Transgressive first clinical experiences (August 2014)

This Study seeks to comprehend learning experiences of nursing students during their first clinical in-service placement. This Paper is part of a longitudinal development project interviewing the Student Nurse after each one of the five clinical in-service placements and then one year after graduation as a Nurse. The Study has a qualitative methodology, inspired by Michael Eraut’s thoughts on learning in the workplace. When the workplace perspective is applied, learning seems to be concentrated on actual situations which the Learner is in, in contrast to employing constructed concepts.The nursing students’ learning seems to be oriented towards socialization in the clinic as a workplace. This means that the nursing students seek to deal with overwhelming experiences concerning the naked bodies of patients and death, useful application of theoretical knowledge, the path from novice to advanced beginner, and adjusting to the workplace community. The conclusion is that the learning of nursing students during their first clinical in-service placement appears informal and not founded on evident best practice

Age at Puberty and the Emerging Obesity Epidemic

Background: Recent studies have shown that puberty starts at younger ages than previously. It has been hypothesized that the increasing prevalence of childhood obesity is contributing to this trend. The purpose of this study was to analyze the association between prepubertal body mass index (BMI) and pubertal timing, as assessed by age at onset of pubertal growth spurt (OGS) and at peak height velocity (PHV), and the secular trend of pubertal timing given the prepubertal BMI. Methodology/Principal Findings: Annual measurements of height and weight were available in all children born from 1930 to 1969 who attended primary school in the Copenhagen municipality; 156,835 children fulfilled the criteria for determining age at OGS and PHV. The effect of prepubertal BMI at age seven on these markers of pubertal development within and between birth cohorts was analyzed. BMI at seven years was significantly inversely associated with age at OGS and PHV. Dividing the children into five levels of prepubertal BMI, we found a similar secular trend toward earlier maturation in all BMI groups. Conclusion/Significance: The heavier both boys and girls were at age seven, the earlier they entered puberty. Irrespective of level of BMI at age seven, there was a downward trend in the age at attaining puberty in both boys and girls, whic

Effectiveness of a brief theory-based health promotion intervention among adults at high risk of type 2 diabetes:One-year results from a randomised trial in a community setting

AbstractAimTo examine the effect of a brief theory-based health promotion intervention delivered in the community on health behaviour and diabetes-related risk factors among Danish adults at high risk of diabetes.MethodsA randomised trial was conducted among 127 individuals aged 28 to 70 with fasting plasma glucose: 6.1–6.9mmol/l and/or HbA1c: 6.0–<6.5% (42–<48mmol/mol) recruited from general practice in Holstebro, Denmark. Participants were randomised to a control group or to receive the intervention delivered over four 2h group sessions during five weeks, and two further sessions after one and six months. Questionnaire data and clinical measures were collected at baseline, three months and one year after intervention. Primary outcomes; total-fat intake <30% of energy intake; saturated-fat intake <10% of energy intake; fibre-intake≥15g/1000kcal; weight reduction >5%; changes in physical activity.Results85% attended one-year follow-up. After adjusting for gender, age and education, Odds ratio (OR) (95% CI) intervention vs control: total-fat intake <30% energy intake: 0.52 (0.22;1.20), saturated-fat intake <10% energy intake: 1.22 (0.52;2.87), fibre intake ≥15g/1000kcal: 1.18 (0.48;2.92), weight reduction >5%: 2.47 (0.95;6.39). β(95% CI) between intervention vs control in changes from baseline: IPAQ, MET min/week: −236 (−2760; 2288), waist circumference,cm: −2.5 (−4.5; −0.5); systolic blood pressure, mmHg: −4.6 (−8.8; −0.3).ConclusionA brief theory-based health promotion intervention delivered in the community indicated effect on weight, waist circumference and systolic blood pressure at one year among Danish adults at high risk of diabetes. No effect was shown on diets or physical activity

Deletion in the uridine diphosphate glucuronyltransferase 2B17 gene is associated with delayed pubarche in healthy boys

