An examination of the care and career experiences of mid-life women who combine formal employment and informal caring of dependent adults

This thesis is based on the care and career experiences of mid-life (ages 45 – 65) women engaging in paid employment alongside informal caring of dependent adults. It was carried out within the context of a growing ‘social care crisis’ in the wake of depleting social and healthcare resources and government policies encouraging people to ‘care for their own’, alongside policies to boost the employment of older workers. Calendar interviews with 30 mid-life women with experience of caring and paid employment in Leicester and Leicestershire were conducted between June and December 2016. This research took place within the interpretive paradigm, with the aim of hearing from women about their experiences in their own voices. The study draws upon three intersecting areas of literature and theory around concepts of work, careers and caring, to make sense of the women’s experiences. As a result, the study reveals key themes: the negative and positive impacts of caring on formal career trajectories; changing perspectives on concepts of work and the notion of care as ‘work’; understandings of career, and the emergence of care as an ‘unexpected career’, which helps in conceptualising women’s careers. The study contributes empirically by generating further knowledge and understanding of caring and career, particularly as there are limited existing qualitative studies in this area. Through analysis of the careers of participants, a typology of women’s formal careers affected by caring and a typology of informal caring careers were developed, providing frameworks for the study of women’s careers. The thesis identifies the notion of women’s polymorphic careers, demonstrated through the development of a new model of women’s formal and informal caring careers. It also offers recommendations for both policy and practice. This includes greater support from local and national government, provision of information and training to carers. It is also important for workplaces to understand the moral and business case for supporting working carers, having clear policies which are structured, with consistent support but also flexible enough to be personalised to individual circumstances. Furthermore, line managers should be given training, support and time to engage with their employees and to understand all aspects of their development. Finally, the thesis concludes with areas for possible future research incorporating further longitudinal study, different participant groups, and applying the model to different contexts

East Midlands Research into Ageing Network (EMRAN) Discussion Paper Series

Academic geriatric medicine in Leicester . There has never been a better time to consider joining us. We have recently appointed a Professor in Geriatric Medicine, alongside Tom Robinson in stroke and Victoria Haunton, who has just joined as a Senior Lecturer in Geriatric Medicine. We have fantastic opportunities to support students in their academic pursuits through a well-established intercalated BSc programme, and routes on through such as ACF posts, and a successful track-record in delivering higher degrees leading to ACL post. We collaborate strongly with Health Sciences, including academic primary care. See below for more detail on our existing academic set-up. Leicester Academy for the Study of Ageing We are also collaborating on a grander scale, through a joint academic venture focusing on ageing, the ‘Leicester Academy for the Study of Ageing’ (LASA), which involves the local health service providers (acute and community), De Montfort University; University of Leicester; Leicester City Council; Leicestershire County Council and Leicester Age UK. Professors Jayne Brown and Simon Conroy jointly Chair LASA and have recently been joined by two further Chairs, Professors Kay de Vries and Bertha Ochieng. Karen Harrison Dening has also recently been appointed an Honorary Chair. LASA aims to improve outcomes for older people and those that care for them that takes a person-centred, whole system perspective. Our research will take a global perspective, but will seek to maximise benefits for the people of Leicester, Leicestershire and Rutland, including building capacity. We are undertaking applied, translational, interdisciplinary research, focused on older people, which will deliver research outcomes that address domains from: physical/medical; functional ability, cognitive/psychological; social or environmental factors. LASA also seeks to support commissioners and providers alike for advice on how to improve care for older people, whether by research, education or service delivery. Examples of recent research projects include: ‘Local History Café’ project specifically undertaking an evaluation on loneliness and social isolation; ‘Better Visits’ project focused on improving visiting for family members of people with dementia resident in care homes; and a study on health issues for older LGBT people in Leicester. Clinical Geriatric Medicine in Leicester We have developed a service which recognises the complexity of managing frail older people at the interface (acute care, emergency care and links with community services). There are presently 17 consultant geriatricians supported by existing multidisciplinary teams, including the largest complement of Advance Nurse Practitioners in the country. Together we deliver Comprehensive Geriatric Assessment to frail older people with urgent care needs in acute and community settings. The acute and emergency frailty units – Leicester Royal Infirmary This development aims at delivering Comprehensive Geriatric Assessment to frail older people in the acute setting. Patients are screened for frailty in the Emergency Department and then undergo a multidisciplinary assessment including a consultant geriatrician, before being triaged to the most appropriate setting. This might include admission to in-patient care in the acute or community setting, intermediate care (residential or home based), or occasionally other specialist care (e.g. cardiorespiratory). Our new emergency department is the county’s first frail friendly build and includes fantastic facilities aimed at promoting early recovering and reducing the risk of hospital associated harms. There is also a daily liaison service jointly run with the psychogeriatricians (FOPAL); we have been examining geriatric outreach to oncology and surgery as part of an NIHR funded study. We are home to the Acute Frailty Network, and those interested in service developments at the national scale would be welcome to get involved. Orthogeriatrics There are now dedicated hip fracture wards and joint care with anaesthetists, orthopaedic surgeons and geriatricians. There are also consultants in metabolic bone disease that run clinics. Community work Community work will consist of reviewing patients in clinic who have been triaged to return to the community setting following an acute assessment described above. Additionally, primary care colleagues refer to outpatients for sub-acute reviews. You will work closely with local GPs with support from consultants to deliver post-acute, subacute, intermediate and rehabilitation care services. Stroke Medicine 24/7 thrombolysis and TIA services. The latter is considered one of the best in the UK and along with the high standard of vascular surgery locally means one of the best performances regarding carotid intervention

