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We conducted a prospective environmental surveillance study to investigate the air, surface, dust, and water contamination of a room occupied by a patient infected with mpox virus (MPXV) at various stages of the illness. The patient tested positive for MPXV from a throat swab and skin lesions. Environmental sampling was conducted in a negative pressure room with 12 unidirectional high efficiency particulate air filter (HEPA) air changes per hour and daily cleaning of the surfaces. A total of 179 environmental samples were collected on days 7, 8, 13, and 21 of illness. Among the days of sampling, air, surface, and dust contamination showed the highest contamination rates on day 7 and 8 of illness, with a gradual decline to the lowest contamination level by day 21. Viable MPXV was isolated from surfaces and dust samples and no viable virus was isolated from the air and water samples. Ministry of Health (MOH) National Environmental Agency (NEA) National Medical Research Council (NMRC) Published version This research is supported by the Singapore Ministry of Health’s (MOH) National Medical Research Council (NMRC) under its NMRC Collaborative Grant: Collaborative Solutions Targeting Antimicrobial Resistance Threats in Health Systems (CoSTAR-HS) (CG21APR2005), NMRC Clinician Scientist Award (MOH-000276), and NMRC Clinician Scientist Individual Research Grant (MOH-CIRG18Nov-0034). The study is also internally funded by the National Environment Agency.

Purpose This paper describes a case study of a developmental program evaluation on the Autism Community Toolkit, a collaborative skills training program for parents and school professionals. The purpose of this study was to examine the influence of the training on participants’ knowledge, competence and perceived collaboration; and potential improvements to the training program. Design/methodology/approach The program included multiple training sessions for families and school professionals, designed to educate participants on autism, evidence-based interventions and to increase home-school communication and collaboration. Data collection methods included pre- and post-measures and feedback forms. Findings Results indicated that the training program was beneficial for participants overall. Pre- and posttest measures indicated growth in knowledge and competency in autism interventions. While there were no statistically significant differences in the quantitative measure of collaboration, qualitative results suggest that participants reported increased collaboration posttraining. Practical implications Overall, the training program was effective, and the ongoing implementation assessment was conducive to continuous improvement. The authors also discuss difficulties with implementation and recommendations for future intervention implementation. Originality/value This case study provides practical information about creating, evaluating and improving a unique intervention designed to support school–home collaboration.

This chapter considers the works of poets Gavin Douglas, Alexander Barclay, Stephen Hawes, and Robert Copland, placing them in the context of the political, cultural, religious, and technological changes of the late fifteenth and early sixteenth centuries. It suggests that their works witness a variety of experiments with poetic form and voice in response to these changes. It argues that each engages with overlapping questions about how to formulate the position of the poet at court, the position of the poet in the text, and the potential of print to reshape the way the poet envisages both his work as writer and the physical manifestations of that work. It further demonstrates that their shared vernacular poetic heritage is central to their thinking about these questions.

We conducted a prospective environmental surveillance study to investigate the air, surface, dust and water contamination of a room occupied by a patient infected with Monkeypox virus (MPXV) at various stages of his illness. The patient tested positive for MPXV from a throat swab and skin lesions. Environmental sampling was conducted in a negative pressure room with 12 unidirectional HEPA air changes per hour and daily cleaning of the surfaces. A total of 179 environmental samples were collected on days 7, 8, 13, and 21 of his illness. Air, surface, and dust contamination was highest during the first eight days of the illness, with a gradual decline to the lowest contamination level by day 21. Viable MPXV was isolated from surfaces and dust samples and no viable virus was isolated from the air and water samples.SynopsisInadequate research prevail on the mode of transmission for monkeypox virus. This study reports the findings of viable monkeypox virus from the patient environment, highlighting its implications for human health and impact on infection and prevention control measures.

Collaboration between school staff, families, and community partners is vital for ensuring all students’ success, particularly those with disabilities. In this case study, we will discuss a community-university partnership involving a university school psychology graduate program, several local school districts, and a specialized medical facility for children with autism and related neurodevelopmental disorders. These partners came together to create the Families and Schools Partnership Program (FSPP). Facilitated by School Psychology faculty and graduate students, FSPP offers support to families and schools through a cohesive multidisciplinary approach to intervention. In this study, we examined the experiences of 700 families referred to the FSPP consultation team and evaluated the reasons for referral, levels of intervention required by each family, and case outcomes. As a result, we offer a series of steps and tips for developing collaborative interagency relationships, an outline of the consultation framework and processes developed, and lessons learned throughout implementation.

