Reflections on Study Abroad: Insights from Registered Nurses

Globalization has resulted in the increased internationalization of higher education with most universities hosting international students and sending domestic students on international learning experiences. As part of this trend, many undergraduate nursing programs offer study abroad clinical placements to promote cultural sensitivity and global citizenship. While there is an abundance of research evaluating student perceptions of specific international study abroad experiences soon upon their return, there is little research exploring longer-term perspectives of participants across a range of diverse international placement sites. To provide guidance for their study abroad program, a nursing school in western Canada gathered the perspectives of participants from the previous one to eight years. These currently practicing registered nurses had clinical placements in one of six countries across four continents between 2008 and 2015 as part of their undergraduate nursing education. In total 35 participants completed an online survey with 13 agreeing to an individual, semi-structured follow-up interview to elicit more detailed responses. The study was guided by Thorne’s interpretive description qualitative approach. The key beneficial features of their experience identified by the participants included cross-cultural learning, relationship building, and exposure to diverse health contexts. Narratives also captured challenges including cultural adjustment, financial burden, meeting placement and academic expectations, and issues of social injustice/inequality. The participants provided advice for the planning and delivery of international nursing clinical placements and recommended close curricular alignment between the course and placement site, faculty presence, and thorough student pre-departure preparation as essential components of study abroad nursing programs. The narratives highlighted the importance of faculty guidance to help participants move toward critical global citizenship by assessing their own beliefs and assumptions while considering the historical, sociocultural, economic, and political factors as well as other perspectives evident in the host placement context. Such transformational learning should be reinforced by the integration of social responsibility and global citizenship within undergraduate nursing curricula to ensure all nursing graduates are exposed to these critical worldviews. The findings provide guidance for the delivery of future international placements at this school of nursing and may help inform the design and implementation of similar programs. These registered nurses reinforced the value of study abroad as rich experiential learning opportunities that facilitate long-term cultural competence and a critical global nursing perspective. Résumé La mondialisation a entraîné une internationalisation accrue de l’enseignement supérieur, la plupart des universités accueillant des étudiants internationaux et soutenant la mobilité de ses propres étudiants pour une partie de leur formation à l’international. Suivant cette tendance, de nombreux programmes de premier cycle en sciences infirmières offrent des stages cliniques à l’international pour soutenir le développement de leur sensibilité culturelle et citoyenneté mondiale. Bien que plusieurs recherches portent sur les perceptions d’étudiantes peu après leur retour d’expériences spécifiques d’études à l’international, peu de recherches ont examiné la perspective à plus long terme des participantes à des stages dans divers contextes internationaux. Afin d’orienter son programme de stages à l’international, une école de sciences infirmières de l’Ouest canadien a recueilli le point de vue de participantes des dernières huit années. Celles-ci, désormais infirmières en exercice, avaient fait un stage clinique dans un de six pays répartis sur quatre continents, au cours de leurs études de premier cycle en sciences infirmières, entre 2008 et 2015. Au total, 35 participantes ont répondu à un sondage en ligne et 13 d’entre elles ont accepté de prendre part à un entretien individuel subséquent semi-dirigé afin d’approfondir leurs réponses. La recherche était guidée par l’approche qualitative de description interprétative proposée par Thorne. Parmi les plus grands avantages de l’expérience, identifiés par les participantes, notons l’apprentissage interculturel, la création de relations et l’exposition à divers contextes de santé. Les récits décrivaient aussi certains défis, dont l’adaptation culturelle, le fardeau financier, le respect des exigences à la fois du milieu de stage et du milieu de formation, ainsi que les questions d’injustice/ inégalité sociale. Les participantes ont formulé des recommandations pour la planification et la réalisation de stages cliniques internationaux en sciences infirmières, et ont jugé essentiels ces éléments pour tout programme de mobilité : un lien pédagogique étroit entre le cours et le milieu de stage, la présence d’un membre du corps professoral et la préparation minutieuse des étudiantes avant leur départ. Les récits soulignaient l’importance de l’encadrement professoral pour soutenir le développement des participantes vers une citoyenneté mondiale critique en analysant leurs propres croyances et idées préconçues, tout en tenant compte des facteurs historiques, socioculturels, économiques et politiques, ainsi que d’autres perspectives observées dans le milieu d’accueil du stage. Une telle expérience d’apprentissage transformationnelle devrait être consolidée par l’intégration des notions de responsabilité sociale et de citoyenneté mondiale dans le programme d’études de premier cycle en sciences infirmières, de sorte que toutes les diplômées soient exposées à ces visions du monde essentielles. Les résultats ont servi à orienter le format des prochains stages internationaux dans cette école de sciences infirmières et pourraient contribuer à la conception et à la mise en œuvre de programmes similaires. Ces infirmières en exercice ont réaffirmé l’importance des études à l’international comme étant de riches occasions d’apprentissage expérientiel, qui favorisent une intégration durable de la compétence culturelle et une perspective globale critique en sciences infirmières

