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This study reports on the unique and personal experiences of 17 teachereducators fromfive different countries when integrating globalcitizenship education (GCE) and multilingual competences (MC) intotheir teaching practices. The qualitative study employed in-depth, semi-structured interviews to capture the complex and individual nature oftheir attitudes and practices towards incorporating GCE and MC intoteaching. Through reflexive thematic analysis,findings revealed thatthese teacher educators experienced different pathways ofunderstanding and gradual growth in their knowledge surrounding thetopics. Furthermore, the study shows that anyone wishing toincorporate GCE and MC into their teaching practice may set out fromdiverse starting points. Findings reveal three motivations for teachingGCE and or MC including making a difference in the world, being ableto deal with the complex education system, and striving for socialequity. Lastly, participants provided advice to teachers and teachereducators about how GCE and MC can be approached. In sum, thestudy uncovered a need to provide time, resources, and opportunitiesfor teachers and teacher educators to grow their own understandingsand capabilities for working with these approaches and the importanceof individual motivation in driving the agenda forward in the absenceof systemic support.

Radiotherapy treatment planning based only on magnetic resonance imaging (MRI) has become clinically achievable. Though computed tomography (CT) is the gold standard for radiotherapy imaging, directly providing the electron density values needed for planning calculations, MRI has superior soft tissue visualisation to guide treatment planning decisions and optimisation. MRI-only planning removes the need for the CT scan, but requires generation of a substitute/synthetic/pseudo CT (sCT) for electron density information. Shortening the MRI imaging time would improve patient comfort and reduce the likelihood of motion artefacts. A volunteer study was previously carried out to investigate and optimise faster MRI sequences for a hybrid atlas-voxel conversion to sCT for prostate treatment planning. The aim of this follow-on study was to clinically validate the performance of the new optimised sequence for sCT generation in a treated MRI-only prostate patient cohort. 10 patients undergoing MRI-only treatment were scanned on a Siemens Skyra 3T MRI as part of the MRI-only sub-study of the NINJA clinical trial (ACTRN12618001806257). Two sequences were used, the standard 3D T2-weighted SPACE sequence used for sCT conversion which has been previously validated against CT, and a modified fast SPACE sequence, selected based on the volunteer study. Both were used to generate sCT scans. These were then compared to evaluate the fast sequence conversion for anatomical and dosimetric accuracy against the clinically approved treatment plans. The average Mean Absolute Error (MAE) for the body was 14.98 ± 2.35 HU, and for bone was 40.77 ± 5.51 HU. The external volume contour comparison produced a Dice Similarity Coefficient (DSC) of at least 0.976, and an average of 0.985 ± 0.004, and the bony anatomy contour comparison a DSC of at least 0.907, and an average of 0.950 ± 0.018. The fast SPACE sCT agreed with the gold standard sCT within an isocentre dose of -0.28% ± 0.16% and an average gamma pass rate of 99.66% ± 0.41% for a 1%/1 mm gamma tolerance. In this clinical validation study, the fast sequence, which reduced the required imaging time by approximately a factor of 4, produced an sCT with similar clinical dosimetric results compared to the standard sCT, demonstrating its potential for clinical use for treatment planning.

