ingestion involving a metallic butter knife lodged at the gastroesophageal junction that required endoscopic removal. Furthermore, we report a novel modification to the dual snare technique of retrieval incorporating a snare placed through a nasogastric tube to facilitate introduction and manipulation of the second snare.

Background: After an anterior cruciate ligament (ACL) injury, ACL reconstruction is an elective procedure, and therefore, an understanding of the attributable risk from undergoing ACL reconstruction is necessary for patients to make a fully informed treatment decision. Purpose: To determine the absolute risk of adverse outcomes including reoperation after ACL reconstruction with comparison, where possible, to the rate of adverse events reported in the general population. Study Design: Descriptive epidemiology study. Methods: National hospital data on all ACL reconstructions performed in England between April 1, 1997, and March 31, 2017, were analyzed. Revision cases, bilateral procedures within 6 months, and cases with concurrent cartilage or multiple ligament surgery were excluded. The primary outcome was the occurrence of at least 1 serious complication (myocardial infarction, stroke, pulmonary embolism, infection requiring surgery, fasciotomy, neurovascular injury, or death) within 90 days. Additionally, 5-year rates of revision ACL reconstruction, contralateral ACL reconstruction, and meniscal surgery were investigated. Results: There were 133,270 ACL reconstructions performed, of which 104,255 were eligible for analysis. Within 90 days, serious complications occurred in 675 (0.65% [95% CI, 0.60-0.70]), including 494 reoperations for infections (0.47% [95% CI, 0.43-0.52]) and 129 for pulmonary embolism (0.12% [95% CI, 0.10-0.15]). Of 54,275 procedures with at least 5 years’ follow-up, 1746 (3.22% [95% CI, 3.07-3.37]) underwent revision ACL reconstruction in the same knee, 1553 underwent contralateral ACL reconstruction (2.86% [95% CI, 2.72-3.01]), and 340 underwent meniscal surgery (0.63% [95% CI, 0.56-0.70]). The overall risk of serious complications fell over time (adjusted odds ratio [OR], 0.96 per year [95% CI, 0.95-0.98]); however, older patients (adjusted OR, 1.11 per 5 years [95% CI, 1.07-1.16]) and patients with a greater modified Charlson Comorbidity Index (adjusted OR, 2.41 per 10 units [95% CI, 1.65-3.51]) were at a higher risk. For every 850 (95% CI, 720-1039) ACL reconstructions, 1 pulmonary embolism could be provoked. For every 213 (95% CI, 195-233), 1 native knee joint infection could be provoked. Conclusion: The overall risk of adverse events after ACL reconstruction is low; however, some rare but serious complications, including infections or pulmonary embolism, may occur. Around 3% of patients undergo further ipsilateral or contralateral ACL reconstruction within 5 years. These data will inform shared decision making between clinicians and patients considering their treatment options.

Education can reduce criminal behavior through preventive influences and later desistance. However, the desistance effect may be hindered by the age at which one returns to formal education. This study explores this point by examining drop out and stop out offenders in the National Longitudinal Survey of Youth 1997. Specifically, this study creates separate subgroups of respondents who reported recommitting to educational pursuits before and after age 18. Results indicate that recommitting to education, and specific degree attainment, differ in their impact on future crime depending on when an offender reenrolls in formal education. This study expands the importance of studying the timing of social events within lives and suggests targeting policy interventions in adolescence.

