Peer learning on clinical wards : supervision, student activities and the learning environment

Introduction: Worldwide, a growing number of healthcare students require clinical environments for learning. Multiple students are placed on clinical wards simultaneously with one supervisor to meet this demand. This can create stress for the supervisor and reduce the quality of learning for students. To ensure continued quality of education, some wards have formally adopted peer learning as a pedagogical framework. Peer learning has been widely shown to have advantages for students, such as developing teaching skills, teamwork, and independence. A deeper understanding is needed of the characteristics of wards that use peer learning as a pedagogical framework, and how these compare to wards that do not. In particular, it is important to explore the nature of supervision in the context of peer learning. Methods: An observational study (I) was conducted on a ward adapted to student peer learning to describe the learning environment. Student nurses, supervisors and other staff were observed, complemented by audio diaries and informal questioning. Field notes were thematically analysed. The findings on the supervisor’s role inspired study II which explored the different ways clinical supervisors view their role in students' peer learning. Semi-structured interviews were performed with 15 supervisors of student nurses from two wards adapted to student peer learning. Transcribed data were coded and analysed using a phenomenographic approach. Study III aimed to explore which of the characteristics and ways of viewing the supervisor role from studies I and II were present in other wards. To investigate this, a questionnaire was developed and psychometrically using the AMEE 7-step guide, and piloted with 46 nurse supervisors. Participants from wards that used peer learning as a pedagogical framework were compared with those that did not. We analysed the pilot results using basic statistics and multivariable discriminant analysis and Variable Importance in Projection. Results: The observational study (I) identified that a ward adapted to student peer learning had student-led learning; student-dedicated space; peer learning; personalised relationships; an inter-professional approach; and supervisors who were motivated to teach. The questionnaire study (III) found that other wards that used peer learning as a pedagogical framework shared these features, however that only the first three of these characteristics were significantly higher than in wards that did not use peer learning as a pedagogical framework. The interview study (II) found four ways in which the supervisors viewed their role in students’ peer learning: the teacher; the facilitator; the stimulator; and the team player. Discussion and conclusions: The observed ward (study I) had a community of practice centred on student learning. Peer learning supervisors’ broadest view of their role was as a team player, supporting the educational enterprise of the ward community (study II). The pilot questionnaire (study III) found differences between some characteristics of the learning environment on different types of wards. A next step is to conduct the questionnaire on a larger scale to explore further the ways in which the pedagogical framework and peer learning can affect supervision and the learning environment. Using a pedagogical framework on a clinical ward could be a key factor in developing a community of practice centred on student learning

I Wish I Had Written That. Artistics and Medical Humanity: Thoughts on the Achievement of Kevin Barry’s Short Story ‘A Cruelty’

The author discussed his favorite passages written by Kevin Barry and explained why a particular passage in Kevin Barry\u27s short story \u27A cruelty\u27 resonated with him

SISTEM INFORMASI SELEKSI BEASISWA TARUNA POLITEKNIK MARITIM NEGERI INDONESIA SEMARANG

Tujuan Tugas Akhir ini adalah untuk rancang bangun sistem informasi seleksi beasiswa taruna pada PoliMARIN Semarang dengan menganalisis sistem yang ada. Sejak berdiri hingga sekarang usia PoliMARIN kini menginjak semester ketiga dan mempunyai program beasiswa yang akan dijalankan di semester keempat, namun dalam pelaksanaannya PoliMARIN belum mempunyai fasilitas untuk menjalankan program beasiswa. Pada penelitian ini, penulis mencoba menerapkan suatu program sistem seleksi beasiswa. Pemrograman yang menggunakan visual basic 6.0. Metode yang sedang digunakan dalam menjalankan sistem adalah Siklus Hidup Pengembangan Sistem System Development Life Cycle-SDLC dengan tahap perancangan, analisis, rancangan, penerapan, dan pemeliharaan. Metode pemodelan sistem menggunakan UML (Unifieed Modelling Language) yang terdiri dari Use case, Sequence diagram, dan Activity diagram. Hasil yang diperoleh dari penelitian ini berupa sistem seleksi penerimaan beasiswa dengan satu user admin yang dapat mengakses sistem. Dengan adanya sistem seleksi ini diharapkan dapat membantu PoliMARIN dalam mengembangkan dan menjalankan proses akademik

Are we using antibiotics responsibly? : assessing antibiotic use in rural Shandong province, China

