Longitudinal and cross-sectional modelling of health related quality of life in people with cystic fibrosis

People with cystic fibrosis (CF) must endure up to four hours treatment per day to maintain health and are vulnerable to complications. The Cystic Fibrosis Quality of Life Questionnaire was developed to measure health related quality of life (HRQoL) in the UK. Most studies on HRQoL are cross-sectional in design with HRQoL measured once per patient. However, the Cystic Fibrosis Quality of Life Questionnaire has been used to monitor HRQoL longitudinally with measures taken over a 12 year period at one clinic in the UK. These data were modelled with a binomial distribution for a domain score and with fixed and random coefficients for the patient-level clinical and demographic variables. The longitudinal study included 182 patients whose HRQoL was first measured within a single calendar year and were then followed-up. These data provided an opportunity to compare, directly and by simulation, the modelling of a cross-sectional with the modelling of a longitudinal study and so provided insights into the statistical merits of longitudinal studies compared to cross-sectional studies in HRQoL

Linking a Pharmaceutical Chemistry Workshop to Pharmacy Practice

This paper describes the design and implementation of a workshop to enhance pharmacy students’ appreciation of the importance of chemistry for pharmacy practice. The workshop was designed to form part of the practical work of two modules taught in the second year of the MPharm degree. In this mandatory workshop, second year pharmacy students were required to spot in the dispensary drugs based on their chemical properties like chirality, their origin and chemical structure. The lecturers involved in the workshop showed examples of the application of chemistry in the day to day work of the dispensary (e.g. calculating the dose for a patient in millimoles or how small modifications from a natural product can change its ability to cross the blood-brain-barrier). Feedback from participating students was collected via two survey instruments to examine the impact of the intervention. The survey results showed a clear shift towards a more positive perception by students of the chemistry taught in the MPharm curriculum

An exploration of sensitive issues in history teaching at secondary school level in England and Northern Ireland, 1991-2001

My thesis explores the teaching of sensitive issues in history at secondary school level in\ud Mid-Ulster in Northern Ireland and Oxford in England between 1991 and 2001. The\ud research is intended to compare the responses of teachers and students, over time and\ud place, to emotionally-charged topics. Questions are asked about the nature of sensitivity\ud and the impact of factors external to the classroom on inter-personal relations during\ud history lessons. Consideration is given to the possible connections between political\ud change and increased sensitivity in the classroom. The teachers' and students'\ud preconceptions, their opinion of the role of history and the stated teaching strategies are\ud compared. There is a literature review of the theory and purpose of history teaching as\ud well as on curriculum development and related disciplines. Although the conceptual\ud framework is primarily anchored in the study of history, it draws on insights from a range\ud of other subject areas. The dominant stance taken is that of a reflective history teacher:\ud questions asked and interpretations of evidence are overtly guided by personal\ud experience. Data is also drawn from a wide range of documents, surveys and semistructured\ud interviews. This combination of teacher self—reflection, archival material and\ud empirical fieldwork, while essentially qualitative, is also underpinned by quantitative\ud analysis of questionnaires distributed to students in both Northern Ireland and Oxford in\ud the years 1991, 1996 and 2001. The findings indicate the following: the importance of\ud formal history lessons; a growing awareness of sensitive issues in the classroom; an\ud apparent discrepancy between some of the teachers' and students' views; and the way\ud regional variations are becoming less marked over time

Enhancing critical thinking through simulation

Purpose: To adopt an evidence-based approach to evaluation of learning experiences reliant on simulated clinical practices in an under-graduate nursing program and to determine whether the learning events are structured in ways that elicit and make explicit critical thinking and other behaviours related to intended learning outcomes. Methods: i) An iterative critical evaluation of pedagogy, philosophy and learning events involving simulations to determine the worth of assessment tasks and their alignment to evidence from the literature and the learning outcomes specified in the chosen curriculum blueprint; ii) Literature Review Results: Appraisal of curriculum leaning goals and outcomes and evidence of outcomes in assessment tasks supported the choice of curriculum model: The capacity for integrating the elements of PBL, critical thinking and medium to high fidelity simulation was demonstrated. Careful construction of simulated learning events address the limitations of clinical placement because it facilitates the development and refinement of clinical judgment acumen. Renewal of a model highlighted the need for staff development in order to support the integration of learning outcomes, encourage development of contemporary stimulus material and enhance opportunities for assessment of critical thinking. Conclusion: The authors propose further curriculum renewal and adoption of an amended curriculum model that facilitates an integrated approach elevating critical thinking that is integral to addressing learning outcomes that mirror behaviours relevant to real-life practice. <br/> Changing contexts of education and practice in health professional programs require further exploration of the potential of simulation to provide alternative and complementary learning to that acquired through clinical placements

