Implementing change in practice: Part 2- the change process

Pain management in premature and sick babies has long been recognisedas a vital component of neonatal care; however practices pertaining to painassessment and administration of analgesia remain variable in Neonatal Units(NNU). Sucrose has been identified as an effective agent in reducing pain during minorpainful procedures in premature babies but the uptake has been modest.This article (part 2) follows on from an earlier article on evidence to support theimplementation of sucrose administration as a measure for pain relief for minorprocedures (part 1) and will centre on practice-based change in the NNU and reflecton the strategies used as well as the effectiveness of the proposed change. A theoreticalchange model will be used as a framework to help unpack the influencesinherent within the change process.

Chief Medical Officer's Report - Evidential Base and Clinical Practice Aspects of Congenital Cardiac Services (August 2013) (PDF 77KB)

Report on Evidential Base and Clinical Practice Aspects of Congenital Cardiac Services The principle drivers that should determine the optimal arrangements for the provision of congenital cardiac services, including  paediatric and adult cardiac surgery, for the population of Northern Ireland is how best those services can be configured to ensure the safest possible care that is of the highest quality possible in order to optimise outcomes and experience for patients and carers. Of necessity, this requires consideration of all requisite supporting services and arrangements to ensure access across the continuum of care. Such a configuration should support safe, high quality service provision on an on-going basis i.e. ensure sustainability as far as can be determined. In addressing this issue, consideration to the changing profile of population need and the evolving nature specialist services is required.  

Local action on health inequalities: practice resources

These documents explain factors contributing to inequality in public health and set out methods for local bodies to reduce them. Documents The Marmot Review (2010) made a range of recommendations to reduce health inequalities in England. Building on the Review, the UCL Institute of Health Equity has produced 4 papers which include evidence, and examples of practical action that can be taken at a local level to reduce health inequalities. They are designed for people working in local services, particularly: directors of public health and public health teams people working in local authorities services that may influence health and wellbeing, such as planning health and wellbeing boards These practice resources build on a series of papers published in 2014 to support local action on health inequalities.

Accessibility Instruments In Planning Practice: Bridging The Implementation Gap

Accessibility concepts are increasingly acknowledged as fundamental to understand cities and urban regions. Accordingly, accessibility instruments have been recognised as valuable support tools for land-use and transport planning. However, despite the relatively large number of instruments available in the literature, they are not widely used in planning practice. This paper aims to explore why accessibility instruments are not widely used in planning practice. To this end, we focus our research on perceived user-friendliness and usefulness of accessibility instruments. First, we surveyed some instrument developers, providing an overview of the characteristics of accessibility instruments available and on developers’ perceptions of their user-friendliness in planning practice. Second, we brought together developers and planning practitioners in some local workshops across Europe and Australia, where participants were asked to use insights provided by accessibility instruments for the development of planning strategies. We found that most practitioners are convinced of the usefulness of accessibility instruments in planning practice, as they generate new and relevant insights for planners. Findings suggest that not only user-friendliness problems but mainly organisational barriers and lack of institutionalisation of accessibility instruments, are the main causes of the implementation gap. Thus user-friendliness improvement may provide limited contributions to the successful implementation of accessibility concepts in planning practice. In fact, there seems to be more to gain from the active and continued engagement of instrument developers with planning practitioners and the institutionalisation of accessibility planning.

Opportunity of integrated production of "Ceratophyllum demersum" in a nutrition trial with "Carassius auratus"

[EN]The integrated culture of fish and plant in a recirculated system is called aquaponics, where a mutual benefit have been demonstrated for the cocultured species. Today this practice is still not well known for the most studied consumed freshwater species, and almost nothing has been done for aquarium species. The objective of present work was to study the opportunity of growing one of the most selled aquarium plant coontail (Ceratophyllum demersum) in a coculture with the goldfish (Carassius auratus) from which a nutritional trial was planned.

