Occupational therapy students’ experiences of professional reasoning during practice-based learning: A dialogical analysis

Background Practice-based learning equates to a third of occupational therapy students’ education and provides an opportunity for development of professional reasoning. Although professional reasoning is a key competency underpinning entry to the occupational therapy profession, little is known about students’ reasoning during their practice-based learning. Methodology A dialogical approach, based on the philosophy of Mikhail Bakhtin, has been used to explore occupational therapy students’ experiences of reasoning during their practice-based learning. A dialogical approach recognises living as both an individual and a social phenomenon. Bakhtin suggests speech is composed of different genres which have distinctive temporal and spatial features, these can indicate how we position ourselves in relation to others. Twelve occupational therapy students were interviewed after they had completed their final practice placement. Findings Fifty-seven key moments were analysed, and two major genres (Bildungsroman and romance) and three minor genres (travel, adventure, and carnival) were identified. The Bildungsroman illustrated experiences of professional socialisation into reasoning. The other genres related to expression of professional identity. The romantic genre was used to convey the person-centred and occupation-centred values that informed the students’ reasoning. The travel genre indicated an inability to reason, for example in a fast-paced setting. The adventure genre was used when the practice educator was experienced as testing reasoning, and the carnival genre when reasoning in an unpredictable situation. Discussion This study demonstrates the value of a dialogical methodology in exploring a complex, individual, and social phenomenon. Reasoning was experienced both as a means of enacting, affirming, and negotiating a professional identity, and of being socialised into the reasoning of an occupational therapist. Some students resisted socialisation into reasoning that was incongruent with their values and developing professional identity. The findings also illustrated the emotionality of learning to reason, and the need for emotional intelligence. Recommendations It is recommended that students and educators are prepared for the emotionality of learning to reason. Preceptorship programmes need to support newly qualified occupational therapists in the development of their professional identit

Experiences of Using Pathways and Resources for Participation and Engagement (PREP) Intervention for Children with Acquired Brain Injury: A Knowledge Translation Study.

Children with acquired brain injury experience participation restrictions. Pathways and Resources for Participation and Engagement (PREP) is an innovative, participation focused intervention. Studies have examined PREP in Canadian research contexts, however little is known about implementation in real-life clinical settings. This study aimed to understand experiences of clinicians implementing PREP in a UK clinical context, with a focus on implementation processes and key factors for successful implementation. A qualitative single-site 8-week knowledge translation intervention study, guided by an action research framework, explored clinicians' experiences of implementation. Six occupational therapists (OTs) working in a neurorehabilitation setting participated. The therapists provided two intervention sessions per week, over four weeks for one child on their caseload. Planning, implementation and evaluation were explored through two focus groups. Thematic analysis was used to analyse data. Two themes, "key ingredients before you start" and "PREP guides the journey", were identified before introducing PREP to practice. Four additional themes were related to PREP implementation: "shifting to a participation perspective", "participation moves beyond the OT", "environmental challengers and remedies" and "whole family readiness". A participation ripple effect was observed by building capacity across the multi-disciplinary team and families. The involvement of peers, social opportunities and acknowledging family readiness were key factors for successful implementation. The findings illustrate practical guidance to facilitate the uptake of participation-based evidence in clinical practice. Further research is required to understand aspects of knowledge translation when implementing participation interventions in other UK clinical settings

Un programme de mentorat LGBTQ+ enrichit l'expérience des étudiants en médecine et des médecins mentors

Implication Statement  The Schulich School of Medicine and Dentistry LGBTQ+ mentorship program positively impacted the personal and professional experience of LGBTQ+ medical students and physician mentors. Mentorship delivered by LGBTQ+ physicians fostered a safe environment for self-expression, and provided mentees with experience-driven guidance in navigating the medical profession. We therefore recommend that all Canadian medical schools consider the longitudinal implementation of an LGBTQ+ mentorship program to support the personal and professional development of their LGBTQ+-identifying students. Énoncé des implications de la recherche Le programme de mentorat LGBTQ+ de la Faculté de médecine et de médecine dentaire Schulich a eu un impact positif sur l'expérience personnelle et professionnelle des étudiants en médecine et des médecins mentors LGBTQ+. Le mentorat offert par les médecins LGBTQ+ a aidé les étudiants LGBTQ+ à envisager un avenir positif dans la profession médicale et à trouver une communauté de confiance. Les mentors ont apprécié l’expérience d'être des modèles positifs pour les mentorés et ils ont éprouvé un sentiment d'appartenance plus fort entre collègues. Nous recommandons à toutes les facultés de médecine canadiennes de songer à mettre en place un programme de mentorat destiné à soutenir le développement personnel et professionnel des étudiants qui se définissent comme LGBTQ+

