Edge Hill University
  • Ormskirk, Lancashire, United Kingdom
Recent publications
Volunteering is an activity based on a non-profit idea of engagement in productive transactions. This paper examines why and how asylum seekers and refugees (ASRs) partake in volunteering focusing particularly on the everyday, mundane experiences of volunteering and the role of the material and financial gains as part of it. Data is drawn from 30 interviews conducted with ASRs from 15 countries residing in Glasgow, 20 interviews with the third sector and state agency staff, and supplemented by participant observation conducted in third sector organisations involved in ASRs’ integration and settlement. Despite the individual and situational differences, volunteering appeals to ASRs as it enables them to gain familiarity with and social connectivity in their new environs as well as supplements subsistence needs, providing material and financial benefits. These mundane and seemingly secondary gains from volunteering consist of the flesh of the otherwise abstract processes of inclusion, due to the symbolic and logistic significance they have in the ASRs’ lives.
Introduction: The SARS-CoV-2 pandemic has devastated populations, posing unprecedented challenges for healthcare services, staff and service-users. In the UK, rapid reconfiguration of maternity healthcare service provision changed the landscape of antenatal, intrapartum and postnatal care. This study aimed to explore the experiences of maternity services staff who provided maternity care during the SARS-CoV-2 pandemic to inform future improvements in care. Material and methods: A qualitative interview service evaluation was undertaken at a single maternity service in an NHS Trust, South London. Respondents (n = 29) were recruited using a critical case purposeful sample of maternity services staff. Interviews were conducted using video-conferencing software, and were transcribed and analyzed using Grounded Theory Analysis appropriate for cross-disciplinary health research. The focus of analysis was on staff experiences of delivering maternity services and care during the SARS-CoV-2 pandemic. Results: A theory of "Precarity and Preparedness" was developed, comprising three main emergent themes: "Endemic precarity: A health system under pressure"; "A top-down approach to managing the health system shock"; and "From un(der)-prepared to future flourishing". Conclusions: Maternity services in the UK were under significant strain and were inherently precarious. This was exacerbated by the SARS-CoV-2 pandemic, which saw further disruption to service provision, fragmentation of care and pre-existing staff shortages. Positive changes are required to improve staff retention and team cohesion, and ensure patient-centered care remains at the heart of maternity care.
This study critically analyses the micro, meso and macro level factors that influence the female academics to engage in academic entrepreneurship (AE). The extant literature, which seeks to understand the female academics engagement in AE, mostly revolves around a gender comparative lens, where women entrepreneurs are understood only in comparison with men. This study examines the association between female AE and the level of asymmetry between the micro, meso and macro level factors (5M framework).
Background Physiotherapy is recommended for people with tennis elbow, but whilst a wide array of treatments is available, the optimal approach remains uncertain. We have therefore recently developed an optimised physiotherapy treatment package for tennis elbow based on a synthesis of the evidence, patient input and clinical consensus. It consists of detailed advice and education, a structured progressive exercise programme and provision of a counter-force elbow brace. Here, we report the protocol for our multicentre pilot and feasibility randomised controlled trial (RCT) designed to (a) examine the feasibility of our optimised physiotherapy treatment package and (b) to pilot trial processes for a future fully powered RCT to test clinical and cost-effectiveness compared with usual physiotherapy treatment. Methods A multicentre pilot and feasibility RCT will be conducted across three sites in England, recruiting up to 50 patients (or for a maximum of 12 months). Participants with tennis elbow, identified from physiotherapy clinic waiting lists and general practice surgeries, will be randomly allocated to receive the optimised physiotherapy treatment package or usual physiotherapy care. Analysis will focus on feasibility measures including consent rate, intervention fidelity, follow-up rate and outcome completion rate. A nested qualitative study will explore the acceptability of the study processes and patient and physiotherapist experiences of the new optimised intervention. Discussion This study will determine the feasibility of a new optimised physiotherapy treatment package for people with tennis elbow and pilot the processes for a future fully powered RCT. In the longer term, this treatment package may provide superior clinical outcomes for patients, in terms of pain and quality of life, and be more cost-effective for the health service. Trial registration Registered with the ISRCTN database 19/7/2021, https://www.isrctn.com/ISRCTN64444585
3D printing was invented thirty years ago. However, its application in healthcare became prominent only in recent years to provide solutions for drug delivery and clinical challenges, and is constantly evolving. This cost-efficient technique utilises biocompatible materials and is used to develop model implants to provide a greater understanding of human anatomy and diseases, and can be used for organ transplants, surgical planning and for the manufacturing of advanced drug delivery systems. In addition, 3D printed medical devices and implants can be customised for each patient to provide a more tailored treatment approach. The advantages and applications of 3D printing can be used to treat patients with different eye conditions, with advances in 3D bioprinting offering novel therapy applications in ophthalmology. The purpose of this review paper is to provide an in-depth understanding of the applications and advantages of 3D printing in treating different ocular conditions in the cornea, glaucoma, retina, lids and orbits.
