Iowa Women: The Kinds of Food They Eat

What does is take to keep nutritionally fit throughout life? Are Iowa women choosing the right kinds of foods? Here\u27s a picture of what Iowa women are eating every day and the nutritional worth of their meals

Clinical learning experiences of healthcare professional students in a student-led clinical learning environment (SLCLE) – A mixed methods evaluation

Aim To evaluate healthcare professional (HCP) students clinical learning experiences’ whilst undertaking placements in a student-led clinical learning environment (SLCLE) and any changes in self-reported ratings of confidence. Background The English NHS Long Term Workforce Plan (2023) highlights the need to expand domestic education of HCPs to meet workforce shortages. The demand for quality clinical placements to support the preparation of HCP students remains a challenge globally. A creative solution has been the development of student-led learning clinical environments in healthcare settings. SLCLEs provide high-quality learning experience, increase clinical placement capacity whilst maintaining patient care standards. A multisite NHS Trust adopted this model as evidence suggests HCP students will be better prepared on qualification to adopt registered practitioner professional responsibilities. This model has been integrated across three hospital sites within a large teaching hospital, providing care for a diverse population and designed to accommodate students from a range of HCP disciplines and higher educational institutions. Design A mixed methods convergent design. MethodsAn online survey was administered to SLCLE allocated nursing and allied health profession (AHP) undergraduate and graduate-entry first, second and third-year students (n=132). Face to face focus groups/individual interviews were undertaken with a purposive sample of student participants (n=80) to evaluate their experiences of clinical learning in SLCLEs. Survey data were analysed using descriptive statistics and paired t-tests, interviews using framework method. Results Undergraduate and graduate-entry students from four UK universities completed the survey (n=132), 103 students (78 %) responded. Most were year 2 students (n=43/42 %), pursuing nursing programmes (n=82/80 %). Most considered the SLCLE met their expectations (n=76/74 %), reported increased confidence post-placement (n=84/82 %), felt supported by staff (n=80/78 %), peers (n=93/90 %) and clinical educators (n=93/90 %). Self-reported confidence scores post-SLCLE were significantly higher than pre-SLCLE. On-line pre-placement information was infrequently accessed yet identified as an omission. Four themes were identified: (i) preconceptions and initial anxiety; (ii) empowerment, growth and a unique learning experience; (iii) collaborative inter-professional learning and support; and (iv) insights and anticipations. Conclusions The SLCLE allocation enhanced students’ confidence and knowledge. Support from clinical educators, ward staff and doctors was perceived as invaluable for creating a positive learning culture. Peer support and opportunities to lead care delivery contributed to students’ professional development. The format and method for providing pre-placement information needs review as do strategies for avoiding delays in completing assessment documentation. Overall, the SLCLE experience offers much potential as a nurturing and effective learning environment for HCP students

Numerical approximation of table functions on the basis of multidimensional optimization methods for modeling physics and technics problems

The aim of the article is to present an approximation method based on multidimensional optimization methods which does not require preliminary information about the derivatives of the approximating function. It is proposed to use a combination of the grid method, coordinate descent method and the golden section method to solve the task of optimizing the objective function (standard deviation in the nodes of the tabular function). The considered example of the approximation of the flight trajectory of a body in the atmosphere illustrates the comparability of the results of the proposed method and the least squares method

Shared Lives: Cancer – Developing an online resource to support people affected by cancer through making academic research publicly accessible.

