Navigating the second-year landscape:How student nurses construct an identity and engage with knowledge in the second year of an undergraduate degree

This thesis focuses on the second year of the undergraduate degree in nursing and how student nurses navigate the contexts of both higher education (HE) and clinical practice environments. In recent years there has been an increasing interest in the second year of study, however most studies have focused on academic grades and performance and the HE environment, with a general lack of research in nurse education and the clinical learning environment. Using a qualitative longitudinal design and a sample of eleven pre-registration nurses who were enrolled in one higher education institution (HEI) in the United Kingdom (UK), data were generated and analysed at three points during the students second year of study. A constructivist grounded theory methodology informed the study, enabling an examination of the social learning environments students engage with and the contextualised processes involved. Data analysis uncovered two identifiable processes: constructing a nursing identity and engaging with knowledge, and these were further examined using two theoretical perspectives. Firstly, symbolic interactionism which helped explain how students act in different situations and why, based on the meanings they ascribe to those situations; secondly social realism which enabled an exploration of the social conditions underpinning knowledge and how knowledge is structured in the curriculum and pedagogic practices. The outcomes of the study indicate a second-year experience whereby students are required to negotiate a landscape in which identity and knowledge are: ingrained in disciplinary situated practices; influenced and constrained by context; shaped by common understandings and expectations embedded in learning environments; and conveyed in implicit and explicit discourses. The study contributes to knowledge by providing an insight into how students experience the second-year journey, how they transition between different learning contexts and the symbolic resources they utilise to make sense of different situations

Transitions of Care: Medication-Related Barriers Identified by Low Socioeconomic Patients of a Federally Qualified Health Center Following Hospital Discharge

This article describes a qualitative research study using a semi-structured interview process to describe barriers surrounding medication access, use, and adherence for recently discharged patients of a federally qualified health center. Common themes which emerged were: 1) Team assumptions regarding patient plans to access or appropriately use discharge medications negatively impact adherence; 2) Unmet expectation for care coordination between primary care physician (PCP) and hospital; 3) Disconnect between patients and health care workers leads to disengagement; and 4) Lack of personal contact hinders access to services

The Stroke Hyperglycemia Insulin Network Effort (SHINE) trial: an adaptive trial design case study

Background: The \u27Adaptive Designs Accelerating Promising Trials into Treatments (ADAPT-IT)\u27 project is a collaborative effort supported by the National Institutes of Health (NIH) and United States Food & Drug Administration (FDA) to explore how adaptive clinical trial design might improve the evaluation of drugs and medical devices. ADAPT-IT uses the National Institute of Neurologic Disorders & Stroke-supported Neurological Emergencies Treatment Trials (NETT) network as a \u27laboratory\u27 in which to study the development of adaptive clinical trial designs in the confirmatory setting. The Stroke Hyperglycemia Insulin Network Effort (SHINE) trial was selected for funding by the NIH-NINDS at the start of ADAPT-IT and is currently an ongoing phase III trial of tight glucose control in hyperglycemic acute ischemic stroke patients. Within ADAPT-IT, a Bayesian adaptive Goldilocks trial design alternative was developed. Methods: The SHINE design includes response adaptive randomization, a sample size re-estimation, and monitoring for early efficacy and futility according to a group sequential design. The Goldilocks design includes more frequent monitoring for predicted success or futility and a longitudinal model of the primary endpoint. Both trial designs were simulated and compared in terms of their mean sample size and power across a range of treatment effects and success rates for the control group. Results: As simulated, the SHINE design tends to have slightly higher power and the Goldilocks design has a lower mean sample size. Both designs were tuned to have approximately 80% power to detect a difference of 25% versus 32% between control and treatment, respectively. In this scenario, mean sample sizes are 1,114 and 979 for the SHINE and Goldilocks designs, respectively. Conclusions: Two designs were brought forward, and both were evaluated, revised, and improved based on the input of all parties involved in the ADAPT-IT process. However, the SHINE investigators were tasked with choosing only a single design to implement and ultimately elected not to implement the Goldilocks design. The Goldilocks design will be retrospectively executed upon completion of SHINE to later compare the designs based on their use of patient resources, time, and conclusions in a real world setting

An Australian longitudinal pilot study examining health determinants of cardiac outcomes 12 months post percutaneous coronary intervention

