Best Practices for Improving Blended Learning in Nigeria: Critical Reflections on the Breast Cancer Clinical Pathway Development Course

Although cancer clinical pathways (CPs) are standardized care plans for the treatment of specific cancers, they are not commonly used in Nigerian hospitals. Many Nigerian clinicians do not have the requisite skill for developing and implementing the use of CPs. Critical reflections provide an important perspective in the philosophy, design, implementation, and outcome of interventions. This paper critically reflects on the design and implementation of a multidisciplinary, blended learning (i.e. online and in-person) course which sought to improve the competence of local doctors, nurses, and allied students in developing clinical pathways. Reflective feedback was obtained from a mix of project designers (n=4) and participants (n=3). The group critically analyzed the project planning and implementation in comparison with best practices. The analysis considered the design of the online course, the distribution of learners, the conduct of the in-person workshops, and the overall evaluation of the educational intervention. Positive aspects of the online learning included the unique design of the green-themed PowerPoint slides and the vibrant discussions through a WhatsApp group. Poor internet services in many parts of Nigeria affected synchronous online discussions that were conducted on Google Meet. The in-person workshops at the three locations enjoyed great community support, especially because the course provided free cancer screening. Future courses should emphasize asynchronous models while ensuring that online tools that allow for low bandwidth are used for synchronous meetings. Community involvement must be emphasized during the planning of blended learning courses in which participants would need healthy volunteers to practice skills. The use of multidisciplinary teams for the planning and implementation of courses should be the standard of practic

PERFORMANCE OF WEANED RABBIT FED GRADED LEVELS OF AFRICAN YAMBEAN IN CASSAVA PEEL MEAL BASED DIETS.

The effect of feeding varying levels of African yambean in cassava peal meal based diet was evaluated in a 12 week feeding trial. Thirty two (32) New Zealand white x Chinchilla crossbred weaned rabbits of about 8 weeks old mixed sexes were randomly divided into 4 treatment groups of 8 rabbits each in a completely randomized design. They were allotted to 4 different diets as follows: African yambean based diets, T1 (control 0%), T2 (10%), T3 (20%) and T4 (30%). The rabbits were housed individually in cages and supplied daily with feed and water ad-libitum under a mixed feeding regime where Ipomea batatas leaves was used as forage supplement. Results obtained from this study showed highly significant difference (P<0.05) in body weight gain, feed intake and feed conversion ratio. Results reveal the inclusion of African yambean up to 20% as protein source in cassava peel meal based diets for weaned rabbits without any adverse effect on performance

Reduced fractalkine levels lead to striatal synaptic plasticity deficits in Huntington's disease

Huntington's disease (HD) is an inherited neurodegenerative disorder in which the striatum is the most affected brain region. Although a chronic inflammatory microglial reaction that amplifies disease progression has been described in HD patients, some murine models develop symptoms without inflammatory microglial activation. Thus, dysfunction of non-inflammatory microglial activity could also contribute to the early HD pathological process. Here, we show the involvement of microglia and particularly fractalkine signaling in the striatal synaptic dysfunction of R6/1 mice. We found reduced fractalkine gene expression and protein concentration in R6/1 striata from 8 to 20 weeks of age. Consistently, we also observed a down-regulation of fractalkine levels in the putamen of HD patients and in HD patient hiPSC-derived neurons. Automated cell morphology analysis showed a non-inflammatory ramified microglia in the striatum of R6/1 mice. However, we found increased PSD-95-positive puncta inside microglia, indicative of synaptic pruning, before HD motor symptoms start to manifest. Indeed, microglia appeared to be essential for striatal synaptic function, as the inhibition of microglial activity with minocycline impaired the induction of corticostriatal long-term depression (LTD) in wild-type mice. Notably, fractalkine administration restored impaired corticostriatal LTD in R6/1 mice. Our results unveil a role for fractalkine-dependent neuron-microglia interactions in the early striatal synaptic dysfunction characteristic of HD

Identification of PKD1L1 Gene Variants in Children with the Biliary Atresia Splenic Malformation Syndrome

