Becoming a mother: a study exploring occupational change in first-time motherhood

Having a first baby is considered a major life event, due to significant role change impacting on the ordinary and familiar activities the new mother performs every day. The aim of this study was to explore changes in the occupational lives of first time mothers. A concurrent nested strategy of enquiry was used. Quantitative data via the Modified Interest Checklist and the Role Checklist was nested within the predominantly qualitative data collection in the form of semi-structured interviews. Six first time mothers, who were two and a half years post motherhood and aged between 28 and 42 years, participated in this study. The findings indicate that 'new mothers' engaging in a balanced lifestyle pre-motherhood in the areas of self-care, leisure, productivity and rest experience a period of occupational disruption and occupational imbalance before adapting into motherhood through activities, tasks and finally occupations. These mothers' occupational lives are productivity dominant with most of their time being spent in paid employment and/or performing homecare/family care activities. Their occupational lives are also obligatory dominant, for example, they are performing activities they need to do to enable them to fulfil their role as mother, as opposed to activities they choose to do. Also evident is a daily process of change as individuals adapt into motherhood

REFLECTION ON CONSERVATION-RESTORATION PRACTICE TODAY. A EUROPEAN PERSPECTIVE

Contemporary conservation-restoration practice is affected by theoretical and ethical principles and by social factors. They are often discussed separately, but their effect on the processes of conservation-restoration is complex and intertwined.This paper offers an overview of the development of professional codes of ethics in conservation-restoration and as they relate to and inform professional competences. It looks at how ethics and competences are defined and link with professional education. It also discusses relationships with other professions in the preservation of cultural heritage and the need for clarification on the role and obligation of these respective professions. The legal and social issues they generate at a European level are touched upon.Contemporary conservation-restoration practice is affected by theoretical and ethical principles and by social factors. They are often discussed separately, but their effect on the processes of conservation-restoration is complex and intertwined.This paper offers an overview of the development of professional codes of ethics in conservation-restoration and as they relate to and inform professional competences. It looks at how ethics and competences are defined and link with professional education. It also discusses relationships with other professions in the preservation of cultural heritage and the need for clarification on the role and obligation of these respective professions. The legal and social issues they generate at a European level are touched upon

Orthotropic hygroscopic behavior of mass timber: theory, computation, and experimental validation

Recent rapid improvements in laminated timber technology have led to the increased use of wood in both mid- and high-rise construction, generally posed as a more carbon-friendly alternative to concrete. However, wood is significantly more sensitive to changes in relative humidity than concrete, which may impact the sustainability and durability of mass timber buildings. Moisture cycling in particular affects not only shrinkage and swelling but also strongly influences wood creep. This sensitivity is of high concern for engineered wood used in mass timber buildings. At the same time, wood, considered as an orthotropic material, exhibits varying diffusivity in all three directions, complicating efforts to characterize its behavior. In this work, an orthotropic hygroscopic model was developed for use in laminated timber. A species database for wood sorption isotherm was created and an existing model was used to fit species-based parameters. Diffusion behavior which considers the sorption isotherm was modeled through numerical simulations, and species-dependent orthotropic diffusion parameters were identified. A database of permeability in all directions for various species was created. The resulting model is able to predict diffusion behavior in glulam and cross-laminated timber (CLT) for multiple species of the lab tests. The model also predicts the moisture ranges for a CLT panel under environmental change with parameters from these sorption isotherm and diffusion databases

Developing a Clinical Academic Career Pathway in a Community and Mental Health NHS Trust

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Background: Despite growing evidence of the impact that clinical academic staff have on patient care and clinical practice, there are disproportionately low numbers of nurses, allied health professionals and other healthcare professionals in clinical academic joint roles, compared to their medical colleagues. Aim: To describe the initial development of a clinical academic career pathway for nurses, allied health professionals and other healthcare professionals in a community and mental health NHS Trust. Methods: Kotter’s Model for Change was used to expand opportunities and research culture across an NHS Trust. Results: A variety of capacity and capability initiatives at different academic levels were created to support clinical academic development and to complement those available externally. These opportunities were underpinned by a research and development strategy, senior leadership buy-in, manager and clinical staff support, and targeted organisation-wide communication. Conclusion: The ongoing development of innovative clinical academic opportunities in the Trust, alongside greater support for staff interested in pursuing clinical academic careers, has resulted in a growing number of individuals successful in developing as clinical academic. This has led to a growth in research culture in the organisation and a greater understanding of what clinical academic staff can bring to patient care, the clinical service, and the wider organisation

