No second chance: the experiences of junior neonatal nurses in providing end-of-life care for babies and families in the NNU

Background

An infant’s death is acutely stressful for parents and professionals. Little is known about junior nurses’ experiences providing end-of-life care in Neonatal Units (NNU).

Objectives

To better understand junior nurses’ experiences providing end-of-life care in NNU, the study explored the challenges and opportunities inherent in their practice relating to providing such care to babies and their families.

Methods

Neonatal nurses (n=12) with less than 3 years’ experience who were undergoing a neonatal education programme participated. Two focus groups were convened each with 6 nurses. The Ethics Committee at the relevant University approved the study. Nominal Group Technique (NGT) was used in the focus groups to build consensus around the challenges faced by junior nurses, alongside suggested developments in improving future care provision. Primary analysis involved successive rounds of ranking and decision making whilst secondary analysis involved thematic analysis.

Results

The study identified the pressures these nurses felt in having only one chance to ‘get it right’ for the infants and their families. They perceived the need for further ‘education and training’ highlighting that improved education provision would include both additional courses and internal training sessions. Greater ‘support’ from mentors themselves more experienced in this aspect of care within the NNU was identified as important in addressing issues around confidence building and skill development.

Conclusions

The results highlight junior nurses’ need for specific education and mentorship around end-of-life care for babies. This presentation will outline the implications for practice, education and further research.

Sociocultural context as a facilitator of student learning of function concepts in mathematics

In Costa Rica, many secondary students have serious difficulties to establish relationships between mathematics and real-life contexts. They question the utilitarian role of the school mathematics. This fact motivated the research object of this report which evidences the need to overcome methodologies unrelated to students’ reality, toward new didactical options that help students to value mathematics, reasoning and its  applications, connecting it with their socio-cultural context. The research used a case study as a qualitative methodology and the social constructivism as an educational paradigm in which the knowledge is built by the student; as a product of his social interactions. A collection of learning situations was designed, validated, and implemented. It allowed establishing relationships between mathematical concepts and the socio-cultural context of participants. It analyzed the impact of students’socio-cultural context in their mathematics learning of basic concepts of real variable functions, consistent with the Ministry of Education (MEP) Official Program.  Among the results, it was found that using students’sociocultural context improved their motivational processes, mathematics sense making, and promoted cooperative social interactions. It was evidenced that contextualized learning situations favored concepts comprehension that allow students to see mathematics as a discipline closely related with their every-day life.

Investigating problem-based learning in Saudi Arabian mathematics education: a TIMSS-related study

The aim of this study is to investigate the effectiveness of problem-based learning (PBL) on students’ mathematical performance. This includes mathematics achievement and students’ attitudes towards mathematics for third and eighth grade students in Saudi Arabia. Mathematics achievement includes, knowing, applying, and reasoning domains, while students’ attitudes towards mathematics covers, ‘Like learning mathematics’, ‘value mathematics’, and ‘a confidence to learn mathematics’. This study goes deeper to examine the interaction of a PBL teaching strategy, with trained face-to-face and self-directed learning teachers, on students’ performance (mathematics achievement and attitudes towards mathematics). It also examines the interaction between different ability levels of students (high and low levels) with a PBL teaching strategy (with trained face-to-face or self-directed learning teachers) on students’ performance. It draws upon findings and techniques of the TIMSS international benchmarking studies. Mixed methods are used to analyse the quasi-experimental study data. One -way ANOVA, Mixed ANOVA, and paired t-tests models are used to analyse quantitative data, while a semi-structured interview with teachers, and author’s observations are used to enrich understanding of PBL and mathematical performance. The findings show that the PBL teaching strategy significantly improves students’ knowledge application, and is better than the traditional teaching methods among third grade students. This improvement, however, occurred only with the trained face-to-face teacher’s group. Furthermore, there is robust evidence that using a PBL teaching strategy could raise significantly students’ liking of learning mathematics, and confidence to learn mathematics, more than traditional teaching methods among third grade students. Howe ver, there was no evidence that PBL could improve students’ performance (mathematics achievement and attitudes towards mathematics), more than traditional teaching methods, among eighth grade students. In 8th grade, the findings for low achieving students show significant improvement compared to high achieving students, whether PBL is applied or not. However, for 3th grade students, no significant difference in mathematical achievement between high and low achieving students was found. The results were not expected for high achieving students and this is also discussed. The implications of these findings for mathematics education in Saudi Arabia are considered.

