Being the Bottom Line: Mothers' Experiences of Fostering Networks That Will Support Their Son or Daughter with Disabilities

This phenomenological study was part of a wider ethnographic research project of nine personal support networks. Participants were purposefully recruited to the project because of their involvement in networks that were committed to actively developing the positive, meaningful future of an adult family member with lifelong disabilities. Data were collected from November 2007 to March 2012. A narrative analysis of a subset of the data, the transcripts of interviews with the mother of the son or daughter with disabilities at the centre of eight of the networks, was conducted for the purposes of this study. Findings were checked with mothers. The mothers in this study anticipated the family, particularly sisters, circles, the service and/ or a good village will support their son or daughter with disabilities when they, and the father of their son or daughter, are no longer able to. They did so by embodying appropriate ways of thinking, supporting siblings and, meeting the shortfall. The networks they anticipated for the future were uniquely configured however they were influenced by transitions and turning points in the lives of their son or daughter with lifelong disabilities. Mothers were the bottom line in these networks. Paradoxically, they exercised their sense of responsibility by engaging others in the networks that will support their sons and daughters into the future. The findings from this study will inform the further development of initiatives that support parents in the process of preparing for the future support of their son or daughter with lifelong disabilities

Promoting the use of reusable coffee cups through environmental messaging, the provision of alternatives and financial incentives

It is estimated that 2.5–10 bn disposable coffee cups are used every year in the U.K. Most of these cups end up in landfill or as litter, as the majority of poly-coated paper cups are not recyclable or not recycled. Here, we report on a field experiment that was conducted at twelve university and business sites to examine whether the use of reusable cups can be promoted through easily implementable measures. The study found that both environmental messaging and the provision of alternatives increased the use of reusable cups. While a charge on disposable cups increased their use as well, a discount on reusable cups did not. The effects for the individual measures were modest, but additive, meaning that the greatest behavioural change was achieved with a combination of measures. None of the measures negatively impacted the total number of hot drink sales. One university continued with the charge after the experiment had finished and distributed more reusable cups for free among their students. This boosted the use of reusable cups up to 33.7% across three cafés. This shows that a charge in combination with the provision of alternatives can increase the use of reusable cups substantially in the long ter

Practice Research Partnerships in Social Work : Addressing Impact and Credible Evidence

Purpose: This article builds on the Practice Research Collaboratives (PRCs) as an initiative that developed from the Fifth Conference on Practice Research to provide a platform for practice researchers to engage actively around impact and influence. Research question: The unique features of research activities that enable transformational impact in three cases in social work practice research involving long-term community and university research partnerships. Methodology: Literature review and comparison of case studies. Results: The cases show how the processes of implementation are not only seen as linear, but constantly evolving at the same time as intervention fidelity in social work is crucial to improving outcomes for people, which can have transformative impacts for individuals and systems alike. Conclusion: We conclude by describing the importance of understanding the feasibility of complex problems and complex social situation which requires meaningful communication between partners, transparency and involvement of all players throughout the process

Using Threshold Concepts to generate a new understanding of teaching and learning Biology

Students come to tertiary institutions with misconceptions of key concepts in the disciplines they are studying. Their misconceptions commonly relate to conceptually difficult or troublesome knowledge (Perkins 1999) and can be: incomplete, contradictory, stable and highly resistant to change and remain intact despite repeated instruction at successively higher levels, being perhaps reinforced by teachers and textbooks (Driver 1983; Driver, Guesne and Tiberghien, 1985; Gabel 1994). For sometime, we have known that a range of concepts in Biology are conceptually difficult e.g. biochemical pathways, evolution and genetics (Brown 1995; Ross and Tronson 2007, Taylor 2006, 2008), but whether these are the ‘threshold concepts’ of (Meyer and Land 1995) is a question that needs to be explored further. We propose an alternative perspective where threshold crossing can be envisaged more productively as a cognitive process with students transported across a conceptual chasm or threshold. Misconceptions may then lie with an underlying ‘cognitive threshold’ and not a ‘threshold concept’ (Ross et al 2008). This current ALTC funded collaborative project involves three Australian universities and aims to identify the cognitive processes which underlie difficult Biological concepts; develop intervention strategies to improve students’ framework of conceptual understanding, in one or more related concept areas (that is, to help the students cross a conceptual threshold); test whether students can subsequently transfer this thinking process to aid their understanding of other similarly difficult concepts (that is, to see if they have learnt how to cross unfamiliar thresholds). In this paper we present the preliminary results of a survey which asked biology academics (both nationally and internationally) to identify troublesome biological concepts in their teaching, describe the cognitive process that underlies them which may determine why they are troublesome, and to identify the links they perceive with our nominated cognitive thresholds

