Development of a Framework to Facilitate a Collaborative Peer Learning 2:1 Model of Practice Placement Education

Aim: The educational approach towards practice placement education in health-related disciplines has changed in recent years. The use of collaborative or peer learning models has increased, associated with positive effects on desired outcomes such as learning, competence and reflective practice. At present, there is little published literature on the implementation or use of such models in dietetics practice placement education. The aim of this study was to conduct a pilot study of a collaborative peer learning 2 students to 1 educator (2:1 model). Methods: Experienced practice placement educators from four clinical sites in the discipline of dietetics in the Republic of Ireland were invited to participate in the study and form an advisory group. Feedback from this group was used to inform the design and development of a framework to guide the wider implementation of the 2:1 model. Results: Feedback from the pilot study was largely positive, with all four sites willing to facilitate a 2:1 model again. The main recommendation was that the practice placement educators require more practical information on the implementation of a 2:1 model, particularly the facilitation of the peer feedback process. In response to this feedback, the Lynam framework was designed, which is the focus of this paper. Conclusions: This pilot study of a 2:1 model in dietetics practice placement education informed the design and development of a framework for implementation of the model. Further research into the use of the 2:1 model for practice placement education and the effectiveness of the Lynam framework to guide the implementation of this model is required

Getting better at Knowledge Management: Integrating individual skills and organisational capability.

This paper arises from a work in progress academia/industry collaborative research project to develop a Knowledge Management (KM) maturity model as a component (critical capability) of the IT Capability Maturity Framework (IT-CMF). KM is understood as an organisational capability i.e. the effective mobilising of the resources of people, processes and technology to support the achievement of an organisation’s objectives. The research questions addressed are as follows: what are the challenges for organizations in developing an effective KM capability?; what are the respective roles of individual skills and organisational capability in developing a KM capability?; how can individual skills and organizational KM capability be integrated to help organisations get better at doing KM? The key finding is that an important challenge for KM in terms of developing capability is the potential for processes and technology to both enable and block how well people manage knowledge. The role of learning is important and the link between individual learnings and organisational capability is key, but challenging to manage. Initial data indicates that combining a skills-based approach with an organisational capability approach might be a helpful practice for organisations and some suggestions are provided on how to synthesise this challenging field into tools and guidelines that practitioners can use

Lateral Variation in Crustal Structure along the Lesser Antilles Arc from Petrology of Crustal Xenoliths and Seismic Receiver Functions

We reconstruct crustal structure along the Lesser Antilles island arc using an inversion approach combining constraints from petrology of magmatic crustal xenoliths and seismic receiver functions. Xenoliths show considerable island-to-island variation in xenolith petrology from plagioclase-free ultramafic lithologies to gabbros and gabbronorites with variable proportions of amphibole, indicative of changing magma differentiation depths. Xenoliths represent predominantly cumulate compositions with equilibration depths in the range 5 to 40 km. We use xenolith mineral modes and compositions to calculate seismic velocities () and density at the estimated equilibration depths. We create a five-layer model of crustal structure for testing against receiver functions (RF) from island seismic stations along the arc. Lowermost layer (5) comprises peridotite with physical characteristics of mantle xenoliths from Grenada. Uppermost layer (1) consists of 5 km of volcaniclastics and sediments, whose physical properties are determined via a grid inversion routine. The three middle layers (2) to (4) comprise igneous arc crust with compositions corresponding to the xenoliths sampled at each island. By inversion we obtain a petrological best-fit for the RF on each island to establish the nature and thicknesses of layers (2) to (4). Along the arc we see variations in the depth and strength of both Moho and mid-crustal discontinuity (MCD) on length-scales of tens of km. Moho depths vary from 25 to 37 km; MCD from 11 and 32 km. The Moho is the dominant discontinuity beneath some islands (St. Kitts, Guadeloupe, Martinique, Grenada), whereas the MCD dominates beneath others (Saba, St. Eustatius). Along-arc variability in MCD depth and strength is consistent with variation in estimated magmatic H2O contents and differentiations depths that, in turn, influence xenolith lithologies. A striking feature is steep, along-arc gradients in similar to those observed at other oceanic arcs. These gradients reflect abrupt changes in rates and processes of magma generation in the underlying crust and mantle. We find no evidence for large, interconnected bodies of partial melt beneath the Lesser Antilles. Instead, the crustal velocity structure is consistent with magma differentiation in vertically-extensive, crystal mush-dominated reservoirs. Along-arc variation in crustal structure may reflect heterogeneous upwelling within the mantle wedge, itself driven by variation in slab-derived H2O fluxes.This work was supported by Natural Environment Research Council grants NE/N001966/1, NE/K004883/1, NE/K014978/1 and NE/K010824/1 and ERC Advanced Grant CRITMAG (Blundy

Life interrupted and life regained? Coping with stroke at a young age

Stroke is a leading cause of disability across the developed world, affecting an increasing number of younger people. In this article, we seek to understand the experience of stroke as a disabling life situation among young people and the strategies that they use to recover and cope. Directed content analysis was conducted from interviews with 17 community-dwelling stroke survivors aged 55 years and younger across the United Kingdom. The sample was drawn from a larger maximum variation sample of stroke survivors. Using the sociological concepts of biographical disruption and biographical repair as a guide, excerpts from the interviews pertaining to aspects of the patients’ life that were interrupted, in addition to how they coped with the changes, were selected and analysed. All individuals described an ‘‘altered sense of self,’’ a theme that included loss of identity, family disruption, and/or loss of valued activities. Individuals sought to adapt their sense of self by seeking external support, by restoring normality, and/or through positive reflection. Despite the adapted self that emerged, most individuals continued to experience impairments. While young stroke survivors adapt to their illness over time, they continue to experience impairments and disruptions in their personal and work lives.Aholistic model of rehabilitation that helps individuals regain the capacity for everyday activities related to work, family life, and leisure can begin to address the emotional ramifications of diseases such as stroke, restore wellness, and work towards minimizing the burden felt by family caregivers and children

