Supporting transformational learning processes for person-centred healthcare research in doctoral education: A critical creative reflection

Background: When becoming person-centred researchers, doctoral students are expected to learn to negotiate new identities and reconceptualise themselves both as people and professionals so they can engage in values-driven research. Therefore, doctoral studies require students to engage in transformational learning for the purpose of contributing to knowledge about healthcare practice and healthcare culture. During this time, there is potential for the learning process to be lonely and overly challenging, which can hinder the development of self required for transformational learning. It is proposed that doctoral supervisors and universities should have an understanding of conditions that facilitate transformational learning, such that students can be supported to develop self and become person-centred researchers.Aim: The aim of this article is to share the continuing story of the doctoral journey of two early career researchers and explore the learning processes through which transformation of understanding and of self has occurred.Conclusions and implications for practice: Recognition of the uniqueness of each doctoral learning process is required for the development of self that enables person-centred research and practice. The principles identified in this article can be drawn on to inform ways of working and learning with doctoral supervisors and within the learning environment that allow human flourishing to occur during the doctoral process. These principles include: Facilitation of self-exploration Engagement in multiple ways of learning and diverse learning experiences Facilitative, person-centred supervisory processes Freedom to learn and engage curiosity Experience of challenge in supportive, social learning environments Sense of belonging in the research environment and processhttps://doi.org/10.19043/ipdj.101.01010pubpub

REALISING AUTHENTIC OCCUPATIONAL THERAPY THROUGH PROFESSIONAL ARTISTRY: UNCOVERING THE NATURE AND CONTEXT OF PRACTICE FOR PERSONS LIVING WITH DEMENTIA

Background: All occupational therapists in the UK are expected to engage in and develop evidence-based, person-centred practice in order to provide therapy that facilitates well-being through occupation. There has been recognition in occupational therapy literature that differences often exist between the values the underpin research evidence and occupational therapists’ professional values, and that practice culture and context influence the way research evidence is used in practice. However, current research into practice with persons living with dementia suggests that the contextual influences on practice have not been adequately considered. This has resulted in research and practice examples that reflect a compliance-orientated model of evidence-based practice. In such examples research guidelines and protocols are applied directly to practice, despite recognition that consideration of contextual factors and other forms of evidence enable creative practice that is meaningful for both persons living with dementia and occupational therapists. This study set out to explore the components of context that facilitate evidence-based practice congruent with professional values, and the values of the person living with dementia, as well as the nature of such practice. Approach and methods: This research is underpinned by a theory of critical creativity, which facilitates understanding, and guides deconstruction, of context through use of creative expression, imagination, and ancient wisdom and traditions. Creativity acts as a vehicle to transform embodied knowledge about the nature of practice to language, through reflection. It also enables blending of worldviews for the purpose of developing research praxis. A critical creativity methodology facilitated exploration of context and foregrounding of the issues that were influencing occupational therapists’ practice. Observation, critical creative reflection, and critical creative dialogue were layered to develop an understanding of the interplay between context and practitioners’ values and action, and the nature of their actions in practice. ii Findings: The findings of the exploration of practice context revealed that occupational therapists appeared to feel fear and anxiety about exploring and sharing their practice as a consequence of conflicting understandings about the way research evidence should be used in practice. Occupational therapists’ engagement in evidence-based practice and intervention ‘roll-out’, which are underpinned by learning that is often removed from practice context, resulted in practice that was often compliance-orientated and devoid of critical reflection. These contextual influences limited occupational therapists’ ability and opportunity to embody person-centred values that they hold, namely to make autonomous decisions about their practice with person(s) living with dementia and their families. Additionally, their engagement in developing professional artistry and creative practice was hindered, and their energy for practice development depleted. Conclusions and implications: Occupational therapists require contexts that are conducive to human flourishing to facilitate exploration, dialogue and development of creative, reflective practice. Such contexts consist of psychologically safe spaces, facilitative leadership, and researchers and practice developers that support all ways of knowing, being and doing in practice, to encourage contextually appropriate learning and practice enquiry. Facilitation of practice development in such contexts should be done in collaboration with practitioners. In such contexts, the contextual relevance of practice policies and guidelines that are heavily informed by technical-rational research evidence should be closely and critically considered. Development of such contexts and developmental approaches could result in authentic practice, in which occupational therapists can embody their values and blend research evidence with other ways of knowing, being and doing, and realise their professional identity. Keywords: occupational therapy, dementia, professional artistry, critical creativity, authentic, context, person-centred, compliance

