‘We don't have recipes; we just have loads of ingredients’: explanations of evidence and clinical decision making by speech and language therapists

Rationale, aims and objectives: Research findings consistently suggest that speech and language therapists (SLTs) are failing to draw effectively on research-based evidence to guide clinical practice. This study aimed to examine what constitutes the reasoning provided by SLTs for treatment choices and whether science plays a part in those decisions. Method: This study, based in Ireland, reports on the qualitative phase of a mixed-methods study, which examined attitudes underpinning treatment choices and the therapy process. SLTs were recruited from community, hospital and disability work settings via SLT managers who acted as gatekeepers. A total of three focus groups were run. Data were transcribed, anonymized and analysed using thematic analysis. Results: In total, 48 participants took part in the focus groups. The majority of participants were female, represented senior grades and had basic professional qualifications. Three key themes were identified: practice imperfect; practice as grounded and growing; and critical practice. Findings show that treatment decisions are scaffolded primarily on practice evidence. The uniqueness of each patient results in dynamic and pragmatic practice, constraining the application of unmodified therapies. Conclusion: The findings emerging from the data reflect the complexities and paradoxes of clinical practice as described by SLTs. Practice is pivoted on both the patient and clinician, through their membership of groups and as individuals. Scientific thinking is a component of decision making; a tool with which to approach the various ingredients and the dynamic nature of clinical practice. However, these scientific elements do not necessarily reflect evidence-based practice as typically constructed

Children’s experiences of a nurture group

Nurture groups (NGs) are a form of specialist educational provision for children experiencing social, emotional and behavioural difficulties (SEBD). The guiding principles behind NGs are drawn from attachment theory. The aim of this study was to investigate the lived experience of children attending a NG and to consider the implications of children's views in respect of future provision for children with SEBD in schools. In particular, it sought to explore the culture developed within the NG; find out what was important to the children in the NG; and identify positive and problematic aspects associated with the NG provision. The focus of the study emerged following a review of the literature around NGs and SEBD. It was felt that there was a gap in the literature whereby the views of children attending NGs were rarely sought, with researchers preferring to investigate the effectiveness of NGs or to work with retrospective accounts from ex NG pupils. The empirical stance of the study is interpretivist in nature while an ethnographic approach was chosen as both a framework for the process of data collection and as an analytical tool. Six children (aged 4 - 7 years) attending one NG participated in the study along with the NG teacher and teaching assistant. Within the ethnographic framework of the study, a combination of: participant-observation; participant- generated photographs; photo-elicitation interviews and drawing sessions; and semi- structured interviews with staff were used. These methods were employed longitudinally over the course of seven months. The resulting data was then analysed to draw out common and individual themes important to the participants. Significant to the children in the study were relationships with other children and staff in the NG, the importance of play and special toys, the routines and rituals of the NG day and outdoor experiences. Other important themes were: the ambiguous nature of 'educational attachment' and how this is interpreted by professionals involved with NGs; the practical problems associated with NGs that deviate from the 'classic' model; the children's sense of belonging to the NG; and their sense of isolation in their home schools. Based on the conclusions of the research, a number of areas that may have implications for Educational Psychologists and other education professionals are discussed, as are suggestions for future research.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Assaying Protein Kinase A Activity Using a FRET-Based Sensor Purified from Mammalian Cells

Protein Kinase A (PKA) is the major intracellular receptor for cAMP. Research into this prototype kinase is supported by kinase assays that are typically performed in vitro using radio-labeled ATP. For in vivo studies, genetically encoded FRET-based sensors have become popular for monitoring PKA activity. Here, we show that it is also possible to apply such reporters in vitro. We describe how to express and purify milligram quantities of a FRET-based PKA activity reporter using cultured human embryonic kidney cells. We demonstrate how to utilize the purified reporter in a plate reader to determine the IC50 for the widely utilized PKA inhibitor H89 in the presence of a physiologically relevant concentration of ATP. The protocol takes advantage of the economical transfection reagent polyethylenimine and can be performed in a standard cell culture facility. Whereas assays based on radiolabelling are more sensitive, the approach presented here has several advantages: It enables continuous measurement of changes in substrate phosphorylation; a single preparation produces enough reporter for thousands of recordings; the reporter has a long shelf life; and it avoids the safety considerations that arise when working with radioactive material