The Power of Dialogue in Adult Learning

How do adults learn? They learn best when they are in dialogue, when they are engaged, when they are the subjects (that is, the decision-makers) of their own education and not just objects, and when their cultural and personal context is understood. A system was emerging that showed and used the power of dialogue

Visual Aids for Nonformal Education

A valuable guide for field workers in nonformal education to create visual aids with materials that are available. The author draws on her work in Kenya and Tanzania to present numerous suggestions for the field worker to make inexpensive materials

Learning to Listen: A Field Guide to Methods of Adult Nonformal Education

This booklet describes practical ways to implement theories of adult learning. Adopting the perspective of the field worker, the author discusses ways of listening to groups, sharing rather than transmitting information, and methods of problem posing in education. Includes the use of codes, role playing, games and folk material. The perspective of this book is that of the field worker. Theory can be found elsewhere in abundance; this is an attempt to consolidate practical ideas on adult learning for working men and women. The operative question of the entire text i: what ways of working with adults contribute towards both their personal development and the purposes of a particular program? Or, stated more succinctly: How can we adult educators learn to listen

Aprenda a escuchar una guia a los metodos de educacion de adultos no formal

Existen análisis estadísticos que indican de manera irrefutable la necesidad que existe alrodedor del mundo de crear programas de educación no formales los cuales deberán alcanzar a millones de personas cuyas necisdades educativas no han sido stisfechas por medio del sistema de educación formal. A medida que estos programas se desarrollan, se llega a la siguiente conclusión: los métodos y enfoques utilizados por el sistema educativo formal para la educación de los adultos no han demonstrado ser eficientes en una educación no formal para adultos. La relación jerárquica entre maestro/estudiante, la lección bien preparada para divulgar concimiento, los ejercicios estructurados para practicar el uso de los nuevos conocimientos, y las pruebas para asegurar tanto al maestro como al estudiante de que éste ûltimo ha tenido éxito en el aprendizaje, carecen simplemente de carácter funcional en las situaciones de campo en las cuales la educación no formal puede ser de ayuda. Tenemos la necesidad de establecer un nuevo precedente: un paradigma o sistema para el aprendizaje de adultos. Los expertos teóricos en este campo han explicado el porqué de manera competente: Malcolm Knowles, Paulo Freire, Philip Coombs, George Axinn, y Tim Simkins han expuesto el plan y el objeto de una nueva pedagogía. Sin embargo, existen pocas guías de campo que indiquen la manera a proceder para implementar tal nuevo enfoque. Este breve libro propone satisfacer esta necesidad mediante la indicación de nuevos métodos de eduicación para el planteamiento de problemas (problem-posing education): el uso de códigos, la representación de juegos de papeles, los juegos, y el material folklórico. Este libro se concibe de la necisidad de una tal guía de campo como lo han expresado los colegas que trabajan en programas de educación no formal y de las experiencas del autor en un programa titulado Educación Comunitaria para el Desarrollo en Musoma, Tanzia. Este libro tiene la perspeciva de un trabajador de campo. Los aspectos teóricos se pueden hallar profusamente en otras referencias; se trata aquí de un intento de consolidar las ideas prácticas sobre el aprendizaje de adultos para hombres y mujeres que trabajan. El problema operativo de todo este texto es: ¿Qué maneras de trabajar con adultos contribuyen tanto a su desarollo personal como a los objectivos de un programa determinado?, o expuesto de manera más sucinta: ¿Cómo podemos nosotros los educadores de adultos, aprender a escuchar

Pharmacovigilance in hospice/palliative care: rapid report of net clinical effect of metoclopramide

Background: Understanding the performance of prescribed medications in day-to-day practice is important to minimize harm, maximize clinical benefits, and, eventually, better target the people who are most likely to benefit, especially in hospice/palliative care where there may be limited time to optimize prescribing. Metoclopramide, a benzamide prokinetic antiemetic, is widely used for a number of indications including nausea, vomiting, hiccups, and reflux. It has recently had a new ‘‘black box’’ warning issued by the Food and Drug Administration in relation to tardive dyskinesia to limit use to 12 weeks. Methods: A consecutive cohort of patients from 12 participating centers in two countries who were having metoclopramide initiated had data collected at three time points—baseline, 2 days (clinical benefit), and day 7 (clinical harm). Additionally, harms could be recorded at any time. Results: Of the 53 people included in the cohort, 23 (43%) reported benefit at 48 hours, but only 18 (34%) of these people were still using it one week after commencing it. For the other 5, the medication was ceased due to harms. The most frequent harms were akathisia (n = 4), headache (n = 4), and abdominal pain (n = 4). Nine people (17%) had no clinical benefit and experienced harms. Conclusion: Overall, one in three people gained net clinical benefit at one week. Limiting effects include sideeffects that need to be sought actively in clinical care

Consensus Paper: Radiological Biomarkers of Cerebellar Diseases

Hereditary and sporadic cerebellar ataxias represent a vast and still growing group of diseases whose diagnosis and differentiation cannot only rely on clinical evaluation. Brain imaging including magnetic resonance (MR) and nuclear medicine techniques allows for characterization of structural and functional abnormalities underlying symptomatic ataxias. These methods thus constitute a potential source of radiological biomarkers, which could be used to identify these diseases and differentiate subgroups of them, and to assess their severity and their evolution. Such biomarkers mainly comprise qualitative and quantitative data obtained from MR including proton spectroscopy, diffusion imaging, tractography, voxel-based morphometry, functional imaging during task execution or in a resting state, and from SPETC and PET with several radiotracers. In the current article, we aim to illustrate briefly some applications of these neuroimaging tools to evaluation of cerebellar disorders such as inherited cerebellar ataxia, fetal developmental malformations, and immune-mediated cerebellar diseases and of neurodegenerative or early-developing diseases, such as dementia and autism in which cerebellar involvement is an emerging feature. Although these radiological biomarkers appear promising and helpful to better understand ataxia-related anatomical and physiological impairments, to date, very few of them have turned out to be specific for a given ataxia with atrophy of the cerebellar system being the main and the most usual alteration being observed. Consequently, much remains to be done to establish sensitivity, specificity, and reproducibility of available MR and nuclear medicine features as diagnostic, progression and surrogate biomarkers in clinical routine

