Safe Space Research Articles

A Planetary Boundary for Mineral, Metal, and Fossil Resource Extraction Rates: How Much Primary Materials Can a Circular Economy Extract?

Resource consumption is expected to further increase in the next decades. A circular economy could decrease the environmental impact of this resource consumption by minimizing the primary raw materials consumption and minimizing emissions that render materials inaccessible for further use. However, such a circular economy will still have primary raw material inflows, due to population growth, stock expansion, energy transition, and inevitable dissipation. The potential magnitude of such primary raw material inflows in a circular economy remains unclear. To address this uncertainty, the planetary boundary framework, which defines absolute limits on resource and emission flows, could be utilized. Although this framework incorporates aspects of biomass, water, and land use, mineral, metal, and fossil resources are not included. This study provides a principle for a planetary boundary for these three resources, based on the net accessibility rate and an allocated share of the accessible resource stock in the ecosphere. Inter- and intragenerational equality are crucial for determining this allocated share and for quantifying a sustainable rate of resource extraction in (an economy transitioning toward) a circular economy. Next steps to operationalize this principle provide further guidance to determine the safe operating space for mineral, metal, and fossil resource extraction.

Making space for grief: The impact of remembrance programs for pediatric healthcare providers.

While caring for seriously ill children is a rewarding experience, pediatric healthcare providers may experience sadness and emotional distress when their patient dies. These feelings, particularly when not addressed, can lead to negative health and occupational outcomes. Remembrance practices can provide a safe space for staff to process their grief. This study explored pediatric healthcare providers' perceptions of an annual Pediatric Remembrance Ceremony (PRC) and a quarterly program, Good Grief and Chocolate at Noon (GGCN), to learn what components of the programs were considered meaningful and the personal impact on those who attended. The programs pivoted to a virtual platform during the COVID-19 pandemic, and the study also assessed providers' perspectives of attending the programs virtually. A 19 multiple choice survey instrument was designed, reviewed, piloted, revised, and re-piloted by an interdisciplinary bereavement committee prior to administration. The survey included 2 open-ended questions, inviting additional insights into personal impact and future directions for remembrance programs. The survey was administered on an encrypted online platform. Components of the PRC respondents most valued included the opportunity for staff to choose a name of a patient they cared for and to light a candle for that patient as their name is read. Those who participated in GGCN found story sharing helpful, along with having a speaker address a topic around loss and grief during the second half of the session. Both programs provided reflection, solidarity, and memorialization. Most respondents prefer having both in-person and virtual options. Healthcare providers are affected by the death of the children they care for and value opportunities provided to join colleagues in remembering their patients. The findings underscore the value of remembrance programs in supporting bereaved staff.

Democracy Ancient and Modern?

Abstract The idea that democracy is in crisis is nothing new; ancient Greek commentators like Plato and Thucydides argued that political instability was baked into democracy as a regime type. Can examples drawn from classical Athens make a useful contribution to discussions of the failings of contemporary democracy? This article considers a range of interventions from the past decade in the United States and the United Kingdom, carried out at different scales and through different methods. It considers the strengths of working with material from the distant past – its non-partisan nature offering a safe space to discuss political conflict without engaging in it – and also the weaknesses, such as the limited franchise of ancient democracies like classical Athens, and the need to consider specific historical issues in their own context. It also considers the unfamiliarity of ancient history and the way in which knowledge of the classical past can itself be perceived as class-bound and exclusionary.

Crisis prevention and response in Ryan white-funded HIV clinics.

ABSTRACTThe high prevalence of trauma among people with HIV (PWH) and its negative impact on HIV outcomes underscore the need for Ryan White-funded HIV clinics (RWCs) to implement trauma-informed care (TIC) inclusive of crisis prevention and response. As part of a mixed-methods study of TIC practices employed by RWCs, we conducted qualitative interviews with 36 administrators, providers, and staff from Southeastern RWCs exploring crisis prevention and response strategies. Interviews were guided by the Substance Abuse and Mental Health Services Administration TIC framework and analyzed using a framework-driven, qualitative thematic approach. Crisis prevention strategies included: using electronic medical records to identify patients at risk for experiencing crisis, peer navigators to help patients bypass clinic public spaces, protocols to ensure perpetrator-victim pairs were not concurrently scheduled, and social workers to help patients identify crisis triggers and develop safety plans, plus dedicating safe spaces for patients with extensive trauma histories. Crisis response included patient referral to onsite and community crisis intake, trauma support, and mental health services and having onsite security personnel and alarm systems. Several participants requested additional training in response protocols. Study findings highlight the need for RW network-wide TIC training and sharing of best practices in crisis prevention and response.

