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Becoming a nurse preceptor, the challenges and rewards of novice registered nurses in high acuity hospital environments
Full text link© 2019 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license:
http://creativecommons.org/licenses/by-nc-nd/4.0/
This author accepted manuscript is made available following 12 month embargo from date of publication (March 2019) in accordance with the publisher’s archiving policyPrecepting is a common and expected role of nurses in clinical settings worldwide. This research explored novice nurse's experiences of precepting undergraduate nursing students in high-acuity hospital environments. An interpretive study was undertaken with 12 novice nurses (<3-years of post-registration clinical experience), who were precepting nursing students. Data was collected through focus groups and thematically analysed. The zone of proximal development theory was applied to understand the relationship of learning that occurs between students and nurses. Three themes were identified. Firstly, participants established that precepting students enhanced their own self-development, and was a rewarding role, that not only developed the student into a nurse, but provided opportunities for the novice nurse to learn. Second, precepting was both challenging and rewarding. The challenges involved the student, the context, and the preceptors' own teaching and learning skills, resulting in feelings of frustration and conflict between nursing care and preceptor roles. Third, precepting was an expectation of both the nursing role and from senior nurses. At times, the participants felt overwhelmed and drained, particularly when having students that challenged them on multiple consecutive shifts. Participants identified the need for guidance and support from more capable peers to develop confidence while precepting nursing students
Obesity related metabolic endotoxemia is associated with oxidative stress and impaired sperm DNA integrity
Full text link© The Author(s). 2019 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background
Obesity is known to be associated with inflammation, oxidative stress and a resulting reduction in sperm DNA integrity. Importantly, obesity is also reported to be associated with an increase in intestinal permeability with the passage of intestinal bacteria into the circulation (metabolic endotoxemia) that triggers a systemic state of inflammation and resultant oxidative stress. Therefore, we hypothesised that this obesity related increase in intestinal permeability and resultant metabolic endotoxemia (ME) may activate inflammation within the male reproductive tract, leading to increased reactive oxygen species production, sperm oxidative stress and a decline in DNA integrity.
Results
Our pilot study of 37 infertile men confirmed a significant positive correlation between body mass index (BMI), increased intestinal permeability (serum zonulin), metabolic endotoxaemia (LBP), sperm DNA oxidative damage (seminal 8 OhDG) and increasing levels of sperm DNA fragmentation (Halosperm). Metabolic endotoxemia was positively correlated with increasing levels of sperm DNA oxidative damage with this relationship remaining significant, even after adjustment for relevant confounders such as age, BMI and days of abstinence. These observations suggest that metabolic endotoxemia and its associated oxidative stress may be a key driver of sperm DNA damage in obese men.
Conclusion
This study confirms a link between obesity, increasing intestinal permeability and endotoxin exposure, and oxidative mediated sperm DNA damage. This warrants further investigation to fully understand the effect of metabolic endotoxemia on male reproductive function which could result in the new therapies to improve male fertility potential
Identity and social connection of Greek dancing in diaspora
Full text link© 2019 the authorsThis paper will discuss findings from a qualitative study undertaken in Melbourne, Australia that investigated Greek dancing as an aspect of cultural identity and wellbeing. This research involved nineteen participants (four male and fifteen female) recruited from a well-established, long standing dancing school in Melbourne. These students were enroled in either the senior, adult or performance group. The participants were interviewed about their participation in Greek dancing and the meaning it had for them as well as their reason for participation. There were a number of differences among the participants, which included country of birth (Australia or Greece), age, dancing class, and length of experience. Despite this, the diaspora experience of the participants was particularly significant, and the core reason for participating in Greek dancing of all participants was to express their identity and manifest their Hellenic heritage in diaspora. Preserving this heritage was important to all participants and served as a vehicle for social connection that enhanced their physical and emotional wellbeing
Outcomes of telephone-delivered low-intensity cognitive behaviour therapy (LiCBT) to community dwelling Australians with a recent hospital admission due to depression or anxiety: MindStep™
Full text linkThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were madeBackground
In 2006, the British government launched ‘Improving Access to Psychological Therapies’ (IAPT), a low intensity cognitive behaviour therapy intervention (LiCBT) designed to manage people with symptoms of anxiety and depression in the community. The evidence of the effectiveness of IAPT has been demonstrated in multiple studies from the UK, USA, Australia and other countries. MindStep™ is the first adaptation of IAPT in Australia, delivered completely by telephone, targeting people with a recent history of a hospital admission for mental illnesses within the private health system. This paper reports on the outcome of the first 17 months of MindStep™ implemented across Australia from March 2016.
