Wider Literature Research Articles

Introduction to the symposium on A Perfectionist Theory of Justice by Collis Tahzib

ABSTRACT This Introduction summarises some of the central arguments in Collis Tahzib’s important new book A Perfectionist Theory of Justice. It locates Tahzib’s contribution within the wider literature and highlights two distinctive features of his account. First, his incorporation of perfectionist considerations into his theory of justice. And, second, his perfectionist public reason liberalism.

Evaluating our “impact”: reflections from the personal learning advice service

The neoliberalisation of higher education in the UK has placed greater pressure on Learning Development units to demonstrate impact. Together with increased regulatory scrutiny from bodies such as the Office for Students in England (and the monitoring of B3 thresholds, awarding gaps, the Teaching Excellence Framework, and other measures), rigorous evaluation is arguably more crucial than ever. In this workshop, we offered reflections and learning from the evaluation of the four-year Personal Learning Advice Service pilot at the Open University (UK). The Personal Learning Advice (PLA) Service project is an Access and Participation Plan initiative which has delivered a one-to-one and group coaching and mentoring service (Clay et al., 2023) for students from disadvantaged backgrounds since January 2021 (Lochtie and Hillman, 2023). Coaching and mentoring approaches have been used by our team to support students’ learning and study habits, wellbeing, and help-seeking behaviours (Hillman et al., in press). In the first part of this workshop, we shared learning from approaches used to evaluate the work of the service – from narrative and empirical evidence to causal evaluation in randomised controlled trials (TASO, 2022) – and situated this in the wider literature on evaluation in HE (Sabri, 2023). We shared findings from our work and reflected on the standards of evidence in HE (OfS, 2019). In the second part of the workshop, we invited delegates to consider how they measure and evaluate impact in their own context. We also explored relevant LD scholarship and publications. Our presentation aligned with the ALDcon24 theme ‘Building Learning Development for the Future’, and we sought to invite discussion about the way we demonstrate ‘impact’ as Learning Developers.

Creating online, inclusive spaces for learning: ‘Study Together’ with the personal learning advice service

There is a wealth of scholarship on the benefits of synchronous writing sessions for staff and students in higher education (Kornhaber et al., 2016; Eardley et al., 2021; Morley and Aston, 2023). In the Personal Learning Advice (PLA) Service at the Open University UK (OU), we developed bespoke, online study spaces for students from groups currently underrepresented in higher education – known as ‘Study Together’ sessions. The sessions prioritise students from minoritised ethnic groups, students with disabilities, and students with mental health needs who are at risk of poorer study outcomes. This presentation charted the development of Study Together in response to student feedback and evaluation and sought to show the value of ‘targeted’ invitations to engage students with spaces for learning development. Our presentation began by outlining the rationale for a 2022-23 Study Together pilot and its impact on community and belonging for students with mental health declarations (Lavery et al., 2023). We shared our approach to hosting Study Together and the techniques used to create an inclusive, productive study space; we showed how these approaches allowed us to incorporate timed study bursts and reflective practice, building positive study habits among students. Finally, we presented findings from the evaluation of Study Together in 2023-24 and situated this within the wider literature on the benefits of virtual communities of practice for learning. Our presentation spoke directly to the ALDcon24 theme ‘Building inclusive learning development spaces’ and invited delegates to consider the place of virtual, guided study spaces in their own practice.

How a buddy scheme created social and intercultural space for international and home students

Buddy schemes are a form of learning intervention that create a space for students to support each other by ‘sharing knowledge, ideas and experience between [...] participants’ (Boud, 2001, p.3). The author set up and conducted research to evaluate a buddy scheme to support international Nursing students on a one-year programme by matching them with a home-student buddy studying at the same level. This small-scale, qualitative study sought to investigate international and home students’ experiences of participating in the buddy scheme. An online survey asked students to evaluate their access to social and academic support before and during the scheme through textual and numerical questions. A self-selecting subgroup of participants subsequently took part in semi-structured interviews to reveal their experiences and insights. These were recorded and transcribed before the data were analysed using inductive textual analysis to identify key themes. In line with wider literature, this study found peer support has a positive influence on international students’ socio-cultural transition (McPherson, Punch and Graham, 2017; Shu et al., 2020; WONKHE, 2022), yet it is also ‘mutually beneficial’ (Boud, 2001, p.3), having a positive impact on both groups of students. Home students valued the opportunity to build relationships with peers they would not have otherwise met (Bethel, Ward and Fetvadjiev, 2020). This opportunity for intercultural exchange enriched their experience too. As such, this study adds weight to existing evidence that buddy schemes are a useful means by which UK universities can support international and home students.

