Finnish Preclinical and Clinical Medical Students as Strategic L2 English Learners: Language Learning Strategies and Communicating with Patients

This thesis focused on medical students’ language learning strategies for patient encounters. The research questions concerned the types of learning strategies that medical students use and the differences between the preclinical students and the clinical students, two groups who have had varying amounts of experience with patients. Additionally, strategy use was examined through activity systems to gain information on the context of language learning strategy use in order to learn language for patient encounters. In total, 130 first-year medical students (preclinical) and 39 fifth-year medical students (clinical) participated in the study by filling in a questionnaire on language learning strategies. In addition, two students were interviewed in order to create activity systems for the medical students at different stages of their studies. The study utilised both quantitative and qualitative research methods; the analysis of the results relies on Oxford’s Strategic Self-Regulation Model in the quantitative part and on activity theory in the qualitative part. The theoretical sections of the study introduced earlier research and theories regarding English for specific purposes, language learning strategies and activity theory. The results indicated that the medical students use affective, sociocultural-interactive and metasociocultural-interactive strategies often and avoid using negative strategies, which hinder language learning or cease communication altogether. Slight differences between the preclinical and clinical students were found, as clinical students appear to use affective and metasociocultural-interactive strategies more frequently compared to the preclinical students. The activity systems of the two students interviewed were rather similar. The students were at different stages of their studies, but their opinions were very similar. Both reported the object of learning to be mutual understanding between the patient and the doctor, which in part explains the preference for strategies that support communication and interaction. The results indicate that the nature of patient encounters affects the strategy use of the medical students at least to some extent.

Determinants of self-medication with NSAIDs in a Portuguese community pharmacy

Background: Non-steroid anti-inflammatory drugs (NSAIDs) are a widely used therapeutic group in the world, and particularly in the Portuguese population. Objective: To compare NSAID’s use by prescription and self-medication acquisition and to determine the pattern of indication of NSAIDs, their usage profile and possible implications for patients’ safety. Methods: A cross-sectional design was used where individuals presenting at a community pharmacy requesting NSAIDs during the study period (one month) were invited to answer a face-to-face interview where socio-demographic characteristics, the indication pattern and previous experience of side effects were assessed. A follow-up interview was performed one week later to assess the incidence of adverse effects. The study was ethically approved. Results: A sample of 130 NSAIDs users was recruited, comprising mostly women (n=87; 66.9%), actively employed (n=77; 59.2%) and presenting a mean age of 49.5 years old (SD=20.49). An equal proportion of individuals acquired NSAIDs by self-medication and with medical prescription (n=65; 50%). Over 4/5 of patients (n=57; 87.7%) acquiring NSAIDs without a prescription were self-medicated by their own initiative, and only 10.8% (n=7) had been advised by the pharmacist. The most commonly acquired active substances were ibuprofen and diclofenac. Self-medicated users more frequently resorted to topical NSAIDs following short term treatments. The major underlying condition motivating NSAIDs sought were musculoskeletal disorders (45.0%), regardless of the regimen. An important proportion of prevalent users of NSAIDs reported previous experience of adverse effects (11.3%). One week after initiating NSAID therapy, a small proportion of patients reported incidence of adverse effects. Conclusion: Self-medication with NSAIDs is sought for numerous medical conditions. Reported adverse effects (prevalent and incident) confirm the need for a more rational use of NSAIDs and ongoing pharmacovigilance.

Haematidrosis: The Rare Phenomenon of Sweating Blood

Objectives: Haematidrosis, also known as haematohidrosis, is a very rare condition where blood is excreted with sweat. As only a few cases have been described in the literature, we present guidelines on management of this rare phenomenon. Case: A 44-year-old man presented with self-limited and spontaneous bleeding episodes from different parts of his body. This had started 2 weeks before admission after an episode of extreme emotional stress. Medical history and laboratory tests were normal. The microscopic examination of a sample of the fluid excreted confirmed all blood elements. Conclusion: The disorder is thought to be related to activation of the sympathetic nervous system. The use of benzodiazepines and beta blockers may be helpful in controlling the bleeding episodes and give some comfort to the patient.

