Multiplex PCR for gastrointestinal parasites in stool: Benchmarking against direct microscopy and simplex PCR.

PURPOSE: To develop and validate a multiplex conventional PCR assay to simultaneously detect Cryptosporidium spp., Entamoeba histolytica, and Giardia lamblia in diarrheal samples as a rapid, cost-effective, and sensitive diagnostic tool for prevalent co-infections for improved diagnostic accuracy and efficiency in resource-limited settings. METHODS: Stool samples collected from patients with gastrointestinal symptoms after taking written consent, processed via wet mount, iodine mount, and PCR assays. Cohen's kappa statistical analysis was done to test agreement. RESULT: Among 240 patients, 28.75% showed intestinal protozoa via Microscopy; Single-plex and multiplex PCR demonstrated 100% concordance, detecting 27.9%; confirmed by sequencing. Highest parasite positivity was observed in transplant and immunocompromised patients, with moderate to almost perfect agreement between microscopy and molecular methods. CONCLUSION: Multiplex-conventional PCR offers superior sensitivity and specificity over microscopy and 100% concordance with single-plex PCR, enabling rapid, cost-effective diagnosis of multiple parasites from single stool sample. Its adoption could revolutionize parasitic infection management in routine diagnostics.

Factors contributing to diabetic ketoacidosis readmission in hospital settings in the United States: A scoping review.

BACKGROUND: Hospitalization of patients with DKA creates a significant burden on the US healthcare system. While previous studies have identified multiple potential contributors, a comprehensive review of the factors leading to DKA readmissions within the US healthcare system has not been done. This scoping review aims to identify how access to care, treatment adherence, socioeconomic status, race, and ethnicity impact DKA readmission-related patient morbidity and mortality and contribute to the socioeconomic burden on the US healthcare system. Additionally, this study aims to integrate current recommendations to address this multifactorial issue, ultimately reducing the burden at both individual and organizational levels. METHODS: The PRISMA-SCR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) was used as a reference checklist throughout this study. The Arksey and O'Malley methodology was used as a framework to guide this review. The framework methodology consisted of five steps: (1) Identify research questions; (2) Search for relevant studies; (3) Selection of studies relevant to the research questions; (4) Chart the data; (5) Collate, summarize, and report the results. RESULTS: A total of 15 articles were retained for analysis. Among the various social factors identified, those related to sex/gender (n = 9) and age (n = 9) exhibited the highest frequency. Moreover, race and ethnicity (n = 8) was another recurrent factor that appeared in half of the studies. Economic factors were also identified in this study, with patient insurance type having the highest frequency (n = 11). Patient income had the second highest frequency (n = 6). Multiple studies identified a link between patients of a specific race/ethnicity and decreased access to treatment. Insufficient patient education around DKA treatment was noted to impact treatment accessibility. Certain recommendations for future directions were highlighted as recurrent themes across included studies and encompassed patient education, early identification of DKA risk factors, and the need for a multidisciplinary approach using community partners such as social workers and dieticians to decrease DKA readmission rates in diabetic patients. CONCLUSION: This study can inform future policy decisions to improve the accessibility, affordability, and quality of healthcare through evidence-based interventions for patients with DM following an episode of DKA.

Lateral redox variability in ca. 1.9 Ga marine environments indicated by organic carbon and nitrogen isotope compositions.

