Facilitating alumni support for a low-resourced high school using a participatory action research approach

South African public schools in disadvantaged areas are experiencing serious levels of under resourcing which negatively impact the educational experiences of learners. Attempts to lessen such negative impact include involving alumni who know the school‟s context, history and ethos. Unfortunately, the concept of alumni support in terms of mentoring and motivating learners is not the norm in many under resourced schools. This research focuses on fostering partnerships with alumni using participatory action research (PAR), because it is holistic, relationally driven and inclusive. Embedded in complexity theory that views the school community as a nonlinear system of different interacting parts functioning to improve the school context, the research follows actionreflection cycles of a group of ten past pupils and five educators from various backgrounds, levels of education and expertise collaborating with and mobilizing other alumni. Data were generated using drawings, photo voice and interviews. Thematic data analysis was used to build patterns and form categories. The following themes emerged namely, the importance of establishing a collective vision for sustained alumni engagement for alumni‟s personal and professional aspirations to serve the vision of the school, the importance of creating an alumni culture that reinforces the concept of „paying it forward‟. Lastly, establishing a sustainable alumni association through sustained actions and interactions and by creating an organisation of excellence The newly developed alumni structure as a „resource fountain‟ generating and cascading energy around the school emerged as an anchor for sustainability. The cascaded energy evolved into a structured „Alumni Week‟ providing ongoing motivation for current learners to sustain alumni engagement

A self-reflection of my interactions, communication and relationship structures in the classroom

Good communication and maintaining effective relationships within a school community are essential for achieving high academic standards. The aim of effective communication between teachers and learners is to elicit and ensure behaviour that will enhance the learning process. It is therefore important that teachers relate to learners in a sensitive manner when they communicate their knowledge (Bingham and Sidorkin 2004, 5). Sotto (2007, 96) further contends that teachers‟ communication styles reveal their core attitude towards learning and that the success of their teaching will be partially determined by how effectively they communicate. Many schools are experiencing disciplinary problems, low teacher and learner expectations, a breakdown of the social order, and a high incidence of academic failure. Bingham and Sidorkin (2004, 5) explain the above-mentioned problems as symptoms of a breakdown in communication between educators and learners. Once relationships in a school have been jeopardised, it becomes increasingly difficult to achieve high academic standards. It is therefore essential that educators create meaningful interactions in an environment in which all individuals can develop to their full potential. The National Education Policy Act No. 27 of 1996 (Education Labour Relations Council 2003, A- 4) advocates the enhancement of quality education and innovation through systematic research and development. The principles contained therein are directed towards enabling the education system to contribute to the full development of each learner, respecting each learner‟s right to freedom of thought, opinion and expression within a culture of respect for teaching and learning. The establishment and strengthening of relationships in a school will contribute to improved academic achievement

The early-stage comprehensive costs of routine PrEP implementation and scale-up in Zambia

Pre-exposure prophylaxis (PrEP) is an effective HIV prevention option, but cost-effectiveness is sensitive to implementation and program costs. Studies indicate that, in addition to direct delivery cost, PrEP provision requires substantial demand creation and client support to encourage PrEP initiation and persistence. We estimated the cost of providing PrEP in Zambia through different PrEP delivery models. Taking a guidelines-based approach for visits, labs and drugs, we estimated the annual cost of providing PrEP per client for five delivery models: one focused on key populations (men-who-have-sex-with-men (MSM) and female sex workers (FSW), one on adolescent girls and young women (AGYW), and three integrated programs (operated within HIV counselling and testing services at primary healthcare centres). Program start-up and support costs were based on program expenditure data and number of PrEP sites and clients in 2018. PrEP clinic visit costs were based on micro-costing at two PrEP delivery sites (2018 USD). Costs are presented in 2018 prices and inflated to 2021 prices. The annual cost/PrEP client varied by service delivery model, from $394 (AGYW) to$655 (integrated model). Cost differences were driven largely by client volume, which impacted the relative costs of program support and technical assistance assigned to each PrEP client. Direct service delivery costs ranged narrowly from $205-212/PrEP-client and were a key component in the cost of PrEP, representing 35–65% of total costs. The results show that, even when integrated into full service delivery models, accessing vulnerable, marginalised populations at substantial risk of HIV infection is likely to cost more than previously estimated due to the programmatic costs involved in community sensitization and client support. Improved data on individual client resource usage and outcomes is required to get a better understanding of the true resource utilization, expected outcomes and annual costs of different PrEP service delivery programs in Zambia