Effective collaboration is associated with positive outcomes for students and is a key component of equitable educational opportunities. There are challenges to effective collaboration, however, as our understanding of it differs based on the various definitions in the literature. The purpose of this systematic review is to identify the common constructs across definitions of collaboration as a means to develop a universal model that can be used in the schools. Through the development of a “building blocks” framework, we provide a common definition and identify the steps that must be taken before true collaboration can occur. This model highlights the iterative nature of the collaborative process and the importance of revisiting the foundational aspects of collaborative development. The systematic review focuses on using a common definition for research and the practice of collaboration.

John Skelton (c 1460-1529) has long been recognised as a poetic innovator, most notably for his invention of the verse-form that bears his name, the Skeltonic. Its origins have been traced to a wide variety of poetic genres and even prose forms; this chapter, however, argues that it also owes a great deal to Skelton’s own earlier writing in the well-established verse-form of rhyme royal. The chapter first traces connections between the ostentatiously experimental Skeltonic and Skelton’s less conspicuous experiments with sound pattern in rhyme royal; it then argues that formal experimentation shapes Skelton’s understanding of poetic authority as something derived from the poet’s own technical skill rather than from external sources.

Rodents living alongside humans increases the probability of encounter and also the transmission of rodent-borne diseases. Singapore’s cosmopolitan urban landscape provides a perfect setting to study the prevalence of four rodent-borne pathogens: Seoul hantavirus (SEOV), Leptospira species, Rickettsia typhi and Yersinia pestis, and identify the potential risk factors which may influence rodent density and transmission of rodent-borne diseases. A total of 1143 rodents were trapped from 10 unique landscape structures throughout Singapore. Real-time quantitative Polymerase Chain Reactions were used to detect pathogenic and intermediate Leptospira spp. and Yersinia pestis, whereas the seroprevalence of SEOV and R. typhi were analysed by Enzyme-Linked Immunosorbent Assay and Immunofluorescence Assay respectively. Multivariable logistic regression analysis was used to evaluate the association between prevalence of infection in rodent reservoirs and risk factors. Most of the rodents were caught in public residential developments (62.2%). Among the tested rodents, 42.4% were infected with Leptospira spp., while 35.5% and 32.2% were seropositive for SEOV and R. typhi respectively, whereas Yersinia pestis was not detected. Furthermore, risk factors including habitat, species, gender, and weight of rodents, influenced prevalence of infection to a varying extent. This study highlights the presence of Leptospira spp., SEOV and R. typhi in Singapore’s rodent population, suggesting the need for effective rodent management and sanitation strategies to prevent further circulation and transmission to humans.

Promoting health and preventing ill health are key standards of proficiency for pre-registration nursing education in the UK. The knowledge and skills required to fulfil this role is dependent on students developing a clear understanding of population health during their educational experience. The websites of the 60 undergraduate adult nursing programmes in England that lead to registration were explored, to see how the population health agenda is presented in the information for future candidates. It was found that only 26% of universities promote a population health agenda in the general description of the adult nursing programme, emphasising clinical skills teaching and partnerships with hospital trusts for placement provision. To embrace the breadth of 21st century nursing practice, universities should be marketing nursing proficiencies and raising awareness of the wider context in which care is delivered during recruitment. This approach to branding has the potential to challenge stereotypes and widen participation.

Science, technology, engineering, and math (STEM) related fields comprise the top 30 occupations expected to grow the fastest by 2026. This increase in job opportunities, coupled with the evolution of technology, is creating higher demands for diversity in the labor market. Currently all student require innovative training and support from a young age to pursue STEM careers successfully. However, women and girls with disabilities face unique barriers along the STEM education pipeline. In this paper, we report the current and projected labor market trends inthe United States. We then consider how this labor market information can be used by elementary educators to engage girls with disabilities in STEM-related learning effectively. Finally, through our analysis of labor market needs and the available assessment and intervention literature, we present a science-informed framework for intervention.

