'How can nurse lecturers teach nursing when they're not doing it...'

A review of the literature on how credibility is understood and built among clinical academics

Evaluating the effectiveness of a training intervention in neonatal resuscitation in a developing country setting: establishing grounds for further rollout

Objective: To evaluate the effectiveness of an educational intervention in neonatal resuscitation in Zambia in order to establish grounds for further rollout. Design: Single case study approach using semi-structured interviews, focus groups, participant questionnaires, observation and document analysis. Setting: Lusaka including the main teaching hospital and surrounding district health centres, the school of nursing, and Livingstone. Participants: At three levels: (a)92%(n=11) trainers trained to train (Nurses, midwives, paediatricians and anaesthetists) participated in focus groups, observation and a structured questionnaire; (b)42% (n=16) staff (midwives, nurses and anaesthetists from among candidates who underwent the initial training) took part in semi-structured interviews; and (c)42% (n=27) of staff (a mixture of nurses, midwives, paediatricians, anaesthetists, and student paediatric nurses) who underwent secondary training took part in focus groups and observation. Relevant data was also collected from analysis of training records. Findings: A number of formal and informal training sessions had been delivered and more staff trained since the initial training. There was consistent evidence of knowledge increase among those who underwent secondary training as shown by pre- and post-test scores and overwhelming consensus that most of the goals set out by the trainers at the initial training had been achieved. More importantly staff reported a positive impact on clinical outcomes and a positive shift in clinical knowledge; the quality of training and content had been fundamentally maintained and the trainers demonstrated ownership of the programme moving forward. At the same time however many participants reported challenges with funding and recognition from government and professional authorities to support further rollout and clinical application. Strategies and suggestions to address these were being proactively explored. Key conclusions: the project appears to have achieved its main objectives at times beyond the targets initially set. Zambian partners have demonstrated commitment to, and ownership of, the programme and vision to reduce neonatal mortality through training and are making concerted efforts for further rollout. However relevant support from professional and governmental authority is key to further progress. Implications for the future: Trainers would benefit from support to strengthen teaching skills. Evaluation of practice in the clinical setting, mentorship and continuing Professional Development (CPD) strategies are useful considerations moving forward. Therefore it is vital that the government recognises and funds the effective rollout and application of the training programme in practice, supported by a programme of national standardisation of neonatal resuscitation

Evaluating service provision for midwifery education: a case study

Abstract In keeping with the ethos of the Higher Education Funding Council for England (HEFCE), related Key Information Sets (KIS) and National Student Survey (HEFCE 2012), the local university’s five year strategic plan 2011-15 (Strategic Plan 2011) includes at its heart investing in the student experience with a curriculum that is flexible and responsive to changes both within and outside the university, and offering a ‘high quality university experience’ through innovative methods of learning. As part of a varied array of teaching, learning and assessment facilities, the university boasts of skills lab services which increasingly provide a unique opportunity for student midwives to practice clinical skills in a safe environment which ultimately prepares them to be fit for practice at the point of registration (Nursing and Midwifery Council (NMC) 2009). However, there has not been a formal evaluation of this service to date. Purpose This study set out to evaluate the current service provided for pre-registration midwifery students in the university skills lab in order to establish current standard, provide a benchmark for future development, and contribute to the students’ learning experience. Methodology Using a case study approach, a representative convenient sample of users of the service was studied. Participants included 7 third year and 3 first year students from the pre-registration midwifery programme based on one of the two university campus sites, and 2 midwifery lecturers plus 2 skills lab support staff working across both campuses. All participants were asked about their experience of using the skills labs. Interviews were transcribed verbatim and analysed using a thematic approach and NVivo software. Student focus groups and staff one-to-one interviews were carried out, as well as observation of activity in the skills lab. Relevant document analysis was also undertaken. Findings The main themes emerging from analysis of the data include the following: both staff and students felt that there was more theory than practice in the teaching and learning activities in the skills lab; that the management of time and communication around the assessment process in the skills lab could be improved; that the quality and authenticity of equipment and facilities could be improved; that capacity issues, consisting of an interaction between student numbers, time and space management in the lab, had a negative impact on the learning experience; and that better communication amongst users overall could further improve the service. Implications Whilst some of the findings support the literature, there appears to be some new information particularly related to student perceptions of the theory - practice ratio of sessions, and capacity issues impacting on learning. The author makes several recommendations for educational institutions providing a skills lab service including the following: Educational institutions should • explore innovative teaching strategies such as the blended approach which would allow more time for students to spend on hands-on practice in the lab, • explore strategies to enhance the authenticity of the equipment to improve the students’ learning experience in the lab, • develop better communication systems and appropriate management of timetables, coupled with clear guidelines for staff-student ratios in order to address capacity issues; clear communication around assessment that takes into account individual students’ unique needs must also be ensured. Limitations The author recognises that this study was primarily based on the experience of students from one out of two university campuses admitting pre-registration midwifery students. This was due to time constraints related to the timetable for the Master’s study. It would therefore be useful to consider further research that encompasses the experience of students from both campus sites as well as addressing possible issues surrounding parity of experience across sites