Social Media Use in Adolescents: Bans, Benefits, and Emotion Regulation Behaviors.

Social media is an integral part of adolescents' daily lives, but the significant time they invest in social media has raised concerns about the effect on their mental health. Bans and severe restrictions on social media use are quickly emerging as an attempt to regulate social media use; however, evidence supporting their effectiveness is limited. Adolescents experience several benefits from social media, including increased social connection, reduced loneliness, and a safe space for marginalized groups (eg, LGBTQ+) to interact. Rather than enforcing bans and severe restrictions, emotion regulation should be leveraged to help adolescents navigate the digital social environment. This viewpoint paper proposes a nuanced approach toward regulating adolescent social media use by (1) discontinuing the use of ineffective bans, (2) recognizing the benefits social media use can have, and (3) fostering emotion regulation skills in adolescents to encourage the development of self-regulation.

Trans-Achilles percutaneous fixation technique for posterior malleolus fracture: a cadaveric study

BackgroundIt has been reported that 43.6% of ankle fractures are accompanied by posterior malleolus fractures. The aim of this study is to define a safe zone for posterior malleolus fractures by determining the locations of the important anatomical structures in this region. Additionally, it aims to identify the trans-Achilles passage line for Kirschner wire insertion through a posteroanterior approach for posterior malleolus fragments.MethodsSix below-knee amputee fresh-frozen leg cadavers were used in this study. A trans-Achilles Kirschner wire was applied to the cadavers in the posteroanterior direction under the guidance of fluoroscopy. The areas where the Kirschner wire passed were dissected, and their proximity to vital anatomical structures was measured.ResultsIn all cadavers, the transverse thickness of the Achilles tendon at the level of the trans-Achilles Kirschner wire was 15.5 mm and the trans-Achilles Kirschner wire application was 18.6 mm from the sural nerve, 16 mm from the posterior tibial tendon, and 12.16 mm from the flexor digitorum longus muscle. It was performed 15.16 and 14.6 mm from the posterior tibial artery and vein, 12.3 mm from the tibial nerve, 13.6 mm from the tibiofibular joint, and 55.5 mm from the insertion site of the Achilles tendon to the calcaneus and at a sufficient distance from vital anatomical structures.ConclusionsThe proposed trans-Achilles percutaneous surgical technique is safe from neurovascular structures for fixing posterior malleolar fractures. However, the long-term clinical outcomes of this technique need to be explored.Level of evidenceLevel III, A cadaveric study.

Oblique or short incisions reduce the risk of saphenous nerve damage during hamstrings harvesting. A model for mapping nerve pathways at the harvest site.

Hamstring autografts are frequently used for ligament reconstruction surgery. Twelve to 84% of patients describe hypo or dysaesthesia secondary to injury of the saphenous nerve or one of its branches after hamstring harvesting. Type of incision (orientation and length) is subject of much debate to limit the risk of nerve damage. A cadaveric study was performed to determine which type of incision limits the risk of injury to the saphenous nerve or one of its branches, based on an anatomic model for mapping nerve pathways at the harvest site. An anatomical study was performed on 20 knees from 12 embalmed bodies. Distance between saphenous nerve branches and 4 points of interest along the tibial crest was measured. Based on these measurements, a digital model of the saphenous nerve and its branches was created. A model of three common types of incision (vertical, horizontal and oblique) was overlaid. Each incision was modelled for three lengths (2, 3 and 4cm). Percentage of collision between nerve course model and incision model was then calculated to determine the risk of nerve damage for each type of incision. Based on the nerve course model, a "low collision risk" safe zone was identified. Nerve damage risk after an oblique incision was significantly lower than for a horizontal or vertical incision, for incision lengths of 3 and 4cm (p<0.05). For a specific incision orientation, the length of the incision did not affect the risk of nerve damage. A trapezoidal space close to the tibial crest and distal to the anterior tibial tuberosity appears to reduce risk of nerve damage. This cadaveric study suggests that during hamstring harvesting, incisions shorter than 2cm reduce the risk of saphenous nerve's branches injuries. For incisions longer than 2cm, using an oblique incision may reduce the risk compared to vertical or horizontal incisions. Level of evidence not applicable: Laboratory experiments.