Small conductance calcium-activated potassium current is important in transmural repolarization of failing human ventricles

BACKGROUND: The transmural distribution of apamin-sensitive small conductance Ca(2+)-activated K(+) (SK) current (IKAS) in failing human ventricles remains unclear. METHODS AND RESULTS: We optically mapped left ventricular wedge preparations from 12 failing native hearts and 2 rejected cardiac allografts explanted during transplant surgery. We determined transmural action potential duration (APD) before and after 100 nmol/L apamin administration in all wedges and after sequential administration of apamin, chromanol, and E4031 in 4 wedges. Apamin prolonged APD from 363 ms (95% confidence interval [CI], 341-385) to 409 (95% CI, 385-434; P<0.001) in all hearts, and reduced the transmural conduction velocity from 36 cm/s (95% CI, 30-42) to 32 cm/s (95% CI, 27-37; P=0.001) in 12 native failing hearts at 1000 ms pacing cycle length (PCL). The percent APD prolongation is negatively correlated with baseline APD and positively correlated with PCL. Only 1 wedge had M-cell islands. The percentages of APD prolongation in the last 4 hearts at 2000 ms PCL after apamin, chromanol, and E4031 were 9.1% (95% CI, 3.9-14.2), 17.3% (95% CI, 3.1-31.5), and 35.9% (95% CI, 15.7-56.1), respectively. Immunohistochemical staining of subtype 2 of SK protein showed increased expression in intercalated discs of myocytes. CONCLUSIONS: SK current is important in the transmural repolarization in failing human ventricles. The magnitude of IKAS is positively correlated with the PCL, but negatively correlated with APD when PCL is fixed. There is abundant subtype 2 of SK protein in the intercalated discs of myocytes

Oralism: a sign of the times? The contest for deaf communication in education provision in late nineteenth-century Scotland

Disability history is a diverse field. In focussing upon children within deaf education in late nineteenth-century Scotland, this essay reflects some of that diversity. In 1880, the International Congress on the Education of the Deaf in Milan stipulated that speech should have ‘preference’ over signs in the education of deaf children. The mode of achieving this, however, effectively banned sign language. Endeavours to teach deaf children to articulate were not new, but this decision placed pressures on deaf institutions to favour the oral system of deaf communication over other methods. In Scotland efforts were made to adopt oralism, and yet educators were faced with the reality that this was not good educational practice for most pupils. This article will consider responses of Scottish educators of deaf children from the 1870s until the beginning of the twentieth century

Radical surgery versus organ preservation via short-course radiotherapy followed by transanal endoscopic microsurgery for early-stage rectal cancer (TREC): a randomised, open-label feasibility study

