Supporting the management of type 2 diabetes with pharmacist-led reviews: an observational analysis

Abstract Objective Describe and assess the impact of a pharmacist-led patient review programme on the management and control of type 2 diabetes (T2D). Design Uncontrolled prospective cohort study with before and after intervention data collection. Setting General practices within NHS Slough Clinical Commissioning Group (CCG). Participants 5910 patients with T2D. Interventions Pharmacists reviewed 5910 patients and worked with general practice teams to schedule any of the 9 key care processes recommended by the National Institute for Health and Care Excellence (NICE) that the patients were lacking, to optimise medication and to make other interventions such as providing lifestyle advice. Main outcome measures The proportion of patients receiving the NICE-recommended 9 key care processes and proportion of patients whose glycated haemoglobin (HbA1c), blood pressure (BP) or total cholesterol (TC) readings were over target before and after the intervention period. Results The proportion of patients receiving all of the NICE-recommended 9 key care processes increased from 46% at project outset in April 2013 to 58% on completion in April 2014 and the percentage of patients achieving HbA1c, BP and TC targets all increased (65% to 70%, 70% to 76%, 78% to 82%, respectively). Quality Outcomes Framework (QOF) data for Slough CCG showed the percentage of diabetic patients achieving target HbA1c, BP and TC readings increased from April 2013 to April 2014, but then diminished in the year after project completion. Conclusions The pharmacist-led review increased the number of key care processes administered and improved diabetic control during the year of programme delivery. The improvement abated during the year after, suggesting that such programmes should be ongoing rather than fixed term. The programme combined the strategic drive and project facilitation skills of Slough CCG, the general practice teams' knowledge of their patients and the clinical and information technology skills of an experienced pharmacist team

Using ICT and Service Learning in Rural Senegal

In 2010, Fairfield University received a three-year grant from the United States Agency for International Development (USAID), through Higher Education for Development (HED), to support a university service-learning program to deliver educational material on health-related topics to middle school students in Bambey, Senegal, a rural area, 60 miles east of the capital, Dakar. Fairfield University must work with the selected partner, Université de Bambey, which has four rural campuses, about 20 miles apart, connected by both paved and dirt roads. Resources are scarce, as is a consistent electricity and water supply. However, the faculty is dedicated and competent, and the students are vibrant, intelligent, and hard working. The various courses of study are distributed across the campuses, unlike the variety on a single campus in the United States. Each Université de Bambey campus might have just two or three majors of study. The USAID/HED grant specifies that Service- Learning must be used to deliver the training, and the use of computer technology is essential. The project will begin with pretesting of the professors and students, followed by testing at the end of the project, to assess the success of the project

Lessons Learned from Two Teacher Educators: What COVID-19 Can Teach Us About Preparing Elementary Preservice Teachers to Teach the Next Generation of Students

Over the last two years, the COVID-19 pandemic has required teacher educators to teach their classes online. Teacher educators now need to reflect on the learning opportunities that the COVID-19 induced shift to online learning has provided. This study shares two teacher educators’ experiences of teaching and supporting preservice teachers (PSTs) as they taught engineering online to elementary students. The two teacher educators noticed (a) positive changes in PSTs’ attitudes and beliefs about technology integration, (b) PSTs’ tendency to select and use of educational technologies, (c) PSTs’ recognition of the importance of online interaction and feedback from K-12 students, (d) the importance of providing PSTs with extended access to physical hardware, and (e) the importance of providing developmentally appropriate digital resources. The paper concludes with suggestions for teacher educators who are preparing PSTs for the next generation of teaching

Preservice Secondary Science Teachers\u27 Reflections in Using Modeling & Simulation Applications as Instructional Tools for Learning

Preparing preservice teachers to construct learning environments integrating technological tools is a challenge that higher education continues to tackle. One way to address this challenge is to have preservice teachers integrate modeling & simulation (M&S) tools while teaching, reflect on the experience, and attempt to identify ways to make improvements in instructional practices. This case study of five preservice secondary science teachers, enrolled in a course along with student teaching, was designed to study M&S tools integrated into instruction and how preservice teachers thought about the experience. Participants taught at least one lesson integrating M&S tools where they were to respond to reflective questions on the application as well as ways to improve the lesson. Findings indicated that preservice teachers fell into a strong or ineffective category in reflecting, which also impacted observations about the tool selected for instruction. This study also identified science teacher preparation programs need greater emphasis in use of M&S tool

Can Effective Urban Teachers Be Developed in an Online Environment?

