Assessment of Practice in Pre-Registration Undergraduate Nursing Programmes. Phase 2 Evaluation: Survey of students’ and mentors’ experiences of grading student competence in practice.

Executive Summary Context Local and national concerns regarding competency in newly qualified practitioners provided the impetus for the undergraduate nursing programme team at Bournemouth University to radically change the practice assessment tool as part of a curriculum rewrite in 2005. Alongside the introduction of the new practice profile, an evaluation strategy was implemented with two stages; Phase One focused on year one of implementation and reported at the end of that year (2005-6). These findings were used to inform mentor education and to amend the tool for new students and those moving into year two. This phase used a qualitative approach to collect data from focus groups with students and mentors (Adult Branch only), and practice/HEI educators concerning their experiences of using the grading practice assessment scheme. Phase Two utilised the qualitative findings to develop a questionnaire survey. Questionnaires were selected as the research tool in order to access greater numbers of students and mentors from across all branch programmes. Education staff was not surveyed in this phase. Purpose and project aim The purpose of the project was to evaluate the impact of the new practice assessment scheme from the perspective of the users and to make suggestions to key stakeholders for quality improvement where necessary. Phase One of the evaluation involved small numbers and only Adult branch students; whilst the findings were informative, it seemed important to test these out on a wider sample. The aim of Phase Two of the grading practice evaluation was to explore: • mentor and student experiences of using the assessment tool across all nursing branches • the impact of quality assurance processes Pertinent literature An overview of the historical and current context of practice assessment for nurses in the UK was provided, including the policy literature from the statutory body. Research on practice assessment in nursing was found to be relatively limited particularly concerning the grading of practice. Key studies include Bondy (1983; 1984) and Hillegas & Valentine (1986) from the USA, Glover et al. (1997) from Australia; from the UK, Burns (1992) and Scammell et al. (2007). All studies had limitations but generally the notion of grading practice was well received by users; however there were concerns about quality assurance processes particularly around reliability as well as issues concerning mentor/practice assessor preparation. In light of an increased national emphasis on nurses’ competency in practice, empirical work that evaluates a new practice assessment initiative is timely. Whilst of value locally in terms of reviewing and improving processes, the findings may also interest colleagues elsewhere. Project design A questionnaire survey of mentors and year two and three nursing students was undertaken to investigate their experiences of using the grading practice assessment tool. All branches of nursing were successfully targeted for inclusion using convenience sampling, but no learning disability students opted to participate. Mentors were accessed via an annual mentor conference; students were accessed via tutor groups. 112 (86%) of the 130 mentors available, completed and returned the questionnaire. The branch representation was adult nursing (62.5%; n=70), Mental Health (21.4%; n=24), Child Health (17%; n=19) and Learning Disability (1.8%; n=2). Questionnaires were distributed to 210 students; 107 were completed (51% response). The sample comprised Adult branch (72%; n=77), Mental Health (19.6%; n=21) and Child Health students (8.4%; n=9). The response rate broadly reflected the proportion of students enrolled within each branch of the targeted cohorts. Most student respondents were undertaking year 3 of their programme (70.1%; n=73); the exception was Child Health where all students were undertaking year 2. As an evaluation study, formal ethical approval was not sought; however permission was granted to conduct the evaluation by the Associate Dean for Nursing, and the educational leads within placement areas. There was a project steering group with representatives of all parties including students and mentors; their role was to oversee the project process and to liase with colleagues within their organisations. Quantitative data was coded and inputted into the Statistical Package for the Social Sciences (SPSS for Windows version 15.0); where possible chi-square analysis was undertaken to explore whether the results were significant. Qualitative aspects of the questionnaire were transcribed and a content analysis was undertaken. Given the sample size, it is not possible to generalise from this evaluation. Others may judge transferability to other settings. In reviewing the findings, a number of limitations must be acknowledged. The most significant limitations are that no Learning Disability students opted to participate and the response rate generally from students was not as high as anticipated (51%). This is however a reasonable response rate for a questionnaire survey but if time had permitted, an extension to the convenience sampling may have been beneficial. Other limitations include the fact that findings were generated from reported practice and, as such, may be subject to distortions of memory. Findings Five key areas emerged from the findings: questions around mentor education indicated that participation in updates was high although the sampling process may have introduced some bias. Indeed poor uptake was identified in Phase One, reflecting other studies and anecdotal evidence for the programme team. The findings around support for practice education were mixed; mentors appeared to want more support than was available. Student experience varied according to branch – Mental health students feeling most supported and Child Health the least. However the use of neutral grades was high in both mentor and student groups indicating some cause for concern. Perception on use of the profile in terms of whether it was fit for purpose indicated positive responses overall but some confusion from both students and mentors as to the status of the written sections in comparison with skills performance; the latter was perceived as the top priority. The fourth area focused on how grading ‘worked’ and yielded some valuable perceptions. Generally respondents liked and wanted to grade or be graded in practice. Whilst the majority of mentors claimed to use the descriptors and found them useful, the number who did not use them was of concern. There were mixed perceptions of the appropriate use of second marking, some students perceiving that they were given middle grades due to logistical problems in accessing second markers, although this was not supported by the mentor data. The vast majority of mentors expressed confidence in grading students. However a significant minority responded neutrally or negatively or did not answer the question when asked whether they felt confident to fail a student. This finding is important when considered alongside the neutral response to feeling supported. Finally accountability within the assessment process appeared strong, although at times profiles were signed by staff who had not worked with the student. It is unclear however whether these mentors were primary mentors or those functioning as second markers. Overview of discussion The Phase Two evaluation was broadly supportive of the Phase One findings but extended these to other nursing branches and has provided more useful detail on some of the issues underpinning the grading practice scheme. Quality assurance is a prime issue: the evaluation has shown that reliability of the tool could be improved if the descriptors are clear and robust processes are in place to ensure these are consistently applied. Second marking is another feature of reliability and perceptions varied as to whether this was utilised as much as required and is an issue for programme and placement staff to consider, particularly in the light of inter-branch discrepancies. Students and mentors should be encouraged to constructively make any concerns known. Education around grading and support for mentors was another key area; there perhaps can never be enough support but if any staff have concerns around failing students, this needs to be addressed. The reasons for differing perceptions of support across branches, needs to be explored further. Overall the grading of competency in nursing practice yields far more benefits than problems. It is an innovative scheme, not without challenges; both evaluation phases provide valuable data to focus quality improvement effectively. Conclusion The evaluation captured the views of mentors and students representing all nursing branches, with the exception of Learning Disability students. The issues raised across the branches were broadly similar, notably that the notion of grading practice was welcomed as a means of valuing the practice element of the programme, although implementation was not without challenges. These are reflected in the focus on the quality assurance processes and in fact this is where the branch experience differs most. Mental Health students felt the most supported in placement, were the most likely to receive grades that required to be second marked (indicating full use of the grading range) and were most satisfied that mentor comments matched the grades awarded. In contrast Child Health students were the least satisfied in all these parameters. Adult branch students gave mainly neutral responses which indicate some underlying issues worthy of further investigation. It can be concluded from the mentor data that experience across branches did not differ markedly. The sample accessed updates and most felt confident in grading practice. However almost 18% did not feel confident about failing students and almost another 20% gave a neutral response to this question, indicating a need for further staff development in this area as well as a review of processes designed to support mentors in making these judgements. Recommendations • Explore ways of engaging learning disability students in sharing their perspective on the practice assessment tool and processes. • Increase transparency of communication channels between placement providers and the university regarding practice assessment. - Flowcharts or algorithms for mentors and students might be useful - Include these on the back of each practice profile • Review support mechanisms for students within placements. Identify best practice and include minimal standards on the clinical audit documentation to increase parity between placements and branches. • Investigate peer support schemes for students in practice which include preparation and support for those undertaking this role. • Child Health programme team should review support for students with practice partners to identify specific issues for improvement. • Review level descriptors with students, mentors as well as programme teams to ensure clarity of language and processes. • Re-emphasise the use of descriptors in mentor education as well as student preparation for placement • Review criteria and processes for second marking and emphasise within mentor education. • Disseminate HSC audit of practice profiles on a placement provider organisation basis and include a focus on quality of feedback in relation to grade awarded. • Review current practice around preparing and supporting mentors in failing students and develop an action plan for implementation over the next academic year