Threshold Concepts: Challenging the Way We Think, Teach and Learn in Biology and Science

Meyer and Land (2003, 2005) proposed the notion of ‘threshold concepts’, which are central to the mastery of a specific discipline due to their transformative, irreversible and integrative nature. Using the methodology of Davies and Mangan (2007) we interviewed novice students (58) and expert academic staff (11) from three Australian universities and conducted an international survey of academics (55) to identify differences in novice and expert conceptions. We matched these data with understandings from the ‘misconceptions’ literature to create the ‘biology thresholds matrix’. The matrix demonstrates that threshold concepts in biology are not necessarily the troublesome content, but rather the tacit understandings of the discipline (Taylor, 2006, 2008; Ross & Tronson, 2007, Ross, Taylor, Hughes, Kofod, Whitaker, Lutze-Mann & Tzioumis, 2010). These are often not explicitly taught (Perkins, 2006) yet underpin difficult content areas including: energy and energy transformation, variation, probability and randomness, proportionality and surface area to volume ratio, dynamic equilibrium, linking the subcellular (submicroscopic) with the macroscopic, temporal and spatial scales (Ross et al., 2010), and the formulation and testing of hypotheses (Taylor & Meyer, 2010). These threshold concepts are not hierarchical in nature, but form a web of epistemes which has commonalities with tacit understandings in other science disciplines

Prostate MR image quality of apparent diffusion coefficient maps versus fractional intracellular volume maps from VERDICT MRI using the PI-QUAL score and a dedicated Likert scale for artefacts

PURPOSE: This study aimed to assess the image quality of apparent diffusion coefficient (ADC) maps derived from conventional diffusion-weighted MRI and fractional intracellular volume maps (FIC) from VERDICT MRI (Vascular, Extracellular, Restricted Diffusion for Cytometry in Tumours) in patients from the INNOVATE trial. The inter-reader agreement was also assessed. METHODS: Two readers analysed both ADC and FIC maps from 57 patients enrolled in the INNOVATE prospective trial. Image quality was assessed using the Prostate Imaging Quality (PI-QUAL) score and a subjective image quality Likert score (Likert-IQ). The image quality of FIC and ADC were compared using a Wilcoxon Signed Ranks test. The inter-reader agreement was assessed with Cohen's kappa. RESULTS: There was no statistically significant difference between the PI-QUAL score for FIC datasets compared to ADC datasets for either reader (p = 0.240 and p = 0.614). Using the Likert-IQ score, FIC image quality was higher compared to ADC (p = 0.021) as assessed by reader-1 but not for reader-2 (p = 0.663). The inter-reader agreement was 'fair' for PI-QUAL scoring of datasets with FIC maps at 0.27 (95% confidence interval; 0.08-0.46) and ADC datasets at 0.39 (95% confidence interval 0.22-0.57). For Likert scoring, the inter-reader agreement was also 'fair' for FIC maps at 0.38 (95% confidence interval; 0.10-0.65) and substantial for ADC maps at 0.62 (95% confidence interval; 0.39-0.86). CONCLUSION: Image quality was comparable for FIC and ADC. The inter-reader agreement was similar when using PIQUAL for both FIC and ADC datasets but higher for ADC maps compared to FIC maps using the image quality Likert score

Regional Histopathology and Prostate MRI Positivity: A Secondary Analysis of the PROMIS Trial