Increased platelet counts and platelet activation in early symptomatic versus asymptomatic carotid stenosis and relationship with microembolic status: Results from the Platelets And Carotid Stenosis (PACS) Study

Background: Cerebral microembolic signals (MES) may predict increased stroke risk in carotid stenosis. However, the relationship between platelet counts or platelet activation status and MES in symptomatic versus asymptomatic carotid stenosis has not been comprehensively assessed. Setting: University teaching hospitals. Methods: This prospective, pilot observational study assessed platelet counts and platelet activation status, and the relationship between platelet activation and MES in asymptomatic versus early (≤4 weeks after TIA/stroke) and late phase (≥3 months) symptomatic moderate or severe (≥50%) carotid stenosis patients. Full blood count measurements were performed, and whole blood flow cytometry was used to quantify platelet surface activation marker expression (CD62P and CD63) and circulating leucocyte-platelet complexes. Bilateral simultaneous transcranial Doppler ultrasound monitoring of the middle cerebral arteries was performed for 1 hour to classify patients as MES-positive or MES-negative. Results: Data from 31 asymptomatic patients were compared with 46 symptomatic patients in the early phase, and 35 of these patients followed up to the late phase after symptom onset. The median platelet count (211 vs. 200 x 109/L; p=0.03) and the median % lymphocyte-platelet complexes were higher in early symptomatic than asymptomatic patients (2.8 vs. 2.4%, p=0.001). The % lymphocyte-platelet complexes was higher in early symptomatic than asymptomatic patients with ≥70% carotid stenosis (p=0.0005), and in symptomatic patients recruited within 7 days of symptom onset (p=0.028). Complete TCD data were available in 25 asymptomatic and 31 early phase symptomatic, and 27 late phase symptomatic patients. 12% of asymptomatic versus 32% of early phase symptomatic (p=0.02) and 19% of late phase symptomatic patients (p=0.2) were MES-positive. Early symptomatic MES-negative patients had ahigher % lymphocyte-platelet complexes than asymptomatic MES-negative patients (2.8 vs. 2.3%; p=0.0085). Discussion: Recently symptomatic carotid stenosis patients have higher platelet counts (potentially reflecting increased platelet production, mobilisation or reduced clearance) and platelet activation status than asymptomatic patients. MES were more frequently detected in early symptomatic than asymptomatic patients, but the differences between late symptomatic and asymptomatic groups were not significant. Increased lymphocyte-platelet complex formation in recently symptomatic vs. asymptomatic MES-negative patients indicates enhanced platelet activation in this early symptomatic subgroup. Platelet biomarkers, in combination with TCD, have the potential to aid risk-stratification in asymptomatic and symptomatic carotid stenosis patients

Research priority 7: what is the role of occupational therapy in supporting self-management? Developing an occupation-centred lens for research and practice

Niamh Kinsella - ORCID: 0000-0001-8160-3812 https://orcid.org/0000-0001-8160-3812inpressinpres

Learning Embodied Practice Wisdom: The Young Sapling Learning from the Old Tree

Niamh Kinsella - ORCID: 0000-0001-8160-3812 https://orcid.org/0000-0001-8160-3812Item is not available in this repository.https://doi.org/10.1163/9789004410497_017pubpu

How context influences person-centred practice: a critical-creative case study examining the use of research evidence in occupational therapy with people living with dementia.

From PubMed via Jisc Publications RouterPublication status: aheadofprintOccupational therapists are encouraged to use research evidence to guide therapeutic interventions that holistically address the consequences of dementia. Recent efforts to use research evidence in practice have emphasized the challenges of doing so in ways aligned to person-centred and professional principles. Using research evidence is a complex process influenced by multiple contextual factors and layers. The influence of context in occupational therapy for dementia is currently unclear. To explore the contextual complexities of using research evidence in practice with people with dementia, and to develop knowledge to improve the approach to using evidence in person-centred, occupation-focused practice. A case study methodology was used, in which the contextual conditions of practice were clarified through the facilitation of critical and creative reflection using the following methods - Think Aloud, practice observation, creative expression and reflective dialogue. Cultural beliefs that affected evidence use included technically-orientated understandings of evidence-based practice. These were underpinned by apprehensions about losing professional identity and taking risks when processes derived from research evidence were adjusted to incorporate a persons' occupations. These cultural factors were perpetuated at the organizational layers of context, where systemic priorities and other team members' needs disproportionately influenced occupational therapists' decisions. Occupational therapists' potential to make reflexive and responsive decisions by adjusting evidence-based processes can be affected by their perceived freedom to address organizational tensions. Raising consciousness of the influence of the organizational context on decision-making about evidence use could adjust occupational therapists' perceptions of their freedom and ability to be person-centred. Intentionality in reflective processes in practice are required to foster reflexivity