Retinal pigment epithelium (RPE) performs essential functions for ensuring retinal homeostasis and is a key site for pathogenic changes leading to age-related macular degeneration (AMD). Compromised proteostasis in RPE results in ER stress and ER stress-dependent antioxidant, apoptosis and autophagic responses. ER stress induces the unfolded protein response (UPR) in which EIF2AK3, encoding the protein kinase RNA-like ER kinase (PERK), acts as a key regulator. Downregulated EIF2AK3 gene expression has recently been identified in AMD using human donor RPE, however the molecular mechanisms that integrate the various ER-mediated cellular pathways underpinning progressive RPE dysfunction in AMD have not been fully characterised. This study investigated the downstream effects of PERK downregulation in response to Brefeldin A (BFA)-induced ER stress in ARPE-19 cells. PERK downregulation resulted in increased ER stress and impaired apoptosis induction, antioxidant responses and autophagic flux. ARPE-19 cells were unable to efficiently induce autophagy following PERK downregulation and PERK presented a role in regulating the rate of autophagy induction. The findings support PERK downregulation as an integrative event facilitating dysregulation of RPE processes critical to cell survival known to contribute to AMD development and highlight PERK as a potential future therapeutic target for AMD.
Purpose of the study: Understanding self-directed learning (SDL) when using point of care information systems (POCIS) can inform educational providers of the usefulness of the system for continuing medical education (CME). Sen's capability approach can offer a unique perspective to understand SDL, which considers the extent to which individual valued learning needs can be achieved. The aim of the study was to pilot the use of a questionnaire informed by the capability approach for understanding SDL when using POCIS in the context of CME. Methods: A semi-structured questionnaire aligned to the capability approach (Capability Approach for SDL with POCIS Questionnaire - CA-SPQ) in the context of CME was developed and implemented with 200 users of a POCIS (BMJ Best Practice). Results: The response rate was 92 and 78% of users considered that their valued outcomes were achieved and that they could apply their new learning to practice. The questionnaire had high content, face, and construct validity. Conclusion: The CA-SPQ can offer a practical instrument to provide data and useful information for understanding SDL, when using POCIS in the context of CME. It also has the potential for adaptation to other areas of medical education.
A significant proportion of autistic adults today were not diagnosed until later in life, a group referred to as the ‘lost generation,’ which may affect mental health. In Study 1 we explored quality of life and autistic trait levels in 420 autistic and TD adults, and in Study 2 we explored the experiences of 8 autistic adults diagnosed as adults. We found that autistic adults had lower quality of life outcomes and higher autistic trait levels which related to age of diagnosis, and qualitative findings indicated that while adults were empowered by their new diagnosis, they still require specialized supports. Our findings are discussed, emphasizing future directions and implications for the current care system in place for autistic adults.