Comparison of Implant Placement Accuracy Between Manual, Robot-Assisted, Computer-Navigated, Augmented Reality Navigated, Patient-Specific Instrumentation, and Accelerometer Navigated Total Hip Arthroplasty: A Systematic Review and Network Meta-Analysis.

Malpositioning of the acetabular cup during total hip arthroplasty (THA) can lead to complications. Robotic surgery and navigation techniques aim to address this issue, but there is limited evidence regarding which method can achieve better clinical outcomes. Therefore, this network meta-analysis (NMA) aimed to compare the efficacy of various navigation methods. This NMA of prospective randomized controlled trials compared robot-assisted systems (RAS), computer-assisted navigation systems (CAS), augmented reality-based portable navigation (AR), patient-specific instrumentation (PSI), portable accelerometer-based navigation (PN), and conventional methods (C) for THA procedures. We searched MEDLINE, EMBASE, Cochrane, Central Register of Controlled Trials, International Clinical Trials Platform Search Portal, and ClinicalTrials.gov. databases. The primary outcomes included revision surgery and postoperative clinical scores, and the secondary outcomes encompassed cup placement accuracy, acetabular cup placement outliers from the Lewinnek safe zone, surgical time, and complications. We used a Bayesian random-effects NMA, and confidence of evidence was assessed using confidence in NMA. We identified 45 studies including 2,122 patients. We did not find large differences in revision surgery, clinical outcome scores, cup inclination, or anteversion angle accuracy among the modalities. AR, CAS, and PSI exhibited a lower risk of outliers from safe zones than C. In addition, RAS and CAS had a longer surgical time than C. Robotic and navigation tools did not reduce the revision risk or enhance clinical outcomes. AR, CAS, PSI, and PN may decrease the risk of cup placement outliers in safe zones. However, the cup placement accuracy was equivalent, and the surgical time may be longer in RAS and CAS than in C. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Development of a horizontal seepage test system of constructed wetland and research on the seepage characteristics based on micro-pollution water

Horizontal subsurface flow constructed wetlands (HSFCW) were widely used as an effective biotechnology for wastewater treatment. However, clogging of the substrate bed was a key factor restricting its application. In this study, a horizontal seepage test system was independently developed, which was used to reveal the development trends of hydraulic resistance in HSFCW, as well as changes in permeability coefficients with time. The relationship between the average permeability coefficient and purification effect was further analyzed. The results showed that the new test system has proved the law of resistance development in HSFCW. The distribution characteristics of the isobaric surface indicate that the blockage of the HSFCW gradually spreads from the lower part to the lower part. The seepage resistance of homogeneous subbed in HSFCW was mainly concentrated in the front end. The growth rate of hydraulic loss in the core zone ranged from 0.685 to 19.515 cm·month−1, the growth rate in the transition zone ranged from 0.223 to 0.695 cm·month−1, and little change occurred in the safety zone. At the end of the HSFCW operation, the widths of the core, transition, and safety zones account for approximately 20–30 %, 50–70 %, and 10–20 % of the entire wetland length, respectively. Meanwhile, the SS removal rate stabilized at over 92 %, when the average permeability coefficient reached 41.45 m·d−1. The removal rate of COD and TN was higher when the average permeability coefficient is between 59.45 and 41.45 m·d−1 and 27.08–59.45 m·d−1, respectively. This study provided a horizontal testing method to accurately understand the changes in the seepage field in HSFCW.