Macromolecular platinum-based anticancer agents

A thesis submitted to the faculty of Science, University of the Witwatersrand, in fulfillment of the degree of Doctor of Philosophy in Science Johannesburg, 2012Platinum is nowadays one of the best and widely used antitumor agents in cancer chemotherapy. The numerous performances reported by many previous researchers for this metal in the fight against several malignancies led to the synthesis of many platinum complexes. However, the clinical responses related to these complexes led to the development of non-platinum compounds with metal ions which exhibit antitumor activity. Ferrocene is one of them, owing the high consideration inter alia to its environmental oxidore-ductive behavior. Methotrexate is another clinically used anticancer drug worthy to be mentioned. With a structure very close to that of folic acid, differing from it by an amine function and a methyl group, respectively, instead of an hydrogen and an hydroxyl group on the folate, methotrexate has been considered as an antagonist of folic acid by its mechanism of action in the biological environment. It has, together with platinum and non-platinum complexes, shown notorious side-effects by fighting both normal and abnormal cells despite their antineoplastic potency. This is the reason why a drug delivery system is considered as a tool to improve metal complexes and other drugs selectivity for cancer cells. The strategy of enhancing the potency of non-polymeric chemically, physically, or biologically active compounds through the expediency of binding such compounds to a polymeric carrier has revolutioned numerous technologies. In the present thesis is demonstrated the synthesis of several water-soluble macromolecular drug carriers intended for biomedical applications, and the anchoring of platinum to ferrocene-containing antineoplastic agents on one side, then to methotrexate-containing antineoplastic agents on the other side, resulting in a co-conjugate or a conjugate bearing two different drugs on a single carrier. This multidrug anchoring offers the advantage to exploit the potency of two different drugs on a single polymeric structure, each drug having its own pharmacokinetic path. Platinum is the common drug, while ferrocene and methotrexate are the various co-drugs. This order of having the platinum imparted to the polymeric carrier after the two drugs above mentioned were adopted in obedience to the strategy of having the most synthetically demanding drug incorporated in the carrier before the least one. Anchoring of the three drugs to polymeric structures was achieved in aqueous environment. Methotrexate (MTX) and ferrocene (Fc) binding were achieved via HBTU as coupling agent. In all cases, more or less, but very close to, 100% drug loading could be achieved under careful control of experimental conditions. The water-soluble polymeric carriers used are copolyaspartamides, prepared by an aminolytic ring-opening process of polysuccinimide, and copoly(amidoamines) obtained by Michael polyaddition of methylenebisacrylamide (MBA). These polymers were designed to bear amine, hydroxyl or carboxylic acid functional groups in their structure, either as part of the main chain or side chain. The functional groups herein mentioned are important for the coupling of the chemically modified drug species. Exploratory in-vitro biological studies are discussed, as the co-conjugation of the metallic antineoplastic drug, ferrocene and the antifolate methotrexate, each with the metallic drug platinum, is performed. The results of these preliminary tests show that polymer-drug conjugates and co-conjugates can play a role in future cancer therapy

Enhancing knowledge and skills through the delivery of a bespoke neonatal resuscitation training programme in a developing country

