Sexual Health Education: an evaluation of the Northumbria Integrated Sexual Health Education (NISHE) Workforce Development Package delivered by UWE, Bristol

Background: Sexual health and wellbeing is a central focus of public health policy and service development in England (Department of Health (DH) 2013a, 2013b, Public Health England (PHE) 2015). Historically, services in the UK have been delivered through Family Planning clinics for contraceptive services or Genito-Urinary (GUM) clinics for sexual health issues. Current NHS Service Specifications for sexual health services emphasise an integrated service, delivered by a single health professional (DH 2013b), which has significant implications for the sexual health workforce. Within the South West, there was a disparity of sexual health education provision with little emphasis on the practical competence element. In order to equip sexual health nurses with the appropriate knowledge and skills to deliver an integrated sexual health service, the University of the West of England (UWE) entered a formal agreement with a partner university who had developed an educational package. UWE commenced delivery of two new sexual health modules in September 2013, incorporating both a newly developed classroom delivered Foundations of Sexual Health module and an established Integrated Sexual Health Education module which incorporated a practice placement, mentor support and blended learning approaches to deliver the theory element. This package had previously been successfully delivered in the North of England (McNall and Kain 2010). Aims This research, conducted between 2013 and 2015, explored the transferability of the model to the South West region and the degree to which the educational delivery met service demands in relation to integrated sexual health provision. Research Methodology: Data were collected using quantitative and qualitative methods, specifically longitudinal baseline and follow-up survey data from students (n=49) using two validated self-efficacy scales, focus groups with students (n=22) and semi-structured interviews with students (n=7) and strategic managers (n=6). Quantitative analysis of questionnaire data was conducted on baseline and follow-up data using SPSS version 2.2. The data exploring self-efficacy were analysed using Wilcoxon tests and Friedman’s tests. Descriptive statistics and frequencies were used to examine the characteristics of the study population. Qualitative analysis was conducted through thematic analysis and constant comparative methods (Braun and Clarke 2006). Key Findings: The results indicated that students who undertook the modules demonstrated significant increases in self-efficacy when using the evidence base in sexual health practice and when communicating in difficult situations. The highest percentage point increase in self-efficacy occurred when the students completed both modules rather than one in isolation. Service manager and student expectation regarding the instructional immediacy and technological specification of the e-learning package were not always met but the electronic mode of delivery was praised for its flexibility, especially important given the large geographical spread of students. Service managers and students were aware of the move to integrated service delivery but were often frustrated by structural restraints that impeded innovation and practice development, such as fragmented commissioning arrangements or lack of collocated services. Although these restraints limited the impact that new learning could have on the service that was offered to patients, there was some evidence that the students were using their professional autonomy to manipulate the system, in line with Lipsky’s (1980) concept of street level bureaucracy. Recommendations: Consideration should be given to the balance of e-learning and face-to-face contact within modules, to enhance instructional immediacy and increase student satisfaction. E-learning packages should be reviewed to meet student expectation by incorporating interactive technology and opportunities for collaborative learning. In addition, where service delivery is in a state of flux, modules should incorporate elements of leadership development to enable practitioners to initiate and manage change in practice

Power-law distributions in empirical data

Power-law distributions occur in many situations of scientific interest and have significant consequences for our understanding of natural and man-made phenomena. Unfortunately, the detection and characterization of power laws is complicated by the large fluctuations that occur in the tail of the distribution -- the part of the distribution representing large but rare events -- and by the difficulty of identifying the range over which power-law behavior holds. Commonly used methods for analyzing power-law data, such as least-squares fitting, can produce substantially inaccurate estimates of parameters for power-law distributions, and even in cases where such methods return accurate answers they are still unsatisfactory because they give no indication of whether the data obey a power law at all. Here we present a principled statistical framework for discerning and quantifying power-law behavior in empirical data. Our approach combines maximum-likelihood fitting methods with goodness-of-fit tests based on the Kolmogorov-Smirnov statistic and likelihood ratios. We evaluate the effectiveness of the approach with tests on synthetic data and give critical comparisons to previous approaches. We also apply the proposed methods to twenty-four real-world data sets from a range of different disciplines, each of which has been conjectured to follow a power-law distribution. In some cases we find these conjectures to be consistent with the data while in others the power law is ruled out.Comment: 43 pages, 11 figures, 7 tables, 4 appendices; code available at http://www.santafe.edu/~aaronc/powerlaws

