Students' and supervisors' experiences of supervision and training in clinical learning environment

Clinical training for health profession students is important prior to commencing their future professions. The literature describes a tension between the education assignment and patient care in clinical environments with high demands. Understanding students and supervisors’ experiences in the clinical learning environment isimportant to enhance the quality of clinical education. The overall aim was to explore the clinical learning environment from students’ and supervisors’ perspectives. Study I compared physiotherapy, medical, speech-language pathology, and nursing students’ perceptions of their clinical learning environments. Study II explored physiotherapy students’ experience of supervisors’ preparedness and supervision practices during their first clinical placement. Study III explored medical students’ experiences in the early stages of clinical training. Study IV explored clinical physiotherapy supervisors’ experience of giving feedback to students. To describe and compare students’ perceptions of their clinical learning environments, the Undergraduate Clinical Education Environment Measure was used. Individual semi-structured interviews were conducted with physiotherapy and medical students. Focus group interviews were performed with physiotherapy supervisors. The findings suggests that students experienced their clinical learning environment differently, the medical students scoring lower than the other students. The physiotherapy students appreciated supervisors who established a relationship with them, encouraged cooperation in the community, and used intended learning outcomes. The medical students were encouraged to push themselves forward in the clinic and ad hoc solutions concerning supervision occurred. Rather than trying to change the circumstances, they opted to adapt to the busy clinical learning environment. The physiotherapy supervisors found it challenging to provide feedback to students but found support within their network. Undergraduate students are generally satisfied with their clinical learning environments, but medical students’ low ratings need attention. It is important that supervisors take the initiative to establish a relationship with students and that focus is given for learning outcomes. Supervisors, need support in their educational role, which otherwise risks being downgraded, resulting in clinical training of variable quality for students. The workplace network provides key support for supervisors’ development of their ability to provide feedback to students

Inverkan av suggans ålder och utfodring på råmjölkens mängd och sammansättning

Newborn piglets have small energy reserves consisting of fat and glycogen, most of which are deposited in the liver and muscle tissues and therefore not available for thermoregulation. Hence, it is of utmost importance for the piglet's survival that it receives nourishment (colostrum) from the sow as soon as possible after birth to cover the piglet’s survival needs and enable a healthy increase in body weight. The composition of the sow’s colostrum changes a lot within the first day after farrowing. How can one improve the sow's colostrum to get the optimal amount and composition? This is a literature study aimed at investigating whether the age and feeding of the sow affects the quantity and composition of the produced colostrum. The literature shows that the feeding of the sow has a significant effect on the composition of the colostrum, and also that the age of the sow has a significant impact on the duration of the farrowing, which in turn has a significant association with the produced colostrum quantity. Something that also emerged during the study was that the genotype of the sow has a significant impact on the colostrum composition.Smågrisar föds med små energireserver bestående av fett och glykogen varav det mesta är uppbundet och inte tillgängligt för värmereglering. Det är av stor betydelse för smågrisens överlevnad att den får i sig råmjölk så fort som möjligt för att täcka dess underhållsbehov samt ge den möjlighet till en god tillväxt. Sammansättningen i suggans råmjölk förändras mycket inom det första dygnet efter grisningen. Hur kan suggans förutsättningar förbättras för att få en optimal mängd och sammansättning på suggans råmjölk? Detta är en litteraturstudie med syftet att undersöka om suggans ålder och utfodring påverkar den producerade råmjölkens mängd och sammansättning. I studien nedan framkommer att suggans utfodring har en signifikant påverkan på råmjölkens sammansättning samt att även suggans ålder har ett signifikant samband med grisningstidens längd, vilket i sin tur har ett signifikant samband med den producerade råmjölksmängden. Något som också framkom under studien var att suggans genotyp har en signifikant påverkan på råmjölkens innehåll

Certifying Navigational Skills: A Video-based Study on Assessments in Simulated Environments