Objective: Only a few genetic loci are known to be associated with male pubertal events. The ability of excreting testosterone (T) and other steroids in the urine depends on sulfation and glucuronidation. One of several essential glucuronidases is encoded by the UGT2B17 gene. In a preliminary report, we found that homozygous deletion of UGT2B17 in boys was associated with lower urinary excretion of T. We hypothesized that boys with a lower glucuronidation capacity may have altered androgen action and excretion affecting pubarche, as this represents a T-dependent event. Design, participants and measures: 668 healthy boys (cross-sectional) aged 6.1–21.9 years (COPENHAGEN puberty study conducted from 2005 to 2006) were included. 65 of the boys where followed longitudinally every 6 months. Participants were genotyped for UGT2B17 copy number variation (CNV). Clinical pubertal staging including orchidometry, anthropometry and serum reproductive hormone levels. Results: 59 of the 668 boys (8.8%) presented with a homozygous deletion of UGT2B17 (del/del). These boys experienced pubarche at a mean age of 12.73 years (12.00–13.46) vs 12.40 years (12.11–12.68) in boys heterozygous for deletion of UGT2B17 (del/ins) vs 12.06 years (11.79–12.33) in boys with the wild-type genotype (ins/ins) (P = 0.029, corrected for BMI z-score). The effect accounted for 0.34 years delay per allele (95% CI: 0.03–0.64). A comparable trend was observed for onset of testicular enlargement >3 mL but did not reach significance. Conclusion: CNV of UGT2B17 is a factor contributing to the timing of male pubarche

Partnerskabt digitalt læringsrum

Dansk Artiklen beskriver et udviklingsprojekt fra Institut for Antropologi på Københavns Universitet. Her har studerende i partnerskab med studieleder, underviser og konsulenter samskabt et socialtkonstruktivistisk funderet digitalt læringsrum til brug på feltarbejde. De studerende på feltarbejde er udfordret af, at de ikke er fysisk tilstede på universitetet i et semester på deres kandidat studie, fordi de er i felten og indsamle empirisk data. Den manglende fysiske tilstedeværelse påvirker nærheden til studiet og konsekvensen er, at de studerende oplever ensomhed såvel som et mindre akademisk fokus. Artiklen er rammesat med Conoles 7C læringsdesign og benytter sig af Salmons 5-trins model for opbygning af den digitale undervisning. Formålet med skabelsen af et digitalt læringsrum til er etablere et socialt-fagligt læringsrum som minimerer fornemmelsen af fysisk fravær. Artiklen dækker både, partnerskabsbegrebet som afsæt for undervisningsudvikling, læringsdesign samt opbygning af et digitialt læringsrum og belyser dermed de studerendes mulighed for læring, kommunikation og samarbejde digitialt i løbet af feltarbejdet. Studenterevalueringer og skriftligt kommunikation mellem de studerende fra det digitiale læringsrum vises eksemplificerende. De teoretiske perspektiver og de empiriske eksempler gør det muligt at konkludere, at det samskabte digitale læringsrummulighed for feedback understøtter de studerende både socialt og akademisk gennem deres feltarbejde. English The article describes a development project from the Department of Anthropology at the University of Copenhagen where students together with the study board, teachers and consultants co-create a digital learning course based on social constructivism thoughts for fieldwork. The fieldwork students are challenged by the fact that they are not physical present at the University for one semester of their master education because they have to generate empirical data in the field. The physical absence complicates the closeness to the department and the consequences have so far been that the students experience loneliness as well as less academic focus during their fieldwork. The article is framed within Conoles 7C learning design model and uses Salmon’s 5-step model for structuring the digital teaching. The purpose of creating a digital learning course is to establish a social and academic learning environment which minimize the felling of physical absence among the students. The article covers both the partnership term for teaching development, the learning design, as well as the creation of a digital learning platform and highlights thereby the student’s possible learning, communication and corporation in a digital environment during fieldwork. Student evaluations as well as online written communication among students from the digital platform are used for exemplification. The theoretical perspectives and the empirical data enable a conclusion which frames that the integrated options for feedback in the co-created digital learning platform support the students in both social and academic ways during their field work

A clinical proteomics study of exhaled breath condensate and biomarkers for pulmonary embolism

