Networked learning ten years on: the rise of the virtual graduate school

The aim of this paper is to reflect on how conceptions of networked learning have changed, particularly in relation to educational practices and uses of technology, that can nurture new ideas of networked learning to sustain multiple and diverse communities of practice in institutional settings. Our work is framed using two theoretical frameworks: Giddens's (1984) structuration theory and Callon & Latour's (1981) Actor Network Theory as critiqued by Fox (2005) in relation to networked learning. We use these frameworks to analyse and critique ideas of networked learning embodied in both cases. We investigate three questions: (a) the role of individual agency in the development of networked learning; (b) the impact of technological developments on approaches to supporting students within institutional infrastructures; and (c) designing networked learning to incorporate Web 2.0 practices that sustain multiple communities and foster engagement with knowledge in new ways. We use an interpretivist approach by drawing on experiential knowledge of the Masters programme in Networked Collaborative Learning and the decision making process of designing the virtual graduate schools. At this early stage, we have limited empirical data related to the student experience of networked learning in current and earlier projects. Our findings indicate that the use of two different theoretical frameworks provided an essential tool in illuminating, situating and informing the process of designing networked learning that involves supporting multiple and diverse communities of practice in institutional settings. These theoretical frameworks have also helped us to analyze our existing projects as case studies and to problematize and begin to understand the challenges we face in facilitating the participation of research students in networked learning communities of practice and the barriers to that participation. We have also found that this process of theorizing has given us a way of reconceptualizing communities of practice within research settings that have the potential to lead to new ideas of networked learning.

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Knight M, Acosta C, Brocklehurst P, Cheshire A, Fitzpatrick K, Hinton L, Jokinen M, Kemp B, Kurinczuk JJ, Lewis G, Lindquist A, Locock L, Nair M, Patel N, Quigley M, Ridge D, Rivero-Arias O, Sellers S, Shah A on behalf of the UKNeS coapplicant group. Background Studies of maternal mortality have been shown to result in important improvements to women’s health. It is now recognised that in countries such as the UK, where maternal deaths are rare, the study of near-miss severe maternal morbidity provides additional information to aid disease prevention, treatment and service provision. Objectives To (1) estimate the incidence of specific near-miss morbidities; (2) assess the contribution of existing risk factors to incidence; (3) describe different interventions and their impact on outcomes and costs; (4) identify any groups in which outcomes differ; (5) investigate factors associated with maternal death; (6) compare an external confidential enquiry or a local review approach for investigating quality of care for affected women; and (7) assess the longer-term impacts. Methods Mixed quantitative and qualitative methods including primary national observational studies, database analyses, surveys and case studies overseen by a user advisory group. Setting Maternity units in all four countries of the UK. Participants Women with near-miss maternal morbidities, their partners and comparison women without severe morbidity. Main outcome measures The incidence, risk factors, management and outcomes of uterine rupture, placenta accreta, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, severe sepsis, amniotic fluid embolism and pregnancy at advanced maternal age (≥ 48 years at completion of pregnancy); factors associated with progression from severe morbidity to death; associations between severe maternal morbidity and ethnicity and socioeconomic status; lessons for care identified by local and external review; economic evaluation of interventions for management of postpartum haemorrhage (PPH); women’s experiences of near-miss maternal morbidity; long-term outcomes; and models of maternity care commissioned through experience-led and standard approaches. Results Women and their partners reported long-term impacts of near-miss maternal morbidities on their physical and mental health. Older maternal age and caesarean delivery are associated with severe maternal morbidity in both current and future pregnancies. Antibiotic prescription for pregnant or postpartum women with suspected infection does not necessarily prevent progression to severe sepsis, which may be rapidly progressive. Delay in delivery, of up to 48 hours, may be safely undertaken in women with HELLP syndrome in whom there is no fetal compromise. Uterine compression sutures are a cost-effective second-line therapy for PPH. Medical comorbidities are associated with a fivefold increase in the odds of maternal death from direct pregnancy complications. External reviews identified more specific clinical messages for care than local reviews. Experience-led commissioning may be used as a way to commission maternity services. Limitations This programme used observational studies, some with limited sample size, and the possibility of uncontrolled confounding cannot be excluded. Conclusions Implementation of the findings of this research could prevent both future severe pregnancy complications as well as improving the outcome of pregnancy for women. One of the clearest findings relates to the population of women with other medical and mental health problems in pregnancy and their risk of severe morbidity. Further research into models of pre-pregnancy, pregnancy and postnatal care is clearly needed.