EFFECTIVE COMMUNICATION ABOUT RISK

Risk and Uncertainty,

Provision of services for rehabilitation of children and adolescents with congenital cardiac disease: a survey of centres for paediatric cardiology in the United Kingdom

A postal questionnaire survey of the 17 centres for paediatric cardiology in the UK investigated the attitudes of staff towards rehabilitation and the current level of provision. The majority of respondents (82%) believed they should provide rehabilitation for their patients, but only one centre had a programme for rehabilitation. Few respondents (18%) believed they were meeting the needs of their patients' for rehabilitation. Major barriers to providing rehabilitation were funding and the wide geographical catchment areas

The Effects of Psychological Home and Place Attachment on Life Satisfaction in Women of Color

The cognitive judgments individuals make to evaluate their quality of life (i.e. life satisfaction), are vital to understanding how individuals perceive their overall well-being. Predictors, such as, gender, ethnicity, and external environmental factors may influence life satisfaction. Few studies examined the relations between psychological home, place attachment, and life satisfaction. The present study was the first to examine these concepts in women of color. For the present study, data were taken from a larger nationwide study of 1,394 adults (M = 53.94 years old) examining the relationship between home, clutter, and well-being. The current study explored the influence of psychological home on life satisfaction, among 99 adult women of color (M = 50.33 years old), after accounting for resource (i.e., annual household income, homeownership status, and relationship status) and contextual (i.e., type of dwelling, number of people in household, and years in residence) variables. Additionally, the effects of place attachment and clutter on psychological home and life satisfaction were examined. Hierarchical regression analyses revealed that psychological home was a significant predictor of life satisfaction over and above resource and contextual variables. Place attachment and clutter did not moderate the relationship between psychological home and life satisfaction. However, clutter mediated the relationship between psychological home and life satisfaction. More research is needed to better understand these processes in woman of color. The implications for community psychology, limitations of the current study, and future directions are discussed

Alarm Pheromone in a Gregarious Poduromorph Collembolan (Collembola: Hypogastruridae)

We report an alarm pheromone in the gregarious poduromorph collembolan, Hypogastrura pannosa. Cuticular rupture results in emission of a rapidly vaporizing hexane-soluble material with an active space diameter of ca. 1 cm. Conspecifics encountering the vapor front respond with stereotypic aversion and dispersal behaviors. This is the first report on the presence of an alarm pheromone in the order Collembola

The nursing contribution to chronic disease management: a whole systems approach: Report for the National Institute for Health Research Service Delivery and Organisation programme