The introduction of MRI linear accelerators (MR-linacs) and the increased use of MR imaging in radiotherapy, requires improved approaches to MRI-only radiotherapy. MRI provides excellent soft tissue visualisation but does not provide any electron density information required for radiotherapy dose calculation, instead MRI is registered to CT images to enable dose calculations. MRI-only radiotherapy eliminates registration errors and reduces patient discomfort, workload and cost. Electron density requirements may be addressed in different ways, from manually applying bulk density corrections, to more computationally intensive methods to produce substitute CT datasets (sCT), requiring additional sequences, increasing overall imaging time. Reducing MR imaging time would reduce potential artefacts from intrafraction motion and patient discomfort. The aim of this study was to assess the impact of reducing MR imaging time on a hybrid atlas-voxel sCT conversion for prostate MRI-only treatment planning, considering both anatomical and dosimetric parameters. 10 volunteers were scanned on a Siemens Skyra 3T MRI. Sequences included the 3D T2-weighted (T2-w) SPACE sequence used for sCT conversion as previously validated against CT, along with variations to this sequence in repetition time (TR), turbo factor, and combinations of these to reduce the imaging time. All scans were converted to sCT and were compared to the sCT from the original SPACE sequence, evaluating for anatomical changes and dosimetric differences for a standard prostate VMAT plan. Compared to the previously validated T2-w SPACE sequence, scan times were reduced by up to 80%. The external volume and bony anatomy were compared, with all but one sequence meeting a DICE coefficient of 0.9 or better, with the largest variations occurring at the edges of the external body volume. The generated sCT agreed with the gold standard sCT within an isocentre dose of 1% and a gamma pass rate of 99% for a 1%/1 mm gamma tolerance for all but one sequence. This study demonstrates that the MR imaging sequence time was able to be reduced by approximately 80% with similar dosimetric results.

Drones have been pioneered and used in the military, however, only recently non-military drones have been introduced. The COVID-19 pandemic has brought into focus the potential value of drones in moving medical supplies. With the onset of social distancing policies and quarantine regulations, the efficiency of traditional logistics systems has been limited. Several companies have recently accelerated their development in this domain, conducting pilot projects at pace, paving the way for the future of the medical logistics supply chain. In this review, we examine both narrative and grey literature for in and out of hospital settings, in order to describe the current state of drone technology in healthcare around the world and some of the most cutting-edge examples of how drones can benefits patients, clinicians and the wider public. We investigate the economic viability and barriers to adopting drones at scale which include regulatory hurdles, public perception and safety of drone technologies, and propose how to overcome these challenges. Further work should look at quantifying the impact and outcomes of how such a service could impact the health outcomes of patients and clinical efficiency. This review aims to equip the National Health Service and more broadly other healthcare systems around the world with the tools to embrace and implement this novel and upcoming technology.

This article is located in the context of the refugee emergency in Europe and responses to it. We draw data from a qualitative study exploring challenges and factors that facilitated professional s...

Accurate knowledge of knee joint motion is needed to evaluate the effects of implant design on functional performance and component wear. We conducted a randomized controlled trial to measure and compare 6-degree-of-freedom (6-DOF) kinematics and femoral condylar motion of posterior-stabilized (PS), cruciate-retaining (CR), and medial-stabilized (MS) knee implant designs for one cycle of walking. A mobile biplane X-ray imaging system was used to accurately measure 6-DOF tibiofemoral motion as patients implanted with PS (n = 23), CR (n = 25), or MS (n = 26) knees walked over ground at their self-selected speeds. Knee flexion angle did not differ significantly between the three designs. Relative movements of the femoral and tibial components were generally similar for PS and CR with significant differences observed only for anterior tibial drawer. Knee kinematic profiles measured for MS were appreciably different: external rotation and abduction of the tibia were increased while peak-to-peak anterior drawer was significantly reduced for MS compared with PS and CR. Anterior-posterior drawer and medial-lateral shift of the tibia were strongly coupled to internal-external rotation for MS, as was anterior-posterior translation of the contact center in the lateral compartment. MS exhibited the least amount of paradoxical anterior translation of the femur relative to the tibia during knee flexion. The joint center of rotation in the transverse plane was located in the lateral compartment for PS and CR and in the medial compartment for MS. Substantial differences were evident in 6-DOF knee kinematics between the healthy knee and all three prosthetic designs. Overall, knee kinematic profiles observed for MS resemble those of the healthy joint more closely than PS and CR.