The purpose of this investigation was to determine if an online Teacher Education Program course could assist in the development of effective urban teacher characteristics of preservice teachers. The Urban Teacher Selection Interview was used to assess seven midrange functions that determine the dimensions of effective urban teaching. Results communicated that although the preservice teachers gained essential knowledge and skills in regards to urban teaching, a link could not be established between specific urban online course activities and the development of effective urban teacher characteristics

Coupling the Thermodynamics, Kinetics and Geodynamics of Multiphase Reactive Transport in Earth’s Interior

Multiscale multiphase reactive transport is a central phenomenon governing geologic processes in Earth's interior. In the upper mantle, melts, produced by partial melting of the peridotitic mantle, and volatile-rich fluids, derived from dehydration of subducting plates, buoyantly ascend through the mantle's porous network. Reaction between these melts and fluids and the surrounding solid matrix control the composition of magmas that reach Earth's crust. Melt-rock reaction is strongly coupled to the dynamics of melt transport: not only do the transport pathways modulate the extent of chemical interaction between melts and the solid matrix, but the melt-rock reactions also feedback into the transport dynamics through reactive changes to bulk physical properties including permeability, density, and viscosity. These feedbacks can result in the emergence of self-organized transport networks, such as the network of high-porosity dunite channels beneath mid-ocean ridges. Understanding the various feedbacks between reaction and melt transport requires consistent coupling of multicomponent multiphase thermodynamics and geodynamics. However, the high-dimensionality of such coupled problems presents a major theoretical and computational challenge. Existing models of reactive multiphase flow have therefore tended to focus separately on the geochemistry of melt-rock interaction, or on the dynamics of melt transport, with simplified thermo-chemical couplings. In this dissertation, I present a new thermodynamically consistent and tractable framework for integrating multicomponent thermodynamics and multiphase geodynamics. I use a non-equilibrium thermodynamic formulation to describe reaction as a time-dependent irreversible process alongside heat and mass transport. This theory is implemented using new thermodynamic software developed through the ENKI project. The main benefits of this approach are two-fold. Firstly, it extends the reach of existing multiphase computational thermodynamics to model macroscopic disequilibrium reaction paths --- this is the first step towards being able to model a host of metastable reaction phenomena in igneous and metamorphic systems. I model disequilibrium batch reaction for a simple system in chapter 2. Secondly, it allows self-consistent integration of multiphase thermodynamics in two-phase flow models, to better explore coupling between reaction and transport. This is demonstrated in chapter 5. Chapter 1 gives a broad introduction to multiphase reactive flow and further discusses the motivation for this work. I outline past work and discuss the scope of problems in which coupling between reaction and transport plays a critical role in geodynamic and geochemical evolution. In chapter 2 I present a general theory for integrating computational thermodynamics and geodynamics. This approach is based on the standard conservation equations for porous melt transport within a deformable solid matrix, but extends the governing equations to include multiple solid phases. The multiphase reactive coupling is described using a kinetic framework that includes explicit stoichiometric reactions between minerals, melts, and fluids. Using the theory of non-equilibrium thermodynamics, the macroscopic reaction rates are controlled by the reaction affinities --- providing closed-form expressions for the net reactive mass transfers. This formulation of disequilibrium reaction is the principal contribution of this dissertation. Coupled with the conservation equations it can describe both equilibrium and disequilibrium reaction paths and is applicable to a range of geological conditions. I outline approaches for modeling melt-mediated, fluid-mediated, and subsolidus grain-boundary-mediated reaction. In extension to previous theories of two-phase flow, this framework permits modeling of more realistic melting and crystallization reactions, including eutectic and peritectic melting. The theoretical framework is supported by software developed as part of the ENKI project. I briefly summarize the software infrastructure in this chapter. In the remaining chapters I step through the workflow for implementing this approach for a series of model problems in the Mg$_2$SiO$_4$--SiO$_2$ binary system. The Mg$_2$SiO$_4$--SiO$_2$ subsystem is an important bounding binary for understanding mantle melting and represents the simplest subsystem for exploring coupled reactive transport dynamics. Widely used thermodynamic models of silicate melting (i.e. MELTS) do not extend to the binary, and existing binary melting models involve complex treatments of melt speciation to account for significant non-ideality at high silica contents. Here, I am concerned mostly with reaction for mafic compositions relevant to mantle magmatism. Therefore, in chapter 3 I present a simple thermodynamic model for melting in the Mg$_2$SiO$_4$--SiO$_2$ system. I use a numerically efficient asymmetric binary mixing model to describe solution in the melt, which is calibrated using a compilation of phase equilibrium experimental data. This chapter is not a self-contained study in and of itself, but rather sets up the thermodynamic model that I will use in the remaining chapters. Chapter 4 applies the theoretical framework to a series of simple model problems for disequilibrium reaction and reactive melt transport in the Mg$_2$SiO$_4$--SiO$_2$ system. Disequilibrium reaction paths can be non-intuitive, and I start by modeling reaction in uniform batch systems. All of the calculations are consistent with the phase diagram in the equilibrium limit. More general conservation equations for disequilibrium reaction in open-system batch reactors are derived in Appendix C. I then integrate irreversible reaction with the dynamics of diffusion and advection of heat and mass to model the formation of reactive fronts around fusible heterogeneities, and a eutectic/peritectic disequilibrium steady-state melting column. This is the first self-consistent inclusion of eutectic/peritectic melting into magma dynamics. Finally, in chapter 5 I apply this framework to explore the formation of dunite channels by incongruent open-system melting. I develop a series of 1-D and 2-D models to investigate the formation of dunite channels in a harzburgitic mantle within the Mg$_2$SiO$_4$--SiO$_2$ binary system. The models predict that influx of deep silica-poor melts promotes a reactive channeling instability that organizes melt into high-porosity dunite channels. During decompression melting in the absence of a basal melt flux, no channelization is observed. This implies that an additional flux of melt is required, either from melting of deep fusible heterogeneities, or from large-scale melt focusing toward the ridge axis at depth. Alternatively, flux melting of additional melt components could help drive reactive channelization in natural peridotite systems

