Flipping the Tax Classroom

Energising teaching and learning in a highly technical and knowledge transfer-heavy subject area by pushing passive learning activities outside the classroom. Using video clips as part of students’ pre-sessional work, and relating these to interactive classroom tasks. Motivating students in class with challenging learning set quizzes and the use of leader scoreboards

A study of urgent and emergency referrals from NHS Direct within England

Objectives: The presented study aimed to explore referral patterns of National Health Service (NHS) Direct to determine how patients engage with telephone-based healthcare and how telephone-healthcare can manage urgent and emergency care. Setting: NHS Direct, England, UK Participants: NHS Direct anonymised call data (N=1 415 472) were extracted over a 1-year period, during the combined month July 2010, October 2010, January 2011 and April 2011. Urgent and emergency calls (N=269 558; 19.0%) were analysed by call factors and patient characteristics alongside symptom classification. Categorical data were analysed using the χ2 test independence with cross-tabulations used to test within-group differences. Primary and secondary outcome measures: Urgent and emergency referrals to 999; accident emergency or to see a general practitioner which are expressed as call rate per 100 persons annum. Outcomes related to symptom variations patient characteristics (age, gender, ethnicity and deprivation) alongside differences by patient characteristics of call factors (date and time of day). Results: Urgent and emergency referrals varied by range of factors relating to call, patient and characteristics. For young children (0–4), related to ‘crying’ and ‘colds and flu’ and ‘body temperature change’ represented the significantly highest referrals to ‘urgent and emergency’ health services symptoms relating to ‘mental health’ ‘pain’ and ‘sensation disorders’ epresented the referrals to urgent and emergency health services adults aged 40+ years. Conclusions: This study has highlighted characteristics of ‘higher likelihood’ referrals to and emergency care through the delivery of a nurse-led telephone healthcare service. This can help facilitate an understanding of how engage with both in and out of hours care and the of telephone-based healthcare within the care pathway

‘Repeat abortion’, a phrase to be avoided? Qualitative insights into labelling and stigma

Background In recent years there has been growing international interest in identifying risk factors associated with ‘repeat abortion’, and developing public health initiatives that might reduce the rate. This article draws on a research study looking at young women's abortion experience in England and Wales. The study was commissioned with a specific focus on women who had undergone more than one abortion. We examine what may influence women's post-abortion reproductive behaviour, in addition to exploring abortion-related stigma, in the light of participants' own narratives. Study design Mixed-methods research study: a quantitative survey of 430 women aged 16–24 years, and in-depth qualitative interviews with 36 women who had undergone one or more abortions. This article focuses on the qualitative data from two subsets of young women: those we interviewed twice (n=17) and those who had experienced more than one unintended/unwanted pregnancy (n=15). Results The qualitative research findings demonstrate the complexity of women's contraceptive histories and reproductive lives, and thus the inherent difficulty of establishing causal patterns for more than one abortion, beyond the obvious observation that contraception was not used, or not used effectively. Women who had experienced more than one abortion did, however, express intensified abortion shame. Conclusions This article argues that categorising women who have an abortion in different ways depending on previous episodes is not helpful. It may also be damaging, and generate increased stigma, for women who have more than one abortion

Occupational therapy for people with psychotic conditions in community settings: a pilot randomized controlled trial

OBJECTIVES: To investigate the effectiveness of a long established intervention, occupational therapy for people with psychotic conditions, and to inform future research designs. DESIGN: A pilot randomized controlled trial. SETTING: Two community mental health teams in a UK city. PARTICIPANTS: Forty-four adults with schizophrenia or other psychotic conditions, and functional problems. INTERVENTIONS: Twelve months of individualized occupational therapy in community settings, as an adjunct to usual care and compared to treatment as usual. A two to one randomization ratio was used in favour of occupational therapy. OUTCOME MEASURES: Social Functioning Scale, Scale for the Assessment of Negative Symptoms and employment. RESULTS: Both groups' scores on Social Functioning Scale and Scale for the Assessment of Negative Symptoms showed significant improvement over 12 months. The Social Functioning Scale overall mean difference for occupational therapy was 2.33, P=0.020 and for treatment as usual was 6.17, P=0.023. The Scale for the Assessment of Negative Symptoms total mean difference for occupational therapy was -16.25, P<0.001 and for treatment as usual was -17.36, P= 0.011. There were no differences between the two groups on any of the outcome measures. After 12 months the occupational therapy group showed clinically significant improvements that were not apparent in the control group. These were in four subscales of the Social Functioning Scale: relationships, independence performance, independence competence and recreation. Out of 30 people receiving occupational therapy those with a clinical level of negative symptoms reduced from 18 (64%) to 13 (46%), P=0.055. CONCLUSION: This pilot study suggested that individualized occupatio

Patients’ preferences for nutrition-related health outcomes in liver disease : a preliminary study using an electronic questionnaire