Supporting self-management: development and evaluation of a digital resource for adults with asthma

The problem: Around 300 million people worldwide have asthma and prevalence is increasing. Support for optimal self-management can be effective in improving a range of outcomes and is cost effective, but is underutilised as a treatment strategy. Supporting optimum self-management using digital technology shows promise, but how best to do this is not clear. Aim: The purpose of this project was to explore the potential role of a digital intervention in promoting optimum self-management in adults with asthma. Methods: Following the MRC Guidance on the Development and Evaluation of Complex Interventions which advocates using theory, evidence, user testing and appropriate modelling and piloting, this project had 3 phases. Phase 1: Examination of the literature to inform phases 2 and 3, using systematic review methods and focussed literature searching. Phase 2: Developing the Living Well with Asthma website. A prototype (paper-based) version of the website was developed iteratively with input from a multidisciplinary expert panel, empirical evidence from the literature (from phase 1), and potential end users via focus groups (adults with asthma and practice nurses). Implementation and behaviour change theories informed this process. The paper-based designs were converted to the website through an iterative user centred process (think aloud studies with adults with asthma). Participants considered contents, layout, and navigation. Development was agile using feedback from the think aloud sessions immediately to inform design and subsequent think aloud sessions. Phase 3: A pilot randomised controlled trial over 12 weeks to evaluate the feasibility of a Phase 3 trial of Living Well with Asthma to support self-management. Primary outcomes were 1) recruitment & retention; 2) website use; 3) Asthma Control Questionnaire (ACQ) score change from baseline; 4) Mini Asthma Quality of Life (AQLQ) score change from baseline. Secondary outcomes were patient activation, adherence, lung function, fractional exhaled nitric oxide (FeNO), generic quality of life measure (EQ-5D), medication use, prescribing and health services contacts. Results: Phase1: Demonstrated that while digital interventions show promise, with some evidence of effectiveness in certain outcomes, participants were poorly characterised, telling us little about the reach of these interventions. The interventions themselves were poorly described making drawing definitive conclusions about what worked and what did not impossible. Phase 2: The literature indicated that important aspects to cover in any self-management intervention (digital or not) included: asthma action plans, regular health professional review, trigger avoidance, psychological functioning, self-monitoring, inhaler technique, and goal setting. The website asked users to aim to be symptom free. Key behaviours targeted to achieve this include: optimising medication use (including inhaler technique); attending primary care asthma reviews; using asthma action plans; increasing physical activity levels; and stopping smoking. The website had 11 sections, plus email reminders, which promoted these behaviours. Feedback during think aloud studies was mainly positive with most changes focussing on clarification of language, order of pages and usability issues mainly relating to navigation difficulties. Phase 3: To achieve our recruitment target 5383 potential participants were invited, leading to 51 participants randomised (25 to intervention group). Age range 16-78 years; 75% female; 28% from most deprived quintile. Nineteen (76%) of the intervention group used the website for an average of 23 minutes. Non-significant improvements in favour of the intervention group observed in the ACQ score (-0.36; 95% confidence interval: -0.96, 0.23; p=0.225), and mini-AQLQ scores (0.38; -0.13, 0.89; p=0.136). A significant improvement was observed in the activity limitation domain of the mini-AQLQ (0.60; 0.05 to 1.15; p = 0.034). Secondary outcomes showed increased patient activation and reduced reliance on reliever medication. There was no significant difference in the remaining secondary outcomes. There were no adverse events. Conclusion: Living Well with Asthma has been shown to be acceptable to potential end users, and has potential for effectiveness. This intervention merits further development, and subsequent evaluation in a Phase III full scale RCT.