Purpose The maxillectomy defect is complex and the best means to achieve optimal reconstruction, and dental rehabilitation is a source of debate. The refinements in zygomatic implant techniques have altered the means and speed by which rehabilitation can be achieved and has also influenced the choice regarding ideal flap reconstruction. The aim of this study is to report on how the method of reconstruction and oral rehabilitation of the maxilla has changed since 1994 in our Institution, and to reflect on case mix and survival. Methods Consecutive head and neck oncology cases involving maxillary resections over a 27-year period between January 1994 and November 2020 were identified from hospital records and previous studies. Case note review focussed on clinical characteristics, reconstruction, prosthetic rehabilitation, and survival. Results There were 186 patients and the tumour sites were: alveolus for 56% (104), hard palate for 19% (35), maxillary sinus for 18% (34) and nasal for 7% (13). 52% (97) were Brown class 2 defects. Forty-five patients were managed by obturation and 78% (142/183) had free tissue transfer. The main flaps used were radial (52), anterolateral thigh (27), DCIA (22), scapula (13) and fibula (11). There were significant changes over time regarding reconstruction type, use of primary implants, type of dental restoration, and length of hospital stay. Overall survival after 24 months was 64% (SE 4%) and after 60 months was 42% (SE 4%). Conclusion These data reflect a shift in the reconstruction of the maxillary defect afforded by the utilisation of zygomatic implants.
The well-known Human Development Index (HDI) goes beyond a single measure of well-being as it is constructed as a composite index of achievements in education, income, and health dimensions. However, it is argued that the above dimensions do not reflect the overall well-being, and new indicators should be included in its construction. This paper uses stochastic dominance spanning to test the inclusion of additional institutional quality (governance) dimensions to the HDI, and we examine whether the augmentation of the original set of welfare dimensions by an additional component leads to distributional welfare gains or losses or neither. We find that differently constructed indicators of the same institutional quality measure produce different distributions of well-being. Supplementary information: The online version contains supplementary material available at 10.1007/s10479-022-04656-w.
A diatom record from Moss Lake, Washington, USA spans the last 14,500 cal year and revealed Holocene climate change in the Pacific Northwest (PNW), including evidence for periodicities related to ocean-atmosphere teleconnections and/or variations in solar output. Three main climate phases were identified: (i) Late Pleistocene to early Greenlandian (until 10,800 cal year BP, spanning GI-1, GS-1), with a cold climate and low diatom abundance; (ii) early Greenlandian to Northgrippian (10,800–7500 cal year BP), shifting to a warmer climate; and (iii) late Northgrippian and Meghalayan from 7500 cal year BP onwards, with a cooler, moist climate. These climate shifts are in good agreement with the pollen record from the same core and other regional studies. Fluctuations in Discostella pseudostelligera and Aulacoseira taxa suggest climate cycles of different frequency and amplitude throughout the record. Spectral and wavelet analyses revealed periodicities of approximately 1400 and 400–500 years. We interpret the ~ 1400-year and ~ 400–500-year cycles to reflect alternating periods of enhanced (and reduced) convective mixing in the water column, associated with increased (and decreased) storms, resulting from ocean–atmosphere teleconnections in the wider Pacific region. The ~ 1400-year periodicity is evident throughout the Late Pleistocene and late Northgrippian/Meghalayan, reflecting high-amplitude millennial shifts from periods of stable thermal stratification of the water column (weak wind intensity) to periods of convective mixing (high wind intensity). The millennial cycle diminishes during the Greenlandian, in association with the boreal summer insolation maximum, consistent with suppression of ENSO-like dynamics by enhanced trade winds. Ocean–atmosphere teleconnection suppression is recorded throughout the PNW, but there is a time discrepancy with other records, some that reveal suppression during the Greenlandian and others during the Northgrippian, suggesting endogenic processes may also modulate the Moss Lake diatom record. The large amplitude of millennial variability indicated by the lake data suggests that regional climate in the PNW was characterised over the longer term by shifting influences of ocean–atmosphere dynamics and that an improved understanding of the external forcing is necessary for understanding past and future climate conditions in western North America.
This marketised higher education environment in the UK has had dire consequences for academics at all levels. Literature suggests that academics are busier and working faster than ever. There is evidence of an undermining of academic professionalism, academic freedom and increased job insecurity in the sector. It is not possible for academics to position themselves outside of the performance culture and still be viewed as a valued team member. Within this paper, our concerns relate specifically to the impact of this culture of performativity on the wellbeing of staff who work in UK higher education institutions.
