Roles and student identities in online large course forums: implications for practice.

The use of large online discussion forums within online and distance learning continues to grow. Recent innovations in online learning the MOOC (Massive Open Online Course) and concomitant growth in the use of online media for the delivery of courses in traditional campus based universities provides both opportunity and challenge for online tutors and learners alike. The recognition of the role that online tutor and student identity plays in the field of retention and progression of distance learners is also well documented in the field of distance learning. Focusing on a course forum linked to a single level 2 undergraduate module and open to over a thousand students, this ideographic case study, set in a large distance learning university, uses qualitative methodology to examine the extent to which participation in a large forum can be considered within community of practice frameworks (COP) and contributes to feelings of efficacy, student identity and motivation. The paper draws on current theory pertaining to online communities and examines this in relation to the extent to which the forum adds to feelings of academic and social integration. The study concludes that although the large forum environment facilitates a certain degree of academic integration and identity there is evidence that it also presents a number of barriers producing negative effects on student motivation and online identity

A Pilot Study for Enhancing Postpartum Discharge Instructions for Incision Care: Assessment of Comprehension

Literacy and Health Care • 14.5% of United States is illiterate 1 • Reading level of most medical forms is 10th grade 2 Improving Outcomes with a Visual Aid • Cesarean Surgical Site Infection (SSI) rate is 5% 3 • A patient with a SSI can be 2 times as expensive 4 • Visual aids improve information recall 8 and confidence in wound care 5 Study Objectives 1. To evaluate the readability of the cesarean wound care discharge instructions relative to the patient population’s reading level 2. To conduct a pilot Randomized Control Trial (RCT) to evaluate the effectiveness of a visual aid on improving comprehension of the cesarean wound care instructionshttps://jdc.jefferson.edu/cwicposters/1034/thumbnail.jp

The use of photo elicitation to explore the role of the main street in Kirkwall in sustaining cultural identity, community, and a sense of place.

This paper explores the value of photo elicitation as a method for investigating the role played by small town main streets in Scottish island communities in sustaining cultural identity, community, and a sense of place. In particular, it critically evaluates the photo elicitation techniques used during a multidisciplinary pilot study, conducted in Kirkwall, Orkney, in 2010. A number of techniques were used, including a photographic exhibition, discussion groups, extended face-to-face interviews, and the creation of a special Facebook page. Throughout all approaches, participants were presented with old and current photographs of the main street, together with some novel merged images combining both historical and contemporary views. These elicitation techniques proved successful in obtaining rich, detailed, qualitative data from 164 informants, who each shared their personal memories and perceptions of the social and cultural role of the Kirkwall main street. Indeed, the very process of identifying familiar buildings, landmarks and faces from photographs (both past and present) appeared to reinforce the participants cultural identity

Association of nutritional status measures with self-efficacy and experiencing depressed mood among Pakistani young women (P10-090-19)

Objectives: We aimed to assess self-efficacy and the experience of depression-related emotions among non-pregnant adolescent and young women (15–23 years) living in rural Pakistan, and determine their association with measures of nutritional status. Methods: Outcomes were assessed from the Matiari emPowerment and Preconception Supplementation (MaPPS) Trial baseline data (n = 25,279). Self-efficacy and depression-related emotions were determined and categorized using the general self-efficacy scale (low, moderate, and high) and DASS-21 tool (normal, mild, moderate, severe, and extremely severe), respectively. Nutritional status was evaluated using hemoglobin concentration (HemoCue Hb 301 System) and body mass index (BMI). Associations were assessed using ordinal logistic regression, and multivariate models were adjusted for education, parity, wealth index, and clustering. Results: The majority of participants were categorized as having moderate self-efficacy (50.6%) and experienced normal range depression-related emotions (76.3%). The mean hemoglobin concentration and BMI were 11.5 ± 1.9 g/dL and 20.2 ± 3.8 kg/m2, respectively. Each unit of increase in hemoglobin was associated with having higher self-efficacy (β = 0.018; 95% confidence interval (CI): 0.005 to 0.031) and lower severe depression-like emotions (β = -0.018; 95% CI: - 0.033 to -0.002). Similarly, BMI was associated with higher self-efficacy (β = 0.010; 95% CI: 0.004 to 0.017) and lower severe depressionlike emotions (β = -0.014; 95% CI: -0.022 to -0.007). For all models, however, wealth index had a stronger effect on the outcomes of interest. Conclusions: Poor nutritional status is suggested to be associated with behavioral organization and one’s emotional state. In this setting with a high prevalence of micronutrient deficiencies, we observed associations between lower hemoglobin and BMI with low self-efficacy and experiencing depressed mood, although the effect sizes were small. Findings may reflect potential confounding in the link between empowerment and mood, and poverty. Funding Sources: Bill and Melinda Gates Foundation, World Food Programme

Effect of life skills building education and micronutrient supplements provided from preconception versus the standard of care on low birth weight births among adolescent and young Pakistani women (15–24 years): A prospective, population-based cluster-randomized trial

