Assessing the implementation of e-learning in primary schools : a case study of Harare Metropolitan Province

The role of technology has become one of the most important issues in 21st century education. Electronic learning has revolutionised the way teaching and learning takes place at almost all levels of the education. The global corona virus disease 2019 (COVID-19) pandemic has challenged both learners and educators to rapidly transform and adopt modern, non-contact ways of education delivery, to fully exploit the potential affordances technology offers, e-learning has emerged as a core of this revolution. While e-learning is not a completely new phenomenon, with already generous coverage of its implementation particularly in high school and tertiary levels of education, the dearth of literature and studies on the adoption and implementation of e-learning in primary schools is conspicuous. This is particularly so in less resourced, developing countries like Zimbabwe. This is despite considerable effort being made towards the adoption and implementation of e-learning. This study is an assessment of the implementation of e-learning in primary schools in Zimbabwe. Adopting a descriptive qualitative case study design, its focus was on schools in the Harare Metropolitan. Three schools were purposively selected to participate in the study, from which a sample of nine teachers and three school heads were selected. Data was collected through interviews, observations, and a review of documents. For analysis, data were examined and categorised, and recurring themes that emerged from the transcripts were identified. Findings revealed a lack of guidance on the specific models to follow for e-learning implementation; the need for continuing professional development of teachers and school leaders on the use of educational technology, as well as the need for resources to support the implementation of e-learning in schools. The role of a supportive and visionary school leadership is proposed as a key factor for success, coupled with availability of technical expertise and ICT coordinating structures in schools.Educational StudiesD. Phil. (Education

Methods and feasibility of conducting pragmatic clinical trials in small animal first opinion practice.

