Doing care work for older people : work identities, motivations and barriers to job satisfaction

There is an increasing care demand for care home workers have a significant role in meeting residents’ care needs from the admission to a care home up to the end of life. However, there is persistent high care home worker turnover that can negatively impact the quality of care residents receive and care workers’ wellbeing. This thesis aimed to explore care home workers’ perceptions, experiences, and motivations of continuing their work role through the lens of self-determination theory (SDT). The first qualitative study (n=22) explored care workers’ perceptions and experiences of providing care for residents from the admission to the care home up to the end of life. Thematic analysis was used to analyse the data. Participants’ accounts reflected that social interaction had a significant role in facilitating the development of their work identities and encouraging them to remain employed in the care homes. The second study (quantitative, n=207) that built on the findings of study 1 investigated how care home workers’ perceptions towards their work roles, psychosocial attributes, psychological needs, and motivation influence their organisational commitment and job satisfaction using structural equation modelling. The study suggested a contextual significance of satisfying care workers’ psychological needs which then shapes their motivation and influences their organisational commitment and job satisfaction. The third study (qualitative, n=10) that complimented the findings of study 1 and 2 was to understand managers’ perspectives on care workers’ support needs and how they provide support to their care workers in the care homes using thematic analysis. Participants’ accounts reflected that meeting care workers’ autonomy need and enhance the effectiveness of communication between managers and care workers helped convey care home values and the meanings of care work to care workers, foster a positive work environment, and improve teamwork. This thesis contributes to the theoretical understanding of care workers’ work identities and motivations of continuing their care worker role. As a career that is dominated by people and interactions with people, social interaction has a significant role in facilitating care workers to establish their work identities and implement role expectations and the meanings of care work in their care practice, satisfying their psychological needs at work, and experiencing a higher organisational commitment and job satisfaction. This thesis highlights the significance of the consistency in management practices which helps eliminate the incongruences care home workers experienced between their work identities and the real job of caring and facilitate the development and maintenance of a stable and positive care home culture. This thesis has the potential to inform or devise interventions with evidence-based information to enhance care workers’ retention and wellbeing

Occupational Therapy Students’ Experiences of Team-Based Learning: A Multi-year Study

Many health sciences disciplines have adopted team-based learning (TBL) as part of their education pedagogy, with studies showing increased classroom participation and learner satisfaction. However, it will be beneficial to explore the learning experiences of occupational therapy students in TBL using a mixed methods approach. In an undergraduate occupational therapy program, students undertook three clinical modules using TBL in years two and three. This study explored their perceptions and experiences of TBL. This was a mixed methods prospective cohort study, during which two cohorts of students from Academic Year (AY) 2016 and AY2017 completed the Team-Based Learning Student Assessment Instrument (TBL-SAI) at the end of their first (midway evaluation) and third clinical module (final evaluation). In addition, they completed a semi-structured survey to share their learning experience. One-hundred twenty-seven occupational therapy students from both cohorts had full data and their results showed higher than neutral for Accountability, Preference for TBL, and Student Satisfaction sub-scales and composite scores at midway and final survey. Collectively, there were no significant changes in TBL perceptions, and no significant relationships were found between TBL-SAI scores and module results. Within the AY2017 cohort, there was positive moderate association between Accountability sub-scale midway score and module results. Qualitative analysis produced four themes: 1) power of discussion; 2) time use; 3) changed learning process and outcome; and 4) tailoring aspects of TBL to enhance learning. Occupational therapy students’ scores in the TBL-SAI domains were higher than neutral at midway and final evaluation. TBL may be a suitable method to aid learning of clinical occupational therapy knowledge

GT-repeat polymorphism in the heme oxygenase-1 gene promoter and the risk of carotid atherosclerosis related to arsenic exposure

