Story Based Learning: A Student Centred Practice-Oriented Learning Strategy

Story based learning (SBL) has evolved as a way to promote quality in nursing education by assisting faculty to develop a student-centred learning environment. SBL is a teaching/learning strategy that also strengthens learners’ capacities to provide quality nursing care. Health professional education has been identified as a key contributor to advancing quality care. Key documents identify the pillars of quality health professional education as client–centred care, inter-professional education, teamwork and collaborative learning, knowledge mobilization and evidence-based practice, awareness of the limits of one’s knowledge as a foundation for reflective practice and life-long learning, and mastery of a field of practice. SBL incorporates elements of problem-based learning, case method teaching, and narrative pedagogy. The student-centred orientation of SBL aligns with the philosophical principles of client-centred nursing: respect for lived experience, participatory dialogue, and critical appraisal of health–related contexts. After providing an overview of SBL, we discuss the power of stories to engage learners in focused practice learning. We show how SBL sensitizes learners to: identify learning needs, develop information literacy, and recognize ethical, personal, interpersonal, and health team issues. We address how SBL fosters collaborative and participatory learning. Through a nursing lens learners using SBL identify a focus for nursing action, a process for negotiating nursing care, and appropriate nursing supports. The SBL process concludes with learners reflecting on what they have learned about learning and nursing. SBL is designed to develop in learners a habit of mind for clinical reasoning, reflective practice, and the delivery of quality nursing care. _________________ L’apprentissage au moyen de récits (AMR) est devenu une manière de favoriser la qualité de la formation en sciences infirmières en amenant le corps professoral à créer un environnement d’apprentissage centré sur l’étudiant(e). L’AMR est une stratégie d’enseignement et d’apprentissage qui renforce également les capacités des apprenants à offrir des soins infirmiers de qualité. La formation des professionnels de la santé constitue un élément essentiel pour l’amélioration de la qualité des soins. Les piliers d’une formation de qualité pour les professionnels de la santé ont été présentés dans des documents clés comme étant des soins centrés sur le client, une formation interprofessionnelle, un travail d’équipe et un apprentissage collaboratif , la mobilisation du savoir et la pratique fondée sur des résultats probants, la conscience des limites de son savoir comme fondement d’une pratique réflexive et d’un apprentissage continu, ainsi que la maîtrise d’un domaine de pratique. L’AMR intègre des éléments de l’apprentissage par problèmes, de la méthode d’ études de cas et de la pédagogie narrative. Le fait que l’AMR soit centré sur l’étudiant(e) cadre avec les principes philosophiques des soins infirmiers centrés sur le client : le respect de l’expérience vécue, le dialogue participatif et l’évaluation critique des contextes liés à la santé. Après avoir donné un aperçu de l’AMR, nous discutons du pouvoir des récits à engager les apprenants dans un apprentissage orienté vers la pratique. Nous présentons la manière dont l’AMR sensibilise les apprenants à identifier les besoins d’apprentissage, à développer une maîtrise de l’information et à reconnaître les questions éthiques, personnelles, interpersonnelles et liées à l’équipe de santé. Nous abordons la manière dont l’AMR favorise l’apprentissage collaboratif et participatif. À partir d’une perspective infirmière, les apprenants qui utilisent l’AMR déterminent une orientation pour l’intervention infirmière, un processus de négociation des soins infirmiers et les sources de soutien appropriées. Le processus d’AMR se termine en amenant les apprenants à réfléchir à ce qu’ils ont appris sur l’apprentissage et sur les sciences infirmières. L’AMR est conçu pour que les apprenants développent une habitude de la pensée pour le raisonnement clinique, la pratique réflexive et la prestation de soins infirmiers de qualité

Is birthweight associated with total and aggressive/lethal prostate cancer risks? A systematic review and meta-analysis