Framework for the Parametric System Modeling of Space Exploration Architectures

This paper presents a methodology for performing architecture definition and assessment prior to, or during, program formulation that utilizes a centralized, integrated architecture modeling framework operated by a small, core team of general space architects. This framework, known as the Exploration Architecture Model for IN-space and Earth-to-orbit (EXAMINE), enables: 1) a significantly larger fraction of an architecture trade space to be assessed in a given study timeframe; and 2) the complex element-to-element and element-to-system relationships to be quantitatively explored earlier in the design process. Discussion of the methodology advantages and disadvantages with respect to the distributed study team approach typically used within NASA to perform architecture studies is presented along with an overview of EXAMINE s functional components and tools. An example Mars transportation system architecture model is used to demonstrate EXAMINE s capabilities in this paper. However, the framework is generally applicable for exploration architecture modeling with destinations to any celestial body in the solar system

Effect of medical student preference on rural clinical school experience and rural career intentions

Introduction: The key parameter for rural clinical schools (RCSs) is to provide at least 1 year of clinical training in rural areas for 25% of Australian Commonwealth supported medical students with the intent to influence future rural medical workforce outcomes. The objective of this study was to describe the association between a medical student’s selection preference and their RCS experience and rural career intent. Methods: Medical students completing an RCS placement in 2012 and 2013 were encouraged to complete a survey regarding their experience and future career intent. Data were analysed to compare medical students for whom the RCS was their first choice with students who described the RCS as other than their first preference. Results: Students for whom RCS was their first choice (724/1092) were significantly more likely to be female, come from a rural background and be from an undergraduate program. These students reported more positive experiences of all aspects of the RCS program (costs, access, support and networks, safety) and were 2.36 times more likely to report intentions to practice in a non-metropolitan area (odds ratio(OR)=2.36 (95% confidence interval(CI)=1.82–3.06), p\u3c0.001). This was true for students of rural (OR=3.11 (95%CI=1.93–5.02), p\u3c0.001) and metropolitan backgrounds (OR=2.07 (95%CI=1.48–2.89), p\u3c0.001). More students in the first-choice group (68.8%) intended to practice in a regional area (not a capital or major city), significantly higher than the 48.4% of participants in the other-preference group (χ2 (1) 42.79, p\u3c0.001). Conclusions: The decision to choose an RCS placement is a marker of rural career intention and a positive rural training experience for students of both rural and metropolitan backgrounds. It may be important to identify other-preference students and their specific social support needs to ensure a positive perception of a future rural career

Simulating the Impact Response of Full-Scale Composite Airframe Structures

NASA Langley Research Center obtained a composite helicopter cabin structure in 2010 from the US Army's Survivable Affordable Repairable Airframe Program (SARAP) that was fabricated by Sikorsky Aircraft Corporation. The cabin had been subjected to a vertical drop test in 2008 to evaluate a tilting roof concept to limit the intrusion of overhead masses into the fuselage cabin. Damage to the cabin test article was limited primarily to the roof. Consequently, the roof area was removed and the remaining structure was cut into test specimens including a large subfloor section and a forward framed fuselage section. In 2011, NASA and Sikorsky entered into a cooperative research agreement to study the impact responses of composite airframe structures and to evaluate the capabilities of the explicit transient dynamic finite element code, LS-DYNA, to simulate these responses including damage initiation and progressive failure. Most of the test articles were manufactured of graphite unidirectional tape composite with a thermoplastic resin system. However, the framed fuselage section was constructed primarily of a plain weave graphite fabric material with a thermoset resin system. Test data were collected from accelerometers and full-field photogrammetry. The focus of this paper will be to document impact testing and simulation results for the longitudinal impact of the subfloor section and the vertical drop test of the forward framed fuselage section

Splanchnic metabolism of nutrients and hormones in steers fed alfalfa under conditions of increased absorption of ammonia and L-arginine supply across the portal-drained viscera

