The gown and the korowai: Maori doctoral students and the spatial organization of academic knowledge

This paper draws on 38 student interviews carried out in the course of the team research project Teaching and Learning in the Supervision of Māori Doctoral Students. Māori doctoral thesis work takes place in the intersections between the Māori (tribal) world of identifications and obligations, the organisational and epistemological configurations of academia, and the bureaucratic requirements of funding or employing bureaucracies. To explore how students accommodate cultural, academic and bureaucratic demands, we develop analytical tools combining three intellectual traditions: Māori educational theory, Bernstein’s sociology of the academy, and Lefebvre’s conceptual trilogy of perceived, conceived, and lived space

An evaluation of the success of the ‘Heart-Fit’ phase IV cardiac rehabilitation programme in Newark, Nottinghamshire: a mixed-method approach

Cardiovascular disease (CVD) is the most common cause of death in England and Wales, with cardiac rehabilitation being one of the best examples of long term condition management for CVD patients (Pluss et al., 2011: Clinical Rehabilitation, 25, 79-87). Phase IV cardiac rehabilitation involves the long term maintenance of health in the form of exercise programmes, such as ‘Heart-Fit’. It has been recommended that mixed methods are required to evaluate CVD prevention programmes (National Institute for Health and Clinical Excellence, 2010), therefore this case study aimed to evaluate the success of a phase IV cardiac rehabilitation programme, both qualitatively and quantitatively, outlining the impact on participants. After ethical clearance from an institutional committee, eleven members (age = 71.2, stature = 1.71m, weight = 79.8kg) of the programme (male = 6, female = 5) volunteered to take part in the study. For eligibility purposes, participants attended the programme once a week. Physical measurements of blood pressure (BP), resting heart rate (RHR), Body Mass Index (BMI) were recorded before and after a twelve week intervention period. Both physical activity levels and smoking status were also recorded by a lifestyle questionnaire. Two focus groups (n = 6 & 5) were held to gain participant perceptions on their experiences relating to the performance of the programme. Paired-sample t-tests indicated statistically significant differences (P = 0.05) pre and post intervention. Using a process of thematic analysis, participants revealed six main themes as being important factors during the 12-week programme. These included the instructor’s influence, the social nature of the group, the availability of clinical observation, psychological development and the perceived beneficial physical improvements made. The CVD risk factors influenced by the programme, in accordance to past literature, were systolic and diastolic BP and BMI. Similar themes have been identified in studies that have evaluated the effectiveness of other exercise referral schemes. Qualitative data collection should be considered alongside quantitative measures in evaluations of similar interventions. Future phase IV cardiac rehabilitation programmes need to gain a greater insight into the patient experience. This will enable health planners and policy makers to generate a sense of context on how these programmes operate at local levels and develop models of best-practice

A social constructionist analysis of talk in episodes of psychiatric student nurse-psychiatric client community clinic based interaction.

Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2007.The study seeks to explore and to offer a critical account for the 'discursive doings' of student psychiatric nmsing practice as they are jointly constructed in the episodes of conversation between the nmse and client-speakers within the context of the communitybased psychiatric clinic. The study is built around a social constructionist framework and is concerned with the analysis of the discursive activities present within seven (7) transttibed, audio-recordings of student nurse-psychiatric client interactions. A thick and sometimes critical description of three of the contextual forces back grounding/foregrounding the discursive processes of psychiatric nursing is given. These include the public health psychiatric care context, the problem-solving approach of the undergraduate psychiatric nursing curriculum and the assumption and effects of modem psychiatric nursing theory. The first level of analysis is an aspect of the methodology and offers a descriptive and interpretive analysis of the talk in the texts. Various conversational discourse analytic tools were used here to transform talk into text and to develop the starting point for the subsequent positioning theory analysis. The second level of analysis is a positioning theory analysis of happenings within these texts. Some of the textual descriptions generated in the first level of analysis are used to illuminate and to add substance to the accounts of these positioning theory happenings. The analysis has shown that from a social constructionist positioning perspective, the unfolding nurse-client dialogue in these texts operates in four potentially distinct ways - highlighting, herding, hectoring and heeding - with specific effects for their going on together in conditions of relationship. These ways of talking are shown to be contrary to the person-eentered rhetoric of modem psychiatric nursing and more aligned with the bio-medical format of talk in helping contexts. Can these activities be dismissed as non-nursing activities? The implications for a modem psychiatric nursing theory that holds the person-centred approach to be its quintessential essence are considered and a number of ideas for how client-authorised expressions may be jointly manifest in conversations situated in this practice context are offered

