Enhancing recovery rates: lessons from year one of IAPT

BACKGROUND: The English Improving Access to Psychological Therapies (IAPT) initiative aims to make evidence-based psychological therapies for depression and anxiety disorder more widely available in the National Health Service (NHS). 32 IAPT services based on a stepped care model were established in the first year of the programme. We report on the reliable recovery rates achieved by patients treated in the services and identify predictors of recovery at patient level, service level, and as a function of compliance with National Institute of Health and Care Excellence (NICE) Treatment Guidelines. METHOD: Data from 19,395 patients who were clinical cases at intake, attended at least two sessions, had at least two outcomes scores and had completed their treatment during the period were analysed. Outcome was assessed with the patient health questionnaire depression scale (PHQ-9) and the anxiety scale (GAD-7). RESULTS: Data completeness was high for a routine cohort study. Over 91% of treated patients had paired (pre-post) outcome scores. Overall, 40.3% of patients were reliably recovered at post-treatment, 63.7% showed reliable improvement and 6.6% showed reliable deterioration. Most patients received treatments that were recommended by NICE. When a treatment not recommended by NICE was provided, recovery rates were reduced. Service characteristics that predicted higher reliable recovery rates were: high average number of therapy sessions; higher step-up rates among individuals who started with low intensity treatment; larger services; and a larger proportion of experienced staff. CONCLUSIONS: Compliance with the IAPT clinical model is associated with enhanced rates of reliable recovery.

Predictors of onset of depression and anxiety in the year after diagnosis of breast cancer

Background Depression and anxiety are common after diagnosis of breast cancer. We examined to what extent these are recurrences of previous disorder and, controlling for this, whether shame, self-blame and low social support after diagnosis predicted onset of depression and anxiety subsequently. Method Women with primary breast cancer who had been treated surgically self-reported shame, self-blame, social support and emotional distress post-operatively. Psychiatric interview 12 months later identified those with adult lifetime episodes of major depression (MD) or generalized anxiety disorder (GAD) before diagnosis and onset over the subsequent year. Statistical analysis examined predictors of each disorder in that year. Results Of the patients, two-thirds with episodes of MD and 40% with episodes of GAD during the year after diagnosis were experiencing recurrence of previous disorder. Although low social support, self-blame and shame were each associated with both MD and GAD after diagnosis, they did not mediate the relationship of disorder after diagnosis with previous disorder. Low social support, but not shame or self-blame, predicted recurrence after controlling for previous disorder. Conclusions Anxiety and depression during the first year after diagnosis of breast cancer are often the recurrence of previous disorder. In predicting disorder following diagnosis, self-blame and shame are merely markers of previous disorder. Low social support is an independent predictor and therefore may have a causal role.

What aspects of rehabilitation provision contribute to self-reported met needs for rehabilitation one year after stroke - amount, place, operator or timing?

BACKGROUND AND OBJECTIVE: To a large extent, people who have suffered a stroke report unmet needs for rehabilitation. The purpose of this study was to explore aspects of rehabilitation provision that potentially contribute to self-reported met needs for rehabilitation 12 months after stroke with consideration also to severity of stroke. METHODS: The participants (n = 173) received care at the stroke units at the Karolinska University Hospital, Sweden. Using a questionnaire, the dependent variable, self-reported met needs for rehabilitation, was collected at 12 months after stroke. The independent variables were four aspects of rehabilitation provision based on data retrieved from registers and structured according to four aspects: amount of rehabilitation, service level (day care rehabilitation, primary care rehabilitation and home-based rehabilitation), operator level (physiotherapist, occupational therapist, speech therapist) and time after stroke onset. Multivariate logistic regression analyses regarding the aspects of rehabilitation were performed for the participants who were divided into three groups based on stroke severity at onset. RESULTS: Participants with moderate/severe stroke who had seen a physiotherapist at least once during each of the 1st, 2nd and 3rd-4th quarters of the first year (OR 8.36, CI 1.40-49.88 P = 0.020) were more likely to report met rehabilitation needs. CONCLUSION: For people with moderate/severe stroke, continuity in rehabilitation (preferably physiotherapy) during the first year after stroke seems to be associated with self-reported met needs for rehabilitation.