The stepwise oxygenation of Earth's surficial environment is thought to have shaped the evolutionary history of life. Microfossil records and molecular clocks suggest eukaryotes appeared during the Paleoproterozoic, perhaps shortly after the Great Oxidation Episode at ca. 2.43 Ga. The mildly oxygenated atmosphere and surface oceans likely contributed to the early evolution of eukaryotes. However, the principal trigger for the eukaryote appearance and a potential factor for their delayed expansion (i.e., intermediate ocean redox conditions until the Neoproterozoic) remain poorly understood, largely owing to a lack of constraints on marine and terrestrial nutrient cycling. Here, we analyzed redox-sensitive element contents and organic carbon and nitrogen isotope compositions of relatively low metamorphic-grade (greenschist facies) black shales preserved in the Flin Flon Belt of central Canada to examine open-marine redox conditions and biological activity around the ca. 1.9 Ga Flin Flon oceanic island arc. The black shale samples were collected from the Reed Lake area in the eastern part of the Flin Flon Belt, and the depositional site was likely distal from the Archean cratons. The black shales have low Al/Ti ratios and are slightly depleted in light rare-earth elements relative to the post-Archean average shale, which is consistent with a limited contribution from felsic igneous rocks in Archean upper continental crust. Redox conditions have likely varied between suboxic and euxinic at the depositional site of the studied section, as suggested by variable U/Al and Mo/Al ratios. Organic carbon and nitrogen isotope compositions of the black shales are approximately -23‰ and +13.7‰, respectively, and these values are systematically higher than those of broadly coeval continental margin deposits (approximately -30‰ for δ13Corg and +5‰ for δ15Nbulk). These elevated values are indicative of high productivity that led to enhanced denitrification (i.e., a high denitrification rate relative to nitrogen influx at the depositional site). Similar geochemical patterns have also been observed in the modern Peruvian oxygen minimum zone where dissolved nitrogen compounds are actively lost from the reservoir via denitrification and anammox, but the large nitrate reservoir of the deep ocean prevents exhaustion of the surface nitrate pool. Nitrogen must have been widely bioavailable in the ca. 1.9 Ga oceans, and its supply to upwelling zones must have supported habitable environments for eukaryotes, even in the middle of oceans around island arcs.

The Impact and Challenges of the Implementation of 5S Methodology in Healthcare Settings: A Systematic Review.

The 5S methodology, rooted in lean manufacturing principles, has been adopted in healthcare settings to improve organization, efficiency, and quality. This systematic review aimed to synthesize the literature on the implementation of the 5S methodology in healthcare, its impact, and factors influencing successful implementation. A comprehensive literature search was conducted in PubMed, Google Scholar, and Cochrane databases for original studies on the implementation of the 5S methodology in healthcare settings. Studies were screened based on inclusion and exclusion criteria, and data were extracted on study characteristics, implementation details, outcomes, and key findings. Six studies met the inclusion criteria, spanning various healthcare settings, including hospitals, clinics, and laboratories. The studies reported positive outcomes associated with implementing the 5S methodology, such as improved workplace organization and cleanliness, increased utilization of healthcare services, enhanced staff satisfaction and motivation, and reduced waste and non-conformities. Critical success factors included commitment from top management, staff involvement, continuous monitoring, and adequate training. However, challenges were noted, including limited resources, small sample sizes, and difficulty assessing long-term sustainability. The implementation of the 5S methodology in healthcare settings can lead to improved organization, efficiency, and quality. However, successful implementation requires addressing critical factors such as leadership commitment, staff engagement, continuous monitoring, and training. Future research should focus on larger-scale implementation studies, long-term assessments, quantitative and qualitative evaluations, and cost-effectiveness analyses to strengthen the evidence base and inform best practices.

Dry Swabs and Dried Saliva as Alternative Samples for SARS-CoV-2 Detection in Remote Areas in Lao PDR.

