Embedded or Modular? Preliminary Findings From a Study of Pre-Registration Nursing EBP Teaching Delivery Methods.

Aim: This study explores the impact of teaching delivery method (embedded vs. modular) on undergraduate pre-registration nursing students’ self-reported Evidence-Based Practice (EBP) implementation, attitudes, knowledge and skills. Background: For the past 20 years EBP has been increasingly emphasised as an effective approach and goal in healthcare. Although research has identified a number of barriers to its adoption and implementation, little research has focused on nurses’ pre-registration training; particularly on the impact of teaching delivery-method EBP throughout the learning process. Method: The study represents an on-going educational audit. Two cohorts of undergraduate nursing students were recruited for a longitudinal, cross-sectional survey study: cohort one (N=57, response rate= 90.1%) were being taught EBP modularly, but cohort two (N=88, response rate= 63.8%) had EBP embedded across their modules. Data was collected using the Evidence-Based Practice Questionnaire (EBPQ; Upton & Upton, 2006), administered at six-monthly intervals across the duration of students’ courses. Results: Preliminary analysis of students’ EBP 6-months into their courses identified no statistically significant differences between the cohorts on EBP Practice (U=2,138.00, Z=-0.13, p=.894). However, statistically significant differences between the two cohorts were identified on EBP attitudes (U=1, 852.00, Z=-2.43, p=.015; embedded group Md= 5.67, modular group Md=6.33) and Knowledge/skills (U=2,802.00, Z=3.68, p<.001; embedded group Md= 4.89, modular group Md=4.29). Conclusions: Although the project is still in its infancy, preliminary findings raise important questions about the relationship between EBP attitudes, practice and skill. The embedded cohort’s lower attitude scores may reflect social-desirability effects: modules dedicated to EBP may instil greater importance of displaying positive EBP attitudes. Embedding EBP may provide an effective means of developing students’ practice, knowledge and skills, without requiring dedicated modules (thereby reducing resource demands)

The mediating role of competitive advantage in the relationship between organisational capabilities and retail performance

This paper investigates the relationships between market, learning and brand orientation with competitive advantage and organisational performance in the context of the UK retail industry. The results indicate that competitive advantage contributes to strategic effectiveness and mediates the relationship between learning and brand orientation and strategic effectiveness. No significant relationship was found in relation to financial performance. Moreover, market orientation was not found to have a significant direct effect on competitive advantage or indirect affect on performance.<br /

Skin temperature reveals the intensity of acute stress

Acute stress triggers peripheral vasoconstriction, causing a rapid, short-term drop in skin temperature in homeotherms. We tested, for the first time, whether this response has the potential to quantify stress, by exhibiting proportionality with stressor intensity. We used established behavioural and hormonal markers: activity level and corticosterone level, to validate a mild and more severe form of an acute restraint stressor in hens (Gallus gallus domesticus). We then used infrared thermography (IRT) to non-invasively collect continuous temperature measurements following exposure to these two intensities of acute handling stress. In the comb and wattle, two skin regions with a known thermoregulatory role, stressor intensity predicted the extent of initial skin cooling, and also the occurrence of a more delayed skin warming, providing two opportunities to quantify stress. With the present, cost-effective availability of IRT technology, this non-invasive and continuous method of stress assessment in unrestrained animals has the potential to become common practice in pure and applied research

A midbrain mechanism for computing escape decisions in the mouse

Animals face frequent threats from predators and must generate appropriate behavioural responses to ensure their survival. To achieve this, they process sensory cues to correctly identify the presence and imminence of a predatory threat, and transform this information into defensive actions. However, despite much research in identifying the circuits that may be responsible for such transformations, little is known about how this occurs mechanistically. We focus on how escape behaviour in the mouse is generated from visual predatory threats, and use a combination of behavioural, neurophysiological and anatomical methods to identify the relevant neurons and understand how they perform this computation. In this work, we developed an innate decision making paradigm in which a mouse detects and assesses sensory stimuli of varying threat evidence during exploration, choosing whether to escape to a shelter, or not. The performance data in this task were best formalised with a drift-diffusion model of decision making, providing a framework to understand innate behavioural tasks in terms of evidence accumulation and boundaries. Next, we performed calcium imaging in freely-moving mice to probe for neural correlates of decision elements and flight behaviour in brain areas that we show to be necessary for the flight responses: we found that VGluT2 neurons in the deeper medial superior colliculus (dmSC) increase their activity during a repeated threatening stimulus, while VGluT2 neurons of the dorsolateral periaqueductal gray (dPAG) are silent until just before the initiation of escape, and are maximally active during escape. These results suggest that the dmSC accumulates evidence of threat which dPAG neurons threshold. This interpretation is supported by optogenetic activation of mSC-VGluT2 neurons in vivo, which recapitulates the statistics of escape probability evoked with a visual stimulus, while activation of VGluT2 neurons in the dPAG evokes an all-or-nothing escape response. Finally, using channelrhodopsin-2-assisted circuit mapping and monosynaptic viral tracing, we reveal that over half of dPAG-VGluT2 neurons receive monosynaptic connections from mSC-VGluT2 neurons with a low probability of release, allowing this synapse to act as a high-pass filter and providing a mechanism for the computation of an escape decision. These findings advance our understanding of how defensive behaviours are generated at circuit and single-cell level, and of how neurons process information in a circuit critical for implementing basic behaviours