I FRONTLINJEN AV COVID-19 PANDEMIN. Sjuksköterskors upplevelse av arbetet på akutmottagning under pandemin

Bakgrund: 2019 drabbades världen av ett nytt virus, SARS-CoV-2, som ledde till en pandemi. Sjuksköterskor på akutmottagningar var de som stod i frontlinjen och mötte de virussmittade. Enligt sjuksköterskans kompetensbeskrivning ska hen arbeta hälsofrämjande, personcentrerat och patientsäkert. Syfte: Att undersöka sjuksköterskors upplevelse av arbetet på akutmottagning under covid-19 pandemin. Metod: En litteraturöversikt baserad på 9 kvalitativa och 2 kvantitativa artiklar. Resultat: Tre huvudteman och åtta subteman identifierades. 1. Tiden på akutmottagningen; starka känslor, rädslan att själv smittas och smitta andra, en positiv utveckling. 2. Nya utmaningar; skyddsutrustning som skydd och hinder, osäkerhet vid triageringen av patienter, en konstant etisk stress. 3. Vikten av stöd; från familj, från kollegor och organisation. Slutsatser: Sjuksköterskors arbete på akutmottagningen under covid-19 pandemin var såväl psykiskt som fysiskt påfrestande då de ställdes inför många oförutsägbara utmaningar. De fick en ökad arbetsbörda till följd av bristande kunskap i relation till en helt främmande situation, användning av skyddsutrustning samt en rädsla för att smitta och bli smittade. De stod även inför nya etiska dilemman där deras yrkeskunnande och yrkesansvar ställdes på prov

A phenomenological analysis of the experience of taking medication to prevent a further heart attack

Background Following an acute myocardial infarction, patients are prescribed a regime of cardio-protective medication to prevent recurrent cardiovascular events and mortality. Adherence to medication is poor in this patient group, and not fully understood. Current interventions have made limited improvements but are based upon presumed principles. Aim To describe the phenomenon of medicine-taking for an individual taking medication for secondary prevention for an AMI. Method Interpretative Phenomenological Analysis was used to analyse transcripts of semi-structured interviews with participants. Themes were generated for each participant, then summarised across participants. Results Five key themes were produced; the participants needed to compare themselves to others, showed that knowledge of their medicines was important to them, discussed how the future was an unknown entity for them, had assimilated their medicines into their lives, and expressed how an upset to their routine reduced their ability to take medication. Conclusion Participants described complex factors and personal adaptations to taking their medication. This suggests that a patient-centred approach is appropriate for adherence work, and these themes could inform clinical practice to better support patients in their medicine adherence

Priority setting for health in the context of devolution in Kenya: implications for health equity and community-based primary care

Devolution changes the locus of power within a country from central to sub-national levels. In 2013, Kenya devolved health and other services from central government to 47 new sub-national governments (known as counties). This transition seeks to strengthen democracy and accountability, increase community participation, improve efficiency and reduce inequities. With changing responsibilities and power following devolution reforms, comes the need for priority-setting at the new county level. Priority-setting arises as a consequence of the needs and demand for healthcare resources exceeding the resources available, resulting in the need for some means of choosing between competing demands. We sought to explore the impact of devolution on priority-setting for health equity and community health services. We conducted key informant and in-depth interviews with health policymakers, health providers and politicians from 10 counties (n = 269 individuals) and 14 focus group discussions with community members based in 2 counties (n = 146 individuals). Qualitative data were analysed using the framework approach. We found Kenya’s devolution reforms were driven by the need to demonstrate responsiveness to county contexts, with positive ramifications for health equity in previously neglected counties. The rapidity of the process, however, combined with limited technical capacity and guidance has meant that decision-making and prioritization have been captured and distorted for political and power interests. Less visible community health services that focus on health promotion, disease prevention and referral have been neglected within the prioritization process in favour of more tangible curative health services. The rapid transition in power carries a degree of risk of not meeting stated objectives. As Kenya moves forward, decision-makers need to address the community health gap and lay down institutional structures, processes and norms which promote health equity for all Kenyans

Exploring Cybersecurity Education at the K-12 Level

K-12 cybersecurity education is receiving growing attention with the growing number of cyberattacks and a shortage of cybersecurity professionals. However, there are many barriers for teachers to implement effective cybersecurity education in formal classroom environments. This study conducts a systematic literature review to examine the current state-of-the-art on K-12 cybersecurity education. Through the systematic literature review, we identified 20 closely relevant papers and recognized that a well-designed curriculum in cybersecurity education at the K-12 level is strongly needed to motivate students to pursue cybersecurity pathways and careers. The challenge and suggestions of curriculum design, teaching strategy, and learning assessment are summarized and discussed