Supporting and Enabling Scholarship: Developing and Sharing Expertise in Online Learning and Teaching

In a highly competitive, rapidly changing higher education market, universities need to be able to generate pedagogical expertise quickly and ensure that it is applied to practice. Since teaching approaches are constantly evolving, partly responding to emerging learning technologies, there is a need to foster ways to keep abreast on an ongoing basis. This paper explores how a small-scale project, the Teaching Online Panel (TOP), used scholarship investigations and a bottom-up approach to enhance one particular aspect of academic practice – online learning and teaching. The experiences of TOP are useful for identifying: - how a scholarship approach can help develop academic expertise - its contribution to enhancing understanding of staff’s different roles in the University - ways of developing the necessary supportive network for those undertaking such scholarship - the effectiveness of staff development which is peer-led rather than imposed from above - how practical examples can stimulate practice development - the relevance of literature on communities of practice and landscapes of practice for scholarship - the important role of ‘brokers’ to facilitate the dissemination of scholarship findings - the benefits to the brokers’ own professional roles - the challenges of sustaining such an approach and lessons learnt. This study has relevance for those involved in supporting scholarship or delivering staff development in Higher Education

The Evolution of Public Health Education and Training in the United Kingdom

The United Kingdom has a long and evolving history of public health education. From the initiation of formal standardised training for Medical Officers for Health in the early 1900s, to the current national public health training programme, public health education has adapted to the changing contexts of public health practice. Whilst the profession was originally only a medical specialty, subsequent re­­cognition of the skills and contribution of the wider public health workforce has led to changes in professional specialist training for public health, which is now open to non-medical applicants. This well-established professional training scheme allows the formal accreditation of competence in a broad range of public health skills. The academic component of public health training is provided by a rapidly growing number of postgraduate courses. Once confined to the UK’s first school of public health, the London School of Hygiene and Tropical Medicine and a handful of British Universities, the current 60 or so courses across the country are found in diverse university settings. Quality and standards in higher education are monitored by the Quality Assurance Agency for Higher Education but there are no other professional accreditation schemes for postgraduate courses in public health nationally. Public health education and training continues to face challenges in the UK, notably the current government plans for major restructuring of the National Health Service (NHS) which threatens the loss of traditional NHS training placements and has created uncertainty around how professional training might be structured in the future. Whilst the long established tradition of public health education and more recent adoption of competency-based approaches to training gives some flexibility to meet these challenges, insight and innovative responses are required to ensure that public health education and training are not destabilised by these challenges. Revisions of the curricula of postgraduate courses and the competencies required for professional accreditation along with provision of experience in the new locations where public health is to be practiced in the future will be key to ensuring that public health professionals are ready to tackle the key issues that confront them

The lived experience of diabetes: conceptualisation using a metaphor

Introduction: It is important for healthcare professionals to understand the reality of living with diabetes in order to better engage and enable people to self-manage. The purpose of this research was thus a preliminary exploration of the lived experience of diabetes. Method: This qualitative study involved seven people with a diagnosis of type 1, type 2 or pre-diabetes. Data was collected via semi-structured interviews and analysed using a phenomenological approach including the use of metaphor. Findings were shared with participants using a felted metaphor of charting a course of health and wellbeing through a choppy sea. Findings: Themes explored within the elements of the metaphor included the boat (self-identity, control, balance, compliance and empowerment, emotions), the sea (physical and social environment, lifestyle, life events), the course (information gathering, change, self-action) and the boatyard (relationships with healthcare providers). Conclusion: For those with type 1, type 2 and pre-diabetes, the elements of charting a course of health and wellbeing through a choppy sea are very much focused on the person in their own context, impacted by their environment, life stage, occupations and attitudes to diabetes self-management, all of which fall within the remit of occupational therapy

Personality disorder and intellectual disability: the impacts of horticultural therapy within a medium-secure unit

This study was designed to explore the efficacy of a horticultural therapy intervention for the enhancement of subjective health and wellbeing in male service users with a dual diagnosis of personality disorder and intellectual disability in a medium secure unit in the north of England, UK. Service users (n=7) were involved in three focus groups; one just prior to a new garden facility opening, and then again at the six and twelve month points, which explored the personal impacts upon service users’ health and wellbeing. The garden was itself an upshot of participant involvement; service users were involved in all aspects of the garden design and maintenance, and also assisted with dissemination of the research goals and findings. Service users reported numerous personal health benefits as a result of their engagement with horticultural activities, allied to personal development enhancements in respect of gardening knowledge, employability skills, personal achievements and positive changes in behaviour towards self and others. Particularly, underlying these outputs, participants identified reduced stress, and a general “feel good” factor as key to their improved life-satisfaction. The mechanisms providing for these impacts included: interaction with a natural environment; enhanced intrinsic motivation derived from participation in a variety of tasks; and opportunities to develop specific horticultural skills. Immersion in horticultural activity may thus be an effective treatment modality in promoting positive health benefits to service users