Chronic kidney disease (CKD) is an important cause of morbidity and mortality in cats, for which many research uncertainties remain unanswered. As for much of veterinary healthcare, the evidence base for treatment decision-making is limited. For the small number of research questions where randomised controlled trials (RCTs) are published, sample sizes are small, and the external validity of results can be limited because the patients included are not representative of the wider population who may have comorbidities. In addition, existing published research evidence does not always address outcomes of importance to treatment decision makers. Pragmatic trials are a very new concept in veterinary healthcare where a literature search found only one pragmatic trial had been designed and carried out in full. However, they are well established in human healthcare. They are a sensible solution to many of the problems with the veterinary healthcare evidence base for several reasons. They address questions which are important to stakeholders and address outcomes of important to decision makers. They are designed to take place where everyday care happens and have less strict eligibility criteria than traditional RCTs, resulting in the inclusion of more diverse patient populations who represent the patients for whom the research will be used. The results are designed to be useful in everyday clinical decision making, in everyday clinical practice. They test real- world treatments and use flexible protocols, being designed to represent normal practice as far as possible. Their results are more widely generalisable than traditional RCTs and they are less expensive to carry out. The aims of this PhD work were to investigate the existing published measures of treatment success in trials for cats with CKD and from there to establish the most important and most appropriate outcomes to use. This list would be designed to provide recommendations for future pragmatic treatment effectiveness trials of which treatment outcomes to assess and prioritise. In addition, this work aimed to establish the feasibility of extracting and using electronic patient records (EPRs) from first opinion veterinary practice, as a data source for clinical trials for these patients. This data source was chosen because EPR use in pragmatic trials is well established in human pragmatic trials, and because the EPR is the location where the presenting signs, diagnosis, treatment and management and outcomes of large numbers of ordinary cats with CKD is already recorded and held. A systematic review of outcomes assessed in published CKD treatment trials was carried out. This found a broad spectrum of outcomes that were assessed in the published literature. No core set of outcomes (COS) recommended for assessment in CKD treatment trials was found and little consistency was identified in the outcomes that were assessed between publications. To address this problem, research was conducted generating a COS for feline CKD. The panel of stakeholders involved in this process included an international panel of cat owners, clinical representatives, regulatory agencies and journal editors. A proposed list of important outcomes for a future COS was brought together via a three round eDelphi and an in-person consensus meeting. The final list created contained 29 core outcomes, grouped into four key areas: the veterinary consultation, blood and urine testing, living with CKD and CKD progression. Further refinement of this COS before it is finalised for inclusion in clinical trials is recommended, to streamline the outcomes into domains, potentially reduce by consensus the size of the final COS and agree by consensus the instruments to assess each domain. One key outcome identified by the COS generation process and known to be of importance to decision makers for cats with CKD was quality of life (QoL). A systematic review of the published literature was conducted to identify all tools used for assessing feline QoL, and the range and quality of tools available. Many of the studies found that discussed QoL either did not assess QoL at all, or assessed QoL with only unvalidated, oversimplified tools. Few publications were found that assessed quality of life in a structured way and few used validated tools to assess QoL, although a validated tool for assessing QoL for cats with CKD was found. Once the full COS for cats with CKD was established, work was conducted to examine whether some of the outcomes highlighted could be measured using data collected in practice management software systems in veterinary practices as part of routine veterinary healthcare. Data transfer from the databases of veterinary practices to those of laboratories, insurers and microchip registration companies is already well established, using XML schema. XML schemas describe the structure and content of the required data extract and present the data in a format which can be easily read by humans or computers. An XML schema was already published for the transfer of data pertaining to clinical research, ‘Clinical Evidence Schema v1.0.5’. To accommodate data from multiple PMS and multiple veterinary practices this schema was adapted, restructured and some new data fields were added. A six-month data batch in XML format was extracted by a PMS, in accordance with the data specifications of the new schema, from 282 veterinary practices. Additional data was also provided by the PMS as Excel files. The whole data batch was deidentified using bespoke script in Microsoft Visual Basic. It was then cleaned and uploaded into a bespoke database written in MySQL. This destination database was then examined and explored using scripts written in data manipulation language and run on the dataset via the SQL Command Prompt. The usefulness of the extracted patient data for possible treatment trials for cats with CKD was then established. Cats with CKD were identified using MySQL scripts, generating a disease prevalence of 2.8%. Validation showed this method to have 83.3% sensitivity, 99.5% specificity and a 40% false positive rate. A couple of relevant outcomes from the COS were extracted for feline CKD patients including blood pressure, bodyweight and survival time. CKD treatment interventions e.g. intravenous fluid therapy, or named therapeutics could be successfully identified within patient records and the longevity of these patients followed over time. In conclusion, EPRs are used within human healthcare for pragmatic trials, however, very few pragmatic trials exist for veterinary healthcare. This PhD thesis has demonstrated that veterinary EPRs are a valuable and feasible data source for research. Pragmatic style trials are likely to address many of the evidence gaps which currently exist in veterinary medicine. Future veterinary research should look to EPRs as a proven, feasible data source, employing the use of COSs to direct the most important outcomes to extract. The next steps in this work should explore the potential for, and practicalities of, running treatment trials within a first opinion veterinary practice environment. This will enable the profession to make real progress into filling the many evidence gaps in existence

Methods and feasibility of conducting pragmatic clinical trials in small animal first opinion practice.