Background: Surveillance of SARS-CoV-2 circulation is mainly based on real-time reverse transcription-polymerase chain reaction, which requires laboratory facilities and cold chain for sample transportation. This is difficult to achieve in remote rural areas of resource-limited settings. The use of dried blood spots shipped at room temperature has shown good efficiency for the detection of arboviral RNA. Using a similar approach, we conducted a study at 3 provincial hospitals in Laos to compare the detection of SARS-CoV-2 from neat and dried spot samples. Methods: Between January 2022 and March 2023, patients with respiratory symptoms were recruited. Nasopharyngeal/oropharyngeal swabs in virus transport medium (VTM), dry swabs, saliva, and dried saliva spotted on filter paper were collected. All samples were tested by SARS-CoV-2 real-time reverse transcription-polymerase chain reaction. Results: In total, 479 participants were included. The VTM samples tested positive for 288 (60.1%). High positive percent agreements were observed for dry swab (84.8%; 95% CI, 80.2%-88.8%) and saliva (89.2%; 95% CI, 85.1%-92.6%) as compared with VTM. There was a loss of sensitivity when saliva was dried on filter paper (73.6%; 95% CI, 68.1%-78.6%) as compared with saliva. SARS-CoV-2 variant (Delta or Omicron) had no significant impact on the performance of the different sample types. Conclusions: Our findings suggest that dry swabs could be a good alternative for sample collection and permit easy shipping at ambient temperature for subsequent viral SARS-CoV-2 RNA purification and molecular investigation. This is a useful tool to consider for a rapid implementation of large-scale surveillance of SARS-CoV-2 in remote areas, which could be extrapolated to other respiratory targets during routine surveillance or in the case of a novel emerging pandemic.

Artificial Intelligence (AI) Applications for Point of Care Ultrasound (POCUS) in Low-Resource Settings: A Scoping Review.

Advancements in artificial intelligence (AI) for point-of-care ultrasound (POCUS) have ushered in new possibilities for medical diagnostics in low-resource settings. This review explores the current landscape of AI applications in POCUS across these environments, analyzing studies sourced from three databases-SCOPUS, PUBMED, and Google Scholars. Initially, 1196 records were identified, of which 1167 articles were excluded after a two-stage screening, leaving 29 unique studies for review. The majority of studies focused on deep learning algorithms to facilitate POCUS operations and interpretation in resource-constrained settings. Various types of low-resource settings were targeted, with a significant emphasis on low- and middle-income countries (LMICs), rural/remote areas, and emergency contexts. Notable limitations identified include challenges in generalizability, dataset availability, regional disparities in research, patient compliance, and ethical considerations. Additionally, the lack of standardization in POCUS devices, protocols, and algorithms emerged as a significant barrier to AI implementation. The diversity of POCUS AI applications in different domains (e.g., lung, hip, heart, etc.) illustrates the challenges of having to tailor to the specific needs of each application. By separating out the analysis by application area, researchers will better understand the distinct impacts and limitations of AI, aligning research and development efforts with the unique characteristics of each clinical condition. Despite these challenges, POCUS AI systems show promise in bridging gaps in healthcare delivery by aiding clinicians in low-resource settings. Future research endeavors should prioritize addressing the gaps identified in this review to enhance the feasibility and effectiveness of POCUS AI applications to improve healthcare outcomes in resource-constrained environments.

Effectiveness of pharmacist-led antimicrobial stewardship programs in perioperative settings: A systematic review and meta-analysis.

OBJECTIVE: We sought to characterize and evaluate the effectiveness of pharmacist-led AMS interventions in improving antimicrobial use and subsequent surgical site infections (SSI) in perioperative settings. METHODS: A systematic review and meta-analysis was conducted by searching PubMed, Embase and CINAHL. Two independent reviewers extracted the data using the Descriptive Elements of Pharmacist Intervention Characterization Tool and undertook quality assessment using the Crowe Critical Appraisal. A meta-analysis was conducted using a random-effect model. RESULTS: Eleven studies were included in this review. Pharmacists were found to have various roles in AMS, including educational sessions, ward rounds, audits and feedback, and guidelines development. The discussion of interventions lacked details on the development. A meta-analysis revealed that pharmacist-led AMS programs in perioperative settings was associated with a significant improvement in antibiotic selection (OR 4.29; 95 % CI 2.52-7.30), administration time (OR 4.93; 95 % CI 2.05-11.84), duration (OR 5.27; 95 % CI 1.58-17.55), and SSI (OR 0.51; 95 % CI 0.34-0.77). CONCLUSION: Pharmacist-led AMS programs were effective in improving antimicrobial prescribing while reducing SSI; however most studies were of moderate quality. Studies lacked the utilization of theory to develop interventions, therefore, it is not clear whether theory-derived interventions are more effective than those without a theoretical element. High-quality, multicomponent, theory-derived, interventional studies using appropriate methodology and standardized data collection, are needed.

