Post-colonialism: Informing Adult Education Research in Developing Countries

Adult education in post-independence developing countries resides within the context of national and local conditions which are connected to the legacy of colonialism. Adult education has been an integral part of development and decolonization in these countries and post-colonialism provides a valuable theoretical frame for adult education researchers working in these contexts

The Investigation of Hospital Staphylococcus Outbreaks by Phage Typing

1. The method of phage typing Staphylococcus aureus has been described in detail together with some of the difficulties which are encountered in the setting up of a phage typing laboratory. 2. Differences in the percentage frequency distribution of phage types isolated from infections in surgical and general wards, in maternity units, and in outpatients are discussed. 3. Phage typing was used to investigate in some detail the epidemiology of outbreaks of staphylococcal infection in 3 surgical units and in a maternity hospital. 4. In the surgical units, most cases of wound infection had been acquired in the operating theatre, but in one outbreak there was some evidence that contamination with staphylococci in the wards prior to operation was probably responsible for a number of these. 5. The development of outbreaks of infection was found to be determined either by the infectivity of the infecting organism, by the wounds being exposed to an unusually dangerous source of organisms in which their natural infectivity is increased, or by the organisms having access to the wounds by a particularly dangerous route of inoculation. 6. Type 80 is a staphylococcal strain of exceptional infectivity. It showed a marked tendency to establish itself rapidly as a predominant cause of widespread infections. In one outbreak it caused frequent septic lesions other than wound infections. It did not cause unusually severe infections in the surgical units. 7. Active lesions were the most dangerous sources of staphylococci, and there was evidence that organisms derived from them were more infective than those from healthy carriers. The presence of infected patients in the wards was considered to have been an important factor in the spread of the epidemics. 8. Wounds are particularly susceptible to infection during operation and direct contact with organisms from a surgeon's hands is probably the most dangerous route of infection. 9. Most outbreaks of wound infection could be prevented if all those suffering from active lesions, whether patients or members of staff, were isolated from the operating theatre and wards. 10. In the epidemic in the maternity hospital, the main sources of infection were the infants themselves and the infection spread from infant to infant. 11. Newborn infants, particularly if they are ill or premature, are unusually susceptible to staphylococcal infection, but the epidemic was primarily determined not by this, but by the appearance of the highly infective type 80 among them. 12. Type 80 in the maternity hospital showed a marked ability to cause severe and sometimes fatal disease and to spread rapidly as the predominant infecting strain. The high case incidence of severe disease was probably due to the greater susceptibility of neonatal infants to staphylococcal infection as compared to adults. It had low powers of colonisation --- in the noses of the nurses and in the hospital environment generally. 13. A considerable amount of infection due to staphylococci acquired in the maternity hospital was discovered only after the infants had been discharged home. 14. Conditions in most maternity hospitals, where babies are congregated into small nurseries or open wards, are held to be largely responsible for the high incidence of staphylococcal disease there and for the appearance of outbreaks of of infection from time to time. 15. The spread of staphylococci from infant to infant and the consequent danger of the outbreak of serious infection could probably be prevented if babies were nursed beside their mothers in separate rooms. 16. Hospital staphylococcal outbreaks could be prevented by using the methods by which we successfully control other infectious diseases

Can we put the poverty of aspirations myth to bed now?

This briefing paper uses responses from parents and children in the birth cohort study Growing Up in Scotland1 to dispel the myth of the ‘poverty of aspiration’ widely used in education and policy circles in Scotland and beyond

Actions to prevent and mitigate child poverty at the local level

This review presents evidence to support local authorities and Community Planning Partnerships (CPP) to: 1. Identify factors that may mitigate the effects of child poverty. 2. Make suggestions on how the local authority can act to prevent child poverty occurring. 3. Identify early trigger signs that may suggest an increased risk of poverty. These three issues are explored for families through pregnancy, in the child’s early years and in the primary school years, under the themes: income maximisation, education and childcare. A fourth theme, lone parenthood, will be explored as a stand-alone cross-cutting theme

No Margin for Error: A Study of Two Women Balancing Motherhood and Ph.D. Studies

This cogenerative ethnography explored the lived experiences of two graduate students balancing Ph.D. studies and motherhood through McClusky’s (1963) Theory of Margi n. Specifically, we asked ourselves: What impact does pregnancy have on personal and academic selves and how are multiple roles and responsibilities managed? Through an analysis of dialogues, artifacts, conceptual maps, and narratives, examples of internal and external lo ad revealed the dynamic nature of the female experiences in graduate school. Excerpts from the data showed how roles, relationships, and experiences are characterized and how similar or different those example s were, given individual context. Implications of this research for students, faculty, and higher education policy are explored