‘Positive disruption’: catalysing system-wide work on health inequalities through embedded research

Abstract Background This presentation explores embedded research as an innovative model for bridging system-level knowledge to action gaps in public health. Embedded researchers (ERers) are university-employed researchers co-located in public health organisations, who work to boost capacity in these organisations to tackle inequalities by better use of evidence in decision-making, evaluation and service improvement Methods Drawing on the initial phase of the role and wider literature, we qualitatively reflect on strengths and limits of a system-level ERer model. Most ERer evidence draws on a one-to-one organisational model. This presentation explores a different model of an ERer embedded in and working across a public health system (health services, municipality, third sector) in a large city in north England Results Our focus is on catalytic features of the ERer role (1) positionality: being embedded at system-level gives fuller understanding of inter-organisational connections and of the implications of emergent system changes; (2) convening: bringing together partners improves mutual awareness and builds interest in collectively pursuing research aligned to identified population health needs and public health priorities in the city; (3) co-production to build capacity: working with a new cross-organisational partnership to collectively address issues constraining opportunities to pursue system-level research; working with the municipality to explore the production/use of research to inform decisions on approaches towards health inequalities. This includes work on links between public health and other functions focused on social determinants of health Conclusions This presentation outlines distinctive consequences of system-level embedded research in a city-wide public health system. It critically appraises the transferability of this model of knowledge production and mobilisation at the intersection of system and cross-organisational action on health inequalities. Key messages • System-level embedded research is an innovative model for helping to bridge system-level knowledge to action gaps in public health. • The model has catalytic benefits and transferability potential, although this needs to be considered in relation to the specific context for proposed system-level embedded research.

Young carers in Ghana: caring activities, ways into care and the impacts of caregiving

ABSTRACT In Ghana, children often provide care and support to family members with disabilities, mental illnesses and other health conditions. Understanding the nature of their caring activities is essential for identifying stressors and promoting better health and wellbeing outcomes for this group of children, described in the wider literature as young carers. This qualitative study investigated the nature and impact of caring activities on young carers aged 11–17 years. The findings revealed that young carers provide domestic, financial, medical and personal care. Caring activities while beneficial, result in a double burden, as young carers often support both the care recipients and their dependents. Despite the challenges associated with caring activities, the study also reveals the myriad reasons young carers enter care work, suggesting that the work of young carers is not simply an obligation or a choice but a process and an integral part of Ghanian family structures. The study highlights the urgent need for formal mechanisms to identify and support young carers and their care recipients in Ghana.

Contested role boundaries and professional title: Implications of the independent review of podiatric surgery in Australia.

In October 2023, the Podiatry Board of Australia commissioned an independent review of the regulation of podiatric surgery in Australia, with a remit to re-evaluate the regulatory framework, identify any risks to patient safety and recommend improvements to public protection. It reported in March 2024 and set out 14 key recommendations. The review was prompted by a number of complaints about podiatric surgeons but also reflected calls for reform by the medical profession and several critical media reports. This paper sets out to examine the review report, alongside the concerns of the medical profession and the media articles expressed within it, through the lens of an established sociological framework focused on interprofessional conflict and the contested use of professional titles. As a review rather than the research paper, the Independent Review of Podiatric Surgery (the 'Paterson Report') served as data for the sociological analysis, adopting a Neo-Weberian and Bordieuan framework to examine the strategies adopted by the medical profession and media reports cited in the report, consistent with the exercise of professional power. The sociological analysis provides insights into the ways in which professions seek to maintain symbolic, social, cultural and economic privileges and rewards through the exclusion of competitors, using strategies such as social closure, symbolic violence, symbolic devaluation, gatekeeper roles, and jurisdictional disputes. The review report acknowledges the influence of the medical profession and its opposition to the practice of podiatric surgery and use of the title 'podiatric surgeon'. The arguments made and strategies deployed are consistent with those found in the wider literature. In light of these findings, the implications for the future of podiatric surgery are considered in terms of professional practice, use of professional title, and access to public funding.

