Developing Community Nursing Practice: Promoting Case Management and Skill Enhancement to Support Shifting the Balance of Care

Five inter-related projects were commissioned by NHS Highland to further knowledge and understanding of key issues that can be used to inform particular aspects of care delivery that supports the community nurse review. The five projects reflect some of the core elements that have been identified to maximise nurses’ contributions in community settings (Scottish Executive 2006a). The projects were designed to provide qualitative evidence of the views of community nurses regarding case management and to support the delivery of skills in community nursing practice. Additionally community nurses identified the knowledge and skills required to develop practice tools that would support areas of generalist and specialist practice, specifically around child welfare and long term conditions (heart care). The five projects were: i. Literature review on case management models in Community Nursing. ii. Action research project to support implementation of Case Management Models in community nursing. iii. Literature review on practitioners with special interest. iv. Research to inform development of practitioner tools for child protection and long term conditions (heart care). v. Research to explore skills transition to support Shifting the Balance of Care. This project focused on 3 key initiatives that are influencing community nursing and it was apparent that they all shared common goals and challenges of implementation. For this reason, it was clear that any development in service provision would impact on, and articulate with, other health, social and profession based changes and could not be implemented in isolation from other related developments that underpin shifting the balance of care. Nurses in the studies articulated insightful challenges for shifting the balance of care, and related role developments, but these were, in the majority, followed by offering practical solutions

Adopting a blended approach to learning: experiences from radiography at Queen Margaret University, Edinburgh

The perspective of the radiography teaching team at Queen Margaret University (QMU) was that a transmission mode of programme delivery was sub-optimal in helping students to learn and make links between theory and practice. Programme redesign adopted a blended learning approach with both face-to-face and online learning aimed at enhancing the students’ control over their own learning. Online tasks within Web Classroom Tools (WebCT) were used as an integral part of careful programme design, which resulted in a programme enabling synthesis of the skills, knowledge and competencies acquired in the academic and clinical environments. With the move towards a more learner-centred, blended educational experience for the students the lecturers’ role shifted to that of facilitator with WebCT providing the tutor with a more transparent view of student learning. Lecturers plan learning activities that build upon the skills students have developed through learning in groups, online and in class. The explicit connections that now exist between the academic programme and the opportunities for applying knowledge in practice allow students to engage more deeply in their learning

A2ML1 and otitis media: novel variants, differential expression, and relevant pathways

A genetic basis for otitis media is established, however, the role of rare variants in disease etiology is largely unknown. Previously a duplication variant within A2ML1 was identified as a significant risk factor for otitis media in an indigenous Filipino population and in US children. In this report exome and Sanger sequencing was performed using DNA samples from the indigenous Filipino population, Filipino cochlear implantees, US probands, Finnish, and Pakistani families with otitis media. Sixteen novel, damaging A2ML1 variants identified in otitis media patients were rare or low-frequency in population-matched controls. In the indigenous population, both gingivitis and A2ML1 variants including the known duplication variant and the novel splice variant c.4061 + 1 G>C were independently associated with otitis media. Sequencing of salivary RNA samples from indigenous Filipinos demonstrated lower A2ML1 expression according to the carriage of A2ML1 variants. Sequencing of additional salivary RNA samples from US patients with otitis media revealed differentially expressed genes that are highly correlated with A2ML1 expression levels. In particular, RND3 is upregulated in both A2ML1 variant carriers and high-A2ML1 expressors. These findings support a role for A2ML1 in keratinocyte differentiation within the middle ear as part of otitis media pathology and the potential application of ROCK inhibition in otitis media

FUT2 Variants Confer Susceptibility to Familial Otitis Media

Non-secretor status due to homozygosity for the common FUT2 variant c.461G>A (p.Trp154∗) is associated with either risk for autoimmune diseases or protection against viral diarrhea and HIV. We determined the role of FUT2 in otitis media susceptibility by obtaining DNA samples from 609 multi-ethnic families and simplex case subjects with otitis media. Exome and Sanger sequencing, linkage analysis, and Fisher exact and transmission disequilibrium tests (TDT) were performed. The common FUT2 c.604C>T (p.Arg202∗) variant co-segregates with otitis media in a Filipino pedigree (LOD = 4.0). Additionally, a rare variant, c.412C>T (p.Arg138Cys), is associated with recurrent/chronic otitis media in European-American children (p = 1.2 × 10−5) and US trios (TDT p = 0.01). The c.461G>A (p.Trp154∗) variant was also over-transmitted in US trios (TDT p = 0.01) and was associated with shifts in middle ear microbiota composition (PERMANOVA p 20 were combined, FUT2 variants were over-transmitted in trios (TDT p = 0.001). Fut2 is transiently upregulated in mouse middle ear after inoculation with non-typeable Haemophilus influenzae. Four FUT2 variants—namely p.Ala104Val, p.Arg138Cys, p.Trp154∗, and p.Arg202∗—reduced A antigen in mutant-transfected COS-7 cells, while the nonsense variants also reduced FUT2 protein levels. Common and rare FUT2 variants confer susceptibility to otitis media, likely by modifying the middle ear microbiome through regulation of A antigen levels in epithelial cells. Our families demonstrate marked intra-familial genetic heterogeneity, suggesting that multiple combinations of common and rare variants plus environmental factors influence the individual otitis media phenotype as a complex trait

