Malnutrition in pre-dialysis chronic kidney disease patients in a teaching hospital in Southern Nigeria.

Background: Malnutrition is a complication in chronic kidney disease (CKD) known to affect quality of life and prognosis although not often diagnosed. It is associated with rapid progression to end stage renal disease (ESRD) and mortality. Early identification and treatment will slow down progression to ESRD and mortality. Objective: To determine the prevalence and pattern of malnutrition in pre-dialysis CKD patients in Southern Nigeria. Methods: One hundred and twenty consecutive pre-dialysis CKD and 40 control subjects without CKD were studied. Data obtained from participants were demographics, body mass index (BMI), and aetiology of CKD. Indices used to assess presence of malnutrition were low BMI, hypocholesterolaemia and hypoalbuminaemia. Statistical significance was taken at 0.05 level. Results: The mean age of the CKD subjects was 48.8±16.6years with a male: female ratio of 1.7:1. Prevalence of malnutrition in the CKD subjects was 46.7%, higher than 27.5% observed in the controls (p=0.033). Prevalence of malnutrition increased significantly across CKD stages 2 to 5 (p=0.020). It was significantly commoner in elderly patients (p=0.047) but not significantly different between males and females(p=0.188). Conclusion: Malnutrition is common in pre-dialysis CKD patients even in early CKD stages. Prevalence of malnutrition increases with worsening kidney function and increasing age.

Ear-related problems among children attending the paediatric and otorhinolaryngology out-patients clinics of the University of Nigeria Teaching Hospital, Enugu.

Background: Ear related diseases are commonly seen in clinics worldwide especially among children. They are associated with significant morbidity and frequent hospital visits. Limited data exists regarding the burden of ear disease among Nigerian children. Objective: To determine the prevalence of ear-related problems among children presenting at the Paediatric and Otorhinolaryngology clinics of the University of Nigeria Teaching Hospital, Enugu. Materials and methods: This was a cross-sectional study conducted at the Paediatric and Otorhinolaryngology Clinics of the University of Nigeria Teaching Hospital Enugu. All children aged 0 and 17 years presenting between 1st June and 31st August 2006 with ear-related problems were enrolled consecutively into the study. Data analysis was by SPSS version 11. Results: Three thousand and twenty-one children were seen during the study period. Out of these, 248 children (8.2%) presented with ear-related problems. Chronic otitis media (30.5%), acute otitis media (29.9%), cerumen auris (11.3%), otitis externa(10.1%), hearing impairment (7.3%) and foreign body in the ear (5.7%) were the most commonly diagnosed ear-related problems. Conclusion: Ear-related problems among children presenting at the UNTH Enugu were not uncommon. However, otitis media was the most commonly diagnosed ailment affecting the ears in children.

Teaching and learning sexuality in nursing education

Sexuality is recognized as part of holistic nursing care, but its inclusion in clinical practice and nursing training is inconsistent. Based on the question "How students and teachers acknowledge sexuality in teaching and learning?", we developed a study in order to characterize the process of teaching and learning sexuality in a micro perspective of cur- riculum development. We used a mixed methods design with a sequential strategy: QUAN → qual of descriptive and explanatory type. 646 students and teachers participated. The quantitative component used ques- tionnaire surveys. Document analysis was used in the additional component. A curricular dimension of sexuality emerges guided by a behaviourist line and based on a biological vision. The issues considered safe are highlighted and framed in steps of adolescence and adulthood and more attached to female sexuality and the procreative aspect. There is in emergence a hidden curriculum by reference to content from other dimensions of sexuality but less often expressed. Theoretical learning follows a communicational model of reality through ab- straction strategies, which infers a deductive method of learning, with a behaviourist approach to assessment. Clinical teaching ad- dresses sexuality in combination with reproductive health nursing. The influencing factors of teaching and learning of sexuality were also explored. We conclude that the vision of female sexuality taught and learned in relation to women has a projection of care in clinical practice based on the same principles.

EXAMINING SECONDARY MATHEMATICS TEACHER CANDIDATES’ LEARNING AND ENACTMENT OF MATHEMATICS TEACHING PRACTICES: A MULTIPLE CASE STUDY

This qualitative case study explored three teacher candidates’ learning and enactment of discourse-focused mathematics teaching practices. Using audio and video recordings of their teaching practice this study aimed to identify the shifts in the way in which the teacher candidates enacted the following discourse practices: elicited and used evidence of student thinking, posed purposeful questions, and facilitated meaningful mathematical discourse. The teacher candidates’ written reflections from their practice-based coursework as well as interviews were examined to see how two mathematics methods courses influenced their learning and enactment of the three discourse focused mathematics teaching practices. These data sources were also used to identify tensions the teacher candidates encountered. All three candidates in the study were able to successfully enact and reflect on these discourse-focused mathematics teaching practices at various time points in their preparation programs. Consistency of use and areas of improvement differed, however, depending on various tensions experienced by each candidate. Access to quality curriculum materials as well as time to formulate and enact thoughtful lesson plans that supported classroom discourse were tensions for these teacher candidates. This study shows that teacher candidates are capable of enacting discourse-focused teaching practices early in their field placements and with the support of practice-based coursework they can analyze and reflect on their practice for improvement. This study also reveals the importance of assisting teacher candidates in accessing rich mathematical tasks and collaborating during lesson planning. More research needs to be explored to identify how specific aspects of the learning cycle impact individual teachers and how this can be used to improve practice-based teacher education courses.