Effects of increased ammonia and/or arginine absorption on net splanchnic (portal-drained viscera [PDV] plus liver) metabolism of nonnitrogenous nutrients and hormones in cattle were examined. Six Hereford × Angus steers (501 ± 1 kg BW) prepared with vascular catheters for measurements of net flux across the splanchnic bed were fed a 75% alfalfa:25% (as-fed basis) corn and soybean meal diet (0.523 MJ of ME/[kg BW0.75.d]) every 2 h without (27.0 g of N/kg of DM) and with 20 g of urea/kg of DM (35.7 g of N/kg of DM) in a split-plot design. Net flux measurements were made immediately before and after a 72-h mesenteric vein infusion of L-arginine (15 mmol/h). There were no treatment effects onPDVor hepaticO2 consumption. Dietary urea had no effect on splanchnic metabolism of glucose or L-lactate, but arginine infusion decreased net hepatic removal of L-lactate when urea was fed (P < 0.01). Net PDV appearance of n-butyrate was increased by arginine infusion (P < 0.07), and both dietary urea (P < 0.09) and arginine infusion (P < 0.05) increased net hepatic removal of n-butyrate. Dietary urea also increased total splanchnic acetate output (P < 0.06), tended to increase arterial glucagon concentration (P < 0.11), and decreased arterial ST concentration (P < 0.03). Arginine infusion increased arterial concentration (P < 0.07) and net PDV release (P < 0.10) and tended to increase hepatic removal (P < 0.11) of insulin, as well as arterial concentration (P < 0.01) and total splanchnic output (P < 0.01) of glucagon. Despite changes in splanchnic N metabolism, increased ammonia and arginine absorption had little measurable effect on splanchnic metabolism of glucose and other nonnitrogenous components of splanchnic energy metabolism

The Development of Two Composite Energy Absorbers for Use in a Transport Rotorcraft Airframe Crash Testbed (TRACT 2) Full-Scale Crash Test

Two composite energy absorbers were developed and evaluated at NASA Langley Research Center through multi-level testing and simulation performed under the Transport Rotorcraft Airframe Crash Testbed (TRACT) research program. A conical-shaped energy absorber, designated the conusoid, was evaluated that consisted of four layers of hybrid carbon-Kevlar plain weave fabric oriented at [+45deg/-45deg/-45deg/+45deg] with respect to the vertical direction. A sinusoidal-shaped energy absorber, designated the sinusoid, was developed that consisted of hybrid carbon-Kevlar plain weave fabric face sheets, two layers for each face sheet oriented at +/-45deg with respect to the vertical direction, and a closed-cell ELFOAM P200 polyisocyanurate (2.0-lb/cu ft) foam core. The design goal for the energy absorbers was to achieve average floor-level accelerations of between 25- and 40-g during the full-scale crash test of a retrofitted CH-46E helicopter airframe, designated TRACT 2. Variations in both designs were assessed through dynamic crush testing of component specimens. Once the designs were finalized, subfloor beams of each configuration were fabricated and retrofitted into a barrel section of a CH-46E helicopter. A vertical drop test of the barrel section was conducted onto concrete to evaluate the performance of the energy absorbers prior to retrofit into TRACT 2. The retrofitted airframe was crash tested under combined forward and vertical velocity conditions onto soft soil. Finite element models were developed of all test articles and simulations were performed using LS-DYNA, a commercial nonlinear explicit transient dynamic finite element code. Test-analysis results are presented for each energy absorber as comparisons of time-history responses, as well as predicted and experimental structural deformations and progressive damage under impact loading for each evaluation level

Change in cost and affordability of a typical and nutritionally adequate diet among socio-economic groups in rural Nepal after the 2008 food price crisis

