Re-conceptualising student resilience through the liminal space of university, from a non-traditional Applied Health and Social Care graduate perspective

This thesis explores the unique recollections of non-traditional Applied Health and Social Care (n-tAHSC) graduates’ experiences as n-tAHSC students in the liminal space of university. The literature reveals that non-traditional (n-t) students face multiple challenges in UK Higher Education (HE), such as limited knowledge of HE, balancing paid work and study and other responsibilities. These stressors are increased when n-t students study AHSC programmes owing to the interdisciplinary hazards, which include ambiguity around career trajectory, lack of discipline-specific codes of conduct and lack of preparation for stressful people facing roles. Yet these students still achieve successful outcomes. A potential facilitating cause of this success is resilience, identified as both a buffer against the stressors that instigate poor mental health and a catalyst for positive mental health and success in HE. To this end, this thesis conceptualises the articulations and practices (conditions, causes and contingencies) of resilience from the unique perspectives of successful non-traditional Applied Health and Social Care (Sn-tAHSC) graduates, a population that has been under-researched across n-t student resilience literature until now. Using a constructivist approach a sample of 20 successful Sn-tAHSC graduates were interviewed via online video call using Microsoft Teams. Using both a Grounded Theory approach and a Bourdieusian lens to interpret and analyse new understandings from the opinions and views of successful Sn-tAHSC graduates, across domains of agency, habitus, field and capital. The outcomes of the study show that n-tAHSC students articulate resilience differently than their ‘traditional’ student counterparts. Building on a concept of bouncing forward the n-tAHSC student commences university with a repertoire of conditions and strategies for resilience, learned from overcoming previous unique challenges and adversities in their former habitus. These students believe resilience to be further bolstered in the liminal space of university (field) through growth mindsets, problem-focussed coping and social models of resilience where they develop self-efficacy, through sharing and exchanging capital for resilience through formal and informal social interactions with peers, staff and services. This thesis makes an original contribution to the evidence by reconceptualising resilience and creating a unique toolkit for n-tAHSC student resilience. Revealing distinct facilitating conditions, causes and contingencies for resilience where unique ‘bouncing forward’ resilience strategies enable n-tAHSC students to not only survive the challenges of HE, but flourish into successful AHSC graduates

The quality of life of single mothers making the transition from welfare to work

This study examined the quality of life of single mothers making the mandatory transition from welfare to work. The Australian government purported that the benefits of making this transition would include higher incomes, better social participation, and improved wellbeing. It is currently unknown, however, how single mothers currently engaged in welfare to work programs evaluate their quality of life. Quality of life scores for 334 single mothers engaged in welfare to work in Australia were compared with normative data. Participants reported significantly lower quality of life scores than the general population for all quality of life domains, highlighting the need to carefully examine welfare to work policies to ensure they promote participants\u27 quality of life. <br /

Strengthening Health Systems for Resilience

In countries with high levels of poverty or instability and with poor health system management and governance, people are highly vulnerable to shocks associated with ill health, including major epidemics. An effective health system can help build their resilience by reducing exposure to infection and minimising the impact of sickness on livelihoods and economic development. There is broad consensus on the key elements of such a health system: measures to protect public health, access to safe and effective basic health services, hospital back-up and a capacity to respond to major health shocks. The creation of such systems requires sustained efforts to strengthen state oversight of the health sector and to build effective partnerships for public health and service delivery. Managing the crisis response should include anticipating the need to build effective, trusted health systems that meet priority needs.UK Department for International Developmen

Inclusive Policy? An Intersectional Analysis of Policy Influencing Women's Reproductive Decision‐Making

Policy can be used and experienced as a tool for social inclusion or exclusion; it can empower or disenfranchise. Women’s reproductive decision‐making and health is impacted by policy, and women’s experiences of diverse and intersecting marginalised social locations can influence their experiences of policy. This research aimed to explore how intersectionality is considered within Victorian state government policies that influence and impact women’s reproductive decision-making. A systematic search of Victorian (Australia) government policy instruments was undertaken, identifying twenty policy instruments. Policies were analysed using an intersectional policy analysis framework using a two‐stage process involving deductive coding into the domains of the framework, followed by inductive thematic analysis within and across domains. Findings reveal inconsistencies within and across policies in how they consider intersecting social relations of power in the representation of problems, women's positionings, policy impacts, and policy solutions. These gaps could exclude and marginalise individuals and groups and contribute to systemic inequities in women’s reproductive decision-making and the outcomes of those decisions, particularly among already marginalised groups. The lack of women's voices in policy further excludes and marginalises those impacted by the policy and limits the representation of all women in policy. Policy development needs to meaningfully involve women with diverse and intersecting marginalised social locations, and critical reflexivity of all stakeholders, to ensure policies can better account for the experiences of, and impacts upon, women who are marginalised and effect change to promote social inclusion and equity in women’s reproductive decision‐making