Background Percutaneous coronary intervention (PCI) is a very common revascularisation procedure for coronary artery disease (CAD). The purpose of this study was to evaluate cardiac outcomes, health related quality of life (HRQoL), resilience and adherence behaviours in patients who have undergone a PCI at two time points (6 and 12 months) following their procedure. Methods A longitudinal pilot study was conducted to observe the cardiac outcomes across a cohort of patients who had undergone a percutaneous coronary intervention (PCI). Participants who had undergone PCI 6 months prior were invited. Those participants who met the inclusion criteria and provided consent then completed a telephone survey (time point 1). These participants were then contacted 6 months later (i.e. 12 months post-intervention, time point 2) and the measures were repeated. Results All patients (n = 51) were recorded as being alive at time point 1. The multiple model indicated that controlling for other factors, gender was significantly associated with a linear combination of outcome measures (p = 0.004). The effect was moderate in magnitude (partial-η2 = 0.303), where males performed significantly better than females 6 months after the PCI procedure physically and with mood. Follow-up univariate ANOVAs indicated that gender differences were grounded in the scale measuring depression (PHQ9) (p = 0.005) and the physical component score of the short form measuring HRQoL (SF12-PCS) (p = 0.003). Thirteen patients were lost to follow-up between time points 1 and 2. One patient was confirmed to have passed away. The pattern of correlations between outcome measures at time point 2 revealed statistically significant negative correlation between the PHQ instrument and the resilience scale (CD-RISC) (r = -0.611; p < 0.001); and the physical component score of the SF-12 instrument (r = -0.437; p = 0.054). Conclusions Men were performing better than women in the 6 months post-PCI, particularly in the areas of mood (depression) and physical health. This pilot results indicate gender-sensitive practices are recommended particularly up to 6 months post-PCI. Any gender differences observed at 6 month appear to disappear at 12 months post-PCI. Further research into the management of mood particularly for women post-PCI is warranted. A more detailed inquiry related to access/attendance to secondary prevention is also warranted

Vocational higher education - does it meet employers’ needs?

This report is the outcome of a study funded by the Learning and Skills Council, the Department for Education and Skills, the Higher Education Funding Council for England and the Council for Industry and Higher Education. The study was undertaken at a time when government policies for higher education included a new ‘push’ towards work-related higher education, and educational policies more generally were seeking to redress the balance between academic and vocational qualifications at various levels within the compulsory and post-compulsory education and training systems in England. One part of the study re-analysed existing data sources to explore the size and nature of vocational higher education provision in England. The main part of the study was an exploration of employers’ views (in a limited number of employment sectors) on the value of vocational higher education for recruitment and workforce development purposes. To complement the ‘employer view’ a limited investigation of the ‘direct consumer’ view (i.e. students on vocational higher education programmes) was also undertaken. The report highlights a series of key issues for policymakers, and also makes recommendations for improvements to data collection

Species-wide Whole Genome Sequencing Reveals Historical Global Spread And Recent Local Persistence In Shigella Flexneri

Shigella flexneri is the most common cause of bacterial dysentery in low-income countries. Despite this, S. flexneri remains largely unexplored from a genomic standpoint and is still described using a vocabulary based on serotyping reactions developed over half-a-century ago. Here we combine whole genome sequencing with geographical and temporal data to examine the natural history of the species. Our analysis subdivides S. flexneri into seven phylogenetic groups (PGs); each containing two-or-more serotypes and characterised by distinct virulence gene complement and geographic range. Within the S. flexneri PGs we identify geographically restricted sub-lineages that appear to have persistently colonised regions for many decades to over 100 years. Although we found abundant evidence of antimicrobial resistance (AMR) determinant acquisition, our dataset shows no evidence of subsequent intercontinental spread of antimicrobial resistant strains. The pattern of colonisation and AMR gene acquisition suggest that S. flexneri has a distinct life-cycle involving local persistence. DOI: 10.7554/eLife.07335.0014Wellcome Trust [098051]Wellcome Trust/NISCHR ISSF project at Cardiff UniversityMRC [MR/L015080/1]Cardiff University - Cardiff University Research Infrastructure Fund)Institut PasteurInstitut de Veille SanitaireFrench Government 'Investissement d'Avenir' program (Integrative Biology of Emerging Infectious Diseases Laboratory of Excellence) [ANR-10-LABX-62-IBEID

Healthy-Eater Self-Schema and Dietary Intake

The types and amounts of foods consumed have been shown to influence the health risks of individuals. Empirical evidence has documented a link between high dietary fat and low fiber intake and the risks for cardiovascular disease, some types of cancer, and obesity. Dietary surveys of Americans show higher fat and lower fiber intake than stipulated in the Dietary Guidelines for Americans, despite the noted increase in public awareness regarding the importance of adopting healthy eating habits. The lack of congruence between the availability of dietary knowledge and behavioral adherence to dietary recommendations suggests a need to further understand the predictors of dietary intake. In this study, the authors used the schema model of the self-concept to explore the role of self-beliefs in predicting dietary intake in community-dwelling, working-class, middle-aged adults.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66463/1/Healthy-Eater Self-Schema and Dietary Intake.pd