Objective The purpose of this study is to explore the self-care support provision for patients with type 2 diabetes by diabetes educators and to explore the challenges that they encountered in providing the intended services. Methods Single embedded qualitative case study design using in-depth individual face to face interviews were adopted. Twelve diabetes educators from three diabetes clinics in urban areas in Malaysia were purposively selected and interviewed within the period of eight months (November 2012–June 2013). The data were transcribed verbatim and analyzed using Framework technique. Result The practice of diabetes educators revolved around the traditional paternalistic approach but emphasize on individualized support. However, their practice was restricted by several factors, including patients’ acceptance and interest in self-care, lack of confidence and opportunity to practice, and fragmented health care system. Conclusion The current practice of diabetes educators is very limited to knowledge provision and rather a generalist. Considering a more specialized role would increase opportunities for diabetes educators to provide high-quality self-care support provision.

Japanese encephalitis virus (JEV) is an important arbovirus in Asia that can cause serious neurological disease. JEV is transmitted by mosquitoes in an enzootic cycle involving porcine and avian reservoirs, in which humans are accidental, dead-end hosts. JEV is currently not endemic in Singapore, after pig farming was abolished in 1992; the last known human case was reported in 2005. However, due to its location along the East-Asian Australasian Flyway (EAAF), Singapore is vulnerable to JEV re-introduction from the endemic regions. Serological and genetic evidence in the last decade suggests JEV’s presence in the local fauna. In the present study, we report the genetic characterization and the first isolation of JEV from 3214 mosquito pools consisting of 41,843 Culex mosquitoes, which were trapped from April 2014 to May 2021. The findings demonstrated the presence of genotype I of JEV (n = 10), in contrast to the previous reports of the presence of genotype II of JEV in Singapore. The genetic analyses also suggested that JEV has entered Singapore on several occasions and has potentially established an enzootic cycle in the local fauna. These observations have important implications in the risk assessment and the control of Japanese encephalitis in non-endemic countries, such as Singapore, that are at risk for JEV transmission.

Background There is increasing evidence that patients with incurable cancer approaching the end-of-life, their carers and clinicians want to know how much time is left to live. Prognostic models can help with planning for the end of life and sorting out affairs, but we know very little about the acceptability of the models to patients, carers and clinicians.Method Semi-structured interviews were conducted with a purposive sample of 29 patients, 20 carers and 32 clinicians who took part in a large validation study of prognostic models, to find out how acceptable they are. Interview data were entered into NVivo 10 and analysed using the five stages of Framework Analysis: (i) familiarisation, (ii) developing a thematic framework, (iii) indexing, (iv) charting, and (v) mapping and interpretation.Findings The use of prognostic models was acceptable to patients and carers, and largely acceptable to clinicians. There was marked discrepancy however between the wishes of patients and carers for prognostic discussions, and the willingness of clinicians to initiate and conduct these conversations. Clinicians’ reluctance was founded on the dual principles of working in patients’ best interests and doing no harm, but was at odds with what patients and carers actually wanted. Conclusion Prognostic models such as PiPS may be a useful adjunct to clinical decision making, but also a helpful tool for initiating difficult conversations at the end of life. In order to conduct these conversations skilfully, communication skills training tailored to end of life prognostic conversations is needed.

Background To effectively realise their role in health promotion nurses need a clear understanding of the social determinants of health. In 1987 the WHO recommended that students participate in meaningful community based problem-solving to prepare them for health promotion practice, including actual or simulated community health projects. Objective To explore the use of community problem-solving in undergraduate nurse education and its impact on students' understanding of population health. Method This literature review used a five-stage iterative method, to explore the following research question; how is community problem-solving being used in undergraduate nurse education and to what effect? Following a systematic database search (CINAHL, MEDLINE, ERIC and ProQuest BNI), forward citation and snowballing, 82 studies were screened against the inclusion and exclusion criteria. A critical appraisal of the studies was conducted using COREQ and data was extracted using a summary table. Thematic analysis was used to identify major themes from the literature. Results Ten studies were identified which explore the use of community problem-solving these provide some useful insight into the design, application and the apparent benefits of the approach in undergraduate nurse education. Three key themes emerge: students develop a broader vison of their future role in health promotion, a deeper understanding of community and social determinants, as well as identifying the role of community assets for health. Only one of the studies included in the review evaluated the impact of community problem-solving on health promotion practice after graduation. Conclusion The concept of CPS in undergraduate nurse education has been around for many years, but there has never been a comprehensive review of its implementation or effectiveness. Research into its impact is needed to examine whether it increases students' understanding of their future role in health promotion. If nurses are expected to play a key role in public health, nurse educators need research evidence to support the design and delivery of CPS to implement a population health approach to undergraduate nurse education.