BACKGROUND: It has been hypothesised that intrauterine exposures are important for subsequent prostate cancer risk. Prior epidemiological studies have used birthweight as a proxy of cumulative intrauterine exposures to test this hypothesis, but results have been inconsistent partly because of limited statistical power. METHODS: We investigated birthweight in relation to prostate cancer in the Medical Research Council (MRC) National Survey of Health and Development (NSHD) using Cox proportional hazards models. We then conducted a meta-analysis of birthweight in relation to total and aggressive/lethal prostate cancer risks, combining results from the NSHD analysis with 13 additional studies on this relationship identified from a systematic search in four major scientific literature databases through January 2015. RESULTS: Random-effects models found that per kg increase in birthweight was positively associated with total (OR=1.02, 95% confidence interval (95% CI)=1.00, 1.05; I(2)=13%) and aggressive/lethal prostate cancer (OR=1.08, 95% CI=0.99, 1.19; I(2)=40%). Sensitivity analyses restricted to studies with birthweight extracted from medical records demonstrated stronger positive associations with total (OR=1.11, 95% CI=1.03, 1.19; I(2)=0%) and aggressive/lethal (OR=1.37, 95% CI=1.09, 1.74; I(2)=0%) prostate cancer. These studies heavily overlapped with those based in Nordic countries. CONCLUSIONS: This study provides evidence that heavier birthweight may be associated with modest increased risks of total and aggressive/lethal prostate cancer, which supports the hypothesis that intrauterine exposures may be related to subsequent prostate cancer risks

Producing Flexible Nurses: How Institutional Texts Organize Nurses’ Experiences of Learning to Work on Redesigned Nursing Teams (Préparer des infirmières polyvalentes : comment des documents officiels orientent les expériences d’apprentissage des infirmières en fonction du travail au sein d’équipes reconfigurées)

The purpose of this qualitative research was to utilize an Institutional Ethnographic (IE) lens to trace how various institutional (regulatory, educational, union, governmental, or health authority) texts and resources organize baccalaureate (RN) and diploma (vocational or practical) nurses’ experiences of learning to practice on acute care teams. Functional care models have been introduced in acute care, creating RN-LPN-health care aide (HCA) teams in conjunction with expanded practice scopes for LPNs. Questions arise as to how nurses (RNs and LPNs) learn to work together on these intra-professional teams. Beginning from the standpoint of front-line workers provides an entry-point into understanding how institutional priorities organize the everyday work of people. Ten RNs and ten LPNs were interviewed in two small community acute care hospitals on Vancouver Island. More specifically, in observations and interviews we looked for ways in which textually mediated work processes (such as regulatory, governmental, health authority, and educational documents) and other conceptual resources influenced nurses’ understandings of nursing education and professional practice. This analysis focused on how RNs and LPNs learn to work on re-designed nursing teams and traced the textually mediated discourses that are organizing this learning in the context of recent changes to LPN education and nursing teams. Our findings highlight unarticulated nursing knowledge/thinking, and the textual insertion of functional, skilled and flexible worker discourses, which organize to blur practice between RN and LPNs making them [potentially] interchangeable in complex acute care contexts. This study, situated as one analysis among a larger study, shows the invisibility of nursing disciplinary and professional goals and knowledge in nurses’ talk, as RNs and LPNs re-learn and sustain nursing practice in ways that fulfill other institutional and organizational goals. This re-alignment has significant implications for educators in nursing programs, who participate in teaching within educational silos. This research has shown that the absence of clarity in functional roles (perpetuating role confusion and ambiguity) is purposeful, with the goal of creating flexible workers. Résumé Cette étude qualitative selon une perspective d’ethnographie institutionnelle, visait à examiner comment divers documents institutionnels (réglementaires, académiques, syndicaux, gouvernementaux ou d’autorité régionale) orientent les expériences d’apprentissage des infirmières formées au baccalauréat (IB, en anglais RN) et des infirmières diplômées de formation professionnelle ou pratique (ID, en anglais LPN), en fonction de la pratique au sein d’équipes de soins aigus . L’intégration de modèles fonctionnels dans les soins aigus a entraîné la création d’équipes d’IBs-IDs- aides-soignantes et élargi la portée de la pratique des IDs. De cette situation surgissent des questions, à savoir comment les infirmières (IBs et IDs) apprennent à collaborer dans ces équipes intraprofessionnelles. Aborder la question du point de vue des travailleuses de première ligne offre une ouverture vers la compréhension de la manière dont les priorités institutionnelles organisent le travail quotidien de ces personnes. Nous nous sommes entretenues avec dix IB et dix ID de deux petits hôpitaux communautaires de soins aigus, sur l’île de Vancouver. Plus spécifiquement, à travers les observations et les entrevues, nous avons cherché les moyens par lesquels les processus de travail inscrits dans des textes institutionnels (documentation réglementaire, gouvernementale, d’autorité régionale et académique), ainsi que d’autres ressources conceptuelles, ont influencé la compréhension des infirmières quant à la formation et à la pratique professionnelle en sciences infirmières. Cette analyse était centrée sur la manière dont les IB et les ID apprennent à travailler au sein d’équipes infirmières reconfigurées et ciblait les énoncés de textes qui orientent cet apprentissage, dans le contexte des récents changements dans la formation des ID et au sein des équipes dont elles font partie. Nos résultats soulignent un savoir/ une pensée infirmière inexprimée et l’intégration textuelle d’un discours de travail fonctionnel, compétent et polyvalent qui contribuent à brouiller les pratiques entre les IB et les ID, les rendant [potentiellement] interchangeables en contexte de soins aigus complexes. Cette étude, qui ne représente qu’une analyse d’une étude plus large, démontre l’invisibilité de la discipline infirmière et des objectifs et savoirs professionnels dans le discours des infirmières, alors que les IB et les ID réapprennent et maintiennent une pratique infirmière qui répond à d’autres objectifs institutionnels et organisationnels. Cet ajustement a d’importantes répercussions pour les enseignantes des programmes de soins et sciences infirmières, qui évoluent de manière parallèle dans des établissements d’enseignement. Cette recherche démontre que l’absence de clarté dans les rôles fonctionnels (qui maintient la confusion de rôle et l’ambiguïté) est délibérée et vise à former des travailleuses polyvalentes