In Maritime Education and Training (MET) where students are trained for professions with high standards of safety, the use of simulators is taken to provide opportunities for safe and cost-effective training. Although the use of simulators for training and certifying technical proficiency and so-called non-technical skills is well established and regulated by international standards, previous research suggests that simulator-based assessment has been poorly implemented in the MET system. Now the challenge is to contribute with knowledge about how to conduct consistent, unbiased, and transparent assessments of navigational skills and competencies. However, in current research it is not evident how training of non-technical skills in simulated environments should be assessed. The aim of this study is to explore the pedagogical challenges instructors face when assessing students\u27 navigational skills and competencies in a simulated environment. The study is based on video-recorded data from the certification part in a navigation course for second year master mariner students. A situated approach to cognition and learning is employed to analyze the co-construction of assessment in the simulated exercises by means of instructors\u27 questions and students\u27 answers. Results reveal an assessment practice where the students are still developing their navigational skills with instructional support from examiners whilst being certified on using Radar equipment in accordance to COLREG

Recirculation of phosphorus : an optimization analysis of processes to recycle phosphorus from sewage sludge

Phosphorus is a limited resource and for countries like Sweden without domestic mines, it becomes increasingly important to recycle this resource. Sewage sludge is rich in phosphorus and has traditionally been used as a fertiliser via direct application to farmland. There are many technologies that have been developed to recover P at the wastewater treatment plant or from sludge ashes, but the adaption of these technologies is slow. In Sweden the most common method of utilisation is still recycling through direct application to farm land, but this still only encompasses 25% of the produced sewage sludge. The Swedish EPA has suggested the objective to recycle 40% of the phosphorus in sewage sludge should be recycled to farmland by 2018, without risk of harming people or environment. Along with this target, new regulations have been suggested, which means that stricter limit values for residue in sludge is to be expected. Thus it will become more difficult to apply sludge to farmland. This makes it important to consider the effects of sludge quality when making strategic decisions. It is thus relevant to investigate which is the least costly processes with potential for recycling phosphorus from sewage sludge, under the suggested new regulations. This study compares the effect of four processes using linear programming to estimate the lowest cost operation, with Kungsängsverket as a case plant. The processes include two wastewater treatments, EBPR and conventional treatment with AS and chemical P precipitation, plus two additional processes; upstream management (Revaq) and recovery from ashes (CleanMAP). EBPR in combination with Revaq was found to be the optimum process combination. It was however rather difficult to make a reliable estimation of construction costs and therefore the results ought to be viewed with caution.Fosfor är en ändlig resurs och för länder som likt Sverige saknar egna gruvor, blir det allt viktigare att återcirkulera denna resurs. Avloppsslam är rikt på fosfor och har traditionellt sett använts som gödselmedel genom direkt spridning på åkermark. Det har utvecklats många tekniker för att återvinna fosfor vid avloppsreningsverk eller från slamaskor efter förbränning. Implementeringen av dessa processer har dock dröjt och direkt spridning på åkermark är fortfarande det största användningsområdet för avloppsslam i Sverige. Ändå sprids bara 25 % av slammet. Naturvårdsverket har föreslagit ett etappmål att 40 % av fosforn ur avloppsslam ska återföras till åkermark senast 2018. Samtidigt har de föreslagit en ny författning med striktare gränsvärden för resthalter i slam vid åkerspridning. Det blir således svårare att återföra slammet. Därmed blir det viktigare att ha slamkvalitén i åtanke vid strategiska beslut. Det är därför relevant att undersöka vilka processer som är de minst kostsamma med potential att producera ett slam eller utvunnen produkt som kan återföras till åkermark med den nya förordningen. Denna studie omfattar fyra processer och använder linjär programmering för att minimera kostnaden. Optimeringen utförs med Kungsängsverket som fallstudie. Processerna som jämförs är två processer för rening av avloppsvatten (biologisk fosfor avskiljning, s.k. Bio-P och konventionell rening med kemisk fosforfällning), samt två ytterligare processer; uppströmsarbete (Revaq) och utvinning av fosfor ur aska (CleanMAP). Bio-P i kombination med Revaq visade sig vara den optimala process-kombinationen. Dock visade det sig vara problematiskt att göra en tillförlitlig uppskattning av konstruktionskostnaden, varför resultaten bör tolkas med försiktighet