Background: Radical surgery via total mesorectal excision might not be the optimal first-line treatment for early-stage rectal cancer. An organ-preserving strategy with selective total mesorectal excision could reduce the adverse effects of treatment without substantially compromising oncological outcomes. We investigated the feasibility of recruiting patients to a randomised trial comparing an organ-preserving strategy with total mesorectal excision. Methods: TREC was a randomised, open-label feasibility study done at 21 tertiary referral centres in the UK. Eligible participants were aged 18 years or older with rectal adenocarcinoma, staged T2 or lower, with a maximum diameter of 30 mm or less; patients with lymph node involvement or metastases were excluded. Patients were randomly allocated (1:1) by use of a computer-based randomisation service to undergo organ preservation with short-course radiotherapy followed by transanal endoscopic microsurgery after 8–10 weeks, or total mesorectal excision. Where the transanal endoscopic microsurgery specimen showed histopathological features associated with an increased risk of local recurrence, patients were considered for planned early conversion to total mesorectal excision. A non-randomised prospective registry captured patients for whom randomisation was considered inappropriate, because of a strong clinical indication for one treatment group. The primary endpoint was cumulative randomisation at 12, 18, and 24 months. Secondary outcomes evaluated safety, efficacy, and health-related quality of life assessed with the European Organisation for Research and Treatment of Cancer (EORTC) QLQ C30 and CR29 in the intention-to-treat population. This trial is registered with the ISRCTN Registry, ISRCTN14422743. Findings: Between Feb 22, 2012, and Dec 19, 2014, 55 patients were randomly assigned at 15 sites; 27 to organ preservation and 28 to radical surgery. Cumulatively, 18 patients had been randomly assigned at 12 months, 31 at 18 months, and 39 at 24 months. No patients died within 30 days of initial treatment, but one patient randomly assigned to organ preservation died within 6 months following conversion to total mesorectal excision with anastomotic leakage. Eight (30%) of 27 patients randomly assigned to organ preservation were converted to total mesorectal excision. Serious adverse events were reported in four (15%) of 27 patients randomly assigned to organ preservation versus 11 (39%) of 28 randomly assigned to total mesorectal excision (p=0·04, χ2 test). Serious adverse events associated with organ preservation were most commonly due to rectal bleeding or pain following transanal endoscopic microsurgery (reported in three cases). Radical total mesorectal excision was associated with medical and surgical complications including anastomotic leakage (two patients), kidney injury (two patients), cardiac arrest (one patient), and pneumonia (two patients). Histopathological features that would be considered to be associated with increased risk of tumour recurrence if observed after transanal endoscopic microsurgery alone were present in 16 (59%) of 27 patients randomly assigned to organ preservation, versus 24 (86%) of 28 randomly assigned to total mesorectal excision (p=0·03, χ2 test). Eight (30%) of 27 patients assigned to organ preservation achieved a complete response to radiotherapy. Patients who were randomly assigned to organ preservation showed improvements in patient-reported bowel toxicities and quality of life and function scores in multiple items compared to those who were randomly assigned to total mesorectal excision, which were sustained over 36 months’ follow-up. The non-randomised registry comprised 61 patients who underwent organ preservation and seven who underwent radical surgery. Non-randomised patients who underwent organ preservation were older than randomised patients and more likely to have life-limiting comorbidities. Serious adverse events occurred in ten (16%) of 61 non-randomised patients who underwent organ preservation versus one (14%) of seven who underwent total mesorectal excision. 24 (39%) of 61 non-randomised patients who underwent organ preservation had high-risk histopathological features, while 25 (41%) of 61 achieved a complete response. Overall, organ preservation was achieved in 19 (70%) of 27 randomised patients and 56 (92%) of 61 non-randomised patients. Interpretation: Short-course radiotherapy followed by transanal endoscopic microsurgery achieves high levels of organ preservation, with relatively low morbidity and indications of improved quality of life. These data support the use of organ preservation for patients considered unsuitable for primary total mesorectal excision due to the short-term risks associated with this surgery, and support further evaluation of short-course radiotherapy to achieve organ preservation in patients considered fit for total mesorectal excision. Larger randomised studies, such as the ongoing STAR-TREC study, are needed to more precisely determine oncological outcomes following different organ preservation treatment schedules. Funding: Cancer Research UK

Student research: can recent research governance developments help?

It is well documented that research capacity within the therapy professions is underdeveloped and that opportunities to engage in research training must be therefore be created and seized (Department of Health 1994, Ilott and Bury 2002, Healey and Jenkins 2009). Over the last decade the development of bureaucratic research governance procedures has had a negative impact on research education and training; largely due to the difficulties associated with gaining the necessary permissions and approvals to conduct research within tight academic timeframes (Corr et al 2006). Recent research governance developments have aimed to correct this and make the research process more accessible (Pettican and Bostock 2009). These developments are presented and analysed below for their potential to enable pre-registration student researc