Strengthening the global system of protected areas post-2020: A perspective from the IUCN World Commission on Protected Areas

Protected areas are the cornerstones of biodiversity conservation and have never been more relevant than at the present time when the world is facing both a biodiversity and a climate change crisis. The International Union for Conservation of Nature (IUCN) World Commission on Protected Areas (WCPA) has been helping to set global standards and best practice guidelines in protected area planning and management for 60 years. Following this guidance, many countries have made significant progress toward their Aichi Target 11 commitments under the Convention on Biological Diversity (CBD). The global community will be coming together at the 15th Conference of the Parties of the CBD to set new biodiversity conservation targets for the next decade, as milestones to 2050 and a vision of “a world living in harmony with nature.” This paper lays out the WCPA perspective on priorities for supporting effective protected and conserved areas for the post-2020 era

The sediment carbon stocks of intertidal seagrass meadows in Scotland

Seagrasses are highly productive ecosystems and hotspots for biodiversity, providing a plethora of benefits to the environment and to people. Their value in sequestering and storing carbon is increasingly being recognised, as the world searches for ways to mitigate the effects and slow the pace of climate change. However, many uncertainties remain, with basic information such as average carbon stocks, variability and species-specific differences missing for many regions. This study evaluates, for the first time, the carbon storage capacity of Zostera noltii and Zostera marina from intertidal seagrass meadows in Scotland. Sediment carbon stocks in the top 50 cm from vegetated and reference unvegetated plots were quantified at 10 estuaries distributed along the Scottish east and west coasts. The organic carbon stocks in the top 50 cm of the seagrass sediment ranged from a minimum of 14.94 Mg C ha−1 at the Moray Firth to a maximum of 105.72 Mg C ha−1 at the Firth of Forth, with a mean (±SD) of 54.79 ± 35.02 Mg C ha−1 across the 10 estuaries sampled. Moreover, seagrass areas showed enhanced carbon storage compared to reference unvegetated ones, however this was highly variable across depth, and among sites and estuaries. This paper addresses key gaps in knowledge concerning the role of intertidal Scottish seagrass meadows as carbon sinks and discusses the implication of this emerging information for their effective management and conservation

Certification in molecular pathology in the united states: An update from the association for molecular pathology training and education committee