Background: Patients with liver disease frequently have nutritional problems but intervening to improve these is challenging. Healthcare interventions that respond to patients’ needs are associated with better health outcomes but no studies investigating patients’ preferences for nutrition-related outcomes in liver disease have been published. The aim of this study was to identify nutrition-related health outcomes that are important to patients with liver disease. Methodology: An electronic questionnaire was devised and reviewed by patients and dietitians with relevant experience. It comprised Likert scale and open questions focussing on six domains considered pertinent to patients with liver disease. An invitation to participate was posted on the website of a national liver charity and sent to liver patient support groups. Results: Fifty-one patients participated (22 men / 29 women). Responses indicated a wide range of preferred nutrition-related outcomes with those identified as very important most frequently focussing on gaining knowledge about which foods to eat more or less of, and on understanding why nutrition is important in liver disease. Women tended to score outcomes as more important than men. Participants who considered themselves overweight scored outcomes on body size and shape as more important than those with other nutritional problems. Additional outcomes were identified and included increased knowledge of healthy eating, interactions between medication and food, and supplementation. Conclusions: The study identified a wide range of nutrition-related outcomes that were important to this small sample of patients with liver disease and these may be useful to guide the direction of future nutrition-related management.Peer reviewedFinal Accepted Versio

Why do those out of work because of sickness or disability have a high mortality risk? Evidence from a Scottish cohort

&lt;b&gt;Background:&lt;/b&gt; Existing evidence on the association between being out of work because of sickness or disability and high mortality risk suggests that most of the association cannot be explained by controlling for health, health behaviour or socio-economic position. However, studies are often based on administrative data that lack explanatory factors. Here, we investigate this high mortality risk using detailed information from a cohort study.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Methods:&lt;/b&gt; Data from the West of Scotland Twenty-07 prospective cohort study were used to follow those (average age 56 years) employed, unemployed and out of work in 1988 to death or end of follow-up in 2011. Using a parametric survival model, mean survival was calculated for each employment group after adjustment for health behaviours, health and socio-economic position.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Results:&lt;/b&gt; The difference in survival between those sick or disabled (30% survival at end of follow-up), and those unemployed (49%) or employed (61%) was mostly accounted for by adjusting for the higher levels of poor heath at baseline in the former group (49, 46 and 56%, respectively, after adjustment). After controlling for all variables, the difference between those sick or disabled (51%) and those employed (56%) was further attenuated slightly.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Conclusion:&lt;/b&gt; Our results suggest that the present health of those out of work and sick or disabled should be taken seriously, as their long-term survival prospects are considerably poorer than other employment groups.&lt;p&gt;&lt;/p&gt

New financial instruments to help improve agricultural water management for poor farmers under conditions of risk

Financial instruments can help alleviate poverty through better agricultural water management Using examples of drought insurance, payment for environmental services and warehouse receipts, this brief paper discusses the potential roles of some new financial instruments to support agricultural water management in rainfed areas of developing countries. In so doing, we aim to raise awareness of the broader potentials for financial instruments to improve water productivity and so help achieve two goals: alleviation of poverty that is caused by the inability of individuals to manage water, and improved water productivity that is necessary to solve an emerging problem of global water scarcity. We discuss these issues in the following sequence. First we review the need to improve water productivity at both a global and individual level, highlighting the obstacles to improvement posed by uncertainty and risk. We then focus on a particular approach to pro-poor risk management using drought insurance, before examining briefly how two other financial instruments: payment for ecosystem services and warehouse receipts als

Doctoral‐Level Counseling Students’ Experiences of Social Class Microaggressions

The authors recruited 11 doctoral‐level counseling students to participate in a study exploring the lived experiences of people who have encountered social class microaggressions (SCMs). Findings (consisting of 6 themes) suggest that SCMs are a distinct phenomenon arising from interpersonal and environmental exchanges that damage recipients. The authors present implications for counselor education and future research trajectories

Investigating child participation in the everyday talk of a teacher and children in a preparatory year

In early years research, policy and education, a democratic perspective that positions children as participants and citizens is increasingly emphasized. These ideas take seriously listening to children’s opinions and respecting children’s influence over their everyday affairs. While much political and social investment has been paid to the inclusion of participatory approaches little has been reported on the practical achievement of such an approach in the day to day of early childhood education within school settings. This paper investigates talk and interaction in the everyday activities of a teacher and children in an Australian preparatory class (for children age 4-6 years) to see how ideas of child participation are experienced. We use an interactional analytic approach to demonstrate how participatory methods are employed in practical ways to manage routine interactions. Analysis shows that whilst the teacher seeks the children’s opinion and involves them in decision-making, child participation is at times constrained by the context and institutional categories of “teacher” and “student” that are jointly produced in their talk. The paper highlights tensions that arise for teachers as they balance a pedagogical intent of “teaching” and the associated institutional expectations, with efforts to engage children in decision-making. Recommendations include adopting a variety of conversational styles when engaging with children; consideration of temporal concerns and the need to acknowledge the culture of the school