To evaluate the feasibility of prostate intrafraction motion monitoring using the SeedTracker real-time image guidance system in order to improve targeting accuracy in prostate radiotherapy.SeedTracker was used to monitor prostate gold fiducial seeds with kV x-ray imaging during radiotherapy in 30 patients. Feedback from radiation therapists was collected via the use of a user evaluation form. The impact on treatment time was established by using a record and verify system. The effective dose and a risk of exposure-induced cancer death (REID) were estimated for a 60-year-old patient when using the SeedTracker system.A total of 22 radiation therapists completed user evaluation forms. The time taken to prepare a reference data set for one patient varied with three (13.6%) radiation therapists taking less than 2 min, 10 (45.5%) between 2 and 4 min, eight (36.4%) between 4 and 6 min and one (4.5%) between 6 and 8 min. The useability of the SeedTracker system was reported as 'easy' by 21 (95.5%) radiation therapists and 'hard' by 1 (4.5%) radiation therapist. Mean treatment time changed from 6 to 7 min with prostate-only radiotherapy treatment and from 6.9 to 10.2 min with prostate and whole pelvis radiotherapy treatments. The maximum effective dose with the SeedTracker was 1.6276 mSv, and increase in REID was 0.007%.The SeedTracker real-time image guidance system is a feasible tool to use in radiotherapy departments to monitor and correct for prostate intrafraction motion.

The introduction of MRI linear accelerators (MR-linacs) and the increased use of MR imaging in radiotherapy, requires improved approaches to MRI-only radiotherapy. MRI provides excellent soft tissue visualisation but does not provide any electron density information required for radiotherapy dose calculation, instead MRI is registered to CT images to enable dose calculations. MRI-only radiotherapy eliminates registration errors and reduces patient discomfort, workload and cost. Electron density requirements may be addressed in different ways, from manually applying bulk density corrections, to more computationally intensive methods to produce substitute CT datasets (sCT), requiring additional sequences, increasing overall imaging time. Reducing MR imaging time would reduce potential artefacts from intrafraction motion and patient discomfort. The aim of this study was to assess the impact of reducing MR imaging time on a hybrid atlas-voxel sCT conversion for prostate MRI-only treatment planning, considering both anatomical and dosimetric parameters. 10 volunteers were scanned on a Siemens Skyra 3T MRI. Sequences included the 3D T2-weighted (T2-w) SPACE sequence used for sCT conversion as previously validated against CT, along with variations to this sequence in repetition time (TR), turbo factor, and combinations of these to reduce the imaging time. All scans were converted to sCT and were compared to the sCT from the original SPACE sequence, evaluating for anatomical changes and dosimetric differences for a standard prostate VMAT plan. Compared to the previously validated T2-w SPACE sequence, scan times were reduced by up to 80%. The external volume and bony anatomy were compared, with all but one sequence meeting a DICE coefficient of 0.9 or better, with the largest variations occurring at the edges of the external body volume. The generated sCT agreed with the gold standard sCT within an isocentre dose of 1% and a gamma pass rate of 99% for a 1%/1 mm gamma tolerance for all but one sequence. This study demonstrates that the MR imaging sequence time was able to be reduced by approximately 80% with similar dosimetric results.

Objectives Whilst gait speed is variable between healthy and injured adults, the extent to which speed alone alters the 3D in vivo knee kinematics has not been fully described. The purpose of this prospective study was to understand better the spatiotemporal and 3D knee kinematic changes induced by slow compared with normal self-selected walking speeds within young healthy adults. Methods A total of 26 men and 25 women (18 to 35 years old) participated in this study. Participants walked on a treadmill with the KneeKG system at a slow imposed speed (2 km/hr) for three trials, then at a self-selected comfortable walking speed for another three trials. Paired t-tests, Wilcoxon signed-rank tests, Mann-Whitney U tests and Spearman’s rank correlation coefficients were conducted using Stata/IC 14 to compare kinematics of slow versus self-selected walking speed. Results Both cadence and step length were reduced during slow gait compared with normal gait. Slow walking reduced flexion during standing (10.6° compared with 13.7°; p < 0.0001), and flexion range of movement (ROM) (53.1° compared with 57.3°; p < 0.0001). Slow walking also induced less adduction ROM (8.3° compared with 10.0°; p < 0.0001), rotation ROM (11.4° compared with 13.6°; p < 0.0001), and anteroposterior translation ROM (8.5 mm compared with 10.1 mm; p < 0.0001). Conclusion The reduced spatiotemporal measures, reduced flexion during stance, and knee ROM in all planes induced by slow walking demonstrate a stiff knee gait, similar to that previously demonstrated in osteoarthritis. Further research is required to determine if these characteristics induced in healthy knees by slow walking provide a valid model of osteoarthritic gait. Cite this article: N. Mannering, T. Young, T. Spelman, P. F. Choong. Three-dimensional knee kinematic analysis during treadmill gait: Slow imposed speed versus normal self-selected speed. Bone Joint Res 2017;6:514–521. DOI: 10.1302/2046-3758.68.BJR-2016-0296.R1.