Assessment of student engagement among junior high school students and associations with self-esteem, burnout, and academic achievement

The aim of the study was to investigate the structure of affective and cognitive engagement using the Student Engagement Instrument (SEI; Appleton, Christenson, Kim, & Reschly, 2006) and to examine the associations to behavioral engagement, as well as student-reported self-esteem, burnout, and academic achievement among Finnish junior high school students. The analyses were carried out in the main sample of 2,485 students, as well as in an independent sample of 821 students. The results showed that the original five-factor structure of the SEI construed along three affective and two cognitive engagement factors fit the current data relatively well. Affective and cognitive student engagement correlated positively with an independent measure of behavioral engagement. Furthermore, affective and cognitive engagement were positively associated with student-reported self-esteem and academic achievement, and negatively with school burnout. The findings provided corroborating evidence for the psychometric properties and utilization of the SEI instrument for assessing the engagement of junior high school students. (DIPF/Orig.)

The development of an eBook for teaching and learning mathematics

Mobile devices, smartphones, phablets and tablets, are widely avail‐ able. This is a generation of digital natives. We cannot ignore that they are no longer the same students for which the education system was designed tradition‐ ally. Studying math is many times a cumbersome task. But this can be changed if the teacher takes advantage of the technology that is currently available. We are working in the use of different tools to extend the classroom in a blended learning model. In this paper, it is presented the development of an eBook for teaching mathematics to secondary students. It is developed with the free and open standard EPUB 3 that is available for Android and iOS platforms. This specification supports video embedded in the eBook. In this paper it is shown how to take advantage of this feature, making videos available about lectures and problems resolutions, which is especially interesting for learning mathematics.

INCORPORATING REAL SCIENCE INTO THE SECONDARY CLASSROOM: AEROSOLS AND CLIMATE CHANGE

Climate science and climate change are included in the Next Generation Science Standards, curriculum standards that were released in 2013. How to incorporate these topics, especially climate change, has been a difficult task for teachers. A team of scientists are studying aerosols in the free troposphere; what their properties are, how they change while in the atmosphere and where they came from. Lessons were created based on this real, ongoing scientific research being conducted in the Azores. During these activities, students are exposed to what scientists actually do in the form of videos and participate in similar tasks such as conducting experiments, collecting data, and analyzing data. At the conclusion of the lessons, students will form conclusions based on the evidence they have at the time.

INCORPORATING STIMULATING QUICK-WRITE PROMPTS WITHIN A SECONDARY SCIENCE CLASSROOM: A CASE STUDY IN LESOTHO

The use of intriguing open-ended quick-write prompts within the Basotho science classroom could potentially provide a way for secondary teachers in Lesotho to have a time-efficient alternative to stimulate student thinking and increase critical thinking or application of scientific principles. Writing can be used as a powerful means to improve the achievement of students across many subject areas, including the sciences (Moore, 1993; Rivard, 1994; Rillero, Zambo, Cleland, and Ryan, 1996; Greenstein, 2013). This study focuses on the use of a non-traditional nor extensively studied writing method that could potentially support learning in science. A quasi-experimental research design, with a control and experimental group, was applied. The study was conducted at two schools, with one experimental classroom in one school and a second control group classroom in the second school for a period of 4 weeks. 51 Form B (US Grade 9 equivalent) students participated as the experimental group and 43 Form B students as the control group. In an effort to assess learning achievement, a 1 hour (35 mark) pre-test evaluation was made by and given to students by Basotho teachers at the beginning of this study to have an idea of student’s previous knowledge. Topics covered were Static Electricity, Current Electricity, Electromagnetic Waves, and Chemistry of Water. After the experimental trial period, an almost completely identical post-test evaluation was given to students in the same fashion to observe and compare gains in achievement. Test data was analyzed using an inferential statistics procedure that compared means and gains in knowledge made by the experimental and control groups. Difference between the gains of mean pre-test and post-test scores were statistically significant within each group, but were not statistically significant when the control and experimental groups were compared. Therefore, there was no clear practical effect. Qualitative data from teachers’ journals and students’ written feedback provides insight on the assessments, incorporation of the teaching method, and the development of participating students. Both mid and post-study student feedback shows that students had an overall positive and beneficial experience participating in this activity. Assessments and teacher journals showed areas of strength and weaknesses in student learning and on differences in teaching styles. They also helped support some feedback claims made by students. Areas of further research and improvement of the incorporation of this teaching method in the Basotho secondary science classroom are explored.

