Accountability for health: a scoping paper for the LGA health commission

This paper for the Local Government Association Health Commission aims to scope the main issues surrounding the accountability of health services in England in the context of the Commission’s terms of reference. These require the Commission to consider, against a background of what is referred to as a ‘new consensus’ about localism, how local councils might work best with National Health Service and other partners to engage local people in decision-making and empower them to hold the health care commissioning and delivery system to account. In this paper, the authors seek to clarify the different ways in which accountability has been understood and expressed in relation to the NHS, and to offer a framework for assessing both current mechanisms and new proposals

Experiences of vulnerability in poverty education settings : developing reflexive ethical praxis

In Timor-Leste’s education system poverty is widespread and vulnerability is experienced by both students and teachers, entangled in the fragile web of policies and day- to-day challenges. As a teacher and researcher working in high poverty education settings across two contexts in Timor-Leste and Australia, I have been interested in exploring my own situatedness in the policies and discourses that perpetuate and define such realities, as well as how ‘vulnerable subjectivities’ are enacted, constructed and experienced within poverty education. How can further engagement with poststructural notions of subjectivity and an autoethnographic methodology help develop praxis within poverty education? This paper uses vignettes which describe violence against students to further examine the ideas of vulnerability. In this paper I argue for a greater understanding of praxis for educators and for ethical autoethnography to be explored by more researchers as central to ethical research particularly in education and postcolonial studies.peer-reviewe

Outdoor environments for people with dementia:An exploratory study using virtual reality

Few studies have investigated how outdoor environments might disable people with dementia. The issue is rarely considered in planning and design guidelines and not at all in regulations, despite dementia being within the scope of disability discrimination legislation in the United Kingdom and other countries. This article reports a study that involved older people with mild to moderate dementias taking two walks, one in a real town centre and one in a virtual reality (VR) simulation. Adaptations were made to the VR simulation to test possible design improvements. Overall, the town centre posed relatively few problems for the 38 older people with dementia who participated, although more difficulty was evident with greater impairment. Some features of particular places were liked more than others, particularly the segregation of spaces from motor traffic. There were measurable benefits from using clear textual signs to support wayfinding and to identify objects and places in the environment. Diminished outdoor activity is likely to be experienced as a decrease in quality of life and may accelerate the progression of dementia. We conclude that older people with mild to moderate dementia should be encouraged to be active outdoors and that this can be facilitated by small environmental modifications. Some limitations of the VR technology used for the study are also reported.</p

Involving persons with dementia in the evaluation of outdoor environments

Using virtual reality (VR), we examined the barriers to and facilitators of functioning outdoors in persons with dementia (PwD) and investigated the generalizability of findings in VR to the real world. An existing town center was modeled in VR. PwD took part in both real- world and VR walks. Based on the results, the model was redesigned and then tested again. Performance on the walks improved, and potentially beneficial adaptations to outdoor environments were identified, but limitations of VR as a representation of the real world were also identified. We conclude that VR models, together with a rigorous behavioral testing method, can be a useful tool for the evaluation of outdoor environments and for identifying improvements for PwD

Divergence or convergence? Health inequalities and policy in a devolved Britain

Since the advent of political devolution in the UK, it has been widely reported that markedly different health policies have emerged. However, most of these analyses are based on a comparison of health care policies and, as such, only tell part of a complex and evolving story. This paper considers official responses to a shared public health policy aim, the reduction of health inequalities, through an examination of national policy statements produced in England, Scotland and Wales respectively since 1997. The analysis suggests that the relatively consistent manner in which the ‘policy problem’ of health inequalities has been framed combined with the dominance of a medical model of health have constrained policy responses. Our findings differ from existing analyses, raising some important questions about the actuality of, and scope for, policy divergence since devolution

Intramembrane proteolysis mediates shedding of a key adhesin during erythrocyte invasion by the malaria parasite.

Apicomplexan pathogens are obligate intracellular parasites. To enter cells, they must bind with high affinity to host cell receptors and then uncouple these interactions to complete invasion. Merozoites of Plasmodium falciparum, the parasite responsible for the most dangerous form of malaria, invade erythrocytes using a family of adhesins called Duffy binding ligand-erythrocyte binding proteins (DBL-EBPs). The best-characterized P. falciparum DBL-EBP is erythrocyte binding antigen 175 (EBA-175), which binds erythrocyte surface glycophorin A. We report that EBA-175 is shed from the merozoite at around the point of invasion. Shedding occurs by proteolytic cleavage within the transmembrane domain (TMD) at a site that is conserved across the DBL-EBP family. We show that EBA-175 is cleaved by PfROM4, a rhomboid protease that localizes to the merozoite plasma membrane, but not by other rhomboids tested. Mutations within the EBA-175 TMD that abolish cleavage by PfROM4 prevent parasite growth. Our results identify a crucial role for intramembrane proteolysis in the life cycle of this pathogen

An Open Research University

This is the final report of the Open University’s RCUK-funded Public Engagement with Research Catalyst, ‘An open research university’, a project designed to create the conditions in which engaged research can flourish. The report describes an evidence-based strategy designed to embed engaged research within the University’s strategic planning for research and the operational practices of researchers. This programme of organisational change was informed by action research, working collaboratively with researchers at all levels across the institution to identify and implement strategies that work for them and the stakeholders, user communities and members of the public that engage with their research. Through a combination of surveys, interviews and interventions, we identified a number of challenges and proposed solutions to address them. For example, we found that researchers have a relatively narrow view of engaged research and the communities with which they interact and very few researchers strategically evaluate their engaged research activities. The report documents some of the interventions we have introduced with the aim of broadening and deepening future researcher engagement, including a definition of engaged research and revised promotion criteria that include knowledge exchange profiles. In conclusion, we argue that there is still a battle to be won for open and engaged research. For a culture of engaged research to be sustainable in the medium to long-term requires ongoing recognition and acceptance of its progressive value(s) by researchers, universities, funders and ultimately, policy-makers