Development of a Key Method for the Optimization of Port Vessel Detection Based on an Improved Multi-Structural Morphology Approach

All over the world, many ports have implemented surveillance camera systems to monitor the vessels and activities around them. These types of systems are not very effective in accurately detecting activities around the port due to background noise and congestion interference at the sea surface. This is why it is difficult to accurately detect vessels, especially smaller vessels, when it turns dark. It is known that some vessels do not comply with maritime rules, particularly in port and safety zones; these must be detected to avoid incidents. For these reasons, in this study, we propose and develop an improved multi-structural morphology (IMSM) approach to eliminate all of this noise and interference so that vessels can be accurately detected in real time. With this new approach, the target vessel is separated from the sea surface background through the weighted morphological filtering of several datasets of structural components. Then, neighborhood-based adaptive fast median filtering is used to filter out impulse noise. Finally, a characteristic morphological model of the target vessel is established using the connected domain; this allows the sea surface congestion to be eliminated and the movement of vessels to be detected in real time. Multiple tests are carried out on a small and discrete area of moving vessels. The results from several collected datasets show that the proposed approach can effectively eliminate background noise and congestion interference in video monitoring. The detection accuracy rate and the processing time are improved by approximately 3.91% and 1.14 s, respectively.

Trust calibration through perceptual and predictive information of the external context in autonomous vehicle

Maintaining an appropriate level of trust is critical for driving safety in autonomous vehicles. While enhancing the driver’s situation awareness (SA) of system information in autonomous driving is known to significantly promote trust calibration, it remains unclear whether enhancing the driver’s SA of the external context during driving contributes to this calibration. This study addresses this gap by improving SA of the external context during Level 3 (L3) driving automation across various driving environments. Driving contexts were manipulated using distinct road conditions containing low, medium, or high contextual risks. To enhance driver’s SA of the driving context, we redesigned the in-vehicle central control panel to display real-time perceptual and predictive information about the external driving context. We hypothesized that SA of driving contexts would facilitate trust calibration rather than merely enhancing trust, allowing trust to adjust to appropriate levels under different driving conditions. Experiment 1 examined the impact of perceptual information about the road, traffic infrastructure, and surrounding vehicles on drivers’ trust. We found that driver’s trust decreased with increased contextual risk only when the reconfigured panel was used, while the number of accidents was not affected. Experiment 2 investigated the effect of predictive information about the external context on drivers’ trust by marking safe and dangerous zones around driver’s vehicle with green and red areas, respectively. We revealed that the predictive information calibrated the trust according to road conditions and increased overall trust levels, while the number of accidents was not affected. Together, these findings suggest that enhancing perception and prediction of external contexts helps drivers align their trust with contextual risk levels in L3 driving automation without compromising driving safety.

Academic nursing administrators perceptions of replacing clinical hours with simulation

BackgroundNursing education has seen a shift towards simulation-based education (SBE) to meet the demands of a rapidly evolving healthcare landscape. Maryland's Clinical Simulation Resource Consortium (MCSRC) aimed to enhance SBE utilization; however, noted a decline in SBE usage post pandemic prompting an investigation into nurse administrators' perspectives on replacing clinical hours with SBE. MethodsThis descriptive quality improvement study was informed by Rogers' Diffusion of Innovation (DOI) Theory. Semi-structured interviews were conducted with four academic nurse administrators from various pre-licensure nursing programs in Maryland. The data collected were analyzed using thematic analysis. ResultsNurse administrators who value SBE as a safe learning space are integral when building and maintaining infrastructure to support simulation usage. Identified barriers related to faculty buy-in, workload, and inadequate human resources to deliver high-quality simulations can hinder sustained adoption of clinical simulation. ConclusionsThis study highlights the necessity of continuous faculty training in SBE and dedicated resources to support simulation infrastructure. Recommendations include sustained investment in faculty development, creating specialized roles for simulation champions, and fostering collaborations to strengthen simulation integration. The findings emphasize the pivotal role of nurse administrators in navigating challenges and maximizing SBE's potential to replace clinical hours in nursing education, urging ongoing support and strategic planning for successful integration.

