Squaring Realities: Governing Boards and Community-Building

This report, prepared for the Kettering Foundation by the Harwood Institute, reveals that nonprofit community organizations face two realities that often seem to conflict: The first is to generate a stronger connection with the communities they work in. The second is the need to demonstrate accountability to the donors who finance them and to the individuals and groups they serve. Findings outlined in this report were obtained in interviews with 75 board presidents of school boards, local foundations, and other civic organizations

Development of a programme to facilitate interprofessional simulation-based training for final year undergraduate healthcare students

Original report can be found at: http://www.health.heacademy.ac.uk/publications/miniproject/alinier260109.pdfIntroduction: Students have few opportunities to practise alongside students from other disciplines. Simulation offers an ideal context to provide them with concrete experience in a safe and controlled environment. This project was about the development of a programme to facilitate interprofessional scenario-based simulation training for final year undergraduate healthcare students and explored whether simulation improved trainees’ knowledge of other healthcare discipline’s roles and skills. Methods: A multidisciplinary academic project team was created and trained for the development and facilitation of this project. The team worked on the development of appropriate multiprofessional scenarios and a strategy to recruit the final year students on a volunteer basis to the project. By the end of the project 95 students were involved in small groups to one of fifteen 3-hour interprofessional simulation sessions. Staff role played the relatives, doctor on call, and patient when it was more appropriate than using a patient simulator (Laerdal SimMan/SimBaby) in the simulated community setting and paediatric or adult emergency department. Each session had 3 to 4 of the following disciplines represented (Adult/Children/Learning Disability Nursing, Paramedic, Radiography, Physiotherapy) and each student observed and took part in one long and relevant high-fidelity scenario. Half the students were randomly selected to fill in a 40-item questionnaire testing their knowledge of other disciplines before the simulation (control group) and the others after (experimental group). Students were assessed on the questions relating to the disciplines represented in their session. Results: By the end of the project 95 questionnaires were collected of which 45 were control group students (Questionnaire before simulation) and 50 experimental group students (Questionnaire after simulation). Both groups were comparable in terms of gender, discipline and age representation. Participants were: Adult nurses (n=46), Children’s nurses (n=4), Learning Disability nurses (n=7), Nurses, Paramedics (n=8), Radiographers (n=20), Physiotherapists (n=8). 15 sessions were run with an average of around 7 participants and at least 3 disciplines represented. The knowledge test results about the disciplines represented was significantly different between the control and experimental groups (Control 73.80%, 95% CI 70.95-76.65; and Experimental 78.81%, 95% CI 75.76-81.87, p=0.02). In addition, there were sometimes reliable differences between the groups in their view of multidisciplinary training; confidence about working as part of a multidisciplinary team was 3.33 (SD=0.80, Control) and 3.79 (SD=0.90, Experimental), p=0.011; their anticipation that working as part of a multidisciplinary team would make them feel anxious was 2.67 (SD=1.17, Control) and 2.25 (SD=1.04, Experimental), p=0.073; their perception of their knowledge of what other healthcare professionals can or cannot do was 3.00 (SD=0.91, Control) and 3.35 (SD=0.93, Experimental), p=0.066; their view that learning with other healthcare students before qualification will improve their relationship after qualification was 3.93 (SD=1.14, Control) and 4.33 (SD=0.81, Experimental), p=0.055; their opinion about interprofessional learning helping them to become better team workers before qualification was 3.96 (SD=1.24, Control) and 4.42 (SD=0.77, Experimental), p=0.036. Conclusions: Although the difference is relatively small (~5%), the results demonstrate that students gained confidence and knowledge about the skills and role of other disciplines involved in their session. Through simulation, the positivism of students about different aspects of learning or working with other healthcare disciplines has significantly improved. Students gained knowledge of other disciplines simply by being given the opportunity to take part in a multiprofessional scenario and observe another one. The results of the test and their reported perception about multidisciplinary team working suggest that they are better prepared to enter the healthcare workforce. Discussions during the debriefings highlighted the fact that multidisciplinary training is important. The main challenges identified have been the voluntary student attendance and timetabling issues forcing us to run the session late in the day due to the number of disciplines involved in each session and their different placement rota. The aim is now to timetable formally this session within their curriculum. Introducing simulation in the undergraduate curriculum should facilitate its implementation as Continuing Professional Development once these students become qualified healthcare professionals

