Curriculum Review: Kiribati Institute of Technology Diploma of Nursing

In Kiribati, as in all PICs, a robust and high-quality nursing workforce constitutes the backbone to the country’s health service. Nurses require broad skills and abilities, as autonomous practitioners serving on the front lines of health provision, and as members of a multi-disciplinary team. Nurse education is provided by the School of Nursing and Health (SONH) at the Kiribati Institute of Technology (KIT), mainly under its core Kiribati Diploma of Nursing program. Midwifery education is also provided by SONH and undertaken by Registered Nurses as an 18 month, postgraduate qualification. The curriculum for the Diploma program currently being taught in Kiribati was imported many years ago from New Zealand, and there is recognition that it needs to be updated and contexualised for unique Kiribati needs. The Government of Kiribati receives assistance from New Zealand to examine the relevance and quality of the Diploma of Nursing curriculum in relation to the specific health challenges, needs, plans, identified gaps and workforce requirements in Kiribati. The vision, health goals and targets for Kiribati’s health service delivery are outlined in the Kiribati Ministry of Health Strategic Plan 2016-2019, the Kiribati Development Plan 2016-2019 (KDP) and the Kiribati 20-Year Vision 2020-36 (KV20). This review fits with the Kiribati strategic objective to address gaps in health service delivery and strengthen the pillars of the health system. It also considers opportunities and pathways for Kiribati nurses under the strategic aim of promoting the employability of Kiribati nursing graduates nationally and providing a standard of training that prepares students to enter the international workforce. Wintec was contracted by New Zealand Ministry of Foreign Affairs and Trade (MFAT) to carry out the review in 2017. Appropriate supporting documents were made available to provide important contextual information on the special character of Kiribati’s situation as a nation, its current health challenges and goals, the healthcare system, the nursing workforce and the current nursing program. During September 2017, a team of three experts from New Zealand and Australia undertook a series of consultative and participatory meetings with relevant people in Kiribati, including from SONH, KIT, Government Ministries, Nursing Council and health sector service providers. A draft report describing their analysis and findings from those meetings was presented to involved stakeholders in Kiribati in November (see Appendix 2 for schedule of meetings), and feedback from those stakeholder meetings has been incorporated into this final version of the report. The reviewers took a holistic approach to the Terms of Reference that went beyond a narrow focus on only the existing Diploma program curriculum to adequately address wider priorities of concern. They identified 28 specific recommendations that are fully detailed in this report; only the most significant findings are outlined in this summary. The overall aim of the new Diploma curriculum should be to provide a course of study that leads to registration with the KNC and to enable novice nurses to capably function in a broad range of clinical contexts specific to Kiribati needs and priorities. It is important the curriculum incorporates the specific local geographic and demographic elements and reflects the unique i-Kiribati cultural values pertinent to effective local health service delivery. Career extension pathways for specific local health needs, such as midwifery, Public Health and specialized care can be provided as additional local courses, where feasible, or internationally where more appropriate due to budgetary and capability constraints. A stronger focus on Primary Health Care and health promotion is required, which will help address serious concerns over the increasing prevalence of Non-Communicable Diseases (NCDs) such as diabetes, cardiovascular and respiratory deseases. To produce a contemporary, locally appropriate curriculum the development must be owned ‘in country’ and involve all key stakeholders, a process that can be informed and guided by external technical experts and internationally available standards, curricula and resources (such as the WHO global standards for the initial education of professional nurses and midwives). A curriculum review working group with representatives from key stakeholders would lead this process. The international support integrated into this locally owned process would assist program articulation to quality frameworks, such as the Pacific Qualifications Framework (PQF), and ensure any Kiribati Quality or Competency Framework is underpinned by a robust quality assurance system that informs institutional internal quality management systems, accreditation and audits. Doing this will also enhance transfer of credit opportunities to facilitate international opportunities in nursing-related roles elsewhere. This report contains some analysis of nursing workforce trends and potential migrant work opportunities in Fiji, New Zealand and Australia. A refreshed, contemporary curriculum would include maximizing the use of available IT infrastructure to promote blended learning approaches, increase student engagement and improve the student experience. Utilizing practicing RNs as sessional or guest tutors and lecturers would further enhance the relationship between SONH and its clinical partners, provide opportunities for clinicians to share their knowledge and expertise with students, and augment the teaching role of Registered Nurses. The provision by KIT of English language training courses, and re-location of the SONH from its current site to the KIT facility at Betio will realise cost savings through increased usage and consolidation of teaching spaces, administration, IT infrastructure and teaching personnel. Sharing facilities with other KIT programs, developing affordable and sustainable clinical simulation and library facilities and ensuring adequate workforce planning and underpinning support systems are all important processes to consider in association with the Review - KIT Diploma in Nursing Final Report 1 December 2017 5 curriculum review. It is important to note that in 2017, KIT received provisional accreditation from the Educational Quality and Assessment Programme (EQAP) of the Secretariat of the Pacific Community (SPC) and KIT-SONH facility improvement and consolidation will be vital in securing full accreditation with this body. A coordinated approach to achieving these aims is essential, driven by local Kiribati leaders and supported by ongoing technical assistance from donor partners. Improving the quality of health services and the care rovided to Kiribati people is at the heart of this review process. The team have listened carefully and sought to accurately capture the voices of the many individuals and groups with whom we have engaged and we trust that this is reflected within this report

