Implementing an e-learning Masters programme for Practice Development

Introduction – The need for more effective person centred care has been propositioned for a number of years (Dewar and Nolan 2013; McCormack, Dewing and McCance, 2011; Dewing, 2004) and Practice Development (PD) has been viewed as one way to embed this into organisational culture (Manley, Sanders, Cardiff and Webster, 2011). More recently multiple policy reports echo this call (Age UK, 2012; Willis Commission on Nursing, 2012; Parliamentary Health Service Ombudsman, 2011). Joint work between the Department of Nursing and England Centre for Practice Development at Canterbury Christ Church University has validated an innovative Masters level programme in Practice Development, utilising workplace and e-learning approaches to facilitate creativity in the work setting. Aim: This paper will briefly describe the programme and then explore the experiences and challenges of implementing a work based and e-learning Masters Practice Development and Innovation programme. Approach: Practice Development is built on the key principles of person-centredness, shared values and vision, transforming individuals and culture through active learning, facilitation and engagement (McCormack, Manley, Titchen 2013). Thus, the approach to the Masters programme reflects these principles and utilises facilitation methods to enable practice development to transform the learner and work setting. As part of this process we, as lecturers, have been developing our own values and beliefs and expanded our knowledge and skills so that we can positively impact on the learner experience and work as learning partners. The programme is, therefore, evolving to embody these principles and enable learners to incorporate them into practice. The programme is built around ten core Practice Development/Innovation principles and the process of Active Learning, which will be expanded on in the presentation. Our vision is to make this programme accessible to regional, national and international learners. The work-based and e-learning approaches make this achievable but bring challenges to ensure that the programme reflects the principles of Practice Development from a distance. This is further complicated by facilitating a range of learners from diverse clinical areas, experiences and cultures who have often been exposed to traditional forms of learning. Thus, facilitating the learners to engage with the material, and incorporate it into their own practice setting, has led to careful consideration of materials for the learners to access. As the programme is progressing areas are emerging that need to be thoughtfully considered and addressed to ensure development of learning. Considerations: Initial themes starting to emerge are: increasing lecturer knowledge and skills around both Practice Development and different tools for e-learning, learners previous experience of facilitation and willingness to take responsibility for their own learning, challenges of promoting active learning approaches online , enabling achievement of Masters level learning outcomes with a distance approach, new ways of working for individuals plus the organisational views around supporting learners in practice. These require both lecturers and learners to be motivated to learn and devote time to engage with material and processes. However, it also requires lecturers and learners to make choices and reflect on activities to assess the relevance and usefulness to their situation. The programme encourages learners to be creative and examine issues differently which takes time to engage with and progress. Conclusion: Evaluation of this programme is in its infancy. A key learning point is that transforming practice through Practice Development and innovation in the workplace also involves transforming University views on learning, engagement and creativity

Influence of a montmorency cherry juice blend on indices of exercise-induced stress and upper respiratory tract symptoms following marathon running—a pilot investigation

Background: Prolonged exercise, such as marathon running, has been associated with an increase in respiratory mucosal inflammation. The aim of this pilot study was to examine the effects of Montmorency cherry juice on markers of stress, immunity and inflammation following a Marathon. Methods: Twenty recreational Marathon runners consumed either cherry juice (CJ) or placebo (PL) before and after a Marathon race. Markers of mucosal immunity secretory immunoglobulin A (sIgA), immunoglobulin G (IgG), salivary cortisol, inflammation (CRP) and self-reported incidence and severity of upper respiratory tract symptoms (URTS) were measured before and following the race. Results: All variables except secretory IgA and IgG concentrations in saliva showed a significant time effect (P < 0.01). Serum CRP showed a significant interaction and treatment effect (P < 0.01). The CRP increase at 24 and 48 h post-Marathon was lower (P < 0.01) in the CJ group compared to PL group. Mucosal immunity and salivary cortisol showed no interaction effect or treatment effect. The incidence and severity of URTS was significantly greater than baseline at 24 h and 48 h following the race in the PL group and was also greater than the CJ group (P < 0.05). No URTS were reported in the CJ group whereas 50 % of runners in the PL group reported URTS at 24 h and 48 h post-Marathon. Conclusions: This is the first study that provides encouraging evidence of the potential role of Montmorency cherries in reducing the development of URTS post-Marathon possibly caused by exercise-induced hyperventilation trauma, and/or other infectious and non-infectious factors

Signalling Responses Following Varying Sequencing of Strength and Endurance Training in a Fed State.

