Development and evaluation of Entrustable Professional Activities embedded in an e-portfolio for work-based assessment in community and public health dietetics

Entrustable professional activities (EPAs) is a recent concept that helps operationalise competency-based education. In this paper, we report on the development of EPAs and incorporation into an e-portfolio for work-based assessment of final year dietetics students in a community and public health professional placement. We aimed to determine the utility of the EPAs for work-based assessment in this context. We used action research methodology to conduct broad consultation with students and supervisors using anonymous surveys and focus groups to understand their beliefs and attitudes towards work-based assessment. Consequently, 40 EPAs with an accompanying four-point entrustment scale were developed and mapped to the National Competency Standards for Dietitians in Australia. The EPAs and assessment tool were piloted and evaluated via an anonymous online user survey across three cohorts of students (n = 133) and supervisors (n = 67). Following mediocre pilot year evaluation results, EPAs were revised and reduced in number. While students positively evaluated the e-portfolio, their appraisal of the EPAs and entrustment scale was less positive compared to supervisors. Supervisor evaluation of the EPA-based e-portfolio supported the validity, feasibility and acceptability of this novel assessment method in a community and public health setting. Assessment using EPAs, and the resulting educational data collected by the tool, offers potential for individual learners to identify areas needing development during placement, as well as potential to inform curriculum improvements and increase understanding of learning opportunities and outcomes for dietetic students in community and public health settings

Employability initiatives in undergraduate education and application to human nutrition: A scoping review

Human nutrition is a growing field with an increasing job market and high demand for university study, yet graduates report feeling underprepared for and unaware of potential job opportunities. This scoping review aimed to identify employment initiatives used in undergraduate programs to support an evidence-based approach to the development of future initiatives for human nutrition courses. The scoping review following PRISMA-ScR criteria was initially conducted in October 2018 and updated in April 2020. Search terms were selected to identify studies that reported on employability or work-readiness embedded within the course curriculum for undergraduate students. Fourteen papers met the eligibility criteria. Papers included were from Australia (9), United Kingdom (2), United States (1), New Zealand (1) and Germany (1). Papers described initiatives fitting broad categories of placements, project-based industry collaboration, practice-based eLearning, mentoring and building graduate attributes. Placements were the most common type of initiative and project-based industry collaboration demonstrated the highest levels of student and employer satisfaction. The success of initiatives was often attributed to incorporating diverse approaches to real-world, problem-solving skills. Mentoring and eLearning were used to promote employability soft skills, while industry-based placements provided students with practical experience. Placement in specific workplace settings should be representative of the diverse job options for nutrition graduates. Human nutrition degrees should consider incorporating strategies that develop soft skills and project-based skills while exposing students to diverse workplace settings within industry

An exploratory study of industry perspectives to inform undergraduate nutrition employability initiatives

Aim The aim of this study was to explore nutrition professionals' perspectives of nutrition graduates' employability skills, and knowledge and skills required in the industry to understand gaps in undergraduate nutrition curriculum. Methods Nutrition professionals (n = 26) across Australia were approached to participate in semi-structured interviews via telephone in 2018. Interviews were transcribed verbatim, data analysed using thematic analysis, and results interpreted and discussed. Results Nine participants across six work environments completed interviews. Common work roles were identified in their diverse areas of practice: nutrition educators, food developers, team members, and business leaders. Nutrition professionals identified that, in addition to evidence-based discipline knowledge, key skills and knowledge needed for their roles were interpersonal communication, including writing and listening. Participants highlighted the need for employability skills to be embedded within curriculum with emphasis on professional skills, business skills and discipline-specific skills in communicating complex science messages to a range of audiences. Networking, and formal and informal work-integrated learning were viewed as important vehicles for developing required skills. Participants expected that universities develop curriculum to address gaps; however, reflection by the academic researchers suggested this should be a joint role. Conclusions Early career planning, professional skill development, work experience and networking opportunities should enhance graduate employability

Evaluating the clinical effectiveness of the NHS Health Check programme: a prospective analysis in the Genetics and Vascular Health Check (GENVASC) study

