A qualitative study of healthcare workers' and patients' perspectives on changing the model of care from outpatient to in-home for the infusion of natalizumab

This study is part of a larger project that examines the safety and clinical effectiveness, acceptability and cost effectiveness of flexible delivery of natalizumab by ambulatory care nurses for people with multiple sclerosis. Currently, people with multiple sclerosis receive natalizumab intravenous infusions through an outpatient intravenous therapy service. Using a hospital in the home model to offer people with multiple sclerosis natalizumab infusions in their own home could be an improved model of care for patients. However, no previous qualitative research has focused on healthcare workers’ and patients’ experiences of a change in the model of care from outpatients to the home for the infusion of natalizumab. This Masters by Research is by publication and includes two published studies as follows. The first stage of this study aimed to understand the experiences of people with multiple sclerosis who received infusions of natalizumab at home instead of in hospital. Returning every four weeks to an outpatient department to complete an intravenous infusion can be taxing for patients with chronic disease. This exploratory-descriptive study incorporated face-to-face digital-recorded interviews with people with multiple sclerosis. Twelve people with multiple sclerosis (two males and 10 females) aged between 18 and 56 years participated in this study. A major theme that emerged from the findings was the importance of ‘patient-centredness’, or the positive contribution of having patients at the centre of care when delivering home infusions. This encompassed three subthemes: ‘in the comfort of their own home’, ‘convenience for patients and their families’ and ‘saving time and money’. Patient-centred care was an important part of the model of care because it provided flexibility for the participants in managing their home and work–life commitments. Although home infusion therapy requires a team approach, this study found that delivering patient-centred home infusions provided significant satisfaction for people with multiple sclerosis. The second stage of this study explored healthcare workers’ experiences of delivering natalizumab infusions in a home environment. In this exploratory-descriptive inquiry, the researcher sought to gain an understanding of healthcare workers’ perspectives on the patient-centred model of care of home infusions of natalizumab. There were 12 participants from two main groups of healthcare workers who participated in delivering natalizumab infusions during the six-month study period. Four participants were from a private provider of home nursing care and eight were from a tertiary hospital ambulatory care day unit. Thematic analysis of the data identified three overarching themes: ‘preparing for change’, ‘focussing on the patient’, and ‘professional support’. Healthcare workers’ practice experience is an important component of patient-centred care during the delivery of an infusion at a patient’s home and flexible processes are required to deliver quality home care. Flexibility, communicating clearly and being willing to work in a team, especially between the hospital and the home nursing staff, were important factors in the safe delivery of infusions at home. Managing the logistics of delivering a flexible and safe home therapy service, though time consuming, was an important part of this patient-centred model of care.Thesis (MClinSc) -- University of Adelaide, Adelaide Nursing School, 202

Physics and Chemistry Teachers’ Teaching Performance Assessment in the Second Cycle Schools of Basic Education in Damascus

  The research aimed at assessing Physics and Chemistry Teachers’ Teaching Performance Assessment in the Second Cycle Schools of Basic Education in Damascus, during the second semester of the academic year 2017/2018. The study sample included (30) male and female teachers. The descriptive analytical research method was used through designing performance scorecard; and the questions were formed as follows: • What is the physics and chemistry teachers’ performance level in terms of: -            Classroom management; -            Presenting and activating lesson content using varied/differentiated and appropriate teaching methods; -            Deepening students’ scientific values; -            Training students to use the acquired knowledge functionally. - Provide students with mental skills. - Conduct the interim and final evaluation as appropriate. • Are there statistically significant differences in physics and chemistry teachers’ performance due to gender variable? 3.         Are  there a statistical difference in the performance of physics and chemistry teachers due to the variable of scientific qualification (University degree, Diploma of educational qualification( The research conclusions demonstrated that: • The conclusions of the teachers’ performance scorecard showed discrepancy in executing the items included in the scorecard. • No statistically significant differences in teachers’ performance due to gender differences. • There are statistically significant differences in teachers’ performance due to differences in degrees/ qualifications.

The possible protective effects of virgin olive oil and Nigella sativa seeds on the biochemical and histopathological changes in pancreas of hyperlipidaemic rats