Survival and disease characteristics of de novo versus recurrent metastatic breast cancer in a cohort of young patients

Abstract: Background: It is not clear how the pathology, presentation and outcome for patients who present with de novo metastatic breast cancer (dnMBC) compare with those who later develop distant metastases. DnMBC is uncommon in younger patients. We describe these differences within a cohort of young patients in the United Kingdom. Methods: Women aged 40 years or younger with a first invasive breast cancer were recruited to the prospective POSH national cohort study. Baseline clinicopathological data were collected, with annual follow-up. Overall survival (OS) and post-distant relapse-free survival (PDRS) were assessed using Kaplan–Meier curves. Results: In total, 862 patients were diagnosed with metastatic disease. DnMBC prevalence was 2.6% (76/2977). Of those with initially localised disease, 27.1% (786/2901) subsequently developed a distant recurrence. Median follow-up was 11.00 years (95% CI 10.79–11.59). Patients who developed metastatic disease within 12 months had worse OS than dnMBC patients (HR 2.64; 1.84–3.77). For PDRS, dnMBC was better than all groups, including those who relapsed after 5 years. Of dnMBC patients, 1.3% had a gBRCA1, and 11.8% a gBRCA2 mutation. Conclusions: Young women with dnMBC have better PDRS than those who develop relapsed metastatic breast cancer. A gBRCA2 mutation was overrepresented in dnMBC

Immunotherapy-related adverse events in real-world patients with advanced non-small cell lung cancer on chemoimmunotherapy: a Spinnaker study sub-analysis

BackgroundThe Spinnaker study evaluated survival outcomes and prognostic factors in patients with advanced non-small-cell lung cancer receiving first-line chemoimmunotherapy in the real world. This sub-analysis assessed the immunotherapy-related adverse effects (irAEs) seen in this cohort, their impact on overall survival (OS) and progression-free survival (PFS), and related clinical factors.MethodsThe Spinnaker study was a retrospective multicentre observational cohort study of patients treated with first-line pembrolizumab plus platinum-based chemotherapy in six United Kingdom and one Swiss oncology centres. Data were collected on patient characteristics, survival outcomes, frequency and severity of irAEs, and peripheral immune-inflammatory blood markers, including the neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII).ResultsA total of 308 patients were included; 132 (43%) experienced any grade irAE, 100 (32%) Grade 1–2, and 49 (16%) Grade 3–4 irAEs. The median OS in patients with any grade irAES was significantly longer (17.5 months [95% CI, 13.4–21.6 months]) than those without (10.1 months [95% CI, 8.3–12.0 months]) (p&lt;0.001), either if Grade 1–2 (p=0.003) or Grade 3–4 irAEs (p=0.042). The median PFS in patients with any grade irAEs was significantly longer (10.1 months [95% CI, 9.0–11.2 months]) than those without (6.1 months [95% CI, 5.2–7.1 months]) (p&lt;0.001), either if Grade 1–2 (p=0.011) or Grade 3–4 irAEs (p=0.036). A higher rate of irAEs of any grade and specifically Grade 1–2 irAEs correlated with NLR &lt;4 (p=0.013 and p=0.018), SII &lt;1,440 (p=0.029 ad p=0.039), response to treatment (p=0.001 and p=0.034), a higher rate of treatment discontinuation (p&lt;0.00001 and p=0.041), and the NHS-Lung prognostic classes (p=0.002 and p=0.008).ConclusionsThese results confirm survival outcome benefits in patients with irAEs and suggest a higher likelihood of Grade 1–2 irAEs in patients with lower NLR or SII values or according to the NHS-Lung score

Scaling Up ART Adherence Clubs in the Public Sector Health System in the Western Cape, South Africa: a Study of the Institutionalisation of a Pilot Innovation

In 2011, a decision was made to scale up a pilot innovation involving ‘adherence clubs’ as a form of differentiated care for HIV positive people in the public sector antiretroviral therapy programme in the Western Cape Province of South Africa. In 2016 we were involved in the qualitative aspect of an evaluation of the adherence club model, the overall objective of which was to assess the health outcomes for patients accessing clubs through epidemiological analysis, and to conduct a health systems analysis to evaluate how the model of care performed at scale. In this paper we adopt a complex adaptive systems lens to analyse planned organisational change through intervention in a state health system. We explore the challenges associated with taking to scale a pilot that began as a relatively simple innovation by a non-governmental organisation