The Role of Family/Friend Social Support in Diabetes Self-Management for Minorities with Type 2 Diabetes

This study investigated how ethnicity, perceived family/friend social support (FSS), and health behaviors are associated with diabetes self-management (DSM) in minorities. The participants were recruited by community outreach methods and included 174 Cuban-, 121 Haitian- and 110 African-Americans with type 2 diabetes. The results indicated that ethnicity and FSS were associated with DSM. Higher FSS scores were associated with higher DSM scores, independent of ethnicity. There were ethnic differences in several elements of FSS. DSM was highest in Haitian- as compared to African-Americans; yet Haitian Americans had poorer glycemic control. The findings suggest FSS together with ethnicity may influence critical health practices. Studies are needed that further investigate the relationships among minorities with diabetes, their intimate network (family and friends) and the diabetes care process.

Oman's foreign policy : foundations and practice

The object of this dissertation is to record and analyze the foreign policy of the Sultanate of Oman from the early twentieth century until 2004. It challenges the central assumption of the contemporary scholarship on the subject that Muscat's modern foreign policy begins in 1970. It is often presumed that the pre-1970 era does not merit a thorough investigation to understand Muscat's modus operandi today. This study argues that for a comprehensive understanding of Muscat's foreign policy since 1970, the frontier of the historical analysis of Oman's regional and international involvement should be pushed back to the 1930's, when the young Sultan Said assumed power over the country divided by the "Treaty" or the "Agreement" of Sib. Indeed, the thrust of this research lies at once in repudiating the conventional wisdom regarding both the persona of Sultan Said and the customary political/historical narrative of Said's reign. The critical analysis of this period is utilized to rebut the pervasive and largely inaccurate historical narrative of the events prior to 1970, to recount an original interpretation of the period, and to use the narrative as a preamble for subsequent foreign policy directions and initiatives. Furthermore, this dissertation covers the gaps in the literature resulting from the absence of any materials that either record or analyze Muscat's foreign policy from 1996 until 2004. In addition, his study provides new information and a fresh analysis of the international relations of the region, including great power rivalry, especially the competition between the United States and Great Britain, and the attitudes of major regional actors, such as Iran, Saudi Arabia, and Iraq. The use of a thorough historical inquiry is vital to support the central claim of this dissertation; therefore, a large section of this dissertation is based almost exclusively on archival materials collected from the British Public Records Office, the University of Oxford and the Library of Congress. This project represents the most comprehensive use of archival materials on the subject matter to date.

Impact of nutrition education on knowledge and eating patterns in HIV-infected individuals

Acquired Immune Deficiency Syndrome (AIDS) and impaired or threatened nutritional status seem to be closely related. It is now known that AIDS results in many nutritional disorders including anorexia, vomiting, protein-energy malnutrition (PEM), nutrient deficiencies, and gastrointestinal, renal, and hepatic dysfunction (1-7, 8). Reversibly, nutritional status may also have an impact on the development of AIDS among HIV-infected people. Not all individuals who have tested antibody positive for the Human Immunodeficiency Virus (HIV) have developed AIDS or have even shown clinical symptoms (9, 10). A poor nutritional status, especially PEM, has a depressing effect on immunity which may predispose an individual to infection (11). It has been proposed that a qualitatively or quantitatively deficient diet could be among the factors precipitating the transition from HIV-positive to AIDS (12, 13). The interrelationship between nutrition and AIDS reveals the importance of having a multidisciplinary health care team approach to treatment (11), including having a registered dietitian on the medical team. With regards to alimentation, the main responsibility of a dietitian is to inform the public concerning sound nutritional practices and encourage healthy food habits (14). In individuals with inadequate nutritional behavior, a positive, long-term change has been seen when nutrition education tailored to specific physiological and emotional needs was provided along with psychological support through counseling (14). This has been the case for patients with various illnesses and may also be true in AIDS patients as well. Nutritional education specifically tailored for each AIDS patient could benefit the patient by improving the quality of life and preventing or minimizing weight loss and malnutrition (15-17). Also, it may influence the progression of the disease by delaying the onset of the most severe symptoms and increasing the efficacy of medical treatment (18, 19). Several studies have contributed to a dietary rationale for nutritional intervention in HIV-infected and AIDS patients (2, 4, 20-25). Prospective, randomized clinical research in AIDS patients have not yet been published to support this dietary rationale; however, isolated case reports show its suitability (3). Furthermore, only nutrition intervention as applied by a medical team in an institution or hospital has been evaluated. Research is lacking concerning the evaluation of nutritional education of either non-institutionalized or hospitalized groups of persons who are managing their own food choice and intake. This study compares nutrition knowledge and food intakes in HIV-infected individuals prior to and following nutrition education. It was anticipated that education would increase the knowledge of nutritional care of AIDS patients and lead to better implementation of nutrition education programs.