Background: The effects of regional histopathologic changes on prostate MRI scans have not been accurately quantified in men with an elevated prostate-specific antigen (PSA) level and no previous biopsy. / Purpose: To assess how Gleason grade, maximum cancer core length (MCCL), inflammation, prostatic intraepithelial neoplasia (PIN), or atypical small acinar proliferation within a Barzell zone affects the odds of MRI visibility. / Materials and Methods: In this secondary analysis of the Prostate MRI Imaging Study (PROMIS; May 2012 to November 2015), consecutive participants who underwent multiparametric MRI followed by a combined biopsy, including 5-mm transperineal mapping (TPM), were evaluated. TPM pathologic findings were reported at the whole-prostate level and for each of 20 Barzell zones per prostate. An expert panel blinded to the pathologic findings reviewed MRI scans and declared which Barzell areas spanned Likert score 3–5 lesions. The relationship of Gleason grade and MCCL to zonal MRI outcome (visible vs nonvisible) was assessed using generalized linear mixed-effects models with random intercepts for individual participants. Inflammation, PIN, and atypical small acinar proliferation were similarly assessed in men who had negative TPM results. / Results: Overall, 161 men (median age, 62 years [IQR, 11 years]) were evaluated and 3179 Barzell zones were assigned MRI status. Compared with benign areas, the odds of MRI visibility were higher when a zone contained cancer with a Gleason score of 3+4 (odds ratio [OR], 3.1; 95% CI: 1.9, 4.9; P < .001) or Gleason score greater than or equal to 4+3 (OR, 8.7; 95% CI: 4.5, 17.0; P < .001). MCCL also determined visibility (OR, 1.24 per millimeter increase; 95% CI: 1.15, 1.33; P < .001), but odds were lower with each prostate volume doubling (OR, 0.7; 95% CI: 0.5, 0.9). In men who were TPM-negative, the presence of PIN increased the odds of zonal visibility (OR, 3.7; 95% CI: 1.5, 9.1; P = .004). / Conclusion: An incremental relationship between cancer burden and prostate MRI visibility was observed. Prostatic intraepithelial neoplasia contributed to false-positive MRI findings

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Evidence into practice: evaluating a child-centred intervention for diabetes medicine management The EPIC Project

BACKGROUND: There is a lack of high quality, child-centred and effective health information to support development of self-care practices and expertise in children with acute and long-term conditions. In type 1 diabetes, clinical guidelines indicate that high-quality, child-centred information underpins achievement of optimal glycaemic control with the aim of minimising acute readmissions and reducing the risk of complications in later life. This paper describes the development of a range of child-centred diabetes information resources and outlines the study design and protocol for a randomized controlled trial to evaluate the information resources in routine practice. The aim of the diabetes information intervention is to improve children and young people's quality of life by increasing self-efficacy in managing their type 1 diabetes. METHODS/DESIGN: We used published evidence, undertook qualitative research and consulted with children, young people and key stakeholders to design and produce a range of child-centred, age-appropriate children's diabetes diaries, carbohydrate recording sheets, and assembled child-centred, age-appropriate diabetes information packs containing published information in a folder that can be personalized by children and young people with pens and stickers. Resources have been designed for children/young people 6-10; 11-15; and 16-18 years.To evaluate the information resources, we designed a pragmatic randomized controlled trial to assess the effectiveness, cost effectiveness, and implementation in routine practice of individually tailored, age-appropriate diabetes diaries and information packs for children and young people age 6-18 years, compared with currently available standard practice.Children and young people will be stratified by gender, length of time since diagnosis ( 2 years) and age (6-10; 11-15; and 16-18 years). The following data will be collected at baseline, 3 and 6 months: PedsQL (generic, diabetes and parent versions), and EQ-5 D (parent and child); NHS resource use and process data (questionnaire and interview). Baseline and subsequent HbA1c measurements, blood glucose meter use, readings and insulin dose will be taken from routine test results and hand-held records when attending routine 3-4 monthly clinic visits.The primary outcome measure is diabetes self-efficacy and quality-of-life (Diabetes PedsQL). Secondary outcomes include: HbA1c, generic quality of life, routinely collected NHS/child-held data, costs, service use, acceptability and utility. TRIAL REGISTRATION: ISRCTN17551624