Authentic alignment : toward an Interpretative Phenomenological Analysis (IPA) informed model of the learning environment in health professions education

It is well established that the goals of education can only be achieved through the constructive alignment of instruction, learning and assessment. There is a gap in research interpreting the lived experiences of stakeholders within the UK learning environment toward understanding the real impact – authenticity – of curricular alignment. This investigation uses a critical realist framework to explore the emergent quality of authenticity as a function of alignment.This project deals broadly with alignment of anatomy pedagogy within UK undergraduate medical education. The thread of alignment is woven through four aims: 1) to understand the alignment of anatomy within the medical curriculum via the relationships of its stakeholders; 2) to explore the apparent complexity of the learning environment (LE); 3) to generate a critical evaluation of the methodology, Interpretative Phenomenological Analysis as an approach appropriate for realist research in the complex fields of medical and health professions education; 4) to propose a functional, authentic model of the learning environment.Findings indicate that the complexity and uncertainty inherent in the LE can be reflected in spatiotemporal models. Findings meet the thesis aims, suggesting: 1) the alignment of anatomy within the medical curriculum is complex and forms a multiplicity of perspectives; 2) this complexity is ripe for phenomenological exploration; 3) IPA is particularly suitable for realist research exploring complexity in HPE; 4) Authentic Alignment theory offers a spatiotemporal model of the complex HPE learning environment:the T-icosa

Authentic Alignment: Toward an Interpretative Phenomenological Analysis (IPA) informed model of the learning environment in health professions education

It is well established that the goals of education can only be achieved through the constructive alignment of instruction, learning and assessment. There is a gap in research interpreting the lived experiences of stakeholders within the UK learning environment toward understanding the real impact – authenticity – of curricular alignment. This investigation uses a critical realist framework to explore the emergent quality of authenticity as a function of alignment. This project deals broadly with alignment of anatomy pedagogy within UK undergraduate medical education. The thread of alignment is woven through four aims: 1) to understand the alignment of anatomy within the medical curriculum via the relationships of its stakeholders; 2) to explore the apparent complexity of the learning environment (LE); 3) to generate a critical evaluation of the methodology, Interpretative Phenomenological Analysis as an approach appropriate for realist research in the complex fields of medical and health professions education; 4) to propose a functional, authentic model of the learning environment. Findings indicate that the complexity and uncertainty inherent in the LE can be reflected in spatiotemporal models. Findings meet the thesis aims, suggesting: 1) the alignment of anatomy within the medical curriculum is complex and forms a multiplicity of perspectives; 2) this complexity is ripe for phenomenological exploration; 3) IPA is particularly suitable for realist research exploring complexity in HPE; 4) Authentic Alignment theory offers a spatiotemporal model of the complex HPE learning environment: the T-icosa

Workflow evaluation of environmental contamination with hazardous drugs during compounding and administration in an UK hospital

IntroductionExposure of healthcare workers to hazardous drugs may result in adverse health effects underscoring the importance of validating working procedures and safety precautions to minimise the risk. The objective was to monitor environmental contamination caused by the hazardous drug workflow: from drug vials, compounding process, to patient administration.MethodsSurface wipe samples were collected from potentially contaminated surfaces in the compounding department and in the administration department. The outside of drug vials, compounded syringes, bags, elastomeric pumps, and gloves used by the nurses for administration were also monitored. Stationary air samples were collected near the isolators and above the bench top. Personal air samples were collected from pharmacy technicians, pharmacists, and nurses. Monitoring was performed in three trials during two-months. Samples were analysed for cyclophosphamide, 5-fluorouracil, docetaxel, and paclitaxel using liquid chromatography tandem mass spectrometry.ResultsContamination was mainly found for 5-fluorouracil and cyclophosphamide on isolator surfaces, bench top, trays, and compounded products. Lower levels of contamination were measured in the administration department on trays, trolley arms and gloves of the nurses. Paclitaxel and docetaxel were incidentally detected. Air contamination was found for paclitaxel in the compounding department in one trial, and 5-fluorouracil was detected once in front of an isolator. Docetaxel was found in one air sample of a nurse.ConclusionsContamination was mainly found for 5-fluorouracil and cyclophosphamide on the products compounded in the isolators. Contamination was further spread along the workflow towards the administration department causing surfaces in between being contaminated too

The Diploid Genome Sequence of an Individual Human

Presented here is a genome sequence of an individual human. It was produced from ~32 million random DNA fragments, sequenced by Sanger dideoxy technology and assembled into 4,528 scaffolds, comprising 2,810 million bases (Mb) of contiguous sequence with approximately 7.5-fold coverage for any given region. We developed a modified version of the Celera assembler to facilitate the identification and comparison of alternate alleles within this individual diploid genome. Comparison of this genome and the National Center for Biotechnology Information human reference assembly revealed more than 4.1 million DNA variants, encompassing 12.3 Mb. These variants (of which 1,288,319 were novel) included 3,213,401 single nucleotide polymorphisms (SNPs), 53,823 block substitutions (2-206 bp), 292,102 heterozygous insertion/deletion events (indels)(1-571 bp), 559,473 homozygous indels (1-82,711 bp), 90 inversions, as well as numerous segmental duplications and copy number variation regions. Non-SNP DNA variation accounts for 22% of all events identified in the donor, however they involve 74% of all variant bases. This suggests an important role for non-SNP genetic alterations in defining the diploid genome structure. Moreover, 44% of genes were heterozygous for one or more variants. Using a novel haplotype assembly strategy, we were able to span 1.5 Gb of genome sequence in segments >200 kb, providing further precision to the diploid nature of the genome. These data depict a definitive molecular portrait of a diploid human genome that provides a starting point for future genome comparisons and enables an era of individualized genomic information