No right to sext? A critical examination of media and legal debates about teenage girls' sexual agency in the digital age

Advances in digital photography and distribution technologies enable many people to produce and distribute images of their sex acts. When teenagers do this, the photos and videos they create can be legally classified as child pornography since the law makes no exception for youth who create sexually explicit images of themselves. The dominant discussions about teenage girls producing sexually explicit media (including sexting) are profoundly unproductive: (1) they blame teenage girls for creating private images that another person later maliciously distributed and (2) they fail to respect—or even discuss—teenagers’ rights to freedom of expression. Cell phones and the internet make producing and distributing images extremely easy, which provide widely accessible venues for both consensual sexual expression between partners and for sexual harassment. Dominant understandings view sexting as a troubling teenage trend created through the combination of camera phones and adolescent hormones and impulsivity, but this view often conflates consensual sexting between partners with the malicious distribution of a person’s private image as essentially equivalent behaviors. In this project, I ask: What is the role of assumptions about teen girls’ sexual agency in these problematic understandings of sexting that blame victims and deny teenagers’ rights? In contrast to the popular media panic about online predators and the familiar accusation that youth are wasting their leisure time by using digital media, some people champion the internet as a democratic space that offers young people the opportunity to explore identities and develop social and communication skills. Yet, when teen girls’ sexuality enters this conversation, all this debate and discussion narrows to a problematic consensus. The optimists about adolescents and technology fall silent, and the argument that media production is inherently empowering for girls does not seem to apply to a girl who produces a sexually explicit image of herself. Instead, feminist, popular, and legal commentaries assert that she is necessarily a victim: of a “sexualized” mass media, pressure from her male peers, digital technology, her brain structures or hormones, or her own low self-esteem and misplaced desire for attention. Why and how are teenage girls’ sexual choices produced as evidence of their failure or success in achieving Western liberal ideals of self-esteem, resistance, and agency? Since mass media and policy reactions to sexting have so far been overwhelmingly sexist and counter-productive, it is crucial to interrogate the concepts and assumptions that characterize mainstream understandings of sexting. I argue that the common sense that is co-produced by law and mass media underlies the problematic legal and policy responses to sexting. Analyzing a range of nonfiction texts including newspaper articles, talk shows, press releases, public service announcements, websites, legislative debates, and legal documents, I investigate gendered, racialized, age-based, and technologically determinist common sense assumptions about teenage girls’ sexual agency. I examine the consensus and continuities that exist between news, nonfiction mass media, policy, institutions, and law, and describe the limits of their debates. I find that this early 21st century post-feminist girl-power moment not only demands that girls live up to gendered sexual ideals but also insists that actively choosing to follow these norms is the only way to exercise sexual agency. This is the first study to date examining the relationship of conventional wisdom about digital media and teenage girls’ sexuality to both policy and mass media.

The Impact of a Simulated Clinical Experience on CEGEP Nursing Students’ Perceptions of Self-Efficacy and Achievement