Morphometrics of the resting eggs of the fairy shrimp Branchinella in Australia (Anostraca: Thamnocephalidae)

Branchinella resting eggs are characterised by having surface ridges arranged more or less in polygons and by almost all species having few, if any, spines. The eggs of 33 out of a known possible 40 species (including 4 out of 6 undescribed species) were studied by SEM. A few species are distinctive by being adorned with lighter coloured surface membranes often strengthened by ribs or sparse spines and one (B.longirostris) is regularly spinose. Those species known to be morphological variable also have variable egg morphologies. This makes it difficult to characterise specific egg morphology, but even so in some species eggs are distinct : B. arborea, B. australiensis, B. budjiti, B. compacta, B. complexidigitata, B. hattahensis, B. kadjikadji, B. longirostris, B. lyrifera, B. occidentalis, B. pinderi and B. vosperi. Most of the remainder are easily confused with at least one or more species. Branchinella egg morphology seems of little value in taxonomical studies and of restricted use in distinguishing eggs in dried sediments

Parent support advisor pilot : first interim report from the evaluation

The Parent Support Adviser (PSA) pilot is a government funded initiative to support 20 Local Authorities (LAs) to introduce PSAs into their workforce. The Department for Children, Schools and Families (DCSF) commissioned the Centre for Educational Development, Appraisal and Research (CEDAR) to evaluate the PSA pilot programme from September 2006 – August 2008. A government grant (£40 million) has been made available to fund employment of PSAs over this period. To date, 717 PSAs are in place, supporting parents in 1167 schools. This first Interim Report is based on semi-structured interviews with 97 PSAs, 85 line managers and 23 other professionals in 12 case study LAs during Phase 1 of the evaluation, which was carried out between April and June 2007. Phase 2 of the study will take place during the period October to December 2007; phase 3 will take place during March to June 2008. In addition to these interview-based studies with the 12 case study LAs, an analysis will be made of the data collected by all 20 LAs over the period of the pilot using a standard database devised by CEDAR. Data are being collected on the PSAs’ work with parents and, where this occurs, with children. Finally, a cost effectiveness study will be undertaken. The findings from these phases of the project will be reported in the final report

A monoclonal antibody against lymphocyte function-associated antigen-1 decreases HIV-1 replication by inducing the secretion of an antiviral soluble factor