Supervision of Maori doctoral students: A descriptive report

This report follows up a previous paper that outlined the goals and plans of a research project that focused on both theoretical and cultural questions regarding the supervisory process for Māori doctoral students (McKinley, Grant, Middleton, Irwin, & Williams, 2007). The major goal of the project is to enhance understanding of the teaching and learning process of supervision for students and supervisors, particularly around issues of culture that arise in research methodologies and practices. This paper reports on the completed project by providing further operational background, design features, the nature of the student and supervisor samples and a summary of interview findings. The results show that there are indeed distinctive issues arising within the supervision of Māori doctoral students. Some of these are to do with both pleasures and challenges found in the supervision relationship, while others relate to the kinds of projects the students undertake. Many projects for example, push at the disciplinary boundaries of Western knowledge and are often rooted in a political desire to enhance the everyday lives of Māori. Yet others are connected to identity formation processes that concern many Māori during their years as doctoral students. A central message for supervisors from this work is that the supervision of Māori doctoral students may require unfamiliar forms of engagement but that these are likely to be deeply rewarding in many different ways

A qualitative study of senior hospital managers' views on current and innovative strategies to improve hand hygiene

Background Despite universal recognition of the importance of hand hygiene in reducing the incidence of healthcare associated infections, health care workers’ compliance with best practice has been sub-optimal. Senior hospital managers have responsibilities for implementing patient safety initiatives and are therefore ideally placed to provide suggestions for improving strategies to increase hand hygiene compliance. This is an under-researched area, accordingly the aim of this study was to identify senior hospital managers’ views on current and innovative strategies to improve hand hygiene compliance. Methods Qualitative design comprising face-to-face interviews with thirteen purposively sampled senior managers at a major teaching and referral hospital in Sydney, Australia. Data were analysed thematically. Results Seven themes emerged: culture change starts with leaders, refresh and renew the message, connect the five moments to the whole patient journey, actionable audit results, empower patients, reconceptualising non-compliance and start using the hammer. Conclusions To strengthen hand hygiene programmes, strategies based on the five moments of hand hygiene should be tailored to specific roles and settings and take into account the whole patient journey including patient interactions with clinical and non-clinical staff. Senior clinical and non-clinical leaders should visibly champion and mandate best practice initiatives and articulate that hand hygiene non-compliance is culturally and professionally unacceptable to the organization. Strategies that included a disciplinary component and which conceptualise hand hygiene non-compliance as a patient safety error may be worth evaluating in terms of staff acceptability and effectiveness

Let's Exploit Available Knowledge on Vegetation Fluorescence

The potential to measure vegetation fluorescence from space (1) and to derive from it direct information on the gross primary productivity (GPP) of terrestrial ecosystems is probably the most thrilling development in remote sensing and global ecology of recent years, as it moves Earth observation techniques from the detection of canopy biophysics (e.g., fraction of absorbed radiation) and biochemistry (chlorophyll and nitrogen content) to the realm of ecosystem function. The existence of a functional relationship between fluorescence and photosynthesis has been elucidated over the last decade by several laboratories, notably as part of the preliminary studies of the European Space Agency Fluorescence Explorer (FLEX) Earth Explorer Mission. The empirical observation presented by Guanter et al. (2) of a linear relationship between fluorescence radiance and GPP, however, provides the first experimental confirmation of the feasibility of the approach already thoroughly tested at leaf levelat the desired scale, despite the confounding effects associated with the satellite detection of such a faint signal. A word of clarification is needed here. The use of fluorescence as a probe of leaf photochemistry has been a staple of plant ecophysiology for decades, rooted in a sound understanding of photosynthetic energy dissipation. However, most past studies had to rely for the interpretation of results on active (pulse-saturated) techniques, making them unsuitable for remote-sensing applications. Over recent years, however, novel process based models have been developed for the interpretation of steady-state, solar-induced fluorescence at the leaf to canopy scale (3). We are therefore in a position to move beyond the mere empirical observation of an association between GPP and fluorescence radiance. In particular, Guanter et al. (2) base their analysis on the assumption of a constant ratio between photosynthetic and fluorescence light use efficiencies (equation 3 in ref. 2).We know, however, that the ratio is not constant, but changes widely in response to light, CO2, stomatal limitations, and extreme stress (4, 5). Whats more, we can make sense of such changes, thus extracting valuable information from the very scatter that is apparent in their data. However, this process will require the availability of more tailored instruments, such as the one planned for the FLEX mission. As already stressed by Guanter et al. (2), the spatial resolution of the Global Ozone Monitoring Experiment-2 sensor (40 80 km) makes it difficult to compare meaningfully the fluorescence signal with ground measurements, when only 6070% of the footprint consists of the desired land-cover type (table S1 in ref. 2), suggesting that this could be largely responsible for the low signals observed in European grasslands. Moreover, the overpass time of the MetOp-A satellite (9:30 AM) implies that fluorescence is generally measured under light-limiting conditions, when fluorescence is only marginally affected by stomatal closure even under stress conditions. This result could explain the seasonal mismatch with daily GPP observed in natural ecosystems in the absence of irrigation (figure 4 in ref. 2). We hope, therefore, that this welcome contribution to this fast-advancing field will help demonstrate the potential of the new technique, and pave the way for more refined studies under both a technological and scientific point of view