Learning from Text: Examining Teacher Thinking and Practice in AP Environmental Science

Thesis (Ph.D.)--University of Washington, 2016-08

From the Members' Perspective: Participants' Perception of the Moderator Role in Educator Communities of Practice

Thesis (Ph.D.)--University of Washington, 2016-08

Évaluation du programme d’intervention en nutrition «Nutriathlon en équipe (version Web)» chez des adolescents du secondaire

Les problématiques de surplus de poids sont en augmentation depuis les dernières décennies, notamment chez les jeunes québécois. Cette augmentation est en lien avec des habitudes alimentaires présentant des différences importantes avec les recommandations nutritionnelles. De plus, le gouvernement provincial a instauré des changements importants au Programme de formation de l’école québécoise afin de stimuler l’adoption de saines habitudes de vie. Afin de contrer ces problématiques de surplus de poids et d’habitudes alimentaires déficientes et de poursuivre dans la lignée de la réforme scolaire, le Nutriathlon en équipe version Web a été développé. Ce programme a pour but d’amener chaque participant à améliorer la qualité de son alimentation en augmentant et en diversifiant sa consommation de légumes, de fruits et de produits laitiers. Les objectifs de la présente étude sont (1) d’évaluer l’impact du programme sur la consommation de légumes, de fruits (LF) et de produits laitiers (PL) d’élèves du secondaire et (2) d’évaluer les facteurs influençant la réussite du programme chez ces jeunes. Les résultats de l’étude ont démontré que pendant le programme ainsi qu’immédiatement après, le groupe intervention a rapporté une augmentation significative de la consommation de LF et de PL par rapport au groupe contrôle. Par contre, aucun effet n’a pu être observé à moyen terme. Quant aux facteurs facilitant le succès du Nutriathlon en équipe, les élèves ont mentionné : l’utilisation de la technologie pour la compilation des portions, la formation d’équipes, l’implication des enseignants et de l’entourage familial ainsi que la création de stratégies pour faciliter la réussite du programme. Les élèves ont également mentionné des barrières au succès du Nutriathlon en équipe telles que le manque d’assiduité à saisir leurs données en dehors des heures de classe, la dysfonction du code d’utilisateur et l’incompatibilité de la plateforme avec certains outils technologiques comme les tablettes.

Developing Innovative TEL Practice in Teacher Education

This interactive symposium will focus on the use of different technologies in developing innovative practice in teacher education at one university in England. Technology Enhanced Learning (TEL) is a field of educational policy and practice that has the power to ignite diametrically opposing views and reactions amongst teachers and teacher educators, ranging across a spectrum from immense enthusiasm to untold terror. In a field where the skills and experience of individuals vary from those of digital natives (Prensky 2001) to lags and lurkers in digital spaces, the challenges of harnessing the potential of TEL are complex. The challenges include developing the IT skills of trainees and educators and the creative application of these skills to pedagogy in all areas of the curriculum. The symposium draws on examples from primary, secondary and post-compulsory teacher education to discuss issues and approaches to developing research capacity and innovative practice using different etools, many of which are freely available. The first paper offers theoretical and policy perspectives on finding spaces in busy professional lives to engage in research and develop research-informed practice. It draws on notions of teachers as researchers, practitioner research and evidenc-ebased practice to argue that engagement in research is integral to teacher education and an empowering source of creative professional learning for teachers and teacher educators. Whilst acknowledging the challenges of this stance, examples from our own research practice illustrate how e-tools can assist us in building the capacity and confidence of staff and students in researching and enhancing teaching, learning and assessment practice. The second paper discusses IT skills development through the TEL pathway for trainee teachers in secondary education across different curriculum subjects. The lead tutor for the TEL pathway will use examples of activities developed with trainee teachers and university subject tutors to enhance their skills in using e-tools, such as QR codes, Kahoot, Padlet, Pinterest and cloud based learning. The paper will also focus on how these skills and tools can be used for action Discussant - the wider use of technologies in a university centre for teacher education; course management, recruitment and mentor training. research, evaluation and feedback and for marking and administrative tasks. The discussion will finish with thoughts on widening trainee teachers’ horizons into the future direction of educational technology. The third paper considers institutional policies and strategies for promoting and embedding TEL, including an initiative called ‘The Learning Conversation’, which aims ‘to share, highlight, celebrate, discuss, problematise, find things out...’ about TEL through an online space. The lead for ‘The Learning Conversation’ will offer reflections on this and other initiatives across the institution involving trainee teachers, university subject tutors, librarians and staff in student support services who are using TEL to engage, enthuse and support students on campus and during placements in schools. The fourth paper reflects on the use of TEL to engage with trainee teachers in post-compulsory education. This sector of education and training is more fragmented than primary and secondary schools sectors and so the challenges of building a community of practice that can support the development of innovative practice are greater.

