A Case Report of Acute Heart Failure Due to Infective Aortic Endocarditis Diagnosed by Point-of-care Ultrasound

Introduction: Infective endocarditis (IE) is a life-threatening condition with significant morbidity and mortality, and can require surgical repair.Case Report: A 36-year-old man presented to the emergency department for worsening dyspnea and chest pain. Point-of-care echocardiography demonstrated a mobile oscillating mass on the aortic valve with poor approximation of the valve leaflets, suggesting aortic valve insufficiency secondary to IE as the cause of acute heart failure. The patient underwent emergent aortic valve replacement within 24 hours.Discussion: While point-of-care echocardiography has been well documented in identifying tricuspid vegetations, aorticvalve involvement and subsequent heart failure is less well described. Earlier recognition of aortic valve vegetations and insufficiency can expedite surgical intervention, with decreased complication rates linked to earlier antimicrobial therapy.Conclusion: This case report highlights the ability of point-of-care ultrasound to identify aortic vegetations, allowing for the earlier diagnosis and therapy

Teacher self -efficacy and beliefs for teaching mathematics in inclusive settings

The purpose of this mixed-design study was to determine if mathematics teachers experienced changes in their self-efficacy and beliefs about their ability to teach students with disabilities in an inclusive setting. The intervention for this study was a 14-month professional development program that consisted of content and methods courses taught during two-week intervals during the summer on the campus of The College of William and Mary followed by specific professional development activities provided by a team of math specialists/facilitators with expertise in mathematics curriculum, instruction, and assessment as well as special education services including inclusive education models. Teachers participating in the study completed a survey, Teaching Mathematics in Inclusive Settings, and participated in focus groups.;Findings indicated that teachers participating in both content/methods courses and school-based professional development activities significantly increased in their self-efficacy with regard to teaching mathematics to students with disabilities in inclusive settings. Components of the professional development program rated as being most valuable as well as changing teaching practices were coaching from a mathematics specialist; discussions and dialogues with a mathematics specialist, and lesson study. School-based professional development designed to support teachers as they integrate research-based instructional strategies may significantly increase their self-efficacy leading to more effective instruction for diverse student populations

Noongar Women\u27s Birth Experience

This qualitative study used a descriptive interpretive approach that drew heavily on the methodological underpinnings of interpretive phenomenology in order to explore the lived experience of Noongar women in childbirth. The aim of the study was to give voice to Noongar women, who despite having poorer outcomes than the wider population, remain marginalised and mute in childbirth reform. The purpose of the study was to acknowledge as authoritative, Noongar women’s wisdom and understanding of their childbirth experience. This study was conducted at the cultural interface, by a non-Indigenous researcher who implemented a collaborative and power sharing model of enquiry. Ten Noongar women were interviewed from 2011 to 2013 from the city of Perth and two regional locations in the south-west of Western Australia. The study was grounded in the work of hermeneutical philosopher, Gadamer and was guided by van Manen and Creswell for interpretive thematic analysis. Five emergent themes revealed that women experienced increased levels of vulnerability; described family as central to birth; understood their present lives were connected to a past history that would influence future generations; were culturally challenged and experienced prejudice and racism at the time of childbirth. Each theme identified elements of tension and trauma, adding considerable negative physical and psychosocial load to the health and wellbeing of the individual woman. Moreover, participants descriptive experiences alluded to a western biomedical model of maternity care that continues to under represent the needs or wants of Aboriginal and Torres Strait Islander women. Despite the challenges experienced along the childbirth continuum, women described birth as a joyful experience. However, they did not experience woman centred care nor did they receive sufficient culturally appropriate options from which to make choices in the care actually received. Insights gained from this study will provide a much deeper understanding of the birth experience for Noongar women so that clinicians, educators and policy makers can plan and deliver more culturally congruent and effective maternity care. The recommendations within this study, if adopted, have the potential to echo the voice of Noongar women throughout the maternity care debate in Western Australia, so that culturally congruent and sensitive woman centred care can be developed, leading to appropriately culturally aligned childbirth choices

The Relative Effectiveness of Programmed Instruction Versus the Lecture and Discussion Method on the Assessment Skills and Reporting Patterns of Child Abuse and Neglect Among Undergraduate Nursing Students