Advance Care Planning: A Retrospective Audit in a National Referral Center for Interstitial Lung Diseases.

Idiopathic and progressive pulmonary fibrosis (IPF/PPF) of known cause are relatively rare lung diseases with a limited survival time after diagnosis. Conscious attention for palliative care is recommended. Optimal care requires collaboration to define goals and preferences for future medical treatment and care with the patient and their families, to inform (or enable) Advance Care Planning (ACP). To get insight into the frequency of key elements of ACP described after dialogues with patients with IPF/PPF. A retrospective audit included charts of patients with IPF/PPF who died between December 2017 and December 2020. A data extraction model was developed based on a guideline for patient federation and wider literature and finally consisted of fourteen key elements. Subsequently content analysis was performed. The medical charts of 60 patients showed that an element of ACP was recorded in 57(95%) of cases. No medical chart contained all fourteen key elements of ACP. Most frequently recorded ACP elements were: knowledge of illness, goals of treatment and care and fears and concerns. The lack of structural implementation of ACP in the care for patients with interstitial lung disease, results in only some elements of ACP being dialogued by health care professionals (HCP). These notes recorded are often superficial and reflect the view of the HCP. Implementation of ACP conversations and structured documentation is needed to gain better insight into the wishes and preferences of the patient.

The global implementation of UNDRIP: a thematic review

ABSTRACT Following almost 25 years of work, the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) was adopted by the United Nations General Assembly in 2007. UNDRIP has been widely recognised as an authoritative statement of human rights norms concerning Indigenous peoples around the world. However, meaningful implementation of UNDRIP has been slow. To better understand the pace and challenges facing implementation, we identify and analyze four key recurring themes that emerge from the growing literature on this topic. This includes (1) Indigenous self-determination versus state autonomy as a driver of potential conflict; (2) the meaning of Free, Prior, and Informed Consent (FPIC) in the context of UNDRIP; (3) the nexus between land, culture, and self-determination; and (4) Western/Global North influence over non-Western/Global South state implementation of UNDRIP. We examine several specific examples from across the globe to reveal the continuities and discontinuities across these four themes. The article concludes by offering ideas on how the limits of the present study and wider literature on UNDRIP might be rectified. That is, by incorporating a greater number of Indigenous perspectives on UNDRIP and adding more studies of governance and implementation challenges encountered in countries located in the Global South.

Techno-Wantons: Adaptive Technology and the Will of Tomorrow

AbstractRecent work within the tradition of 4E cognitive science and philosophy of mind has drawn attention to the ways that our technological, material, and social environments can act as hostile, oppressive, and harmful scaffolding. These accounts push back against a perceived optimistic bias in the wider literature, whereby, according to the critics, our engagements with technology are painted as taking place on our terms, to our benefit, in ways uncomplicated by political realities. This article enters into that conversation, and aims to highlight a specific form of threat from emerging technology: the threat of the ‘techno-wanton. ’ Drawing on classic work on personhood by Harry Frankfurt, I argue that emerging forms of adaptive technology threaten to degrade the depth and reflexivity of our economy of preferences. Techno-wantonness is a wanton-like state of diminished agency and personhood, whereby adaptive technology facilitates the wanton satisfaction of shallow preferences and the weakening of higher order volition. I argue that the concept of ‘mind invasion’, within the context of the hostile scaffolding literature has been applied too broadly, to the detriment of our analysis, and argue that the notion of ‘techno-wantonness’ should replace ‘mind invasion’ in regard to a specific class of case. In short, the new concept allows for a more subtle distinction between scaffolding impinging on an unwilling mind and technology that panders to the preferences of initially often very willing users.