Background The present study, #HealthinSchools, explores health professionals in training as leaders of first aid teaching and health promotion in UK secondary schools. First aid teaching in schools is associated with improved cardiac arrest outcomes and was mandated by the UK government in January 2019. Diet, sleep hygiene, smoking cessation, alcohol moderation and 20 minutes of daily exercise have been shown to prevent cardio-respiratory disease and alleviate depression. Aims This study aims to: A) Identify an evidence-based approach to lead first aid teaching in UK schools, B) Promote behaviour change to prevent modifiable risk factors and co-morbidities, C) Up-skill foundation doctors with leadership skills, D) Drive a sustainable NHS workforce which represents the community it serves. Methods First aid teaching was delivered by 51 foundation doctors to 3251 UK secondary school children in 17 schools in regions of varying deprivation. Teaching sessions lasted one hour and were structured to include an: introduction, interactive face to face masterclass style demonstration, opportunity for pupils to practice on mannequins the psychomotor skills involved, including CPR, whilst being observed and a plenary. Pre and post-course questionnaires and focus groups were carried out among pupils and foundation doctors. Results Results identified a significant improvement in trainee healthcare professionals’ perceived leadership skills and pupils’ knowledge and confidence of first aid skills. A statistically significant correlation was noted between schools in more deprived regions and increased pupil aspirations to: 1) incorporate 20 minutes of exercise daily and 2) apply for NHS careers. Conclusions #HealthinSchools establishes healthcare professionals as leaders of effective first-aid teaching in UK secondary schools with potential benefits for widening participation to NHS careers and promoting healthy behaviour changes to reduce cardio-respiratory disease morbidity.

Despite a burgeoning body of empirical research on ‘the international student experience’, the area remains under-theorized. The literature to date lacks a guiding conceptual model that captures the adjustment and adaptation trajectories of this unique, growing, and important sojourner group. In this paper, we therefore put forward a conceptual model of international student adjustment and adaptation which integrates theory and recent empirical research exploring the academic, psychological, and sociocultural aspects of and influences on the experience of study abroad. The article discusses, from an intercultural and educational research perspective, contributory factors to international student adjustment. It also details the theoretical background underpinning the model. We conclude by showing how the proposed integrated model can serve as a heuristic tool for international students and higher education practitioners, and we discuss its implications for practice and application. We also show how...

Adopting principles of person-centred communication has been highlighted as one strategy to improve care of people living with dementia (PLWD) in health and social care settings. However, person-centred communication is interpreted and applied variably in different settings, and healthcare professionals’ views about communicating with PLWD are under-explored. This study aimed to investigate medical students’ views about the principles and applicability of a model of person centred communication – the Dementia Model of Effective Communication (DeMEC) – to clinical practice. Quantitative and qualitative data was collected using questionnaires ( n = 531), focus groups ( n = 21) and interviews ( n = 10). Students generally endorsed the person-centred approach to communication, but two aspects were highlighted as complex and divisive – the acceptability or otherwise of lying, and of communicating with family in advance of the PLWD. We discuss the nature of these communicative dilemmas, implications for the education and training of medical students, and future directions for research.