“Safe spaces are built": How African American Women Discuss Professional Connectedness in Online Doctoral Programs

“Safe spaces are built": How African American Women Discuss Professional Connectedness in Online Doctoral Programs

Team roles and challenges in experiential learning in sustainability accounting education: A four-stage learning cycle

ABSTRACT This study aims to provide insights into the process of team-based experiential learning in a sustainability accounting course. A case study of a postgraduate course on material flow cost accounting at a German university was applied. Data were collected from learning journals and in-depth interviews. The findings provide insights into the process of team-based experiential learning. The process is indicated by four team roles of students: interpersonal, information, analytic, and action roles, which move around the four-stage learning cycle. Six challenges in students' experiential learning in teams were found at different stages: the characteristics of team dynamics, the selection of relevant information from the case, confusion and frustration, connecting information in a meaningful manner, time constraints, and the increasingly complex level of the tasks. The study contributes to the accounting education literature and experiential learning literature by extending knowledge about team roles and learning challenges around the learning cycle. Practical implications for educators are discussed to facilitate team-based experiential learning toward sustainability education. These include the adoption of educator role profiles to support students' learning, the creation of a safe learning space for students, and the design of experiential learning activities on the foundation of four-stage learning processes.

Socioeconomic Status and Physical Fitness Levels among University Students

This study examines the correlation between socioeconomic status (SES) and physical fitness levels among university students in Henan, China. The research considers various SES indicators, including parental education, household income, and access to healthcare, in relation to students' self-assessed physical fitness and activity levels across multiple domains, such as vigorous physical activity, organized sports, and recreational activities. Findings reveal that students from lower SES backgrounds often face barriers, such as limited access to safe recreational spaces and organized sports, which may hinder their ability to participate in physical activities, thereby impacting their fitness levels. In contrast, students from higher SES backgrounds have greater access to fitness resources, leading to more favorable physical fitness outcomes. The study underscores the need for policy interventions and school programs that prioritize equitable access to physical activity opportunities for students of all socioeconomic backgrounds.

Pedagogical uses of AI tools: reflection on a case study

Academic writing is central to assessment in UK universities (Goodfellow, 2005). The emergence of easily accessible generative artificial intelligence (GenAI) tools took the sector by storm, with some voices raising critical concerns about academic integrity and the de-skilling of writing, while others pointed to the developmental and time-saving opportunities these tools can offer (OpenAI, 2023; UNESCO, 2023). This presentation reflected on the author’s experience of designing and delivering a workshop on ‘Introduction to proofreading techniques using AI tools’. The workshop was developed as part of a broader Academic Innovation Project designed to support the developmental and ethical use of GenAI tools by student writers at one institution in line with internal and emerging sector policies (such as Russell Group, 2023). The presentation outlined the workshop plan, including learning outcomes and sample activities, alongside highlighting some of the challenges experienced during the design process. It also offered critical insights into the delivery and impact on student learning, with reference to the author’s reflections as well as student engagement and feedback. A major challenge that can be transferable to other pedagogical uses of GenAI tools was the difficulty in navigating the thin line between, on the one hand, encouraging workshop participants to experiment with a range of tools in a safe learning space and, on the other hand, raising their awareness of the ethical implications and potential risks that over-reliance on such tools may pose to their learning, particularly the development of their academic writing.

A qualitative investigation of crisis cafés in England: their role, implementation, and accessibility

BackgroundCrisis cafés (also known as crisis sanctuaries or havens) are community-based services which support people in mental health crises, aiming to provide an informal, non-clinical and accessible setting. This model is increasingly popular in the UK; however, we are aware of no peer-reviewed literature focused on this model. We aimed to investigate the aims of crisis cafés, how they operate in practice and the factors that affect access to these services and implementation of the intended model.MethodsA qualitative approach was used. Semi-structured interviews were conducted with 12 managers of crisis cafés across England. These interviews explored managers’ views on the implementation of their services, and the factors that help and hinder successful implementation. Data were analysed using Braun and Clarke’s reflexive thematic approach.ResultsWe identified five main perceived aims for crisis cafés: providing an alternative to Emergency Departments; improving access to crisis care; providing people in acute distress with someone to talk to in a safe and comfortable space; triaging effectively; and improving crisis planning and people’s coping skills. Factors seen as influencing the effectiveness of crisis cafés included accessibility, being able to deliver person-centred care, relationships with other services, and staffing. These factors could both help and hinder access to care and the implementation of the intended model. There were a number of trade-offs that services had to consider when designing and running a crisis café: (1) Balancing an open-door policy with managing demand for the service through referral routes, (2) Balancing risk management procedures with the remit of offering a non-clinical environment and (3) Increasing awareness of the service in the community whilst avoiding stigmatising perceptions of it.ConclusionsFindings illustrate the aims of the crisis café model of care and factors which are influential in its implementation in current practice. Future research is needed to evaluate the efficacy of these services in relation to their aims. Crisis café service users’ views, and views of stakeholders from the wider crisis care system should also be ascertained.

