The role of reflective practice in professional development

Reflective practice (RP) is a process of critical evaluation and self-assessment whereby one deeply explores an event in order to learn from experiences, and consequently undertakes a change in perception or behaviour. RP can benefit practice through enhancing professionalism and encouraging self-directed learning (SDL). SDL is an important part of the lifelong learning undertaken by registered veterinary nurses (RVNs) who participate in ongoing continuing professional development (CPD). CPD is traditionally delivered using an input-based model, where the time in attendance of activities, such as lectures and seminars, are accrued. Although this model ensures a learning activity has been undertaken, it does not ensure any actual learning has occurred, and whether there has been a resultant increase in professional competency. As such, an outcome-based model of CPD has been proposed by the Royal College of Veterinary Surgeons (RCVS) which includes planning, doing, recording and reflecting. The addition of RP to this new cycle ensures that RVNs explore the completed CPD activity more deeply, and consider what specific learning has occurred. This learning can then be measured as outcomes, which may include, for example, improvements to patient care, client service delivery, local processes, the wider organisation, or the management of staff or students. There have been concerns expressed within the profession about the proposed move to an outcome-based CPD model, including the increased time that measuring and recording outcomes will add to the process. If the implementation of this new model is to prove successful, these concerns will need to be addressed

The role of reflective practice in professional development

Reflective practice (RP) is a process of critical evaluation and self-assessment whereby one deeply explores an event in order to learn from experiences, and consequently undertakes a change in perception or behaviour. RP can benefit practice through enhancing professionalism and encouraging self-directed learning (SDL). SDL is an important part of the lifelong learning undertaken by registered veterinary nurses (RVNs) who participate in ongoing continuing professional development (CPD). CPD is traditionally delivered using an input-based model, where the time in attendance of activities, such as lectures and seminars, are accrued. Although this model ensures a learning activity has been undertaken, it does not ensure any actual learning has occurred, and whether there has been a resultant increase in professional competency. As such, an outcome-based model of CPD has been proposed by the Royal College of Veterinary Surgeons (RCVS) which includes planning, doing, recording and reflecting. The addition of RP to this new cycle ensures that RVNs explore the completed CPD activity more deeply, and consider what specific learning has occurred. This learning can then be measured as outcomes, which may include, for example, improvements to patient care, client service delivery, local processes, the wider organisation, or the management of staff or students. There have been concerns expressed within the profession about the proposed move to an outcome-based CPD model, including the increased time that measuring and recording outcomes will add to the process. If the implementation of this new model is to prove successful, these concerns will need to be addressed

Becoming a reflective practitioner

Reflective practice (RP) can be defined as the process of considering an event or a situation in order to examine the factors that influenced it so that one can determine what could have been done differently, or to identify what learning occurred. RP has many potential benefits to professional practice including developing critically thoughtful approaches to patient care, influencing professional decision-making, developing emotional intelligence, and stimulating personal and professional growth. Specific skills must be developed to successfully undertake RP including self-awareness, description, critical analysis, synthesis and evaluation. These skills can be developed using a model of reflection. Models encourage a structured and guided approach to RP and encourage individuals to achieve a deeper level of understanding of the event. To make effective use of a model of reflection, a written account is preferred. This can easily be achieved through the use of a journal, which is a personal collection of notes, thoughts, observations and experiences. Journals can enhance learning through the action of writing and critically exploring experiences. Group reflection is another method of RP, and allows participants to learn from the perspectives of others, and to receive feedback on their practice. There are barriers to RP including lack of time and power to implement changes, as such there is a need for organisations to recognise the importance of RP and to allocate appropriate resources to help support its action

Genome variation and population structure among 1142 mosquitoes of the African malaria vector species Anopheles gambiae and Anopheles coluzzii

