A person-centred enquiry into the experiences of teaching and learning reflection and reflective practice in pre and post-registration mental health nurse training

Reflection and reflective practice has become a key issue for curriculum development within nurse education, particularly mental health nursing. The Nursing and Midwifery Council have linked the demonstration of reflective skills to clinical competence to gain entrance onto the professional register. However, despite a significant volume of literature on reflection there is a paucity of research evidence regarding how nurse educators teach mental health nursing students to reflect and become effective reflective practitioners and, little research exploring experiences of staff and students engaged in reflection for teaching and learning purposes. A person-centred enquiry was undertaken to explore staff and student perceptions and understanding of reflection in the context of the undergraduate pre- and post-registration mental health nursing diploma programme, utilising a framework involving four focus groups and conducted in the university setting. Findings indicated that participants’ definitions were congruent with the literature on reflection. However, it was evident that students were uncertain as to how to reflect on their practice and this was attributed (by students) to a lack of appropriate teaching, whilst staff felt that they lacked the appropriate context within which to teach skills of reflection. A new model and extended description of effective reflection is offered together with some non-prescriptive recommendations aimed at enhancing teaching practice

Systematic versus opportunistic risk assessment for the primary prevention of cardiovascular disease

Background Screening programmes can potentially identify people at high cardiovascular risk and reduce cardiovascular disease (CVD) morbidity and mortality. However, there is currently not enough evidence showing clear clinical or economic benefits of systematic screening-like programmes over the widely practised opportunistic risk assessment of CVD in primary care settings. Objectives The primary objective of this review was to assess the effectiveness, costs and adverse effects of systematic risk assessment compared to opportunistic risk assessment for the primary prevention of CVD. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on the Cochrane Library, MEDLINE, EMBASE on 30 January 2015, and Web of Science Core Collection and additional databases on the Cochrane Library on 4 December 2014. We also searched two clinical trial registers and checked reference lists of relevant articles. We applied no language restrictions. Selection criteria We selected randomised controlled trials (RCTs) that assessed the effects of systematic risk assessment, defined as a screening-like programme involving a predetermined selection process of people, compared with opportunistic risk assessment which ranged from no risk assessment at all to incentivised case finding of CVD and related risk factors. Participants included healthy adults from the general population, including those who are at risk of CVD. Data collection and analysis Two review authors independently selected studies. One review author extracted data and assessed them for risk of bias and a second checked them. We assessed evidence quality using the GRADE approach and present this in a ’Summary of findings’ table. Main results Nine completed RCTs met the inclusion criteria, of which four were cluster-randomised. We also identified five ongoing trials. The included studies had a high or unclear risk of bias, and the GRADE ratings of overall quality were low or very low. The length of follow-up varied from one year in four studies, three years in one study, five or six years in two studies, and ten years in two studies. Eight studies recruited participants from the general population, although there were differences in the age ranges targeted. One study recruited family members of cardiac patients (high risk assessment). There were considerable differences between the studies in the interventions received by the intervention and control groups. There was insufficient evidence to stratify by the types of risk assessment approaches. Limited data were available on all-cause mortality (risk ratio (RR) 0.97, 95% confidence interval (CI) 0.92 to 1.02; 3 studies,103,571 participants, I² = 0%; low-quality evidence) and cardiovascular mortality (RR 1.00, 95% CI 0.90 to 1.11; 2 studies, 43,955 participants, I² = 0%), and suggest that screening has no effect on these outcomes. Data were also limited for combined non-fatal endpoints; overall, evidence indicates no difference in total coronary heart disease (RR 1.01, 95% CI 0.95 to 1.07; 4 studies, 5 comparisons, 110,168 participants, I² = 0%; low-quality evidence), non-fatal coronary heart disease (RR 0.98, 95% CI 0.89 to 1.09; 2 studies, 43,955 participants, I² = 39%), total stroke (RR 0.99, 95% CI 0.90 to 1.10; 2 studies, 79,631 participants, I² = 0%, low-quality evidence), and non-fatal stroke (RR 1.17, 95% CI 0.94 to 1.47; 1 study, 20,015 participants). Overall, systematic risk assessment appears to result in lower total cholesterol levels (mean difference (MD) -0.11 mmol/l, 95% CI -0.17 to -0.04, 6 studies, 7 comparisons, 12,591 participants, I² = 57%; very low-quality evidence), lower systolic blood pressure (MD -3.05 mmHg, 95% CI -4.84 to -1.25, 6 studies, 7 comparisons, 12,591 participants, I² = 82%; very low-quality evidence) and lower diastolic blood pressure (MD -1.34 mmHg, 95% CI -1.76 to -0.93, 6 studies, 7 comparisons, 12,591 participants, I² = 0%; low-quality evidence). One study assessed adverse effects and found no difference in psychological distress at five years (1126 participants). Authors' conclusions The results are limited by the heterogeneity between trials in terms of participants recruited, interventions and duration of follow-up. Limited data suggest that systematic risk assessment for CVD has no statistically significant effects on clinical endpoints. There is limited evidence to suggest that CVD systematic risk assessment may have some favourable effects on cardiovascular risk factors. The completion of the five ongoing trials will add to the evidence base