OBJECTIVE: The aim of the study was to assess the clinical effectiveness of the national cardiovascular disease (CVD) prevention programme-National Health Service Health Check (NHSHC) in reduction of CVD risk. DESIGN: Prospective cohort study. SETTING: 147 primary care practices in Leicestershire and Northamptonshire in England, UK. PARTICIPANTS: 27 888 individuals undergoing NHSHC with a minimum of 18 months of follow-up data. OUTCOME MEASURES: The primary outcomes were NHSHC attributed detection of CVD risk factors, prescription of medications, changes in values of individual risk factors and frequency of follow-up. RESULTS: At recruitment, 18% of participants had high CVD risk (10%-20% 10-year risk) and 4% very high CVD risk (>20% 10-year risk). New diagnoses or hypertension (HTN) was made in 2.3% participants, hypercholesterolaemia in 0.25% and diabetes mellitus in 0.9%. New prescription of stains and antihypertensive medications was observed in 5.4% and 5.4% of participants, respectively. Total cholesterol was decreased on average by 0.38 mmol/L (95% CI -0.34 to -0.41) and 1.71 mmol/L (-1.48 to -1.94) in patients with initial cholesterol >5 mmol/L and >7.5 mmol/L, respectively. Systolic blood pressure was decreased on average by 2.9 mm Hg (-2.3 to -3.7), 15.7 mm Hg (-14.1 to -17.5) and 33.4 mm Hg (-29.4 to -37.7), in patients with grade 1, 2 and 3 HTN, respectively. About one out of three patients with increased CVD risk had no record of follow-up or treatment. CONCLUSIONS: Majority of patients identified with increased CVD risk through the NHSHC were followed up and received effective clinical interventions. However, one-third of high CVD risk patients had no follow-up and therefore did not receive any treatment. Our study highlights areas of focus which could improve the effectiveness of the programme. TRIAL REGISTRATION NUMBER: NCT04417387

International genome-wide meta-analysis identifies new primary biliary cirrhosis risk loci and targetable pathogenic pathways.

Primary biliary cirrhosis (PBC) is a classical autoimmune liver disease for which effective immunomodulatory therapy is lacking. Here we perform meta-analyses of discovery data sets from genome-wide association studies of European subjects (n=2,764 cases and 10,475 controls) followed by validation genotyping in an independent cohort (n=3,716 cases and 4,261 controls). We discover and validate six previously unknown risk loci for PBC (Pcombined<5 × 10(-8)) and used pathway analysis to identify JAK-STAT/IL12/IL27 signalling and cytokine-cytokine pathways, for which relevant therapies exist

Towards a scientific interpretation of the terroir concept: plasticity of the grape berry metabolome

BACKGROUND: The definition of the terroir concept is one of the most debated issues in oenology and viticulture. The dynamic interaction among diverse factors including the environment, the grapevine plant and the imposed viticultural techniques means that the wine produced in a given terroir is unique. However, there is an increasing interest to define and quantify the contribution of individual factors to a specific terroir objectively. Here, we characterized the metabolome and transcriptome of berries from a single clone of the Corvina variety cultivated in seven different vineyards, located in three macrozones, over a 3-year trial period. RESULTS: To overcome the anticipated strong vintage effect, we developed statistical tools that allowed us to identify distinct terroir signatures in the metabolic composition of berries from each macrozone, and from different vineyards within each macrozone. We also identified non-volatile and volatile components of the metabolome which are more plastic and therefore respond differently to terroir diversity. We observed some relationships between the plasticity of the metabolome and transcriptome, allowing a multifaceted scientific interpretation of the terroir concept. CONCLUSIONS: Our experiments with a single Corvina clone in different vineyards have revealed the existence of a clear terroir-specific effect on the transcriptome and metabolome which persists over several vintages and allows each vineyard to be characterized by the unique profile of specific metabolites.Andrea Anesi, Matteo Stocchero, Silvia Dal Santo, Mauro Commisso, Sara Zenoni, Stefania Ceoldo, Giovanni Battista Tornielli, Tracey E. Siebert, Markus Herderich, Mario Pezzotti and Flavia Guzz

Search for gravitational-lensing signatures in the full third observing run of the LIGO-Virgo network