Where’s the fun in that? Building an authentic, inclusive, serious-yet-playful learning development framework

At the University of the West of Scotland, one of the ways in which first year students engage in exploring academic, personal, and professional literacies is through an embedded and contextualised credit-bearing module that runs alongside subject specific study. The module offers students opportunities to explore aspects of identity, values, and motivations as part of long, thin, scaffolded engagement running over two terms, and provides a mutable space for student-led discussion on a breadth of aspects of longitudinal transition support, becoming, as well, a space to engage with learning development principles and practices. In so doing, learning experiences within the module are at once guided and exploratory, presenting a risky safe space (Boyd, Wilson and Smith, 2023) for students to use in their transition towards increased autonomy and confidence. This session considered how the flexibility of the learning and teaching spaces created in the module (physical and virtual) allows for both reinforcement of formal structures/ requirements such as assessment processes (the serious part) as well as the freedom to negotiate personalised, aspirational, agentic, experimental learning experiences (more playfully intended). The session shared examples of classroom activities and presented learner feedback. Delegates were invited to share reflection on their own experiences of designing and delivering similar experiences and contribute to a fuller understanding of the value of maintaining balance within the serious-play spectrum.

Public Spaces are Failing Girls and Women

Public spaces are often failing girls and women, with male dominance and a lack of representation being prevalent issues. The 2030 Agenda emphasises the need for safe and accessible public spaces for women, children and other disadvantaged or marginalised groups. Nevertheless, women and girls tend to be neglected in the development of urban areas, and their specific needs and risks are not fully considered. Hence, there is a need for feminist urban planning. Feminist planning aims to understand, challenge, and change power relations in public spaces, by involving the experiences, needs, and desires of marginalised groups in the planning process in order to create more equal cities. This approach recognises the individual and collective power that women and other disadvantaged groups already possess. Social innovation is an innovative practice for meeting social needs and shares a common goal with feminist planning of promoting social change and increasing power for disadvantaged groups. However, whereas feminist urban planning – and urban planning in general – tend to end when a project has been planned and executed, social innovation has a stronger and more explicit focus on results or impact of the process or project. This is an aspect where feminist planning can learn from social innovation. By addressing the specific needs of marginalised groups and focusing on results and actual change, feminist planning can contribute to positive social change and empower women and girls in urban development processes. This viewpoint argues that feminist planning can learn from the focus of social innovation on results (i.e. output, outcome and impact of the planning), which has the potential to change planning practices and challenge gendered social norms in order to create more equal, just and socially sustainable public spaces and cities.

Challenges and opportunities of sustained public involvement in maternal health research: a practice case study with reflections from researchers and public contributors

It is widely agreed that collaboration with people with lived experience of specific health conditions or health services is both a moral imperative and a utility to improve research quality, validity and impact. However, there is little agreement about how to practise public involvement. In this article, we describe the formation and work of the Nottingham Maternity Research Network, an ongoing research reference panel that supports public involvement in maternal health research. Drawing on nine years’ experience, researchers and public contributors reflect together on the key issues to consider when co-producing research with maternity service users: first, pragmatic considerations, and second, creating a safe space for drawing on intimate and sometimes traumatic experiences. We argue that a sustained model of public involvement and engagement – that is, a standing group rather than a series of project-based, time-limited opportunities for involvement – brings opportunities to build trust and to develop a community that is supportive and inclusive. However, the sustained model of public involvement also brings practical challenges.