Competencies Required in Education Research and Teaching Systematization according to Students from the Preschool, Primary and Secondary Education Programs of the University of Costa Rica

The purpose of this paper is to present the results of two online forums carried out with the participation of 42 students of the Licenciaturas  in Preschool Education, Primary Education and Secondary Education of the University of Costa Rica. The main purpose of the forums was to determine the insights of the participant students about the competencies they have achieved in the field of education research, and which have been the essential tools for them to systematize their own teaching practices. The discussion forums were part of the course FD5091 Métodos de Investigación Educativa [Education Research Methods] of the School of Teacher Education, delivered from March-April 2010.  Of the sample, 60 percent were students of the Preschool teaching program, 35 percent were from the Primary Education teaching program and 5 percent were from the Secondary Education teaching program in the fields of Science, Mathematics and Social Studies. According to the insights and beliefs showed by the participants –both, the future teachers and the profession practitioners–, there are no opportunities for research or systematization of their own teaching mediation, in the current work situation.(1) Translator’s Note: In Costa Rica, the “Licenciatura” is a one-year post-Bachelor study program, usually including thesis. “Primary Education” refers to students from the 1st to 6th grades, and “Secondary Education” refers to students from the 7th to 11th grades.

Hemorrhagic Shock Secondary To Button Battery Ingestion.

Button battery ingestion is a frequent pediatric complaint. The serious complications resulting from accidental ingestion have increased significantly over the last two decades due to easy access to gadgets and electronic toys. Over recent years, the increasing use of lithium batteries of diameter 20 mm has brought new challenges, because these are more detrimental to the mucosa, compared with other types, with high morbidity and mortality. The clinical complaints, which are often nonspecific, may lead to delayed diagnosis, thereby increasing the risk of severe complications. A five-year-old boy who had been complaining of abdominal pain for ten days, was brought to the emergency service with a clinical condition of hematemesis that started two hours earlier. On admission, he presented pallor, tachycardia and hypotension. A plain abdominal x-ray produced an image suggestive of a button battery. Digestive endoscopy showed a deep ulcerated lesion in the esophagus without active bleeding. After this procedure, the patient presented profuse hematemesis and severe hypotension, followed by cardiorespiratory arrest, which was reversed. He then underwent emergency exploratory laparotomy and presented a new episode of cardiorespiratory arrest, which he did not survive. The battery was removed through rectal exploration. This case describes a fatal evolution of button battery ingestion with late diagnosis and severe associated injury of the digestive mucosa. A high level of clinical suspicion is essential for preventing this evolution. Preventive strategies are required, as well as health education, with warnings to parents, caregivers and healthcare professionals.

Homozygous Inactivating Mutation In Nanos3 In Two Sisters With Primary Ovarian Insufficiency.

Despite the increasing understanding of female reproduction, the molecular diagnosis of primary ovarian insufficiency (POI) is seldom obtained. The RNA-binding protein NANOS3 poses as an interesting candidate gene for POI since members of the Nanos family have an evolutionarily conserved function in germ cell development and maintenance by repressing apoptosis. We performed mutational analysis of NANOS3 in a cohort of 85 Brazilian women with familial or isolated POI, presenting with primary or secondary amenorrhea, and in ethnically-matched control women. A homozygous p.Glu120Lys mutation in NANOS3 was identified in two sisters with primary amenorrhea. The substituted amino acid is located within the second C2HC motif in the conserved zinc finger domain of NANOS3 and in silico molecular modelling suggests destabilization of protein-RNA interaction. In vitro analyses of apoptosis through flow cytometry and confocal microscopy show that NANOS3 capacity to prevent apoptosis was impaired by this mutation. The identification of an inactivating missense mutation in NANOS3 suggests a mechanism for POI involving increased primordial germ cells (PGCs) apoptosis during embryonic cell migration and highlights the importance of NANOS proteins in human ovarian biology.

A Modified Acidic Approach For Dna Extraction From Plant Species Containing High Levels Of Secondary Metabolites.