A signaling visualization toolkit to support rational design of combination therapies and biomarker discovery: SiViT

Targeted cancer therapy aims to disrupt aberrant cellular signalling pathways. Biomarkers are surrogates of pathway state, but there is limited success in translating candidate biomarkers to clinical practice due to the intrinsic complexity of pathway networks. Systems biology approaches afford better understanding of complex, dynamical interactions in signalling pathways targeted by anticancer drugs. However, adoption of dynamical modelling by clinicians and biologists is impeded by model inaccessibility. Drawing on computer games technology, we present a novel visualisation toolkit, SiViT, that converts systems biology models of cancer cell signalling into interactive simulations that can be used without specialist computational expertise. SiViT allows clinicians and biologists to directly introduce for example loss of function mutations and specific inhibitors. SiViT animates the effects of these introductions on pathway dynamics, suggesting further experiments and assessing candidate biomarker effectiveness. In a systems biology model of Her2 signalling we experimentally validated predictions using SiViT, revealing the dynamics of biomarkers of drug resistance and highlighting the role of pathway crosstalk. No model is ever complete: the iteration of real data and simulation facilitates continued evolution of more accurate, useful models. SiViT will make accessible libraries of models to support preclinical research, combinatorial strategy design and biomarker discovery.

Caracterização do índice de biofilme oral em doentes internados no serviço de cuidados intensivos 1 do Centro Hospitalar do Porto

Introdução: A cavidade oral de um doente que esteja internado num serviço hospitalar apresenta uma flora diferente das pessoas saudáveis. Ao fim de 48 horas de internamento, a flora apresenta um maior número de microrganismos que rapidamente podem ser responsáveis por aparecimento de infeções secundárias, tais como pneumonias, resultante à proliferação bactérias que lhe está associada. Este risco é ainda superior em doentes críticos. Nesta população torna-se fundamental a implementação de um efetivo protocolo de higiene oral, procurando controlar ao máximo o desenvolvimento do biofilme oral. Objetivo: Avaliar o índice de biofilme oral dos doentes na admissão a um serviço de Cuidados Intensivos, procedendo á sua reavaliação após 7 dias de internamento e, procurando deste modo avaliar a eficácia de higienização oral efetuada no Serviço. Materiais e Métodos: Estudo prospetivo, institucional, descritivo, analítico e observacional realizado no Serviço de Cuidados Intensivos do CHP. Foram envolvidos no estudo doentes com mais de 18 anos, e com um tempo de internamento igual ou superior a 7 dias. Procedeu-se à colheita de dados demográficos, motivo de admissão, tempo de internamento, medicação prescrita, tipo de alimentação efetuada no serviço, necessidade ou não de suporte respiratório e qual o tipo de higiene realizada no serviço. Foi avaliado o índice de higiene oral simplificado de Greene & Vermillion (IHO-S) nas primeiras 24h e 7 dias após a 1ª avaliação. O IHO-S é um indicador composto que avalia 2 componentes, a componente de resíduos e a componente de cálculo, sendo cada componente avaliada numa escala de 0 a 3. São avaliadas 6 faces dentárias que são divididas em 3 porções clínicas (porção gengival, terço médio e porção oclusal). No final de cada avaliação é calculado o somatório do valor encontrado para cada face, sendo este total dividido pelo nº de faces analisadas. O cálculo do IHO-S por indivíduo corresponde à soma das componentes. Resultados: Foram avaliados 74 doentes, tendo-se excluído 42 por não terem a dentição mínima exigida. Os 32 doentes que completaram o estudo apresentaram uma idade média de 60,53 ± 14,44 anos, 53,1% eram do género masculino, e na sua maioria pertenciam a pacientes do foro médico e cirúrgico (37,5,5%). Os doentes envolvidos no estudo tiveram uma demora média de 15,69±6,69 dias de internamento, tendo-se verificado que 17 dos pacientes (53,1%) estiveram internados mais de 14 dias no Serviço de Cuidados Intensivos 1. Relativamente às características particulares da amostra verificou-se que durante o período de avaliação a maioria dos doentes estiveram sedados (75%), sob suporte ventilatório (81,3%) e a fazer suporte nutricional por via entérica por sonda nasogástrica (62,6%). O IHO-S inicial foi de 0,67±0,45tendo-se verificado um agravamento significativo ao fim de sete dias de internamento 1,04±0.51 (p<0,05).Este agravamento parece estar fundamentalmente dependente dos maus cuidados orais prestados aos doentes, não se tendo observado qualquer diferença significativa resultante dos aspetos particulares avaliados, com exceção para a nutrição entérica versus a soroterapia. Discussão e Conclusão: Apesar de vários estudos evidenciarem a necessidade de um boa higiene oral para evitar a proliferação bacteriana e o risco de infeção nosocomial, muitas das instituições de saúde continuam a não valorizar esta prática. Neste estudo observa-se que os doentes na admissão apresentam um bom índice de higiene oral tendo-se contudo observado um agravamento significativo ao fim de uma semana de internamento. Embora este agravamento possa não ser importante para o doente com uma semana de internamento ele poderá ser indicativo de um risco acrescido para infeções nosocomiais em doentes com internamentos mais prolongados, necessitando estes doentes de uma higiene oral mais eficaz.