Abstract : Providing high-quality clinical experiences to prepare students for the complexities of the current health-care system has become a challenge for nurse educators. Additionally, there are concerns that the current model of clinical practice is suboptimal. Consequently, nursing programs have explored the partial replacement of traditional in-hospital clinical experiences with a simulated clinical experience. Despite research demonstrating numerous benefits to students following participation in simulation activities, insufficient research conducted within Québec exists to convince the governing bodies (Ordre des infirmières et des infirmiers du Québec, OIIQ; Ministère de L’Éducation supérieur, de la Recherche, de la Science et de la Technologie) to fully embrace simulation as part of nurse training. The purpose of this study was to examine the use of a simulated clinical experience (SCE) as a viable, partial pedagogical substitute for traditional clinical experience by examining the effects of a SCE on CEGEP nursing students’ perceptions of self-efficacy (confidence), and their ability to achieve course objectives. The findings will contribute new information to the current body of research in simulation. The specific case of obstetrical practice was examined. Based on two sections of the Nursing III-Health and Illness (180-30K-AB) course, the sample was comprised of 65 students (thirty-one students from section 0001 and thirty-four students from section 0002) whose mean age was 24.8 years. With two sections of the course available, the opportunity for comparison was possible. A triangulation mixed method design was used. An adapted version of Ravert’s (2004) Nursing Skills for Evaluation tool was utilized to collect data regarding students’ perceptions of confidence related to the nursing skills required for care of mothers and their newborns. Students’ performance and achievement of course objectives was measured through an Objective Structured Clinical Examination (OSCE) consisting of three marked stations designed to test the theoretical and clinical aspects of course content. The OSCE was administered at the end of the semester following completion of the traditional clinical experience. Students’ qualitative comments on the post -test survey, along with journal entries served to support the quantitative scale evaluation. Two of the twelve days (15 hours) allocated for obstetrical clinical experience were replaced by a SCE (17%) over the course of the semester. Students participated in various simulation activities developed to address a range of cognitive, psychomotor and critical thinking skills. Scenarios incorporating the use of human patient simulators, and designed using the Jeffries Framework (2005), exposed students to the care of families and infants during the perinatal period to both reflect and build upon class and course content in achievement of course objectives and program competencies. Active participation in all simulation activities exposed students to Bandura’s four main sources of experience (mastery experiences, vicarious experiences, social persuasion, and physiologic/emotional responses) to enhance the development of students’ self-efficacy. Results of the pre-test and post-test summative scores revealed a statistically significant increase in student confidence in performing skills related to maternal and newborn care (p < .0001) following participation in the SCE. Confidence pre-test and post-test scores were not affected by the students’ section. Skills related to the care of the post-partum mother following vaginal or Caesarean section delivery showed the greatest change in confidence ratings. OSCE results showed a mean total class score (both sections) of 57.4 (70.0 %) with normal distribution. Mean scores were 56.5 (68.9%) for section 0001 and 58.3 (71.1%) for section 0002. Total scores were similar between sections (p =0.342) based on pairwise comparison. Analysis of OSCE scores as compared to students’ final course grade revealed similar distributions. Finally, qualitative analysis identified how students’ perceived the SCE. Students cited gains in knowledge, development of psychomotor skills and improved clinical judgement following participation in simulation activities. These were attributed to the « hands on » practice obtained from working in small groups, a safe and authentic learning environment and one in which students could make mistakes and correct errors as having the greatest impact on learning through simulation.

Students’ Self-Report of Motivational Orientation and Teacher Evaluation on Coping and Motivational Orientation Related to Elementary Students’ Mathematical Problem Solving and Reading Comprehension

The present study examined the correlations between motivational orientation and students’ academic performance in mathematical problem solving and reading comprehension. The main purpose is to see if students’ intrinsic motivation is related to their actual performance in different subject areas, math and reading. In addition, two different informants, students and teachers, were adopted to check whether the correlation is different by different informants. Pearson’s correlational analysis was a major method, coupled with regression analysis. The result confirmed the significant positive correlation between students’ academic performance and students’ self-report and teacher evaluation on their motivational orientation respectively. Teacher evaluation turned out with more predictive value for the academic achievement in math and reading. Between the subjects, mathematical problem solving showed higher correlation with most of the motivational subscales than reading comprehension did. The highest correlation was found between teacher evaluation on task orientation and students’ mathematical problem solving. The positive relationship between intrinsic motivation and academic achievement was proved. The disparity between students ’ self-report and teacher evaluation on motivational orientation was also addressed with the need of further examination.