Distinct clinical and immunological profiles of patients with evidence of SARS-CoV-2 infection in sub-Saharan Africa

Although the COVID-19 pandemic has left no country untouched there has been limited research to understand clinical and immunological responses in African populations. Here we characterise patients hospitalised with suspected (PCR-negative/IgG-positive) or confirmed (PCR-positive) COVID-19, and healthy community controls (PCR-negative/IgG-negative). PCR-positive COVID-19 participants were more likely to receive dexamethasone and a beta-lactam antibiotic, and survive to hospital discharge than PCR-negative/IgG-positive and PCR-negative/IgG-negative participants. PCR-negative/IgG-positive participants exhibited a nasal and systemic cytokine signature analogous to PCR-positive COVID-19 participants, predominated by chemokines and neutrophils and distinct from PCR-negative/IgG-negative participants. PCR-negative/IgG-positive participants had increased propensity for Staphylococcus aureus and Streptococcus pneumoniae colonisation. PCR-negative/IgG-positive individuals with high COVID-19 clinical suspicion had inflammatory profiles analogous to PCR-confirmed disease and potentially represent a target population for COVID-19 treatment strategies

Regulatory T Cell Responses in Participants with Type 1 Diabetes after a Single Dose of Interleukin-2: A Non-Randomised, Open Label, Adaptive Dose-Finding Trial

BACKGROUND: Interleukin-2 (IL-2) has an essential role in the expansion and function of CD4+ regulatory T cells (Tregs). Tregs reduce tissue damage by limiting the immune response following infection and regulate autoreactive CD4+ effector T cells (Teffs) to prevent autoimmune diseases, such as type 1 diabetes (T1D). Genetic susceptibility to T1D causes alterations in the IL-2 pathway, a finding that supports Tregs as a cellular therapeutic target. Aldesleukin (Proleukin; recombinant human IL-2), which is administered at high doses to activate the immune system in cancer immunotherapy, is now being repositioned to treat inflammatory and autoimmune disorders at lower doses by targeting Tregs. METHODS AND FINDINGS: To define the aldesleukin dose response for Tregs and to find doses that increase Tregs physiologically for treatment of T1D, a statistical and systematic approach was taken by analysing the pharmacokinetics and pharmacodynamics of single doses of subcutaneous aldesleukin in the Adaptive Study of IL-2 Dose on Regulatory T Cells in Type 1 Diabetes (DILT1D), a single centre, non-randomised, open label, adaptive dose-finding trial with 40 adult participants with recently diagnosed T1D. The primary endpoint was the maximum percentage increase in Tregs (defined as CD3+CD4+CD25highCD127low) from the baseline frequency in each participant measured over the 7 d following treatment. There was an initial learning phase with five pairs of participants, each pair receiving one of five pre-assigned single doses from 0.04 × 106 to 1.5 × 106 IU/m2, in order to model the dose-response curve. Results from each participant were then incorporated into interim statistical modelling to target the two doses most likely to induce 10% and 20% increases in Treg frequencies. Primary analysis of the evaluable population (n = 39) found that the optimal doses of aldesleukin to induce 10% and 20% increases in Tregs were 0.101 × 106 IU/m2 (standard error [SE] = 0.078, 95% CI = -0.052, 0.254) and 0.497 × 106 IU/m2 (SE = 0.092, 95% CI = 0.316, 0.678), respectively. On analysis of secondary outcomes, using a highly sensitive IL-2 assay, the observed plasma concentrations of the drug at 90 min exceeded the hypothetical Treg-specific therapeutic window determined in vitro (0.015-0.24 IU/ml), even at the lowest doses (0.040 × 106 and 0.045 × 106 IU/m2) administered. A rapid decrease in Treg frequency in the circulation was observed at 90 min and at day 1, which was dose dependent (mean decrease 11.6%, SE = 2.3%, range 10.0%-48.2%, n = 37), rebounding at day 2 and increasing to frequencies above baseline over 7 d. Teffs, natural killer cells, and eosinophils also responded, with their frequencies rapidly and dose-dependently decreased in the blood, then returning to, or exceeding, pretreatment levels. Furthermore, there was a dose-dependent down modulation of one of the two signalling subunits of the IL-2 receptor, the β chain (CD122) (mean decrease = 58.0%, SE = 2.8%, range 9.8%-85.5%, n = 33), on Tregs and a reduction in their sensitivity to aldesleukin at 90 min and day 1 and 2 post-treatment. Due to blood volume requirements as well as ethical and practical considerations, the study was limited to adults and to analysis of peripheral blood only. CONCLUSIONS: The DILT1D trial results, most notably the early altered trafficking and desensitisation of Tregs induced by a single ultra-low dose of aldesleukin that resolves within 2-3 d, inform the design of the next trial to determine a repeat dosing regimen aimed at establishing a steady-state Treg frequency increase of 20%-50%, with the eventual goal of preventing T1D. TRIAL REGISTRATION: ISRCTN Registry ISRCTN27852285; ClinicalTrials.gov NCT01827735.This is the final version of the article. It first appeared from the Public Library of Science via http://dx.doi.org/10.1371/journal.pmed.100213