Creating the E-Buzz around Collaborative and Collective DEI Efforts

Like many academic libraries, the Leatherby Libraries at Chapman University (USA) is committed to supporting and promoting diversity, equity, and inclusion (DEI) for students, faculty, researchers, and staff and has increased its efforts in the last several years to reflect that commitment through its resources, services, and outreach activities. However, in the wider literature, the efforts of scholarly communication librarians in DEI initiatives outside of open-access advocacy are less discussed. Nevertheless, precisely because scholarly communication librarians are concerned with advancing the dissemination of knowledge, they fit naturally into DEI efforts that seek to elevate new or historically marginalized voices and can and should work with library marketing teams to increase the reach and impact of those efforts. This paper focuses on several collaborations between the DEI and marketing librarian and the scholarly communication librarian and invites all library workers to imagine new and unique collaborative opportunities to promote diversity, equity, and inclusion within their institutions.

Patient Feedback Applied in Undergraduate Dental Education for Individual Student Development and Assessment: A Scoping Review.

Active involvement of patients in healthcare professional education is well established, taking a variety of forms. There is a steer towards patient feedback informing the development of dental students and while there is recognition of its potential value to individual students, challenges exist related to collection and use. What is unclear is, within a dental education setting, the extent and use of patient feedback to individual students. A scoping review was conducted to assess and map the volume and characteristics of the research/literature in this area. Systematic searches of bibliographic databases Ovid MEDLINE(R), Scopus, ERIC and Embase were conducted, and wider literature (Google Scholar) was searched. Screening was conducted based on eligibility criteria and a customised data charting form was used. The electronic and citation tracking searches identified 1021 studies. After duplicates were removed, 778 studies were screened by title and abstract, and 718 studies were found to be irrelevant to the current review. Sixty full-text studies were assessed for eligibility, 46 studies were excluded, and 14 studies were included for data charting. This review has identified that patient feedback has been captured through both simulated and real patient encounters. There was a bias towards feedback generated through simulated patient encounters. Feedback was reported to support the development of a range of skills, most frequently communication and patient management. Challenges that were identified by researchers related to staff/student engagement and available resources.

Is return on investment the appropriate tool for healthcare quality improvement governance?

PurposeIn this article, we outline our views on the appropriateness and utility of Return on Investment (ROI) for the evaluation of the value of healthcare quality improvement (QI) programmes.Design/methodology/approachOur recent research explored the ROI concept and became the genesis of our viewpoint. We reflect on our findings from an extensive research project on the concept of ROI, involving a multidisciplinary global systematic literature review, a qualitative and Delphi study with mental healthcare leaders from the United Kingdom National Health Service. Research participants included board members, clinical directors and QI leaders. Our findings led to our conclusions and interpretation of ROI against the broad QI governance. We discuss our views against the predominant governance frameworks and wider literature.FindingsROI is in-line with top-down control governance frameworks based in politics and economics. However, there is evidence that to be of better utility, a tool for the assessment of the value of QI benefits must include comprehensive benefits that reflect broad monetary and non-monetary benefits. This is in-line with bottom-up and collaborative governance approaches. ROI has several challenges that may limit it as a QI governance tool. This is supported by wider literature on ROI, QI as well as modern governance theories and models. As such, we question whether ROI is the appropriate tool for QI governance. A more pragmatic governance framework that accommodates various healthcare objectives is advised.Practical implicationsThis article highlights some of the challenges in adopting ROI as a QI governance tool. We signal a need for the exploration of a suitable QI governance approach. Particularly, are healthcare leaders to be perceived as “agents”, “stewards” or both. The evidence from our research and wider literature indicates that both are crucial. Better QI governance through an appropriate value assessment tool could improve clarity on QI value, and thus investment allocation decision-making. Constructive discussion about the utility and appropriateness of ROI in the evaluation of healthcare QI programmes may help safeguard investment in effective and efficient health systems.Originality/valueThe article raises awareness of QI governance and encourages discussions about the challenges of using ROI as a tool for healthcare QI governance.