Background Transforming the delivery of care for people with Long Term Conditions (LTCs) requires understanding about how health care policies in England and historical patterns of service delivery have led to different models of chronic disease management (CDM). It is also essential in this transformation to analyse and critique the models that have emerged to provide a more detailed evidence base for future decision making and better patient care. Nurses have made, and continue to make, a particular contribution to the management of chronic diseases. In the context of this study, there is a particular focus on the origins of each CDM model examined, the processes by which nursing care is developed, sustained and mainstreamed, and the outcomes of each case study as experienced by service users and carers. Aims To explore, identify and characterise the origins, processes and outcomes of effective CDM models and the nursing contribution to such models using a whole systems approach Methods The study was divided into three phases: Phase 1: Systematic mapping of published and web-based literature. Phase 2: A consensus conference of nurses working within CDM. Sampling criteria were derived from the conference and selected nurses attended a follow up workshop where case study sites were identified. Phase 3: Multiple case study evaluation Sample: 7 case studies representing 4 CDM models. These were: i) public health nursing model; ii) primary care nursing model; iii) condition specific nurse specialist model; iv) community matron model. Methods: Evaluative case study design with the unit of analysis the CDM model (Yin, 2003): • semi-structured interviews with practitioners, patients, their carers, managers and commissioners • documentary analysis • psycho-social and clinical outcome data from specific conditions • children and young people: focus groups, age-specific survey tools. Benchmarking outcomes: Adults benchmarked against the Health Outcomes Data Repository (HODaR) dataset (Currie et al, 2005). Young people were benchmarked against the Health Behaviour of School aged Children Survey (Currie et al, 2008). Cost analysis: Due to limitations in the available data, a simple costing exercise was undertaken to ascertain the per patient cost of the nurse contribution to CDM in each of the models, and to explore patterns of health and social care utilisation. Analysis: A whole system methodology was used to establish the principles of CDM. i) The causal system is a “network of causal relationships” and focuses on long term trends and processes. ii) The data system recognises that for many important areas there is very little data. Where a particular explanatory factor is important but precise data are lacking, a range of methods should be employed to illuminate each factor as much as possible. iii) The organisational whole system emphasises how various parts of the health and social care system function together as a single system rather than as parallel systems. iv) The patient experience recognises that the whole system comes together and is embodied in the experience of each patient. Key findings While all the models strove to be patient centred in their implementation, all were linked at a causal level to disease centric principles of care which dominated the patient experience. Public Health Model • The users (both parents and children) experienced a well organised and coordinated service that is crossing health and education sectors. • The lead school nurse has provided a vision for asthma management in school-aged children. This has led to the implementation of the school asthma strategy, and the ensuing impacts including growing awareness, prevention of hospital admissions, confidence in schools about asthma management and healthier children. Primary Care Model • GP practices are providing planned and routine management of chronic disease, tending to focus on single diseases treated in isolation. Care is geared to the needs of the uncomplicated stable patient. • More complex cases tend to be escalated to secondary care where they may remain even after the patient has stabilised. • Patients with multiple diagnoses continue to experience difficulty in accessing services or practice that is designed to provide a coherent response to the idiosyncratic range of diseases with which they present. This is as true for secondary care as for primary care. • While the QOF system has clearly been instrumental in developing and sustaining a primary care nursing model of CDM, it has also limited the scope of the model to single diseases recordable on a register, rather than focus on patient centred care needs. Nurse Specialist Model • The model works under a disease focused system underpinned by evidence based medicine exemplified by NICE guidelines and NSF’s. • The model follows a template drawn from medicine and sustainability is significantly dependent on the championship and protectionism offered by senior medical clinicians. • A focus on self-management in LTCs gives particular impetus to nurse-led enablement of self-management. • The shift of LTC services from secondary care to primary care has often not been accompanied by a shift in expertise. Community Matron Model • The community matron model was distinctive in that it had been implemented as a top down initiative. • The model has been championed by the community matrons themselves, and the pressure to deliver observable results such as hospital admission reductions has been significant. • This model was the only one that consistently resulted in open access (albeit not 24 hours) and first point of contact for patients for the management of their ongoing condition. Survey Findings Compared to patients from our case studies those within HODaR visited the GP, practice nurse or NHS walk-in centres more, but had less home visits from nurses or social services within the six weeks prior to survey. HODaR patients also took significantly more time off work and away from normal activities, and needed more care from friends/ relatives than patients from our study within the last six weeks. The differences between the HODaR and case study patients in service use cannot easily be explained but it could be speculated when referring to the qualitative data that the case study patients are benefiting from nurse-led care. Cost analysis – The nurse costs per patient are at least ten times higher for community matrons conducting CDM than for nurses working in other CDM models. The pattern of service utilisation is consistent with the focus of the community matron role to provide intensive input to vulnerable patients. Conclusions Nurses are spearheading the kind of approaches at the heart of current health policies (Department of Health, 2008a). However, tensions in health policy and inherent contradictions in the context of health care delivery are hampering the implementation of CDM models and limiting the contribution nurses are able to make to CDM. These include: ? data systems that were incompatible and recorded patients as a disease entity ? QOF reinforced a disease centric approach ? practice based commissioning was resulting in increasing difficulties in cross health sector working in some sites ? the value of the public health model may not be captured in evaluation tools which focus on the individual patient experience. Recommendations Commissioners and providers 1. Disseminate new roles and innovations and articulate how the role or service fits and enhances existing provision. 2. Promote the role of the nurses in LTC management to patients and the wider community. 3. Actively engage with service users in shaping LTC services to meet patients’ needs. 4. Improve the support and supervision for nurses working within new roles. 5. Develop training and skills of nurses working in the community to enable them to take a more central role in LTC management. 6. Develop organisations that are enabling of innovation and actively seek funding for initiatives that provide an environment where nurses can reach their potential in improving LTC services. 7. Work towards data systems that are compatible between sectors and groups of professionals. Explore ways of enabling patients to access data and information systems for test results and latest information. 8. Promote horizontal as well as vertical integration of LTC services. Practitioners 1. Increase awareness of patient identified needs through active engagement with the service user. 2. Work to develop appropriate measures of nursing outcomes in LTC management including not only bureaucratic and physiological outcomes, but patient-identified outcomes. Implications of research findings 1. Investment should be made into changing patient perceptions about the traditional division of labour, the nurses’ role and skills, and the expertise available in primary care for CDM. 2. Development and evaluation of patient accessible websites where patients can access a range of information, their latest test results and ways of interpreting these. 3. Long-term funding of prospective evaluations to enable identification of CDM outcomes. 4. Mapping of patient experience and patient satisfaction so that the conceptual differences between these two related ideas can be demonstrated. 5. Development of appropriate measures of patient experience that can be used as part of the quality outcome measures. 6. Cost evaluation/effectiveness studies carried out over time that includes national quality outcome indicators and valid measures of patient experience. 7. The importance of whole system working needs to be identified in the planning of services. 8. Research into the role of the health visitor in chronic disease management within a public health model