Background The benefits of aspirin for primary prevention of stroke are uncertain. Methods We performed a cumulative meta-analysis of trials investigating aspirin for primary prevention of cardiovascular disease with a focus on stroke. We assessed the effects of aspirin on non-fatal stroke, hemorrhagic stroke, non-fatal myocardial infarction, all-cause mortality, cardiovascular mortality, major gastrointestinal bleeding, and an analysis of net clinical effect, in populations without a history of clinical or subclinical cardiovascular disease. Summary of review results Among 11 trials (157,054 participants), aspirin was not associated with a statistically significant reduction in non-fatal stroke (odds ratio, 0.94; 95% CI, 0.85 to 1.04) but was associated with an increased risk of hemorrhagic stroke (odds ratio, 1.29; 95% CI, 1.06 to 1.56). Aspirin was not associated with a statistically significant reduction in all-cause mortality (odds ratio, 0.97; 95% CI, 0.92 to 1.03) or cardiovascular mortality (odds ratio, 0.94; 95% CI, 0.85 to 1.03). Aspirin was associated with a reduction in non-fatal myocardial infarction (odds ratio, 0.80; 95% CI, 0.69 to 0.94) and an increased risk of major gastrointestinal bleeding (odds ratio, 1.83; 95% CI, 1.43 to 2.35). Using equal weighting for non-fatal events and major bleeding, we observed no net clinical benefit with aspirin use for primary prevention. Conclusion Our meta-analysis reports no benefit of aspirin for primary stroke prevention.

Type 2 diabetes (T2D) is a highly prevalent metabolic disease, affecting nearly 10% of the American population. Although the etiopathogenesis of T2D remains poorly understood, advances in DNA sequencing technologies have allowed for sophisticated interrogation of the human microbiome, providing insight into the role of the gut microbiome in the development and progression of T2D. An emerging body of research reveals that gut–brain axis (GBA) perturbations and a high-fat diet (HFD), along with other modifiable and nonmodifiable risk factors, contribute to gut microbiome homeostatic imbalance. Homeostatic imbalance or disruption increases gut wall permeability and facilitates translocation of endotoxins (lipopolysaccharides) into the circulation with resultant systemic inflammation. Chronic, low-grade systemic inflammation ensues with pro-inflammatory pathways activated, contributing to obesity, insulin resistance (IR), pancreatic β-cell decline, and, thereby, T2D. While GBA perturbations and HFD are implicated in provoking these conditions, prior mechanistic models have tended to examine HFD and GBA pathways exclusively without considering their shared pathways to T2D. Addressing this gap, this article proposes a mechanistic model informed by animal and human studies to advance scientific understanding of (1) modifiable and nonmodifiable risk factors for gut microbiome homeostatic disruption, (2) HFD and GBA pathways contributing to homeostatic disruption, and (3) shared GBA and HFD pro-inflammatory pathways to obesity, IR, β-cell decline, and T2D. The proposed mechanistic model, based on the extant literature, proposes a framework for studying the complex relationships of the gut microbiome to T2D to advance study in this promising area of research.

Education has been consistently studied as a source of crime prevention and control, but the relevance of returning and completing educational degrees among offenders who drop out, as an opportunity to further the process of desistance, has not received empirical attention. The current study addresses this gap in desistance research by examining the impact of educational return and specific degree attainment on desistance from crime using data from the National Longitudinal Survey of Youth 1997. Results indicate that reenrolling in educational pursuits can produce partial desistance effects as does specific degree attainment. The findings suggest a reconsideration of education as both a source of prevention and desistance and expands theoretical and practical discussion of desistance through educational pursuits.

In August 2019, academics, practitioners and advocates as well as individuals with lived experiences of confinement, came together at the University of Melbourne to reflect on the parallels between the spaces and practices of care and control in diverse sites of confinement. This research workshop sought to generate insights into places of confinement from varying perspectives. In the following dialogue between former migration support worker, Judge, and one of the editors of this Special Themed Collection of papers, Loughnan, the daily violence of Australia's immigration detention system is brought to light. Judge shares her stories of working in regional offshore processing centres. This provides important insights into the Australian government's border protection policies, described as one of the harshest in the world. Judge witnessed this first-hand when she was employed by the Australian Government to implement these policies and laws as a migration support worker. During this time, she was consistently faced with a tension between her role responsibility and her ethical obligations to others. The decisions she made to document these practices, to resist and then speak out have had a lasting impact on her: she says she is compelled to continue to document these stories, despite the severity of potential criminal repercussions for doing so under ‘gag orders’ on imposed on detention staff through laws enacted by the Australian Government.