A 'pockets' approach to addressing financial vulnerability

This briefing paper outlines recent evidence on financial vulnerability among families in Scotland, and draws on the Healthier, Wealthier Children case study as an example of action that could help families both at risk of, and experiencing, poverty

Obstetric and long-term kidney outcomes in renal transplant recipients: a 40 year single-centre study

Female renal transplant recipients of childbearing age may ask what the outcomes are for pregnancy and whether pregnancy will affect graft function. We analyzed obstetric and transplant outcomes among renal transplant recipients in our center who have been pregnant between 1973 and 2013. A case−cohort study was performed identifying 83 pairs of pregnant and non-pregnant controls matched for sex, age, transplant vintage, and creatinine. There were 138 pregnancies reported from 89 renal transplant recipients. There were live births in 74% of pregnancies with high prevalence of prematurity (61%), low birth weight (52%), and pre-eclampsia (14%). Lower eGFR (OR 0.98; p = 0.05) and higher uPCR (OR 1.86; p = 0.02) at conception were independent predictors for poor composite obstetric outcome. Lower eGFR (OR 0.98; p = 0.04), higher uPCR (OR 1.50; p = 0.04), and live organ donation (OR 0.35; p = 0.02) were predictors of ≥20% loss of eGFR between immediately pre-pregnancy and one yr after delivery. There was no difference in eGFR at one, five, and 10 yr in pregnant women compared with non-pregnant controls and a pregnancy was not associated with poorer 10-yr transplant or 20-yr patient survival. Despite high rates of obstetric complications, most women had successful pregnancies with good long-term transplant function

Development and evaluation of a novel interprofessional learning activity addressing the management of phenylketonuria.

This new initiative across the School of Pharmacy and Life Sciences at Robert Gordon University focuses around students from the Overseas Pharmacist's Assessment Programme (OSPAP), and third-year Nutrition and Dietetics students working in an interprofessional setting to manage the care of individuals with Phenylketonuria (PKU). A problem-based learning approach was employed, which involved small-group interprofessional working to solve a series of simulated case studies concerned with the management of phenylketonuria. The session was further enhanced by an expert patient narrative and the opportunity to test a series of commercially-available low protein/low phenylalanine food substitutes, which are used in the disease management. The substitutes were provided by SHS-Nutricia and Vitaflo. Group evaluation of the activity was generally positive, with all groups indicating that the learning objectives had been achieved in a setting that promoted collaborative interprofessional working, acquisition of knowledge pertaining to the management of PKU, and a format that enabled a breadth and depth of material to be covered in a relatively short time. The contributions of the expert patient and availability of test samples enhanced the interactivity of the session, and provided a meaningful insight into the lived experience of PKU patients. Limitations of the session included the rather narrow range of healthcare professional students involved in the activity and the need for better signposting of preparatory reading material. Planned future developments of this initiative aim to involve health visiting, biomedical science and social work students, in order to enable consideration of a more holistic approach to the health and social care issues of PKU. Additionally, future developments include the creation of an Articulate quiz activity for student self-evaluation, prior to the event. In conclusion, this initiative addressed the six learning objectives in an interactive manner, receiving positive learner feedback and having a clear strategy for future development

The feasibility of a single-blinded fast-track pragmatic randomised controlled trial of a complex intervention for breathlessness in advanced disease.

BACKGROUND: The Breathlessness Intervention Service is a novel service for patients with intractable breathlessness regardless of aetiology. It is being evaluated using the Medical Research Council's framework for the evaluation of complex interventions. This paper describes the feasibility results of Phase II: a single-blinded fast-track pragmatic randomised controlled trial. METHODS: A single-blinded fast-track pragmatic randomised controlled trial was conducted for patients with chronic obstructive pulmonary disease referred to the service. Patients were randomised to either receive the intervention immediately for an eight-week period, or receive the intervention after an eight-week period on a waiting list during which time they received standard care. Outcomes examined included: response rates to the trial; response rates to the individual questionnaires and items; comments relating to the trial functioning made during interviews with patients, carers, referrers and service providers; and, researcher fieldwork notes. RESULTS: 16 of the 20 eligible patients agreed to participate in a recruitment visit (16/20); 14 respondents went on to complete a recruitment visit/baseline interview. The majority of those who completed a recruitment visit/baseline interview completed the RCT protocol (13/14); 12 of their carers were recruited and completed the protocol. An unblinding rate of 6/25 respondents (patients and carers) was identified. Missing data were minimal and only one patient was lost to follow up. The fast-track trial methodology proved feasible and acceptable. Two of the baseline/outcome measures proved unsuitable: the WHO performance scale and the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW). CONCLUSION: This study adds to the evidence that fast-track randomised controlled trials are feasible and acceptable in evaluations of palliative care interventions for patients with non-malignant conditions. Reasonable response rates and low attrition rates were achieved. Further, with adequate preparation of the research and randomisation teams, clinicians, and responders, and effective liaison with the clinicians, single-blinding proved possible. Methods were identified to reduce unblinding through careful attention to the type of data collected at unblinded measurement points; the content of interviews should be carefully considered when designing blinded-trial protocols. TRIAL REGISTRATION: Clinical Trials.gov NCT00711438.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Constraint-Induced aphasia therapy: Three single case studies.