Oscillation-free method for semilinear diffusion equations under noisy initial conditions

Noise in initial conditions from measurement errors can create unwanted oscillations which propagate in numerical solutions. We present a technique of prohibiting such oscillation errors when solving initial-boundary-value problems of semilinear diffusion equations. Symmetric Strang splitting is applied to the equation for solving the linear diffusion and nonlinear remainder separately. An oscillation-free scheme is developed for overcoming any oscillatory behavior when numerically solving the linear diffusion portion. To demonstrate the ills of stable oscillations, we compare our method using a weighted implicit Euler scheme to the Crank-Nicolson method. The oscillation-free feature and stability of our method are analyzed through a local linearization. The accuracy of our oscillation-free method is proved and its usefulness is further verified through solving a Fisher-type equation where oscillation-free solutions are successfully produced in spite of random errors in the initial conditions.Comment: 19 pages, 9 figure

Love\u27s Victory : Waltz

https://digitalcommons.library.umaine.edu/mmb-ps/1745/thumbnail.jp

Assessing Community Information Needs

Offers strategies for building a healthy information environment and enabling community change: define and engage the community early, mobilize the community as a resource, cultivate boundary-spanning groups, and ensure multiple entry points

Extracorporeal shockwave therapy for the treatment of lower limb intermittent claudication: Study protocol for a randomised controlled trial (the SHOCKWAVE 1 trial)

© 2017 The Author(s). Background: Peripheral arterial disease (PAD) has a population prevalence of 4.6% with intermittent claudication (IC) presenting as one of the earliest and most common symptoms. PAD has detrimental effects on patients' walking ability in terms of maximum walking distance (MWD) and pain-free walking distance (PFWD). Research has suggested extracorporeal shockwave therapy (ESWT) may induce angiogenesis in treated tissue; therefore, our objective is to assess the tolerability and efficacy of ESWT as a novel treatment of intermittent claudication. Methods/design: Patients with unilateral claudication will be randomised to receive either ESWT (PiezoWave 2 shockwave system) or sham treatment to the calf muscle bulk three times per week for 3 weeks. All patients are blinded to treatment group, and all assessments will be performed by a masked assessor. Treatment tolerability using a visual analogue scale, ankle-brachial pressure index, MWD, PFWD and safety will all be formally assessed as outcome measures at baseline and at 4, 8 and 12 weeks follow-up. Discussion: This trial will be the first of its kind in terms of methodology in relation to ESWT for intermittent claudication. A double-masked randomised controlled trial will provide useful information about the potential for the use of ESWT as a non-invasive treatment option and the need for further robust research. Trial registration: ClinicalTrials.gov, NCT02652078. Registered on 17 October 2014

An Unusual Hip Injury in a Male Soccer Player

Please refer to the pdf version of the abstract located adjacent to the title

Contribution à l'évaluation écotoxicologique du Tébuthiuron - un herbicide de la classe des urées substituées