Mosquito control remains a central pillar of efforts to reduce malaria burden in sub-Saharan Africa. However, insecticide resistance is entrenched in malaria vector populations, and countries with a high malaria burden face a daunting challenge to sustain malaria control with a limited set of surveillance and intervention tools. Here we report on the second phase of a project to build an open resource of high-quality data on genome variation among natural populations of the major African malaria vector species Anopheles gambiae and Anopheles coluzzii. We analyzed whole genomes of 1142 individual mosquitoes sampled from the wild in 13 African countries, as well as a further 234 individuals comprising parents and progeny of 11 laboratory crosses. The data resource includes high-confidence single-nucleotide polymorphism (SNP) calls at 57 million variable sites, genome-wide copy number variation (CNV) calls, and haplotypes phased at biallelic SNPs. We use these data to analyze genetic population structure and characterize genetic diversity within and between populations. We illustrate the utility of these data by investigating species differences in isolation by distance, genetic variation within proposed gene drive target sequences, and patterns of resistance to pyrethroid insecticides. This data resource provides a foundation for developing new operational systems for molecular surveillance and for accelerating research and development of new vector control tools. It also provides a unique resource for the study of population genomics and evolutionary biology in eukaryotic species with high levels of genetic diversity under strong anthropogenic evolutionary pressures

Resistance to pirimiphos-methyl in West African Anopheles is spreading via duplication and introgression of the Ace1 locus

Vector population control using insecticides is a key element of current strategies to prevent malaria transmission in Africa. The introduction of effective insecticides, such as the organophosphate pirimiphos-methyl, is essential to overcome the recurrent emergence of resistance driven by the highly diverse Anopheles genomes. Here, we use a population genomic approach to investigate the basis of pirimiphos-methyl resistance in the major malaria vectors Anopheles gambiae and A. coluzzii. A combination of copy number variation and a single non-synonymous substitution in the acetylcholinesterase gene, Ace1, provides the key resistance diagnostic in an A. coluzzii population from Coˆte d’Ivoire that we used for sequence-based association mapping, with replication in other West African populations. The Ace1 substitution and duplications occur on a unique resistance haplotype that evolved in A. gambiae and introgressed into A. coluzzii, and is now common in West Africa primarily due to selection imposed by other organophosphate or carbamate insecticides. Our findings highlight the predictive value of this complex resistance haplotype for phenotypic resistance and clarify its evolutionary history, providing tools to for molecular surveillance of the current and future effectiveness of pirimiphos-methyl based interventions

2019 ARIA Care pathways for allergen immunotherapy

Allergen immunotherapy (AIT) is a proven therapeutic option for the treatment of allergic rhinitis and/or asthma. Many guidelines or national practice guidelines have been produced but the evidence-based method varies, many are complex and none propose care pathways. This paper reviews care pathways for AIT using strict criteria and provides simple recommendations that can be used by all stakeholders including healthcare professionals. The decision to prescribe AIT for the patient should be individualized and based on the relevance of the allergens, the persistence of symptoms despite appropriate medications according to guidelines as well as the availability of good-quality and efficacious extracts. Allergen extracts cannot be regarded as generics. Immunotherapy is selected by specialists for stratified patients. There are no currently available validated biomarkers that can predict AIT success. In adolescents and adults, AIT should be reserved for patients with moderate/severe rhinitis or for those with moderate asthma who, despite appropriate pharmacotherapy and adherence, continue to exhibit exacerbations that appear to be related to allergen exposure, except in some specific cases. Immunotherapy may be even more advantageous in patients with multimorbidity. In children, AIT may prevent asthma onset in patients with rhinitis. mHealth tools are promising for the stratification and follow-up of patients.Peer reviewe

ARIA digital anamorphosis : Digital transformation of health and care in airway diseases from research to practice

Digital anamorphosis is used to define a distorted image of health and care that may be viewed correctly using digital tools and strategies. MASK digital anamorphosis represents the process used by MASK to develop the digital transformation of health and care in rhinitis. It strengthens the ARIA change management strategy in the prevention and management of airway disease. The MASK strategy is based on validated digital tools. Using the MASK digital tool and the CARAT online enhanced clinical framework, solutions for practical steps of digital enhancement of care are proposed.Peer reviewe

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good