It is important to gauge and explore current Thai perceptions of and attitudes towards varieties of English. Language attitudes are some of the factors that affect language policy direction and institutional practices, and the Association of Southeast Asian Nations (ASEAN), including Thailand, are adopting English as their sole official language in 2015, making such an investigation particularly timely. In Thailand little if any prior research had investigated attitudes. For this questionnaire-based study, research questions investigated which varieties 251 Thai learners of English thought they were actually using; which they saw as their target model; and also explored their attitudes towards different ‘native-speaker’ varieties – pre-work had indicated that such varieties still predominated over alternatives such as ‘English as a Lingua Franca’. Responses were analysed using both qualitative and quantitative keyword and content analysis. Findings indicated strong but diverse perceptions of the nature of...

There are currently more than four million people worldwide studying in higher education (HE) institutions located outside their country of origin, and numbers are growing (OECD 2013). ‘Internation...

Novel probiotics and prebiotics designed to manipulate the gut microbiota for improving health outcomes are in demand as the importance of the gut microbiota in human health is revealed. The regulations governing introduction of novel probiotics and prebiotics vary by geographical region. Novel foods and foods with health claims fall under specific regulations in several countries. The paper reviews the main requirements of the regulations in the EU, USA, Canada and Japan. We propose a number of areas that need to be addressed in any safety assessment of novel probiotics and prebiotics. These include publication of the genomic sequence, antibiotic resistance profiling, selection of appropriate in vivo model, toxicological studies (including toxin production) and definition of target population.

There is a growing body of research examining the role of technology in supporting the care of--and relationships surrounding--people with dementia, yet little attention has been given to how this relates to younger family members. We conducted a qualitative study based on a series of 6 co-design workshops conducted with 14 young people who had personal experience with dementia. Initially, our workshops focused on understanding the difficulties that young people face when engaging, interacting and being with people with dementia. Initial analysis of workshop data informed the design of three digital tool concepts that were used as the basis for user enactment workshops. Our findings highlight the young people's desire to be more involved in their family discussions around dementia and a need for them to find new ways to connect with their loved ones with dementia. We offer a set of design considerations for future systems that support these needs and reflect on some of the complexities we faced around engaging young people in this difficult topic of discussion.

When studying English or through the medium of English, some mainland Chinese students adopt non-heritage names. This phenomenon has arisen as a result of language contact in an increasingly interconnected world. Our paper investigates reasons for the adoption of non-heritage names among Chinese students and the kinds of functions that these names are seen to fulfill. We surveyed 156 English linguistics majors. Our findings indicate that most of those surveyed use non-heritage names. These appear to serve interrelated roles and can also be associated with Chinese nick-naming. In addition, the names in our sample seem to reflect aspects of students’ lives that are relevant in specific contexts, and these contexts both shape and are shaped by participants’ use of given and non-heritage names.

The recent increase in the provision of cross- and intercultural education for sojourners has not been matched by commensurate research into its effects on participants. Evaluation, where undertaken at all, has been largely confined to expatriate business contexts and has tended to be undertaken pre-sojourn. Crucially, evaluation has not engaged with the adaptation, adjustment and performance of sojourners related to their actual lived experience of adjustment, or with any key outcomes of sojourns. In response, this mixed-method, two-stage study explored both the adjustment and adaptation of student sojourners, with a particular focus on those studying cross-cultural communication (CCC). In stage one, analysis of results of ‘international’ postgraduate students (N = 680) at a UK university over a five-year period indicated that those doing a degree in CCC tended to perform significantly better over different measures of academic achievement than a closely comparable peer group following a similar programm...

The 2013 ALS User Meeting, held from October 7–9, began with a welcome from Users' Executive Committee chair Corie Ralston and Berkeley Lab director Paul Alivisatos. ALS director Roger Falcone followed with a “state of the ALS” presentation that reminded everyone of the ALS mission: “Supporting users in doing outstanding science in a safe environment.” Falcone gave the 400-plus meeting attendees an update on ALS beamlines, which included good news about increased user numbers thanks to the new RAPIDD access system, enhanced robotics, and remote capabilities. Falcone reflected that ALS metrics continue to represent the highly productive users—the number of journal articles and papers per user based on ALS research has continued to grow in the past year. Looking forward, Falcone touched on how a proposed ALS upgrade to a diffraction-limited light source would increase scientific capabilities. The Lab's government relations representative, Don Medley, followed with a presentation on how to talk about science...