p21-activated kinase (PAK) regulates cytoskeletal reorganization and directional migration in human neutrophils

Neutrophils serve as a first line of defense in innate immunity owing in part to their ability to rapidly migrate towards chemotactic factors derived from invading pathogens. As a migratory function, neutrophil chemotaxis is regulated by the Rho family of small GTPases. However, the mechanisms by which Rho GTPases orchestrate cytoskeletal dynamics in migrating neutrophils remain ill-defined. In this study, we characterized the role of p21-activated kinase (PAK) downstream of Rho GTPases in cytoskeletal remodeling and chemotactic processes of human neutrophils. We found that PAK activation occurred upon stimulation of neutrophils with f-Met-Leu-Phe (fMLP), and PAK accumulated at the actin-rich leading edge of stimulated neutrophils, suggesting a role for PAK in Rac-dependent actin remodeling. Treatment with the pharmacological PAK inhibitor, PF3758309, abrogated the integrity of RhoA-mediated actomyosin contractility and surface adhesion. Moreover, inhibition of PAK activity impaired neutrophil morphological polarization and directional migration under a gradient of fMLP, and was associated with dysregulated Ca2+ signaling. These results suggest that PAK serves as an important effector of Rho-family GTPases in neutrophil cytoskeletal reorganization, and plays a key role in driving efficient directional migration of human neutrophils

Inhibition of DDAH1, but not DDAH2, results in apoptosis of a human trophoblast cell line in response to TRAIL.