Exploring non-invasive sampling of parasites by metabarcoding gastrointestinal nematodes in Madagascar frog species

Peer reviewe

Liberal arts student learning outcomes: An integrated approach

Researchers completing a study of liberal arts education sought to identify learning outcomes associated with both wisdom and citizenship. They have synthesized these themes into seven outcomes that facilitate effective student learning and development.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/57388/1/222_ftp.pd

Effect of Capacity Building Interventions on Classroom Teacher and Early Childhood Educator Physical Activity and Fundamental Movement Skills Related Self-efficacy, Knowledge, and Attitudes: A Systematic Review and Meta-Analysis

Generalist teachers and early childhood educators (ECEs) play an important role in promoting physical activity and fundamental movement skills in children. However, teachers face several barriers to promoting physical activity and fundamental movement skills including inadequate training and professional development. Therefore, this study aimed to determine the efficacy of capacity building interventions on teachers’ and ECEs’ physical activity and fundamental movement skills related knowledge, self-efficacy and attitudes. The search revealed 22 studies which reported on 25 unique samples. The most common capacity building intervention component implemented was training/professional development. The results of this study revealed that capacity building interventions are efficacious at improving teachers’ and ECEs’ physical activity related self-efficacy, knowledge, and attitudes. Pre-service teachers and ECEs should be provided training in physical activity and FMS as part of their degrees, and continual professional development and capacity building should be offered to in-service teachers and ECEs to promote physical activity and FMS in children

Phonomotor Rehabilitation of Apraxia of Speech: A Phase II Study

In this Phase II rehabilitation study, we investigated the effects of an intensive phonomotor rehabilitation program founded on schema theory and principles of motor learning on verbal production in an individual with severe apraxia of speech and aphasia. In the context of a single-subject, multiple-baseline design, we investigated the effects of treatment on repetition of trained phonemes, generalization to untrained phonemes, CVC real and nonwords and measures of ecologic validity, and maintenance of treatment effects two-months post treatment.  Results show acquisition of trained phonemes, generalization to untrained phonemes, CVC real words and caregiver report, and maintenance of all treatment effects

Uso de las Tecnologías de Información y Comunicación en el proceso de enseñanza–aprendizaje, en los estudiantes del Liceo Sonafluca, CINDEA San Isidro de Peñas Blancas y Colegio Técnico Profesional La Fortuna

Proyecto de Graduación (Maestría en Educación Técnica) Instituto Tecnológico de Costa Rica, Escuela de Educación Técnica, 2017El presente trabajo permite conocer acerca de las tecnologías de la información y la comunicación aplicadas al proceso de enseñanza-aprendizaje en la mediación pedagógica y andragógica, las implicaciones que estas tienen y cómo se aplican y usan en los salones de clase. Parte importante de este trabajo se lleva a cabo con los estudiantes, docentes y administrativos del Liceo Sonafluca, Colegio Técnico Profesional La Fortuna y CINDEA San Isidro de Peñas Blancas. El principal objetivo es determinar el impacto del uso de las Tecnologías de Información y Comunicación en el proceso enseñanza-aprendizaje, aplicadas por los docentes a los estudiantes. Para ello, se investiga acerca de los recursos tecnológicos con que cuentan los centros educativos en estudio, la aplicación y el uso de las TIC en el proceso de enseñanza-aprendizaje por medio de la mediación pedagógica y andragógica que realiza el docente para el mejoramiento del rendimiento académico del estudiante