The growth in the number of ‘international’ students in higher education is a phenomenon of increasing importance to educators, researchers and policymakers worldwide. This multi-methodological study explored factors associated with their adjustment, successful or otherwise. It integrated associations across three domains of enquiry which had hitherto usually been pursued separately – psychosocial, intercultural and educational adjustment. Specifically, the study investigated associations between a broad range of outcome indices – academic grades (for both taught and research assignments), psychological well-being, and satisfaction with life in the new environment – and, as contributory factors, participants' intercultural competence, language proficiency, and the degree, quality and patterns of social contact during their sojourn. Participants were 108 non-UK postgraduate students from a wide range of countries undertaking MA programmes at a British university. Of these, 102 completed a question...

Positron emission tomography (PET) imaging has been used to provide additional information regarding patient tumor location, size, and staging for radiotherapy treatment planning purposes. This additional information reduces interobserver variability and produces more consistent contouring. It is well recognized that different contouring methodology for PET data results in different contoured volumes. The goal of this study was to compare the difference in PET contouring methods for 2 different treatment planning systems using a phantom dataset and a series of patient datasets. Contouring methodology was compared on the ADAC Pinnacle Treatment Planning System and the CMS XiO Treatment Planning System. Contours were completed on the phantom and patient datasets using a number of PET contouring methods-the standardized uptake value 2.5 method, 30%, 40%, and 50% of the maximum uptake method and the signal to background ratio method. Differences of >15% were observed for PET-contoured volumes between the different treatment planning systems for the same data and the same PET contouring methodology. Contoured volume differences between treatment planning systems were caused by differences in data formatting and display and the different contouring tools available. Differences in treatment planning system as well as contouring methodology should be considered carefully in dose-volume contouring and reporting, especially between centers that may use different treatment planning systems or those that have several different treatment planning systems.

This paper examines how intercultural communication (ICC) and the notion of culture are framed in on-line promotional discourse of higher education intercultural communication courses. It analyses a specialised corpus comprised of 14,842 words from 43 course websites of master’s programmes in intercultural communication in the UK and the US—internationally, the two largest providers of such programmes. Through combining corpus tools with a ‘situated meaning’ approach, the analysis reveals that while a small number of courses acknowledge cultural ‘complexity’, culture is still very often reduced to an essentialised and static notion, despite growing criticism against such an approach in ICC literature. Intercultural communication is valorised as a combination of desirable skills and knowledge conducive to effective communication of different cultural groups and for those working in international arenas. Significant differences between the UK and US courses are identified with regard to the extent of associations with diversity-related social categories. The lack of interpretive, critical and constructivist positions on culture in promotional discourse is discussed in the context of neoliberal discourse and the current thinking towards professional competences dominant in Britain, North America, and other parts of the world.

Aim To study the sensitivity of three commercial dosimetric systems, Delta4, Multicube and Octavius4D, in detecting Volumetric Modulated Arc Therapy (VMAT) delivery errors. Methods Fourteen prostate and head and neck (H&N) VMAT plans were considered for this study. Three types of errors were introduced into the original plans: gantry angle independent and dependent MLC errors, and gantry angle dependent dose errors. The dose matrix measured by each detector system for the no-error and error introduced delivery were compared with the reference Treatment Planning System (TPS) calculated dose matrix for no-error plans using gamma (γ) analysis with 2%/2 mm tolerance criteria. The ability of the detector system in identifying the minimum error in each scenario was assessed by analysing the gamma pass rates of no error delivery and error delivery using a Wilcoxon signed-rank test. The relative sensitivity of the system was assessed by determining the slope of the gamma pass line for studied error magnitude in each error scenario. Results In the gantry angle independent and dependent MLC error scenario the Delta4, Multicube and Octavius4D systems detected a minimum 2 mm error. In the gantry angle dependent dose error scenario all studied systems detected a minimum 3% and 2% error in prostate and H&N plans respectively. In the studied detector systems Multicube showed relatively less sensitivity to the errors in the majority of error scenarios. Conclusion The studied systems identified the same magnitude of minimum errors in all considered error scenarios.

