Wellness from Diabetes: Community Health and Diabetes Assessment

The Republic of the Marshall Islands (RMI) is highly prevalent in type 2 diabetes mellitus (T2DM) with a prevalence rate of 37.37%, the highest in the world. T2DM dominates Majuro, the country’s capital, as a leading cause of mortality and morbidity, despite efforts of health care workers, local community organizations, and government. Income and education are social determinants of health. The correlations between good health and high income, and between good health and high education level, are positive. However, there is a continuous growth of T2DM incidence and prevalence on Majuro. Therefore, we hypothesized that there is no significant difference between healthful dietary and exercise practices of two groups of people on Majuro, RMI: those with high income and high education levels, and those with low income and low education levels. Community-based research conducted on Majuro helped test our hypothesis and gain knowledge of necessary steps to reverse this epidemic. During beginning stages of our research, related literature on diabetes, social determinants of health, and research methods were reviewed. To acquire qualitative data, focus group discussions (FGDs) and key informant interviews (KIIs) were conducted. FGDs were held with people grouped according to profession (health, education, community). With the KIIs, key members deeply involved or active in the community were interviewed one-on-one. The bulk of our quantitative data will be gathered by surveys on basic demographics, economics, and health-related perceptions. In collaboration with the Ministry of Health and local organizations, 400 surveys will be administered in Marshallese and English, and collected

Investigating the use of simulations in enhancing clinical judgement of students to practice as registered nurses

University of Technology, Sydney. Faculty of Arts and Social Sciences.On entry to the workforce nursing graduates are expected to respond to a range of clinical situations they may not have experienced during their program. The social aspects of practice such as professional behaviours are equally important for transitioning to the registered nurse role. Contemporary simulation strategies can provide students with experiences of how Registered Nurses would respond in a guaranteed range of patient care situations. The exponential rise of healthcare simulation over the last 15 years is reflected in the prolific number of publications about its use, participant evaluation and satisfaction, or improvements in skills technique. Few of these evaluations capture the impact of the simulation learning experiences beyond the immediate timeframe of the activity. Similarly, there is little research about how simulations may contribute to the ‘thinking’ aspects and holistic nature of professional practice and the pedagogy of simulation practices. This research explored the contribution of simulation for final year nursing students’ learning and clinical judgement capabilities; and the effect of simulations on students’ subsequent practice as new Registered Nurses in the year following graduation. Methods A multi-phase mixed methods approach was used in the research which comprised two studies. In Study 1, 108 final year nursing students responded to a pre- post-simulation survey. Opinion was sought about self-rated skills, knowledge and dimensions of practice prior to and following the simulation. The post-survey asked students to rate 11 components of the designated simulation to the application of clinical judgment. Study 2 comprised group interviews with nine students at degree completion, and 1:1 interviews during the first three months of registered nurse practice. Standard statistical analysis was applied to quantitative data and word clouds were created from the survey free text responses. Data from group and individual interviews produced a number of themes following iterative analyses. Students from three study streams were represented in both studies: 3-year program, 2-year accelerated graduate entry program; and 2-year accelerated enrolled nurse program. Key findings Prior to the simulation students felt least able about: caring for patients, their knowledge and clinical abilities. Following the simulation there was greater importance on the patient, communication and assessment. The top three simulation components which assisted students with clinical judgements were: post-simulation reflection, facilitated debriefing and guidance by the academic. At course completion students reported the simulations provided them with greater insight into the professional traits required for registered nurse practice as the activities presented opportunities to glue things together, draw on tacit knowledge and appreciate the holism of practice. Learning within simulation was situated, experiential and contextual but also elicited affective elements of learning, that is: emotions, behavioural norms and professional attitudes. Immediate effects on practice were greater attention to noticing patient cues and a willingness to inquire further and respond in meaningful ways. In the early months of practice, participants recalled the simulation experiences during sequent patient care situations of similar or contrasting contexts. Each new graduate nurse cited at least one instance where they were able to anticipate what may happen next in the patient care trajectory and responded by making judgements and decisions relative to the urgency of a situation. Clear connections were made between the simulations and their contributions to clinical practice. Conclusion Unlike other educational strategies, simulations provided unique learning opportunities for nursing students which contributed in meaningful ways as preparation for independent practice. In addition to improving confidence for practice, these new graduate nurses were able to make appropriate clinical judgements often within challenging situations, which influenced patient outcomes in positive ways