Pandora`s box : academic perceptions of student plagiarism in writing

Plagiarism is viewed by many academics as a kind of Pandora's box—the elements contained inside are too frightening to allow escape for fear of the havoc that may result. Reluctance by academic members of staff to discuss student plagiarism openly may contribute to the often untenable situations we, as teachers, face when dealing with student plagiarism issues. In this article, I examine the dilemmas English for Academic Purposes (EAP) staff face when dealing with student plagiarism in the tertiary classroom. The perceptions of all 11 teachers involved in teaching a first year EAP writing subject at South-Coast University are detailed in light of the university's policy on plagiarism. My research indicates that not only is an agreed definition of plagiarism difficult to reach by members of staff teaching the same subject, but plagiarism is a multi-layered phenomenon encompassing a spectrum of human intention. Evaluating the spectrum can lead to differences in the implementation of university plagiarism policy, the result of which embodies issues of equity. The aim of the article is to encourage policy-makers and academic staff to acknowledge the concerns about implementation of plagiarism policy. Collaborative, cross-disciplinary re-thinking of plagiarism is needed to reach workable solutions.

The tangled web internet plagiarism and international students` academic writing

This study explores the notion of plagiarism and the Internet from 11 English as Second Language (ESL) teachers and 186 first-year ESL students at South-Coast University in Melbourne, Australia. Data collection was by a questionnaire and semi-structured interviews, and coded using SPSS and N*Vivo software to ascertain trends in response. The most significant difference in response related to the concept of the Internet as copyrightable space. ESL teachers in this study regarded cyberspace as a limitless environment for ‘cut and paste’ plagiarism in students’ academic writing, whereas ESL students considered the Internet a ‘free zone’ and not governed by legal proprietary rights. These conflicting views, it is suggested, relate to differing notions of authorship and attribution: the Romantic notion protected by legal theory and sanctions versus literary theory and techno-literacy notions of authorship. This research highlights the need to reformulate plagiarism policies in light of global and technological perspectives of authorship and attribution of text.

Calcium- and vitamin D3 - fortified milk reduces bone loss at clinically relevant skeletal sites on llder men: a 2-year randomised controlled trial

In this 2-year randomized controlled study of 167 men >50 years of age, supplementation with calcium-vitamin D3-fortified milk providing an additional 1000 mg of calcium and 800 IU of vitamin D3 per day was effective for suppressing PTH and stopping or slowing bone loss at several clinically important skeletal sites at risk for fracture.

Introduction: Low dietary calcium and inadequate vitamin D stores have long been implicated in age-related bone loss and osteoporosis. The aim of this study was to assess the effects of calcium and vitamin D3 fortified milk on BMD in community living men >50 years of age.

Materials and Methods: This was a 2-year randomized controlled study in which 167 men (mean age ± SD, 61.9 ± 7.7 years) were assigned to receive either 400 ml/day of reduced fat (1%) ultra-high temperature (UHT) milk containing 1000 mg of calcium plus 800 IU of vitamin D3 or to a control group receiving no additional milk. Primary endpoints were changes in BMD, serum 25(OH)D, and PTH.

Results: One hundred forty-nine men completed the study. Baseline characteristics between the groups were not different; mean dietary calcium and serum 25(OH)D levels were 941 ± 387 mg/day and 77 ± 23 nM, respectively. After 2 years, the mean percent change in BMD was 0.9-1.6% less in the milk supplementation compared with control group at the femoral neck, total hip, and ultradistal radius (range, p < 0.08 to p < 0.001 after adjusting for covariates). There was a greater increase in lumbar spine BMD in the milk supplementation group after 12 and 18 months (0.8-1.0%, p ≤ 0.05), but the between-group difference was not significant after 2 years (0.7%; 95% CI, −0.3, 1.7). Serum 25(OH)D increased and PTH decreased in the milk supplementation relative to control group after the first year (31% and −18%, respectively; both p < 0.001), and these differences remained after 2 years. Body weight remained unchanged in both groups at the completion of the study.