Effects of sub-lethal single, simultaneous, and sequential abiotic stresses on phenotypic traits of Arabidopsis thaliana

Plant responses to abiotic stresses are complex and dynamic, and involve changes in different traits, either as the direct consequence of the stress, or as an active acclimatory response. Abiotic stresses frequently occur simultaneously or in succession, rather than in isolation. Despite this, most studies have focused on a single stress and single or few plant traits. To address this gap, our study comprehensively and categorically quantified the individual and combined effects of three major abiotic stresses associated with climate change (flooding, progressive drought and high temperature) on 12 phenotypic traits related to morphology, development, growth and fitness, at different developmental stages in four Arabidopsis thaliana accessions. Combined sub-lethal stresses were applied either simultaneously (high temperature and drought) or sequentially (flooding followed by drought). In total, we analyzed the phenotypic responses of 1782 individuals across these stresses and different developmental stages. Overall, abiotic stresses and their combinations resulted in distinct patterns of effects across the traits analyzed, with both quantitative and qualitative differences across accessions. Stress combinations had additive effects on some traits, whereas clear positive and negative interactions were observed for other traits: 9 out of 12 traits for high temperature and drought, 6 out of 12 traits for post-submergence and drought showed significant interactions. In many cases where the stresses interacted, the strength of interactions varied across accessions. Hence, our results indicated a general pattern of response in most phenotypic traits to the different stresses and stress combinations, but it also indicated a natural genetic variation in the strength of these responses. Overall, our study provides a rich characterization of trait responses of Arabidopsis plants to sub-lethal abiotic stresses at the phenotypic level and can serve as starting point for further in-depth physiological research and plant modelling efforts

External Validation of a Tool Predicting 7-Year Risk of Developing Cardiovascular Disease, Type 2 Diabetes or Chronic Kidney Disease

BACKGROUND: Chronic cardiometabolic diseases, including cardiovascular disease (CVD), type 2 diabetes (T2D) and chronic kidney disease (CKD), share many modifiable risk factors and can be prevented using combined prevention programs. Valid risk prediction tools are needed to accurately identify individuals at risk. OBJECTIVE: We aimed to validate a previously developed non-invasive risk prediction tool for predicting the combined 7-year-risk for chronic cardiometabolic diseases. DESIGN: The previously developed tool is stratified for sex and contains the predictors age, BMI, waist circumference, use of antihypertensives, smoking, family history of myocardial infarction/stroke, and family history of diabetes. This tool was externally validated, evaluating model performance using area under the receiver operating characteristic curve (AUC)-assessing discrimination-and Hosmer-Lemeshow goodness-of-fit (HL) statistics-assessing calibration. The intercept was recalibrated to improve calibration performance. PARTICIPANTS: The risk prediction tool was validated in 3544 participants from the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). KEY RESULTS: Discrimination was acceptable, with an AUC of 0.78 (95% CI 0.75-0.81) in men and 0.78 (95% CI 0.74-0.81) in women. Calibration was poor (HL statistic: p < 0.001), but improved considerably after intercept recalibration. Examination of individual outcomes showed that in men, AUC was highest for CKD (0.85 [95% CI 0.78-0.91]) and lowest for T2D (0.69 [95% CI 0.65-0.74]). In women, AUC was highest for CVD (0.88 [95% CI 0.83-0.94)]) and lowest for T2D (0.71 [95% CI 0.66-0.75]). CONCLUSIONS: Validation of our previously developed tool showed robust discriminative performance across populations. Model recalibration is recommended to account for different disease rates. Our risk prediction tool can be useful in large-scale prevention programs for identifying those in need of further risk profiling because of their increased risk for chronic cardiometabolic diseases