Attending to Persons with Intellectual and/or Other Developmental Disorders in Crisis Settings.

Crisis response is growing across the United States with increasingly broad phone, text, and chat response systems that lead to triaging callers who may be in need of further outreach. This might include deploying a mobile crisis response team and/or referring a caller to a crisis stabilization unit. The information set forth earlier aims to help advance the field and individual practices to ensure that persons with intellectual and/or other developmental disorders receive equivalent care and treatment with information that helps focus on this population's unique features and needs.

Infection Rates and Symptomatic Proportion of SARS-CoV-2 and Influenza in Pediatric Population, China, 2023.

We conducted a longitudinal cohort study of SARS-CoV-2 and influenza rates in childcare centers and schools in Wuxi, China, collecting 1,760 environmental samples and 9,214 throat swabs from 593 students (regardless of symptoms) in weekly collections during February-June 2023. We estimated a cumulative infection rate of 124.8 (74 episodes)/1,000 persons for SARS-CoV-2 and 128.2 (76 episodes)/1,000 persons for influenza. The highest SARS-CoV-2 infection rate was in persons 18 years of age, and for influenza, in children 4 years of age. The asymptomatic proportion of SARS-CoV-2 was 59.6% and 66.7% for influenza; SARS-CoV-2 symptomatic proportion was lower in 16-18-year-olds than in 4-6-year-olds. Only samples from frequently touched surface tested positive for SARS-CoV-2 (4/1,052) and influenza (1/1,052). We found asynchronous circulation patterns of SARS-CoV-2 and influenza, similar to trends in national sentinel surveillance. The results support vaccination among pediatric populations and other interventions, such as environmental disinfection in educational settings.

Surgical mentorship in low-resource environments: Opportunities and challenges, a perspective.

Background and aims: In low- and middle-income countries (LMICs), a shortage of skilled surgical practitioners hampers healthcare delivery, impacting well-being and economic growth. Surgical mentorship programs offer a promising solution but face challenges in implementation. This review aims to comprehensively assess the impact of surgical mentorship programs in LMICs and identify challenges and opportunities for their development and implementation. Methods: A thorough literature search was conducted from 2000 to 2023 using multiple databases, focusing on surgical mentorship programs in LMICs. Inclusion criteria encompassed full-text articles in English that demonstrated characteristics of mentorship. Rigorous exclusion criteria were applied to ensure high-quality evidence inclusion. Results: Surgical mentorship programs in LMICs strengthen local surgical capacity, improve surgical skills and patient outcomes, optimize resources and technology utilization, and positively impact medical students aspiring to be surgeons. However, challenges such as resistance to change, resource limitations, financial constraints, logistical and technological challenges, and time constraints hinder their implementation. Conclusion: Despite challenges, surgical mentorship programs hold promise for enhancing surgical capacity and healthcare quality in LMICs. Standardized metrics for accountability, innovative funding mechanisms, collaborative partnerships for scalability, interdisciplinary integration, and leveraging virtual mentorship programs are key strategies to overcome challenges and foster sustainable learning cultures, ultimately contributing to improved healthcare equity and quality in low-resource settings.

Chronic hepatitis B virus infection in Eastern Ethiopia: Clinical characteristics and determinants of cirrhosis.