Background: Lymphocyte Function-Associated Antigen-1 (LFA-1) likely plays a role in the pathogenesis of against HIV-1 and is known to facilitate cell-to-cell transmission of the virus. A monoclonal antibody specific for LFA-1 (Cytolin®) was evaluated as a potential therapeutic in pilot studies performed in the mid-1990s. These uncontrolled human studies suggested that administration of this anti-LFA-1 antibody to HIV-1 infected individuals could provide a modest benefit by decreasing circulating HIV-1 RNA and increasing CD4+ T cell counts. At the time, it was proposed that when bound to cytolytic T cells, the antibody inhibited lysis of activated CD4+ T cells. Given the renewed interest in monoclonal antibody therapy for HIV-1 infected individuals, we investigated possible mechanisms of action of this antibody in vitro. Methods: To assess whether this anti-LFA-1 antibody binds to HIV-1, a virus capture assay was performed. Binding of the antibody to cells was assessed using flow cytometry. Inhibition of HIV-1 replication was determined in culture by measuring the amount of p24 produced by ELISA. After co-culture of the antibody with peripheral blood mononuclear cells, supernatants were assayed for cytokines and chemokines using various immunoassays. Results: Our experiments demonstrate that anti-LFA-1 antibody binds to CCR5 and CXCR4 utilizing strains of HIV-1. It also binds to CD8+ T cells and dendritic cells. When bound to virus prior to infection, there is no decrease in HIV-1 replication, suggesting it does not directly inhibit viral replication via virus binding. When bound to cells, it does not inhibit lysis of CD4+ T cells, as was originally hypothesized. Binding to cells does appear to induce the production of a soluble factor that inhibits HIV-1 replication. We determined that this soluble factor was not any of the cytokines or chemokines with known anti-HIV-1 activity. Further, the antibody does not appear to induce any common immune modulating cytokines or chemokines. Conclusions: These results suggest that one possible mechanism of action of this anti-LFA-1 antibody is to inhibit HIV-1 replication via the production of a soluble antiviral factor that is induced upon binding to cells

Water-Rock Interactions in Outer Solar System Bodies: Evidence from the Coordinated Analysis of Interplanetary Dust

NASA has an ongoing program of collecting interplanetary dust particles (IDPs) in the stratosphere using high altitude research aircraft. The collected IDPs are derived from asteroids and comets and here we report studies of a subset of hydrated IDPs rich in carbonaceous matter that are proposed to have a cometary origin. Our studies are aimed at understanding the evolution of oxygen reservoirs in the Solar System and their interaction with cometary minerals and organic matter. The small size (<20 m) and fragility of these IDPs present a number of analytical challenges. We have pioneered techniques for performing chemical, mineralogical, isotopic, and spectroscopic measurements on the same sample in a carefully coordinated sequence. Coordinated analyses of nanogram-size samples is made possible by several delicate sample preparation techniques. To avoid organic contamination, we embed IDPs in elemental sulfur and use ultramicrotomy to partly section the particles (the first few micrometers). Multiple thin sections (50-70 nm thick) are placed on different substrates depending on the analysis technique. We use a JEOL 2500SE scanning, transmission electron microscope (STEM) to determine the mineralogy, microstructure, and elemental compositions of constituent minerals in the thin sections through a combination of high resolution imaging, electron diffraction, quantitative energy-dispersive x-ray mapping, and electron energy-loss spectroscopy. Following the STEM analyses, we use a NanoSIMS 50L for high spatial resolution isotopic measurements of H, C, N, and O to search for presolar grains and to understand the origin of the indigenous organic matter. The isotopic analyses are performed on the same sections analyzed in the STEM in order to correlate isotopic properties with the elemental and mineralogical data. We reserve other thin sections for non-destructive analyses utilizing synchrotron-based techniques including Fourier-transform infrared (FTIR) micro-spectroscopy and X-ray absorption near-edge structure (XANES) analyses, especially for functional group analysis of organic matter in the particles. The remainder of the IDP is extracted from the sulfur bead that was used for microtomy and is pressed into Au foil for quantitative analysis (including light elements) using a JEOL 8530F field emission electron probe microanalyzer (EPMA). After the EPMA measurements, high precision oxygen isotopic analyses are obtained using Cameca IMS1270/1290 instruments at UCLA. The hydrated IDPs in this study are dominated by saponitic clays, with minor magnetite, carbonate and abundant organic matter. The remarkable oxygen isotopic compositions, high carbon contents, and the abundance of isotopically anomalous organic matter, together suggest that the high carbon, hydrated IDPs are derived from primitive sources not yet represented in meteorite collections such as outer main belt P- and D-type asteroids or comets