Field testing of different chemical combinations as odour baits for trapping wild mosquitoes in The Gambia.

Odour baited traps have potential use in population surveillance of insect vectors of disease, and in some cases for vector population reduction. Established attractants for human host-seeking mosquitoes include a combination of CO(2) with L-lactic acid and ammonia, on top of which additional candidate compounds are being tested. In this field study in rural Gambia, using Latin square experiments with thorough randomization and replication, we tested nine different leading candidate combinations of chemical odorants for attractiveness to wild mosquitoes including anthropophilic malaria vectors, using modified Mosquito Magnet-X (MM-X) counterflow traps outside experimental huts containing male human sleepers. Highest catches of female mosquitoes, particularly of An. gambiae s.l. and Mansonia species, were obtained by incorporation of tetradecanoic acid. As additional carboxylic acids did not increase the trap catches further, this 'reference blend' (tetradecanoic acid with L-lactic acid, ammonia and CO(2)) was used in subsequent experiments. MM-X traps with this blend caught similar numbers of An. gambiae s.l. and slightly more Mansonia and Culex mosquitoes than a standard CDC light trap, and these numbers were not significantly affected by the presence or absence of human sleepers in the huts. Experiments with CO(2) produced from overnight yeast cultures showed that this organic source was effective in enabling trap attractiveness for all mosquito species, although at a slightly lower efficiency than obtained with use of CO(2) gas cylinders. Although further studies are needed to discover additional chemicals that increase attractiveness, as well as to optimise trap design and CO(2) source for broader practical use, the odour-baited traps described here are safe and effective for sampling host-seeking mosquitoes outdoors and can be incorporated into studies of malaria vector ecology

Dry season ecology of Anopheles gambiae complex mosquitoes in The Gambia

BACKGROUND: Malaria in The Gambia is highly seasonal, with transmission occurring as Anopheles gambiae s.l. populations expand during and immediately after a single annual rainy season that lasts from June to October. There has been very limited investigation of the ecology of vectors during the dry season, when numbers are very limited and distributions may be restricted. METHODS: Weekly adult mosquito collections (pyrethrum spray, light trap, and search collections from rooms, as well as light trap collections from animal shelters, abandoned wells and grain stores), and artificial sentinel breeding site surveys were performed in four villages near the upper tidal and partially saline part of the Gambia River in the last four months of an annual dry season (March to June). Mosquito species were identified by morphological and DNA analysis, and ELISA assays were performed to test for Plasmodium falciparum sporozoites and human blood meal components. RESULTS: Adults of An. gambiae s.l. were collected throughout the period, numbers increasing towards the end of the dry season when humidity was increasing. Adult collections were dominated by An. melas (86%), with An. gambiae s.s. (10%) and An. arabiensis (3%) also present throughout. Most females collected in room search and spray collections contained blood meals, but most from light traps were unfed. None of the females tested (n = 1709) contained sporozoites. Larvae (mostly An. gambiae s.s.) were recovered from artificial sentinel breeding sites in the two villages that had freshwater pools. These two villages had the highest proportions of An. gambiae s.s. adults, and experienced the most substantial increase in proportions of An. gambiae s.s. after the onset of rains. CONCLUSION: During the dry season population minimum, An. melas was the predominant vector species, but differences among villages in availability of fresh-water breeding sites correlate with egg laying activity and relative numbers of An. gambiae s.s. adults, and with the increase in this species immediately after the beginning of the rains. Local variation in dry season vector persistence is thus likely to influence spatial heterogeneity of transmission intensity in the early part of the rainy season