STUDY QUESTION: Does inhibition of dimethylarginine dimethylaminohydrolase (DDAH) increase the sensitivity of trophoblasts to TRAIL-induced apoptosis? SUMMARY ANSWER: Inhibition of DDAH1, but not DDAH2, increases the sensitivity of trophoblasts to TRAIL-induced apoptosis. WHAT IS KNOWN ALREADY: Successful human pregnancy is dependent on adequate trophoblast invasion and remodelling of the maternal spiral arteries. Increased trophoblast apoptosis is seen in pregnancies complicated by pre-eclampsia. The mechanism underlying this increase is unknown. We have previously shown that nitric oxide (NO) is involved in regulating trophoblast motility and invasion, and have also demonstrated an important role for NO in regulating trophoblast sensitivity to apoptotic stimuli. DDAH is an enzyme that metabolizes asymmetric dimethylarginine (ADMA), an endogenous inhibitor of NO synthesis, previously shown to be elevated in the plasma of pre-eclamptic mothers. STUDY DESIGN, SIZE, DURATION: This study used the human extravillous trophoblast-derived cell line SGHPL-4 cells. All experiments were performed at least three times. PARTICIPANTS/MATERIALS, SETTING, METHODS: The effect of DDAH on trophoblast apoptosis was examined using siRNA and time-lapse microscopy. Changes in the expression of DDAH were followed by PCR and western blot analysis. Receptor expression was followed by flow cytometry. MAIN RESULTS AND THE ROLE OF CHANCE: Inhibiting the expression of DDAH1, but not DDAH2, resulted in a significant increase in the sensitivity of the EVT cell line SGHPL-4 to tumour necrosis factor related apoptosis inducing ligand (TRAIL) induced apoptosis (P < 0.01). This response could be mimicked by the addition of Asymmetric Dimethylarginine (ADMA), an endogenous inhibitor of NO synthesis and the substrate for both isoforms of DDAH. We further showed that this increased sensitivity to apoptosis is accompanied by a significant increase in the expression of TRAIL receptor 2 (TR2; P < 0.05) but not TRAIL receptor 1 (TR1). LIMITATIONS, REASONS FOR CAUTION: This study was performed only in vitro using a well characterized trophoblast cell line, SGHPL-4, derived from first trimester extravillous trophoblasts. WIDER IMPLICATIONS OF THE FINDINGS: This study provides new insight into the role of the DDAH/ADMA pathway in the regulation of trophoblast function. Both dysregulation of DDAH and the accumulation of ADMA have been associated with the development of pre-eclampsia. This is the first study to implicate the DDAH/ADMA pathway as a mechanism that might underlie the poor trophoblast invasion seen in this common pregnancy disorder. STUDY FUNDING/COMPETING INTERESTS: B.A.L. was supported by a grant from Action Medical Research UK (SP4577). A.E.W. was supported by a grant from the Wellcome Trust (091550). There are no competing interests and the authors have no conflict interest to declare

Marine benthic flora and fauna of Gourdon Bay and the Dampier Peninsula in the Kimberley region of North-Western Australia