TITLE OF POSTER: CONSTRAINT INDUCED APHASIA THERAPY - THREE SINGLE CASE STUDIES INTRODUCTION This research project was inspired by the Specific Interest Group in Aphasia study day given by Professor Pulvermuller in January 2011. Constraint Induced Aphasia Therapy (CIAT) is sometimes referred to as Intensive Language Action Therapy (ILAT). This technique has an impressive research base to support its use for people with aphasia (PWA) and the evidence base includes both single case and randomised control trial evidence (Pulvermuller, Neininger, Elbert, Mohr, Rockstroh, Koebbl & Taub, 2001). Pulvermuller et al (2001) describe CIAT as a game of pairs. The game is normally played by four players: a therapist and three PWA. A 32 pack of cards consisting of 16 pairs is shuffled and divided equally between the four players. No one can see anyone else’s cards. The aim of the game is to win the most pairs of cards. Clients can win a pair by asking each of the other players in turn, for a matching card. All requests and responses should be verbal but participants may describe the target word or use a gesture in order to achieve saying the word. An essential part of the game is that each player should see and hear the name of the card in play. RESEARCH METHOD Three PWA were prioritised from a typical general hospital SLT caseload. All three clients were one to two years post onset of their aphasia and had already been provided with impairment focussed, functional and psychosocial SLT input. They had moderate to severe aphasia, had difficulties at several levels of single word processing and frequently failed to convey their message despite having a degree of linguistic competence and an ability to use alternative communication strategies. Accessible formal assessment measures (Kaplan, Goodglass & Weintraub 1983, Goodglass, Kaplan & Barresi 2000 & Swinburn, Porter & Howard 2004) were used to evaluate the success of therapy in a four step repeated measures research design: Baseline 1, 30 hours CIAT therapy, Baseline 2, Baseline 3. SUMMARY OF RESULTS For 2/3 clients, assessment results suggested that participation in the CIAT programme resulted in a positive measurable change in language behaviour. This positive change was not apparent in assessments of understanding. Selective improvement of language ability suggests that the therapy directed at language output had resulted in improved word and sentence level skills for 2/3 of our clients. There were also positive changes that were not captured by the assessment data: reduced use of written and therapist cues, improved repetition skills, improved self-monitoring and a reduced tendency to produce jargon type utterances. Relatives corroborated therapist perceptions. CONCLUSIONS In 2006 Beeson & Robey (2006, p162) proposed that rehabilitation outcome research should be conducted in five phases. Our study is one of the first to provide evidence to support the use of intensive CIAT therapy in the community (phase 4 – an effectiveness study). Other studies have assessed the usefulness of the therapeutic effect of ILAT (phase 1), optimised the ILAT procedure (phase 2) and tested its usefulness under ideal conditions (phase 3). The final phase outlined by Beeson & Robey (2006) is the cost-benefit analysis (phase 5) and we would welcome debate within the profession on improving this type of input and the role of Speech and Language Therapists in intensive aphasia therapy provision. REFERENCES Pulvermuller, F., Neininger, B., Elbert, T., Mohr, B., Rockstroh, B., Koebbl,P. & Taub, E. (2001) Constraint induced therapy for chronic aphasia after stroke. Stroke, 1621-1626. Beeson, P. M. & Robey, R.R. (2006) Evaluating single-subject treatment research: Lessons learnt from the aphasia literature. Neuropsychological Review, 16, 161-169. KAPLAN, E., GOODGLASS, H. and WEINTRAUB, S. (1983) The Boston Naming Test. Philadelphia: Lea and Febiger. Goodglass, H., Kaplan, E. & Barresi, B. (2000) Boston Diagnostic Aphasia Examination. 3rd Edition. San Antonio: Pearson. Swinburn, K., Porter, G., & Howard, D. (2004). The Comprehensive Aphasia Test. Hove: Psychology Press