Setting up and operationalizing a health professions education research (HPER) unit: AMEE Guide No.170

In the same way as clinical medicine, health professions education should be evidence-based rather than based on tradition and convenience. Health professions education research (HPER), an academic area that first emerged in the 1950s, is essential for identifying new and better ways to educate health professionals. Again, just as with clinical research, setting up sustainable HPER units is critical to coordinate research efforts and facilitate the production of clear and strategic HPER. In this AMEE guide we draw upon the scholarly and grey literature and our own experiences as HPER unit leaders in several different global contexts to provide practical guidance on establishing and sustaining a HPER unit. We outline the multiple elements and considerations required to set up and operationalize a successful HPER unit, from engagement of key stakeholders and documentation of milestones to the production of programmatic research and its implementation. These are considered under the areas of • Who do you need to partner with? • Setting the agenda – or What will your unit be known for? • Your most valuable resource – people! • Operationalizing your HPER agenda • Leading the way We provide concrete tips on each of the above and illustrate these key steps with examples from our own experiences or the wider literature. Whether the reader is beginning, maintaining, or seeking to renew their HPER unit, we hope that the guidance we provide is as useful as it has been to us during our own research program building endeavours.

The meaning of apathy in Huntington's disease: A qualitative study of caregiver perspectives

ABSTRACT Although one of the most prevalent and impactful features of Huntington’s disease (HD), little is known about the impact of apathy on HD caregivers, although there is evidence it affects perceptions of distress and burden. Given the importance of the caregivers, we aimed to explore the lived experience of people supporting someone with HD and associated apathy. Semi-structured interviews were conducted with 11 caregivers and analysed using reflective thematic analysis, informed by a phenomenological framework. Five overarching themes were produced: (1) What even is apathy? (2) It makes my life harder: the practical impact of apathy, (3) They haven’t forgotten me, but they have forgotten that they ever loved me, (4) I’m grieving for someone who hasn’t died yet, and (5) I need a safe space to say what I really feel without fear of judgement. Inter-woven between these themes were complex narratives about the unspoken nature of HD, the invisibility of caregivers who felt trapped and unheard, and the one-sided nature of loving someone with the disease. Findings are discussed in relation to theoretical frameworks of anticipatory grief and ambiguous loss, and situated within the wider literature on caregiving for people with a neurodegenerative condition.

Narrative Preparedness: Policy-makers Must Engage with People's Values and Experiences to Ensure Effective Implementation of Interventions in Health Emergencies; Comment on "Health Preparedness and Narrative Rationality: A Call for Narrative Preparedness"

Engebretsen and Baker’s conceptual paper ‘Health Preparedness and Narrative Rationality: A Call for Narrative Preparedness’ advocates for the adoption of narrative preparedness in addition to health preparedness, emphasising the importance of engaging with people's stories and values during health emergencies. This ensures that policymakers and health authorities gain the trust of communities as there is evidence this leads to improved outcomes. Their key argument is that science cannot be used effectively in policy unless it makes sense to people and is presented in a way that resonates with their values. This commentary draws on the wider literature and some key examples showing the wisdom of this approach. However, it also suggests that to be successful in integrating narrative preparedness in policy we need to look beyond working with health authorities and use a more transdisciplinary approach as well as addressing both the process and normative challenges in its adoption.

The case against “alt-right”: A review and typology of scholarly approaches

ABSTRACT Scholars and journalists frequently use the term “Alt-right” to encapsulate a broad collection of identities and ideologies within the political right. Although early interpretations of the “Alt-right” provide a valuable foundation for understanding the range of (far)-right ideologies that have grown in recent decades, current characterizations remain fraught in the wider literature. To sharpen understandings of the “Alt-right” in academic discourse, I offer a typology outlining five common approaches scholars use to portray it, showing how scholarship routinely lacks definitional clarity. Consequently, I argue that the continued use of the term in academic literature is ill-advised. Specifically, the term normalizes and perpetuates the white supremacist ideologies entrenched within the broader history of academia; it hinders historically and theoretically grounded examinations of (far)-right variations and their situatedness within spectrum of far-right ideologies worldwide; and it blurs crucial distinctions between them that precludes the meaningful evaluation of their extremist tendencies and material threats.