A pilot study in the application of texture relief for digitally designed facial prostheses

This pilot research aims to identify and assess suitable technologies that may be used to capture, create, and produce fine textures and wrinkles that may be incorporated into computer aided prosthesis design and production techniques. A range of suitable technologies is identified and two methods that may be used in different prosthetic rehabilitation situations are assessed: the creation of three-dimensional relief in a computer aided design environment and the capture of facial anatomy and texture using fringe-projection surface scanning. Patterns were produced using the suitable rapid prototyping processes identified, and these were assessed by a qualified and experienced prosthetist. The suitability of the technologies is commented upon, limitations discussed, and future directions identified

Additively manufactured versus conventionally pressed cranioplasty implants: An accuracy comparison

This article compared the accuracy of producing patient-specific cranioplasty implants using four different approaches. Benchmark geometry was designed to represent a cranium and a defect added simulating a craniectomy. An ‘ideal’ contour reconstruction was calculated and compared against reconstructions resulting from the four approaches –‘conventional’, ‘semi-digital’, ‘digital – non-automated’ and ‘digital – semi-automated’. The ‘conventional’ approach relied on hand carving a reconstruction, turning this into a press tool, and pressing titanium sheet. This approach is common in the UK National Health Service. The ‘semi-digital’ approach removed the hand-carving element. Both of the ‘digital’ approaches utilised additive manufacturing to produce the end-use implant. The geometries were designed using a non-specialised computer-aided design software and a semi-automated cranioplasty implant-specific computer-aided design software. It was found that all plates were clinically acceptable and that the digitally designed and additive manufacturing plates were as accurate as the conventional implants. There were no significant differences between the additive manufacturing plates designed using non-specialised computer-aided design software and those designed using the semi-automated tool. The semi-automated software and additive manufacturing production process were capable of producing cranioplasty implants of similar accuracy to multi-purpose software and additive manufacturing, and both were more accurate than handmade implants. The difference was not of clinical significance, demonstrating that the accuracy of additive manufacturing cranioplasty implants meets current best practice

The examination of lymph nodes following surgery for colorectal cancer

Background: The number of lymph nodes (LN) harvested following colorectal cancer (CRC) resection is important for accurate LN stage discrimination and has been considered as a quality marker in the surgical treatment of CRC. Stage discrimination is critical to ensure that patients receive the optimal treatment for their disease stage and to provide prognostic information for the patient. Aims: To identify factors that independently predicted LN harvest (LNH), study the impact of national guidelines and audit had on LNH at national level and to examine the impact that LNH has on survival of node negative and node positive CRC. Methods: Data on patients having CRC resection at unit and national level were studied, and multivariate statistical modelling used to determine independent predictors of harvest and survival. Results: The reporting pathologist is an independent variable for LNH The operating surgeon did not influence LNH Inter unit variability in LNH exists National audit against national standards improved nodal yield at a national level Increasing LNH independently predicted survival in Dukes’ stage B CRC, up to a level of 15 nodes per patient. Lymph node ratio (LNR) independently predicted survival in Dukes’ C CRC and may be a more sensitive prognostic indicator than current lymph node staging systems. Conclusions: The principal conclusions of this thesis were that LNH is an appropriate quality indicator of combined pathological and surgical activity, but not surgery in isolation. National audit against national guidelines has improved LNH in Wales. Survival differences in node negative CRC up to a level of fifteen nodes suggests that the current national guidelines of twelve nodes per patient should be increased. LNR was found to predict survival in CRC patients suggesting it might be appropriate to include LNR in future staging systems for CRC

Cost Implications of the Prevalence of HIV/AIDS on the Economic Development of Nigeria.

HIV/AIDS emerged in the last three decades as visible threat to health and the socio-economic conditions of developing countries including Nigeria. Against this background, this study sought to determine the cost implications of the prevalence of HIV/AIDs on the economic development of Nigeria. The study adopted mainly qualitative approach sourced from National Bureau of Statistics-(NBS) and Central Bank of Nigeria-(CBN) statistical Bulletin respectively for analysis. Findings seem to support claims that the incidence of HIV/AIDS exert serious negative influences on the economic growth of Nigeria. This is due to the fact that HIV/AIDS reduces to a large extent the proportion of the working population with its huge corresponding cost implications, which in turn affect economic resources in the country. The policy interventions strategies recommended for stemming the scourge of HIV/AIDS include; prevention of new infections, cost reduction of treatments for patients, positive adjustments of patients to employment environment and development of activities like pycho-educational programme to motivate and foster HIV/AIDS prevention and management  behaviours among the Nigeria populace especially the youth. Keywords: Cost, Economic Growth; Employment, HIV/AIDS, Productivit