The past 25 years have witnessed the field of molecular pathology evolving from an imprecisely defined discipline to a firmly established medical subspecialty that plays an essential role in patient care. During this time, the training, certification, and licensure requirements for directing and performing testing in a molecular pathology or molecular diagnostics laboratory have become better defined. The purpose of this document is to describe the various board certifications available to individuals seeking certification in molecular diagnostics at the level of laboratory director, supervisor, or technologist. Several national organizations offer certification in molecular pathology or molecular diagnostics for doctoral-level clinical scientists to function as the director of a molecular diagnostics laboratory. Furthermore, 12 states and Puerto Rico require licensing of medical technologists, including those working in molecular diagnostic laboratories. The information provided here updates a 2002 document by the Training and Education Committee of the Association for Molecular Pathology and has been expanded to include certification and licensing requirements for laboratory technologists

Population Genomics of the Immune Evasion (var) Genes of Plasmodium falciparum

Var genes encode the major surface antigen (PfEMP1) of the blood stages of the human malaria parasite Plasmodium falciparum. Differential expression of up to 60 diverse var genes in each parasite genome underlies immune evasion. We compared the diversity of the DBLα domain of var genes sampled from 30 parasite isolates from a malaria endemic area of Papua New Guinea (PNG) and 59 from widespread geographic origins (global). Overall, we obtained over 8,000 quality-controlled DBLα sequences. Within our sampling frame, the global population had a total of 895 distinct DBLα “types” and negligible overlap among repertoires. This indicated that var gene diversity on a global scale is so immense that many genomes would need to be sequenced to capture its true extent. In contrast, we found a much lower diversity in PNG of 185 DBLα types, with an average of approximately 7% overlap among repertoires. While we identify marked geographic structuring, nearly 40% of types identified in PNG were also found in samples from different countries showing a cosmopolitan distribution for much of the diversity. We also present evidence to suggest that recombination plays a key role in maintaining the unprecedented levels of polymorphism found in these immune evasion genes. This population genomic framework provides a cost effective molecular epidemiological tool to rapidly explore the geographic diversity of var genes

Calcitonin Receptor Neurons in the Mouse Nucleus Tractus Solitarius Control Energy Balance via the Non-aversive Suppression of Feeding.

To understand hindbrain pathways involved in the control of food intake, we examined roles for calcitonin receptor (CALCR)-containing neurons in the NTS. Ablation of NTS Calcr abrogated the long-term suppression of food intake, but not aversive responses, by CALCR agonists. Similarly, activating CalcrNTS neurons decreased food intake and body weight but (unlike neighboring CckNTS cells) failed to promote aversion, revealing that CalcrNTS neurons mediate a non-aversive suppression of food intake. While both CalcrNTS and CckNTS neurons decreased feeding via projections to the PBN, CckNTS cells activated aversive CGRPPBN cells while CalcrNTS cells activated distinct non-CGRP PBN cells. Hence, CalcrNTS cells suppress feeding via non-aversive, non-CGRP PBN targets. Additionally, silencing CalcrNTS cells blunted food intake suppression by gut peptides and nutrients, increasing food intake and promoting obesity. Hence, CalcrNTS neurons define a hindbrain system that participates in physiological energy balance and suppresses food intake without activating aversive systems

Walk to me when I smile, step back when I’m angry: emotional faces modulate whole-body approach–avoidance behaviors

Facial expressions are potent social cues that can induce behavioral dispositions, such as approach–avoidance tendencies. We studied these tendencies by asking participants to make whole-body forward (approach) or backward (avoidance) steps on a force plate in response to the valence of social cues (happy or angry faces) under affect-congruent and incongruent mappings. Posturographic parameters of the steps related to automatic stimulus evaluation, step initiation (reaction time), and step execution were determined and analyzed as a function of stimulus valence and stimulus–response mapping. The main result was that participants needed more time to initiate a forward step towards an angry face than towards a smiling face (which is evidence of a congruency effect), but with backward steps, this difference failed to reach significance. We also found a reduction in spontaneous body sway prior to the step with the incongruent mapping. The results provide a crucial empirical link between theories of socially induced action tendencies and theories of postural control and suggest a motoric basis for socially guided motivated behavior