Thalidomide upper limb embryopathy - : pathogenesis, past and present management and future considerations

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The role of intergenerational relationships in challenging educational inequality : improving participation of working-class pupils in higher education

Analysis of data on school leavers in the UK points to considerable inequality in access to higher education. This is particularly acute in Scotland where access to the most competitive courses remains extremely difficult for those young people who are first in their generation to try and enter university or from low-income households. Programs to address this issue have had varied approaches framed around policy ambitions to “close the attainment gap” or “raise aspirations.” However, research has argued that these approaches have largely conceptualized the problem at an individual rather than structural level (Cummings et al., 2012; Gorard, Beng, & Davies, 2012). The Intergenerational Mentoring Network is an ongoing research and development project which recruits retired professionals as volunteer mentors and matches them with 15–18 year old secondary school pupils from lower-income areas of the city. This paper draws from research within this project to demonstrate the difficulties these young people face surrounding their interaction with very different social and cultural worlds, of which they have limited understanding and very restricted access. The paper illuminates the crucial role that intergenerational relationships can play in supporting young people in their journey into higher education. These are roles that, collectively, are enabling more young people to move into university and professional careers and through increasing social mobility are challenging inequality

Mentor suitability and mentoring relationship quality : lessons from the Glasgow Intergenerational Mentoring Network

The research literature on mentoring is diverse, draws mainly on studies from the US and spans youth, academic and workplace mentoring (Eby et al, 2010). School-based mentoring programmes targeted at socially disadvantaged young people vary from those employing peer mentors, older students and adults of different ages, and show modest positive impacts on outcomes such as truancy, misconduct and academic abilities (Rhodes et al., 2005). A meta-analysis of 73 US mentoring programmes (DuBois et al, 2011) suggested overall effectiveness showing positive outcomes for young people across social, emotional, academic and behavioural domains, and positioning mentoring as having equal effectiveness compared with other forms of youth intervention. Furthermore, the findings showed that young people not engaged in mentoring declined over time on similar outcomes

Widening the gap? The challenges for equitable music education in Scotland

Exposure to and potential to engage in music is now very different for children and young people from more middle class and affluent backgrounds compared to those from working class or poor households. Middle class children and young people have access to opportunities to learn an instrument and engage in performance, predominantly for intrinsic reward and on occasion as the basis of a future career. Children and young people from more working class or poor backgrounds are more likely to be excluded from these opportunities and are less likely to take advantage of opportunities within the wider world of music industries. This research draws on in depth case studies of three local authorities in Scotland to reveal the ways in which local provision for music education is largely being re-shaped by economic factors and restraints. Drawing on aspects of critical theory it discusses the ways in which economic based decisions are interacting with the dominant social and cultural values to influence provision. It makes the argument that in an era of austerity the social and cultural values of the middle class are dominant and effectively increasing inequality in access to music. Children and young people from poor or working class households are increasingly excluded from opportunities to engage with formal music provision

How are patients with rare diseases and their carers in the UK impacted by the way care is coordinated? An exploratory qualitative interview study.

BACKGROUND: Care coordination is considered important for patients with rare conditions, yet research addressing the impact of care coordination is limited. This study aimed to explore how care coordination (or lack of) impacts on patients and carers. Semi-structured interviews were conducted with 15 patients and carers/parents in the UK, representing a range of rare conditions (including undiagnosed conditions). Transcripts were analysed thematically in an iterative process. RESULTS: Participants described a range of experiences and views in relation to care coordination. Reports of uncoordinated care emerged: appointments were uncoordinated, communication between key stakeholders was ineffective, patients and carers were required to coordinate their own care, and care was not coordinated to meet the changing needs of patients in different scenarios. As a result, participants experienced an additional burden and barriers/delays to accessing care. The impacts described by patients and carers, either attributed to or exacerbated by uncoordinated care, included: impact on physical health (including fatigue), financial impact (including loss of earnings and travel costs), and psychosocial impact (including disruption to school, work and emotional burden). Overall data highlight the importance of flexible care, which meets individual needs throughout patients'/carers' journeys. Specifically, study participants suggested that the impacts may be addressed by: having support from a professional to coordinate care, changing the approach of clinics and appointments (where they take place, which professionals/services are available and how they are scheduled), and improving communication through the use of technology, care plans, accessible points of contact and multi-disciplinary team working. CONCLUSION: This study provides further evidence of impacts of uncoordinated care; these may be complex and influenced by a number of factors. Approaches to coordination which improve access to care and lessen the time and burden placed on patients and carers may be particularly beneficial. Findings should influence future service developments (and the evaluation of such developments). This will be achieved, in the first instance, by informing the CONCORD Study in the UK