Biliary atresia (BA) is the most common cause of end‐stage liver disease in children and the primary indication for pediatric liver transplantation, yet underlying etiologies remain unknown. Approximately 10% of infants affected by BA exhibit various laterality defects (heterotaxy) including splenic abnormalities and complex cardiac malformations — a distinctive subgroup commonly referred to as the biliary atresia splenic malformation (BASM) syndrome. We hypothesized that genetic factors linking laterality features with the etiopathogenesis of BA in BASM patients could be identified through whole exome sequencing (WES) of an affected cohort. DNA specimens from 67 BASM subjects, including 58 patient‐parent trios, from the NIDDK‐supported Childhood Liver Disease Research Network (ChiLDReN) underwent WES. Candidate gene variants derived from a pre‐specified set of 2,016 genes associated with ciliary dysgenesis and/or dysfunction or cholestasis were prioritized according to pathogenicity, population frequency, and mode of inheritance. Five BASM subjects harbored rare and potentially deleterious bi‐allelic variants in polycystin 1‐like 1, PKD1L1, a gene associated with ciliary calcium signaling and embryonic laterality determination in fish, mice and humans. Heterozygous PKD1L1 variants were found in 3 additional subjects. Immunohistochemical analysis of liver from the one BASM subject available revealed decreased PKD1L1 expression in bile duct epithelium when compared to normal livers and livers affected by other non‐cholestatic diseases. Conclusion WES identified bi‐allelic and heterozygous PKD1L1 variants of interest in 8 BASM subjects from the ChiLDReN dataset. The dual roles for PKD1L1 in laterality determination and ciliary function suggest that PKD1L1 is a new, biologically plausible, cholangiocyte‐expressed candidate gene for the BASM syndrome

Increasing health worker capacity through distance learning: a comprehensive review of programmes in Tanzania

<p>Abstract</p> <p>Background</p> <p>Tanzania, like many developing countries, faces a crisis in human resources for health. The government has looked for ways to increase the number and skills of health workers, including using distance learning in their training. In 2008, the authors reviewed and assessed the country's current distance learning programmes for health care workers, as well as those in countries with similar human resource challenges, to determine the feasibility of distance learning to meet the need of an increased and more skilled health workforce.</p> <p>Methods</p> <p>Data were collected from 25 distance learning programmes at health training institutions, universities, and non-governmental organizations throughout the country from May to August 2008. Methods included internet research; desk review; telephone, email and mail-in surveys; on-site observations; interviews with programme managers, instructors, students, information technology specialists, preceptors, health care workers and Ministry of Health and Social Welfare representatives; and a focus group with national HIV/AIDS care and treatment organizations.</p> <p>Results</p> <p>Challenges include lack of guidelines for administrators, instructors and preceptors of distance learning programmes regarding roles and responsibilities; absence of competencies for clinical components of curricula; and technological constraints such as lack of access to computers and to the internet. Insufficient funding resulted in personnel shortages, lack of appropriate training for personnel, and lack of materials for students.</p> <p>Nonetheless, current and prospective students expressed overwhelming enthusiasm for scale-up of distance learning because of the unique financial and social benefits offered by these programs. Participants were retained as employees in their health care facilities, and remained in their communities and supported their families while advancing their careers. Space in health training institutions was freed up for new students entering in-residence pre-service training.</p> <p>Conclusions</p> <p>A blended print-based distance learning model is most feasible at the national level due to current resource and infrastructure constraints. With an increase in staffing; improvement of infrastructure, coordination and curricula; and decentralization to the zonal or district level, distance learning can be an effective method to increase both the skills and the numbers of qualified health care workers capable of meeting the health care needs of the Tanzanian population.</p

Half the story: Thermal effects on within-host infectious disease progression in a warming climate

Immune defense is temperature dependent in cold-blooded vertebrates (CBVs) and thus directly impacted by global warming. We examined whether immunity and within-host infectious disease progression are altered in CBVs under realistic climate warming in a seasonal mid-latitude setting. Going further, we also examined how large thermal effects are in relation to the effects of other environmental variation in such a setting (critical to our ability to project infectious disease dynamics from thermal relationships alone). We employed the three-spined stickleback and three ecologically relevant parasite infections as a “wild” model. To generate a realistic climatic warming scenario we used naturalistic outdoors mesocosms with precise temperature control. We also conducted laboratory experiments to estimate thermal effects on immunity and within-host infectious disease progression under controlled conditions. As experimental readouts we measured disease progression for the parasites and expression in 14 immune-associated genes (providing insight into immunophenotypic responses). Our mesocosm experiment demonstrated significant perturbation due to modest warming (+2°C), altering the magnitude and phenology of disease. Our laboratory experiments demonstrated substantial thermal effects. Prevailing thermal effects were more important than lagged thermal effects and disease progression increased or decreased in severity with increasing temperature in an infection-specific way. Combining laboratory-determined thermal effects with our mesocosm data, we used inverse modeling to partition seasonal variation in Saprolegnia disease progression into a thermal effect and a latent immunocompetence effect (driven by nonthermal environmental variation and correlating with immune gene expression). The immunocompetence effect was large, accounting for at least as much variation in Saprolegnia disease as the thermal effect. This suggests that managers of CBV populations in variable environments may not be able to reliably project infectious disease risk from thermal data alone. Nevertheless, such projections would be improved by primarily considering prevailing thermal effects in the case of within-host disease and by incorporating validated measures of immunocompetence