Morphine-induced modification of quinine palatability: Effects of multiple morphine-quinine trials

Contemporary research investigating the effects of opiate receptor agonists and antagonists indicates a role for endorphinergic mechanisms in the control of consummatory behaviours. One way in which opiates may exert an effect on feeding is by altering the hedonic properties or palatability of food and drink. Investigations of the role of palatability in the effect of opiates on feeding and drinking have primarily considered the effect of single exposures to opiates. Recognizing that chronic exposure to opiates may result in the development of tolerance to their palatability-altering properties, the taste reactivity test, a direct measure of the hedonic properties of a tastant, was used to assess the ability of morphine to modify the palatability of a bitter quinine solution across eight conditioning trials (Experiment 1). Morphine consistently reduced aversive reactions to the quinine solution across all eight conditioning trials, but tolerance did not develop to this effect. In tests for conditioned modification of quinine palatability, administered after the third and the eighth conditioning trial, quinine elicited conditioned attenuation of aversive reactions in the Contingent, but not in the Noncontingent group. Hence, there was evidence of drug-similar conditioned responses suggesting that an association had been established between the effect of morphine on palatability, and the taste of quinine. In order to determine how rapidly this association was established, a second experiment was conducted whereby subjects received a single injection of morphine 30 min prior to a 10 min infusion of quinine. The results of this experiment indicated that a single exposure is insufficient for the formation of an association between the effect of morphine on palatability, and the taste of quinine. In summary, therefore, tolerance did not develop to the ability of morphine to attenuate aversive reactions to the taste of quinine. Furthermore, quinine elicited conditioned attenuation of aversive reactions when assessed during drug-free tests, suggesting that the palatability of quinine was conditionally altered in a positive direction following its association with morphine

Power, politics and professional contracts: an exploration of parenting in elite youth football

The purpose of this research was to explore the phenomenon of parenting in English elite youth football and provide a rich, detailed description and nuanced interpretation of parenting in this highly challenging and competitive culture. The research positioned parenting in youth sport as a dynamic, culturally-situated process, constituted through interaction with significant others. This allowed for an in-depth understanding of how parenting was experienced in elite youth football that included children s accounts of their interaction with parents. Using a phenomenological methodology, research was undertaken in three English professional football clubs to explore how parenting in elite youth football was experienced as lived. Parents of players registered to an elite youth football academy, players aged between 8 and 17 years and academy coaches participated in interviews. Participant observation was used to complement interview data. Embracing multi-perspectivalism (Kellner, 1995), multiple qualitative analytical techniques were used to explore data from different epistemological perspectives, providing sensitivity to the variation and subtlety of participants experiences. The findings from four empirical, qualitative research studies are presented. Firstly, an exploration of the experience of being a parent of an elite youth footballer described how parents were socialised into the academy culture, and experienced a change in identity and a heightened sense of responsibility to facilitate their child s football development. Secondly, an examination of elite youth footballers experience of interaction with their parents demonstrated how players experienced their body as an object to be scrutinised and assessed when watched by parents, experienced conflict with parents from within a power relation, and ascribed meaning to their interaction with parents in relation to their goal of becoming a successful academy footballer. Thirdly, an idiographic analysis of parents and players individual and dyadic experiences of parent-player interactions highlighted how relationships were constituted by; relations with other family members; an embodied sense of closeness; the temporal significance of football transitions; and gender and power relations. Finally, an analysis of coaches accounts of the parent-coach relationship in elite youth football demonstrated how parent-coach interactions occurred within an imbalanced power relation, which centred on establishing the rights to be responsible for player development. Together, these findings present a complex picture of parenting in elite youth football, as an embodied, temporal and culturally-situated experience, constituted through interaction and power relations between parents, players, coaches and academies. This research highlights the importance of conceptualising parenting in youth sport as a social, culturally-embedded process and supports the need to include children in research about issues that affect them. Extending this further, adopting a theoretical perspective that allows for the contextual power relations to be examined can further enhance understanding of parenting in youth sport. Finally, this research recommends that listening to and valuing the experiences of participants in the elite youth football culture, alongside open discussion and critical reflection upon academy practices, may have the greatest potential for enhancing the experiences of parents, players and coaches