Methods
This prospective observational study investigated the MindStep™ program in a cohort of clients with a recent hospitalisation for mental illnesses. The study used quantitative methods to compare pre-post treatment clinical measures (N = 680) using Patient Health Questionnaire (PHQ-9) and the Generalised Anxiety Disorder (GAD-7). This study also included in-depth interviews with participants (N = 14) and coaches (N = 4) to determine the feasibility and acceptability of the program.
Results
Of the 867 clients referred to MindStep™, 757 had initial assessments by phone making an enrolment rate of 87.3%. Following assessment, 680 commenced treatment and of them, 427 (62.7%) completed treatment. According to ‘per-protocol’ analysis (N = 427), there was a large effect size for post-treatment PHQ-9 (d = 1.03) and GAD-7 (d = 0.99) scores; reliable recovery rate was 62% (95% CI: 57–68%). For intent-to-treat analysis using multiple imputation (N = 680), effect sizes were also large for pre-post treatment change: PHQ-9 (d = 0.78) and GAD-7 (d = 0.76). The reliable recovery rate was 49% (95% CI: 45–54%). Qualitative findings supported these claims where participants were positive about MindStep™ and found the telephone delivery and use of mental health coaches highly acceptable.
Conclusions
MindStep™ has demonstrated encouraging outcomes that suggest LiCBT can be successfully delivered to people with a history of hospital admissions for anxiety and depressive disorders and achieve target recovery rates of > 50%. Other promising evaluation findings indicate the MindStep™ option is acceptable, feasible and safe within the stepped models of mental health care delivery in Australia
Wellbeing intervention for chronic kidney disease (WICKD): a randomised controlled trial study protocol
Full text linkThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were madeBackground
Incidence of end stage kidney disease (ESKD) for Indigenous Australians is especially high in remote and very remote areas of Australia (18 and 20 times the rate of comparable non-Indigenous people). Relocating away from family and country for treatment, adjusting to life with a chronic condition and time lost to dialysis cause grief and sadness which have immense impact on quality of life and challenges treatment adherence. We describe the first randomised controlled trial to address both chronic disease and mental health in Indigenous people with ESKD, which is the first to test the effectiveness of a culturally adapted e-mental health intervention in this population. It builds on an existing program of mental health research with demonstrated efficacy – the Aboriginal and Islander Mental Health Initiative (AIMhi) – to test the newly developed electronic motivational care planning (MCP) therapy – the AIMhi Stay Strong App.
Methods
This is a 3-arm, waitlist, single-blind randomised controlled trial testing the efficacy of the Stay Strong App in improving psychological distress, depressive symptoms, quality of life and treatment adherence among Indigenous clients undergoing haemodialysis for ESKD in Alice Springs and Darwin with follow up over two periods of 3 months (total of 6 months observation). The study compares the efficacy of MCP using the AIMhi Stay Strong App with two control groups (control app intervention and treatment as usual) on participant-reported psychological distress (the primary outcome) using the Kessler Distress Scale (K10); depressive symptoms using the adapted Patient Health Questionnaire (PHQ-9); quality of life using the EuroQoL instrument (EQ5D) and adherence to dialysis treatment planning through file audit. Participants are randomised to receive MCP either at baseline (early treatment) or after 3 months (delayed treatment). The study also examines the cost effectiveness of this therapy in this setting through examination of health care service utilisation across groups during the first 3 months.
Discussion
This project will contribute much needed evidence on the efficacy of an electronic wellbeing intervention for Indigenous people with ESKD – a group in which distress is likely to be unacceptably high, yet relatively untreated
Evaluation of the sub-surface morphology and composition of gunshot residue using focussed ion beam analysis
Full text link© 2019 Elsevier B.V. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
This author accepted manuscript is made available following 12 month embargo from date of publication (January 2019) in accordance with the publisher’s archiving policyRecent work in the forensic analysis of Gunshot residues (GSR) has suggested that the sub-surface or internal composition and morphology of these residues be explored. A particular area of interest is in heavy metal free, or non-toxic ammunition, which are becoming more frequently encountered in the marketplace. As the formulation of the primer compound changes the conditions of the firearm discharge, there is the possibility that different primer formulations may result in the formation of different GSR particles with distinct internal morphologies and compositions. To that end, the internal morphology and composition of GSR particles may provide additional information that could be useful in the investigation of firearms crime.
This research investigated the internal morphology of GSR originating from a variety of different ammunition products. Both traditional three-component primed ammunition, and a selection of heavy metal free and non-toxic alternatives were considered. Particles were identified using SEM–EDS, before being cross-sectioned using a focussed ion beam (FIB) instrument. The FIB-sectioned particles were then re-acquired and mapped using SEM–EDS, to assess both internal morphology and composition.
