Reflections on Professionalism: Driving Forces that Refine and Shape Professional Practice

Early education systems in England require those who work alongside children to follow policies intended to promote quality early education and care. Their professional role is embedded into those systems and includes promoting integrated inter-professional working, safeguarding children’s welfare, supporting children to meet national early learning goals and promoting inclusive education. Their professional responsibilities include demonstrating sound pedagogical practice and a detailed developmental assessment of children. They are also asked to forge positive relationships with families and are accountable to parents and regulators. This paper provokes further thinking and exploration of these roles, responsibilities and relationships. It asks whether existing regulatory systems are the driving forces which shape professional practice and determine professionalism or if there is more to being a competent, adaptive, reflective early educator

Insurance Invoice: Jacob Goodman- Mrs. Rosie Holmes Walker

Bill: Invoice from Jacob Goodman Dr., Insurance, handwritten notation of with date and signature. Date: March 4, 192

Reflections on Professionalism: Driving Forces that Refine and Shape Professional Practice

Early education systems in England require those who work alongside children to follow policies intended to promote quality early education and care. Their professional role is embedded into those systems and includes promoting integrated inter-professional working, safeguarding children’s welfare, supporting children to meet national early learning goals and promoting inclusive education. Their professional responsibilities include demonstrating sound pedagogical practice and a detailed developmental assessment of children. They are also asked to forge positive relationships with families and are accountable to parents and regulators. This paper provokes further thinking and exploration of these roles, responsibilities and relationships. It asks whether existing regulatory systems are the driving forces which shape professional practice and determine professionalism or if there is more to being a competent, adaptive, reflective early educator

Walking Several Inches Taller: Student Reflections on a University Conference on the Lived Experience of Refugee Children and Families

The development of higher order thinking skills is an important pedagogic outcome of Foundation and BA degrees within the UK as it enables students to work positively with complex issues within early years practice. Our annual conference, held at a university within the West Midlands, is one strategy for this development. The conference under consideration was held in 2017 and was entitled ‘Lived Experience of Refugee Children and their Families.’ This offered students an experience of understanding at first hand the plight of refugee children and families and the implications for practice. At the end of the conference the students were asked to critically reflect on their experience and to present this as a 500 word piece of writing during the fortnight after the conference. Using a hermeneutic and interpretive approach to analyse the writing, three key themes emerged which included: the impact of learning through first-hand experience, changes in perspective previously informed by negative media coverage and developing politicisation and positioning of self as a result of the conference. Students identified a number of actions they would take as a result of their learning. The value of a critically reflective opportunity after conferences was highlighted as an essential part of developing higher order thinking and gaining maximum impact for the student learning from the experience

Conceptualising energy use and energy poverty using a capabilities framework

In this article we conceptualise energy use from a capabilities perspective, informed by the work of Amartya Sen, Martha Nussbaum and others following them. Building on this, we suggest a corresponding definition of energy poverty, as understood in the capabilities space. We argue that such an understanding provides a theoretically coherent means of comprehending the relationship between energy and wellbeing, and thus conceptualising energy deprivation, that makes sense across settings including both the global North and South: a coherence which has previously been lacking. At the same time, it has the flexibility to be deployed in a way that is sensitive to local contexts. Understanding energy use in the capabilities space also provides a means for identifying multiple sites of intervention, including some areas that are currently largely overlooked. We argue that this is advantageous for attempts to address energy poverty in the context of climate change and imperatives for the containment of aggregate energy consumption

Investigation of putative regulatory loci relevant to the pathogenesis of psychiatric illness

The genetic contribution to the aetiology of psychiatric illness is well-established; however, few variants that alter the encoded protein have been irrefutably identified as causative, leading to the hypothesis that variants affecting gene regulation may play a pathogenic role. This thesis focuses on two genes, Neuregulin 1 (NRG1) and Disrupted in Schizophrenia 1 (DISC1), for which there is strong genetic evidence for involvement in psychiatric illness, as well as evidence for altered expression in patients. Association analysis was carried out to assess the involvement of six intronic NRG1 single nucleotide polymorphisms (SNPs) in schizophrenia and bipolar disorder in two independent samples from the Scottish (Scottish 2; n = 307 control subjects, 303 schizophrenic patients, and 239 bipolar disorder patients and German populations (n = 397 control subjects, 396 schizophrenic patients, and 400 bipolar disorder patients). These SNPs form two haplotypes, one encompassing the 5’ and promoter region of the gene and the other located at the 3’ end of the gene, that were previously associated with schizophrenia and bipolar disorder in a Scottish sample (Scottish 1). The location of these haplotypes, together with the prior evidence for altered NRG1 expression in schizophrenia, suggested the potential involvement of regulatory variants. On combining the Scottish 1 and Scottish 2 samples (combined n = 765 control subjects, 682 schizophrenic patients and 601 bipolar disorder patients), a two- SNP haplotype spanning both coding and non-coding regions in the 3’ region was associated with schizophrenia (p = 0.0037, OR=1.3, 95% CI: 1.1-1.6) and the combined schizophrenia and bipolar disorder case group (p = 0.0080, OR=1.2, 95% CI: 1.1-1.5), with both these associations remaining significant after permutation analysis (p = 0.022 and p = 0.044, respectively). To further understanding of how DISC1, a leading candidate gene for schizophrenia that has also been implicated in other psychiatric disorders, is regulated the previously uncharacterised promoter region was assessed both bioinformatically and in vitro using the dual luciferase reporter assay. The region was found to lack canonical promoter motifs but to contain a CpG island, consistent with DISC1’s ubiquitous pattern of expression. A region located 300bp to -177bp relative to the transcription start site (TSS) was identified as contributing positively to DISC1 promoter activity, whilst a region -982bp to -301bp relative to the TSS was found to confer a repressive effect. FOXP2, a transcription factor which is mutated in a rare speech and language disorder and implicated in autism pathogenesis, was found to repress transcription from the DISC1 promoter. Two pathogenic FOXP2 point mutations reduced this transcriptional repression. Preliminary evidence for a bi-directional regulatory relationship between DISC1 and FOXP2 was observed: a mouse model of schizophrenia that carries a Disc1 L100P amino acid substitution and shows altered developmental Disc1 expression was also found to show altered developmental expression of Foxp2. These results further understanding of two genes whose altered expression might contribute to the pathogenesis of psychiatric illness

