Shaping the future of learning using the student voice: we’re listening but are we hearing clearly?

Student voice data is a key factor as Manchester Metropolitan University strives to continually improve institutional technology enhanced learning (TEL) infrastructure. A bi-annual Institutional Student Survey enables students to communicate their experience of learning, teaching and assessment on programmes and specific units studied. Each cycle of the survey contains approximately 40–50,000 free text comments from students pertaining to what they appreciate and what they would like to see improved. A detailed thematic analysis of this data has identified 18 themes, arranged into six categories relating to the ‘Best’ aspects of courses, and 25 themes, arranged in seven categories in relation to aspects of courses considered to be ‘in need of improvement’. This student data was then used as a basis for semi-structured interviews with staff. Anecdotally, evidence suggested that student expectations and staff expectations around TEL and the virtual learning environment (VLE) differed. On-going evaluation of this work has highlighted a disconnect. In significant instances, academic colleagues seemingly misinterpret the student voice analysis and consequently struggle to respond effectively. In response to the analysis, the learning technologist's role has been to re-interpret the analysis and redevelop TEL staff development and training activities. The changes implemented have focused on: contextualising resources in VLE; making lectures more interactive; enriching the curriculum with audio–visual resources; and setting expectations around communications

Birth without intervention in women with severe mental illness:Cohort study

The rate of normal birth outcomes (i.e. full-term births without intervention) for women with severe mental illness (SMI - psychotic and bipolar disorders) is not known. We examined rates of birth without intervention (spontaneous labour onset, spontaneous vaginal delivery without instruments, no episiotomy and no indication of pre- or post-delivery anaesthesia) in women with SMI (584 pregnancies) compared with a control population (70 942 pregnancies). Outcome ratios were calculated standardising for age. Women with SMI were less likely to have a birth without intervention (29.5%) relative to the control population (36.8%) (standardised outcome ratio 0.74, 95% CI 0.63-0.87). </p

Control of electron, ion and neutral heating in a radio-frequency electrothermal microthruster via dual-frequency voltage waveforms

The development of low power micro-propulsion sources is of recent interest for application on miniature satellite platforms. Radio-frequency. (rf) plasma electrothermal microthrusters can operate without a space-charge neutralizer and provide increased control of spatiotemporal power deposition. Further understanding of how the phase-resolved rf plasma heating mechanisms affect the phase-averaged bulk plasma properties, e.g. neutral gas temperature, could allow for in-flight tailoring of plasma thrusters. In this work, experimentally validated two-dimensional fluid-kinetic simulations were employed to study the spatially resolved electron and ion power deposition and neutral gas heating in a dual-frequency rf electrothermal microthruster operating at 1.5. Torr plenum pressure in argon. Experimental validation was performed through a comparison of the measured and simulated phase resolved Ar(2p(1)) excitation rates, showing close agreement. Two types of dual-frequency voltage waveforms were investigated, and comprise the combination of a 13.56 MHz voltage waveform with 27.12 MHz and 40.68 MHz waveforms, respectively. Varying the phase offset of the higher harmonic relative to the fundamental 13.56. MHz voltage waveform was found to modulate the dc self-bias voltage by 11% and 3% of the maximum applied peak-to-peak voltage, respectively. The 13.56. MHz, 27.12. MHz dual-frequency voltage waveform provided the highest degree of control, where the fraction of total rf power deposited into Ar+ ions was found to vary from 57% to 77%, modulating the on-axis neutral gas temperature by 35%. This control is attributed to the variation in the fraction of the rf phase cycle for which the sheath is collapsed, altering the phase-averaged electric field strength adjacent to the radial wall. The application of dual-frequency waveforms provides the ability to optimize the particle heating mechanisms with application to electrothermal propulsion.The work presented herein was funded by the Engineering and Physical Sciences Research Council (EPSRC, EP/M508196/1)

Repositioning the Boundaries between Public and Private Healthcare Providers in the English NHS