Particles observed in this study presented distinct morphological and compositional features at the sub-particle level that may provide an indication of the primer formulation from which they originated. That said, further investigation of a variety of samples should be undertaken to verify the consistency of these features, or any deviations that may be observed based on primer type. However, these results indicate that there may be promise in obtaining additional detail from sub-particle morphology and composition
Changes in teachers’ epistemic cognition about self–regulated learning as they engaged in a researcher-facilitated professional learning community
Full text link“This is an Accepted Manuscript of an article published by Taylor & Francis in Asia-Pacific Journal of Teacher Education on 9th April 2019, available online: http://www.tandfonline.com/10.1080/1359866X.2019.1599098.”
This author accepted manuscript is made available following 18 month embargo from date of publication (April 2019) in accordance with the publisher’s archiving policyResearch into teachers’ epistemic cognition is emerging as a key to understanding the quality of teachers’ knowledge for teaching. Typically, investigations into the quality of teachers’ knowledge have been situated within traditional subject areas, such as science or maths. However, developing good quality teacher knowledge about improving students’ abilities to engage in self-regulated learning (SRL), across subject areas, is equally important. Studies have demonstrated gaps in teachers’ knowledge and epistemic beliefs about SRL – the foundations for teachers’ epistemic cognition about SRL. This paper introduces a model of teachers’ epistemic cognition about SRL, and reports a micro-analytic study with four secondary science teachers who undertook a 12-week researcher-facilitated Professional Learning Community (PLC). Thematic and numerical analysis of interviews and lesson plans indicated that the PLC facilitated teachers’ reflexive examination of their knowledge and their epistemic beliefs about SRL. Improvements in SRL content knowledge, pedagogical content knowledge and constructivist beliefs were observed consistently for three of the four teachers. Providing opportunities, such as a facilitated PLC, to enable teachers to reflexively examine their epistemic cognition about a generic subject such as SRL, may be a necessary step in translating research about learning and instruction into classroom practices
A randomised controlled trial of guided internet-based cognitive behavioural therapy for perfectionism: Effects on psychopathology and transdiagnostic processes
Full text link© 2019 Elsevier Ltd. This manuscript version is made available under the CC-BY-NC-ND 4.0 license:
http://creativecommons.org/licenses/by-nc-nd/4.0/
This author accepted manuscript is made available following 24 month embargo from date of publication (March 2019) in accordance with the publisher’s archiving policyBackground and objectives
Perfectionism is a transdiagnostic process that has been associated with a range of psychopathology and also with other transdiagnostic processes. We have previously shown that guided internet-based cognitive behavioural therapy (ICBT) can reduce symptoms of dysfunctional perfectionism, however, no impact was observed on symptoms of depression and anxiety. Here we explore the impact of guided ICBT for perfectionism on symptoms of other associated psychopathology, specifically obsessive-compulsive disorder (OCD) and eating disorders, and also on other associated transdiagnostic processes (self-esteem, intolerance of uncertainty, and self-compassion).
Methods
Participants who presented with clinical levels of perfectionism were randomised to an experimental group that received the intervention (n = 62), or a wait list control group (n = 58). Questionnaires assessing symptoms of OCD, eating disorders, self-esteem, intolerance of uncertainty, and fear of self-compassion were completed pre-intervention, post-intervention (12 weeks), and at follow-up (24 weeks). Between group effect sizes are reported.
Results
The intervention led to significant decreases in symptoms of OCD (d = −0.9; CI: -1.4, −0.4) and eating disorders (d = −0.6; CI: -1.0, −0.1), and had an impact on other transdiagnostic processes resulting in increased self-esteem (d = 0.7; CI: 0.2, 1.2), decreases in intolerance of uncertainty (d = −0.9; CI: -1.4, −0.4), and fear of self-compassion (d = −0.8; CI: -1.3, −0.3). At follow-up changes were maintained in symptoms of OCD (d = −1.3; CI: -1.8, −0.8), disordered eating (d = −0.7; CI: -1.2, −0.2), intolerance of uncertainty (d = −0.8; CI: -1.2, −0.3), and fear of self-compassion (d = −1.0; CI: -1.5, −0.5).