BACKGROUND: Chronic hepatitis B (CHB) virus infection is a major cause of liver-associated morbidity and mortality, particularly in low-income countries. A better understanding of the epidemiological, clinical, and virological characteristics of CHB will guide appropriate treatment strategies and improve the control and management of CHB in Ethiopia. AIM: To investigate the characteristics of CHB in Eastern Ethiopia and assess the efficacy and safety of antiviral treatment. METHODS: This cohort study included 193 adults who were human immunodeficiency virus-negative with CHB between June 2016 and December 2019. Baseline assessments included chemistry, serologic, and viral markers. χ 2 tests, Mann-Whitney U tests, and logistic regression analyses were used to identify the determinants of cirrhosis. Tenofovir disoproxil fumarate (TDF) was initiated using treatment criteria from the Ethiopian CHB pilot program. RESULTS: A total of 132 patients (68.4%) were men, with a median age of 30 years [interquartile range (IQR): 24-38]. At enrollment, 60 (31.1%) patients had cirrhosis, of whom 35 (58.3%) had decompensated cirrhosis. Khat use, hepatitis B envelope antigen positivity, and a high viral load were independently associated with cirrhosis. Additionally, 66 patients (33.4%) fulfilled the treatment criteria and 59 (30.6%) started TDF. Among 29 patients who completed 24 months of treatment, the median aspartate aminotransferase to platelet ratio index declined from 1.54 (IQR: 0.66-2.91) to 1.10 (IQR: 0.75-2.53) (P = 0.002), and viral suppression was achieved in 80.9% and 100% of patients after 12 months and 24 months of treatment, respectively. Among the treated patients, 12 (20.3%) died within the first 6 months of treatment, of whom 8 had decompensated cirrhosis. CONCLUSION: This study highlights the high prevalence of cirrhosis, initial mortality, and the efficacy of TDF treatment. Scaling up measures to prevent and control CHB infections in Ethiopia is crucial.

Generative Artificial Intelligence: Enhancing Patient Education in Cardiovascular Imaging.

Cardiovascular disease (CVD) is a major cause of mortality worldwide, especially in resource-limited countries with limited access to healthcare resources. Early detection and accurate imaging are vital for managing CVD, emphasizing the significance of patient education. Generative artificial intelligence (AI), including algorithms to synthesize text, speech, images, and combinations thereof given a specific scenario or prompt, offers promising solutions for enhancing patient education. By combining vision and language models, generative AI enables personalized multimedia content generation through natural language interactions, benefiting patient education in cardiovascular imaging. Simulations, chat-based interactions, and voice-based interfaces can enhance accessibility, especially in resource-limited settings. Despite its potential benefits, implementing generative AI in resource-limited countries faces challenges like data quality, infrastructure limitations, and ethical considerations. Addressing these issues is crucial for successful adoption. Ethical challenges related to data privacy and accuracy must also be overcome to ensure better patient understanding, treatment adherence, and improved healthcare outcomes. Continued research, innovation, and collaboration in generative AI have the potential to revolutionize patient education. This can empower patients to make informed decisions about their cardiovascular health, ultimately improving healthcare outcomes in resource-limited settings.

Patient's Experiences of a Cognitive Behaviour Therapy Informed Crisis Intervention for Psychosis Delivered in Inpatient Settings: A Qualitative Exploration.

Cognitive behaviour therapy for psychosis (CBTp) should be offered to patients receiving psychiatric inpatient care, yet very little is known about patients' perspectives on this. The aim of this study was to examine patients' experiences of a CBTp-informed intervention delivered in inpatient settings. We recruited 10 participants from the intervention arm of a randomised controlled trial examining the feasibility and acceptability of a CBTp-informed intervention for psychiatric inpatient settings. We undertook semistructured interviews examining their experiences of the intervention and analysed them using thematic analysis. The study was conducted in partnership with a coproduction group of key stakeholders (people with lived experience, family and carers, and clinicians). The intervention was found helpful by almost all participants, and all participants would recommend it to others in similar situations to themselves. The results demonstrated that participants valued the therapist's professionalism and emphasised the importance of the therapeutic relationship. Participants highlighted the importance of the therapy focusing on navigating admission and developing skills to manage the crisis experience so they could return to their normal lives. Participants described challenges to having psychological therapy in the acute crisis context including therapy interruptions and ongoing distressing experiences of psychosis. The study demonstrated the importance of prioritising the therapeutic relationship, that therapy was a valued process to navigate admission and discharge, but that some environmental and patient-level challenges were present. Further research is needed to explore inpatients' experiences of psychological interventions in this setting. TRIAL REGISTRATION: ISRCTN trial registry: ISRCTN59055607.