French good practice guidelines for medical and occupational surveillance of the low back pain risk among workers exposed to manual handling of loads

International audience

A preliminary examination of the relationship between compulsive exercise and shame in individuals with an eating disorder: and clinical research portfolio

Objective: To explore the relationship between compulsive exercise and shame in a clinical sample of eating disorder patients. Method: In a cross-sectional study, individuals with an eating disorder (n=21) completed self-report measures of compulsive exercise, internal shame, external shame, bodily shame, anxiety and depression. Results: Internal shame was moderately associated with compulsive exercise (r=.496, p<.05). No further variables were significantly related to compulsive exercise. Individuals with Anorexia-Nervosa and Bulimia-Nervosa did not significantly differ on any of the study variables. Discussion: Hypotheses regarding the possible nature of the relationship between compulsive exercise and shame are suggested. For instance, that compulsive exercise may serve a role in the regulation of internal shame. That compulsive exercise may act as a compensatory behaviour and be a consequence of high levels of shame. Or that internal shame may result as a response to negative perceptions of one’s exercise habits. The results are discussed in line with current literature.

A self-inducible heterologous protein expression system in Escherichia coli

International audience

BLACK, MALE, AND HIGH-ACHIEVING: AN EXAMINATION OF A RISK FACTOR AND CULTURAL RESOURCES FOR BLACK MALE ACADEMIC ACHIEVEMENT

Black boys are confronted with unique educational circumstances. They are often misdiagnosed and misplaced into special education programs (Bush-Daniels, 2008; Patton, 1998; Terman et al., 1996). Additionally, they are less likely to be enrolled in gifted and talented programs, even if their former achievements reflect their aptitude to succeed (Black Alliance for Educational Options, n.d.; Moore & Flowers, 2012). Given these statistics, a considerable emphasis has been placed on the causes and the consequences of low/under achievement for this population. As a result, the experiences of Black males who are achieving have been greatly neglected. Moreover, little is known about the factors that facilitate academic achievement among high-achieving Black boys. In an effort to bring the heterogenic nature of schooling experiences for Black boys to light, the present study examined the influence risk and protective factors had on the academic experiences of high-achieving Black boys. Grounded in the risk and resilience framework and the Integrative Model for the Study of Minority Youth Development, this study explored whether the high-achieving Black high school boys in this sample (n =88) reported experiencing discrimination (i.e. academic-based) and how this academic-based discrimination related to their 1) academic performance (i.e. GPA), 2) perceptions of math ability, and 3) race-based academic self-concept. In addition to exploring how academic-based discrimination was linked to academic achievement, this study examined how cultural resources such as racial socialization messages and racial identity related to academic achievement. Specifically, cultural socialization, preparation for bias, egalitarianism, private regard and public regard were evaluated alongside the three academic outcomes under study. Finally, the study explored whether aspects of racial socialization or racial identity buffered the effects of discrimination on any of the outcomes. Interestingly, the race/ethnicity of the student mattered for how students perceived their math ability. The risk factor academic-based discrimination was linked to academic performance. Cultural resources cultural socialization, preparation for bias, and private regard were linked to various academic outcomes of interest. There was only one significant moderating effect: a high private regard buffered the relationship between academic-based discrimination and race-based academic self-concept. Limitations and implications of this study are discussed.

