Recovery as a troublesome concept: A phenomenographic study of mental health nursing students’ learning experiences

The notion of recovery is central to mental health nursing practice, yet little is known about the ways in which nursing students understand it. This study explores the variation in how recovery is experienced by nursing students and the troublesome nature of their learning journeys as they engage with the concept. Contemporary understanding of recovery has moved beyond the idea of ‘cure’ and is concerned with the person building a meaningful and satisfying life. This challenges the traditional thinking and practices of mental health professionals. There is evidence to suggest that in some areas nurses still rely on out-dated authoritative models of care; however, there is little literature exploring how the concept is understood by nursing students. As today’s student nurses represent the future nursing workforce, it is important that their educational experiences support the knowledge development required to embrace this contemporary practice. Phenomenography and the threshold concept framework provide the research design. Semi-structured interviews were carried out with 13 pre-registration students at one UK University. Following phenomenographic analysis four qualitatively distinct categories of description, or ways of understanding recovery, were identified; Recovery as Clinical Improvement, Recovery as Making Progress, Recovery as Managing to Live Well, and Recovery as Learning to Live Differently. The threshold concept framework was utilised in considering the variation in how students’ progress (or otherwise) in their understanding of recovery in considering the obstacles to learning that students encounter. Four categories were identified; Troublesome Knowledge, Troublesome Learning Environments, Troublesome Practice, and Troublesome Relationships. Understanding the dimensions of variation in student understanding and the obstacles to learning they might face provides important insights for future teaching. Findings here identify recovery as posing particular challenges for students requiring educators to consider a range of strategies to support transformational learning

De cemitério de ideias a embrião de sementes : uma experiência sobre a mobilização social em Fernando de Noronha

Dissertação (mestrado)—Universidade de Brasília, Centro de Excelência em Turismo, Programa de Pós-Graduação em Turismo, 2013.A Ilha pernambucana de Fernando de Noronha (FN), um dos principais destinos turísticos do Brasil, está a beira de um colapso socioambiental, segundo o Estudo de Capacidade de Suporte (ECS) e Indicadores de Sustentabilidade de Fernando de Noronha (FN), feito pelo Ministério do Meio Ambiente (MMA), em 2009. Noronha opera com uma sobrecarga de cerca de 2000 pessoas e se desenvolve privilegiando o crescimento do turismo e a preservação da natureza em detrimento da qualidade de vida dos moradores. Este quadro de dilaceramento socioambiental pode ser revertido se a comunidade, administração e turistas mudarem seus padrões de comportamento e se mobilizarem para transformar o destino de Noronha. Tendo como inspiração e base o programa Noronha +20 (2011), um projeto construído na Ilha de forma participativa com o objetivo de promover a gestão socioambiental sustentável de FN, esta pesquisa buscou analisar como seria possível mobilizar a comunidade a participar dos processos decisórios na administração insular. Ao pesquisar o histórico de mobilização na Ilha, uma bela história veio à tona: o movimento “SOS Noronha”, quando toda a comunidade lutou contra a anexação da Ilha a Pernambuco em 1988. Desde então, a comunidade está desunida, perdeu a esperança e vontade de batalhar pelo bem comum e pouco se envolve nos projetos e nas decisões que estão relacionadas diretamente ao seu futuro. Como resgatar esse sentimento que uniu a Ilha inteira em 1988 e usar o aprendizado desse movimento para mobilizar os jovens, única geração ainda capaz de iniciar esse necessário processo de transformação socioambiental? Para buscar essa resposta, pesquisei ferramentas de comunicação para mobilizar os atores envolvidos e produzi com os alunos do ensino fundamental e médio da Escola Arquipélago, única escola da Ilha, um documentário sobre a mobilização de 1988. Mobilizar trabalhando o afeto, a cidadania e a auto-estima são algumas descobertas dessa experiência compartilhada com cerca de 20 jovens noronhenses. A transmissão de saberes entre as gerações e o resgate histórico obtidos com essa pesquisa podem contribuir para propor estratégias visando um planejamento participativo voltado ao desenvolvimento sustentável de Noronha, cenário onde seria possível pensar na retomada do crescimento populacional, no turismo sustentável e, acima de tudo, na melhoria da qualidade de vida dos filhos da Ilha. ______________________________________________________________________________ ABSTRACTFernando de Noronha, an island located neartheast coast of Brazil, in the state of Pernambuco -Fernando de Noronha (FN); one of Brazil’s main touristic spots is at the edge of socio environmental collapse, according by the Study of Support Capacity (or Estudo de Capacidade de Suporte (ECS), in Portuguese) and local indicators of sustainability, done by the Ministry of Natural Environment, in 2009. Noronha operates with an overflow of about 2000 people and develops itself favoring the growth of tourism and the conservation of nature in detriment of the local habitant’s quality of life. This situation of socio environmental shattering could be reverted if the community, local administration and tourists changed their behavior patterns and mobilized themselves to change Noronha’s destiny. Having as an inspiration and ground base the program Noronha +20 (2011)- one of the first projects built on the island in a participative way and with the goal of promoting a sustainable socio environmental management in FN, this research analyzed how it would be possible to mobilize the community for the participation in the decisive processes of the insular administration. While searching the mobilization history of the island, a handy story came to surface: the “SOS Noronha” movement. A movement when the whole community fought in vain against the island’s annexation to the state of Pernambuco, in 1988. Since then, the community has been split, lost all hope and will of battling for the common good and has little involvement in projects and decisions that are directly related to their future. How to redeem this feeling that united the whole island in 1988 and use the lessons learned from this movement to gather the young – only generation still capable of starting the necessary processes of socio environmental transformation? To find this answer, I produced, together with the Escola Arquipélago students, a documentary about the 1988’s mobilization. To mobilize working with affection, citizenship and self-esteem are some of the discoveries of this experience shared with about 20 young Noronhenses (people from FN). The passing on of knowledge between generations and the historical rescue attained with this research could contribute to suggest strategies seeking a participative planning, aimed at the sustainable development of Noronha, a scenario where it would be possible to think about the resumption of the population’s growth, sustainable tourism, and, above all, the improvement of the island’s quality of life