Why invent the handle? Electromyography (EMG) and efficiency of use data investigating the prehistoric origin and selection of hafted stone knives

Abstract: For over 3 million years hominins held stone-cutting tools in the hand, gripping the portion of tool displaying a sharp cutting edge directly. During the late Middle Pleistocene human populations started to produce hafted composite knives, where the stone element displaying a sharp cutting edge was secured in a handle. Prevailing archaeological literature suggests that handles convey benefits to tool users by increasing cutting performance and reducing musculoskeletal stresses, yet to date these hypotheses remain largely untested. Here, we compare the cutting performance of hafted knives, ‘basic’ flake tools, and large bifacial tools during two standardized cutting tasks. Going further, we examine the comparative ergonomics of each tool type through electromyographic (EMG) analysis of nine upper limb muscles. Results suggest that knives (1) recruit muscles responsible for digit flexion (i.e. gripping) and in-hand manipulation relatively less than alternative stone tool types and (2) may convey functional performance benefits relative to unhafted stone tool alternatives when considered as a generalised cutting tool. Furthermore, our data indicate that knives facilitate greater muscle activity in the upper arm and forearm, potentially resulting in the application of greater cutting forces during tool use. Compared to unhafted prehistoric alternatives, hafted stone knives demonstrate increased ergonomic properties and some functional performance benefits. These factors would likely have contributed to the invention and widespread adoption of hafted stone knives during the late Middle Pleistocene

Development of models of care coordination for rare conditions: a qualitative study.

INTRODUCTION: Improving care coordination for people with rare conditions may help to reduce burden on patients and carers and improve the care that patients receive. We recently developed a taxonomy of different ways of coordinating care for rare conditions. It is not yet known which models of care coordination are appropriate in different situations. This study aimed to: (1) explore what types of care coordination may be appropriate in different situations, and (2) use these findings to develop hypothetical models of care coordination for rare conditions. METHODS: To explore appropriateness of different types of care coordination, we conducted interviews (n = 30), four focus groups (n = 22) and two workshops (n = 27) with patients, carers, healthcare professionals, commissioners, and charity representatives. Participants were asked about preferences, benefits and challenges, and the factors influencing coordination. Thematic analysis was used to develop hypothetical models of care coordination. Models were refined following feedback from workshop participants. RESULTS: Stakeholders prefer models of care that: are nationally centralised or a hybrid of national and local care, involve professionals collaborating to deliver care, have clear roles and responsibilities outlined (including administrative, coordinator, clinical and charity roles), provide access to records and offer flexible appointments (in terms of timing and mode). Many factors influenced coordination, including those relating to the patient (e.g., condition complexity, patient's location and ability to coordinate their own care), the healthcare professional (e.g., knowledge and time), the healthcare environment (e.g., resources) and societal factors (e.g., availability of funding). We developed and refined ten illustrative hypothetical models of care coordination for rare conditions. CONCLUSION: Findings underline that different models of care coordination may be appropriate in different situations. It is possible to develop models of care coordination which are tailored to the individual in context. Findings may be used to facilitate planning around which models of care coordination may be appropriate in different services or circumstances. Findings may also be used by key stakeholders (e.g. patient organisations, clinicians and service planners) as a decision-making tool

Accuracy of staging of oral squamous cell carcinoma of the tongue: should incisional biopsy be done before or after magnetic resonance imaging?

Accurate staging of oral squamous cell carcinoma (oral SCC) is essential. Some clinicians delay diagnostic biopsy until after magnetic resonance imaging (MRI). We retrospectively studied the clinical records and histopathological databases of 58 patients with SCC of the tongue; 39 had biopsy before MRI and 19 afterwards. In the group who had the biopsy first, eight were up-staged, nine were down-staged, and in 22 the T stage was accurate. In those who had MRI first, the corresponding figures were two, six, and 11, respectively. The time between initial biopsy and excision was significantly longer in the MRI group (43 days), than in the biopsy group (16 days) (p<0.001). Differences in staging between the two groups were not significant. Whether the biopsy was taken before or after MRI does not seem to affect the accuracy of clinical staging, and to delay biopsy until after staging may be unnecessary