Educational outreach visits to improve venous thromboembolism prevention in hospitalised medical patients: a prospective before-and-after intervention study

BACKGROUND: Despite the availability of evidence-based guidelines on venous thromboembolism (VTE) prevention clinical audit and research reveals that hospitalised medical patients frequently receive suboptimal prophylaxis. The aim of this study was to evaluate the acceptability, utility and clinical impact of an educational outreach visit (EOV) on the provision of VTE prophylaxis to hospitalised medical patients in a 270 bed acute care private hospital in metropolitan Australia. METHODS: The study used an uncontrolled before-and-after design with accompanying process evaluation. The acceptability of the intervention to participants was measured with a post intervention survey; descriptive data on resource use was collected as a measure of utility; and clinical impact (prophylaxis rate) was assessed by pre and post intervention clinical audits. Doctors who admit >40 medical patients each year were targeted to receive the intervention which consisted of a one-to-one educational visit on VTE prevention from a trained peer facilitator. The EOV protocol was designed by a multidisciplinary group of healthcare professionals using social marketing theory. RESULTS: Nineteen (73%) of 26 eligible participants received an EOV. The majority (n = 16, 85%) felt the EOV was effective or extremely effective at increasing their knowledge about VTE prophylaxis and 15 (78%) gave a verbal commitment to provide evidence-based prophylaxis. The average length of each visit was 15 minutes (IQ range 15 to 20) and the average time spent arranging and conducting each visit was 92 minutes (IQ range 78 to 129). There was a significant improvement in the proportion of medical patients receiving appropriate pharmacological VTE prophylaxis following the intervention (54% to 70%, 16% improvement, 95% CI 5 to 26, p = 0.004). CONCLUSIONS: EOV is effective at improving doctors’ provision of pharmacological VTE prophylaxis to hospitalised medical patients. It was also found to be an acceptable implementation strategy by the majority of participants; however, it was resource intensive requiring on average 92 minutes per visit

Diurnal and Directional Responses of Chlorophyll Fluorescence and the PRI in a Cornfield

Determining the health and vigor of vegetation using high spectral resolution remote sensing is an important goal which has application to monitoring agriculture and ecosystem productivity and carbon exchange. Two spectral indices used to assess whether vegetation is performing near-optimally or exhibiting symptoms of environmental stress (e.g., drought or nutrient deficiency, non-optimal temperatures, etc.) are the Photochemical Reflectance Index (PRI) and solar-induced red and far-red Chlorophyll Fluorescence (Fs). Both the PRI and Fs capture the dynamics of photoprotection mechanisms within green foliage: the PRI is based on the association of the reflected radiation in the green spectrum with the xanthophyll cycle, whereas Fs measures the emitted radiation in the red and far-red spectrum. Fs was determined from retrievals in the atmospheric oxygen absorption features centered at 688 and 760 nm using a modified Fraunhofer Line Depth (FLD) method. We previously demonstrated diurnal and seasonal PRI differences for sunlit vs. shaded foliage in a conifer forest canopy, as expressed in the hotspot and darkspot of the Bidirectional Reflectance Function (BRF). In a USDA-ARS experimental field site located in Beltsville, MD, USA, measurements were acquired over a corn crop from a nadir view in 2008 with an ASD FieldSpec Pro (Analytical Spectral Devices, Inc., Boulder, CO, USA) to study the behavior of the PRI for sunlit and shaded foliage as captured in reflectance variations associated with the BRF, in a I m tall canopy in the vegetative growth stage. Those observations were compared to simulations obtained from two radiative transfer models. Measurements were then acquired to examine whether the PRI and Fs were influenced by view zenith and azimuth geometries at different times of day. Those measurements were made in 2010 with the Ocean Optics USB4000 Miniature Fiber Optic Spectrometer (Ocean Optics Inc., Dunedin, Florida, USA) at several times during the day on multiple days throughout the growing season. We found that the PRI consistently had higher values, indicating lower stress, in the BRF darkspot associated with shaded foliage than in the hotspot associated with sunlit foliage. We also found that Fs exhibited differences associated with sunlit and shaded canopy sectors, which were most pronounced for the red/far-red Fs ratio. Values indicated greater physiological stress in afternoons compared to mornings, and in the early senescent canopy as compared to the vegetative growth stage, BRFs for both the PRI and the red/far-red Fs ratio were bowl-shaped for the full azimuth sweep of the canopy. These two spectral indices (PRI, Fs ratio) provided complementary information on the photosynthetic function of the corn canopy