The problem studied in this investigation was whether different instructional methods could increase the assessment skills and affect reporting patterns of child abuse and neglect among undergraduate students majoring in nursing. Two hundred and nineteen nursing students were selected for inclusion in the study from two urban universities located in Hampton Roads, Virginia. The sample was predominantly female (91.3%), African-American (79.9%) and mostly under 25 years of age (67.1%). A programmed instruction manual, Child Abuse and Neglect, a pretest booklet, and a posttest booklet were developed specifically for this research. The pretest booklets and posttest booklets contained vignettes and questions developed by and used with the permission of Zellman (1990), and Dukes and Kean (1989). The nonequivalent control-group design was selected for this quasi-experimental study. The responses of students to a series of questions regarding the assessment of child abuse and neglect and the legal obligations of mandatory reporters in Virginia were pretested. Students were then given instructions on the assessment of child abuse and neglect and the legal responsibility of mandatory reporters. The control group was instructed by the lecture and discussion method while the experimental group completed a programmed instruction manual. Both the control group and the experimental group were retested approximately 30 days later in order to assess differences in retention. Programmed instruction is viable as an alternative method of instruction on the topic of child abuse and neglect for undergraduate nursing students. Further, students who are instructed using the programmed instruction manual are able to acquire and retain information on the topic equally as well as those students who are instructed by the more traditional method of lecture and discussion. Correlation coefficients on the data revealed that only 4 of 72 responses to the vignettes were significantly correlated with the type of instruction. Therefore, the effect of programmed instruction as compared with the lecture and discussion method on the responses of students to vignettes remains inconclusive

Support for older people with COPD in community settings: a systematic review of qualitative research.

There are an estimated three million people affected by Chronic Obstructive Pulmonary Disease (COPD) in the UK with only about 900,000 of these being diagnosed according to the Healthcare Commission, and prevalence is increasing. Significant progress has been made in respect of treatment and management of the disease. However, there is limited evidence related to the perspective of those with COPD despite an acknowledgement that lung function, as determined by spirometry, does not necessarily equate with pulmonary disease5 and subsequent functional level or disability. The impact of COPD on patients, their family, carers and healthcare services demands that better ill health prevention and disease maintenance strategies be employed. The objective of this review was to explore the common and shared experiences of those in caring partnership for patients with COPD receiving care and support in their community. For this review, the definition of support takes the view that support relates to ‘any activity or intervention aimed at improving or maintaining the health status of a patient with COPD’. The review focused on the experiences of patients, carers, family members, nurses and doctors involved in providing support to patients with COPD in their own home. Patients aged 65 years and over were included. The review considered studies that represented patient, carer, nursing and medical staff experiences and perceptions of support relating to COPD. The review considered evidence from qualitative research including phenomenology, grounded theory, and descriptive studies, where support for COPD in a community context was the focus. The search set out to find published studies in English from 1990-2010. The studies were appraised and findings extracted using the JBI critical appraisal tool for qualitative research. Three reviewers appraised the studies independently. 72 studies were critically appraised and 39 met the inclusion criteria. Findings from included papers were aggregated, categorised and synthesised. Three syntheses were extracted from the categorised findings: 1) Consistence in service provision. If those with COPD received more consistent support in relation to information, rehabilitation, end of life care and other service provision then their quality of life could be enhanced. 2) Home based care. Better planned and more integrated support for home based care around self-care/management and in managing exacerbations can reduce patient and carer anxiety and distress related to COPD. 3) Individualisation of care. Individualisation of care, which is not based on the patient's ‘disease state’ (i.e. physical parameters) but on assessed need, is a necessary part of care for those with COPD

A New Social Order: Mechanisms for Social Network Site Boundary Regulation

Social Network Site (SNS) use has become ubiquitous, with hundreds of millions of users sharing and interacting online. Yet,constant, unbounded sharing and interacting with others can cause social crowding and emotional harm (Altman 1975). Weexplore interpersonal boundary regulation on Social Network Sites to understand these tradeoffs and examine how toimprove the social experiences of users. In this paper, we present a taxonomy of five categories of interpersonal boundarymechanisms relevant to SNSs and the specific interface controls that sites provide for managing these boundaries. Wequalitatively research how SNS users employ these mechanisms and the boundary issues that arise while interacting onlinewith others. These results present a first step towards a model of SNS interpersonal boundary regulation