Genetic testing and personalized ovarian cancer screening: a survey of public attitudes

Background Advances in genetic technologies are expected to make population-wide genetic testing feasible. This could provide a basis for risk stratified cancer screening; but acceptability in the target populations has not been explored. Methods We assessed attitudes to risk-stratified ovarian cancer (OC) screening based on prior genetic risk assessment using a survey design. Home-based interviews were carried out by the UK Office of National Statistics in a population-based sample of 1095 women aged 18–74. Demographic and personal correlates of attitudes to risk-stratified OC screening based on prior genetic risk assessment were determined using univariate analyses and adjusted logistic regression models. Results Full data on the key analytic questions were available for 829 respondents (mean age 46 years; 27 % ‘university educated’; 93 % ‘White’). Relatively few respondents felt they were at ‘higher’ or ‘much higher’ risk of OC than other women of their age group (7.4 %, n = 61). Most women (85 %) said they would ‘probably’ or ‘definitely’ take up OC genetic testing; which increased to 88 % if the test also informed about breast cancer risk. Almost all women (92 %) thought they would ‘probably’ or ‘definitely’ participate in risk-stratified OC screening. In multivariate logistic regression models, university level education was associated with lower anticipated uptake of genetic testing (p = 0.009), but with more positive attitudes toward risk-stratified screening (p <0.001). Perceived risk was not significantly associated with any of the outcome variables. Conclusions These findings give confidence in taking forward research on integration of novel genomic technologies into mainstream healthcare

A Transcriptional Regulatory Network of \u3cem\u3eRsv3\u3c/em\u3e-Mediated Extreme Resistance against \u3cem\u3eSoybean Mosaic Virus\u3c/em\u3e

Resistance genes are an effective means for disease control in plants. They predominantly function by inducing a hypersensitive reaction, which results in localized cell death restricting pathogen spread. Some resistance genes elicit an atypical response, termed extreme resistance, where resistance is not associated with a hypersensitive reaction and its standard defense responses. Unlike hypersensitive reaction, the molecular regulatory mechanism(s) underlying extreme resistance is largely unexplored. One of the few known, naturally occurring, instances of extreme resistance is resistance derived from the soybean Rsv3 gene, which confers resistance against the most virulent Soybean mosaic virus strains. To discern the regulatory mechanism underlying Rsv3-mediated extreme resistance, we generated a gene regulatory network using transcriptomic data from time course comparisons of Soybean mosaic virus-G7-inoculated resistant (L29, Rsv3-genotype) and susceptible (Williams82, rsv3-genotype) soybean cultivars. Our results show Rsv3 begins mounting a defense by 6 hpi via a complex phytohormone network, where abscisic acid, cytokinin, jasmonic acid, and salicylic acid pathways are suppressed. We identified putative regulatory interactions between transcription factors and genes in phytohormone regulatory pathways, which is consistent with the demonstrated involvement of these pathways in Rsv3-mediated resistance. One such transcription factor identified as a putative transcriptional regulator was MYC2 encoded by Glyma.07G051500. Known as a master regulator of abscisic acid and jasmonic acid signaling, MYC2 specifically recognizes the G-box motif (“CACGTG”), which was significantly enriched in our data among differentially expressed genes implicated in abscisic acid- and jasmonic acid-related activities. This suggests an important role for Glyma.07G051500 in abscisic acid- and jasmonic acid-derived defense signaling in Rsv3. Resultantly, the findings from our network offer insights into genes and biological pathways underlying the molecular defense mechanism of Rsv3-mediated extreme resistance against Soybean mosaic virus. The computational pipeline used to reconstruct the gene regulatory network in this study is freely available at https://github.com/LiLabAtVT/rsv3-network