Emirati women do not shy away from competition: evidence from a patriarchal society in transition

We explore gender attitudes towards competition in the United Arab Emirates—a traditionally patriarchal society which in recent times has adopted numerous policies to empower women and promote their role in the labor force. The experimental treatments vary whether individuals compete in single-sex or mixed-sex groups. In contrast to previous studies, women in our sample are not less willing to compete than men. In fact, once we control for individual performance, Emirati women are more likely to select into competition. Our analysis shows that neither women nor men shy away from competition, and both compete more than what would be optimal in monetary terms as the fraction of men in their group increases. We offer a detailed survey of the literature and discuss possible reasons for the lack of gender differences in our experiment

Exploring Barriers and Opportunities in Adopting Crowdsourcing Based New Product Development in Manufacturing SMEs

Crowdsourcing is an innovative business practice of obtaining needed services, ideas, or content or even funds by soliciting contributions from a large group of people (the ‘Crowd’). The potential benefits of utilizing crowdsourcing in product design are well-documented, but little research exists on what are the barriers and opportunities in adopting crowdsourcing in new product development (NPD) of manufacturing SMEs. In order to answer the above questions, a Proof of Market study is carried out on crowdsourcing-based product design under an Innovate UK funded Smart project, which aims at identifying the needs, challenges and future development opportunities associated with adopting crowdsourcing strategies for NPD. The research findings from this study are reported here and can be used to guide future development of crowdsourcing-based collaborative design methods and tools and provide some practical references for industry to adopt this new and emerging collaborative design method in their business

Variability in Isotope Discrimination Factors in Coral Reef Fishes: Implications for Diet and Food Web Reconstruction

Interpretation of stable isotope ratios of carbon and nitrogen (δ13C and δ15N) is generally based on the assumption that with each trophic level there is a constant enrichment in the heavier isotope, leading to diet-tissue discrimination factors of 3.4‰ for 15N (ΔN) and ∼0.5‰ for 13C (ΔC). Diet-tissue discrimination factors determined from paired tissue and gut samples taken from 152 individuals from 26 fish species at Ningaloo Reef, Western Australia demonstrate a large amount of variability around constant values. While caution is necessary in using gut contents to represent diet due to the potential for high temporal variability, there were significant effects of trophic position and season that may also lead to variability in ΔN under natural conditions. Nitrogen enrichment increased significantly at higher trophic levels (higher tissue δ15N), with significantly higher ΔN in carnivorous species. Changes in diet led to significant changes in ΔN, but not tissue δ15N, between seasons for several species: Acanthurus triostegus, Chromis viridis, Parupeneus signatus and Pomacentrus moluccensis. These results confirm that the use of meta-analysis averages for ΔN is likely to be inappropriate for accurately determining diets and trophic relationships using tissue stable isotope ratios. Where feasible, discrimination factors should be directly quantified for each species and trophic link in question, acknowledging the potential for significant variation away from meta-analysis averages and, perhaps, controlled laboratory diets and conditions

The ‘heritagisation’ of the British seaside resort: The rise of the ‘old penny’ arcade.

Amusement arcades have long been a key component of the British seaside resort. For almost a century, they enjoyed popularity and success and became established as a quintessential feature of the British seaside holiday. However, the advent of home-based video games along with recent gambling legislation has led to a decline of the seaside amusement arcade sector. Arcades gained a reputation as unsavoury places and their appearance and fortunes often mirrored those of the resorts in which they were located. However, over the past decade, a new variant of the seaside amusement arcade has appeared, featuring mechanical machines working on pre-decimal currency. Such ‘old penny arcades’ frequently describe themselves as museums or heritage centres and they offer an experience based on a nostalgic affection for the ‘traditional’ seaside holiday. They have appeared in the context of an increasing interest in the heritage of the British seaside resort and constitute one element of the ‘heritagisation’ of such resorts. This paper argues that such arcades can be important elements of strategies to reposition and rebrand resorts for the heritage tourism market