ObjectivesTo investigate factors that promote and prevent the use of compression therapy in people with venous leg ulcers.DesignQualitative interview study with nurses using the Theoretical Domains Framework (TDF).SettingThree National Health Service Trusts in England.ParticipantsPurposive sample of 15 nurses delivering wound care.ResultsNurses described factors which made provision of compression therapy challenging. Organisational barriers (TDF domains environmental context and resources/knowledge, skills/behavioural regulation) included heavy/increasing caseloads; lack of knowledge/skills and the provision of training; and prescribing issues (variations in bandaging systems/whether nurses could prescribe). Absence of specialist leg ulcer services to refer patients into was perceived as a barrier to providing optimal care by some community-based nurses. Compression use was perceived to be facilitated by clinics for timely initial assessment; continuity of staff and good liaison between vascular/leg ulcer clinics and community teams; clear local policies and care pathways; and opportunities for training such as ‘shadowing’ in vascular/leg ulcer clinics. Patient engagement barriers (TDF domains goals/beliefs about consequences) focused on getting patients ‘on board’ with compression, and supporting them in using it. Clear explanations were seen as key in promoting compression use.ConclusionsRising workload pressures present significant challenges to enhancing leg ulcer services. There may be opportunities to develop facilitated approaches to enable community nursing teams to make changes to practice, enhancing quality of patient care. The majority of venous leg ulcers could be managed in the community without referral to specialist community services if issues relating to workloads/skills/training are addressed. Barriers to promoting compression use could also be targeted, for example, through the development of clear patient information leaflets. While the patient engagement barriers may be easier/quicker to address than organisational barriers, unless organisational barriers are addressed it seems unlikely that all people who would benefit from compression therapy will receive it.