Background: Hyperlipidaemia is a risk factor for the development and progression of atherosclerosis and is linked to various diseases. This study was done to evaluate the possible protective effects of virgin olive oil and Nigella sativa seeds on the biochemical and histopathological changes which occurred in the pancreas of the rats. The study lasted 8 weeks and included 24 albino rats that were divided into four groups (6 rats each); Group I — control group, fed with normal standard diet, Group II — fed with high fat diet (HFD), Group III — fed with HFD and virgin olive oil, Group IV — fed with HFD and Nigella sativa seeds powder. Materials and methods: After finishing the experiment, blood samples were collected and assessed for the lipid profile, fasting blood glucose, pancreatic amylase and insulin levels. Then, the rats were sacrificed and the pancreata were extracted and slices of them were processed for histological examination using haematoxylin stain and Masson’s trichrome stain. Small fragments from the tail of the pancreata were extracted and processed for electron microscopic examination. The statistical analysis of the data using the appropriate statistical tests was also conducted. Results: In the present study, the serum lipid profile in hyperlipidaemic rats was ameliorated in rats fed on high fat diet with virgin olive oil or Nigella sativa seed powder, which was reflected by a significant decrease in total cholesterol, low-density lipoprotein-cholesterol and triglycerides. Moreover, Nigella sativa decreased high-density lipoprotein (HDL), while virgin olive oil significantly increased HDL. Also a significant decrease in the serum levels of blood glucose and amylase and a significant increase in insulin levels were present in these groups. The histological and ultrastructural results revealed regeneration of the exocrine and endocrine parts of the pancreatic tissues from the hyperlipidaemic rats fed with virgin olive oil or Nigella sativa seeds. Conclusions: In this study, the biochemical results were paralleled to the histological and ultrastructural results; therefore, it could be concluded that virgin olive oil and Nigella sativa seeds had antihyperlipidaemic and hypoglycaemic effects and they could protect the pancreas from hyperlipidaemia-induced injury. Daily consumption of virgin olive oil and Nigella sativa seeds in the diet is highly recommended

دراسة العلاقة بين قيم التخدد وخواص المواد المشكلة للرصف المرن باستخدام النمذجة الحاسوبية

تعتبر المشاكل المرتبطة بتصدع الرصف المرن من الامور التي كانت الحلول الموضوعة لها غير كاملة على مدى عقود وذلك بسبب صعوبة ربط خواص المواد المشكّلة للرصف وسماكات الرصف وكذلك العلاقة المتبادلة بين الطبقات المتنوعة المشكلة لها خاصّة باستخدام العلاقات والطرائق التقليدية. لكن خلال العقود الماضية، تم بنجاح استخدام طرائق رياضية ومن أهمها طريقة العناصر المحددة في التحليل الدقيق لمشاكل الرصف المختلفة. في هذه الدراسة تم نمذجة وتحليل طبقات الرصف باستخدام التحليل الثنائي البعد (استخدام عناصر محددة ثنائية البعد) باستخدام برنامج الأباكوس من أجل التحقق من تأثير حمولة العجلات المتكررة على حدوث التخدد من خلال استجابة وتفاعل طبقات الرصف معها ومع الزمن.  نمذجنا طبقات رصف حقيقية بخصائص مواد مختلفة وخاضعة لأحمال مختلفة باستخدام نظريات العناصر المحددة وذلك للتنبؤ بشكل سليم بقيم التخدد ومكان حدوثها، حيث تمَّ اعتبار سلوك المواد المفككة (سلوك لدن مرن خطيّ) اعتماداً على نموذج (Drucker Prager)، أمّا بالنسبة لسلوك الطبقة الأسفلتية تم نمذجتها سلوك لدن لزج. اعتبرنا الحمولة التصميمية ضغط النفخ للإطارMPa)0.7 (مع حمولة دورية تصل إلى 100000 دورة تحميل وذلك خلال زمن قدره 100 ثانية.  تمَّ مقارنة عمق التخدد المتوقع من خلال برنامج الأباكوس مع عمق التخدد المحسوب من العلاقات التقليدية، وأظهرت النتائج أن عمق التخدد باستخدام نموذج اللدونة اللزجة للطبقة الاسفلتية يطابق عمق التخدد المحسوب بنسبة 86% لنموذج رصف متحلق جبلة، و95% بالنسبة لنموذج المتحلق الشمالي لمدينة اللاذقية، بالإضافة إلى أنّ المدد الزمنية لحدوث التخدد تتجاوز العمر التصميمي للرصف (15 سنة)

Digital dermatitis in cattle is associated with an excessive innate immune response triggered by the keratinocytes

Background: Digital Dermatitis (DD) is a common disease of dairy cows, the pathogenesis of which is still not clear. This study examined some host responses associated with the typical lesions, in an attempt to further elucidate the pathogenesis of the disease. Twenty four samples representing the 5 different clinical stages of DD (M0-M4) were collected from slaughtered cattle for histopathological and immunological analyses. Results: Significant increases in total epidermal thickness were found in M2, M3, and M4 when compared with M0 and M1. M3 samples, when compared with M0 and M1, were characterized by a significant increase in the thickness of the keratin layer. Counts of both eosinophils and neutrophils were at a maximum in the M2 stage and decreased in the M3 and M4 stage. A significant increase in IL8 expression was observed in the M2-M3 stages of the disease and immunohistochemical staining showed the source as keratinocytes, suggesting an important role for keratinocyte-derived IL8 in the pathogenesis of DD. Conclusion: Results of the present study point to a strong stimulation of the innate immune response at the level of the keratinocytes throughout most of the clinical stages, and a delayed response of the adaptive immune reaction