Implementation of Preceptorship in Ghana: “Marriage between school and clinical settings”

This research study was designed to explore roles of nursing students, preceptors and nurse educators in the implementation of preceptorship in the Ghanaian context. Preceptorship provides the opportunity for preceptors to offer practical experience to nursing students in the clinical setting. In order to provide effective clinical teaching and learning in Ghana, preceptorship was introduced in nursing education and preceptors were prepared primarily to provide clinical teaching at the clinical settings in Ghana. Ghanaian nurse educators therefore draw on preceptors to supervise students in the clinical practice setting. In Ghana, however, preceptorship is faced with challenges such as ineffective lines of communication between the nursing educational institution and the clinical settings. To date, little research has been conducted to examine preceptorship in Ghana. Focused ethnography was used to guide the current study. Purposive sampling was used to recruit 26 participants. Eight nurse educators, nine nursing students, and nine preceptors from a regional hospital and a diploma level nursing educational institution in a small city in Ghana participated in the study. The findings from this study revealed that the preceptors’ role involved predominantly teaching and the evaluation of student performance. The nurse educators supervised both students and preceptors in the clinical setting. The major roles of students included asking questions and expressing an interest to learn. In Ghana, preceptors, nursing students and nurse educators played important roles in the implementation of preceptorship. Inadequate preceptor support, lack of equipment and discrepancies during the evaluation process however, were major challenges to effective clinical teaching and learning. It is worth noting that that the use of preceptorship in this resource deprived setting is a major accomplishment. Résumé : La présente recherche a été conçue pour examiner le rôle des étudiants en soins infirmiers, des précepteurs et des infirmiers enseignants dans la mise en œuvre du préceptorat au Ghana. Le préceptorat est une occasion pour les précepteurs d’offrir une expérience pratique en milieu clinique aux étudiants en soins infirmiers. En vue d’offrir des occasions d’enseignement/ apprentissage cliniques efficaces au Ghana, le préceptorat a été mis en place dans la formation, et les précepteurs ont été préparés principalement pour l\u27enseignement clinique en milieux de santé au Ghana. Les infirmiers enseignants du Ghana font donc appel aux précepteurs pour superviser les étudiants en pratique clinique. Cependant, le préceptorat au Ghana se heurte à certains défis, notamment des canaux de communication inefficaces entre l’établissement d’enseignement et les milieux cliniques. Jusqu’à présent, peu de recherches ont été réalisées en vue d’étudier le préceptorat au Ghana. L’ethnographie centrée a été choisie pour mener la présente étude, et nous avons fait appel à l’échantillonnage intentionnel pour recruter 26 participants. Huit infirmiers enseignants, neuf étudiants et neuf précepteurs provenant d’un hôpital régional et d’un établissement d’enseignement délivrant des diplômes de soins infirmiers d’une petite ville du Ghana ont participé à l’étude. Les constats de celle-ci ont révélé que le rôle des précepteurs était principalement d’enseigner et d’évaluer le rendement des étudiants. Les infirmiers enseignants, quant à eux, supervisaient tant les étudiants que les précepteurs en milieu clinique. Enfin, les étudiants devaient poser des questions et démontrer de l’intérêt pour l\u27apprentissage. Au Ghana, les précepteurs, les étudiants et les infirmiers enseignants ont joué un rôle important dans la mise en œuvre du préceptorat. Par contre, le soutien insuffisant aux précepteurs, le manque d’équipement et les écarts durant les processus d’évaluation se sont avérés des embûches importantes à l’efficacité de l’enseignement/ apprentissage cliniques. Il convient de noter que le recours au préceptorat dans ce milieu privé de ressources est une réalisation importante

Does mainstream BRCA testing affect surgical decision-making in newly-diagnosed breast cancer patients?

Background: Germline pathogenic variants mutations) in the BRCA1 and BRCA2 genes cause an increased risk of breast cancer and ovarian cancer. Mainstream cancer genetic testing (MCG) was introduced for breast cancer patients in our unit in 2013. Non-geneticist clinicians have been trained to offer genetic testing during initial treatment planning. We assessed the impact of timely test results on surgical decision-making. Methods: Women who had undergone mainstream genetic testing for breast cancer between September 2013 and September 2018 were identified from a prospective database. Surgical data were collected retrospectively. Results: 580 eligible women had mainstream genetic testing. For 474 this was their first breast cancer diagnosis. The median age was 46 years (interquartile range (IQR) 38–57). The indications were: age ≤45 years for 233 (49%); triple negative disease for 192 women (40.5%); bilateral breast cancer age \u3c60 for 39 (8%) and other for 72 (14%) women. The median time for test initiation to result was 18 days (IQR 15-21). 302 (64% received results before surgery. 88% of those found to have a BRCA mutation before surgery opted for bilateral mastectomy (compared to 5% with BRCA wild type). An additional 106 patients had a new diagnosis on a background of previous treatment. Of these all with a pathogenic variant chose bilateral mastectomy. Conclusion: Timely BRCA gene testing influences surgeons’ and patients’ choice of surgery. It reassures women with a negative result and allows those with a positive result to take an active decision about the management of their future risk

Keeping Unwanted Gulls Away - A Progress Report

Nearly 50 years ago, wires were strung over fish ponds to discourage fish-eating birds from taking fish destined for other uses (McAtee and Piper 1936). Twenty years ago, overwiring of open ditches began on airports to keep ducks from using them and causing hazards to aircraft (Solman 1973). Both techniques used coarse wires spaced closely enough to form a physical barrier to prevent ducks and herons from landing on or taking off from the water

Does mainstream BRCA testing affect surgical decision-making in newly-diagnosed breast cancer patients?