Raciolinguistic ideologies are sets of beliefs about language which perceive racialised communities as displaying linguistic deficiencies which require remediation. These ideologies are tethered to European colonialism and white supremacist logics which have long been normalised and actively written into teacher education policy in England. In this article I argue that raciolinguistic ideologies are integral to the contemporary, state-crafted policy assemblage that pre-service teachers and teacher educators must navigate, including the Teachers’ Standards, the Core Content Framework and various documents produced by Ofsted, the schools inspectorate. I argue that this policy assemblage represents a form of hostile governance which is attempting to derail and curtail anti-racist efforts. I show how raciolinguistic ideologies surface under guises of career advancement, pedagogical excellence, scientific objectivity, research validity and social justice. These guises operate to coerce pre-service teachers and teacher educators to reproduce raciolinguistic ideologies in their own practice, reduce professional agency and place responsibility on low-income and racialised communities to modify their language towards idealised whiteness. The article ends with some proposals for how teacher educators might find cracks in this oppressive system, in locating spaces for resistance which seek to undo harmful and colonial ideologies about language in the struggle against white supremacy.
Regulations ensuring that the promotion and advertising of foods high in fat, sugar, and salt were restricted from October 2022 are now to be delayed by the UK Government. The delay of this policy is to be condemned because it will set back the anticipated improvement to population diets and obesity levels by postponing the expected transformation of retail food environments in‐store and online. Governmental justifications for delaying these policies, the implementation of which was the responsibility of the UK food industry, can be perceived to reflect a short‐sighted willingness to use the current economic circumstances to push the responsibility for obesity and dietary choices back into the court of the consumer. Delaying these polices will, yet again, leave public health and clinical practitioners tackling obesity with less‐effective approaches focused on individual willpower and information provision.
International studies of talk‐intensive (or ‘dialogic’) pedagogies have demonstrated that children who experience academically challenging classroom discussion (‘dialogue’) make greater progress than their peers who have not had this experience. In England, gains in achievement have been greatest for pupils from less privileged socio‐economic backgrounds, thus underlining the importance of dialogue to social mobility. However, policy prescriptions on ‘standard English’ run counter to the principles of dialogic teaching by privileging ‘correct’ forms of expression over emerging ideas. In this article, we argue that schools can be coerced by macro‐level policy into creating meso‐level policies which police nonstandardised forms in the classroom with the assumption that this will improve literacy rates. We draw upon a corpus of Ofsted reports as well as data collected in primary schools – pupil writing and focus groups, video‐recorded literacy lessons and teacher interviews – to demonstrate that features of spoken dialect grammar occur infrequently in pupil writing, yet the narrative that spoken dialect is a ‘problem’ within education is driving policy/practice that is detrimental to classroom talk and pupil learning. We argue that this must be addressed urgently if we are to exploit the full potential of talk for learning and for addressing educational inequities.
Physical activity plays an important role in controlling obesity and maintaining healthy living. It becomes increasingly important during a pandemic due to restrictions on outdoor activities. Tracking physical activities using miniature wearable sensors and state-of-the-art machine learning techniques can encourage healthy living and control obesity. This work focuses on introducing novel techniques to identify and log physical activities using machine learning techniques and wearable sensors. Physical activities performed in daily life are often unstructured and unplanned, and one activity or set of activities (sitting, standing) might be more frequent than others (walking, stairs up, stairs down). None of the existing activities classification systems have explored the impact of such class imbalance on the performance of machine learning classifiers. Therefore, the main aim of the study is to investigate the impact of class imbalance on the performance of machine learning classifiers and also to observe which classifier or set of classifiers is more sensitive to class imbalance than others. The study utilizes motion sensors’ data of 30 participants, recorded while performing a variety of daily life activities. Different training splits are used to introduce class imbalance which reveals the performance of the selected state-of-the-art algorithms with various degrees of imbalance. The findings suggest that the class imbalance plays a significant role in the performance of the system, and the underrepresentation of physical activity during the training stage significantly impacts the performance of machine learning classifiers.