Background: Workplace-based assessment (WBA), foundational to competency-based medical education, relies on preceptors providing feedback to residents. Preceptors however get little timely, formative, specific, actionable feedback on the effectiveness of that feedback. Our study aimed to identify useful qualities of feedback for family medicine residents and to inform improving feedback-giving skills for preceptors in PGME training program.Methods: This study employed a two-phase exploratory design. Phase 1 collected qualitative data from preceptor feedback given to residents through Field Notes (FNs) and quantitative data from residents who provided feedback to preceptor about the quality of the feedback given. Phase 2 employed focus groups to explore ways in which residents are willing to provide preceptors with constructive feedback about the quality of the feedback they receive. Descriptive statistics and a thematic approach were used for data analysis.Findings: We collected 22 FNs identified by residents as being impactful to their learning; analysis of these FNs resulted in five themes. Functionality was then added to the electronic FNs allowing residents to indicate impactful feedback with a “Thumbs Up” icon. Over one year, 895 out of 8,496 FNs (11%) had a “Thumbs up” added, divided into reasons of: confirmation of learning (28.6%), practice improvement (21.2%), new learning (18.8%), motivation (17.7%), and evoking reflection (13.7%). Two focus groups (12 residents, convenience sampling) explored residents’ perception of constructive feedback and willingness to also provide constructive feedback to preceptors.Conclusion: Adding constructive feedback to existing positive feedback choices will provide preceptors with holistic information about the impact of their feedback on learners, which, in turn, should allow them to provide more effective feedback to learners. However, power differential, relationship impact, and institutional support were concerns for residents that would need to be addressed for this to be optimally operationalized., Contexte : L’évaluation en milieu de travail (EMT), qui est à la base de la formation médicale fondée sur les compétences, repose sur la rétroaction donnée par les superviseurs aux résidents. En revanche, il est rare que les superviseurs reçoivent à leur tour, et en temps utile, une rétroaction formative, précise et pratique sur l’efficacité des commentaires qu’ils ont offerts. L’objectif de notre étude était de déceler les caractéristiques qu’un tel retour doit avoir pour être utile aux résidents en médecine familiale afin de guider l’amélioration des compétences en rétroaction des superviseurs de programmes d’éducation médicale postdoctorale.Méthodes : Nous avons utilisé un devis exploratoire en deux phases. Lors de la première phase, nous avons recueilli les données qualitatives à partir des commentaires fournis par les précepteurs aux résidents par le biais de feuilles de route (FR) et les données quantitatives de rétroactiondes résidents sur la qualité de la rétroaction qui leur a été offerte par les superviseurs. Dans la phase 2, des groupes de discussion ont été constitués pour explorer les moyens par lesquels les résidents sont prêts à fournir aux superviseurs une rétroaction constructive sur la qualité de la rétroaction qu’ils reçoivent. L’analyse des données a été faite à l’aide de statistiques descriptives et d’une approche thématique.Résultats : Les auteurs ont recueilli 22 feuilles de route (FR) qui, d’après les résidents, ont eu un effet sur leur apprentissage. L’analyse des FR a permis de relever cinq thèmes. Une fonctionnalité a par la suite été ajoutée aux FR électroniques, permettant aux résidents d’indiquer qu’une rétroaction a été efficace à l’aide d’un pictogramme « Pouce levé ». En un an, 895 des 8496 FR (11 %) ont reçu un « Pouce levé » et les raisons qui l’expliquent sont réparties de la manière suivante : la rétroaction confirmait au résident ses acquis (28,6 %), elle l’aidait à améliorer sa pratique (21,2 %), elle lui apprenait quelque chose de nouveau (18,8 %), elle stimulait sa motivation (17,7 %) ou encore sa réflexion (13,7 %). Deux groupes de discussion (12 résidents, échantillon de convenance) ont exploré ce que les résidents perçoivent comme étant une rétroaction constructive, et s’ils sont prêts à fournir à leur tour un commentaire constructif aux superviseurs.Conclusion : Le fait d’ajouter des commentaires constructifs aux commentaires positifs renseignerait les superviseurs de manière plus complète sur l’effet qu’a eu leur rétroaction pour les apprenants, et les aiderait ainsi à améliorer l’efficacité des rétroactions qu’ils donnent. Cependant, pour mettre en place ce processus de manière optimale, il faut tenir compte des préoccupations qu’ont les résidents quant au déséquilibre de pouvoir, aux répercussions sur leur relation avec le superviseur et à l’appui de l’établissement.

Some students with autism spectrum disorder and other learning differences may have superior visual acuity, increased attentional focus, and logical thinking abilities, lending to an affinity for science, technology, engineering, and mathematics (STEM) fields. At the same time, economists report that, the United States will experience a 28.2% increase in STEM-related jobs between 2014 and 2024. Although students with disabilities (SWD) can help to fill those positions, 85% of SWD graduates are either underemployed or unemployed as they enter young adulthood. Thus, there is a need to develop, evaluate, and report outcomes of STEM preparation programs specifically tailored to SWD. This mixed-methods study was designed to develop an evaluation procedure to measure a STEM school’s program for SWD and to analyze the first two years of data to help shape the evaluation process. A comprehensive evaluation model of STEM education for children with learning differences was developed and tested. Implications for practice and future research are discussed.

The reduction of school violence requires a coordinated effort that enhances school climate and improves the sense of safety on campus. This chapter addresses the related topics of school violence, school safety, and school climate; provides an overview of the interactions among these constructs; and illustrates how they are directly linked to student mental and emotional well-being. A multidisciplinary approach is described that addresses these constructs, which are grounded in a school safety model that provides a foundation to promote students’ mental health. The process for moving toward action includes selecting an appropriate model for organizing intervention efforts, building a multidisciplinary team, developing a plan for assessment, and creating a systematic process for intervention implementation. Finally, a case study is provided to illustrate how a school district can interpret and implement these key components in the real world.