After a moderate to severe traumatic brain injury, it is widely recommended that family members be actively engaged in the client's rehabilitation journey because evidence suggests that this is associated with better outcomes. The ability of family members to fully engage in rehabilitation may be hindered by the barriers (logistical and psychological) they encounter. However, rehabilitation services can facilitate family engagement through a person-centred approach that provides support to remove barriers. Limited published guidance exists regarding practical and effective methods for delivering such support. This paper describes how one rehabilitation service has developed an eight-tiered approach.Family support is provided by explicit structuring of services to include (i) early engagement, (ii) meeting cultural needs, (iii) keeping families together, (iv) actively listening, (v) active involvement, (vi) education, (vii) skills training, and (viii) support for community re-integration. Implementation of these support strategies are individualised based on the expressed needs of each family. Families report a high level of satisfaction with the service.A practice-based quality improvement model identified challenges, implemented changes, and observed/evaluated the results to successfully develop a multifaceted strategy for supporting families, thereby encouraging their engagement in rehabilitation. Ongoing refinements and evaluation are planned.

Since its foundation in 1948 the NHS has remained true to its core principles: 1. It meets the needs of everyone; 2. It is free at the point of delivery; and 3. It is based on clinical need and not the ability to pay. Although almost 70 years have passed since then, our values haven’t changed. However, the clinical and social challenges we are presented with have. Our population is living longer, often with multiple chronic comorbidities, so that now approximately 70% of our healthcare spend is now allocated to the management of chronic disease. Does the system we designed in the 1940s serve us as well now as it did then? In 2017 if we were to design a new NHS would we start from here? How can we utilise the latest, greatest innovations to deliver the healthcare service we need? The challenges presented by an ageing population with multiple chronic conditions are not unique to the UK or the NHS. Many countries across our planet are grappling with how best to deal with these issues and deliver the often quoted triple aims of better health, better care, delivered with higher quality and at a lower cost. Nations have faced grand challenges in the past and the words of Abraham Lincoln in his speech to Congress in December 1862 ring true now for the challenges we face in health care: ‘ The dogmas of the quiet past, are inadequate to the stormy present. The occasion is piled high with difficulty, and we must rise with the occasion. As our case is new, so we must think anew, and act anew. We must disenthrall ourselves, and then we shall save our country .’ The future of healthcare often appears to be piled high with difficulty. Sometimes being the largest, longest established healthcare system …

This paper reports on an investigation into the beliefs and practices of experienced teachers in the USA, UK and France relating to the application of a model of intercultural communicative competence (ICC) to English language programmes. Broadly, ‘intercultural’ approaches to language learning and teaching are strongly advocated in both the recent theoretical applied linguistics literature and in curricular guidance in frameworks such as the Council of Europe's Common European framework of reference for languages. However, little prior empirical research has addressed the extent to which such approaches are actually operationalised. The investigation was multimethodological, combining diaries, focus groups, and questionnaires. Byram's language-pedagogical model of ICC was the specific focus. Findings indicated a general consensus across locations, with an apparent disparity between teachers’ attitudes to and beliefs about ICC and their current classroom priorities. Most reported beliefs that supported th...

Dementia and dementia care present huge and growing challenges, both to individuals and to societies worldwide. In the United Kingdom, the context for the study reported here, recent key policy initiatives have highlighted problems in care provision, noting a lack of appropriate carer guidance, and an overemphasis on strictly biomedical interventions. Communication practices which support agency and empowerment have been identified as areas for particular improvement. A number of communication training and guidance packages are currently available, but these exhibit shortcomings, including a lack of user input and cross-referencing to other communications theory or to relevant empirical evidence; a lack of individualisation; and high context-specificity. In general, their uptake and level of application to care is very low. As a response, the study described here developed a new communications intervention characterised by the direct involvement of a broad spectrum of lay and professional stakeholders. This inter-group dialogue produced an agreed free-to-users, user-informed and user-relevant dementia communications toolkit (DEMTEC), which is empirically supported and adaptable to different socio-cultural and care environments. We detail the conceptual background to the toolkit, the inclusive and iterative methodology for its formulation, and how it can be used to help support ‘personhood’ and quality of life and to challenge the socially-constructed ‘othering’ of people with dementia.