“Preparing them for the profession”: An interpretative phenomenological analysis of anatomy educators coping with complexity in the United Kingdom curriculum

Efforts to integrate the basic sciences into the ever-changing curriculum are a trending area of research in health professions education. Low-stakes, high-frequency assessment methods such as the progress test are now widely implemented in the United Kingdom and Northern Ireland as a means of furthering curricular integration toward contemporary goals of competency and professional identity formation. The anatomy educator's experience vis-à-vis these curricular changes is not well understood. This study aimed to explore how anatomy educators make sense of the shifting demands of their role. The interviews were semi-structured, particularly concerned with the phenomenon of teachers adapting to the complexity of their learning environment. The study used interpretative phenomenological analysis (IPA) to focus on the lived experiences of participants coping with the phenomena in question: how do anatomy educators make sense of the learning environment in the United Kingdom? Interviews were transcribed verbatim and interpreted inductively, identifying four key themes: confidence through connectedness, variations in appraisals of curricular integration, managing expectations to perform in paradoxical situations, and the emergence of innovative teaching. Results point to the learning environment as a complex system and highlight the importance of feeling support from and connection to colleagues, enabling individual educators to develop confidence, meet the top-down demands of changing curricula, and experience personal identity development and uncertainty tolerance within their role. This IPA study offers insight into the lived experiences of anatomy educators whose experiential interpretations of a complex and changing curriculum can uniquely inform stakeholders in health professions education

Decrement of the skin conductance response to repeated volitional inspiration

Objective. To examine response decrement of the recently reported inspiratory skin conductance response (SCR) [Lim CL, Seto-Poon M, Clouston PD, Morris JG. Sudomotor nerve conduction velocity and central processing time of the skin conductance response. Clin Neurophysiol 2003;114:2172–80]. Methods. Twelve healthy adult volunteers performed 3 tasks (A) a control task of maintaining tidal breathing and then two randomized tasks, (B) a deep inspiration to a target oral pressure and (C) tapping with a finger. Each task was performed 30 times on cue every 20 s in 3 runs with 5 min of rest between runs. The SCR, oral pressure, airflow, inspired volume and cue signal were recorded continuously and analysed offline. SCR amplitude was logarithmically transformed and then statistically analysed, using a linear mixed effects model, as a function of run number, trial number and absolute error between target and actual oral pressures. Results. Inspiratory efforts elicited exponentially decreasing SCR amplitude with increasing trial number during each run (P<0.0001). After adjusting for trial number, the mean SCR amplitude of the second and the third run were, respectively, 24.2 (95% CI (0.175, 0.336), P<0.001) and 14.4% (95% CI (0.104, 0.200), P<0.001) of the first run amplitude. Conclusions. Volitional deep inspiration reliably activates an SCR that exhibits response decrement with repetition, which may be habituation. Significance. The volitional inspiratory SCR may assist in the assessment of sympathetic autonomic status in patients with peripheral afferent neuropathy

The blood DNA virome in 8,000 humans

<div><p>The characterization of the blood virome is important for the safety of blood-derived transfusion products, and for the identification of emerging pathogens. We explored non-human sequence data from whole-genome sequencing of blood from 8,240 individuals, none of whom were ascertained for any infectious disease. Viral sequences were extracted from the pool of sequence reads that did not map to the human reference genome. Analyses sifted through close to 1 Petabyte of sequence data and performed 0.5 trillion similarity searches. With a lower bound for identification of 2 viral genomes/100,000 cells, we mapped sequences to 94 different viruses, including sequences from 19 human DNA viruses, proviruses and RNA viruses (herpesviruses, anelloviruses, papillomaviruses, three polyomaviruses, adenovirus, HIV, HTLV, hepatitis B, hepatitis C, parvovirus B19, and influenza virus) in 42% of the study participants. Of possible relevance to transfusion medicine, we identified Merkel cell polyomavirus in 49 individuals, papillomavirus in blood of 13 individuals, parvovirus B19 in 6 individuals, and the presence of herpesvirus 8 in 3 individuals. The presence of DNA sequences from two RNA viruses was unexpected: Hepatitis C virus is revealing of an integration event, while the influenza virus sequence resulted from immunization with a DNA vaccine. Age, sex and ancestry contributed significantly to the prevalence of infection. The remaining 75 viruses mostly reflect extensive contamination of commercial reagents and from the environment. These technical problems represent a major challenge for the identification of novel human pathogens. Increasing availability of human whole-genome sequences will contribute substantial amounts of data on the composition of the normal and pathogenic human blood virome. Distinguishing contaminants from real human viruses is challenging.</p></div