Wellbeing and family effect of Roux-en-Y gastric bypass surgery : results from an observational study and RCT

Introduction: Obesity is a world-wide public health issue. Bariatric surgery has shown to be the only effective way to reduce and maintain weight loss over time, with Roux- en-Y Gastric Bypass (RYGB) as the most common method used in Sweden. Technical complications after surgery have decreased substantially, thus, our focus of research has turned towards the wellbeing of these patients. Physical part of quality of life increases substantially after surgery, with a peak after approximately one year, followed by a gradual decline. The mental part of quality of life has shown less clear results, as is also the case with objectively measured physical activity, eating behavior and other psychosocial aspects. Psychosocial interventions after bariatric surgery might help to improve these outcomes. Additionally, the major lifestyle changes that relate to bariatric surgery have made researchers ask questions how this might affect the patients’ families, but little is known about this topic. Aims: The general aims of this thesis were to see if there were any long-term effects from mothers’ RYGB surgery on their children’s weight status, eating attitudes, body- esteem, self-concept, physical activity and sedentary time. Additional aims include to investigate if a dissonance-based group intervention can improve wellbeing after RYGB surgery and if health related quality of life was associated with physical activity before and after RYGB. Methods: This thesis consists of two data collections. The first one consists of a prospective cohort study of women undergoing RYGB surgery and their children, with a 4-year follow-up of psychosocial outcomes and physical activity. This data collection included home visits to the families, wearing accelerometers to objectively assess data on physical activity, and a number of psychosocial scales. The other data collection consists of a randomized controlled intervention study. Women waiting for RYGB surgery were recruited and then randomized to a dissonance- based group intervention (4 sessions) post-RYGB surgery or control group (standard care). These women also wore accelerometers and answered some psychosocial scales before, and one year after surgery. Results: Sixty-nine women and 81 of their children were recruited and 35 women and 43 of their children participated in all 3 measurements (pre-surgery, 9 months and 4 years post-surgery). Out of these, 30 women and 40 children provided valid accelerometer data. Children’s prevalence of overweight and obesity decreased 9 months post-surgery but increased again at 4 years follow-up. The same pattern was seen for children’s eating attitudes and women’s eating behavior, sleep quality and symptoms of depression and anxiety. Children’s self-concept and body-esteem declined gradually. There were no differences in women’s physical activity levels from pre- to post-surgery and children decreased their physical activity and increased their sedentary time over the same time period. The intervention study recruited 259 women with 156 women randomized to the intervention group and 103 to the control group. Fifty-three women from the intervention group did not attend any group sessions and 203 women in total completed one-year follow up assessments. A great improvement in quality of life was seen one-year post RYGB, but there were no differences between the intervention and control group in any of the measured outcomes. Moreover, physical activity was associated with quality of life both pre- and post-RYGB surgery (the data set included over 60 women from the control group with complete data). Conclusions: There might be an effect of mothers’ RYGB surgery on their children, but more research, preferable studies including a control group, are needed to tease out if this effect is a natural pattern or not. Women and children did not increase their physical activity levels after the mothers’ RYGB surgery and a decline in children’s psychosocial variables were shown. Many of women’s psychosocial variables showed a rebound effect 4 years after surgery, despite that weight remained stable from 9 months to 4 years post-surgery. Physical activity is associated with health-related quality of life in women both before and after RYGB surgery. Meeting with physical activity recommendations showed overall stronger associations post- compared to pre-RYGB. We found no early one-year effect on health-related quality of life, physical activity, social adjustment, body-esteem or eating behavior of a dissonance-based group intervention after RYGB surger