The impact of green exercise on volunteers’ mental health and well being: findings from a community project in a woodland setting

An increasingly robust evidence base supports the therapeutic value of nature on mental health and well being. The rise in reported mental ill-health across the world has major implications for the effective use of healthcare budgets, as well as economic consequences. Health practitioners may need to consider going beyond traditional mental health service provision and look to more widespread engagement with community-based interventions. This is especially important given that the structured nature of service provision may present significant challenges for some people with mental ill-health (MIND, 2016). Thus, this study explored the experiences of volunteers with mental health problems attending an unorthodox center in a woodland setting within the North West of England, which seeks to promote health and well being through green exercise. An ethnographic approach, involving the use of fieldwork diaries and photographs, explored the center’s informal and unique physical and socio-cultural environment. Formally researching as outsiders on participants was deemed incongruent with the empowering ethos of the center. Following a six-week relationship building period, in which the researchers immersed themselves in the practical activities, individual fieldwork interviews were conducted with each of the volunteers (n=11). Transcribed data revealed three key themes underpinning the self-reported positive impacts on personal mental health and well being. The importance of the physical and social environment was paramount, whereby volunteers recognized the restorative effects of the natural environment, but also stressed the flexible, informal and ‘no nonsense’ ethos of the center, combined with the social support, as major factors in delivering positive health outcomes. The clear sense of purpose and meaning underpinning activity choice participation, and the feeling of togetherness this fostered, were also major influences. Using existing skills and developing new ones demonstrated the power of occupational engagement in enhancing enjoyment, achievement and overall contribution. Recognition of the influence of the context and structure of services on people’s ability to engage in therapeutic activities is therefore crucial in order to enable people to access support in their mental health recovery

Disclosure of lesbian, gay and bisexual identity, what do we need to know?

Introduction: Disclosure of Lesbian, Gay and Bisexual (LGB) orientation is identified as a continual process with negative and positive experiences holding long and short-term health and wellbeing impacts (Ryan, Legate and Weinstein, 2015). Occupational therapists claim holistic practice encompassing individuals’ diverse values, beliefs, and behaviours, yet evidence in addressing issues related to sexuality and disclosure is limited. It remains an under-researched area and from some perspectives, its relevance to occupational therapy is contested as illustrated in Couldrick (2005). A lack of understanding of the impact of disclosure on people’s occupational lives emphasises a need for this review of existing knowledge and its relevance to occupational therapy. Method: A structured database search and critical appraisal identified 17 articles that met the review criteria relating to LGB, disclosure, health & wellbeing and occupation. Data were extracted and analysed for themes according to Aveyard (2014). Findings: The review identified the factors influencing disclosure and the impact of disclosing sexual orientation on people’s health and wellbeing. Disclosure was a need, which increased alongside LGB identity affirmation. Analysis revealed how nondisclosure or negative disclosure experiences contributed to occupational deprivation, reduced participation and occupational performance. A lack of education amongst health professionals and ‘heteronormative’ practice was one of the key factors for negative impacts of disclosure. Conclusion: Disclosure of sexual orientation is a complex process impacting on individuals’ occupational identity, performance and engagement. This confirms the importance of developing occupational therapists’ understanding in order to support service users with an LGB orientation whom they may encounter in practice. The review has presented some foundations for future research directions and professional practice

Occupational engagement in a woodland: belonging and wellbeing for mental health

Introduction: Extensive evidence supports the value of horticulture, green exercise and the influence of nature on wellbeing (Fieldhouse & Sempik 2014) but some people in mental health recovery may not regard formal and structured services as accessible. In contrast, this study was set in an informal rural centre offering conservation and horticultural activities. The research purpose was to explore participants’ perceptions of this unique socio-cultural and physical environment and its impact on occupational engagement. Method: An ethnographic approach (Hammersley & Atkinson 2007) enabled exploration of the centre’s culture and the experiences of its volunteers. Researching as outsiders on participants would not be congruent with its empowering and flexible ethos. Hence, our immersion in the physical and social activities enabled live conversations with participants and we contributed to the practical work there. Transcribed interview data were analysed thematically (Braun & Clarke 2006). Member-checking of the preliminary findings will be offered at an informal workshop to invite participant comments and feedback for incorporation into the final analysis and dissemination. Discussion: Preliminary analysis indicates key themes of belonging, of being valued and respected. Additionally, the centre’s informality allowed flexibility in attendance, and the support of co-volunteers and the woodland owners were significant in maintaining involvement. Opportunities to use existing skills and develop new ones demonstrated the power of occupation in enhancing feelings of enjoyment, achievement and connection. The importance of the physical and social environments in facilitating engagement and contributing to wellbeing were paramount. Conclusion: Recognition of the influence of the context and structure of services on people’s ability to engage in therapeutic activities is crucial in order to enable individuals to access support in their mental health recovery

Anxiety in couples undergoing IVF: evidence from E-Freeze randomised controlled trial