Exclusive breastfeeding duration and infant infection

BACKGROUND/OBJECTIVES: We estimated the risk of infection associated with the duration of exclusive breastfeeding (EBF). SUBJECT/METHODS: We analysed the data on 15 809 term, singleton infants from the UK Millennium Cohort Study. Infants were grouped according to months of EBF: never, <2, 2-4, 4-6 and 6 (the latter being World Health Organisation (WHO) policy since 2001: 'post-2001 WHO policy'). Among those EBF for 4-6 months, we separated those who started solids, but not formula, before 6 months, and were still breastfeeding at 6 months (that is, WHO policy before 2001: 'pre-2001 WHO policy'), from other patterns. Outcomes were infection in infancy (chest, diarrhoeal and ear). RESULTS: EBF was not associated with the ear infection, but was associated with chest infection and diarrhoea. EBF for <4 months was associated with a significantly increased risk of chest infection (adjusted risk ratios (RR) 1.24-1.28) and diarrhoea (adjusted RRs 1.42-1.66) compared with the pre-2001 WHO policy. There was an excess risk of the chest infection (adjusted RR 1.19, 95% confidence interval (CI): 0.97-1.46) and diarrhoea (adjusted RR 1.66, 95% CI: 1.11, 2.47) among infants EBF for 4-6 months, but who stopped breastfeeding by 6 months, compared with the pre-2001 WHO policy. There was no significant difference in the risk of chest infection or diarrhoea in those fed according to the pre-2001 versus post-2001 WHO policy. CONCLUSIONS: There is an increased risk of infection in infants EBF for <4 months or EBF for 4-6 months who stop breastfeeding by 6 months. These results support current guidelines of EBF for either 4-6 or 6 months, with continued breastfeeding thereafter.European Journal of Clinical Nutrition advance online publication, 27 July 2016; doi:10.1038/ejcn.2016.135

Precise event sampling on AMD versus intel: quantitative and qualitative comparison

Precise event sampling is a profiling feature in commodity processors that can sample hardware events and accurately locate the instructions that trigger the events. This feature has been used in a large number of tools to detect application performance issues. Although precise event sampling is readily supported in modern multicore architectures, vendor supports exhibit great differences that affect their accuracy, stability, overhead, and functionality. This work presents the most comprehensive study to date on benchmarking the event sampling features of Intel PEBS and AMD IBS and performs in-depth analysis on key differences through series of microbenchmarks. Our qualitative and quantitative analysis shows that PEBS allows finer-grained and more accurate sampling of hardware events, while IBS offers richer set of information at each sample though it suffers from lower accuracy and stability. Moreover, OS signal delivery, which is a common method used by the profiling software, introduces significant time overhead to the original overhead incurred by the hardware mechanisms in both PEBS and IBS. We also found that both PEBS and IBS have bias in sampling events across multiple different locations in a code. Lastly, we demonstrate how our findings on microbenchmarks under different thread counts hold for a full-fledged profiling tool that runs on the state-of-the-art Intel and AMD machines. Overall our detailed comparisons serve as a great reference and provide invaluable information for hardware designers and profiling tool developers

Delivering a large cohort simulation - Beginning nursing students' experience: A pre-post survey

Background: The use of simulation has been growing rapidly within nursing programs, internationally. Simulation provides opportunity for beginning nursing students to rehearse patient care experiences and develop confidence in technical and non-technical nursing skills

Manipulating adenovirus hexon hypervariable loops dictates immune neutralisation and coagulation factor X-dependent cell interaction in vitro and in vivo

Adenoviruses are common pathogens, mostly targeting ocular, gastrointestinal and respiratory cells, but in some cases infection disseminates, presenting in severe clinical outcomes. Upon dissemination and contact with blood, coagulation factor X (FX) interacts directly with the adenovirus type 5 (Ad5) hexon. FX can act as a bridge to bind heparan sulphate proteoglycans, leading to substantial Ad5 hepatocyte uptake. FX “coating” also protects the virus from host IgM and complement-mediated neutralisation. However, the contribution of FX in determining Ad liver transduction whilst simultaneously shielding the virus from immune attack remains unclear. In this study, we demonstrate that the FX protection mechanism is not conserved amongst Ad types, and identify the hexon hypervariable regions (HVR) of Ad5 as the capsid proteins targeted by this host defense pathway. Using genetic and pharmacological approaches, we manipulate Ad5 HVR interactions to interrogate the interplay between viral cell transduction and immune neutralisation. We show that FX and inhibitory serum components can co-compete and virus neutralisation is influenced by both the location and extent of modifications to the Ad5 HVRs. We engineered Ad5-derived HVRs into the rare, native non FX-binding Ad26 to create Ad26.HVR5C. This enabled the virus to interact with FX at high affinity, as quantified by surface plasmon resonance, FX-mediated cell binding and transduction assays. Concomitantly, Ad26.HVR5C was also sensitised to immune attack in the absence of FX, a direct consequence of the engineered HVRs from Ad5. In both immune competent and deficient animals, Ad26.HVR5C hepatic gene transfer was mediated by FX following intravenous delivery. This study gives mechanistic insight into the pivotal role of the Ad5 HVRs in conferring sensitivity to virus neutralisation by IgM and classical complement-mediated attack. Furthermore, through this gain-of-function approach we demonstrate the dual functionality of FX in protecting Ad26.HVR5C against innate immune factors whilst determining liver targeting