Ética da alimentação: porque devemos, segundo Kant, escolher uma alimentação adequada e saudável

This thesis proposes the adoption of a practical and philosophic approach to the discussion about what should be a healthy food, in view of the actual problems concerning this subject (from famine to obesity), which affect food and nutritional security and constitute target of many official policies. In order to handle this task, this work resorts to ethic, pedagogical and anthropological concepts inherent to Immanuel Kant’s philosophy, as valuable contributions to the practice of the professional nutritionist committed to the support and accomplishment of the human right to adequate nutrition (DHAA). Under this assumption, it intends to surpass the prevailing idea inside the social programs and policies favoring the utilitarian argument. It considers rather that a healthy food is also a duty of virtue, according to the Kantian duties to one-self. The liberation of transgenic seeds in Brazil comes up as an example of the violation of the right to food security and affects it negatively, resulting from the conflict between politics and moral faced by the Brazilian government. This paper concludes that DHAA realization requires not only a committed state, but also committed citizens and suggests that Kant’s philosophy should offer important contributions to supporting the practice of the professional nutritionist, awarding him the necessary information about this matter.

Ética da alimentação: porque devemos, segundo Kant, escolher uma alimentação adequada e saudável

This thesis proposes the adoption of a practical and philosophic approach to the discussion about what should be a healthy food, in view of the actual problems concerning this subject (from famine to obesity), which affect food and nutritional security and constitute target of many official policies. In order to handle this task, this work resorts to ethic, pedagogical and anthropological concepts inherent to Immanuel Kant’s philosophy, as valuable contributions to the practice of the professional nutritionist committed to the support and accomplishment of the human right to adequate nutrition (DHAA). Under this assumption, it intends to surpass the prevailing idea inside the social programs and policies favoring the utilitarian argument. It considers rather that a healthy food is also a duty of virtue, according to the Kantian duties to one-self. The liberation of transgenic seeds in Brazil comes up as an example of the violation of the right to food security and affects it negatively, resulting from the conflict between politics and moral faced by the Brazilian government. This paper concludes that DHAA realization requires not only a committed state, but also committed citizens and suggests that Kant’s philosophy should offer important contributions to supporting the practice of the professional nutritionist, awarding him the necessary information about this matter.

An Audit and Feedback Intervention for Reducing Antibiotic Prescribing in General Dental Practice : The RAPiD Cluster Randomised Controlled Trial

Funding: This study was conducted as part of the TRiaDS programme of implementation research which is funded by NHS Education for Scotland (NES). The Health Services Research Unit which is funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates supported the study. The funder had no influence over the design, conduct, analysis and write up of the study.

Parvalbumin-positive interneurons of the prefrontal cortex support working memory and cognitive flexibility

We were supported by the Biotechnology and Biological Sciences Research Council grant BB/H001123/1 (P.W.), the Medical Research Council grants G0601498 and G1100546/2 (P.W.), Tenovus Scotland Grant G09/17 (A.J.M.) and the University of Aberdeen (P.W.). We thank O. Tüscher for discussion, P. Teismann and the microscopy core facility at the University of Aberdeen for the use of microscopy equipment, L. Strachan, A. Plano, S. Deiana for help with behavioral testing.

Mapping the Asthma Care Process : Implications for Research and Practice

The authors would like to thank the participants to the Respiratory Effectiveness Group Adherence symposium for their comments on the model overview presented during this meeting, members of the ASTRO-LAB consortium for collaborative work on reviewing literature and performing qualitative interviews, and patients and clinicians that shared valuable insights into asthma management during the telephone interviews.