BackgroundThe international literature has largely conceptualised transition to university as a process of adjustment to both the social and the academic demands of university life. Several factors influence this process including: student, parent and university staff expectations; student preparedness; and student belongingness. Moreover, some student groups (groups well-represented in nursing) appear to have particular difficulty in successfully transitioning to university life.Study AimsTo explore first year nursing students' experiences of the transition to university; to compare nursing students' experiences with those of other disciplines and identify ways of easing the transition for nursing students.MethodologyAs part of their coursework, first year nursing students at an English University submitted a 500-word, formative reflection on the transition to university. Anonymised reflections from 161 students were available to the researchers for thematic content analysis; 50 reflections, however, proved sufficient for ‘information power’.ResultsTwo main themes emerged from the data: (i) ‘managing expectations’, an overarching theme that permeated most of the reflections; and (ii) ‘practical tools and support aids’, the practical, concrete actions that either the university took, or the students developed themselves, to ease the transition. Both themes embraced inter-related academic, social and personal domains.ConclusionsNursing students' transition experiences are similar to those of other university students. However, the particular demographics of nursing student cohorts amplifies certain aspects of the transition experience: more students who are likely to struggle with transition but also more students who embrace the developmental aspects of going to university. Transition requires joint enterprise between students and university staff, especially in terms of expectations and the support required to become independent learners. Transitions can be eased by tapping into student resourcefulness and seeing transition as a gradual process that cuts across academic, social and personal dimensions rather than as a short, one-off event.

This research examined the risk and protective factors of responders and nonresponders to a schoolwide implementation of positive behavioral interventions and supports (SW-PBIS) within an alternati...

Wastewater-based surveillance has been widely used as a non-intrusive tool to monitor population-level transmission of COVID-19. Although various approaches are available to concentrate viruses from wastewater samples, scalable methods remain limited. Here, we sought to identify and evaluate SARS-CoV-2 virus concentration protocols for high-throughput wastewater testing. A total of twelve protocols for polyethylene glycol (PEG) precipitation and four protocols for ultrafiltration-based approaches were evaluated across two phases. The first phase entailed an initial evaluation using a small sample set, while the second phase further evaluated five protocols using wastewater samples of varying SARS-CoV-2 concentrations. Permutations in the pre-concentration, virus concentration and RNA extraction steps were evaluated. Among PEG-based methods, SARS-CoV-2 virus recovery was optimal with 1) the removal of debris prior to processing, 2) 2 h to 24 h incubation with 8% PEG at 4 °C, 3) 4000 xg or 14,000 xg centrifugation, and 4) a column-based RNA extraction method, yielding virus recovery of 42.4-52.5%. Similarly, the optimal protocol for ultrafiltration included 1) the removal of debris prior to processing, 2) ultrafiltration, and 3) a column-based RNA extraction method, yielding a recovery of 38.2%. This study also revealed that SARS-CoV-2 RNA recovery for samples with higher virus concentration were less sensitive to changes in the PEG method, but permutations in the PEG protocol could significantly impact virus yields when wastewater samples with lower SARS-CoV-2 RNA were used. Although both PEG precipitation and ultrafiltration methods resulted in similar SARS-CoV-2 RNA recoveries, the former method is more cost-effective while the latter method provided operational efficiency as it required a shorter turn-around-time (PEG precipitation, 9-23 h; Ultrafiltration, 5 h). The decision on which method to adopt will thus depend on the use-case for wastewater testing, and the need for cost-effectiveness, sensitivity, operational feasibility and scalability. Published version

Vector control remains an important strategy in preventing rodent-borne diseases. Studies quantifying the impact of anticoagulant bait use on rodent populations are scarce in tropical settings. This study examined the impact of anticoagulant bait use on three measures of rodent activity in Singapore to inform rodent-borne disease control strategies. Using a controlled interrupted time-series analytical design with negative binomial and linear regression models, the average rodent activity levels were compared in the pre- and post-intervention periods. There was a 62.7% (Incidence Rate Ratio (IRR): 0.373, 95% CI: [0.224, 0.620]) reduction in the number of rodents caught, a 25.8-unit (coefficient = -25.829, 95% CI: [-29.855, -21.804]) reduction in the number of 30 g/unit baits consumed and a 61.9% (IRR: 0.381, 95% CI: [0.218, 0.665]) reduction in the number of marred bait stations relative to the pre-intervention period. There was a rise in all three outcome measures within four months after the post-intervention period. This study provided strong evidence that anticoagulant baits substantially reduces rodent activity. The population resurgence after the post-intervention period reinforces the importance of timing the resumption of control measures aimed at reducing rodent-borne disease transmission.