Surveys undertaken to characterise the marine benthic habitats along the Dampier Peninsula and further south at Gourdon Bay in the Kimberley region of Western Australia were augmented with epibenthic sled sampling of soft and hard bottom habitats. This paper describes the species collected, their biomass and relative abundance for the main groups of marine macrophytes and invertebrates. Five localities were surveyed; Gourdon Bay, Quondong Point to Coulomb Point, Carnot Bay to Beagle Bay, Perpendicular Head and Packer Island. Sampling was limited to fifteen epibenthic dredge operations from a range of habitat types and was designed to target the most common habitat types and to obtain species identifications of the most important species and those which typified different habitat types. Surveys covered a total of 1,350 m 2 of seabed in depths between 11 and 23m. We identified 415 taxa comprising: 1 seagrass, 43 algae, 52 sponges, 30 ascidians, 10 hydroids, 14 scleractinian corals, 52 other cnidarians, 69 crustaceans, 73 molluscs and 71 echinoderms. Despite the limited nature of the sampling, a significant number of new species, range extensions and new records for Western Australia and Australia were recorded. Within the algae, one range extension (Halimeda cf. cuneata f. digitata not previously recorded in Western Australia) and one possible new species of Areschougia were recorded. Two range extensions were present in the ascidians; the solitary ascidian Polycarpa cf. intonata has previously only been recorded in Queensland and Cnemidocarpa cf. radicosa only in temperate Australian waters. There were several range extensions for the crustacea, for example, the sponge crab, Tumidodromia dormia, has only been recorded in Queensland. One species of holothurian of the genus Phyllophorus could not be identified from the literature available and may represent a new species. Similarly, a small species of the echinoid Gymnechinus could possibly be a new species. The collections of hydroids, hard corals, crinoids and molluscs contained no new species or range extensions. There was difficulty in identification of some groups to species level due to the status of the current taxonomic literature (e.g. Cnidaria, Porifera and ascidians) and there may be a number of new species among the material collected. Among the anthozoa, there is at least one new species of Chromonephthea and potentially 10 range extensions to Western Australia. Sinularia cf. acuta and Chromonephthea curvata are both new records for Australia with both previously recorded in Indonesia only. Among the better known taxa (e.g. molluscs, echinoderms, corals), most of the taxa identified to species level have been recorded to occur throughout north-western Australia, however the diversity recorded in this study is less than other parts of the Kimberley and this is almost certainly a result of the small overall area sampled and the single method of collection utilised. The most important species on soft bottom habitats in terms of biomass was the heart urchin Breynia desorii (up to 326 g.m -2). Sponges were the dominant fauna by biomass (up to 620 g.m -2) on hard bottom habitats and biomass was dominated a by a few large cup and massive sponge species (e.g. Pione velans and two unidentified Spheciospongia). The biomass of other filter feeders, especially ascidians (e.g. Aplidium cf. crateriferum), soft corals (e.g. Chromonephthea spp.), gorgonians (e.g. Junceella fragilis and Dichotella gemmacea) was also high, indicating the importance of these groups in characterising hard bottom habitats. Although low in biomass, crinoids such as Comaster multifidus and Comatula pectinata were abundant in samples that included a high biomass of other filter feeders

First experimental demonstration of nonlinear inverse synthesis transmission over transoceanic distances

We demonstrate for the first time, the transmission performance of 10Gbaud nonlinear inverse synthesis based signal over transoceanic distances, showing a significant improvement in data capacity x distance product (x12) compared with other NFT-based systems

Two-body correlations in Bose condensates

We formulate a method to study two-body correlations in a condensate of N identical bosons. We use the adiabatic hyperspheric approach and assume a Faddeev like decomposition of the wave function. We derive for a fixed hyperradius an integro-differential equation for the angular eigenvalue and wave function. We discuss properties of the solutions and illustrate with numerical results. The interaction energy is for N~20 five times smaller than that of the Gross-Pitaevskii equation

Renal crystal deposits and histopathology in patients with cystine stones

We have biopsied the papillae of patients who have cystine stones asking if this stone type is associated with specific tissue changes. We studied seven cystine stone formers (SF) treated with percutaneous nephrolithotomy using digital video imaging of renal papillae for mapping and obtained papillary biopsies. Biopsies were analyzed by routine light and electron microscopy, infrared spectroscopy, electron diffraction, and micro-CT. Many ducts of Bellini (BD) had an enlarged ostium, and all such were plugged with cystine crystals, and had injured or absent lining cells with a surrounding interstitium that was inflamed to fibrotic. Crystal plugs often projected into the urinary space. Many inner medullary collecting ducts (IMCD) were dilated with or without crystal plugging. Apatite crystals were identified in the lumens of loops of Henle and IMCD. Abundance of interstitial Randall's plaque was equivalent in amount to that of non-SF. In the cortex, glomerular obsolescence and interstitial fibrosis exceeded normal. Cystine crystallizes in BD with the probable result of cell injury, interstitial reaction, nephron obstruction, and with the potential of inducing cortical change and loss of IMCD tubular fluid pH regulation, resulting in apatite formation. The pattern of IMCD dilation, and loss of medullary structures is most compatible with such obstruction, either from BD lumen plugs or urinary tract obstruction from stones themselves

Threshold criterion for wetting at the triple point

Grand canonical simulations are used to calculate adsorption isotherms of various classical gases on alkali metal and Mg surfaces. Ab initio adsorption potentials and Lennard-Jones gas-gas interactions are used. Depending on the system, the resulting behavior can be nonwetting for all temperatures studied, complete wetting, or (in the intermediate case) exhibit a wetting transition. An unusual variety of wetting transitions at the triple point is found in the case of a specific adsorption potential of intermediate strength. The general threshold for wetting near the triple point is found to be close to that predicted with a heuristic model of Cheng et al. This same conclusion was drawn in a recent experimental and simulation study of Ar on CO_2 by Mistura et al. These results imply that a dimensionless wetting parameter w is useful for predicting whether wetting behavior is present at and above the triple temperature. The nonwetting/wetting crossover value found here is w circa 3.3.Comment: 15 pages, 8 figure