Violence against Women Policy and Practice in Uganda - Promoting Justice within the Context of Patriarchy

The goal of this study was to understand how and whether policy and practice relating to violence against women in Uganda, especially Uganda’s Domestic Violence Act of 2010, have had an effect on women’s beliefs and practices, as well as on support and justice for women who experience abuse by their male partners. Research used multi-sited ethnography at transnational, national, and local levels to understand the context that affects what policies are developed, how they are implemented, and how, and whether, women benefit from these. Ethnography within a local community situated global and national dynamics within the lives of women. Women who experience VAW within their intimate partnerships in Uganda confront a political economy that undermines their access to justice, even as a women’s rights agenda is working to develop and implement laws, policies, and interventions that promote gender equality and women’s empowerment. This dissertation provides insights into the daily struggles of women who try to utilize policy that challenges duty bearers, in part because it is a new law, but also because it conflicts with the structural patriarchy that is engrained in Ugandan society. Two explanatory models were developed. One explains factors relating to a woman’s decision to seek support or to report domestic violence. The second explains why women do and do not report DV. Among the findings is that a woman is most likely to report abuse under the following circumstances: 1) her own, or her children’s survival (physical or economic) is severely threatened; 2) she experiences severe physical abuse; or, 3) she needs financial support for her children. Research highlights three supportive factors for women who persist in reporting DV. These are: 1) the presence of an “advocate” or support 2) belief that reporting will be helpful; and, 3) lack of interest in returning to the relationship. This dissertation speaks to the role that anthropologists can play in a multi-disciplinary approach to a complex issue. This role is understanding – deeply and holistically; and, articulating knowledge generated locally that provides connections between what happens at global, national and local levels.

EXAMINING THE IMPACT OF TEACHER PRACTICE ON STUDENT LEARNING IN INTERACTIVE RADIO INSTRUCTION (IRI) CLASSROOMS: LESSONS FROM NEW DELHI AND RAJASTHAN (INDIA)

This quantitative study examines the impact of teacher practices on student achievement in classrooms where the English is Fun Interactive Radio Instruction (IRI) programs were being used. A contemporary IRI design using a dual-audience approach, the English is Fun IRI programs delivered daily English language instruction to students in grades 1 and 2 in Delhi and Rajasthan through 120 30-minute programs via broadcast radio (the first audience) while modeling pedagogical techniques and behaviors for their teachers (the second audience). Few studies have examined how the dual-audience approach influences student learning. Using existing data from 32 teachers and 696 students, this study utilizes a multivariate multilevel model to examine the role of the primary expectations for teachers (e.g., setting up the IRI classroom, following instructions from the radio characters and ensuring students are participating) and the role of secondary expectations for teachers (e.g., modeling pedagogies and facilitating learning beyond the instructions) in promoting students’ learning in English listening skills, knowledge of vocabulary and use of sentences. The study finds that teacher practice on both sets of expectations mattered, but that practice in the secondary expectations mattered more. As expected, students made the smallest gains in the most difficult linguistic task (sentence use). The extent to which teachers satisfied the primary and secondary expectations was associated with gains in all three skills – confirming the relationship between students’ English proficiency and teacher practice in a dual-audience program. When it came to gains in students’ scores in sentence use, a teacher whose focus was greater on primary expectations had a negative effect on student performance in both states. In all, teacher practice clearly mattered but not in the same way for all three skills. An optimal scenario for teacher practice is presented in which gains in all three skills are maximized. These findings have important implications for the way the classroom teacher is cast in IRI programs that utilize a dual-audience approach and in the way IRI programs are contracted insofar as the role of the teacher in instruction is minimized and access is limited to instructional support from the IRI lessons alone.