Pulmonary Embolism (PE) can be a diagnostic challenge. Current diagnostic markers for PE are unspecific and new diagnostic tools are needed. The air we exhale is a possible new source for biomarkers which can be tapped into by analysing the exhaled breath condensate (EBC). We analysed the EBC from patients with PE and controls to investigate if the EBC is a useful source for new diagnostic biomarkers of PE. We collected and analysed EBC samples from patients with suspected PE and controls matched on age and sex. Patients in whom PE was ruled out after diagnostic work-up were included in the control group to increase the sensitivity and generalizability of the identified markers. EBC samples were collected using an RTube™. The protein composition of the EBCs were analysed using data dependent label-free quantitative nano liquid chromatography-tandem mass spectrometry. EBC samples from 28 patients with confirmed PE, and 49 controls were analysed. A total of 928 EBC proteins were identified in the 77 EBC samples. As expected, a low protein concentration was determined which resulted in many proteins with unmeasurable levels in several samples. The levels of HSPA5, PEBP1 and SFTPA2 were higher and levels of POF1B, EPPK1, PSMA4, ALDOA, and CFL1 were lower in PE compared with controls. In conclusion, the human EBC contained a variety of endogenous proteins and may be a source for new diagnostic markers of PE and other diseases. The project is registered at ClinicalTrials.gov (Identifier NCT04010760).</p

Status and Clinical Experiences from the Challenge Trial – A Randomized Controlled Trial Investigating Virtual Reality-based Therapy for Auditory Hallucinations

Background: Auditory verbal hallucinations are a prevalent symptom in schizophrenia and other psychotic disorders, affecting around 70% of patients. A sizable proportion does not achieve adequate treatment response with current interventions, including antipsychotic medication. Virtual reality-based therapy (VRT) shows promise as a new intervention. Methods: The Challenge Trial is a randomized controlled study examining the efficacy of VRT compared to standard treatment for auditory hallucinations in patients with psychotic disorders. In the intervention arm, virtual reality software and voice modulation are used to design a visual representation of the patient's voice (an avatar) and to transform the therapist's voice to sound like the voice the patient hears. The aim is to foster a dialogue for the patient to strengthen their power, practice self-efficacy, and alter their relation to the voice. During therapy, the avatar becomes more compassionate and/or less powerful. Results: Quantitative data are currently unavailable as recruitment is ongoing. Instead, the design and intervention are presented along with recruitment data, retention rates, and case vignettes. Early clinical experiences are promising, with high acceptability and tolerance among patients. The trial has successfully enrolled a diverse patient population, including those with long-standing histories of hospitalization, medication use, and chronic hallucinations. The effectiveness of VRT varies, for example, some patients have reported significant reductions in the frequency of voices and associated distress, whereas others have primarily noted improvements in emotional responses to the voices. Conclusions: Based on the first 2 years of the Challenge Trial, VRT shows considerable promise as a potential treatment for auditory verbal hallucinations

The AMH genotype (rs10407022 T&gt;G) is associated with circulating AMH levels in boys, but not in girls

Objective: Fetal anti-Müllerian hormone (AMH) is responsible for normal male sexual differentiation, and circulating AMH is used as a marker of testicular tissue in newborns with disorders of sex development. Little is known about the mechanism of action in postnatal life. A recent genome wide association study (GWAS) reported genetic variation of AMH affecting AMH levels in young men. This study investigated the effect of genetic variation of AMH and AMH type II receptor (AMHR2) (AMHrs10407022 T>G and AMHR2rs11170547 C>T) on circulating reproductive hormone levels and pubertal onset in boys and girls. Design and methods: This study is a combined longitudinal and cross-sectional study in healthy Danish boys and girls from the general population. We included 658 boys aged 5.8–19.8 years and 320 girls aged 5.6–16.5 years. The main outcome measures were genotyping of AMH and AMHR2, pubertal staging and serum levels of reproductive hormones. Results: AMHrs10407022T>G was associated with higher serum levels of AMH in prepubertal boys (TT: 575 pmol/L vs TG: 633 pmol/L vs GG: 837 pmol/L, P = 0.002) and adolescents (TT: 44 pmol/L vs TG: 58 pmol/L vs GG: 79 pmol/L, P < 0.001). Adolescent boys carrying the genetic variation also had lower levels of LH (TT: 3.0 IU/L vs TG: 2.8 IU/L vs GG: 1.8 IU/L, P = 0.012). Hormone levels in girls and pubertal onset in either sex did not seem to be profoundly affected by the genotypes. Conclusion: Our findings support recent GWAS results in young adults and expand our understanding of genetic variation affecting AMH levels even in boys prior to the pubertal decline of circulating AMH