Angiotensin-Converting Enzyme 2: The First Decade

The renin-angiotensin system (RAS) is a critical regulator of hypertension, primarily through the actions of the vasoactive peptide Ang II, which is generated by the action of angiotensin-converting enzyme (ACE) mediating an increase in blood pressure. The discovery of ACE2, which primarily metabolises Ang II into the vasodilatory Ang-(1-7), has added a new dimension to the traditional RAS. As a result there has been huge interest in ACE2 over the past decade as a potential therapeutic for lowering blood pressure, especially elevation resulting from excess Ang II. Studies focusing on ACE2 have helped to reveal other actions of Ang-(1-7), outside vasodilation, such as antifibrotic and antiproliferative effects. Moreover, investigations focusing on ACE2 have revealed a variety of roles not just catalytic but also as a viral receptor and amino acid transporter. This paper focuses on what is known about ACE2 and its biological roles, paying particular attention to the regulation of ACE2 expression. In light of the entrance of human recombinant ACE2 into clinical trials, we discuss the potential use of ACE2 as a therapeutic and highlight some pertinent questions that still remain unanswered about ACE2

Towards a Formal Verification Methodology for Collective Robotic Systems

We introduce a UML-based notation for graphically modeling systems’ security aspects in a simple and intuitive way and a model-driven process that transforms graphical specifications of access control policies in XACML. These XACML policies are then translated in FACPL, a policy language with a formal semantics, and the resulting policies are evaluated by means of a Java-based software tool

Comparing the Gut Flora of Irish Breastfed and Formula-fed Neonates Aged Between Birth and 6 Weeks Old

The exact composition of the complex microsystem that constitutes the gut flora continues to be explored as molecular methodology supplements traditional microbiological studies. The current study reports a random analysis of the faecal flora composition for 31 neonates in the 0–1 day age group, 41 neonates aged 2–5 days and 33 6-week-old neonates. All infants, born at the National Maternity Hospital, Ireland, were considered healthy, full-term normal deliveries and were either exclusively breastfed or formula-fed from birth. Microbiological and biochemical analyses of the faecal samples were used to specifically enumerate Lactobacillus spp., Bifidobacterium spp., Enterococcus spp., Staphylococcus spp., Bacteroides spp., Clostridium spp. and coliforms present in the gut. The results were analysed for the presence, prevalence and dominance of each of the species. In general, there were no major statistical variations in the findings for the two feeding regimes. However, Escherichia coli was found to be more dominant (p=0.042) in the gut flora of 6-week-old formula-fed neonates, while there was a tendency for Bifidobacterium spp. to be more prevalent in the gut flora of breastfed neonates at 2–5 days (p=0.108)

Systematic versus opportunistic risk assessment for the primary prevention of cardiovascular disease: Cochrane systematic review protocol

A large number of people, considered at increased risk of vascular disease, remainunidentified, untreated and not reached by lifestyle advice or intervention, despite publichealth and clinical efforts. This has prompted the initiation of national  screening/systematic risk assessment programmes for vascular disease in healthy populations. These exist in addition to the more ad hoc opportunistic risk assessment initiatives undertaken worldwide. There is currently not enough indisputable evidence either showing clear clinical or economic benefits of systematic screening-like programmes over opportunistic risk assessment of cardiovascular disease (CVD) in primary care. We present the rationale and methodology of a Cochrane systematic review, assessing the effectiveness, costs and adverse effects of systematic risk assessment compared to opportunistic risk assessment for the primary prevention of CVD