Doing Gender Im Technisch-Naturwissen-Schaftlichen Bereich

Für die Lösung des Nachwuchsproblems in den Technikwissenschaften spielt die Gewinnung von Frauen eine zentrale Rolle. Die in der Expertise dargestellten Befunde verdeutlichen dreierlei: (1) In den Natur- und Technikwissenschaften "verliert" man Frauen sehr früh im Lebensverlauf. (2) Wie beim Durchlauf eines Trichters (leaking pipeline) verringert sich mit jeder Bildungs- und Karrierestufe die Anzahl von Frauen in diesen Fächern und Berufen. (3) Die Erhöhung des Interesses für Technikwissenschaften von Mädchen und Frauen ist nicht nur "ein Problem" für das Bildungssystem, sondern ganz wesentlich auch des Arbeitsmarktes. Die Befunde der Expertise zeigen, dass es unbedingt notwendig ist, jungen Frauen, die in technischen Berufen gut ausgebildet sind, eine höhere Chance als bisher zu geben, (a) ihren Beruf aus dem Bereich Mathematik, Informatik, Naturwissenschaften, Technik (im Folgenden kurz: MINT) auszuüben und (b) dies auch mit den gleichen Gratifikationen wie Männer. Diese Herausforderung muss - und zwar unabhängig von der Nachfrage nach neuem Personal in technischen Berufen - schnell gemeistert werden, wenn Wirtschaft und Politik ein ernst gemeintes Interesse an "Frauen in MINT-Berufen" besitzen

Effects of eight neuropsychiatric copy number variants on human brain structure

peer reviewedMany copy number variants (CNVs) confer risk for the same range of neurodevelopmental symptoms and psychiatric conditions including autism and schizophrenia. Yet, to date neuroimaging studies have typically been carried out one mutation at a time, showing that CNVs have large effects on brain anatomy. Here, we aimed to characterize and quantify the distinct brain morphometry effects and latent dimensions across 8 neuropsychiatric CNVs. We analyzed T1-weighted MRI data from clinically and non-clinically ascertained CNV carriers (deletion/duplication) at the 1q21.1 (n = 39/28), 16p11.2 (n = 87/78), 22q11.2 (n = 75/30), and 15q11.2 (n = 72/76) loci as well as 1296 non-carriers (controls). Case-control contrasts of all examined genomic loci demonstrated effects on brain anatomy, with deletions and duplications showing mirror effects at the global and regional levels. Although CNVs mainly showed distinct brain patterns, principal component analysis (PCA) loaded subsets of CNVs on two latent brain dimensions, which explained 32 and 29% of the variance of the 8 Cohen’s d maps. The cingulate gyrus, insula, supplementary motor cortex, and cerebellum were identified by PCA and multi-view pattern learning as top regions contributing to latent dimension shared across subsets of CNVs. The large proportion of distinct CNV effects on brain morphology may explain the small neuroimaging effect sizes reported in polygenic psychiatric conditions. Nevertheless, latent gene brain morphology dimensions will help subgroup the rapidly expanding landscape of neuropsychiatric variants and dissect the heterogeneity of idiopathic conditions. © 2021, The Author(s)

Understanding first year university students: personal epistemology and learning

Whilst participation in higher education has increased dramatically over the last two decades, many universities are only now beginning to pay more attention to the learning experiences of first year students. It is important for universities to understand how first year students conceive of learning and knowing in order to promote effective approaches to learning. Even though an extensive body of research demonstrates that beliefs about learning and knowing influence student approaches to learning and learning outcomes, there has been no Australian research that has investigated this critical learner characteristic across first year university students. This paper reports on preliminary data from an ongoing longitudinal study designed to investigate first year students’ beliefs about knowing and learning (epistemological beliefs). Students from teacher education and creative industry faculties in two Australian universities completed the Epistemological Beliefs Survey (EBS) in the first week of their first semester of study. A series of one-way ANOVA using key demographics as independent variables and the EBS factor scores as dependent variables showed that epistemological beliefs were related to the course of study, previous post-school education experience, family experience at University, gender and age. These data help us to understand students’ beliefs about learning and knowing with a view to informing effective learning in higher education