Background: Risk factors known to impact maternal and newborn nutrition and health can exist from adolescence. If an undernourished adolescent girl becomes pregnant, her own health and pregnancy are at an increased risk for adverse outcomes. Offering preconception carefrom adolescence could provide an opportunity for health and nutrition promotion to improve one\u27s own well-being, as well as future pregnancy outcomes and the health of the next generation.Methods: The Matiari emPowerment and Preconception Supplementation (MaPPS) Trial is a population-based two-arm, cluster-randomized, controlled trial of life skills building education and multiple micronutrient supplementation provided in a programmatic context to evaluate the impact on pre-identified nutrition and health outcomes among adolescent and young women (15-24 years) in Matiari district Pakistan, and the infants born to them within the context of the trial. The primary aim is to assess the effect of the intervention on the prevalence of low birth weight births (\u3c 2500 g). The intervention includes bi-monthly life skills building education provided from preconception, and supplementation with multiple micronutrients during preconception (twice-weekly), pregnancy (daily), and post-partum (daily to 6 months). The standard of care includes non-regulated community-based health sessions and daily iron and folic acid supplementation during pregnancy. Additional outcome information will also be collected at set time periods. Among participants, these relate to nutrition (anthropometry, nutritional status), morbidity, and mortality. Among infants, these include birth outcomes (stillbirth, preterm birth, length of gestation, small for gestational age, birth defects), anthropometry, morbidity, and mortality.Discussion: Preconception care from adolescence that includes interventions targeting life skills development and nutrition is suggested to be important to improving the health and nutrition of adolescent and young women and their future offspring. This study is expected to offer insight into providing such an intervention both within a programmatic context and with an extended exposure period prior to conception

Factors influencing community case management and care hours for clients with traumatic brain injury living in the UK

Objective: To investigate the relationship between deficits associated with traumatic brain injury (TBI) and case management (CM) and care/support (CS) in two UK community samples. Research design: Prospective descriptive study. Method: Case managers across the UK and from a single UK CM service contributed client profiles to two data sets (Groups 1 and 2, respectively). Data were entered on demographics, injury severity, functional skills, functional-cognition (including executive functions), behaviour and CM and CS hours. Relationships were explored between areas of disability and service provision. Results: Clients in Group 2 were more severely injured, longer post-injury and had less family support than clients in Group 1. There were few significant differences between Groups 1 and 2 on measures of Functionalskill, Functional-cognition and Behaviour disorder. Deficits in Functionalskills were associated with CS, but not CM. Deficits in measures of executive functions (impulsivity, predictability, response to direction) were related to CM, but not to CS. Insight was related to both CM and CS. Variables related to behaviour disorder were related to CM, but were less often correlated to CS. Conclusions: The need for community support is related not only to Functionalskills (CS), but also to behaviour disorder, self-regulatory skills and impaired insight (CM)

Characterizing micronutrient status and risk factors among late adolescent and young women in rural Pakistan: A cross-sectional assessment of the MaPPS trial

Nutritional deficiencies are a leading underlying risk factor contributing to the global burden of disease. In Pakistan, late adolescence is considered a nutritionally vulnerable period, as micronutrient requirements are increased to support maturation, and dietary staples are nutrient poor. However, there has been limited evaluation of micronutrient status beyond anemia and its determinants. Using cross-sectional data from late adolescent and young women (15-23 years) at enrolment in the Matiari emPowerment and Preconception Supplementation (MaPPS) Trial, we aimed to describe the prevalence of key micronutrient deficiencies of public health concern, and generate hierarchical models to examine associations with proxies for social determinants of health (SDoH). The prevalence of micronutrient deficiencies was high: 53.6% (95% confidence interval (CI): 53.0-54.3%) had anemia; 38.0% (95% CI: 36.4-39.6%) iron deficiency anemia; 31.8% (95% CI: 30.2-33.3%) vitamin A deficiency; and 81.1% (95% CI: 79.8-82.4%) vitamin D deficiency. At least one deficiency was experienced by 91.0% (95% CI: 90.1-92.0%). Few SDoH were maintained in the final hierarchical models, although those maintained were often related to socioeconomic status (e.g., education, occupation). To improve the micronutrient status of late adolescent and young women in Pakistan, a direct micronutrient intervention is warranted, and should be paired with broader poverty alleviation methods

Persistent Cryptococcal Brain Infection despite Prolonged Immunorecovery in an HIV-Positive Patient.

Background. HIV-positive people starting combined antiretroviral therapy may develop immune reconstitution to latent or treated opportunistic infections. Immune reconstitution to cerebral Cryptococcus is poorly understood and can be fatal. Case Presentation. A 33-year-old Zimbabwean female presented with cryptococcal meningitis and newly diagnosed HIV with a CD4 count of 51 cells/ μ L (4%). She was treated with amphotericin and flucytosine. Combined antiretroviral therapy was started four weeks later and she showed early improvement. However, over the ensuing 18 months, her clinical course was marked by periodic worsening with symptoms resembling cryptococcal meningitis despite having achieved CD4 counts ≥400 cells/ μ L. Although initially treated for relapsing cryptococcal immune reconstitution syndrome, a brain biopsy taken 17 months after initial presentation showed budding Cryptococci. Conclusion. This unusually protracted case highlights the difficulties in differentiating relapsing cryptococcal meningitis from immune reconstitution and raises questions concerning the optimum timing of initiation of combined antiretroviral therapy in such patients