Conclusions: Supplementing the diet of men >50 years of age with reduced-fat calcium- and vitamin D3-enriched milk may represent a simple, nutritionally sound and cost-effective strategy to reduce age-related bone loss at several skeletal sites at risk for fracture in the elderly.

Australian parents` views on their 5-6-year-old children's food choices

The home food environment is central to the development of healthy eating behaviours, but associations between the home food environment and children's food choices are not yet fully understood. The aims of this study were to explore parents' views regarding factors that influence children's food choices and parents' decision-making regarding the food they provide to their children. In-depth one-on-one interviews were conducted using a semi-structured interview schedule. Key concepts and themes were coded independently by two investigators. Participants include seventeen parents (16 mothers and 1 father) of children in their first year of formal schooling (aged 5–6 years). Five main themes emerged from the interviews: food marketing, food availability/food exposure, feeding strategies, modelling of eating and opportunities for food involvement. Parents believed that food marketing influenced their child's food preferences but differed in the ways they managed these influences. The food made available to children was also seen to influence what a child ate. Yet, although some parents believed it was the parents' role to determine what foods were made available to their child, others offered food on the basis of the child's tastes or preferences. The use of food as a reward was a feeding strategy employed by many parents. Family mealtimes were seen as an important opportunity for modelling of eating behaviour by parents. Peers were also seen to influence children's food preferences and eating behaviour. Finally, many parents believed that involving children in the preparation of food had a positive impact on children's food choices. Associations between the home food environment and children's food choices are complex and involve multiple mediators. Parents' views on the promoters and reinforcers of their decision-making regarding food and their child's food choices provide useful insights into these mediating factors. Increased understanding of these relationships is likely to enhance obesity prevention efforts.

(E)Research, (e)learning, (e)teaching in (e)ntrapment

In this paper I reflect on three research projects emerging from my on online learning and teaching.

The data used in this paper is current and the media is low-tech and accessible. This paper is not about the hardware and software of technology. Rather, it is about a teacher educator's struggle to try to make sense of online pedagogy at a time when academics seem to be constantly exhorted to take their courses online. This paper draws on data from the following projects:

1. My involvement in the development and teaching of the 'Education Studies Major Online Project'. I have been teaching undergraduate students doing their first year education studies program with the option of:

•  Not attending university-based lectures or tutorials and doing all their work online;
•  Attending face-to-face lectures and tutorials, and
•  A mixture of face-to-face and online.

2. The Research in Computers in Education (RICE) group which started in 1995.

3. The Good Learning on the World Wide Web (GLOW) Project with a secondary college in which undergraduate teacher education students tutor year 9/10 students from the college.

4. Two Masters in Education units with particular reference to the compulsory online discussion component.

5. The Faculty Research Group project entitled 'The social and pedagogical implications of new learning technologies for learners and teachers'.

Peer mentoring the first time around : Is it all a matter of negotiation?

In 2002, the senior executive at Deakin University sought applications from staff for academic professional development funding. This was intended to support programs related to the Deakin First Year Initiative, a university-wide coordinated approach to transition. The Faculty of Health & Behavioural Sciences was successful in gaining a grant for the design, implementation and evaluation of a peer mentoring pilot program, which has been introduced this year for students undertaking the Bachelor of Applied Science (Health Sciences). This generic undergraduate program draws from and complements the specialist fields of study on offer in the Faculty. It is very flexible, within given parameters, allowing students to combine study according to their interests, abilities and career aspirations. In this session, we will explore the challenges faced so far by the program managers in devising a program that will successfully cater for approximately 50 first year students undertaking diverse majors across the Faculty.