Identification of a BRCA2-Specific modifier locus at 6p24 related to breast cancer risk

Common genetic variants contribute to the observed variation in breast cancer risk for BRCA2 mutation carriers; those known to date have all been found through population-based genome-wide association studies (GWAS). To comprehensively identify breast cancer risk modifying loci for BRCA2 mutation carriers, we conducted a deep replication of an ongoing GWAS discovery study. Using the ranked P-values of the breast cancer associations with the imputed genotype of 1.4 M SNPs, 19,029 SNPs were selected and designed for inclusion on a custom Illumina array that included a total of 211,155 SNPs as part of a multi-consortial project. DNA samples from 3,881 breast cancer affected and 4,330 unaffected BRCA2 mutation carriers from 47 studies belonging to the Consortium of Investigators of Modifiers of BRCA1/2 were genotyped and available for analysis. We replicated previously reported breast cancer susceptibility alleles in these BRCA2 mutation carriers and for several regions (including FGFR2, MAP3K1, CDKN2A/B, and PTHLH) identified SNPs that have stronger evidence of association than those previously published. We also identified a novel susceptibility allele at 6p24 that was inversely associated with risk in BRCA2 mutation carriers (rs9348512; per allele HR = 0.85, 95% CI 0.80-0.90, P = 3.9×10−8). This SNP was not associated with breast cancer risk either in the general population or in BRCA1 mutation carriers. The locus lies within a region containing TFAP2A, which encodes a transcriptional activation protein that interacts with several tumor suppressor genes. This report identifies the first breast cancer risk locus specific to a BRCA2 mutation background. This comprehensive update of novel and previously reported breast cancer susceptibility loci contributes to the establishment of a panel of SNPs that modify breast cancer risk in BRCA2 mutation carriers. This panel may have clinical utility for women with BRCA2 mutations weighing options for medical prevention of breast cancer

An original phylogenetic approach identified mitochondrial haplogroup T1a1 as inversely associated with breast cancer risk in BRCA2 mutation carriers

Introduction: Individuals carrying pathogenic mutations in the BRCA1 and BRCA2 genes have a high lifetime risk of breast cancer. BRCA1 and BRCA2 are involved in DNA double-strand break repair, DNA alterations that can be caused by exposure to reactive oxygen species, a main source of which are mitochondria. Mitochondrial genome variations affect electron transport chain efficiency and reactive oxygen species production. Individuals with different mitochondrial haplogroups differ in their metabolism and sensitivity to oxidative stress. Variability in mitochondrial genetic background can alter reactive oxygen species production, leading to cancer risk. In the present study, we tested the hypothesis that mitochondrial haplogroups modify breast cancer risk in BRCA1/2 mutation carriers. Methods: We genotyped 22,214 (11,421 affected, 10,793 unaffected) mutation carriers belonging to the Consortium of Investigators of Modifiers of BRCA1/2 for 129 mitochondrial polymorphisms using the iCOGS array. Haplogroup inference and association detection were performed using a phylogenetic approach. ALTree was applied to explore the reference mitochondrial evolutionary tree and detect subclades enriched in affected or unaffected individuals. Results: We discovered that subclade T1a1 was depleted in affected BRCA2 mutation carriers compared with the rest of clade T (hazard ratio (HR) = 0.55; 95% confidence interval (CI), 0.34 to 0.88; P = 0.01). Compared with the most frequent haplogroup in the general population (that is, H and T clades), the T1a1 haplogroup has a HR of 0.62 (95% CI, 0.40 to 0.95; P = 0.03). We also identified three potential susceptibility loci, including G13708A/rs28359178, which has demonstrated an inverse association with familial breast cancer risk. Conclusions: This study illustrates how original approaches such as the phylogeny-based method we used can empower classical molecular epidemiological studies aimed at identifying association or risk modification effects.Peer reviewe