Objective: This paper presents the design, implementation and immediate outcomes of an educational intervention in neonatal resuscitation. Setting: The training programme took place in Sub-Saharan Africa. Participants 50 midwives, nurses, neonatal, paediatric doctors, and anaesthetists, who provide care during labour and birth. Interventions: The design, implementation and immediate evaluation of a training programme was based on a "train the trainer" and an outreach programme approach which was delivered over five days. All candidates received one day training in knowledge and skills for immediate care and resuscitation of the newborn. In addition, those "trained to train" attended additional sessions to observe teaching and were equipped with relevant information and material to perpetuate the training. Measurements and findings: Immediate evaluation was undertaken by comparing pre- and post-training knowledge. The total average pre-test score was 63.5% and the total average post-test score 83.8%. There was an increase in knowledge for every individual except two where knowledge remained static. Qualitative comments about the training were also obtained which were very positive. Key conclusions: The training programme was successfully implemented and has largely achieved its objectives in impacting participant knowledge and skills. Furthermore a team of trainers has been equipped with the knowledge, skills and material to cascade the training further. Overall the project had achieved its immediate objectives through the educational strategies employed

Pneumonia: A Challenging Health Concern with the Climate Change

Pneumonia is still a global health concern with high mortality rate, mainly among children under 5 years and adults over 65 years. In addition to pathogen virulence, immunoevasion capacity, and drug resistance ability, risk factors for the patient include aging, comorbidities, malnutrition, and all causes affecting the immune system. The extent to which environmental disorders affect the respiratory health is established for chronic diseases such as asthma, COPD, and cardiovascular diseases, but less is known about the underlying mechanisms of their impact on infectious diseases of the respiratory system. This chapter aims to recall the epidemiology, diagnosis, and treatment of pneumonia, with a focus on the impact of climate change and related risk factors on acute low tract respiratory infections

Quantifying and comparing the life cycle cost of light emitted diode and conventional streetlights

Abstract: Today, lighting accounts for more than 19 percent of the world electricity consumption and 6 percent of the CO2 emissions. At the same time, streetlighting is a significant municipal duty which plays an important role in the life of a community. At present, streetlights are converted to more sustainable solutions that are energy-efficient and cost-effective for both the state and local governments. The goal of this research is to measure and compare the cost of the life cycle of a light emitted diode (LED) and conventional streetlights. This is achieved by first determining the energy use of LED streetlights compared to conventional streetlights. Secondly, establishing the total cost of ownership of an LED streetlight compared to a conventional streetlight to encourage municipalities and key decision-makers to evaluate the merit and costs of street lighting projects. A cost framework for the life cycle has been developed from the current literature to determine the energy use and the total cost of ownership of both streetlight technologies. The selected mathematical formulas were classified and implemented using secondary data collected from a study from a project conducted by the Greater Tzaneen municipality and the researcher’s employer to calculate costs for both technologies. It is noted that post-acquisition costs are the largest part of the life cycle cost for both street lighting technologies. When comparing the calculated results, it is noted that streetlights with conventional technology use 56 percent more energy than their comparable LED streetlights. The findings also suggest cost savings of between 13 and 22 percent of the total cost of ownership over a year in favour of LED streetlights. The findings of this study indicate that LED streetlights are the best technology to implement based on their energy consumption and total cost of ownership. Municipalities and decision-makers can use this research’s framework to argue on their selected technology choice. The design of the measurement method used in this research allows users to adapt it to their context and include additional costs drivers to assist cities and key decision-makers in making literature informed decision when presented with the question of which streetlight technology to consider.M.Ing. (Engineering Management