Life interrupted and life regained? Coping with stroke at a young age

Stroke is a leading cause of disability across the developed world, affecting an increasing number of younger people. In this article, we seek to understand the experience of stroke as a disabling life situation among young people and the strategies that they use to recover and cope. Directed content analysis was conducted from interviews with 17 community-dwelling stroke survivors aged 55 years and younger across the United Kingdom. The sample was drawn from a larger maximum variation sample of stroke survivors. Using the sociological concepts of biographical disruption and biographical repair as a guide, excerpts from the interviews pertaining to aspects of the patients’ life that were interrupted, in addition to how they coped with the changes, were selected and analysed. All individuals described an ‘‘altered sense of self,’’ a theme that included loss of identity, family disruption, and/or loss of valued activities. Individuals sought to adapt their sense of self by seeking external support, by restoring normality, and/or through positive reflection. Despite the adapted self that emerged, most individuals continued to experience impairments. While young stroke survivors adapt to their illness over time, they continue to experience impairments and disruptions in their personal and work lives.Aholistic model of rehabilitation that helps individuals regain the capacity for everyday activities related to work, family life, and leisure can begin to address the emotional ramifications of diseases such as stroke, restore wellness, and work towards minimizing the burden felt by family caregivers and children

Equity and the financial costs of informal caregiving in palliative care: a critical debate.

BACKGROUND: Informal caregivers represent the foundation of the palliative care workforce and are the main providers of end of life care. Financial pressures are among the most serious concerns for many carers and the financial burden of end of life caregiving can be substantial. METHODS: The aim of this critical debate paper was to review and critique some of the key evidence on the financial costs of informal caregiving and describe how these costs represent an equity issue in palliative care. RESULTS: The financial costs of informal caregiving at the end of life can be significant and include carer time costs, out of pocket costs and employment related costs. Financial burden is associated with a range of negative outcomes for both patient and carer. Evidence suggests that the financial costs of caring are not distributed equitably. Sources of inequity are reflective of those influencing access to specialist palliative care and include diagnosis (cancer vs non-cancer), socio-economic status, gender, cultural and ethnic identity, and employment status. Effects of intersectionality and the cumulative effect of multiple risk factors are also a consideration. CONCLUSIONS: Various groups of informal end of life carers are systematically disadvantaged financially. Addressing these, and other, determinants of end of life care is central to a public health approach to palliative care that fully recognises the value of carers. Further research exploring these areas of inequity in more depth and gaining a more detailed understanding of what influences financial burden is required to take the next steps towards meeting this aspiration. We will address the conclusions and recommendations we have made in this paper through the work of our recently established European Association of Palliative Care (EAPC) Taskforce on the financial costs of family caregiving

The survival benefit associated with complete macroscopic resection in epithelial ovarian cancer is histotype-specific

Background: Complete macroscopic resection (CMR) is a key factor associated with prolonged survival in ovarian cancer. However, most evidence derives from high grade serous ovarian carcinoma (HGSOC), and the benefit of CMR in other histotypes is poorly characterised. We sought to determine which histotypes derive the greatest benefit from CMR to better inform future decisions on radical cytoreductive efforts. Methods: We performed multivariable analysis of disease-specific survival (DSS) across two independent patient cohorts to determine the magnitude of benefit associated with CMR within each histotype. Results: Across both cohorts (Scottish, n=1622; SEER, n=18947), CMR was associated with prolonged DSS; this was more marked in the Scottish cohort (multivariable HR 0.44, 95%CI 0.37-0.52 vs 0.59, 95%CI 0.57-0.62 in SEER). In both cohorts, clear cell ovarian carcinoma (CCOC) was among the histotypes to benefit most from CMR (multivariable HR 0.23 and 0.50 in Scottish and SEER cohorts); HGSOC cases demonstrated highly significant and clinically meaningful survival benefit, but this was of lower magnitude than in CCOC and endometrioid ovarian carcinoma (EnOC) across both cohorts. The benefit derived in low grade serous ovarian carcinoma is also high (multivariable HR 0.27 in Scottish cohort). CMR was associated with prolonged survival in mucinous ovarian carcinoma (MOC) patients in the SEER cohort (multivariable HR 0.65), but the associated failed to reach statistical significance in the Scottish cohort. Conclusions: The overall ovarian cancer patient population demonstrates significant survival benefit associated with CMR; however, the magnitude of benefit differs between histotypes. <br/

Reply to Lipworth et al.

We thank Dr. Lipworth and colleagues for their interest in our work published recently in the Journal (1). They rightly point out that the biology of asthma attacks is more complex than blood eosinophils alone and that corticosteroids have a wide range of other potentially relevant antiinflammatory effects. However, local treatment with inhaled corticosteroids (ICS) is usually the mainstay of patients with frequent eosinophilic exacerbations, and therefore in the great majority of patients, the key question is what oral corticosteroids (OCS) add to ICS in an acute attack (2) and whether this effect is seen with benralizumab. We suggest that depletion of circulating eosinophils is the only effect OCS are likely to have that are not shared with ICS (3)