Conclusions
Guided ICBT for perfectionism improves associated psychopathology and transdiagnostic processes. ClinicalTrials.gov registration no. NCT02756871
Influence of the time of day on axial length and choroidal thickness changes to hyperopic and myopic defocus in human eyes
Full text link© 2019 Elsevier Ltd. This manuscript version is made available under the CC-BY-NC-ND 4.0 license:
http://creativecommons.org/licenses/by-nc-nd/4.0/
This author accepted manuscript is made available following 12 month embargo from date of publication (March 2019) in accordance with the publisher’s archiving policyResearch in animal models have shown that exposing the eye to positive or negative spectacle lenses can lead to predictable changes in eye growth. Recent research indicates that brief periods (1–2 h) of monocular defocus results in small, but significant changes in axial length and choroidal thickness of human subjects. However, the effects of the time of day on these ocular changes with defocus are not known. In this study, we examined the effects of monocular myopic and hyperopic defocus on axial length and choroidal thickness when applied in the morning (change between 10 a.m. and 12 p.m.) vs the evening (change between 5 and 7 p.m.) in young adult human participants (mean age, 23.44 ± 4.52 years). A series of axial length (using an IOL Master) and choroidal thickness (using an optical coherence tomographer) measurements were obtained over three consecutive days in both eyes. Day 1 (no defocus) examined the baseline ocular measurements in the morning (10 a.m. and 12 p.m.) and in the evening (5 and 7 p.m.), day 2 investigated the effects of hyperopic and myopic defocus on ocular parameters in the morning (subjects wore a spectacle lens with +3 or −3 DS over the right eye and a plano lens over the left eye between 10 a.m. and 12 p.m.), and day 3 examined the effects of defocus in the evening (+3 or −3 DS spectacle lens over the right eye between 5 and 7 p.m.). Exposure to myopic defocus caused a significant reduction in axial length and thickening of the subfoveal choroid at both times; but, compared to baseline data from day 1, the relative change in axial length (−0.021 ± 0.009 vs +0.004 ± 0.003 mm, p = 0.009) and choroidal thickness (+0.027 ± 0.006 vs +0.007 ± 0.006 mm, p = 0.011) with defocus were significantly greater for evening exposure to defocus than for the morning session. On the contrary, introduction of hyperopic defocus resulted in a significant increase in axial length when given in the morning (+0.026 ± 0.006 mm), but not in the evening (+0.001 ± 0.003 mm) (p = 0.047). Furthermore, hyperopic defocus resulted in a significant thinning of the choroid (p = 0.005), but there was no significant influence of the time of day on choroidal changes associated with hyperopic defocus (p = 0.672). Exposure to hyperopic and myopic defocus at different times of the day was also associated with changes in the parafoveal regions of the choroid (measured across 1.5 mm nasal and temporal choroidal regions on either side of the fovea). Our results show that ocular response to optical defocus varies significantly depending on the time of day in human subjects. These findings represent a potential interaction between the signal associated with the eye's natural diurnal rhythm and the visual signal associated with the optical defocus, making the eye perhaps more responsive to hyperopic defocus (or ‘go’ signal) in the morning, and to myopic defocus (or ‘stop’ signal) in the latter half of the day
Methods for analysis of glass in glass-containing gunshot residue (gGSR) particles
Full text link© 2019 Elsevier B.V. This manuscript version is made available under the CC-BY-NC-ND 4.0 license:
http://creativecommons.org/licenses/by-nc-nd/4.0/
This author accepted manuscript is made available following 12 month embargo from date of publication (March 2019) in accordance with the publisher’s archiving policyWhen lead, barium and antimony, or lead, barium, calcium, silicon and tin are found together in particles associated with a shooting investigation they are considered characteristic of gunshot residue (GSR). Antimony and tin are often absent from the primer of many low calibre rimfire ammunitions, which are the type most commonly used in Australia. Therefore, the likelihood of characteristic particles forming during the firing process of such rimfire ammunition is significantly less than the likelihood of these particles arising from higher calibre ammunition. The majority of rimfire ammunition examined in this research contains ground glass in the primer, which functions as a frictionator. These ammunitions produce a small number of gunshot residue particles containing glass coated with other primer components, which we refer to as glass-containing GSR (gGSR). If these particles are observed in an investigation, they have the potential to add a new dimension to gunshot residue analysis because they are not common in the environment. Furthermore, the composition of glass frictionator is stable during firing, which raises the possibility that chemical testing of the glass in gGSR may be used to identify the ammunition from which the residue was derived or to link deposits of GSR.
This paper examines the application of scanning electron microscopy-energy dispersive X-ray spectrometry (SEM-EDS), focussed ion beam (FIB) techniques and time of flight-secondary ion mass spectrometry (ToF-SIMS) to the semi-quantitative analysis and comparisons of gGSR and frictionator extracted from unfired cartridges. SEM-EDS is effective for comparing gGSR with unfired frictionator, but the use of FIB to expose clean glass from the centre of gGSR followed by ToF-SIMS, or ToF-SIMS using ion sputtering to expose clean glass, offers more power for comparisons due to their capability for higher discrimination between frictionators from different sources