External Validation of a Tool Predicting 7-Year Risk of Developing Cardiovascular Disease, Type 2 Diabetes or Chronic Kidney Disease

BACKGROUND: Chronic cardiometabolic diseases, including cardiovascular disease (CVD), type 2 diabetes (T2D) and chronic kidney disease (CKD), share many modifiable risk factors and can be prevented using combined prevention programs. Valid risk prediction tools are needed to accurately identify individuals at risk. OBJECTIVE: We aimed to validate a previously developed non-invasive risk prediction tool for predicting the combined 7-year-risk for chronic cardiometabolic diseases. DESIGN: The previously developed tool is stratified for sex and contains the predictors age, BMI, waist circumference, use of antihypertensives, smoking, family history of myocardial infarction/stroke, and family history of diabetes. This tool was externally validated, evaluating model performance using area under the receiver operating characteristic curve (AUC)-assessing discrimination-and Hosmer-Lemeshow goodness-of-fit (HL) statistics-assessing calibration. The intercept was recalibrated to improve calibration performance. PARTICIPANTS: The risk prediction tool was validated in 3544 participants from the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). KEY RESULTS: Discrimination was acceptable, with an AUC of 0.78 (95% CI 0.75-0.81) in men and 0.78 (95% CI 0.74-0.81) in women. Calibration was poor (HL statistic: p < 0.001), but improved considerably after intercept recalibration. Examination of individual outcomes showed that in men, AUC was highest for CKD (0.85 [95% CI 0.78-0.91]) and lowest for T2D (0.69 [95% CI 0.65-0.74]). In women, AUC was highest for CVD (0.88 [95% CI 0.83-0.94)]) and lowest for T2D (0.71 [95% CI 0.66-0.75]). CONCLUSIONS: Validation of our previously developed tool showed robust discriminative performance across populations. Model recalibration is recommended to account for different disease rates. Our risk prediction tool can be useful in large-scale prevention programs for identifying those in need of further risk profiling because of their increased risk for chronic cardiometabolic diseases

Effects of sub-lethal single, simultaneous, and sequential abiotic stresses on phenotypic traits of Arabidopsis thaliana

Plant responses to abiotic stresses are complex and dynamic, and involve changes in different traits, either as the direct consequence of the stress, or as an active acclimatory response. Abiotic stresses frequently occur simultaneously or in succession, rather than in isolation. Despite this, most studies have focused on a single stress and single or few plant traits. To address this gap, our study comprehensively and categorically quantified the individual and combined effects of three major abiotic stresses associated with climate change (flooding, progressive drought and high temperature) on 12 phenotypic traits related to morphology, development, growth and fitness, at different developmental stages in four Arabidopsis thaliana accessions. Combined sub-lethal stresses were applied either simultaneously (high temperature and drought) or sequentially (flooding followed by drought). In total, we analyzed the phenotypic responses of 1782 individuals across these stresses and different developmental stages. Overall, abiotic stresses and their combinations resulted in distinct patterns of effects across the traits analyzed, with both quantitative and qualitative differences across accessions. Stress combinations had additive effects on some traits, whereas clear positive and negative interactions were observed for other traits: 9 out of 12 traits for high temperature and drought, 6 out of 12 traits for post-submergence and drought showed significant interactions. In many cases where the stresses interacted, the strength of interactions varied across accessions. Hence, our results indicated a general pattern of response in most phenotypic traits to the different stresses and stress combinations, but it also indicated a natural genetic variation in the strength of these responses. Overall, our study provides a rich characterization of trait responses of Arabidopsis plants to sub-lethal abiotic stresses at the phenotypic level and can serve as starting point for further in-depth physiological research and plant modelling efforts