Investigating the role of Wnt/Planar cell polarity (PCP) in Neuromesodermal Progenitors (NMPs)

Neuromesodermal progenitors (NMPs) are bipotent progenitors, located at the caudal end of the embryo and are essential for axis formation. These stem cell-like progenitors possess the ability to self-renew and differentiate to both mesodermal and neural lineages, such as skeletal muscle and spinal cord derivatives. These progenitors arise at E8.5 and are localised in the caudal lateral epiblast (CLE), a posterior region of the embryo near the primitive streak. Later in development, they reside in the tail bud until cessation of axial elongation at E13.5. Throughout these stages NMPs are characteristically marked by co-expression of T(Bra) (Brachyury) and Sox2. This characteristic is also present in in vitro NMPs, which can be derived from Epiblast Stem Cells (EpiSCs) through treatment with Wnt/β-catenin signalling agonists and Fgf2, which simulates their in vivo environment. Protein and mRNA profiling of NMPs and mutant phenotypes in vivo supports the hypothesis that a non-canonical Wnt pathway, the Wnt/Planar Cell Polarity pathway (PCP) could be involved in NMP fate decision and/or maintenance. This thesis focuses on understanding more about the role of PCP by aiming to identify the spatio-temporal profile of Wnt/PCP pathway components in NMP regions during axial elongation, as well as determining its role in NMP behaviour through manipulation of this pathway via in vivo and in vitro assays Employing in situ hybridisation and immunohistochemistry techniques, key Wnt/PCP components, including Pk1, Vangl2 and Ptk7, were confirmed to be present in in vivo and in vitro NMPs, thus, providing strong evidence that Wnt/PCP may be involved regulating NMP behaviour. Disruption of Wnt/PCP signalling through overexpression of Wnt/PCP components was tested in refined in vivo and in vitro assays. Overexpression of Vangl2 and Ptk7, but not Pk1 in NMPs regions in vivo resulted in loss of contribution to neural lineages, as well as lower contribution to NMP regions themselves. Similarly, Wnt/PCP components were disrupted in vitro through generation of dox-inducible overexpression cells lines for Wnt/PCP components. These lines were used to generate NMPs from an optimised novel alternative source Epiblast-Like Cells (EpiLCs), however no clear affect to lineage was observed. Overall this work has successfully advanced our knowledge of Wnt/PCP mediated control of NMP differentiation and maintenance, and provided a finer grained description of the relationships between them

