Non-intubated patients with acute respiratory failure due to COVID-19 could benefit from awake proning. Awake proning is an attractive intervention in settings with limited resources, as it comes with no additional costs. However, awake proning remains poorly used probably because of unfamiliarity and uncertainties regarding potential benefits and practical application. To summarize evidence for benefit and to develop a set of pragmatic recommendations for awake proning in patients with COVID-19 pneumonia, focusing on settings where resources are limited, international healthcare professionals from high and low- and middle-income countries (LMICs) with known expertise in awake proning were invited to contribute expert advice. A growing number of observational studies describe the effects of awake proning in patients with COVID-19 pneumonia in whom hypoxemia is refractory to simple measures of supplementary oxygen. Awake proning improves oxygenation in most patients, usually within minutes, and reduces dyspnea and work of breathing. The effects are maintained for up to 1 hour after turning back to supine, and mostly disappear after 6–12 hours. In available studies, awake proning was not associated with a reduction in the rate of intubation for invasive ventilation. Awake proning comes with little complications if properly implemented and monitored. Pragmatic recommendations including indications and contraindications were formulated and adjusted for resource-limited settings. Awake proning, an adjunctive treatment for hypoxemia refractory to supplemental oxygen, seems safe in non-intubated patients with COVID-19 acute respiratory failure. We provide pragmatic recommendations including indications and contraindications for the use of awake proning in LMICs.
Binnen sociaal werk opleidingen is er steeds vaker aandacht voor mensenrechten. Het belang om mensenrechten een plek te geven in sociaal werk curricula wordt benadrukt door het manifest ‘Stel mensenrechten centraal in het sociaal werk’ (Hartman et. al. 2016) dat sinds mei 2016 door tientallen lectoren en docenten is ondertekend. Om een bijdrage te leveren aan deze ontwikkeling heeft het Lectoraat Toegang tot het Recht van het Kenniscentrum Sociale Innovatie van de Hogeschool Utrecht een onderzoeksproject ‘Sociaal Werk en Mensenrechten’ gestart om beter inzicht te krijgen in de verbanden tussen sociaal werk en mensenrechten. Deze verkenning is een product van dit project.
This article investigates possible pathways of habitus change by informal tourism entrepreneurs in Thailand. Bourdieu's concept of habitus is depicted as a person's understanding of the world. Do people adapt their worldview in response to only external stimuli? Through ethnographic fieldwork including participant observations and active semi-structured interviews with 53 participants, this paper identifies a classification of four modes of habitus adaptation: (1) Understanding and appreciating the field and its conditions, (2) Challenging core beliefs systems, (3) Applying a practical sense to ‘objective possibilities’, and, (4) Challenging non-reflective dispositions. We argue that charting the modes of habitus adaptation could help policymakers understand the change processes of informal entrepreneurs in the tourism sector and their willingness to change.
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