Background and Objectives: Neoliberal ‘reform’ has in many countries shifted services across the boundary between the public and private sector. This policy re-opens the question of what structural and managerial differences, if any, differences of ownership make to healthcare providers. This paper examines the relationships between ownership, organisational structure and managerial regime within an elaboration of Donabedian’s reasoning about organisational structures. Using new data from England it considers: 1. How do the internal managerial g regimes of differently owned healthcare providers differ, or not? 2. In what respects did any such differences arise from differences in ownership or for other reasons? Methods: An observational systematic qualitative comparison of differently-owned providers was the strongest feasible research design. We systematically compared a maximum-variety sample (by ownership) of community health services (CHS); out-of-hours primary care (OOH); hospital planned orthopaedics and ophthalmology providers (N=12 cases). The framework of comparison was the ownership theory mentioned above. Findings: The relationships between ownership (one one hand) and organisation structures and managerial regimes (on the other), differed at different organisational levels. Top-level governance structures diverged by organisational ownership and objectives among the case-study organisations. All the case-study organisations irrespective of ownership had hierarchical, bureaucratic structures and managerial regimes for coordinating everyday service production, but to differing extents. In doctor-owned organisations the doctors’, but not other occupations’, work was controlled and coordinated in a more-or-less democratic, self-governing ways. Conclusion: Ownership does make important differences to healthcare providers’ top-level governance structures and accountabilities; and to work coordination activity, but with different patterns at different organisational levels. These findings have implications for understanding the legitimacy, governance and accountability of healthcare organisations, the distribution and use of power within them, and system-wide policy interventions, for instance to improve care coordination; and for the correspondingly required foci of healthcare organisational research

The efficient use of the maternity workforce and the implications for safety and quality in maternity care : a population-based, cross-sectional study

Background: The performance of maternity services is seen as a touchstone of whether or not we are delivering high-quality NHS care. Staffing has been identified in numerous reports as being a critical component of safe, effective, user-centred care. There is little evidence regarding the impact of maternity workforce staffing and skill mix on the safety, quality and cost of maternity care in the UK. Objectives: To understand the relationship between organisational factors, maternity workforce staffing and skill mix, cost and indicators of safe and high-quality care. Design and methods: Data included Hospital Episode Statistics (HES) from 143 NHS trusts in England in 2010–11 (656,969 delivery records), NHS Workforce Statistics, England, 2010–11, Care Quality Commission Maternity Survey of women’s experiences 2010 and NHS reference costs 2010/11. Ten indicators were derived from HES data. They included healthy mother and healthy baby outcomes and mode of birth. Adjustments were made for background characteristics and clinical risk. Data were analysed to examine the influence of organisational factors, staffing and costs using multilevel logistic regression models. A production function analysis examined the relationship between staffing, skill mix and output. Results: Outcomes were largely determined by women’s level of clinical risk [based on National Institute for Health and Care Excellence (NICE) guidance], parity and age. The effects of trust size and trust university status were small. Larger trust size reduced the chance of a healthy mother outcome and also reduced the likelihood of a healthy mother/healthy baby dyad outcome, and increased the chances of other childbirth interventions. Increased investment in staff did not necessarily have an effect on the outcome and experience measures chosen, although there was a higher rate of intact perineum and also of delivery with bodily integrity in trusts with greater levels of midwifery staffing. An analysis of the multiplicative effects of parity and clinical risk with the staffing variables was more revealing. Increasing the number of doctors had the greatest impact on outcomes in higher-risk women and increasing the number of midwives had the greatest impact on outcomes in lower-risk women. Although increased numbers of support workers impacted on reducing childbirth interventions in lower-risk women, they also had a negative impact on the healthy mother/healthy baby dyad outcomes in all women. In terms of maximising the capacity of a trust to deliver babies, midwives and support workers were found to be substitutes for each other, as were consultants and other doctors. However, any substitution between staff groups could impact on the quality of care given. Economically speaking, midwives are best used in combination with consultants and other doctors. Conclusions: Staffing levels have positive and negative effects on some outcomes, and deployment of doctors and midwives where they have most beneficial impact is important. Managers may wish to exercise caution in increasing the number of support workers who care for higher-risk women. There also appear to be limited opportunities for role substitution. Future work: Wide variations in outcomes remain after adjustment for sociodemographic and clinical risk, and organisational factors. Further research is required on what may be influencing unexplained variation such as organisational climate and culture, use of NICE guidelines in practice, variation of models of care within trusts and women’s choices. Funding: The National Institute for Health Research Health Services and Delivery Research programme

Inducing locally structured ion energy distributions in intermediate-pressure plasmas