Reclaiming behaviour settings: reviewing empirical applications of Barker's behaviour settings theory.

Behaviour settings theory is the product of Roger Barker and Herbert F. Wright's decades-long Midwest Field Station research programme. The theory followed from the demonstration that the best predictor of a person's behaviour was the setting (i.e. location, timing and activity) in which their behaviour took place, rather than any individual trait (e.g. personality). Now little known in psychology, behaviour settings theory is often further obscured by being presented as a theory only, neglecting the clear methodology Barker provided for investigating the question: 'What do people do in everyday life?' This literature review takes a comprehensive look at Barker's contributions both within and outside of psychology. The corpus comprises both theoretical and empirical articles; however, our primary interest is in the empirical articles. We describe the who, when and where of behaviour settings research over the past half-century, and we identify branches and neighbours of behaviour settings research (e.g. manning theory, behaviour mapping and activity settings theory). Primarily, however, we attempt to answer the following questions: (i) Are any of Barker's tools for studying people in everyday settings being used currently? (ii) How accurately has Barker's theory been explained, or his methods applied? (iii) Does such work contribute to behaviour settings theory in a meaningful way? This article is part of the theme issue 'People, places, things and communities: expanding behaviour settings theory in the twenty-first century'.

People, places, things and communities: expanding behaviour settings theory in the twenty-first century.

Trends and developments in recent behavioural and cognitive sciences demonstrate the need for a well-developed theoretical and empirical framework for examining the ecology of human behaviour. The increasing recognition of the role of the environment and interaction with the environment in the organization of behaviour within the cognitive sciences has not been met with an equally disciplined and systematic account of that environment (Heft 2018 Ecol. Psychol. 30, 99-123 (doi:10.1080/10407413.2018.1410045); McGann 2014 Synth. Philos. 29, 217-233). Several bodies of work in behavioural ecology, anthropology and ecological psychology provide some frameworks for such an account. At present, however, the most systematic and theoretically disciplined account of the human behavioural ecosystem is that of behaviour settings, as developed by the researchers of the Midwest Psychological Field Station (see Barker 1968 Ecological psychology: concepts and methods for studying the environment of human behavior). The articles in this theme issue provide a critical examination of these theoretical and methodological resources. The collection addresses their theoretical value in connecting with contemporary issues in cognitive science and research practice in psychology, as well as the importance of the methodological specifics of behaviour settings research. Additionally, articles diagnose limitations and identify points of potential extension of both theory and methods, particularly with regard to changes owing to the advance of technology, and the complex relationship between the individual and the collective in behaviour settings work. This article is part of the theme issue 'People, places, things, and communities: expanding behaviour settings theory in the twenty-first century'.

Enabling spaces for (varied) co-existence.

For people in homelessness, access to social services may appear difficult and alienating, which often contributes to poor health and a risk of accelerated marginalization. Historically, day centres for people in homelessness have been characterized by an emphasis on providing refuge and momentary restitution, accommodating urgent basic needs. In this article, we present a case study of the design of a new day centre in Denmark that aspires to move beyond the historical place-for-being. Rather, the new day centre is to be a place-for-being-and-becoming, focusing on bridging the varied needs of people in homelessness with easy access to social services at the day centre. This article explores the creation of new behaviour settings along with the challenges and considerations in designing enabling spaces for people in societally marginalized positions, concurrently offering and supporting a sense of inclusion, the possibility to develop one's agency and experience of lived citizenship. This article is part of the theme issue 'People, places, things, and communities: expanding behaviour settings theory in the twenty-first century'.

Places for reasoning.