Aims and objectives: To explore self‐care and self‐care support in patients with Type 2 diabetes in urban Malaysia. Background: The prevalence of Type 2 diabetes in Malaysia and associated long‐term and life‐changing complications is increasing. With effective self‐care and self‐care support, severe complications of the condition can be avoided or reduced. Prior to this study, no evidence existed about Malaysian patients’ management of the condition or support for self‐care from the healthcare system. Design: A single embedded qualitative case study. Methods: Semistructured interviews with 18 patients with Type 2 diabetes aged 28–69 years, healthcare professionals (n = 19), observations (n = 13) of clinic appointments from two urban settings in Malaysia and a documentary analysis. Recordings were transcribed verbatim, field notes were made during observations and the data analysed and synthesised within and across case using Framework analysis. Findings: Three main themes explained self‐care and self‐care support in Malaysia: fatalism, faith and fear. Patients were fatalistic about developing diabetes—they perceived it as inevitable because it is so common in Malaysia. However, faith in God, coupled with fear of the consequences of diabetes, motivated them to engage in self‐care practices. The fear was largely induced by diabetes healthcare professionals working in overcrowded clinics, and stretched thinly across the service, who used a direct and uncompromising approach to instil the importance of self‐care to avoid severe long‐term complications. Conclusion: This study provided important insight on how people in Malaysia developed diabetes, their responses to the disease and the approach of healthcare professionals in supporting them to engage with self‐care. Relevance to clinical practice: Any future development of self‐care programmes in Malaysia needs to recognise the factors that motivate patients to self‐care and include components that build self‐efficacy.

Patients on district nursing caseloads have multiple physical morbidities, and related emotional concerns. District nurses are ideally placed to assess and meet patients' emotional needs but in increasingly stretched workplaces, it is difficult to find time. There is also evidence that district nurses sometimes believe they lack skills to address patients' concerns. Traditional communication skills training is useful for encouraging patients to open up about their concerns, but less helpful at finding workable solutions. District nurses can be afraid to open a ‘can of worms' of concerns that they are unable to deal with. SAGE and THYME is a person-centred, evidence-based communication skills model that addresses district nurses' concerns about time and skills. It provides a structure for conversations about concerns, and empowers patients to work with district nurses to find solutions. Research suggests that it is a promising model for district nursing practice.

The present paper presents constructions of gender roles among Taiwanese sexual minority women with different gender identities (i.e., butch and femme, known as T and Po, respectively, in Taiwan) and associations between their views toward their own breasts and breast healthcare intentions and behaviour. A total of 37 face-to-face interviews were conducted among women aged 20 years or older who self-identified as lesbians or women who partnered with other women in four areas of Taiwan between August 2012 and October 2012. The majority of the T -identity lesbians held negative views toward their own breasts. The T-identified lesbians' negative intentions toward breast cancer screenings were associated with their negative views toward their own breasts and body construction process. All Po-identified lesbians reported positive views toward their own breasts; these views facilitated positive breast healthcare intentions and behaviour. The study findings can be used to help healthcare providersin understanding the importance of providing competent cultural care to sexual minority women and to help policymakers in formulating suitable policy to meet women's healthcare needs.