Paradoxes of ‘career’ and ‘progress’ in the neoliberal university: a self-critique and deconstruction

This paper takes a person-in-context approach to explore how the neoliberal university, embroiled in discourses of ‘progress’, influences academics’ narrativization and navigation of career. Whilst aware of the role ‘progress’ plays in framing a ‘traditional career’, academics find themselves having to navigate the contours of the university – where matrices shout to the tide of ‘progress’ and where what gets measured supposedly gets done. Such matrices, providing a violent quantification of reality (Gee, 2020), reduce pedagogy to lustful percentages of satisfaction, research to star status – mirroring the aspirations of a McDonald’s ‘Diningroom Server’ - and community engagement to a hurtful simile of impact. This research engages in dialogical-biography to provide insight into career turning points and meaning-making, with attention to broader contextual and conceptual dimensions. The paper explores tensions between ‘social justice’ and ‘progress’ with the aim of furthering debate within career-studies on the paradoxical relations of ‘career’ and ‘progress’ in academia today and considering the implications for human resource development

Novel pathogenic variants and quantitative phenotypic analyses of Robinow syndrome:WNT signaling perturbation and phenotypic variability

Robinow syndrome (RS) is a genetically heterogeneous disorder with six genes that converge on the WNT/planar cell polarity (PCP) signaling pathway implicated (DVL1, DVL3, FZD2, NXN, ROR2, and WNT5A). RS is characterized by skeletal dysplasia and distinctive facial and physical characteristics. To further explore the genetic heterogeneity, paralog contribution, and phenotypic variability of RS, we investigated a cohort of 22 individuals clinically diagnosed with RS from 18 unrelated families. Pathogenic or likely pathogenic variants in genes associated with RS or RS phenocopies were identified in all 22 individuals, including the first variant to be reported in DVL2. We retrospectively collected medical records of 16 individuals from this cohort and extracted clinical descriptions from 52 previously published cases. We performed Human Phenotype Ontology (HPO) based quantitative phenotypic analyses to dissect allele-specific phenotypic differences. Individuals with FZD2 variants clustered into two groups with demonstrable phenotypic differences between those with missense and truncating alleles. Probands with biallelic NXN variants clustered together with the majority of probands carrying DVL1, DVL2, and DVL3 variants, demonstrating no phenotypic distinction between the NXN-autosomal recessive and dominant forms of RS. While phenotypically similar diseases on the RS differential matched through HPO analysis, clustering using phenotype similarity score placed RS-associated phenotypes in a unique cluster containing WNT5A, FZD2, and ROR2 apart from non-RS-associated paralogs. Through human phenotype analyses of this RS cohort and OMIM clinical synopses of Mendelian disease, this study begins to tease apart specific biologic roles for non-canonical WNT-pathway proteins