521 research outputs found
âI Canât Go On, Iâll Go Onâ: Liminality in Undergraduate Writing
According to Jan Meyer and Ray Land (2006), along with being troublesome, integrative, transformative, and probably irreversible, threshold
concepts are characterized as liminal. Their liminal nature is summarized by Linda Adler- Kassner and Elizabeth Wardle (2016): âThreshold
concepts involve what the name impliesâ thresholds. But the movement
toward and the (hopeful) crossing of those thresholds isnât straightforward; instead, it happens in a two- steps- forward- one- step- back kind of
way as learners push against troublesome knowledgeâ (ix). Glynis Cousin
(2006) observes that the idea of liminal states aids âour understanding
of the conceptual transformations students undergoâ in challenging
learning situations, like the grasping of threshold concepts (4). And
yet, Ray Land, Julie Rattray, and Peter Vivian (2014) suggest that the
liminal space âhas remained relatively ill- defined, something of a âblack
boxâ within the conceptual framework of Threshold Conceptsâ (201).
This chapter focuses on this liminal space. Specifically, we wanted to
better understand the nature, occurrence, and impact of liminality in
undergraduate writing through the lens of threshold concepts of writing, through which those concepts could in turn provide an effective
theoretical and pedagogical framework for our particular context. Our
setting is a relatively new writing center (established 2011) in an Irish
university that has an undergraduate population of 10,050 students and
a postgraduate enrollment of 1,900. Following a presentation of our
distilled findings, we explore and contextualize one key action- oriented
insight about undergraduatesâ experiences with threshold concepts of
writing that emerged from the data, that of the coexistence of apparent liminality, a stage that can be paralyzing for students, and authentic
liminality, a stage that is important for students grappling with threshold
concepts and that is therefore productive and potentially transformative.
In the next section, we review literature that has contributed to these
ideas of liminality; following that review, we describe the research that
led us to these definition
When people living with dementia say ânoâ: negotiating refusal in the acute hospital setting.
A quarter of UK acute hospital beds are occupied by people living with dementia (PLWD). Concerns have been raised by both policy makers and carers about the quality of communication between hospital staff and PLWD. PLWD may experience communication impairments such as word finding difficulties, limited ability to construct coherent narratives and difficulties understanding others. Since much healthcare delivery occurs through talk, healthcare professionals (HCPs) and PLWD are likely to experience increased communication barriers. Consistent with this, HCPs report stress and reduced job satisfaction associated with difficulty communicating with PLWD. HCPs face these challenges whilst striving to deliver person-centred care, respecting the autonomy and wishes of the patient before them. However, best practice recommendations in the field tend not to be based on actual interactional evidence. This paper investigates recurring interactional difficulties around HCP requests to carry out health and social care tasks and subsequent reluctance or refusal on the part of PLWD. Using conversation analysis, we examined 41 video recordings of HCP/PLWD interactions collected across three acute inpatient wards. We identify both the nature of the refusals, and any mitigation offered, and explore the requests preceding them in terms of entitlement and contingency. We also explore the nature of HCP requests which precede PLWD agreement with a course of action. We conclude that several features of requests can be seen to precede acceptance, principally the use of higher entitlement requests, and the lowering of contingencies. Our findings underline the importance of examining the contextual interactional detail involved in the negotiation of healthcare, which here leads to an understanding of how design of HCP requests can impact on an important healthcare activity being carried out. They also emphasise the power of conversation analytic methods to identify areas of frequent interactional trouble in dementia care which have not previously been articulated
The VOICE study â a before and after study of a dementia communication skills training course
Background
A quarter of acute hospital beds are occupied by persons living with dementia, many of whom have communication problems. Healthcare professionals lack confidence in dementia communication skills, but there are no evidence-based communication skills training approaches appropriate for professionals working in this context. We aimed to develop and pilot a dementia communication skills training course that was acceptable and useful to healthcare professionals, hospital patients and their relatives.