Text Messages as a Reminder Aid and Educational Tool in Adults and Adolescents with Atopic Dermatitis: A Pilot Study

Optimal management of atopic dermatitis (AD) requires patients to adhere to self-care behaviors. Technologies, such as cell phones, have been widely adopted in the USA and have potential to reinforce positive health behaviors. We conducted a pilot study with 25 adolescents and adults age 14 years and older [mean 30.5 yrs, SD 13.4] with AD. Daily text messages (TMs) that provided medication reminders and AD education were sent for six weeks to participants. Our goals were to (1) measure changes in pre- and posttest scores in treatment adherence, self-care behaviors, disease severity, and quality of life and (2) assess the usability and satisfaction of the TM system. Significant improvements in treatment adherence, self-care behaviors, skin severity, and quality of life (P ≤ .001, .002, <.001, and .014, resp.) were noted postintervention. User feedback on the TM system was positive with 88% and 92% of participants reporting that the reminder TMs and educational TMs were helpful, respectively. In conclusion, study participants were receptive to using TMs as a reminder aid and educational tool. The positive trends observed are promising and lay the ground work for further studies needed to elucidate the full potential of this simple and cost-effective intervention

Use of Remote Monitoring to Improve Outcomes in Patients with Heart Failure: A Pilot Trial

Remote monitoring (RM) of homebound heart failure (HF) patients has previously been shown to reduce hospital admissions. We conducted a pilot trial of ambulatory, non-homebound patients recently hospitalized for HF to determine whether RM could be successfully implemented in the ambulatory setting. Eligible patients from Massachusetts General Hospital (n = 150) were randomized to a control group (n = 68) or to a group that was offered RM (n = 82). The participants transmitted vital signs data to a nurse who coordinated care with the physician over the course of the 6-month study. Participants in the RM program had a lower all-cause per person readmission rate (mean = 0.64, SD ± 0.87) compared to the usual care group (mean = 0.73, SD ± 1.51; P-value = .75) although the difference was not statistically significant. HF-related readmission rate was similarly reduced in participants. This pilot study demonstrates that RM can be successfully implemented in non-homebound HF patients and may reduce readmission rates

Phosphorylation of CLEC-2 is dependent on lipid rafts, actin polymerization,secondary mediators, and Rac

The C-type lectin-like receptor 2 (CLEC-2)activates platelets through Src and Syk tyrosine kinases via a single cytoplasmic YxxL motif known as a hem immunoreceptor tyrosine-based activation motif (hemITAM).Here, we demonstrate using sucrose gradient ultracentrifugation and methyl--cyclodextrin treatment that CLEC-2 translocates to lipid rafts upon ligand engagement and that translocation is essential for hemITAM phosphorylation and signal initiation. HemITAM phosphorylation, but not translocation, is also critically dependent on actin polymerization,Rac1 activation, and release of ADP and thromboxane A2 (TxA2). The role of ADP and TxA2 in mediating hosphorylation is dependent on ligand engagement and rac activation but is independent of platelet aggregation. In contrast,tyrosine phosphorylation of the GPVIFcR -chain ITAM, which has 2 YxxL motifs,is independent of actin polymerization and secondary mediators. These results reveal a unique series of proximal events in CLEC-2 phosphorylation involving actin polymerization, secondary mediators,and Rac activation