Chronic kidney disease (CKD) is an important cause of morbidity and mortality in cats, for which many research uncertainties remain unanswered. As for much of veterinary healthcare, the evidence base for treatment decision-making is limited. For the small number of research questions where randomised controlled trials (RCTs) are published, sample sizes are small, and the external validity of results can be limited because the patients included are not representative of the wider population who may have comorbidities. In addition, existing published research evidence does not always address outcomes of importance to treatment decision makers. Pragmatic trials are a very new concept in veterinary healthcare where a literature search found only one pragmatic trial had been designed and carried out in full. However, they are well established in human healthcare. They are a sensible solution to many of the problems with the veterinary healthcare evidence base for several reasons. They address questions which are important to stakeholders and address outcomes of important to decision makers. They are designed to take place where everyday care happens and have less strict eligibility criteria than traditional RCTs, resulting in the inclusion of more diverse patient populations who represent the patients for whom the research will be used. The results are designed to be useful in everyday clinical decision making, in everyday clinical practice. They test real- world treatments and use flexible protocols, being designed to represent normal practice as far as possible. Their results are more widely generalisable than traditional RCTs and they are less expensive to carry out. The aims of this PhD work were to investigate the existing published measures of treatment success in trials for cats with CKD and from there to establish the most important and most appropriate outcomes to use. This list would be designed to provide recommendations for future pragmatic treatment effectiveness trials of which treatment outcomes to assess and prioritise. In addition, this work aimed to establish the feasibility of extracting and using electronic patient records (EPRs) from first opinion veterinary practice, as a data source for clinical trials for these patients. This data source was chosen because EPR use in pragmatic trials is well established in human pragmatic trials, and because the EPR is the location where the presenting signs, diagnosis, treatment and management and outcomes of large numbers of ordinary cats with CKD is already recorded and held. A systematic review of outcomes assessed in published CKD treatment trials was carried out. This found a broad spectrum of outcomes that were assessed in the published literature. No core set of outcomes (COS) recommended for assessment in CKD treatment trials was found and little consistency was identified in the outcomes that were assessed between publications. To address this problem, research was conducted generating a COS for feline CKD. The panel of stakeholders involved in this process included an international panel of cat owners, clinical representatives, regulatory agencies and journal editors. A proposed list of important outcomes for a future COS was brought together via a three round eDelphi and an in-person consensus meeting. The final list created contained 29 core outcomes, grouped into four key areas: the veterinary consultation, blood and urine testing, living with CKD and CKD progression. Further refinement of this COS before it is finalised for inclusion in clinical trials is recommended, to streamline the outcomes into domains, potentially reduce by consensus the size of the final COS and agree by consensus the instruments to assess each domain. One key outcome identified by the COS generation process and known to be of importance to decision makers for cats with CKD was quality of life (QoL). A systematic review of the published literature was conducted to identify all tools used for assessing feline QoL, and the range and quality of tools available. Many of the studies found that discussed QoL either did not assess QoL at all, or assessed QoL with only unvalidated, oversimplified tools. Few publications were found that assessed quality of life in a structured way and few used validated tools to assess QoL, although a validated tool for assessing QoL for cats with CKD was found. Once the full COS for cats with CKD was established, work was conducted to examine whether some of the outcomes highlighted could be measured using data collected in practice management software systems in veterinary practices as part of routine veterinary healthcare. Data transfer from the databases of veterinary practices to those of laboratories, insurers and microchip registration companies is already well established, using XML schema. XML schemas describe the structure and content of the required data extract and present the data in a format which can be easily read by humans or computers. An XML schema was already published for the transfer of data pertaining to clinical research, ‘Clinical Evidence Schema v1.0.5’. To accommodate data from multiple PMS and multiple veterinary practices this schema was adapted, restructured and some new data fields were added. A six-month data batch in XML format was extracted by a PMS, in accordance with the data specifications of the new schema, from 282 veterinary practices. Additional data was also provided by the PMS as Excel files. The whole data batch was deidentified using bespoke script in Microsoft Visual Basic. It was then cleaned and uploaded into a bespoke database written in MySQL. This destination database was then examined and explored using scripts written in data manipulation language and run on the dataset via the SQL Command Prompt. The usefulness of the extracted patient data for possible treatment trials for cats with CKD was then established. Cats with CKD were identified using MySQL scripts, generating a disease prevalence of 2.8%. Validation showed this method to have 83.3% sensitivity, 99.5% specificity and a 40% false positive rate. A couple of relevant outcomes from the COS were extracted for feline CKD patients including blood pressure, bodyweight and survival time. CKD treatment interventions e.g. intravenous fluid therapy, or named therapeutics could be successfully identified within patient records and the longevity of these patients followed over time. In conclusion, EPRs are used within human healthcare for pragmatic trials, however, very few pragmatic trials exist for veterinary healthcare. This PhD thesis has demonstrated that veterinary EPRs are a valuable and feasible data source for research. Pragmatic style trials are likely to address many of the evidence gaps which currently exist in veterinary medicine. Future veterinary research should look to EPRs as a proven, feasible data source, employing the use of COSs to direct the most important outcomes to extract. The next steps in this work should explore the potential for, and practicalities of, running treatment trials within a first opinion veterinary practice environment. This will enable the profession to make real progress into filling the many evidence gaps in existence

What outcomes should be measured in feline chronic kidney disease treatment trials? Establishing a core outcome set for research

Chronic Kidney Disease (CKD) is an important cause of feline morbidity and mortality. There is currently no agreement on which outcomes are most important in CKD treatment trials to assist evidence-based decision making.Core Outcome Sets (COSs) originated in human healthcare and are an agreed set of outcomes to be measured and reported as a minimum in any trial conducted relating to a particular disease. To establish a COS for feline CKD, this study used a systematic review and two consensus methodologies (an electronic Delphi (eDelphi), and an in-person consensus meeting), with an international panel of key stakeholders.The systematic review identified 104 unique published parameters, which were rated by panellists in round 1 of the eDelphi. Panellists were also asked to suggest additional parameters. In round 2 these additional parameters were rated and any parameters not understood by >10 % of panellists in round 1 were redefined and re-rated. Parameters reaching consensus in rounds 1 and 2 were removed from round 3, when all remaining parameters were re-rated by panellists who could view their own previous rating alongside the median rating of the whole panel. To reach inclusion in the COS, parameters had to be rated 8 or 9 on a Likert scale of 1−9 (where 1 was not important and 9 was very important) by more than 80 % of panellists. In the consensus meeting, panellists discussed and re-rated borderline parameters and streamlined the final COS. Borderline parameters were those that had been closest to, but not achieved, the 80 % threshold for inclusion.The eDelphi panel (n = 73) rated 24/104 parameters highly enough for inclusion and proposed an additional 20 parameters, of which 3 reached the inclusion threshold. This totalled 27 parameters for inclusion. The consensus meeting panel (n = 16) rated an additional 6/20 borderline parameters highly enough for inclusion. During the streamlining process, 4 parameters were removed as one was considered not an outcome, and three were already addressed by other parameters. The remaining COS totalled 29 parameters. These were grouped into 9 core themes: clinical examination, quality of life, serum biochemistry, complete blood count, urinalysis, total amount of food eaten, CKD progression, survival time and cause of death.This is the first COS for feline medicine. In future treatment efficacy trials the COS will strengthen the evidence-base for this condition, by facilitating easier comparison of results between studies, and reduce research waste

A systematic review of the quality of life assessment tools for cats in the published literature

Quality of life (QoL) is an important parameter to assess in cats, as it can be pivotal to important decision-making. Research reports that owners of cats with heart disease would trade longevity for QoL, and treatment associated improvement in QoL is very important for cats with chronic kidney disease. This systematic review aimed to explore the published literature to identify the number and range of QoL assessment tools available to researchers and veterinary professionals, by discovering tools which have already been used in published studies. Medline and CAB Abstracts were searched in March 2018, using terms relevant to cats and QoL or well-being. Inclusion and exclusion criteria were applied and information on uniqueness, validation and a short description of each tool extracted. A total of 1138 manuscripts were identified, of which 96 met all criteria. Forty of 96 manuscripts contained an assessment of QoL, using one of 32 unique tools identified. Sixteen of the tools identified were structured, making detailed patient assessments. Only eight of the structured tools were validated, and of these, three could be applied to healthy cats; the remainder being specific to a disease or being hospitalised. Some validated tools appeared in more than one manuscript. Overall, 12 manuscripts used a validated tool. In the 16 unstructured tools, five tools assessed QoL by assigning a single word (e.g. ‘poor’). Eight tools assessed QoL on a single Likert scale (e.g. a number between 1 and 5). This work identifies the tools that are currently available for the assessment of QoL by researchers and veterinary professionals. Additionally, it demonstrates that many are not validated or lack detailed animal assessment, highlighting that further work in this important area is needed

Modelling Knowledge Integration Process in Early Contractor Involvement Procurement at Tender Stage - A Western Australian Case Study

Purpose This paper aims to disseminate the knowledge integration process modelling throughout the phases of the early contractor involvement (ECI) procurement methodology, to optimise the benefit of ECI procurement method. The development of the model was aimed at taking advantage from the associated benefits of integrating knowledge and of ECI procurement. ECI provides contractors with an alternative means to tendering, designing and constructing projects. Thus, this paper explores knowledge interconnectivity and its integration involving numerous disciplines with various stakeholders to benefit from the collaborative environment of ECI. Design/methodology/approach The methodology implemented in the research includes a thorough literature review to establish the characteristics of the ECI tender stage as well as the characteristics of knowledge to be integrated in an ECI setting. Following this, an embedded case study research methodology was used involving three healthcare ECI projects undertaken by a Western Australian commercial contractor through 20 semi-structured interviews and project archival study, followed by the development of knowledge integration process models throughout the ECI process of the studied cases. Findings The research findings provide the basis to develop a knowledge integration process model throughout the ECI stages. The tender stage was found to be the most crucial stage for knowledge integration, particularly from the main contractor’s perspective to impart change and to influence the project outcome. The outcome of this research identifies the richness and interconnectivity of knowledge throughout the knowledge integration process in an ECI project starting from the intra-organisational knowledge integration process followed by the inter-organisational process of knowledge integration. This inside-out perspective of knowledge integration also revealed the need for mapping the implementation of knowledge integration from instrumental to incremental approach throughout the ECI stages in optimising the intended benefits of integrating knowledge. Originality/value This paper reports the development of a knowledge integration process model with the view to optimise the management effectiveness of integrating knowledge in ECI projects. Although knowledge integration and ECI can be considered existing and widely accepted concepts, the novelty of this research lies in the specific use of the knowledge integration process to analyse the knowledge flow, transformation and, hence, management in ECI projects. As it has been acknowledged that knowledge integration is beneficial but also a complex process, the methodology implemented here in modelling the process can be used as the basis to model knowledge integration in other ECI projects to further capitalise from ECI as a collaborative procurement method

A method for extracting electronic patient record data from practice management software systems used in veterinary practice

BackgroundData extracted from electronic patient records (EPRs) within practice management software systems are increasingly used in veterinary research. The use of real patient data gives the potential to generate research that can readily be applied to clinical practice. The use of veterinary EPRs for research in the United Kingdom is hindered by the number of different Practice Management System (PMS) providers used by practices, as obtaining and combining data from different systems electronically can be problematic. The use of extensible mark up language (XML) to extract clinical data for research would potentially resolve the compatibility issues between systems. The aim of this study was to establish and validate a method for the extraction of small animal patient records from a veterinary PMS that could potentially be used across multiple systems. An XML schema was designed to extract clinical information from EPRs. The schema was tested and validated in a test system, and was then tested in a real small animal practice where data was extracted for 16 weeks. A 10 % sample of the extracted records was then compared to paper copies provided by the practice.ResultsAll 21 fields encoded by the XML schema, from all of the records in the test system, were extracted with 100 % accuracy. Over the 18 week data collection period 4946 records, from 1279 patients, were extracted from the small animal practice. The 10 % printed records checked and compared with the XML extracted records demonstrated all required data was present. No unrequired, sensitive information e.g. costs or services/products or personal client information was extracted.ConclusionsThis is the first time a method for data extraction from EPRs in veterinary practice using an XML schema has been reported in the United Kingdom. This is an efficient and accurate way of extracting data which could be applied to all PMSs nationally and internationally

High carriage rate of high-level penicillin-resistant Streptococcus pneumoniae in a Taiwan kindergarten associated with a case of pneumococcal meningitis

BACKGROUND: The Taiwan(19F)-14 Streptococcus pneumoniae clone and its variants are being found with increasing frequency in the Asia-Pacific region. A 5-year old child with S. pneumoniae meningitis caused by a high-level penicillin resistant strain (MIC = 4 μg/ml) was admitted to a hospital in southern Taiwan. We carried out a study to determine the potential source of this strain. METHODS: Nasopharyngeal cultures were obtained from all children attending the same kindergarten as the index case. To determine their relatedness all isolates were compared by serotype, antimicrobial susceptibility profile and pulsed field gel electrophoresis (PFGE). RESULTS: A high proportion of the children including the index case (32/78, 41.0%) carried S. pneumoniae in their nasopharynx (NP). The most common serotype was 19F (13/32, 40.6%). The PFGE types of the 19F serotype isolates obtained from the patient's blood, CSF and NP were identical and were related to 11 other serotype 19F NP isolates including 10 that were indistinguishable from the Taiwan(19F)-14 clone. All 14 isolates had similar high-level penicillin and multi-drug resistance. The serotypes of the other 19 NP isolates included 6A (2), 6B (10), 23F (5), 9V (1) and 3 (1). The overall rate of penicillin resistance in these S. pneumoniae from these children was 87.5% (28/32), with an MIC(50 )of 2 and MIC(90 )of 4 ug/ml. In addition, multi-drug resistant-isolates (isolates resistant to 3 different classes of antimicrobials) accounted for 87.5% (28/32) of all isolates. CONCLUSION: The high carriage rate of high-level penicillin- and multi-drug- resistant S. pneumoniae in a kindergarten associated with a case of pneumococcal meningitis emphasizes the need for restraint in antibiotic use and consideration of childhood immunization with conjugate pneumococcal vaccine to prevent the further spread of resistant S. pneumoniae in Taiwan

Effect of Seven-Valent Pneumococcal Conjugate Vaccine on Staphylococcus aureus Colonisation in a Randomised Controlled Trial

Background: Heptavalent pneumococcal conjugate vaccine (PCV7) shifts nasopharyngeal colonisation with vaccine serotype pneumococci towards nonvaccine serotypes. Because of the reported negative association of vaccine serotype pneumococci and Staphylococcus aureus in the nasopharynx, we explored the effect of PCV7 on nasopharyngeal colonisation with S. aureus in children and parents. Methodology/Principal Findings: This study was part of a randomised controlled trial on the effect of PCV7 on pneumococcal carriage, enrolling healthy newborns who were randomly assigned (1: 1: 1) to receive PCV7 (1) at 2 and 4 months of age (2) at 2, 4 and 11 months or (3) no PCV7 (controls). Nasopharyngeal colonisation of S. aureus was a planned secondary outcome. Nasopharyngeal swabs were obtained from all children over a 2-year period with 6-months interval and from one parent at the child's age of 12 and 24 months and cultured for Streptococcus pneumoniae and S. aureus. Between July 2005 and February 2006, 1005 children were enrolled and received either 2-doses of PCV7 (n = 336), 2+1-doses (336) or no dose (n = 333) before PCV7 implementation in the Dutch national immunization program. S. aureus colonisation had doubled in children in the 2+1-dose group at 12 months of age compared with unvaccinated controls (10.1% versus 5.0%; p = 0.019). A negative association for co-colonisation of S. pneumoniae and S. aureus was observed for both vaccine serotype (adjusted odds ratio (aOR) 0.53, 95% confidence interval (CI) 0.38-0.74) and nonvaccine serotype pneumococci (aOR 0.67, 95% CI 0.52-0.88). Conclusions/Significance: PCV7 induces a temporary increase in S. aureus colonisation in children around 12 months of age after a 2+1-dose PCV7 schedule. The potential clinical consequences are unknown and monitoring is warranted