The objective of this study was to compare anabolic signalling responses to differing sequences of concurrent strength and endurance training in a fed state.Eighteen resistance-trained males were randomly assigned to the following experimental conditions; i) strength training (ST), ii) strength followed by endurance training (ST-END) or iii) endurance followed by strength training (END-ST). Muscle tissue samples were taken from the vastus lateralis before each exercise protocol, upon cessation of exercise, and 1 h-post cessation of strength training. Tissue was analysed for total and phosphorylated (p-) signalling proteins linked to the mTOR and AMPK networks.Strength training performance was similar between ST, ST-END and END-ST. p-S6k1 was elevated from baseline 1 h post training in ST and ST-END (both p < 0.05). p-4E-BP1 was significantly lower than baseline post ST (p = 0.01), while 1 h post exercise in the ST-END condition p-4E-BP1 was significantly greater than post exercise (p = 0.04). p-ACC was elevated from baseline both post and 1 h post exercise (both p < 0.05) in the END-ST condition. AMPK, mTOR, p38, PKB, eEF2 responded similarly to the ST, ST-END and END-ST. Signalling responses to ST, ST-END and END were largely similar. As such it cannot be ascertained which sequence of concurrent strength and endurance training is most favourable in promoting anabolic signalling.These data indicate that in the case of the present study an acute bout of concurrent training of differing sequences elicited similar responses of the AMPK and mTOR networks

Effects of Cycling Intensity on Acute Signaling Adaptations to 8-weeks Concurrent Training in Trained Cyclists

© 2022 Jones, Eddens, Kupusarevic, Simoes, Furber, Van Someren and Howatson. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). https://creativecommons.org/licenses/by/4.0/This study examined whether the intensity of endurance stimuli modifies the adaptation in strength and endurance following concurrent training and whether the acute molecular response to concurrent exercise is affected by training status. Using a parallel group design, trained cyclists were randomized to either resistance exercise followed by moderate intensity continuous training (RES + MICT, n = 6), or resistance exercise followed by work matched high intensity interval training (RES + HIIT, n = 7), across an 8 weeks training programme. A single RES + MICT or RES + HIIT exercise stimulus was completed 1 week before and within 5 days of completing the training programme, to assess phosphorylation of protein kinases of the mTOR and AMPK signaling pathways. There were no main effects of time or group on the phosphorylation of protein kinases in response to concurrent exercise stimulus pre- and post-training intervention (p > 0.05). Main effects of time were observed for all maximal strength exercises; back-squat, split-squat, and calf-raise (p 0.05). Whilst preliminary data due to limited sample size the intensity of endurance activity had no effect on performance outcomes, following concurrent training. Further, the acute molecular response to a concurrent exercise stimulus was comparable before and after the training intervention, suggesting that training status had no effect on the molecular responses assessed.Peer reviewedFinal Published versio

Aerobic exercise intensity does not affect the anabolic signaling following resistance exercise in endurance athletes

Abstract: This study examined whether intensity of endurance stimulus within a concurrent training paradigm influenced the phosphorylation of signaling proteins associated with the mTOR and AMPK networks. Eight male cyclists completed (1) resistance exercise (RES), 6 × 8 squats at 80% 1-RM; (2) resistance exercise and moderate intensity cycling of 40 min at 65% V̇O2peak, (RES + MIC); (3) resistance exercise and high intensity interval cycling of 40 min with 6 alternating 3 min intervals of 85 and 45% V̇O2peak (RES + HIIC), in a cross-over design. Muscle biopsies were collected at rest and 3 h post-RES. There was a main effect of condition for mTORS2448 (p = 0.043), with a greater response in the RES + MIC relative to RES condition (p = 0.033). There was a main effect of condition for AMPKα2T172 (p = 0.041), with a greater response in RES + MIC, relative to both RES + HIIC (p = 0.026) and RES (p = 0.046). There were no other condition effects for the remaining protein kinases assessed (p > 0.05). These data do not support a molecular interference effect in cyclists under controlled conditions. There was no intensity-dependent regulation of AMPK, nor differential activation of anabolism with the manipulation of endurance exercise intensity.Peer reviewe

Dietary sugars and cardiometabolic risk: Systematic review and meta-analyses of randomized controlled trials of the effects on blood pressure and lipids