Background: Shared Lives: Cancer (SL:C) is an innovative approach to making qualitative research data publically available. SL:C aims to support people living with and affected by cancer and cancer professionals. Developed collaboratively by the University of Lincoln, Lincolnshire Clinical Commissioning Group, and Macmillan Cancer Support. SL:C comprises a library of over anonymised 3000 quotes pertaining to people’s cancer experience. Ten anonymised patient stories, further support the quote database. Signposting to existing support and resources, are provided to help facilitate engagement with self-management. Methods: SLC has been developed using the data from 3 independent research studies (2017-2019) undertaken with people living with and affected by cancer, which resulted in 34 interview transcripts and 183 survey free-text comments. All studies were subject to the appropriate ethical and research governance approvals. The 217 participant contributions were consolidated and thematically coded as a single data-set. The project is defined as dissemination, therefore, no analysis was performed. Results: Coding resulted in the identification of 870 unique quotes that are searchable by 40 broad themes and over 70 keywords that can be filtered by age, gender, cancer type, and treatment received. For example, someone might wish to search by ‘exercise’, ‘fatigue and tiredness’ ‘chemotherapy’ or ‘prostate cancer’, and quotes that have been assigned to these themes/keywords will be displayed. Conclusion: SL:C is a new and innovative approach to the dissemination of academic research. SL:C has the potential to support people living with and affected by cancer at all stages of the cancer journey, as well as helping professionals, researchers, and the general public to better understand the cancer experience, which consequently, could improve care outcomes for people living with cancer. Impact Statement: SL:C, will continually evolve through collaboration and an independent associated project that will enable users to share their stories, therefore, SL:C has the potential to reach people living with cancer at a national and international level

Considerations for Individual-Level Versus Whole-School Physical Activity Interventions:Stakeholder Perspectives

Strategies to address declining physical activity levels among children and adolescents have focused on ‘individual-level’ approaches which often fail to demonstrate impact. Recent attention has been on an alternative ‘whole-school’ approach to increasing physical activity that involves promoting physical activity throughout all aspects of the school environment. There is, however, a lack of evidence on how whole-school physical activity approaches could be implemented in the UK. This qualitative study explored perspectives of key stakeholders on potential reasons for the lack of impact of individual-level school-based interventions on children’s physical activity, and key considerations for adopting a whole-school approach. Nineteen semi-structured interviews were conducted with a range of stakeholders involved in the implementation of physical activity programmes in UK schools. Data were analysed using an inductive approach. Respondents suggested that individual-level school-based interventions to increase physical activity often failed to consult end users in the design and were typically implemented in environments unsupportive of long-term change. They subsequently outlined specific barriers and key facilitators for the adoption and implementation of whole-school approaches in UK settings and recommended a shift in research foci towards building an evidence base around educational outcomes and whole-school implementation insights

Physical activity and psychosocial characteristics of the peer supporters in the PLAN-A study – a latent class analysis

PLAN-A is a cluster randomised controlled trial of a peer-led physical activity intervention which uses peer supporters to increase the physical activity of 13–14-year-old girls in the UK. This paper uses latent class analysis to identify classes in the whole study population and investigate how those selected as peer supporters in PLAN-A were drawn from different social groups. We identified five classes of girls, based on psychosocial variables (self-esteem, physical activity self-efficacy, motivation, physical activity values among friends and peer support for physical activity (PA) and physical activity behaviour variables (average minutes of weekday MVPA, sedentary time and screen viewing). Peer supporters were similar to the whole study population in terms of overall demographics, but were drawn unequally from the five classes. In addition, there was considerable variation in the distribution of peer supporters between schools. The selection of peer supporters is an integral component of peer-led interventions and should be explored and linked to underlying theory to understand the characteristics of those recruited. However, demographic representativeness is not necessarily the aim, and simple reporting of overall demographic comparisons may mask important differences within subgroups

Chronic NCD care in crises: A qualitative study of global experts' perspectives on models of care for hypertension and diabetes in humanitarian settings.