PHIBSS fibs : a SCUBA2 followup of z ~ 2.5, gas-rich, star forming galaxies

vii, 69 leaves : ill., chiefly col. ; 29 cm.Includes abstract.Includes bibliographical references (leaves 61-69).Emissions from high redshift (i.e. z ~ 2.5), star forming galaxies provide a unique window into the state the universe at earlier epochs, and how these galaxies evolve over time. Accurate studies of these galaxies, however, require the ability to distinguish between different types of objects. The Institut de Radioastronomie Millimétrique Plateau de Bure High-z Blue Sequence Survey (Tacconi et al. 2010) aims to understand the gas content in massive, star forming galaxies. To date, H[alpha] and ultraviolet emission, along with CO(3-2) emission were used to derive star formation rates, and estimate gas masses respectively. This thesis focuses on the high redshift sample of these galaxies and uses far-infrared emission to learn more about the interstellar medium and star formation rates of these objects. Results show, however, that 23% of these galaxies are not what they seem. Two of the objects appear to be submillimetre galaxies, and two likely host active galactic nuclei

Self-monitoring of Blood Glucose in Black Caribbean and South Asian Canadians with Non-insulin Treated Type 2 Diabetes Mellitus: A Qualitative Study of Patients’ Perspectives.

Abstract Background:To examine the views and current practice of SMBG among Black Caribbean and South Asian individuals with non-insulin treated Type 2 diabetes mellitus. Methods: Twelve participants completed semi-structured interviews that were guided by the Health Belief Model and analyzed using thematic network analysis. Results: The frequency of monitoring among participants varied from several times a day to once per week. Most participants expressed similar experiences regarding their views and practices of SMBG. Minor differences across gender and culture were observed. All participants understood the benefits, but not all viewed SMBG as beneficialto their personal diabetes management. SMBG can facilitate a better understanding and maintenance of self-care behaviours. However, it can trigger both positive and negative emotional responses, such as a sense of disappointment when high readings are not anticipated, resulting in emotional distress. Health care professionals play a key role in the way SMBG is perceived and used by patients. Conclusion:While the majority of participants value SMBG as a self-management tool, barriers exist that impede its practice, particularly its cost. How individuals cope with these barriers is integral to understanding why some patients adopt SMBG more than others

Can Nitrogen-13 Ammonia Kinetic Modeling Define Myocardial Viability Independent of Fluorine-18 Fluorodeoxyglucose?

AbstractObjectives. The hypothesis of this study was that evaluation of myocardial flow and metabolism using nitrogen-13 (N-13) ammonia kinetic modeling with dynamic positron emission tomographic (PET) imaging could identify regions of myocardial scar and viable myocardium as defined by fluorine-18 fluorodeoxyglucose (F-18 FDG) PET.Background. Uptake of most perfusion tracers depends on both perfusion and metabolic retention in tissue. This characteristic has limited their ability to differentiate myocardial scar from viable tissue. The kinetic modeling of N-13 ammonia permits quantification of blood flow and separation of the metabolic component of its uptake, which may permit differentiation of scar from viable tissue.Methods. Sixteen patients, >3 months after myocardial infarction, underwent dynamic N-13 ammonia and F-18 FDG PET imaging. Regions of reduced and normal perfusion were defined on static N-13 ammonia images. Patients were classified into two groups (group I [ischemic viable], n = 6; group II [scar], n = 10) on the basis of percent of maximal F-18 FDG uptake in hypoperfused segments. Nitrogen-13 ammonia kinetic modeling was applied to dynamic PET data, and rate constants were determined. Flow was defined by K1; volume of distribution (VD = K1/k2) of N-13 ammonia was used as an indirect indication of metabolic retention.Results. Fluorine-18 FDG uptake was reduced in patients with scar compared with normal patients with ischemic viable zones (ischemic viable 93 ± 27% [mean ± SD]; scar 37 ± 16%, p ≤ 0.01). Using N-13 ammonia kinetic modeling, flow and VD were reduced in the hypoperfused regions of patients with scar (ischemic viable flow: 0.65 ± 0.20 ml/min per g; scar: 0.36 ± 0.16 ml/min per g, p ≤ 0.01; VD: 3.9 ± 1.3 and 2.0 ± 1.07 ml/g, respectively, p ≤ 0.01). For detection of viable myocardium in these patients, the sensitivity and specificity were 100% and 80% for N-13 ammonia PET flow >0.45 ml/min per g; 100% and 70% for VD >2.0 ml/g; and 100% and 90% for both flow > 0.45 ml/min per g and VD > 2.0 ml/g, respectively. The positive and negative predictive values for the latter approach were 86% and 100%, respectively.Conclusions. In this cohort, patients having regions with flow ≤0.45 ml/min per g or VD ≤ 2.0 ml/g had scar. Viable myocardium had both flow >0.45 ml/min per g and VD > 2.0 ml/g. Nitrogen-13 ammonia kinetic modeling permits determination of blood flow and metabolic integrity in patients with previous myocardial infarction and can help differentiate between scar and ischemic but viable myocardium.(J Am Coll Cardiol 1997;29:537–43