Design and synthesis of polymeric anticancer agents

Presently used anticancer drugs deficiency prompted studies of their possible binding to polymeric structures called carriers which serve as vehicles for transportation of the drug to the target cell. Availability of natural polymers, firstly used, was limited by intrinsic characteristics required by anticancer agents. Synthetic polymers are advantageous as they may be tailored to meet specific structural requirements. They should thus possess desirable biomedical properties such as water-solubility, biodegradability and biocompatibility. They should also bear functional groups for drug binding. In the present dissertation project, known and novel water-soluble carriers were synthesized and some of them were used for bioreversible binding (anchoring) of antineoplastic agents, such as methotrexate and ferrocene, to provide conjugates for biomedical application. Polyaspartamide carriers equipped with hydrosolubilizing and amine-terminated side chains suitable for drug attachment were prepared from poly-D, Lsuccinimide by a previously developed technique involving successive aminolytic ring-opening steps mediated by amines. Chosen amines include diethylenetriamine (DET), 2, 2’-(ethylenedioxy)diethylamine (EDDA), hydrazine (HY), 1,3-propylenediamine (PDA) and 3-(N,N-dimethylamino)propylamine (DMP). Other aliphatic polyamide carriers were prepared by polycondensation methods involving 2-hydroxypyridine as a catalyst, diethyl L-tartrate (TART) and diamines ethylenediamine (EDA), EDDA and 4, 7, 10-trioxa-1,13-tridecanediamine (TRIA). The use of diethyl L-tartrate leads to polyamides bearing hydroxyl groups for drug iv attachment, while the three diamine monomers enhance polymer solubility and provide intra-chain drug anchoring sites. Polyamidoamine carriers, possessing intra-chain functional amino and hydroxyl groups for drug binding, were synthesized by a Michael polyaddition reaction of methylene bisacrylamide (MBA) with comonomer 3-amino-1, 2-propanediol (APD) and 3-(N,N-dimethylamino)propylamine (DMP). All polymeric carriers prepared were fractionated by aqueous-phase dialysis in 12000-14000 molecular-mass cut-off membrane tubing (25000 cut-off for selected polymers) and isolated by freeze-drying. Yields ranged from 10 to 69% and inherent viscosities, ηinh, from 6 to 29 mL/g. They were then characterized spectroscopically. All polymers dissolved completely in aqueous media, thus fulfilling the requirements of water solubility. Methotrexate is one of the highly potent anticancer drugs. The literature reveals high folic acid antagonistic properties and high antiproliferative activity against all kinds of cells. In the present dissertation, a series of water-soluble methotrexate conjugates was synthesized by N-acylation of linear appropriately amine-functionalized polyaspartamide carriers with methotrexate. Acylation was brought about by mediation of O-benzotriazol-1-yl-tetramethyluronium salt (HBTU) as coupling agent. The anticancer The anticancer activity of metal compounds has been of major interest in drug research for two decades. The literature shows certain ferrocene-bound conjugates to possess the same high antineoplastic activity against HeLa cells as observed with analogous platinum conjugates. In the present dissertation, a series of water-soluble ferrocene conjugates was synthesized by using the same method as for methotrexate: N-acylation of linear amine-functionalized polyaspartamide carriers with 4-ferrocenylbutanoic acid. Acylation was here again brought about by mediation of O-benzotriazol-1-yltetramethyluronium salt (HBTU) as coupling agent. All conjugates synthesized were purified by aqueous-phase dialysis and collected by freeze-drying as water-soluble solids. Resulting water-soluble polymer-drug conjugates displayed inherent viscosities, ηinh, of 5 to 24mL/g, and contained 18- 23 % of drug by weight. In conformance with the project’s objective, methotrexate conjugates were contributed to a major pool of experimental polymeric antineoplastic agents, to be submitted to the department of Pharmacology, University of Pretoria, for extended cell culture testing to asses their antiproliferative activity

Empirical analysis of neural networks training optimisation

A Dissertation submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Science in Mathematical Statistics,School of Statistics and Actuarial Science. October 2016.Neural networks (NNs) may be characterised by complex error functions with attributes such as saddle-points, local minima, even-spots and plateaus. This complicates the associated training process in terms of efficiency, convergence and accuracy given that it is done by minimising such complex error functions. This study empirically investigates the performance of two NNs training algorithms which are based on unconstrained and global optimisation theories, i.e. the Resilient propagation (Rprop) and the Conjugate Gradient with Polak-Ribière updates (CGP). It also shows how the network structure plays a role in the training optimisation of NNs. In this regard, various training scenarios are used to classify two protein data, i.e. the Escherichia coli and Yeast data. These training scenarios use varying numbers of hidden nodes and training iterations. The results show that Rprop outperforms CGP. Moreover, it appears that the performance of classifiers varies under various training scenarios.LG201