Purified genomic DNA can be difficult to obtain from some plant species because of the presence of impurities such as polysaccharides, which are often co-extracted with DNA. In this study, we developed a fast, simple, and low-cost protocol for extracting DNA from plants containing high levels of secondary metabolites. This protocol does not require the use of volatile toxic reagents such as mercaptoethanol, chloroform, or phenol and allows the extraction of high-quality DNA from wild and cultivated tropical species.

Genomic Copy Number Alterations Of Primary And Secondary Metastasizing Pleomorphic Adenomas.

Metastasizing pleomorphic adenoma (MPA) is a rare tumour, and its mechanism of metastasis still is unknown. To date, there has been no study on MPA genomics. We analysed primary and secondary MPAs with array comparative genomic hybridization to identify somatic copy number alterations and affected genes. Tumour DNA samples from primary (parotid salivary gland) and secondary (scalp skin) MPAs were subjected to array comparative genomic hybridization investigation, and the data were analysed with NEXUS COPY NUMBER DISCOVERY. The primary MPA showed copy number losses affecting 3p22.2p14.3 and 19p13.3p123, and a complex pattern of four different deletions at chromosome 6. The 3p deletion encompassed several genes: CTNNB1, SETD2, BAP1, and PBRM1, among others. The secondary MPA showed a genomic profile similar to that of the primary MPA, with acquisition of additional copy number changes affecting 9p24.3p13.1 (loss), 19q11q13.43 (gain), and 22q11.1q13.33 (gain). Our findings indicated a clonal origin of the secondary MPA, as both tumours shared a common profile of genomic copy number alterations. Furthermore, we were able to detect in the primary tumour a specific pattern of copy number alterations that could explain the metastasizing characteristic, whereas the secondary MPA showed a more unbalanced genome.

Aspectos médicos e sociais no atendimento oftalmológico de urgência

Purpose: A survey was carried out on one hundred patients of the Emergency Service of the Ophthalmology Department of the Hospital das Clinicas of the University of Campinas (UNICAMP), in order to analyze the personal characteristics and the barriers against getting resolving ophthalmologic assistance. Variables, were the following: sex, age, home town, average distance between the place of initial symptoms and first visit to the hospital, time spent between the first examination (if performed in any other service) and the examination performed at the Hospital das Clinicas of University of Campinas, diagnosis, veracity of emergency, need to refer patients previously seen in other services to our Service and possibility of assistance and treatment at a secondary level. Methods: The sample showed the following characteristics: distances between 20 and 100 kilometers covered by 50.0% of the patients to be seen at University of Campinas. 75.0% of those patients needed someone to stay with them and 67.0% came from other municipalities. The long distances covered meant additional expenses for the treatment of diseases which should be treated locally. Results: Among the patients referred to University of Campinas by ophthalmologists of other services, 87.5% could have their diseases treated at a secondary level of assistance and 66.7% of real emergencies and 60% of false emergencies took longer than 7 days to reach the emergency room of University of Campinas. This shows the poor infrastructure of secondary services regarding excellence of emergency care and education of patients. Conclusions: We recommend education of general physicians and ophthalmologists for emergency eye care and also the supply of both secondary and tertiary public services or medicare, strategically setup in the whole state of Sao Paulo.

Validity and reliability of methods for the detection of secondary caries around amalgam restorations in primary teeth

Secondary caries has been reported as the main reason for restoration replacement. The aim of this in vitro study was to evaluate the performance of different methods - visual inspection, laser fluorescence (DIAGNOdent), radiography and tactile examination - for secondary caries detection in primary molars restored with amalgam. Fifty-four primary molars were photographed and 73 suspect sites adjacent to amalgam restorations were selected. Two examiners evaluated independently these sites using all methods. Agreement between examiners was assessed by the Kappa test. To validate the methods, a caries-detector dye was used after restoration removal. The best cut-off points for the sample were found by a Receiver Operator Characteristic (ROC) analysis, and the area under the ROC curve (Az), and the sensitivity, specificity and accuracy of the methods were calculated for enamel (D2) and dentine (D3) thresholds. These parameters were found for each method and then compared by the McNemar test. The tactile examination and visual inspection presented the highest inter-examiner agreement for the D2 and D3 thresholds, respectively. The visual inspection also showed better performance than the other methods for both thresholds (Az = 0.861 and Az = 0.841, respectively). In conclusion, the visual inspection presented the best performance for detecting enamel and dentin secondary caries in primary teeth restored with amalgam.