Gravitational lensing by massive objects along the line of sight to the source causes distortions of gravitational wave-signals; such distortions may reveal information about fundamental physics, cosmology and astrophysics. In this work, we have extended the search for lensing signatures to all binary black hole events from the third observing run of the LIGO--Virgo network. We search for repeated signals from strong lensing by 1) performing targeted searches for subthreshold signals, 2) calculating the degree of overlap amongst the intrinsic parameters and sky location of pairs of signals, 3) comparing the similarities of the spectrograms amongst pairs of signals, and 4) performing dual-signal Bayesian analysis that takes into account selection effects and astrophysical knowledge. We also search for distortions to the gravitational waveform caused by 1) frequency-independent phase shifts in strongly lensed images, and 2) frequency-dependent modulation of the amplitude and phase due to point masses. None of these searches yields significant evidence for lensing. Finally, we use the non-detection of gravitational-wave lensing to constrain the lensing rate based on the latest merger-rate estimates and the fraction of dark matter composed of compact objects

Validity and educational impact of clinical entrustable professional activities linked to the nutrition care process for work-based assessment of entry-level dietetics students : Evaluation of a 3-year implementation study in Australia

Background Entrustable professional activities (EPAs) describe key workplace activities and are increasingly being used for student work-based assessment. An EPA-based work-based assessment tool offers potential to increase understanding of dietetics student skill development and opportunity for standardised work-based student assessment. Objective To determine construct validity and educational impact of an EPA work-based assessment tool for dietetics placement students in clinical settings. Design Using a time series design, supervisor and student self-assessment data collected from an EPA-based assessment tool from three cohorts of dietetics students and supervisors from 2017-2019 was analyzed. Participants and setting Dietetics students (n = 145) from an accredited dietetic training program in Australia and affiliated metropolitan and rural hospitals. Main outcome measures Construct validity was determined through analysis of supervisor evaluation of student performance against EPAs over time. Educational impact was determined through comparing student performance across EPAs to predicted milestones to identify areas of least entrustment. Statistical analyses performed Student performance over time and differences between student self-assessment and supervisor assessment for each EPA were investigated using Wilcoxon signed-rank tests and linear mixed-model analysis. Descriptive statistics summarised student performance against each EPA. Results Performance significantly increased over time in 35 out of 37 EPAs. Significant differences between supervisor and student self-assessment were evident in 9 out of 37 EPAs. Dietetics student performance varied across EPAs with 88.2% of students achieving entrustment for nutrition management EPAs compared with 100% for professionalism EPAs. Conclusions The tool’s construct validity was established. EPAs identified areas of Nutrition Care Process skills development requiring additional support. Data collected by the tool can inform teaching

Design, implementation and evaluation of novel work-based clinical assessment tool : An e-portfolio with embedded Entrustable Professional Activities

Background A new concept in work-based assessment, Entrustable Professional Activities (EPAs) describe key activities a work-ready practitioner can perform independently. EPAs are widely used in medicine to support competency-based education and are gaining acceptance in other professions such as nursing, pharmacy and dietetics. There is currently no widely accepted work-based assessment tool for student clinical placement assessment in dietetics and EPAs offer potential to address this gap. Objectives To design, implement and evaluate a work-based assessment tool using EPAs embedded in an e-portfolio for use in clinical dietetics. Setting An accredited dietetic training program in Australian university and affiliated metropolitan and rural hospitals. Participants Three consecutive cohorts of final year dietetic students (n = 126) and their professional placement supervisors (n = 101). Methods A working party consisting of dietetic academics with experience in clinical dietetics and education developed clinical dietetic EPAs and milestones that were mapped to the National Competency Standards for Dietitians in Australia. A design model incorporating multiple rounds of user feedback was used to create an e-portfolio with the EPAs embedded. Students and supervisors were invited to complete anonymous on-line surveys with Likert responses (1 = highly dissatisfied, 5 = highly satisfied) to evaluate the face validity, acceptability and feasibility of the tool. Results A total of 37 EPAs were developed with an accompanying four-point entrustment scale to measure performance. Evaluation survey response rates were high and ranged from 35 to 45% for students and 57-83% for supervisors across the study period. Both students and supervisors evaluated the tool positively with a mean overall satisfaction of 4.12 ± 0.69 and 4.03 ± 0.68, respectively. Survey items evaluating face validity, feasibility and acceptability scored >3.75 for both groups of users. Conclusions The EPA based e-portfolio demonstrated face validity, feasibility and acceptability and offers potential for a widely accepted tool for work-based assessment of clinical dietetic students