THE INFLUENCE OF MOTIVATION ON EMOTION REGULATION AND MOTOR PERFORMANCE: EXAMINATION OF A NEURO-AFFECTIVE MODEL

Mental stress is known to disrupt the execution of motor performance and can lead to decrements in the quality of performance, however, individuals have shown significant differences regarding how fast and well they can perform a skilled task according to how well they can manage stress and emotion. The purpose of this study was to advance our understanding of how the brain modulates emotional reactivity under different motivational states to achieve differential performance in a target shooting task that requires precision visuomotor coordination. In order to study the interactions in emotion regulatory brain areas (i.e. the ventral striatum, amygdala, prefrontal cortex) and the autonomic nervous system, reward and punishment interventions were employed and the resulting behavioral and physiological responses contrasted to observe the changes in shooting performance (i.e. shooting accuracy and stability of aim) and neuro-cognitive processes (i.e. cognitive load and reserve) during the shooting task. Thirty-five participants, aged 18 to 38 years, from the Reserve Officers’ Training Corp (ROTC) at the University of Maryland were recruited to take 30 shots at a bullseye target in three different experimental conditions. In the reward condition, $1 was added to their total balance for every 10-point shot. In the punishment condition, $1 was deducted from their total balance if they did not hit the 10-point area. In the neutral condition, no money was added or deducted from their total balance. When in the reward condition, which was reportedly most enjoyable and least stressful of the conditions, heart rate variability was found to be positively related to shooting scores, inversely related to variability in shooting performance and positively related to alpha power (i.e. less activation) in the left temporal region. In the punishment (and most stressful) condition, an increase in sympathetic response (i.e. increased LF/HF ratio) was positively related to jerking movements as well as variability of placement (on the target) in the shots taken. This, coupled with error monitoring activity in the anterior cingulate cortex, suggests evaluation of self-efficacy might be driving arousal regulation, thus affecting shooting performance. Better performers showed variable, increasing high-alpha power in the temporal region during the aiming period towards taking the shot which could indicate an adaptive strategy of engagement. They also showed lower coherence during hit shots than missed shots which was coupled with reduced jerking movements and better precision and accuracy. Frontal asymmetry measures revealed possible influence of the prefrontal lobe in driving this effect in reward and neutral conditions. The possible interactions, reasons behind these findings and implications are discussed.

Self determination, embodied languages and landscapes in women's video art.

This paper addresses how, since the 1960s to the present, part of women's video art has broken the traditional representation of women’s body and proposed new forms of recording women's images, explicit or symbolic, using body part close-ups, and not sparing any efforts to ensure the prevention of the cataloguing of women’s bodies according to normative categories, such as gender, race and age, and in this way challenging the Western representation codes that objectify women. The methodology employed had as its primary purpose the examination of the association existing between the micro-sociological level of body gestures and performances in women's videos and the macro-sociological level of social forces such as the dimensions of gender and sexuality. This study concluded that narratives of identity and self-determination are present in women's video pieces contributing to women's empowerment through visual discourses that could possibly point to the production of new signs and symbols, new values and models, but also for the formation of new types of social roles and even a new type of interpersonal relationships.

External ophthalmomyiasis by Oestrus ovis treated with tobacco: clinical case report and medical literature review

External ophthalmomyiasis is an infestation of conjunctiva with larvae or maggots of certain lies. Oestrus ovis is the most common cause of human ophthalmomyiasis. The case of a 16-yearold female is described, who presented with foreign body sensation, pain, and redness in the left eye. Slit-lamp biomicroscopy revealed 32 tiny larvae crawling around the conjunctival sac. The larvae were mechanically removed under topical anesthesia, and identiied under a light microscope as irst-stage larvae of O. ovis causing external ophthalmomyiasis. She was successfully treated with topical tobacco juice. Follow-up examination of these cases is recommended to avoid possible complications.

Evaluation of Educational Environment for Medical Students of a Tertiary Pediatric Hospital in Tehran, Using DREEM Questionnaire

Background: Tertiary pediatric hospitals usually provide excellent clinical services, but such centers have a lot to do for educational perfection. Objectives: This study was performed to address under-graduate educational deficits and find feasible solutions. Patients and Methods: This cross-sectional study was done in a target population of 77 sixth year undergraduate medical students (response rate = 78%) who spent their 3-month pediatric rotation in the Children’s Medical Center, the Pediatrics Center of Excellence in Tehran, Iran. The Dundee ready educational environment measure (DREEM) instrument was used for assessing educational environment of this subspecialized pediatric hospital. Results: Among 60 students who answered the questionnaires, 24 were male (40%). Participants’ age ranged from 23 to 24 years. The mean total score was 95.8 (48%). Comparison of scores based on students’ knowledge showed no significant difference. Problematic areas were learning, academic self-perception, and social self-perception. Conclusions: Having an accurate schedule to train general practitioner, using new teaching methods, and providing a non-stressful atmosphere were suggested solutions.