<p>Abstract</p> <p>Background</p> <p>Arsenic is a strong stimulus of heme oxygenase (HO)-1 expression in experimental studies in response to oxidative stress caused by a stimulus. A functional GT-repeat polymorphism in the HO-1 gene promoter was inversely correlated to the development of coronary artery disease in diabetics and development of restenosis following angioplasty in patients. The role of this potential vascular protective factor in carotid atherosclerosis remains unclear. We previously reported a graded association of arsenic exposure in drinking water with an increased risk of carotid atherosclerosis. In this study, we investigated the relationship between HO-1 genetic polymorphism and the risk of atherosclerosis related to arsenic.</p> <p>Methods</p> <p>Three-hundred and sixty-seven participants with an indication of carotid atherosclerosis and an additional 420 participants without the indication, which served as the controls, from two arsenic exposure areas in Taiwan, a low arsenic-exposed Lanyang cohort and a high arsenic-exposed LMN cohort, were studied. Carotid atherosclerosis was evaluated using a duplex ultrasonographic assessment of the extracranial carotid arteries. Allelic variants of (GT)n repeats in the 5'-flanking region of the HO-1 gene were identified and grouped into a short (S) allele (< 27 repeats) and long (L) allele (≥ 27 repeats). The association of atherosclerosis and the HO-1 genetic variants was assessed by a logistic regression analysis, adjusted for cardiovascular risk factors.</p> <p>Results</p> <p>Analysis results showed that arsenic's effect on carotid atherosclerosis differed between carriers of the class S allele (OR 1.39; 95% CI 0.86-2.25; <it>p </it>= 0.181) and non-carriers (OR 2.65; 95% CI 1.03-6.82; <it>p </it>= 0.044) in the high-exposure LMN cohort. At arsenic exposure levels exceeding 750 μg/L, difference in OR estimates between class S allele carriers and non-carriers was borderline significant (<it>p </it>= 0.051). In contrast, no such results were found in the low-exposure Lanyang cohort.</p> <p>Conclusions</p> <p>This exploratory study suggests that at a relatively high level of arsenic exposure, carriers of the short (GT)n allele (< 27 repeats) in the HO-1 gene promoter had a lower probability of developing carotid atherosclerosis than non-carriers of the allele after long-term arsenic exposure via ground water. The short (GT)n repeat in the HO-1 gene promoter may provide protective effects against carotid atherosclerosis in individuals with a high level of arsenic exposure.</p

Estrogen Augments Shear Stress–Induced Signaling and Gene Expression in Osteoblast-like Cells via Estrogen Receptor–Mediated Expression of β1-Integrin

Estrogen and mechanical forces are positive regulators for osteoblast proliferation and bone formation. We investigated the synergistic effect of estrogen and flow-induced shear stress on signal transduction and gene expression in human osetoblast-like MG63 cells and primary osteoblasts (HOBs) using activations of extracellular signal-regulated kinase (ERK) and p38 mitogen-activated protein kinase (MAPK) and expressions of c-fos and cyclooxygenase-2 (I) as readouts. Estrogen (17β-estradiol, 10 nM) and shear stress (12 dyn/cm2) alone induced transient phosphorylations of ERK and p38 MAPK in MG63 cells. Pretreating MG63 cells with 17β-estradiol for 6 hours before shearing augmented these shear-induced MAPK phosphorylations. Western blot and flow cytometric analyses showed that treating MG63 cells with 17β-estradiol for 6 hrs induced their β1-integrin expression. This estrogen-induction of β1-integrin was inhibited by pretreating the cells with a specific antagonist of estrogen receptor ICI 182,780. Both 17β-estradiol and shear stress alone induced c-fos and Cox-2 gene expressions in MG63 cells. Pretreating MG63 cells with 17β-estradiol for 6 hrs augmented the shear-induced c-fos and Cox-2 expressions. The augmented effects of 17β-estradiol on shear-induced MAPK phosphorylations and c-fos and Cox-2 expressions were inhibited by pretreating the cells with ICI 182,780 or transfecting the cells with β1-specific small interfering RNA. Similar results on the augmented effect of estrogen on shear-induced signaling and gene expression were obtained with HOBs. Our findings provide insights into the mechanism by which estrogen augments shear stress responsiveness of signal transduction and gene expression in bone cells via estrogen receptor–mediated increases in β1-integrin expression. © 2010 American Society for Bone and Mineral Research

A new measurement of antineutrino oscillation with the full detector configuration at Daya Bay

We report a new measurement of electron antineutrino disappearance using the fully-constructed Daya Bay Reactor Neutrino Experiment. The final two of eight antineutrino detectors were installed in the summer of 2012. Including the 404 days of data collected from October 2012 to November 2013 resulted in a total exposure of 6.9$\times$10$^5$ GW$_{\rm th}$-ton-days, a 3.6 times increase over our previous results. Improvements in energy calibration limited variations between detectors to 0.2%. Removal of six $^{241}$Am-$^{13}$C radioactive calibration sources reduced the background by a factor of two for the detectors in the experimental hall furthest from the reactors. Direct prediction of the antineutrino signal in the far detectors based on the measurements in the near detectors explicitly minimized the dependence of the measurement on models of reactor antineutrino emission. The uncertainties in our estimates of $\sin^{2}2\theta_{13}$ and $|\Delta m^2_{ee}|$ were halved as a result of these improvements. Analysis of the relative antineutrino rates and energy spectra between detectors gave $\sin^{2}2\theta_{13} = 0.084\pm0.005$ and $|\Delta m^{2}_{ee}|= (2.42\pm0.11) \times 10^{-3}$ eV$^2$ in the three-neutrino framework.Comment: Updated to match final published versio