'The children have only got one education and you have to make sure it's a good one': parenting and parent–school relations in a neoliberal age

This article draws on data from 20 years of qualitative projects with parents to discuss and analyse four issues. The first is the apparent responsibilities of parents to deliver both the school and home setting which will provide ‘the best’ for their children. Second, the gendering of parental responsibilities. Third, I investigate how class and ethnicity shape parents’ relationships with educational institutions. Drawing on Bourdieu’s conceptual framework, I consider how parents’ habitus and the forms and volumes of capital they both possess and can activate inform their struggles for position in the field of schooling. Fourth, I seek to complicate the binary between middle-class and working-class parents with the former commonly assumed to be powerful and effective in the field of schooling, and the latter powerless and ineffective. I conclude by considering the direction of future research on home–school relations

How do health service professionals consider human factors when purchasing interactive medical devices? A qualitative interview study

We present findings of a UK study into how those involved in purchasing interactive medical devices go about evaluating usability, the challenges that arise, and opportunities for improvement. The study focused on procurement of infusion devices because these are used by various professionals across healthcare. A semi-structured interview study was carried out involving a range of stakeholders (20 in total) involved in or impacted by medical device procurement. Data was analysed using thematic analysis, a qualitative method designed to support the identification, analysis and reporting of patterns. In principle, health service purchasing was found to accommodate consideration of equipment usability. In practice, the evaluation process was driven primarily by engineering standards; assessment of local needs did not accommodate substantive assessment of usability; and choice was limited by the availability of equipment on the marketplace. We discuss ways in which purchasing could be improved through techniques that account for social circumstances

Dual PI-3 kinase/mTOR inhibition impairs autophagy flux and induces cell death independent of apoptosis and necroptosis

The PI-3 kinase (PI-3K)/mTOR pathway is critical for cell growth and proliferation. Strategies of antagonising this signaling have proven to be detrimental to cell survival. This observation, coupled with the fact many tumours show enhanced growth signaling, has caused dual inhibitors of PI-3K and mTOR to be implicated in cancer treatment, and have thus been studied across various tumour models. Since PI-3K (class-I)/mTOR pathway negatively regulates autophagy, dual inhibitors of PI-3K/mTOR are currently believed to be autophagy activators. However, our present data show that the dual PI-3K/mTOR inhibition (DKI) potently suppresses autophagic flux. We further confirm that inhibition of Vps34/PI3KC3, the class-III PI-3K, causes the blockade to autophagosome-lysosome fusion. Our data suggest that DKI induces cell death independently of apoptosis and necroptosis, whereas autophagy perturbation by DKI may contribute to cell death. Given that autophagy is critical in cellular homeostasis, our study not only clarifies the role of a dual PI-3K/mTOR inhibitor in autophagy, but also suggests that its autophagy inhibition needs to be considered if such an agent is used in cancer chemotherapy

The challenges of delivering validated personas for medical equipment design

Representations of archetypal users (personas) have been advocated as a way to avoid designing in isolation. They allow communication of user needs and orient teams towards user experience. One of the challenges for developers of interactive medical devices is that most devices are used by a wide variety of people, and that developers have limited access to those people; personas have the potential to make developers more aware of who they are designing for. But this raises the question of whether it is possible to deliver useful, valid personas of interactive medical device users. The aim of this research was to develop and test a rigorous, empirically grounded process of constructing personas, with the objective of reflecting on that process. Many challenges were encountered: we found that directly linking the personas to a user population was not possible and although personas were a useful tool for supporting communication and elicitation across disciplines, it was hard to make them representative when picking details that were relevant and checking accuracy. Checking the content resulted in disparate, possibly incommensurable, views. Despite this, the personas proved useful in supporting the transfer of knowledge across professional perspectives

Usability standards meet scenario-based design: Challenges and opportunities.

The focus of this paper is on the challenges and opportunities presented by developing scenarios of use for interactive medical devices. Scenarios are integral to the international standard for usability engineering of medical devices (IEC 62366:2007), and are also applied to the development of health software (draft standard IEC 82304-1). The 62366 standard lays out a process for mitigating risk during normal use (i.e. use as per the instructions, or accepted medical practice). However, this begs the question of whether "real use" (that which occurs in practice) matches "normal use". In this paper, we present an overview of the product lifecycle and how it impacts on the type of scenario that can be practically applied. We report on the development and testing of a set of scenarios intended to inform the design of infusion pumps based on "real use". The scenarios were validated by researchers and practitioners experienced in clinical practice, and their utility was assessed by developers and practitioners representing different stages of the product lifecycle. These evaluations highlighted previously unreported challenges and opportunities for the use of scenarios in this context. Challenges include: integrating scenario-based design with usability engineering practice; covering the breadth of uses of infusion devices; and managing contradictory evidence. Opportunities included scenario use beyond design to guide marketing, to inform purchasing and as resources for training staff. This study exemplifies one empirically grounded approach to communicating and negotiating the realities of practice