Background: Tackling the misuse and overuse of antibiotics is critical both for global sustainable development and for reducing social inequalities in the world. The World Health Organisation Global Action Plan on antimicrobial resistance calls on all Member States to develop multi-sectoral National Action Plans and to “monitor and promote optimization of antimicrobial use at national and local levels”. There is a particular need to assess how antibiotics are being used in resource-limited settings, which tend to have the highest burdens of infections and of antibiotic resistance. In such settings antibiotics are commonly overused and misused in agriculture too, emphasizing the need for One Health approaches. In 2010, China was estimated to be the second largest consumer of antibiotics for human use by total volumes, and the largest consumer of antibiotics within food animal production. Information on antibiotic use in human healthcare in rural areas is lacking in China, as is knowledge of the volumes and patterns of antibiotic use in agriculture, particularly in backyard pig farms which remain highly prevalent. Aim: To assess how antibiotics are being used for humans and on backyard pig farms in a rural region in China. Methods: All studies were conducted in rural areas of Shandong province, located in eastern China. Two main methods were used: analyses of prescriptions from healthcare facilities, and surveys of doctors', rural residents' and backyard pig farmers' knowledge, attitudes and practices concerning antibiotic use and resistance. In Paper I we assessed the rates and types of antibiotics prescribed for patients with common cold diagnoses during one month at thirty healthcare facilities in three different counties. These healthcare facilities covered three different levels in the rural healthcare system: village clinics, township health centres and county hospitals. All 188 doctors working at the healthcare facilities were invited to participate in a questionnaire on knowledge and attitudes towards antibiotic use. In Paper II we prospectively monitored antibiotic prescribing over a 2.5 year period at eight village clinics located around a single town in a rural county. We conducted individual prescriberlevel analyses in order to assess the extent of variations in prescribing practices, focussing on prescriptions containing diagnoses of likely viral acute upper respiratory tract infections (AURI). In Paper III we assessed the knowledge, attitudes and practices towards antibiotic use and resistance of 769 rural residents living in the twelve villages that are served by the village clinics in Paper II. In Paper IV we assessed the knowledge, attitudes and practices towards antibiotic use in pigs of the 271/769 rural residents who had backyard pig farms. We also observed the rates and types of antibiotics stored in households for use in humans and pigs in Papers III and IV. Results: Over half of all prescriptions with a common cold diagnosis at healthcare facilities in Paper I contained at least one antibiotic, as did almost two-thirds of the prescriptions for likely viral AURIs at village clinics in Paper II. The majority of antibiotics prescribed were broad-spectrum. Antibiotics were more likely to be prescribed on common cold prescriptions from village clinics than on prescriptions from higher level healthcare facilities. There was widespread variation in the antibiotic prescribing practices of individual village doctors. Significant gaps existed between doctors' knowledge and attitudes, and their actual prescribing practices, despite a majority of doctors reporting that they had recently attended training on rational antibiotic use. Rural residents and backyard pig farmers had low levels of knowledge about what antibiotics are and when they should be used. Rural residents more frequently thought that antibiotics are needed for infectious conditions than for non-infectious conditions, but they did not differentiate significantly between infections caused by bacteria, where antibiotics may be needed, and those caused by viruses, where they are not. Rural residents commonly reported acquiring antibiotics without prescriptions, as well as using leftover antibiotics. Similarly, backyard pig farmers reported frequently using antibiotics in healthy pigs when they are not needed, and purchasing antibiotics without consulting veterinarians. Backyard pig farmers had differences in their knowledge, attitudes and practices towards antibiotic use in humans compared with other rural residents, and these appeared to be inter-related with their knowledge, attitudes and practices towards antibiotic use in pigs. Household storage of antibiotics for human use was common, and similar to levels identified in previous studies in Asia; storage of antibiotics on backyard pig farms was also frequent, and many of the stored antibiotics are considered to be critically important for human medicine. Conclusions: The work in this thesis strongly suggests that antibiotics are not being used responsibly enough for humans and on backyard pig farms in the study region: doctors, rural residents and backyard pig farmers in rural Shandong province are frequently overusing and misusing antibiotics. There is a need to investigate which additional drivers are causing doctors to prescribe antibiotics unnecessarily, despite knowing that they are not needed. Rural residents' and backyard pig farmers' knowledge and attitudes may be contributing to overuse and misuse of antibiotics, for example through having expectations to receive antibiotics from healthcare professionals in situations for which they are not clinically needed. In resource-limited settings, high quality, cross-sectoral assessments of antibiotic use at a small number of study sites can provide valuable insights into how responsibly antibiotics are being used

Space weathering: Laboratory analyses and in-situ instrumentation

Simulations of space weathering using laser irradiation are exploited to study the formation of sub-microscopic iron. A variety of magnetic techniques are evaluated to characterise this iron and are considered for in-situ instrumentation

Beta-Delayed Neutron Data and Models for SCALE

Recent advancements in experimental and theoretical nuclear physics have yielded new data and models that more accurately describe the decay of fission products compared to historical data currently used for many applications. This work examines the effect of the adopting the Effective Density Model theory for beta-delayed neutron emission probability on calculations of delayed-neutron production and fission product nuclide concentrations after fission bursts as well as the total delayed neutron fraction in comparison with the Keepin 6-group model. We use ORIGEN within the SCALE code package for these calculations. We show quantitative changes to the isotopic concentrations for fallout nuclides and delayed neutron production after fission bursts on the order of a few percent. We also show that the changes are larger at small times for short lived fission products, and that corrections to the cumulative fission product yields has an impact upon the total delayed neutron fraction for 235U [Uranium 235]. The effect of modeling the β2n [beta delayed double neutron emission] decay mode is also studied but no significant changes from the single beta-delayed neutron emission is currently seen