Background: Germline pathogenic variants mutations) in the BRCA1 and BRCA2 genes cause an increased risk of breast cancer and ovarian cancer. Mainstream cancer genetic testing (MCG) was introduced for breast cancer patients in our unit in 2013. Non-geneticist clinicians have been trained to offer genetic testing during initial treatment planning. We assessed the impact of timely test results on surgical decision-making. Methods: Women who had undergone mainstream genetic testing for breast cancer between September 2013 and September 2018 were identified from a prospective database. Surgical data were collected retrospectively. Results: 580 eligible women had mainstream genetic testing. For 474 this was their first breast cancer diagnosis. The median age was 46 years (interquartile range (IQR) 38–57). The indications were: age ≤45 years for 233 (49%); triple negative disease for 192 women (40.5%); bilateral breast cancer age \u3c60 for 39 (8%) and other for 72 (14%) women. The median time for test initiation to result was 18 days (IQR 15-21). 302 (64% received results before surgery. 88% of those found to have a BRCA mutation before surgery opted for bilateral mas- tectomy (compared to 5% with BRCA wild type). An additional 106 patients had a new diagnosis on a back- ground of previous treatment. Of these all with a pathogenic variant chose bilateral mastectomy. Conclusion: Timely BRCA gene testing influences surgeons’ and patients’ choice of surgery. It reassures women with a negative result and allows those with a positive result to take an active decision about the management of their future risk

Utilization of soil organic phosphorus as a strategic approach for sustainable agriculture

Soil organic phosphorus (P org ) can significantly assist in minimizing the adverse effects of chemi- cal phosphorus fertilizers on aquatic and marine resources. Success to achieve the desired last- ing transformation is primarily reliant on the drastic reduction of wasteful applications of chemical phosphorus fertilizers, thereby paving the way for proper investment of soil P org reserves. To this end, organically-bound phosphorus can be viewed as a cornerstone for the future development of agriculture. Thus, we consider it very timely to emphasize the suitability of soil P org to lead the way

Exploring the effects of cigarette smoking on inflammatory bowel disease using Mendelian randomisation

Background. Previous observational evidence has suggested an association between smoking and inflammatory bowel disease (IBD). Methods. We used observational techniques followed by Mendelian randomisation (MR) to explore if smoking is a causal factor in the development of IBD and its subtypes.Results. In those who have ever smoked, we observed increased risk of IBD, and, in current smokers, we observed increased risk of Crohn’s disease and decreased risk of Ulcerative Colitis. However, our MR analyses found little evidence that smoking affects the development of IBD. Conclusion. Overall, our results suggest that smoking does not causally influence the risk of IBD

Chimeric Investigations into the Diamide Binding Site on the Lepidopteran Ryanodine Receptor

Alterations to amino acid residues G4946 and I4790, associated with resistance to diamide insecticides, suggests a location of diamide interaction within the pVSD voltage sensor-like domain of the insect ryanodine receptor (RyR). To further delineate the interaction site(s), targeted alterations were made within the same pVSD region on the diamondback moth (Plutella xylostella) RyR channel. The editing of five amino acid positions to match those found in the diamide insensitive skeletal RyR1 of humans (hRyR1) in order to generate a human−Plutella chimeric construct showed that these alterations strongly reduce diamide efficacy when introduced in combination but cause only minor reductions when introduced individually. It is concluded that the sites of diamide interaction on insect RyRs lie proximal to the voltage sensor-like domain of the RyR and that the main site of interaction is at residues K4700, Y4701, I4790 and S4919 in the S1 to S4 transmembrane domains

Diamide insecticide resistance in transgenic Drosophila and Sf9-cells expressing a full-length diamondback moth ryanodine receptor carrying an I4790M mutation

BACKGROUNDResistance to diamide insecticides in Lepidoptera is known to be caused primarily by amino acid changes on the ryanodine receptor (RyR). Recently, two new target site mutations, G4946V and I4790M, have emerged in populations of diamondback moth, Plutella xylostella, as well as in other lepidopteran species, and both mutations have been shown empirically to decrease diamide efficacy. Here, we quantify the impact of the I4790M mutation on diamide activation of the receptor, as compared to alterations at the G4946 locus.RESULTSI4790M when introduced into P. xylostella RyR expressed in an insect-derived Sf9 cell line was found to mediate just a ten-fold reduction in chlorantraniliprole efficacy (compared to 104- and 146-fold reductions for the G4946E and G4946V variants, respectively), whilst in the field its presence is associated with a ≥150-fold reduction. I4790M-mediated resistance to flubendiamide was estimated to be >24-fold. When the entire coding sequence of P. xylostella RyR was integrated into Drosophila melanogaster, the I4790M variant conferred ~4.4-fold resistance to chlorantraniliprole and 22-fold resistance to flubendiamide in the 3rd instar larvae, confirming that it imparts only a moderate level of resistance to diamide insecticides. Although the I4790M substitution appears to bear no fitness costs in terms of the flies' reproductive capacity, when assessed in a noncompetitive environment, it does, however, have potentially major impacts on mobility at both the larval and adult stages.CONCLUSIONSI4790M imparts only a moderate level of resistance to diamide insecticides and potentially confers significant fitness costs to the insect