Bags, batteries and boxes: A qualitative interview study to understand how syringe drivers are adapted and used by healthcare staff

Syringe drivers are medical devices that are critical for end of life care. They deliver continuous medication over extended periods of time. Their design contributes to the quality of experience for both patients and healthcare professionals. Little research has been published about the factors that influence the usability of this type of equipment for frontline users (i.e. those in direct contact with patients) and how equipment gets introduced. Understanding how syringe drivers are used in practice can help improve the design of equipment. 27 semi-structured interviews were conducted across acute hospitals, community hospitals and hospices (4 organisations in total). All participating organisations used the same type of syringe driver. It was found that frontline staff needed to adapt this equipment to fit the circumstances of use. The analysis provided examples of this happening for aspects relating to the appearance of the device (bags), accessories (batteries) and security (the lockable box)

Patient safety and interactive medical devices: Realigning work as imagined and work as done

Medical devices are essential tools for modern healthcare delivery. However, significant issues can arise if medical devices are designed for ‘work as imagined’ when this is misaligned with ‘work as done’. This problem can be compounded as the details of device design, in terms of usability and the way a device supports or changes working practices, often receives limited attention. The ways devices are designed and used affect patient safety and quality of care: inappropriate design can provoke user error, create system vulnerabilities and divert attention from other aspects of patient care. Current regulation involves a series of pre-market checks relating to device usability, but this assumes that devices are always used under the conditions and for the purposes intended (i.e. work as imagined); there are many reasons for devices being used in ways other than those assumed at development time. Greater attention needs to be paid to learning points in actual use and user experience (i.e. work as done). This needs to inform manufacturers’ designs, management procurement decisions and local decisions about how devices are used in practice to achieve co-adaptation; without these, we foster risks and inefficiencies in healthcare

Friendship and Diversity: Children's and Adults' Friendships Across Social Class and Ethnic Difference

This two year qualitative project, funded by the Economic and Social Research Council, explores the friendships of 8/9 year old children, and their parents, in ‘super-diverse1’ localities in London, England. The project uses school sites as a lens through which to understand social relations in localities which are experiencing rapid urban population change. We examine the ways in which local primary schools work as sites of everyday encounter, exchange and friendship making in multicultural and rapidly gentrifying London geographies. Through a focus on three primary school classrooms, we explore how difference is experienced, and whether and how friendships and friendship networks are made and maintained across ethnic and social class differences. Our aim is to identify what friendships reveal about the nature and extent of ethnic and social divisions in contemporary multicultural society. In short, does living in diverse areas mean local populations have diverse friendship groups

Time trends in service provision and survival outcomes for patients with renal cancer treated by nephrectomy in England 2000-2010.

OBJECTIVE: To describe the temporal trends in nephrectomy practice and outcomes for English patients with renal cell carcinoma (RCC). PATIENTS AND METHODS: Adult RCC nephrectomy patients treated between 2000 and 2010 were identified in the National Cancer Data Repository and Hospital Episode Statistics, and followed-up until date of death or 31 December 2015 (n = 30 763). We estimated the annual frequency for each nephrectomy type, the hospital and surgeon numbers and their case volumes. We analysed short-term surgical outcomes, as well as 1- and 5-year relative survivals. RESULTS: Annual RCC nephrectomy number increased by 66% during the study period. Hospital number decreased by 24%, whilst the median annual hospital volume increased from 10 to 23 (P < 0.01). Surgeon number increased by 27% (P < 0.01), doubling the median consultant number per hospital. The proportion of minimally invasive surgery (MIS) nephrectomies rose from 1% to 46%, whilst the proportion of nephron-sparing surgeries (NSS) increased from 5% to 16%, with 29% of all T1 disease treated with partial nephrectomy in 2010 (P < 0.01). The 30-day mortality rate halved from 2.4% to 1.1% and 90-day mortality decreased from 4.9% to 2.6% (P < 0.01). The 1-year relative survival rate increased from 86.9% to 93.4%, whilst the 5-year relative survival rate rose from 68.2% to 81.2% (P < 0.01). Improvements were most notable in patients aged ≥65 years and those with T3 and T4 disease. CONCLUSIONS: Surgical RCC management has changed considerably with nephrectomy centralisation and increased NSS and MIS. In parallel, we observed significant improvements in short- and long-term survival particularly for elderly patients and those with locally advanced disease