Improving training for carers who support individuals with Intellectual Disabilities and Dementia: A service evaluation

Background:Within the Intellectual Disability (ID) population, the prevalence rate of dementia is higher than the general population (Chapman et al., 2018). This signifies a heightened demand on carers to support the transition from routine ID-based care to expert dementia care (Ryan et al., 2014). In line with the National Health Service’s (NHS) long-term plan (2019), it is vital for carers to access regular training to meet individuals’ dementia-related needs.Rationale:The local NHS Community Learning Disability Health Team developed two dementia training packages for paid carers working in residential and supported living facilities. Training package two (TP2) was developed in response to carer feedback obtained from training package one (TP1). This service evaluation aims to investigate the impact of TP2 on participants’ knowledge of dementia and post-diagnostic interventions. Furthermore, this evaluation aims to explore whether the quality of training improved between TP1 and TP2.Methodology:Participants who attended TP2 completed a pre and post knowledge measure; data was analysed using a repeated measures t-test. Quality scores were also completed post TP1 and TP2; this data was analysed using an independent t-test.Results:Participants reported statistically significantly higher dementia knowledge and post-diagnostic support knowledge scores following TP2. Compared with TP1, TP2 had statistically higher post-training quality scores.Discussion:Results from TP2 suggest that this dementia training package is viable and useful. The implications of these findings and wider literature are discussed, in addition to a critical review of the evaluation’s limitations, strengths and recommendations.

What's different about digital? A qualitative interview study exploring experiences of adapting in-person behaviour change interventions for digital delivery.

Digital health behaviour change interventions may be adapted from in-person interventions, without appropriate consideration of how the digital context might differ. Drawing on the wider literature on behaviour change intervention development, this research aims to explore the digital adaptation process of health behaviour change interventions and the specific considerations for digital modes of delivery. A qualitative interview study. Interviews with 15 intervention developers/facilitators were analysed using inductive thematic analysis. Findings highlight a continuum of digitalization, where variation in technology available and human support influences considerations for digital adaptation. 'What vs how: "trying to do the impossible"' describes the balance between retaining the intervention's active ingredients while modifying for digital delivery. Through 'Trial and error', participants described an iterative process based on experience of delivery. 'Creating connection and engagement' emphasizes the importance of social support and the challenges of replicating this. Several considerations for digital adaptations are proposed including the involvement of end-users (facilitators and recipients) during adaptation, the need to understand the original intervention and new context for use, and the different motivational needs of digital intervention recipients.

Versatile Deep Learning Pipeline for Transferable Chemical Data Extraction.

Chemical information disseminated in scientific documents offers an untapped potential for deep learning-assisted insights and breakthroughs. Automated extraction efforts have shifted from resource-intensive manual extraction toward applying machine learning methods to streamline chemical data extraction. While current extraction models and pipelines have ushered in notable efficiency improvements, they often exhibit modest performance, compromising the accuracy of predictive models trained on extracted data. Further, current chemical pipelines lack both transferability─where a model trained on one task can be adapted to another relevant task with limited examples─and extensibility, which enables seamless adaptability for new extraction tasks. Addressing these gaps, we present ChemREL, a versatile chemical data extraction pipeline emphasizing performance, transferability, and extensibility. ChemREL utilizes a custom, diverse data set of chemical documents, labeled through an active learning strategy to extract two properties: normal melting point and lethal dose 50 (LD50). The normal melting point is selected for its prevalence in diverse contexts and wider literature, serving as the foundation for pipeline training. In contrast, LD50 evaluates the pipeline's transferability to an unrelated property, underscoring variance in its biological nature, toxicological context, and units, among other differences. With pretraining and fine-tuning, our pipeline outperforms existing methods and GPT-4, achieving F1-scores of 96.1% for entity identification and 97.0% for relation mapping, culminating in an overall F1-score of 95.4%. More importantly, ChemREL displays high transferability, effectively transitioning from melting point extraction to LD50 extraction with 10 randomly selected training documents. Released as an open-source package, ChemREL aims to broaden access to chemical data extraction, enabling the construction of expansive relational data sets that propel discovery.