Prior research suggests that while autistic people may demonstrate poorer facial emotion recognition when stimuli are human, these differences lessen when stimuli are anthropomorphic. To investigate this further, this work explores emotion recognition in autistic and neurotypical adults (n = 196). Groups were compared on a standard and a cartoon version of the Reading the Mind in the Eyes test. Results indicated that autistic individuals were not significantly different from neurotypicals on the standard version. However, autistic people outperformed neurotypicals on the cartoon version. The implications for these findings regarding emotion recognition deficits and the social motivation account of autism are discussed and support the view of socio‐cognitive differences rather than deficits in this population. The Reading the Mind in the Eyes test and a cartoon version were tested on autistic and neurotypical adults. Autistic adults were not significantly different on the original test compared to neurotypicals, but they outperformed neurotypical adults on the cartoon version.
Objectives: To investigate whether a single bout of mixed circuit training (MCT) can elicit acute blood pressure (BP) reduction in chronic hemiparetic stroke patients, a phenomenon also known as post-exercise hypotension (PEH). Methods: Seven participants (58 ± 12 years) performed a non-exercise control session (CTL) and a single bout of MCT on separate days and in a randomized counterbalanced order. The MCT included 10 exercises with 3 sets of 15-repetition maximum per exercise, with each set interspersed with 45 s of walking. Systolic (SBP) and diastolic (DBP) blood pressure, mean arterial pressure (MAP), cardiac output (Q), systemic vascular resistance (SVR), baroreflex sensitivity (BRS), and heart rate variability (HRV) were assessed 10 min before and 40 min after CTL and MCT. BP and HRV were also measured during an ambulatory 24-h recovery period. Results: Compared to CTL, SBP (∆-22%), DBP (∆-28%), SVR (∆-43%), BRS (∆-63%), and parasympathetic activity (HF; high-frequency component: ∆-63%) were reduced during 40 min post-MCT ( p < 0.05), while Q (∆35%), sympathetic activity (LF; low-frequency component: ∆139%) and sympathovagal balance (LF:HF ratio: ∆145%) were higher ( p < 0.001). In the first 10 h of ambulatory assessment, SBP (∆-7%), MAP (∆-6%), and HF (∆-26%) remained lowered, and LF (∆11%) and LF:HF ratio (∆13%) remained elevated post-MCT vs. CTL ( p < 0.05). Conclusion: A single bout of MCT elicited prolonged PEH in chronic hemiparetic stroke patients. This occurred concurrently with increased sympathovagal balance and lowered SVR, suggesting vasodilation capacity is a major determinant of PEH in these patients. This clinical trial was registered in the Brazilian Clinical Trials Registry (RBR-5dn5zd), available at https://ensaiosclinicos.gov.br/rg/RBR-5dn5zd . Clinical Trial Registration: https://ensaiosclinicos.gov.br/rg/RBR-5dn5zd , identifier RBR-5dn5zd
We examined the compositional associations between the intensity spectrum derived from incremental acceleration intensity bands and the body mass index (BMI) z-score in youth, and investigated the estimated differences in BMI z-score following time reallocations between intensity bands. School-aged youth from 63 schools wore wrist accelerometers, and data of 1453 participants (57.5% girls) were analysed. Nine acceleration intensity bands (range: 0–50 mg to ≥700 mg) were used to generate time-use compositions. Multivariate regression assessed the associations between intensity band compositions and BMI z-scores. Compositional isotemporal substitution estimated the differences in BMI z-score following time reallocations between intensity bands. The ≥700 mg intensity bandwas strongly and inversely associated with BMI z-score (p < 0.001). The estimated differences in BMI z-score when 5 min were reallocated to and from the ≥700 mg band and reallocated equally among the remaining bands were −0.28 and 0.44, respectively (boys), and −0.39 and 1.06, respectively (girls). The time in the ≥700 mg intensity band was significantly associated with BMI z-score, irrespective of sex. When even modest durations of time in this band were reallocated, the asymmetrical estimated differences in BMI z-score were clinically meaningful. The findings highlight the utility of the full physical activity intensity spectrum over a priori-determined absolute intensity cut-point approaches.
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Nicola Relph
  • Department of Applied Health and Social Care
Richard Page
  • Department of Sport and Physical Activity
Nicola Van Rijsbergen
  • Department of Psychology
Lars Mcnaughton
  • Department of Sport and Physical Activity
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