Practice teaching in the Republic of the Maldives : issues and challenges

Practicum is an important but challenging part of primary teacher education especially in developing countries like the Republic of the Maldives where the effectiveness of practicum can be impeded by geographical distance, isolation, levels of teacher expertise, and by a highly structured system of primary schooling and teacher education. The current paper reports on a study of beginning teachers in their first year of full-time teaching practice and their perceptions of the effectiveness of their practicum experiences during their teacher training both generally and in terms of developing desirable teaching competencies. Teachers reported that their relationship with school and academic staff was one of the most effective and positive features of practice teaching but reported less positively on the processes used to assess and evaluate students during their teaching practice.

Life after CELTA : a precarious transition into English language teaching

The thesis examined the transition of new teachers with a skills-based Cambridge Certificate in English Language Teaching to Adults (CELTA) into diverse English Language Teaching sites around the world. The mixed methods study demonstrated that the first year of teaching was a precarious journey for most of these teachers.

Learning cultures of problem-based learning teams

The learning experiences of first-year engineering students to a newly implemented engineering problem-based learning (PBL) curriculum is reported here, with an emphasis on student approaches to learning. Ethnographic approaches were used for data collection and analysis. This study found that student learning in a PBL team in this setting was mainly influenced by the attitudes, behaviour and learning approaches of the student members in that team. Three different learning cultures that emerged from the analysis of eight PBL teams are reported here. They are the finishing culture, the performing culture and the collaborative learning culture. It was found that the team that used a collaborative approach to learning benefited the most in this PBL setting. Students in this team approached learning at a deep level. The findings of this study imply that students in a problem-based, or project-based, learning setting may not automatically adopt a collaborative learning culture. Hence, it is important for institutions and teachers to identify and consider the factors that influence student learning in their particular setting, provide students with necessary tools and ongoing coaching to nurture deep learning approaches in PBL teams.

Children and university architecture students working together : a pedagogical model of children’s participation in architectural design

Increasing efforts have been made to engage children in the design of the built environment, and several participatory models have been developed. The aim of this paper is to propose a pedagogical model for children's genuine participation in architectural design, developed in an architectural education context. According to this pedagogical model, children (primary school students) and youth (university architecture students) work in teams to develop the architectural design proposals. This model was developed through a joint educational project between Deakin University and Wales Street Primary School (both institutions are based in Victoria, Australia). In the four-week duration of the project, first year architecture students worked with Grade 3 and 4 primary school children to design a school playground. The final product of the project was a 1:20 scale model of a playground, which was installed and presented at the end of the fourth week. The project received positive feedback from all the participants, including children, architecture students, university lecturers, primary school teachers and architects. In addition, it achieved a high level of children's genuine participation. This model can be refined and applied in new situations, and potentially with other primary schools working with Deakin University.

Cross-curriculum priorities and the ethics of interpreting Indigenous texts

Deakin University’s first-year unit, ‘Reading Children’s Texts’, is mandatory for the B.Ed. (Primary). Newly revised, it addresses the cross- curriculum priorities, Indigenous histories and cultures, and Australia’s engagements with Asia. The unit introduces the study of narrative, genre, and ideology. But how should the political topics embedded in the English curriculum be framed for pre-service teachers, and how relevant are literary texts to the teaching of ethical interpretation of texts to both primary and secondary students?

Self-conscious emotion: how two teachers explore the emotional work of teaching

Teachers are constantly involved in emotional management. This chapter focuses on two second year teachers and the self-conscious emotional work of teaching. Both teachers were working in a prep ( 5-year-olds) class. The teachers engaged in The Participatory Inquiry Program (PIP), which is framed by active and critical reflections on classroom practices. The teachers collaborated with each other, firstly filming the other's practice, and then acting as a critical peer when reviewing the other's film. Teachers also examined internal feelings and thought processes that influenced their actions. The teachers concluded their participation in PIP by narrating their experience and learning. These narratives were then analysed by focusing on how they became cognisant of emotion and emotion regulation that enhances practice and learning outcomes. Emotion work for these two teachers revolved around three key themes: the emotion work with regard to colleagues; the emotional work that arises in relation to students (feelings of love; annoyance, anger), and emotion and self-awareness.