Ion energy distribution functions (IEDFs) incident upon material surfaces in radio frequency (rf) capacitively coupled plasmas are coupled to spatial and temporal sheath dynamics. Tailoring the ion energy distribution function within intermediate-pressure plasmas (133 Pa, 1 Torr), which find application in surface modification and aerospace industries, is challenging due to the collisional conditions. In this work, experimentally benchmarked 2D fluid/Monte-Carlo simulations are employed to demonstrate the production of structured IEDFs in a collisional (200 Pa 1.5 Torr argon) rf hollow cathode discharge. The formation of structures within the IEDFs is explained by an increase in the Arþ ion-neutral mean-free-path and a simultaneous decrease in the phase-averaged sheath extension as the rf voltage frequency increases over 13.56–108.48 MHz for a constant rf voltage amplitude (increasing plasma power) and gas flow rate. Two distinct transitions in the shape of the IEDF are observed at 450 V, corresponding to the formation of “mid-energy” (60–180 eV) structures between 40.68 and 54.24 MHz and additional “high energy” (180 eV) structures between 81.36 and 94.92 MHz, with the structures within each region displaying a distinct sensitivity to the applied voltage amplitude. Transitions between these energy ranges occurred at lower applied voltages for increased applied voltage frequencies, providing increased control of the mean and modal ion energy over a wider voltage range. The capabitlity to extend the range of access to an operational regime, where the structured IEDFs are observed, is desirable for applications that require control of the ion-bombardment energy under collisional plasma conditionsThe work presented herein was funded by the Engineering and Physical Sciences Research Council (EPSRC), Grant No.: EP/ m508196/1

Timing of singleton births by onset of labour and mode of birth in NHS maternity units in England, 2005-2014: A study of linked birth registration, birth notification, and hospital episode data

BACKGROUND: Maternity care has to be available 24 hours a day, seven days a week. It is known that obstetric intervention can influence the time of birth, but no previous analysis at a national level in England has yet investigated in detail the ways in which the day and time of birth varies by onset of labour and mode of giving birth. METHOD: We linked data from birth registration, birth notification, and Maternity Hospital Episode Statistics and analysed 5,093,615 singleton births in NHS maternity units in England from 2005 to 2014. We used descriptive statistics and negative binomial regression models with harmonic terms to establish how patterns of timing of birth vary by onset of labour, mode of giving birth and gestational age. RESULTS: The timing of birth by time of day and day of the week varies considerably by onset of labour and mode of birth. Spontaneous births after spontaneous onset are more likely to occur between midnight and 6am than at other times of day, and are also slightly more likely on weekdays than at weekends and on public holidays. Elective caesarean births are concentrated onto weekday mornings. Births after induced labours are more likely to occur at hours around midnight on Tuesdays to Saturdays and on days before a public holiday period, than on Sundays, Mondays and during or just after a public holiday. CONCLUSION: The timing of births varies by onset of labour and mode of birth and these patterns have implications for midwifery and medical staffing. Further research is needed to understand the processes behind these findings

Low birthweight and preterm birth in young people with special educational needs: a magnetic resonance imaging analysis

<p>Abstract</p> <p>Background</p> <p>Although neuroanatomical and cognitive sequelae of low birthweight and preterm birth have been investigated, little is understood as to the likely prevalence of a history of low birthweight or preterm birth, or neuroanatomical correlates of such a history, within the special educational needs population. Our aim was to address these issues in a sample of young people receiving additional learning support.</p> <p>Methods</p> <p>One hundred and thirty-seven participants aged 13–22 years, receiving additional learning support, were recruited via their schools or colleges and underwent structural magnetic resonance imaging (MRI). Obstetric records, available in 98 cases, included birthweight and gestational data in 90 and 95 cases, respectively. Both qualitative and quantitative voxel-based analyses of MRI data were conducted.</p> <p>Results</p> <p>A history of low birthweight and preterm birth was present in 13.3% and 13.7% of cases, respectively. Low birthweight and preterm birth were associated with specific qualitative anomalies, including enlargement of subarachnoid cisterns and thinning of the corpus callosum. Low birthweight was associated with reduced grey matter density (GMD) in the superior temporal gyrus (STG) bilaterally, left inferior temporal gyrus and left insula. Prematurity of birth was associated with reduced GMD in the STG bilaterally, right inferior frontal gyrus and left cerebellar hemisphere. Comparison of subjects with no history of low birthweight or preterm birth with a previously defined control sample of cognitively unimpaired adolescents (<it>n </it>= 72) demonstrated significantly greater scores for several anomalies, including thinning of the corpus callosum, loss of white matter and abnormalities of shape of the lateral ventricles.</p> <p>Conclusion</p> <p>Although a two-fold increased prevalence of a history of low birthweight and preterm birth exists within the special educational needs population, other aetiological factors must be considered for the overwhelming majority of cases. Neuroanatomical findings within this sample include qualitative anomalies of brain structure and grey matter deficits within temporal lobe structures and the cerebellum that persist into adolescence. These findings suggest a neurodevelopmental mechanism for the cognitive difficulties associated with these obstetric risk factors.</p