Methods
The course was developed using conversation analytic findings from video recordings of healthcare professionals talking to patients living with dementia in the acute hospital, together with systematic review evidence of dementia communication skills training and taking account of expert and service-user opinion. The two-day course was based on experiential learning theory, and included simulation and video workshops, reflective diaries and didactic teaching. Actors were trained to portray patients living with dementia for the simulation exercises. Six courses were run between January and May 2017. 44/45 healthcare professionals attended both days of the course. Evaluation entailed: questionnaires on confidence in dementia communication; a dementia communication knowledge test; and participantsâ satisfaction. Video-recorded, simulated assessments were used to measure changes in communication behaviour.
Results
Healthcare professionals increased their knowledge of dementia communication (mean improvement 1.5/10; 95% confidence interval 1.0â2.0; p<0.001). Confidence in dementia communication also increased (mean improvement 5.5/45; 95% confidence interval 4.1â6.9; p<0.001) and the course was well-received. One month later participants reported using the skills learned in clinical practice. Blind-ratings of simulated patient encounters demonstrated behaviour change in taught communication behaviours to close an encounter, consistent with the training, but not in requesting behaviours.
Conclusion
We have developed an innovative, evidence-based dementia communication skills training course which healthcare professionals found useful and after which they demonstrated improved dementia communication knowledge, confidence and behaviour
âI canât say that anything has changedâ: parents of autistic young people (16â25âyears) discuss the impact of the Children and Families Act in England and Wales
IntroductionIn 2014, changes to special educational needs and disability (SEND) legislation were introduced in England and Wales. These reforms aimed for young people and their families to receive the help and support they need, have a say regarding their support needs, and achieve better outcomes.MethodsWe examine the views of parents of autistic young people (16â25 years) regarding the impact of the reforms, several years after their introduction. In total, 115 parents of autistic young people (16â25 years) in England and Wales took part in our research: 84 completed an online survey, one took part in an interview, and 30 participated in both the survey and interview. Quantitative data, collected via the online survey, were analyzed descriptively. Qualitative data, collected via the survey and interview, were analyzed using inductive thematic analysis.ResultsParents overwhelmingly reported that their experiences had not improved since the introduction of the SEND reforms. This experience impacted their own, and their childrenâs, wellbeing. Parents felt that the reforms were simply delaying the inevitable, and there was still limited support for them or their children as they transitioned to adulthood.DiscussionDespite promises of a radically different system, and the potential of these reforms, parents reported that little had changed for them or their children since the introduction of the Children and Families Act
A novel murine infection model for Shiga toxin-producing Escherichia coli
Enterohemorrhagic E. coli (EHEC) is an important subset of Shiga toxin-producing (Stx-producing) E. coli (STEC), pathogens that have been implicated in outbreaks of food-borne illness and can cause intestinal and systemic disease, including severe renal damage. Upon attachment to intestinal epithelium, EHEC generates attaching and effacing (AE) lesions characterized by intimate attachment and actin rearrangement upon host cell binding. Stx produced in the gut transverses the intestinal epithelium, causing vascular damage that leads to systemic disease. Models of EHEC infection in conventional mice do not manifest key features of disease, such as AE lesions, intestinal damage, and systemic illness. In order to develop an infection model that better reflects the pathogenesis of this subset of STEC, we constructed an Stx-producing strain of Citrobacter rodentium, a murine AE pathogen that otherwise lacks Stx. Mice infected with Stx-producing C. rodentium developed AE lesions on the intestinal epithelium and Stx-dependent intestinal inflammatory damage. Further, the mice experienced lethal infection characterized by histopathological and functional kidney damage. The development of a murine model that encompasses AE lesion formation and Stx-mediated tissue damage will provide a new platform upon which to identify EHEC alterations of host epithelium that contribute to systemic disease