Study question What are the risk factors and impacts of anxiety in women and men in heterosexual couples undergoing IVF as part of a randomised trial, with a delay in embryo transfer in one arm? Summary answer Duration of infertility, ethnicity, and male partner’s anxiety levels were associated with women’s anxiety at the start of treatment, while initial anxiety score, partner’s anxiety score at embryo transfer, ethnicity, and clinic location were associated with women’s anxiety levels at embryo transfer; although women undergoing IVF were more anxious than their partners for slightly different reasons, their self-reported state anxiety was not associated with achieving clinical pregnancy, nor with switching from delayed frozen embryo transfer to fresh embryo transfer in an IVF trial. What is known already Use of IVF treatment continues to rise and patients undergoing IVF are anxious. Participating in a randomised controlled trial (RCT) with uncertainty of arm randomisation might increase their anxiety, while a delay in treatment may add further to anxiety. Study design, size, duration A mixed methods study was conducted using data from the multi-centre E-Freeze RCT cohort conducted across 13 clinics in the UK from 2016 to 2019. A regression analysis on anxiety scores of couples undergoing the IVF trial and a qualitative analysis of participant questionnaires were performed. Participants/materials, setting, methods Six hundred and four couples participating in the E-Freeze trial, who had at least one useable State-Trait Anxiety Inventory (STAI) State Anxiety subscale (STAI-S) standardised self-report questionnaire for at least one of the partners, were included in the study. STAI-S scores were measured at consent for trial (T1) and again at embryo transfer (T2). Linear and log-binomial regression were used to explore the association between characteristics and STAI-S scores, and the associations between STAI-S scores and non-compliance and clinical pregnancy, respectively. Responses to the open text question were qualitatively analysed inductively using content analysis. Main results and the role of chance Women’s STAI-S scores at T1 (consent) were associated with their ethnicity, duration of infertility, and their male partner’s STAI-S score at T1. Women’s STAI-S scores at T2 (embryo transfer) were associated with their ethnicity, location of fertility clinic, their STAI-S score at consent, and their male partner’s STAI-S score at embryo transfer. The adjusted coefficient (95% CI) for women’s STAI-S scores at T2 was −4.75 (−7.29, −2.20, P  Limitations, reasons for caution Data were not available on education level or social support, which might influence anxiety scores. Men’s baseline characteristics were not collected. Wider implications of the findings Identifying couples at increased risk of emotional distress may be improved by using standardised anxiety measures at the start of the fertility treatment. Women can be reassured that their self-reported state anxiety does not affect their chances of achieving clinical pregnancy through IVF, and this may help to reduce anxiety levels. The psychological wellbeing and experiences of couples undergoing IVF could be supported by patient-centred care: making information about the whole process of treatment and choices available to both partners in accessible formats; ensuring interactions with staff are kind and supportive; and acknowledging and addressing the different concerns of women undergoing IVF and their partners. Study funding/competing interest(s) This study was an NIHR HTA (National Institute for Health and Care Research Health Technology Assessment) funded study. There are no conflicts of interest to declare. Trial registration number ISRCTN registry: ISRCTN61225414

Reverse exchange of healthcare devices: the case of hearing aid equipment in the UK

Reverse exchange (RE) in dealing with the return, recycle and reuse of products is receiving a growing focus. When properly handled, RE in healthcare can deliver an economic benefit of cost minimisation and has extensive positive impacts on both human health and the environment (Li and Olorunniwo, 2008) but to date, RE research is mostly limited to pharmaceutical return. This paper investigates the potential for RE benefits in the UK National Health Service (NHS) supply chain for medical devices. Hearing aids supplied to adults with hearing loss are used as an illustrative example. This research applied a consensus approach through the use of dispersed nominal groups in order to obtain qualitative data on information, barriers, solutions and priorities to support findings. Findings illustrate that the end user behaviour of returning the device, and the requirement by NHS Procurement for manufacturers to meet RE targets are secondary to the importance of audiology departments who have the autonomy to design RE processes and successfully implement initiatives. A schematic highlighting the information and materials flow of the supply chain and the barriers and facilitators to RE is presented for hearing aid devices with potential for transferability to other small medical device supply chains

Single antibody detection in a DNA origami nanoantenna

DNA nanotechnology offers new biosensing approaches by templating different sensor and transducer components. Here, we combine DNA origami nanoantennas with label-free antibody detection by incorporating a nanoswitch in the plasmonic hotspot of the nanoantenna. The nanoswitch contains two antigens that are displaced by antibody binding, thereby eliciting a fluorescent signal. Single-antibody detection is demonstrated with a DNA origami integrated anti-digoxigenin antibody nanoswitch. In combination with the nanoantenna, the signal generated by the antibody is additionally amplified. This allows the detection of single antibodies on a portable smartphone microscope. Overall, fluorescence-enhanced antibody detection in DNA origami nanoantennas shows that fluorescence-enhanced biosensing can be expanded beyond the scope of the nucleic acids realm