La cohérence dans une économie mondialisée : harmonisation du traitement de la R&D dans les comptes nationaux et la balance des paiements en Irlande / Consistency in a Globalised Economy: Aligning the Treatment of R&D in the Irish National Accounts and Balance of Payments

Increasing globalisation of the world’s business economy presents challenges to compilers of official statistics when producing consistent economic accounts. This paper examines two inconsistencies between national accounts and balance of payments – firstly, in the measurement of depreciation of intellectual property products, and secondly, in the recording of expenditure on research and development (R&D) services. These inconsistencies can lead to sizeable discrepancies in net factor flows in the national accounts. Business data collected by the Central Statistics Office in Ireland is used to measure the divergence between the balance of payments and national accounts. The findings suggest that it is necessary to adjust the balance of payments data related to intellectual property products and R&D services to ensure consistency with national accounting methodology.La mondialisation croissante de l’activité des entreprises pose divers problèmes à la statistique publique pour produire des comptes économiques cohérents. Le présent article examine deux incohérences entre les comptes nationaux et la balance des paiements : premièrement, dans la mesure de la dépréciation des produits de la propriété intellectuelle, et, deuxièmement, dans l’enregistrement des dépenses consacrées aux services de recherche et de développement (R&D). Ces incohérences peuvent engendrer des anomalies importantes dans les flux nets de facteurs au sein des comptes nationaux. Les données commerciales collectées par l’institut national de statistique irlandais (Central Statistics Office) servent à mesurer la divergence entre la balance des paiements et les comptes nationaux. Les conclusions suggèrent qu’il est nécessaire de redresser les données de la balance des paiements relatives aux produits de la propriété intellectuelle et aux services de R&D afin d’assurer la cohérence avec la méthodologie de la comptabilité nationale.Holton Niamh, Kinsella Margaret, Mangan Oisín, McLaughlin Shaun, Quill Patrick. La cohérence dans une économie mondialisée : harmonisation du traitement de la R&D dans les comptes nationaux et la balance des paiements en Irlande / Consistency in a Globalised Economy: Aligning the Treatment of R&D in the Irish National Accounts and Balance of Payments. In: Economie et Statistique / Economics and Statistics, n°517-519, 2020. Numéro spécial : Au-delà et autour du PIB : questions à la comptabilité nationale / Special Issue : Beyond and Around GDP: Questions to National Accounting pp. 205-219

How Covid-19 changed drug crime in Ireland.

COVID-19 restrictions saw drug traffickers use rental cars, the postal service, exploit children as mules and stash their money at home in a desperate bid to keep their business going, say senior garda sources..... Covid-19 restrictions made it difficult for drug addicts to either feed or afford their drug habits and this had repercussions for drug rehabilitation services......

Proteomic detection of PhoPQ- and acid-mediated repression of Salmonella motility

Salmonella adaptation to low pH is a critical survival response and essential for virulence. Here, we show that another key virulence-associated process, flagellamediated cell motility, is co-regulated by low pH via the PhoPQ signal transduction system. Using a proteomic approach, we found that phase 1 and phase 2 flagellin were specifically down-regulated when acid-adapted (pH 5.0) Salmonella SL1344 cells were exposed to pH 3.0. Decreased flagellin expression and cell motility was dependent on activation of the PhoPQ pathway, which directly or indirectly negatively regulated transcription of the flagellin gene fliC. In contrast, the general stress sigma factor RpoS (S) positively regulated flagellar gene expression. Low external pH had no effect on the level of H-NS protein, a further regulator of flagellar gene expression. We suggest that flagellar repression at low pH conserves ATP for survival processes and helps to limit the influx of protons into the cytosol. These results highlight the power of proteomics to reveal unanticipated links between relatively well-characterised regulatory systems in bacteria