Exploring business models to provide a foundation for enhanced eye care services in high street optometric practice

High street optometric practices are for-profit businesses. They mostly provide sight testing and eye examination services and sell optical products, such as spectacles and contact lenses. The sight testing services are often sold at a vastly reduced price and profits are generated primarily through high margin spectacle sales, in a loss leading strategy. Published literature highlights weaknesses in this strategy as it forms a barrier to widening the scope of services provided within optometric practices. This includes specialist non-refraction based services, such as shared care. In addition this business strategy discourages investment in advanced diagnostic equipment and higher professional qualifications. The aim of this thesis was to develop a greater understanding of the traditional loss-leading strategy. The thesis also aimed to assess the plausibility of alternative business models to support the development of specialist non-refraction services within high street optometric practice. This research was based on a single independent optometric practice that specialises in advanced retinal imaging and offers a broad range of shared care services. Specialist non-refraction based services were found to be poor generators of spectacle sales likely due to patient needs and presenting concerns. Alternative business strategies to support these services included charging more realistic professional fees via cost-based pricing and monthly payment plans. These strategies enabled specialist services to be more self-sustainable with less reliance on cross-subsidy from spectacle sales. Furthermore, improving operational efficiency can increase stand-alone profits for specialist services.Practice managers may be reluctant to increase professional fees due to market pressures and confidence. However, this thesis found that patients were accepting of increased professional fees. Practice managers can implement alternative business models to enhance eye care provision in high street optometric practices. These alternative business models also improve revenues and profits generated via clinical services and improve patient loyalty.

Towards a model for exploring the relationship between managerial decision problems and decision support opportunities

The organisational decision making environment is complex, and decision makers must deal with uncertainty and ambiguity on a continuous basis. Managing and handling decision problems and implementing a solution, requires an understanding of the complexity of the decision domain to the point where the problem and its complexity, as well as the requirements for supporting decision makers, can be described. Research in the Decision Support Systems domain has been extensive over the last thirty years with an emphasis on the development of further technology and better applications on the one hand, and on the other hand, a social approach focusing on understanding what decision making is about and how developers and users should interact. This research project considers a combined approach that endeavours to understand the thinking behind managers’ decision making, as well as their informational and decisional guidance and decision support requirements. This research utilises a cognitive framework, developed in 1985 by Humphreys and Berkeley that juxtaposes the mental processes and ideas of decision problem definition and problem solution that are developed in tandem through cognitive refinement of the problem, based on the analysis and judgement of the decision maker. The framework facilitates the separation of what is essentially a continuous process, into five distinct levels of abstraction of manager’s thinking, and suggests a structure for the underlying cognitive activities. Alter (2004) argues that decision support provides a richer basis than decision support systems, in both practice and research. The constituent literature on decision support, especially in regard to modern high profile systems, including Business Intelligence and Business analytics, can give the impression that all ‘smart’ organisations utilise decision support and data analytics capabilities for all of their key decision making activities. However this empirical investigation indicates a very different reality.

Mock-ups in design : the implications of utlizing [sic] a mock-up review process in professional practice

The purpose of this research is to examine the use of a mock-up review process in interior design projects to better understand the implications of using such a process within the standard professional practice model. The research consisted of interviewing design professionals who utilize mock-ups as part of their standard of practice. These interviews were centered around two groups - those working in shipbuilding, where mock-ups have a long history, and those working in land-based projects, where mock-up use is rare. Analysis of the interviews indicated a positive relationship between mock-up use and collaboration, innovation, and problem solving. The interviews also brought to light concerns on behalf of all the professionals surveyed about the current practice model in land-based building design and construction projects within the United States. The positive relationships shown in the thesis support further research to explore how mock-ups can be best utilized in interior design.

Measuring Scope of Practice Enactment among Primary Care Registered Nurses in Ontario

Background: Primary care is the sector of health care in which patients first establish contact with the health system, are provided person-focused care over time for all new or common needs, and receive coordinated integrated health services provided elsewhere by other members of the health care team. Registered Nurses (RNs) in Canada provide care within this sector in varying roles. The extent to which RNs enact their full scope of practice in primary care settings in Canada is not known. The Actual Scope of Practice questionnaire (ASCOP) is a 26 item Likert scale questionnaire developed by researchers in Canada and validated in the acute care setting to measure the extent to which RNs apply the knowledge, skills and competencies of the professional full scope of practice. Similar to the acute care setting, there is a need to measure scope of practice enactment in the primary care setting. Objectives: The overall aim of this thesis was to measure scope of practice enactment in the primary care setting. Two research objectives were addressed: (1) to revise and adapt the ASCOP questionnaire for use in the primary care setting, and (2) to determine internal consistency, construct validity, and sensitivity of the modified instrument, the ASCOP-PC. Methods: To address the first objective, a narrative literature review and synthesis and an expert panel review was conducted. To address the second objective a cross-sectional survey of 178 RNs working in primary care organizations in Ontario was conducted Results: The ASCOP, with few modifications, addressed key attributes of nursing scope of practice in the primary care setting. The ASCOP-PC yielded acceptable alpha coefficients ranging from 0.66 to 0.91 and explained variances from 44.2 to 62.6. Total mean score of 5.16 suggests that RNs within these models of care almost always engage in activities reflected in the ASCOP-PC. Interpretation: Findings from this study support the use of a the modified ASCOP questionnaire as a reliable and valid measure of scope of practice enactment among primary care nurses in the primary care setting.