There is evidence that healthcare professionals (HCPs) do not always possess the appropriate knowledge or attitudes to care for people living with dementia (PLWD). As the number of PLWD increases internationally, it is important to foster education and training that leads to the development of positive attitudes amongst HCPs. This study compared the attitudes of medical students at different stages of training in three international locations. The Approaches to Dementia Questionnaire (ADQ) was completed by 770 medical students in years 1, 3 and 5 of their degree programs in one UK and two Malaysian institutions. An ordinary least squares regression model was applied to assess the influence of stage and location on sum score. The mean ADQ sum score (71.58) indicated a generally positive attitude. ADQ sum score varied among stages (P

Communication is generally realised through social action in the form of interpersonal discourse. Social action can make implicit and/or explicit claims about the various associated, and perhaps co...

This study explored the beliefs of ‘non-native English speaking’ teachers about the usefulness and appropriacy of varieties such as English as an International Language (EIL) and English as a Lingua Franca (ELF), compared with native speaker varieties. The study therefore addresses the current theoretical debate concerning ‘appropriate’ target models of English in different contexts worldwide. Participants were asked to reflect on their experiences both as learners and as teachers of English and to consider which variety or varieties of English they had learned, and which variety, if any, they chose or were ‘told’ (by education authorities or curricula) to teach. In addition, participants were asked for their views on the attractiveness and usefulness of the different varieties, as well as their views on the nature of EIL/ELF. Finally, we asked teachers to consider which model(s) were likely to predominate in their teaching contexts in the future. Results indicated that teachers may work without any clear...

This study investigated the views of language teachers and learners on the utility and validity of applied learning style theory. Learning styles attempt to categorise people's habitual cognitive, affective and psychosocial responses and approaches to new information. There are numerous definitions of the term, and a profusion of taxonomies inform the instruments which purport to index the learning styles of individuals, and of cultural groups. The study found little evidence of the validity of a Style Analysis Survey, especially as a predictor of ‘cultural’ styles. However, learners and some teachers did see the instrument as a tool for empowering individual learners.

A new exploration of the teaching and learning of culture in English language teaching and learning is overdue, given the particular importance of approaches to culture and intercultural communication in the teaching and learning of the ‘global language’. The review undertaken here finds a growing body of literature exploring culture as a context for and background influence on English language teaching and learning. However, comparatively little research literature explores the actual ‘learning of and about culture’ on English language programmes worldwide. There is some empirical evidence, detailed and discussed here, that culture is not approached in the classroom in a principled, active and engaged manner, and that this lack of engagement may have a detrimental effect on learning. Where it is approached actively, there are indications that a nonessentialised, critical, mediating, ‘intercultural’ approach may have a positive effect on learning. Although this approach informs much of the curric...

In this article, the authors highlight the need for a Code of Practice (CoP) to address the communicative needs of people with dementia and their formal and informal carers. The authors also detail a proposed CoP, as well as an innovative and inclusive consultation process through which the authors and other stakeholders will produce a complete final working version. The authors produced a three level framework for a proposed CoP. Level 1 is a statement of beliefs and principles underlying a person-centred and empowering approach to effective communication with people with dementia. Based on this, Level 2 consists of components of communication strategies and considerations for effective communication. The authors have produced three examples of level 2 components, and these are detailed here. Level 3 of the proposed CoP will consist of practical and individualized advice on actual communication with people at various stages of dementia. The authors also outline a regime for empirically testing the efficacy of the CoP in different contexts, and discuss implications for research and for communication practices in health care contexts.