Genome-Wide Association Study in BRCA1 Mutation Carriers Identifies Novel Loci Associated with Breast and Ovarian Cancer Risk

BRCA1-associated breast and ovarian cancer risks can be modified by common genetic variants. To identify further cancer risk-modifying loci, we performed a multi-stage GWAS of 11,705 BRCA1 carriers (of whom 5,920 were diagnosed with breast and 1,839 were diagnosed with ovarian cancer), with a further replication in an additional sample of 2,646 BRCA1 carriers. We identified a novel breast cancer risk modifier locus at 1q32 for BRCA1 carriers (rs2290854, P = 2.7×10-8, HR = 1.14, 95% CI: 1.09-1.20). In addition, we identified two novel ovarian cancer risk modifier loci: 17q21.31 (rs17631303, P = 1.4×10-8, HR = 1.27, 95% CI: 1.17-1.38) and 4q32.3 (rs4691139, P = 3.4×10-8, HR = 1.20, 95% CI: 1.17-1.38). The 4q32.3 locus was not associated with ovarian cancer risk in the general population or BRCA2 carriers, suggesting a BRCA1-specific associat

A self-reflection of my interactions, communication and relationship structures in the classroom

Good communication and maintaining effective relationships within a school community are essential for achieving high academic standards. The aim of effective communication between teachers and learners is to elicit and ensure behaviour that will enhance the learning process. It is therefore important that teachers relate to learners in a sensitive manner when they communicate their knowledge (Bingham and Sidorkin 2004, 5). Sotto (2007, 96) further contends that teachers‟ communication styles reveal their core attitude towards learning and that the success of their teaching will be partially determined by how effectively they communicate. Many schools are experiencing disciplinary problems, low teacher and learner expectations, a breakdown of the social order, and a high incidence of academic failure. Bingham and Sidorkin (2004, 5) explain the above-mentioned problems as symptoms of a breakdown in communication between educators and learners. Once relationships in a school have been jeopardised, it becomes increasingly difficult to achieve high academic standards. It is therefore essential that educators create meaningful interactions in an environment in which all individuals can develop to their full potential. The National Education Policy Act No. 27 of 1996 (Education Labour Relations Council 2003, A- 4) advocates the enhancement of quality education and innovation through systematic research and development. The principles contained therein are directed towards enabling the education system to contribute to the full development of each learner, respecting each learner‟s right to freedom of thought, opinion and expression within a culture of respect for teaching and learning. The establishment and strengthening of relationships in a school will contribute to improved academic achievement

The early-stage comprehensive costs of routine PrEP implementation and scale-up in Zambia.

Pre-exposure prophylaxis (PrEP) is an effective HIV prevention option, but cost-effectiveness is sensitive to implementation and program costs. Studies indicate that, in addition to direct delivery cost, PrEP provision requires substantial demand creation and client support to encourage PrEP initiation and persistence. We estimated the cost of providing PrEP in Zambia through different PrEP delivery models. Taking a guidelines-based approach for visits, labs and drugs, we estimated the annual cost of providing PrEP per client for five delivery models: one focused on key populations (men-who-have-sex-with-men (MSM) and female sex workers (FSW), one on adolescent girls and young women (AGYW), and three integrated programs (operated within HIV counselling and testing services at primary healthcare centres). Program start-up and support costs were based on program expenditure data and number of PrEP sites and clients in 2018. PrEP clinic visit costs were based on micro-costing at two PrEP delivery sites (2018 USD). Costs are presented in 2018 prices and inflated to 2021 prices. The annual cost/PrEP client varied by service delivery model, from $394 (AGYW) to$655 (integrated model). Cost differences were driven largely by client volume, which impacted the relative costs of program support and technical assistance assigned to each PrEP client. Direct service delivery costs ranged narrowly from $205-212/PrEP-client and were a key component in the cost of PrEP, representing 35-65% of total costs. The results show that, even when integrated into full service delivery models, accessing vulnerable, marginalised populations at substantial risk of HIV infection is likely to cost more than previously estimated due to the programmatic costs involved in community sensitization and client support. Improved data on individual client resource usage and outcomes is required to get a better understanding of the true resource utilization, expected outcomes and annual costs of different PrEP service delivery programs in Zambia