Une étude écotoxicologique a été menée à l'égard du Tébuthiuron (TB), un phytocide homologué inhibant la croissance de végétation nuisible, afin de mieux cerner son impact sur le milieu aquatique susceptible d'être affecté par des épandages terrestres. La toxicité du TB a été évaluée en réalisant des bioessais à trois paliers écologiques, soit avec la truite arc-en-ciel (Salmo gairdneri), avec l'algue Selenaslrum capricornutum et avec la bactérie (Photobacterium phosphoreum) du système Microtox®. Parmi ces trois indicateurs, les algues se sont montrées les plus sensibles (C150 = 0,08 mg • L-1), suivies des truites (CL50 = 115 mg • L-1) et enfin, des bactéries du système Microtoxe (C150 - 328 mg • L-1). Des résidus maximaux variant de 0,091 à 0,18 mg • L-1 rapportés pour le TB en milieu aquatique, suite à des applications expérimentales, laissent donc croire que seules les algues pourraient étre victimes d'une agression marquée. D'autre part, les essais réalisés avec le SOS Chromotest ont démontré que le TB était faiblement génotoxique sans activation métabolique. En revanche, des algues exposées à 1 mg • L-1 de TB durant 4 heures n'ont pu ni (dés)actlver ni bioaccumuier l'herbicide. En général, notre enquéte corrobore certaines données générées pour fins d'homologation de ce produit, lesquelles concluaient en faveur de son innocuité relative à l'égard de l'environnement aquatique. Les effets chroniques que pourrait avoir une longue exposition de faibles concentrations de TB sur certains paliers écologiques devraient cependant faire l'objet d'lnvestigations futures.A wide array of chemical products are commonly used to inhibit the growth of a diversity of undesirable vegetation types for numerous purposes. In forestry applications, herbicides can improve ranges, contribute to sylviculture and facilitate rights-of-way management, for example. Among congeners of the substituted urea class herbicides, Tebuthiuron (TB) has proven efficient for such activities. Since its commercial appearance in 1974, this broad-spectrum weed killer was employed to control a variety of herbaceous and woody plants. When applied on soil before or during the onset of plant emergence, TB irreversibly affects photosynthesis after being absorbed by roots and translocated to its target sites. Prior to its registration as a herbicide, TB had undergone extensive (eco)toxicological testing which had generally indicated low potential for environmental concern, with regards to terrestrial and avian fauna. Although TB is generally purported to be unproblematic towards fish, the overall impact of substituted urea class herbicides is still not fully documented, as far as various members of the aquatic community are concerned. The experimental results presented herein - specifically on TB - contribute both confirmatory as well as some new information in this respect.In our study, TB toxicity was investigated at three ecological levels by undertaking acute bioassays with rainbow trout (Salmo gairdeneri), algae (Selenastrum capricornutum) and bacteria (Photobacterium phosphoreum). Among these bio-indicators, algae proved to be the most sensitive (EC50 = 0.08 mg • L-1), followed by rainbow trout (LC50 = 115 mg • L-1) and bacteria (EC50 = 328 mg • L-1). Since maximum TB residues lying between 0.091 and 0.18 mg • L-1 have been reported for aquatic systems following experimental terrestrial applications, our toxicity results suggest that only algae could be adversely affected following acute exposure to the herbicide.Additional tests performed with the SOS Chromotest, a bacterial colorimetric assay for detecting DNA-damaging agents, first showed that TB is weakly genotoxic without metabolic activation. Since recent genotoxicity studios have revealed that vegetal systems can either detoxify, activate or uptake specific chemicals, we then explored this possibility by exposing S. capricornutum (106 cells • mL-1) to 1 mg • L-1 of TB for 4 h. Results of this acute exposure indicated an absence of positive (detoxication) or negative (activation, accumulation) phytoplanktonic interactions. Indeed, the genotoxic characteristics of TB, before and after algal exposure, were unaltered, as demonstrated by SOS Chromotest assays. In this same experiment, a similar assay on TB-exposed algal cells (i.e. SOS Chromotest on an algal cell solvent extract) detected no genotoxic activity.In conclusion, our study corroborates existing data generated for TB registration purposes and essentially supports the notion that this chemical is relatively harmless towards the aquatic environment under normal use conditions. Nevertheless, an important caveat remains concerning chronic affects on specific organisms, which could result from long term exposure to low concentrations of TB. Since such potential effects have not yet been adequately addressed, further studios are warranted in this area