Barriers to working with people affected by cancer: Preliminary qualitative data from a mixed methods exploration of practitioner perspectives in nutritional therapy

Introduction: Cancer is a leading cause of death worldwide. Nutrition may affect occurrence, recurrence and survival rates and many cancer patients and survivors seek individualized nutrition advice. Appropriately skilled nutritional therapy (NT) practitioners may be well-placed to safely provide this advice, but little is known of their perspectives on working with people affected by cancer. This mixed-methods study seeks to explore their views on training, barriers to practice, use of evidence, and other resources, to support the development of safe evidence-based practice. Preliminary data on barriers to practice are reported here. Methods: Two cohorts of NT practitioners were recruited from all UK registered NT practitioners, by an on-line anonymous survey. 84 cancer practitioners (CP) and 165 non-cancer practitioners (NCP) were recruited. Mixed quantitative and qualitative data was collected by the survey. Content analysis was used to analyze qualitative data on the use of evidence, barriers to practice and perceived needs for working with clients with cancer, for further exploration using interviews and focus groups. Preliminary results: For the NCP cohort, exploring themes of perceived barriers to working with people affected by cancer suggested that perceived complexity, risk and need for caution in this area of practice were important barriers. Insufficient specialist knowledge and skills also emerged as barriers. Some NCPs perceived opposition from medical practitioners and other mainstream healthcare professions as an obstacle to starting cancer practice. To overcome these barriers, specialist training emerged as most important. For the CP cohort, in exploring the skills they considered enabled them to undertake cancer work, specialist clinical and technical knowledge emerged strongly. Only 10% CP participants did not want more work with people affected by cancer. 10% CPs reported some NHS referrals, whereas most received clients by self-referral or from other practitioners. When considering barriers that impede their cancer practice, the dominant categories for CPs were hostility or opposition by mainstream oncology professionals, and lack of dialogue and engagement with them. To overcome these barriers, CPs desired engagement with oncology professionals and recognized specialist cancer NT training. For both NCPs and CPs, evidence resources, practice guidelines and practitioner support networks also emerged as potential enablers to cancer practice. Conclusions: This is the first detailed exploration of NT practitioners’ perceived barriers to working with people affected by cancer. Acquiring specialist skills and knowledge appears important to enable NCPs to start cancer work, and for CPs with these skills, the perceived barriers appear foremost in the relationship with mainstream cancer professionals. Further exploration of these themes, and other NT practitioner perspectives on working with people affected by cancer, is underway. This work will inform and support the development of professional practice, training and other resources.

Bootcamp EMMA MOOC Assessment for learning in practice

Formative assessment or assessment for learning is a relevant theme for teachers and educationalists. Formative assessment is a valuable tool for supporting the learning process. It is applied during learning and offers you more and better opportunities to guide your students. Formative assessment allows for more individual and/or personalised guidance. In this MOOC Assessment for learning in practice we will provide you with theory and guidelines for knowledge construction on the topic of formative assessment while offering support in designing assessments that can be applied as a tool for learning and training of competences. In this MOOC you can learn what formative assessment is, learn to differentiate between summative and formative assessment, and how formative assessment can contribute to the learning of your pupils or students. Design of rubrics, the role and functions of feedback, the use of technology for formative assessment are the topics of the MOOC.

Podcast: After the Liverpool Care Pathway clear guidance and support on end-of-life care is needed

In this podcast Roberta Heale talks to Dr Peter O'Halloran about the paper "After the Liverpool Care Pathway clear guidance and support on end-of-life care is needed." They discuss the newly implemented pathways and the effects these have on practice and patients.