ABSTRACT Background: Dietary sugars have been suggested as a cause of obesity, several chronic diseases, and a range of cardiometabolic risk factors, but there is no convincing evidence of a causal relation between sugars and risk factors other than body weight. Objective: We conducted a systematic review and meta-analysis of randomized controlled trials that examined effects of the modification of dietary free sugars on blood pressure and lipids. Design: Systematic searches were conducted in OVID Medline, Embase, Scopus, Cumulative Index to Nursing and Allied Health Literature, and Web of Science databases (to August 2013) to identify studies that reported intakes of free sugars and at least one lipid or blood pressure outcome. The minimum trial duration was 2 wk. We pooled data by using inverse-variance methods with random-effects models. Results: A total of 39 of 11,517 trials identified were included; 37 trials reported lipid outcomes, and 12 trials reported blood pressure outcomes. Higher compared with lower sugar intakes significantly raised triglyceride concentrations [mean difference (MD): 0.11 mmol/L; 95% CI: 0.07, 0.15 mmol/L; P , 0.0001], total cholesterol (MD: 0.16 mmol/L; 95% CI: 0.10, 0.24 mmol/L; P , 0.0001), lowdensity lipoprotein cholesterol (0.12 mmol/L; 95% CI: 0.05, 0.19 mmol/L; P = 0.0001), and high-density lipoprotein cholesterol (MD: 0.02 mmol/L; 95% CI: 0.00, 0.03 mmol/L; P = 0.03). Subgroup analyses showed the most marked relation between sugar intakes and lipids in studies in which efforts were made to ensure an energy balance and when no difference in weight change was reported. Potential explanatory factors, including a weight change, in most instances explained ,15% of the heterogeneity between studies (I 2 = 36-75%). The effect of sugar intake on blood pressure was greatest in trials $8 wk in duration [MD: 6.9 mm Hg (95% CI: 3.4, 10.3 mm Hg; P , 0.001) for systolic blood pressure and 5.6 mm Hg (95% CI: 2.5, 8.8 mm Hg; P = 0.0005) for diastolic blood pressure]. Conclusions: Dietary sugars influence blood pressure and serum lipids. The relation is independent of effects of sugars on body weight. Protocols for this review were registered separately for effects of sugars on blood pressure and lipids in the PROSPERO International prospective register of systematic reviews as PROS-PERO 2012: CRD42012002379 and 2012: CRD42012002437, respectively. Am J Clin Nut

Minimal muscle damage after a marathon and no influence of beetroot juice on inflammation and recovery

This study examined whether beetroot juice (BTJ) would attenuate inflammation and muscle damage following a marathon. Using a double blind, independent group’s design, 34 runners (~16 previous marathons completed) consumed either BTJ or an isocaloric placebo (PLA) for 3 days following a marathon. Maximal isometric voluntary contractions (MIVC), countermovement jumps (CMJ), muscle soreness, serum cytokines, leucocytosis, creatine kinase (CK), high sensitivity C-reactive protein (hs-CRP) and aspartate aminotransferase (AST) were measured pre, post, and on the 2 days after the marathon. CMJ and MIVC were reduced after the marathon (P0.05). Muscle soreness was increased in the day after the marathon (BTJ; 45±48 vs. PLA; 46±39 mm) and had returned to baseline by day 2, irrespective of supplementation (P=0.694). Cytokines (Interleukin-6; IL-6, interleukin-8, tumour necrosis factor-α) were increased immediately post-marathon but apart from IL-6 had returned to baseline values by day 1 post. No interaction effects were evident for IL-6 (P=0.213). Leucocytes increased 1.7 fold after the race and remained elevated 2 days post, irrespective of supplement (P<0.0001). CK peaked at 1 day post marathon (BTJ: 965±967 & PLA: 1141±979 IU·L-1) and like AST and hs-CRP, was still elevated 2 days after the marathon (P<0.05); however, no group differences were present for these variables. Beetroot juice did not attenuate inflammation or reduce muscle damage following a marathon, possibly because most of these indices were not markedly different from baseline values in the days after the marathon

Effect of local cold-pack application on systemic anabolic and inflammatory response to sprint-interval training: a prospective comparative trial

We evaluated the effect of cold ice-pack application following a brief sprint-interval training on the balance between anabolic mediators [growth hormone (GH), insulin-like growth factor-I (IGF-I), testosterone], catabolic markers (cortisol, IGFBP-1), and circulating pro [Interlukin-6 (IL-6) and IL-1β]- and anti-inflammatory cytokines [IL-1 receptor antagonist (IL-1ra)]. Twelve males, elite junior handball players performed 4 × 250 m treadmill run, at 80% of each individual’s maximal speed, followed by a rest period with and without local cold-pack application. Pre, immediately post, and 60-min post-exercise blood samples were drawn. Exercise was associated with a significant increase in IL-6, GH, IGFBP-3, and testosterone levels. Local cold-pack application was associated with significant decreases in IL-1β, IL-1ra, IGF-I, and IGFBP-3 and a greater increase of IGFBP-1 during recovery. Local ice therapy immediately following sprint-interval training was associated with greater decreases in both pro- and anti-inflammatory cytokines and anabolic hormones supporting some clinical evidence for possible negative effects on athletic performance