Background: The high and rising global burden of non-communicable diseases (NCDs) is reflected among crisis-affected populations. People living with NCDs are especially vulnerable in humanitarian crises. Limited guidance exists to support humanitarian actors in designing effective models of NCD care for crisis-affected populations in low- and middle-income countries (LMICs). We aimed to synthesise expert opinion on current care models for hypertension and diabetes (HTN/DM) in humanitarian settings in LMICs, to examine the gaps in delivering good quality HTN/DM care and to propose solutions to address these gaps. Methods: We interviewed twenty global experts, purposively selected based on their expertise in provision of NCD care in humanitarian settings. Data were analysed using a combination of inductive and deductive methods. We used a conceptual framework for primary care models for HTN/DM in humanitarian settings, guided by the WHO health systems model, patient-centred care models and literature on NCD care in LMICs. Results: HTN/DM care model design was highly dependent on the type of humanitarian crisis, the implementing organisation, the target population, the underlying health system readiness to deal with NCDs and its resilience in the face of crisis. Current models were mainly based at primary-care level, in prolonged crisis settings. Participants focussed on the basic building blocks of care, including training the workforce, and strengthening supply chains and information systems. Intermediate health system goals (responsiveness, quality and safety) and final goals received less attention. There were notable gaps in standardisation and continuity of care, integration with host systems, and coordination with other actors. Participants recommended a health system strengthening approach and aspired to providing patient-centred care. However, more evidence on effective integration and on patients' priorities and experience is needed. More funding is needed for NCD care and related research. Conclusions: Comprehensive guidance would foster standardization, continuity, integration and, thus, better quality care. Future models should take a health system strengthening approach, use patient-centred design, and should be co-created with patients and providers. Those designing new models may draw on lessons learned from existing chronic care models in high- and low-income settings

Effectiveness and cost-effectiveness of the PLAN-A intervention, a peer led physical activity program for adolescent girls:Results of a cluster randomised controlled trial

Background Physical activity is associated with improved health. Girls are less active than boys. Pilot work showed that a peer-led physical activity intervention called PLAN-A was a promising method of increasing physical activity in secondary school age girls. This study examined the effectiveness and cost-effectiveness of the PLAN-A intervention. Methods We conducted a cluster randomised controlled trial with Year 9 (13–14 year old) girls recruited from 20 secondary schools. Schools were randomly assigned to the PLAN-A intervention or a non-intervention control group after baseline data collection. Girls nominated students to be peer leaders. The top 18 % of girls nominated by their peers in intervention schools received three days of training designed to prepare them to support physical activity. Data were collected at two time points, baseline (T0) and 5–6 months post-intervention (T1). Participants wore an accelerometer for seven days to assess the primary outcome of mean weekday minutes of moderate-to-vigorous physical activity (MVPA). Multivariable mixed effects linear regression was used to estimate differences in the primary outcome between the two arms on an Intention-to-Treat (ITT) basis. Resource use and quality of life were measured and a within trial economic evaluation from a public sector perspective was conducted. Results A total of 1558 girls were recruited to the study. At T0, girls in both arms engaged in an average of 51 min of MVPA per weekday. The adjusted mean difference in weekday MVPA at T1 was − 2.84 min per day (95 % CI = -5.94 to 0.25) indicating a slightly larger decline in weekday MVPA in the intervention group. Results were broadly consistent when repeated using a multiple imputation approach and for pre-specified secondary outcomes and sub-groups. The mean cost of the PLAN-A intervention was £2817 per school, equivalent to £31 per girl. Economic analyses indicated that PLAN-A did not lead to demonstrable cost-effectiveness in terms of cost per unit change in QALY. Conclusions This study has shown that the PLAN-A intervention did not result in higher levels of weekday MVPA or associated secondary outcomes among Year 9 girls. The PLAN-A intervention should not be disseminated as a public health strategy

Framing the Next Nuclear Posture Review: A State-Centric, Strategic Approach

The Nuclear Posture Review (NPR), released by the Department of Defense (DoD) in 2010, announced an unprecedented shift in the U.S. nuclear policy away from state-based threats to nuclear proliferation and nuclear terrorism concerns. While these issues remain important, the evolving global strategic environment dictates that the next NPR return to a state-centric, strategic focus emphasizing four states: Russia, China, North Korea, and Iran. The only strategic peer to the United States, Russia, is actively modernizing all aspects of its nuclear arsenal and has placed nonstrategic nuclear weapons (NSNWs) at the center of its national security.1 China has overhauled the structure of its nuclear weapons program and nuclear and missile developments in North Korea are ongoing. Not long ago Iran reached the cusp of nuclear capability before the implementation of the Joint Comprehensive Plan of Action (JCPOA). The United States must now ensure that this agreement is implemented effectively. All of these developments make it impossible to ignore the importance of nuclear weapons in the U.S. global strategic posture today