Knowledge, attitudes, beliefs and behaviour intentions for three bowel management practices in intensive care: effects of a targeted protocol implementation for nursing and medical staff.

Background Bowel management protocols have the potential to minimize complications for critically ill patients. Targeted implementation can increase the uptake of protocols by clinicians into practice. The theory of planned behaviour offers a framework in which to investigate clinicians’ intention to perform the behaviour of interest. This study aimed to evaluate the effect of implementing a bowel management protocol on intensive care nursing and medical staffs’ knowledge, attitude, subjective norms, perceived behavioural control, behaviour intentions, role perceptions and past behaviours in relation to three bowel management practices. Methods A descriptive before and after survey using a self-administered questionnaire sent to nursing and medical staff working within three intensive care units before and after implementation of our bowel management protocol (pre: May – June 2008; post: Feb – May 2009). Results Participants had significantly higher knowledge scores post-implementation of our protocol (pre mean score 17.6; post mean score 19.3; p = 0.004). Post-implementation there was a significant increase in: self-reported past behaviour (pre mean score 5.38; post mean score 7.11; p = 0.002) and subjective norms scores (pre mean score 3.62; post mean score 4.18; p = 0.016) for bowel assessment; and behaviour intention (pre mean score 5.22; post mean score 5.65; p = 0.048) for administration of enema. Conclusion This evaluation, informed by the theory of planned behaviour, has provided useful insights into factors that influence clinician intentions to perform evidence-based bowel management practices in intensive care. Addressing factors such as knowledge, attitudes and beliefs can assist in targeting implementation strategies to positively affect clinician behaviour change. Despite an increase in clinicians’ knowledge scores, our implementation strategy did not, however, significantly change clinician behaviour intentions for all three bowel management practices. Further research is required to explore the influence of opinion leaders and organizational culture on clinicians’ behaviour intentions related to bowel management for intensive care patients

Using EO-1 Hyperion to Simulate HyspIRI Products for a Coniferous Forest: The Fraction of PAR Absorbed by Chlorophyll (fAPAR(sub chl)) and Leaf Water Content (LWC)

This study presents development of prototype products for terrestrial ecosystems in preparation for the future imaging spectrometer planned for the Hyperspectral Infrared Imager (HyspIRI) mission. We present a successful demonstration example in a coniferous forest of two product prototypes: fraction of photosynthetic active radiation (PAR) absorbed by chlorophyll of a canopy (fAPAR(sub chl)) and leaf water content (LWC), for future HyspIRI implementation at 60 m spatial resolution. For this, we used existing 30 m resolution imaging spectrometer data available from the Earth Observing One (EO-1) Hyperion satellite to simulate and prototype the level one radiometrically corrected radiance (L1R) images expected from the HyspIRI visible through shortwave infrared spectrometer. The HyspIRI-like images were atmospherically corrected to obtain surface reflectance, and spectrally resampled to produce 60 m reflectance images for wavelength regions that were comparable to all seven of the MODerate resolution Imaging Spectroradiometer (MODIS) land bands. Thus, we developed MODIS-like surface reflectance in seven spectral bands at the HyspIRI-like spatial scale, which was utilized to derive fAPARchl and LWC with a coupled canopy-leaf radiative transfer model (PROSAIL2) for the coniferous forest[1]. With this study, we provide additional evidence that the fAPARchl product is more realistic for describing the physiologically active canopy than the traditional fAPAR parameter for the whole canopy (fAPAR(sub canopy)), and thus should replace it in ecosystem process models to reduce uncertainties in terrestrial carbon cycle studies and ecosystem studies