Chronic AMPK activity dysregulation produces myocardial insulin resistance in the human Arg302Gln-PRKAG2 glycogen storage disease mouse model

BACKGROUND: The cardiac PRKAG2 mutation in the γ2-subunit of adenosine monophosphate activated kinase (AMPK) is characterized by excessive glycogen deposition, hypertrophy, frequent arrhythmias, and progressive conduction system disease. We investigated whether myocardial glucose uptake (MGU) was augmented following insulin stimulation in a mouse model of the PRKAG2 cardiac syndrome. METHODS: Myocardial and skeletal muscle glucose uptake was assessed with 2-[(18)F]fluoro-2-deoxyglucose positron emission tomography imaging in n = 3 transgenic wildtype (TGwt) vs n = 7 PRKAG2 mutant (TGmut) mice at baseline and 1 week later, 30 min following acute insulin. Systolic function, cardiac glycogen stores, phospho-AMPK α, and insulin-receptor expression levels were analyzed to corroborate to the in vivo findings. RESULTS: TGmut Patlak Ki was reduced 56% at baseline compared to TGwt (0.3 ± 0.2 vs 0.7 ± 0.1, t test p = 0.01). MGU was augmented 71% in TGwt mice following acute insulin from baseline (0.7 ± 0.1 to 1.2 ± 0.2, t test p < 0.05). No change was observed in TGmut mice. As expected for this cardiac specific transgene, skeletal muscle was unaffected at baseline with a 33% to 38% increase (standard uptake values) for both genotypes following insulin stimulation. TGmut mice had a 47% reduction in systolic function with a fourfold increase in cardiac glycogen stores correlated with a 29% reduction in phospho-AMPK α levels. There was no difference in cardiac insulin receptor expression between mouse genotypes. CONCLUSIONS: These results demonstrate a correlation between insulin resistance and AMPK activity and provide the basis for the use of this animal model for assessing metabolic therapy in the treatment of affected PRKAG2 patients

Self-monitoring of blood glucose in Black Caribbean and South Asian Canadians with non-insulin treated Type 2 diabetes mellitus: a qualitative study of patients' perspectives

Background: To examine the views and current practice of SMBG among Black Caribbean and South Asian individuals with non-insulin treated Type 2 diabetes mellitus. Methods: Twelve participants completed semi-structured interviews that were guided by the Health Belief Model and analyzed using thematic network analysis. Results: The frequency of monitoring among participants varied from several times a day to once per week. Most participants expressed similar experiences regarding their views and practices of SMBG. Minor differences across gender and culture were observed. All participants understood the benefits, but not all viewed SMBG as beneficial to their personal diabetes management. SMBG can facilitate a better understanding and maintenance of self-care behaviours. However, it can trigger both positive and negative emotional responses, such as a sense of disappointment when high readings are not anticipated, resulting in emotional distress. Health care professionals play a key role in the way SMBG is perceived and used by patients. Conclusion: While the majority of participants value SMBG as a self-management tool, barriers exist that impede its practice, particularly its cost. How individuals cope with these barriers is integral to understanding why some patients adopt SMBG more than others