Background: Although the technology has been available and several pilot studies have shown success, use of telemedicine has previously been limited in the United States, especially among surgeons. This study aimed to investigate the benefits and obstacles for successful implementation of telemedicine visits in paediatric surgical subspecialties amid the COVID-19 pandemic. Methods: We analysed survey data from telemedicine visits with paediatric surgical subspecialists from May 1 through June 30, 2020 at our paediatric surgery subspecialty clinics. Univariate logistic regression was used to determine associations in survey responses and various demographic factors. Results: There were 164 respondents to the survey. The most frequently cited barrier to care was ability to get time off work (46.3%). Overall satisfaction with the telemedicine visit was 93.8%, and 55.6% responded that they would choose video telemedicine rather than an in-person or telephone visit. Those living at least 25 miles from the hospital had increased odds of indicating interest in using telemedicine for future visits (OR = 2.56, 95% CI = 1.12–5.86, p = 0.026). The average respondent saved between 30 minutes and 1 hour, and 45 minutes using telemedicine. Conclusions: The implementation of telemedicine at our institution in the paediatric surgical subspecialties has proven to be effective and well-received. Given the benefits of time and money saved for families, paired with high satisfaction rates and continued interest, paediatric surgical subspecialists should work to incorporate virtual visits into regular patient care, even well after the COVID-19 pandemic. Level of Evidence: Level IV

This article establishes a theoretical link between the business model of social media and the resurgence of antiliberal populism. Through a novel set of tactics I term “identity biopolitics,” political campaigns and foreign governments alike can identify voters as members of socioculturally differentiated populations, then target them with political messages aimed at cultivating voters’ awareness of their particular disadvantage within the prevailing liberal order. Identity biopolitics exploits a positive feedback loop between targeting and content: the sociocultural differentiations liberalism declares politically irrelevant are used to target content that cultivates awareness of subjects’ particular depoliticized disadvantage within the prevailing liberal order. The antiliberal populist exploits this condition to drive support for their political program. This article presents case studies of the Internet Research Agency and Cambridge Analytica during the 2016 general election in the United States to demonstrate the symbiosis between social media and antiliberal populism.

Due to inconsistent concepts of regulatory stringency, scholars offer conflicting accounts about whether competing private governance initiatives “race to the bottom,” “ratchet up,” “converge,” or “diverge.” To remedy this, we offer a framework for more systematic comparisons across programs and over time. We distinguish three often-conflated measures of stringency: regulatory scope, prescriptiveness, and performance levels. Applying this framework, we compare competing U.S. forestry certification programs, one founded by environmental activists and their allies, the other by the national industry association. We find ‘upwardly divergent’ policy prescriptiveness: both programs increased in prescriptiveness, but this increase was greater for the activist-backed program. Furthermore, requirements added by the activist-backed program were more likely to impose costs on firms than requirements added by the industry-backed program, many of which may even benefit firms. These results are consistent with the hypothesis that industry-backed programs emphasize less costly types of stringency than activist-backed programs. They also reveal patterns of change that previous scholarship failed to anticipate, illustrating how disentangling types of stringency can improve theory building and testing.

The unmet needs of people living with dementia have been shown to be multidimensional and impact well-being. However, there are a lack of studies examining variability of unmet needs and need-related distress from the person living with dementia’s perspective. The current study ( n = 12) examined the self-reported unmet needs and need-related distress of people with mild to moderate dementia. Seventy-five percent of participants ( n = 9) identified at least one unmet need and 50% ( n = 6) reported 10 or more unmet needs. “Finding and Arranging Services” and “Health Information” subscales had the highest reported average unmet needs. The most frequently reported unmet need-item was “ getting information about your memory problems?” Participants reported variability in distress for both unmet and met needs. Continued research can provide beneficial information on the relationship between unmet needs, need-related distress, and outcomes of well-being for future interventions.

The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a position statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the task force used an iterative process and expert consensus to finalize the position statement. The objective of this position statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport.