The coronavirus outbreak: the central role of primary care in emergency preparedness and response

On the last day of 2019, a cluster of cases of a pneumonia with unknown cause were reported by the Chinese authorities to the World Health Organization (WHO), believed to be connected to a seafood market in Wuhan, China. This market was closed the following day. On 7 January 2020, a novel coronavirus was isolated, and known pathogens were ruled out.1 Coronaviruses usually cause respiratory illness ranging from the common cold to severe acute respiratory syndrome (SARS). Clinical symptoms and signs of the Wuhan coronavirus include fever, with some sufferers experiencing difficulty breathing and bilateral pulmonary infiltrates seen on chest X-ray. WHO are referring to it as ‘2019-nCov’. At the time of writing, there have been over 4,500 confirmed cases and 106 deaths, including among healthcare workers. Over 98% of these cases are within mainland China, but cases have also been confirmed in tens of other countries

Perceptions of the learning environment, attitudes towards science, and understandings of the nature of science among prospective elementary teachers in an innovative science course

The major purpose of this study was to evaluate the impact of a science course for prospective elementary teachers on their perceptions of the learning environment, attitudes towards science, and understandings of the nature of science. The sample consisted of 525 female students enrolled in 27 classes of A Process Approach to Science (SCED 401) at a large urban university in Southern California. Also comparisons were made between SCED 401 and the students' previous laboratory course with regard to the learning environment and attitudes. Perceptions of the learning environment were measured using scales from the Science Laboratory Environment Inventory (Open-Endedness and Material Environment) and the What Is Happening In this Class? (Student Cohesiveness, Instructor Support, Cooperation, Investigation). Attitudes towards science were assessed using the Enjoyment of Science Lessons scale from the Test of Science-Related Attitudes (TOSRA). Students completed the Nature of Scientific Knowledge Survey (NSKS) based on their entire science education experience-not just the one laboratory class which they had taken previously. Comparisons were then made with their understandings after having completed SCED 401. Finally, associations between the learning environment and the student outcomes of attitudes and understandings of the nature of science were explored. This study embraced the current trend in classroom learning environments research of combining quantitative and qualitative methods. Qualitative components included items from the open-ended questionnaire, Views of Nature of Science, interviews with students, and an analysis of concept maps. The qualitative findings expanded and complemented the quantitative results and, in several cases, supported the construct validity of scales assessing the learning environment and attitudes.Another purpose of this study was to investigate the effects of using real research data for growth rates of four species of Antarctic seabirds (i.e., implementing an 'intervention') in six classes of SCED 401. The objective of the intervention was to increase the authenticity and quality of an experimental design project. In addition, the wildlife biologist who collected the data guided the students during the project. Although the intervention did not lead to an appreciable improvement in students' perceptions of the learning environment, differences between intervention and nonintervention classes were statistically significant for Enjoyment of Science Lessons from the TOSRA and for Creative from the NSKS (effect sues were 2.64 and 2.06 standard deviations, respectively). Results of this study indicated that during a factor analysis, the large majority of learning environment items belonged to their a priori scale (43 out of 46 items had factor loadings above 0.40) A valid instrument for use with prospective elementary teachers was produced by combining relevant scales from the Science . Laboratory Environment Inventory and the What Is Happening In this Class? A weaker factor structure was found for the Nature of Scientific Knowledge Survey. However, by moving close to half of the -faulty' items from the NSKS, the internal consistency reliability of scales improved considerably. This study also found large and statistically significant differences between students' previous laboratory class and SCED 401 for all six leaning environment scales. The largest difference was found for the level of Open-Endedness (effect size was 6.74 standard deviations).A statistically significant difference also was found for Enjoyment of Science Lessons (effect size was 2.98 standard deviations). Differences were not as dramatic with regard to understandings of the nature of science, although differences for two scales (Creative and Unified) from the NSKS were positive and statistically significant. This study replicated past research by finding statistically significant positive correlations between all six learning environment scales and Enjoyment of Science Lessons. However, by far, Instructor Support had the largest independent association with enjoyment, using both the individual and class mean as the units of analysis. A positive link between a favorable leaning environment and the student outcome of understanding nature of science also was found. This research makes a distinctive contribution to the learning environments field because it is the first study to investigate laboratory classroom environments at the university level with prospective elementary teachers. The study is also the first to build a bridge between the classroom learning environment and the student outcome of understanding the nature of science. The study has implications for undergraduate laboratory course instructors, for science teacher educators who develop and instruct in elementary teacher preparation programs, and for future elementary teachers and the science learning of their future students

Effect of maternal age on facility-based delivery: analysis of first-order births in 34 countries of sub-Saharan Africa using demographic and health survey data.

OBJECTIVES: Increasing access to skilled birth attendance, usually via childbirth in health facilities, is a key intervention to reduce maternal and perinatal mortality and morbidity. Yet, in some countries of sub-Saharan Africa, the uptake is <50%. Age and parity are determinants of facility-based delivery, but are strongly correlated in high fertility settings. This analysis assessed the independent effect of age on facility-based delivery by restricting to first-order births. It was hypothesised that older first-time mothers in this setting might have lower uptake of facility-based deliveries than women in the most common age groups for first birth. SETTING: The most recent Demographic and Health Surveys from 34 sub-Saharan African countries were used to assess women's delivery locations. PARTICIPANTS: 72 772 women having their first birth in the 5 years preceding the surveys were included in the analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: Proportions and 95% CIs of facility-based deliveries were estimated overall and by country. Multivariable logistic regression was used to calculate the odds of facility-based delivery for different maternal age groups (15-19, 20-24 and ≥25 years) for a pooled sample of all countries. RESULTS: 59.9% of women had a facility-based delivery for their first birth (95% CI 58.6 to 61.2), ranging from 19.4% in Chad to 96.6% in Rwanda. Compared with women aged 15-19 years, the adjusted odds of having a facility-based delivery for those aged 20-24 was 1.4 (95% CI 1.3 to 1.5, p<0.001) and for those aged ≥25, 1.9 (95% CI 1.6 to 2.2, p<0.001). CONCLUSIONS: Older age at first birth was independently associated with significantly higher odds of facility-based delivery. This went against the hypothesis. Further mixed-method research is needed to explore how increased age improves uptake of facility-based delivery. Promoting facility-based delivery, while ensuring quality of care, should be prioritised to improve birth outcomes in sub-Saharan Africa

Development of an online palliative care medicines training series for health and social care staff

Aim or goal of work: Frontline support staff working in General Practice (GP) (i.e. receptionists), Community Pharmacies (CP) and Care Homes are likely to face issues concerning palliative care medicines amongst their patient group. Previous service evaluations by the authors found a need for sustainable and accessible palliative care training for these staff. A national online training resource on palliative medicines for health and social care staff was subsequently developed and is currently being evaluated. Design, methods & approach taken: Various education and training materials for these staff groups were consolidated and re-developed into one interactive course, comprised of Core sessions for all staff (e.g. Introduction to Palliative Care) and discipline specific sessions i.e. Pharmacy (e.g. Dispensing Opioids) and Care Home (e.g. Palliative Medicines & Risk of Falls) staff. User feedback was obtained via a questionnaire measuring satisfaction, usefulness and impact. Results: All 50 participants (11 staff from GP Practices, Community Pharmacies (n=9) and Care Homes (n=30)) agreed that the training was useful and with the correct degree of difficulty. Participants liked the delivery format and felt the training was “informative” and “easy to access”. Staff also reported that managers were supportive of them undertaking the training. The training provided a good introduction and, for some, a refresher to palliative care. Some participants provided real-life examples of how the training had been beneficial to (and applied by) them in the workplace. Conclusions and lessons learned: This new training resource provides education in an engaging, accessible format to frontline health and social care multi-disciplinary teams. It will be available nationally from November 2016 to support the provision of palliative care by frontline staff at the point of need

Development of the NES online palliative care medicines training series for health and social care support staff

Previous Macmillan Cancer Support and Health Board funded palliative care pharmacy service evaluations in NHS Greater Glasgow & Clyde (urban) and NHS Highland (rural) (1-4) observed a steady integration of the community pharmacy team into local palliative care services. Frontline staff in General Practice, Community Pharmacies and Care Homes in these areas were found to lack knowledge about palliative care medicines amongst their patient group. Both evaluations resulted in the development and testing of training materials in a variety of face-to-face and online formats and for different support staff

Cocoa Flavanol Supplementation and the Effect on Insulin Resistance in Females Who Are Overweight or Obese: A Randomized, Placebo-Controlled Trial

There is interest in the impact that dietary interventions can have on preventing the transition from insulin resistance to type 2 diabetes, including a suggestion that the bioactive components of cocoa may enhance fasting insulin sensitivity. However, a role for cocoa flavanols (CF) in reducing insulin resistance in the insulin-stimulated state, an important risk factor for cardiovascular disease, is unresolved. This study investigated whether CF consumption improved whole-body insulin-mediated glucose uptake (‘M’) in females with overweight/obesity, using a randomized, double-blinded, placebo-controlled, parallel-group design. Thirty-two premenopausal females (19–49 years; 27–35 kg·m−2) with elevated HOMA-IR (HOMA-IR >1.5) supplemented their habitual diet with two servings/day of a high-flavanol cocoa drink (HFC; 609 mg CF/serving; n = 16) or low-flavanol cocoa drink (LFC; 13 mg CF/serving; n = 16) for 4 weeks. Assessment of HOMA-IR and ‘M’ during a 3-h, 60 mIU insulin·m−2·min−1 euglycemic clamp was performed before and after the intervention. Data are the mean (SD). Changes to HOMA-IR (HFC −0.003 (0.57); LFC −0.0402 (0.86)) and ‘M’ (HFC 0.99 (7.62); LFC –1.32 (4.88) µmol·kg−1·min−1) after the intervention were not different between groups. Four weeks’ consumption of ~1.2 g CF/day did not improve indices of fasting insulin sensitivity or insulin-mediated glucose uptake. A recommendation for dietary supplementation with cocoa flavanols to improve glycemic control is therefore not established

Magnetic particle characterization in the Seine river system: Implications for the determination of natural versus anthropogenic input

International audience[1] This study presents an innovative application of well-established environmental magnetic proxy parameters on fluvial sediments, with the aim to trace geological and human-induced processes in the complex Seine river drainage system in northern France. We seek to identify environmental fingerprints of mechanical and chemical weathering processes, the regional distribution of the suspended material, and changes in the balance of natural input versus anthropogenic pollution. In order to reach these goals, we applied a combination of rock magnetic and advanced scanning electron microscopic techniques on a large number of sediment trap samples. Generally, we observe an increase in magnetic concentration coupled with a coarsening in magnetic grain size downstream of the Seine river system. Furthermore, the dominant magnetomineralogy changes from high-coercivity minerals upstream in more rural areas to magnetite-dominated assemblages downstream. Each river (segment) shows its specific trend line depending on regional initial input, weathering conditions, drainage area, and potential pollution sources. One major outcome of this study is the observed significant correlation between anthropogenic antimony-rich iron oxide particles and the magnetic concentration. This shows the potential of magnetic remanence measurements as proxy parameters for specific heavy metal pollution concentrations. Hence, the environmental magnetic study presented herein serves to identify major trends as well as local particularities and leads to quantitative analyses of the contributions of individual tributaries in the Seine river system. Components: 9513 words, 9 figures, 4 tables

Reflecting on ’classroom readiness’ in initial teacher education in a time of global pandemic from the perspectives of eight university providers from across England, UK

In the context of a decade of change and reform in Initial Teacher Education (ITE) policy making, we assess the impact of the substantial changes caused by Covid-19 affecting ITE from the perspectives of eight university providers in England. Whilst previous research has documented the impact of the first period of lockdown in the UK, initiated in March 2020, we draw on the conceptual framework of classroom readiness to consider the continued and variable disruption caused by Covid-19 on ITE programmes in England during the period September 2020 – June 2021. Through a participatory workshop, which included identifying key questions, group discussion and written reflections with teacher educators working across eight institutions, we assess the changes to pre-service teacher education provision over this period, with a focus on postgraduate programmes. We identify that the nature and implementation of school visits and the role of technology and digital pedagogies are key areas of change during the pandemic period, whilst continuity in the value and strength of school and university partnerships remain. We consider the ways in which ideas of developing ‘classroom readiness’ have been informed and shaped through changes to teacher education brought about during the pandemic period. We argue that conceptualisations of classroom readiness need to be grounded in reflective professional learning in the context of collaborative professional communities so to enable pre-service teachers to become adaptable pastorally engaged subject specialists. We reflect on how learning from this period might be incorporated into future international ITE programmes and policy