Coming theses from other universities
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FROM CHALLENGES TO STRENGTH : EXPLORING RESILIENCE DEVELOPMENT IN THAI NURSING STUDENTS DURING CLINICAL EDUCATION
Link: http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-68781
This series of studies examined resilience among nursing students in the context of clinical education in Thailand. Using both quantitative and qualitative methods, this study explored factors associated with resilience, experiences of challenges and support, and strategies for promoting resilience from the perspectives of both nursing students and instructors.
To examine empirical research on resilience among nursing students in the context of nursing education, an integrative review in which the existing literature on nursing student resilience was synthesized in Study I. Key themes around the conceptualization of resilience, factors affecting resilience, and its mediating role in student well-being were identified. To investigate the relationship between nursing students’ resilience and relevant variables in the context of clinical education, a cross-sectional study of 319 Thai nursing students was conducted in Study II. The results indicated that social support, self-directed learning, and perceived stress were significantly associated with resilience levels during clinical education.
Moreover, to describe nursing students’ experiences regarding challenges and support for resilience within the context of clinical education, in-depth interviews with 28 nursing students were conducted in Study III. The results revealed two main themes regarding nursing students’ experiences of resilience during clinical practice: “experiences of vulnerability” and “experiences of meaningfulness.” The students described challenges in navigating uncertainty, transcending professional struggles, and adapting to diverse clinical encounters. However, they also found meaning through social connections and engaging in positive transformation as key support strategies.
To explore nursing instructors’ experiences with challenges and support strategies to promote resilience among nursing students during clinical education, focus group interviews with 27 nursing instructors were conducted in Study IV. The results highlighted themes around challenges and support strategies for fostering student resilience. The instructors emphasized difficulties in bridging theory and practice, building clinical confidence, adapting to new environments, and managing expectations. They described strategies such as providing thorough preparation, facilitating peer support, and utilizing reflective activities to enhance resilience.
Across the studies, resilience emerged as a crucial quality for nursing students to develop during clinical education. It was conceptualized as a dynamic process influenced by personal attributes, social support, and environmental factors. The research highlighted the complex interplay between challenges that test resilience and strategies that can strengthen it. The findings align with the Unitary Caring Science Resilience Model, which emphasizes caring relationships, holistic well-being, and reflective practice.
Recommendations include integrating resilience building into nursing curricula, implementing comprehensive student support systems, enhancing instructor training, and further research on targeted interventions. These studies underscore the need for a holistic approach to nursing education that fosters clinical competence and resilience. Nursing instructors can better prepare students to thrive amid the complexities of healthcare environments by addressing challenges and leveraging the support strategies identified.
This study contributes fundamental insight into promoting resilience among nursing students in Thailand, with implications for nursing education globally. Further studies could explore cultural factors, evaluate specific interventions, and examine the long-term effects on nursing careers and patient care.
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Oral Multidrug Amorphous Formulations : Impact of Solution Components on Drug Supersaturation, Solution Chemistry, and Thermodynamic Activity
Link: http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-539689
Combination drug therapy offers substantial clinical benefits by enhancing treatment efficacy and improving patient compliance. However, it presents complex challenges from a dosage form development perspective, particularly for drugs with low water solubility. To enhance solubility and bioavailability, amorphous formulations are an attractive formulation strategy. This thesis aimed to optimize and implement a rational design approach for amorphous multidrug formulations with a robust and predictable performance after oral administration. This was achieved by investigating the influence of drugs, formulation excipients, and biorelevant intestinal media on solution chemistry, colloidal precipitate stability, and membrane transport of drug combinations.
Dissolution, solubility, and supersaturation of drug combinations were investigated in buffer and fasted state simulated intestinal fluids (FaSSIF). The solution behavior of the drugs was the same for structurally related compounds, highlighting the impact of their molecular properties and chemical diversity on the solubility profiles. A reduction in the maximum achievable concentration of drugs in combination was observed in buffer and FaSSIF, but the extent of reduction in FaSSIF was affected by the degree of solubilization by media components. Membrane transport studies demonstrated that drug transport across membranes is dominated by the degree of supersaturation, rather than solubilization. The colloidal particles formed as a result of liquid-liquid phase separation underwent uncontrolled coarsening. Polymers, in comparison to surfactants and small molecules, were more effective in controlling the particle size of this colloidal phase.
The mechanistic studies on multidrug combinations led to the development of a novel approach for preparing amorphous formulations using spray drying. The developed formulation successfully maintained drug supersaturation and ensured controlled colloidal particle size upon dissolution.
The undertaken scientific efforts contribute to the knowledge in the evolving field of amorphous multidrug formulations. These findings highlight the potential of particle engineering, where a mechanistically informed selection of excipients is combined with an appropriate spray drying process, to achieve stable amorphous multidrug formulations—critical for ensuring robust drug performance and enabling intestinal absorption.
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Environmental effects on the acid tolerance of oral biofilms
Link: http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-71794
This thesis investigates the acid tolerance (AT) of oral biofilms and how this property is affected by changes in the local environment, to further understand the phenotypical modifications of the bacterial communities that occur during caries development.
Paper I explored the effect of biofilm growth and presence of salivary proteins on the AT of five oral species, as well as their ability to induce an acid tolerance response (ATR). The results show that surface contact, presence of salivary proteins and sensing of environmental pH can contribute to high levels of AT.
In paper II, the AT, metabolic profile and microbial composition of plaque samples from children with oral health and children with severe caries were compared. Differences between the two groups were observed in organic acid production and species composition of the plaque samples, and significantly higher levels of AT was observed in plaque collected from caries active children.
In paper III, the effect of probiotic strains on the ATR of four oral species when grown in dual-species biofilms was investigated. The results showed that the presence of the probiotic strain L. reuteri PTA5289 was able to inhibit the ATR of oral species and led to a down-regulation of three key genes involved in acid stress tolerance.
The results of this thesis suggest that many species of the oral biofilm can obtain high levels of acid tolerance and that signals in the extracellular environment contribute to an increase and decrease of this property. Biofilm AT might therefore be a future focus in the development of new predictive biomarkers and therapeutic interventions for dental caries.