Diet quality is an important determinant of nutrition and food security and access can be constrained by changes in food prices and affordability. Poverty, malnutrition, and food insecurity are high in Nepal and may have been aggravated by the 2008 food price crisis. To assess the potential impact of the food price crisis on the affordability of a nutritionally adequate diet in the rural plains of Nepal, data on consumption patterns and local food prices were used to construct typical food baskets, consumed by four different wealth groups in Dhanusha district in 2005 and 2008. A modelled diet designed to meet household requirements for energy and essential nutrients at minimum cost, was also constructed using the ‘Cost of Diet’ linear programming tool, developed by Save the Children. Between 2005 and 2008, the cost of the four typical food baskets increased by 19% – 26% and the cost of the nutritionally adequate modelled diet increased by 28%. Typical food baskets of all wealth groups were low in macro and micronutrients. Income data for the four wealth groups in 2005 and 2008 were used to assess diet affordability. The nutritionally adequate diet was not affordable for poorer households in both 2005 and 2008. Due to an increase in household income levels, the affordability scenario did not deteriorate further in 2008. Poverty constrained access to nutritionally adequate diets for rural households in Dhanusha, even before the 2008 food price crisis. Despite increased income in 2008, households remain financially unable to meet their nutritional requirements

Multi-Level Experimental and Analytical Evaluation of Two Composite Energy Absorbers

Two composite energy absorbers were developed and evaluated at NASA Langley Research Center through multi-level testing and simulation performed under the Transport Rotorcraft Airframe Crash Testbed (TRACT) research program. A conical-shaped energy absorber, designated the conusoid, was evaluated that consisted of four layers of hybrid carbon-Kevlar plain weave fabric oriented at [+45 deg/-45 deg/-45 deg/+45 deg] with respect to the vertical, or crush, direction. A sinusoidal-shaped energy absorber, designated the sinusoid, was developed that consisted of hybrid carbon-Kevlar plain weave fabric face sheets, two layers for each face sheet oriented at +/-45deg with respect to the vertical direction and a closed-cell ELFOAM P200 polyisocyanurate (2.0-lb/cu ft) foam core. The design goal for the energy absorbers was to achieve average floor-level accelerations of between 25- and 40-g during the full-scale crash test of a retrofitted CH-46E helicopter airframe, designated TRACT 2. Variations in both designs were assessed through dynamic crush testing of component specimens. Once the designs were finalized, subfloor beams of each configuration were fabricated and retrofitted into a barrel section of a CH-46E helicopter. A vertical drop test of the barrel section was conducted onto concrete to evaluate the performance of the energy absorbers prior to retrofit into TRACT 2. The retrofitted airframe was crash tested under combined forward and vertical velocity conditions onto soil, which is characterized as a sand/clay mixture. Finite element models were developed of all test articles and simulations were performed using LS-DYNA, a commercial nonlinear explicit transient dynamic finite element code. Test-analysis results are presented for each energy absorber as comparisons of time-history responses, as well as predicted and experimental structural deformations and progressive damage under impact loading for each evaluation level

Mas-related G-protein–coupled receptors inhibit pathological pain in mice

An important objective of pain research is to identify novel drug targets for the treatment of pathological persistent pain states, such as inflammatory and neuropathic pain. Mas-related G-protein–coupled receptors (Mrgprs) represent a large family of orphan receptors specifically expressed in small-diameter nociceptive primary sensory neurons. To determine the roles of Mrgprs in persistent pathological pain states, we exploited a mouse line in which a chromosomal locus spanning 12 Mrgpr genes was deleted (KO). Initial studies indicated that these KO mice show prolonged mechanical- and thermal-pain hypersensitivity after hind-paw inflammation compared with wild-type littermates. Here, we show that this mutation also enhances the windup response of dorsal-horn wide dynamic-range neurons, an electrophysiological model for the triggering of central pain sensitization. Deletion of the Mrgpr cluster also blocked the analgesic effect of intrathecally applied bovine adrenal medulla peptide 8–22 (BAM 8–22), an MrgprC11 agonist, on both inflammatory heat hyperalgesia and neuropathic mechanical allodynia. Spinal application of bovine adrenal medulla peptide 8–22 also significantly attenuated windup in wild-type mice, an effect eliminated in KO mice. These data suggest that members of the Mrgpr family, in particular MrgprC11, may constitute an endogenous inhibitory mechanism for regulating persistent pain in mice. Agonists for these receptors may, therefore, represent a class of antihyperalgesics for treating persistent pain with minimal side effects because of the highly specific expression of their targets