Preliminary assessment of pre-morbid DNA methylation in individuals at high genetic risk of mood disorders

OBJECTIVES: Accumulating evidence implicates altered DNA methylation in psychiatric disorders, including bipolar disorder (BD) and major depressive disorder (MDD). It is not clear, however, whether these changes are causative or result from illness progression or treatment. To disentangle these possibilities we profiled genome‐wide DNA methylation in well, unrelated individuals at high familial risk of mood disorder. DNA methylation was compared between individuals who subsequently developed BD or MDD [ill later (IL)] and those who remained well [well later (WL)]. METHODS: DNA methylation profiles were obtained from whole‐blood samples from 22 IL and 23 WL individuals using the Infinium HumanMethylation450 BeadChip. Differential methylation was assessed on a single‐locus and regional basis. Pathway analysis was performed to assess enrichment for particular biological processes amongst nominally significantly differentially methylated loci. RESULTS: Although no locus withstood correction for multiple testing, uncorrected P‐values provided suggestive evidence for altered methylation at sites within genes previously implicated in neuropsychiatric conditions, such as Transcription Factor 4 (TCF4) and Interleukin 1 Receptor Accessory Protein‐Like 1 ([IL1RAPL1]; P≤3.11×10(−5)). Pathway analysis revealed significant enrichment for several neurologically relevant pathways and functions, including Nervous System Development and Function and Behavior; these findings withstood multiple testing correction (q≤0.05). Analysis of differentially methylated regions identified several within the major histocompatibility complex (P≤.000 479), a region previously implicated in schizophrenia and BD. CONCLUSIONS: Our data provide provisional evidence for the involvement of altered whole‐blood DNA methylation in neurologically relevant genes in the aetiology of mood disorders. These findings are convergent with the findings of genome‐wide association studies

Is it possible to predict improved diabetes outcomes following diabetes self-management education : a mixed-methods longitudinal design

Objective: To predict the diabetes-related outcomes of people undertaking a type 2 Diabetes Self-Management Education (DSME) programme from their baseline data. Design: A mixed-methods longitudinal experimental study. 6 practice nurses and 2 clinical academics undertook blind assessments of all baseline and process data to predict clinical, behavioural and psychological outcomes at 6 months post-DSME programme. Setting Primary care. Participants: –31 people with type 2 diabetes who had not previously undertaken DSME. Intervention: All participants undertook the Diabetes Manual 1:1 self-directed learning 12-week DSME programme supported by practice nurses trained as Diabetes Manual facilitators. Outcome variables: Glycated haemoglobin (HbA1c), diabetes knowledge, physical activity, waist circumference, self-efficacy, diabetes distress, anxiety, depression, demographics, change talk and treatment satisfaction. These variables were chosen because they are known to influence self-management behaviour or to have been influenced by a DSME programme in empirical evidence. Results: Baseline and 6-month follow-up data were available for 27 participants of which 13 (48%) were male, 22 (82%) white British, mean age 59 years and mean duration of type 2 diabetes 9.1 years. Significant reductions were found in HbA1c t(26)=2.35, p=0.03, and diabetes distress t(26)=2.30, p=0.03, and a significant increase in knowledge t(26)=−2.06, p=0.05 between baseline and 6 months. No significant changes were found in waist circumference, physical activity, anxiety, depression or self-efficacy. Accuracy of predictions varied little between clinical academics and practice nurses but greatly between outcome (0–100%). The median and mode accuracy of predicted outcome was 66.67%. Accuracy of prediction for the key outcome of HbA1c was 44.44%. Diabetes distress had the highest prediction accuracy (81.48%). Conclusions: Clinicians in this small study were unable to identify individuals likely to achieve improvement in outcomes from DSME. DSME should be promoted to all patients with diabetes according to guidelines