Background: Majority of the progress and development in palliative care in the last decade has been improvements in physical aspects of treatment, namely pain and symptom management. Psychosocial aspects of care have improved, although not enough to meet the needs of many patients and family members. This is evident in many parts of the world and notably in Singapore, where palliative care is seen as an emerging medical and nursing specialty. Aim: To discuss the implementation of the SAGE and THYME communication model in a palliative care context. The article examines the use of the model and how its implementation can improve communication between patients and nurses. The model works by reviewing contemporary developments made in relation to improving communication in palliative care. These include, highlighting the importance of meeting individual needs, therapeutic relationship building, and advanced communication training within a Singaporean context. Results: The implementation of the SAGE and THYME model can be a useful way of enabling nurses to improve and maintain effective communication in a medically dominated health care system. The challenges and constraints in educating and training nurses with limited skills in palliative care, forms part of the review, including the cultural and attitude constraints specific to Singaporean palliative care.

This chapter centres on the New England beach house in Elizabeth Bishop’s poem ‘The End of March’. It argues that her contradictory descriptions of this house are intimately connected with the poet’s mental processes. Drawing both on classical and medieval memory arts, and on the consonances between Bishop’s work and the shadow-boxes constructed by the artist Joseph Cornell, it posits that Bishop’s dream-house does not just enable the creative process, but is coterminous with it.

Autism Spectrum Disorders are a class of neurodevelopmental disorders which usually present with difficulties in social interactions, verbal and nonverbal forms of communication, repetitive behaviors, and restricted interests. While there are several guides that describe the Americans with Disabilities Act requirements for employers looking to hire those with disabilities, the academic literature describing actual current employer programming to support employees with disabilities is scarce. This study utilizes unsupervised machine learning to explore the policies and practices of 285 employers with regard to autism spectrum disorders, with the ultimate goal of understanding shortcomings in employment practices that can be improved through a combination of educational programs and changes to corporate culture.

This chapter presents the individual, organizational, and societal issues surrounding autism in the workplace. The term Generation A is introduced to refer to the 1.5 million individuals with autism spectrum disorder (ASD) who will reach adulthood in the next decade. Studies of young adults with ASD have found that they have much higher rates of unemployment than the general population. Young adults with ASD may face many challenges as they enter the workplace, and potentially throughout their lives as their careers unfold. It is important to focus on employment for these individuals as it has the potential to result in more positive life outcomes for individuals with ASD, their families, and caregivers. Little is known about the employment and career outcomes that these individuals will experience. The issues associated with autism in the workplace underscore the importance of this topic for both academics and practitioners.

The integration of individuals with ASD into the workplace offers numerous benefits to individuals with autism, their families and caregivers, the organizations that employ them, and society as a whole. This chapter examines these benefits at the individual, organizational, and societal levels. While research on this topic is in the early stage, preliminary results suggest that a wide spectrum of benefits are incurred when Generation A is included in the workforce.

Employers globally are struggling to find skilled workers and to fill the skills gap. Many individuals with ASD possess or can develop the skills needed to meet the labor market demands of employers. This chapter focuses on the need to obtain and utilize labor market data to enhance outcomes for individuals with ASD. Part of this process includes identifying labor market gaps and matching them to the specific skills of individuals with ASD. Information about how labor market data may be used to enhance employment outcomes is discussed. Labor market data for the United States and a sample state and county are presented. A localized labor market report explicitly based on the skills often associated with individuals with ASD is shared. A system-wide approach for improving the workforce pipeline is detailed.

This chapter introduces a diversity and inclusion model for organizations that wish to hire individuals with autism and provide them with positive work and career outcomes. While inclusive environments have been achieved in educational, religious, and community settings for neurodiverse individuals, there is still much work to be done to create diverse and inclusive organizations and workplaces. This chapter presents a seven-step model for organizations to develop inclusive programs to hire individuals with ASD. Diversity and inclusion programs have the potential to be of a great value to organizations and employees with autism. Additionally, successful programs may help to mitigate the stigma associated with ASD.

Labor market data indicate that there is a need for skilled employees in several areas. Given the right supports, individuals with autism spectrum disorder (ASD) can help to fill these positions. This chapter outlines the importance of understanding and integrating the employers’ perspective when improving employment outcomes for individuals’ with ASD. Potential barriers and facilitators to hiring individuals with disabilities are highlighted in this chapter. Current employment practices are presented, as well as employers’ perspectives on hiring individuals with ASD. A summary of employers’ training and support needs in order to successfully improve their employment practices and increase the employment rate of individuals with ASD is presented.