In this article, we explore behaviour settings that enable reasoning and the diversity of constraints that not only limit but also make these behaviour settings possible. We focus specifically on reasoning and surveying how behaviour settings allow for the generation of norms of action that are nevertheless differentiated by geographies and sociocultural systems. These geographies and sociocultural systems involve diverse trajectories for reasoning even within similar behaviour settings. We will touch on places for reasoning like Twitter, social movements, traditional knowledge and laboratories set up for experimentation on our reasoning abilities. We will show how these places and the behaviour settings that emerge in them can be studied in terms of the complexity of the interactions between their participants and in terms of enabling constraints. This article is part of the theme issue 'People, places, things, and communities: expanding behaviour settings theory in the twenty-first century'.

Behaviour setting transformation methodology, filling in the gaps of the conventional architectural design process.

This article recounts 6 years of empirical research in a humanitarian context on spatial behaviour using the behaviour settings theory. This research journey details the shortcomings of conventional architectural processes and the subsequent development of a human-centred behaviour setting methodology that drives behaviour change for adaptable spaces. The research work puts Barker's theory of behaviour settings into practice to show its significant methodological abilities in shaping behaviours through spaces. While the original theory was solely an analytical account of existing behaviours in certain settings, this study marks the first pragmatic exploration of the theory into both residential and refugee contexts. The methodology that is subsequently proposed is a complementary tool to account for the deficiencies of conventional architectural design processes. A method that enables one to fully immerse themselves in the environment, recognize specific architectural interventions, assess their effects and reiterate. It is a proposal for humanizing architecture, sympathizing its processes and personalizing its results for the users of any space. This article is part of the theme issue 'People, places, things, and communities: expanding behaviour settings theory in the twenty-first century'.

Enactive behaviour settings: situating agency, normativity and transformation.

Behaviour settings are sociocultural places defined by three main ecological aspects: the affordances of material structures, typical patterns of skilful action and socially situated norms. These aspects explain the observed regularities of human behaviour associated with the material characteristics of places. However, the focus of ecological theories on how individual agents attune their actions to the pre-established order of behaviour settings neglects the agents' active role in sustaining or motivating transformations in this order. We therefore propose an alternative enactive approach to behaviour settings that accounts for the role of agents as active supporters and transformers of behaviour settings. Based on the enactive concepts of agency, normativity and dialectics, we argue that agents, as participants of behaviour settings, simultaneously respond to multiple normative dimensions (e.g. biological, sensorimotor and interactive). To sustain the order of behaviour settings, agents sometimes need to inhibit other normative responses of their bodies, which sometimes is detrimental to one or many aspects of their lives. Nonetheless, agents can collectively trigger the transformation of behaviour settings. This transformation can occur dialectically as tensions between two or more norms to which human bodies respond are resolved, even if new tensions arise and the process of changing behaviour setting continues. This article is part of the theme issue 'People, places, things and communities: expanding behaviour settings theory in the twenty-first century'.

Behaviour settings as a way to order types of situations for the study of speech aids.

This article revisits the notion of behaviour settings, coined by Roger G. Barker (Barker 1968, Ecol. Psychol. 28, 39-55 (10.1080/10407413.2016.1121744)), as a useful concept for the analysis of situations and communicative needs of persons after larynx removal surgery (laryngectomy). We claim that behaviour settings offer a way to characterize types of situations and types of participation, which, in turn, helps to identify aspects of communication where compensation is needed; these steps are crucial in the design process of reliable and context-sensitive speech aids. Moreover, we advocate complementing the behaviour setting concept as a unit of analysis with modern developments in the cognitive sciences, such as conversational analysis of co-operative actions (Goodwin 2017, Co-operative action (learning in doing: social, cognitive and computational perspectives). Cambridge: Cambridge University Press (10.1017/9781139016735)) and the analysis of multi-perspectival experience (De Jaegher 2021, Phenomenol. Cogn. Sci. 20, 847-870 (10.1007/s11097-019-09634-5)). Such an integration of macro- and micro-level patterns should help discover the relevant relations and values in particular situations. We illustrate our claims with examples from Barker's own work and from our ongoing analyses of the everyday life of persons after laryngectomy. This article is part of the theme issue 'People, places, things, and communities: expanding behaviour settings theory in the twenty-first century'.