The Effect of Processing and Seasonallity on the Iodine and Selenium Concentration of Cow's Milk Produced in Northern Ireland (NI): Implications for Population Dietary Intake
Cowâs milk is the most important dietary source of iodine in the UK and Ireland, and also contributes to dietary selenium intakes. The aim of this study was to investigate the effect of season, milk fat class (whole; semi-skimmed; skimmed) and pasteurisation on iodine and selenium concentrations in Northern Ireland (NI) milk, and to estimate the contribution of this milk to consumer iodine and selenium intakes. Milk samples (unpasteurised, whole, semi-skimmed and skimmed) were collected weekly from two large NI creameries between May 2013 and April 2014 and were analysed by inductively coupled plasma-mass spectrometry (ICP-MS). Using milk consumption data from the National Diet and Nutrition Survey (NDNS) Rolling Programme, the contribution of milk (at iodine and selenium concentrations measured in the present study) to UK dietary intakes was estimated. The mean ± standard deviation (SD) iodine concentration of milk was 475.9 ± 63.5 ”g/kg and the mean selenium concentration of milk was 17.8 ± 2.7 ”g/kg. Season had an important determining effect on the iodine, but not the selenium, content of cowâs milk, where iodine concentrations were highest in milk produced in spring compared to autumn months (534.3 ± 53.7 vs. 433.6 ± 57.8 ”g/kg, respectively; p = 0.001). The measured iodine and selenium concentrations of NI milk were higher than those listed in current UK Food Composition Databases (Food Standards Agency (FSA) (2002); FSA (2015)). The dietary modelling analysis confirmed that milk makes an important contribution to iodine and selenium intakes. This contribution may be higher than previously estimated if iodine and selenium (+25.0 and +1.1 ”g/day respectively) concentrations measured in the present study were replicable across the UK at the current level of milk consumption. Iodine intakes were theoretically shown to vary by season concurrent with the seasonal variation in NI milk iodine concentrations. Routine monitoring of milk iodine concentrations is required and efforts should be made to understand reasons for fluctuations in milk iodine concentrations, in order to realise the nutritional impact to consumers
Relationships between dental appearance, self-esteem, socio-economic status, and oral health-related quality of life in UK schoolchildren: A 3-year cohort study.
Objectives: To examine the relationships between dental appearance, characteristics of the individual and their environment, and oral health-related quality of life (OHQoL) in young people over time.
Methods: A total of 374 young people (122 boys, 252 girls) aged 11â12 years from seven different XX schools were recruited at baseline and 258 (78 boys, 180 girls) followed-up 3 years later, aged 14â15 years (69 per cent response rate). Participants completed a measure of OHQoL (CPQ11â14 ISF-16) and self-esteem (SE, CHQ-CF87). A clinical examination was undertaken, including clinician and self-assessed normative measures of need [Index of Orthodontic Treatment Need (IOTN)] and dental caries. The Index of Multiple Deprivation was used to indicate socio-economic status (SES).
Results: There was a general improvement between baseline and follow-up in the measures of malocclusion, as well as OHQoL. Multiple linear regression indicated that there were significant cross-sectional associations at baseline between OHQoL and SES (rho = â0.11; P = 0.006), SE (rho = â0.50; P < 0.001), and self-assessed IOTN (rho = 0.27; P < 0.001). There were significant longitudinal associations between the change in OHQoL and change in SE (rho = â0.46; P < 0.001) and change in the decayed, missing, or filled surfaces (rho = â0.24; P = 0.001). The mean improvement in the total CPQ11â14 ISF-16 score for those with a history of orthodontic treatment was 3.2 (SD = 6.9; P = 0.009) and 2.4 (SD = 8.8; P < 0.001) for those with no history of treatment. The difference was not statistically significant (P = 0.584).
Conclusions: OHQoL improved in young people over time, whether they gave a history of orthodontic treatment or not. Individual and environmental characteristics influence OHQoL and should be taken into account in future studies
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