Factors associated with gastro-duodenal disease in patients undergoing upper GI endoscopy at the Korle-Bu Teaching Hospital, Accra, Ghana.

Background: There is a high prevalence of gastro-duodenal disease in sub-Saharan Africa. Peptic ulcer disease in dyspeptic patients, 24.5%, was comparable to prevalence of gastro-duodenal disease among symptomatic individuals in developed countries (12 – 25%). Limited data exists regarding its associated risk factors despite accumulating evidence indicating that gastroduodenal disease is common in Ghana. Objectives: This study investigates risk factors associated with gastro-duodenal disease at the Korle-Bu Teaching Hospital, Accra, Ghana. Methods: This study utilized a cross-sectional design to consecutively recruit patients referred with upper gastro-intestinal symptoms for endoscopy. The study questionnaire was administered to study participants. Helicobacter pylori infection was confirmed by rapid-urease examination at endoscopy. Results: Of 242 patients sampled; 64 had duodenal ulcer, 66 gastric ulcer, 27gastric cancer and 64 non-ulcer dyspepsia. Nineteen (19) had duodenal and gastric ulcer while 2 had gastric ulcer and cancer. A third (32.6%) of patients had history of NSAIDuse. H. pylori was associated with gastric ulcer (p=0.033) and duodenal ulcer (p=0.001). There was an increased prevalence of duodenal ulcer in H. pylori-infected patients taking NSAIDs, P=0.003. Conclusion: H. pylori was a major risk factor for peptic ulcer disease. However, NSAID-related gastro-duodenal injury has been shown to be common in H. pylori infected patients. It highlights the need for awareness of the adverse gastro-intestinal effects in a H. pylori endemic area.

„Schulinterne Unterstützungs- und Beratungsteams“ (SUBs) - konzeptionelle Skizzierungen im Kontext inklusiver Schulentwicklung, in Anlehnung an das kanadische Modell der Methods & Resource Teams

Mit der Ratifizierung der UN-Behindertenrechtskonvention verpflichtet sich Deutschland seit 2009, ein inklusives Bildungssystem einzurichten. Vor diesem Hintergrund ist auf schulorganisatorischer Ebene ein heterogenes, multiprofessionelles Team mit entsprechenden Unterstützungsmaßnahmen und Unterstützungsrollen notwendig, das sich strukturell und personell abbildet. In diesem Beitrag werden - auf Basis des kanadischen "Methods & Resource Teams" - Überlegungen zu einer schulinternen und systemisch ausgerichteten Unterstützungrolle in Schule und Unterricht in Deutschland vorgestellt, die in die Konzeption eines "Schulinternen Unterstützungs- und Beratungsteams" (SUB) münden. (Autor)

Assessment of laboratory test utilization for HIV/AIDS care in urban ART clinics of Lilongwe, Malawi

Background The 2011 Malawi HIV guidelines promote CD4 monitoring for pre-ART assessment and considering HIVRNA monitoring for ART response assessment, while some clinics used CD4 for both. We assessed clinical ordering practices as compared to guidelines, and determined whether the samples were successfully and promptly processed. Methods We conducted a retrospective review of all patients seen in from August 2010 through July 2011,, in two urban HIV-care clinics that utilized 6-monthly CD4 monitoring regardless of ART status. We calculated the percentage of patients on whom clinicians ordered CD4 or HIVRNA analysis. For all samples sent, we determined rates of successful labprocessing, and mean time to returned results. Results Of 20581 patients seen, 8029 (39%) had at least one blood draw for CD4 count. Among pre-ART patients, 2668/2844 (93.8%) had CD4 counts performed for eligibility. Of all CD4 samples sent, 8082/9207 (89%) samples were successfully processed. Of those, mean time to processing was 1.6 days (s.d 1.5) but mean time to results being available to clinician was 9.3 days (s.d. 3.7). Regarding HIVRNA, 172 patients of 17737 on ART had a blood draw and only 118/213 (55%) samples were successfully processed. Mean processing time was 39.5 days (s.d. 21.7); mean time to results being available to clinician was 43.1 days (s.d. 25.1). During the one-year evaluated, there were multiple lapses in processing HIVRNA samples for up to 2 months. Conclusions Clinicians underutilize CD4 and HIVRNA as monitoring tools in HIV care. Laboratory processing failures and turnaround times are unacceptably high for viral load analysis. Alternative strategies need to be considered in order to meet laboratory monitoring needs.

Effects of two teaching interventions on nursing students’ acquisition of competence in ECG interpretation

Purpose: Nurse ability to recognise patient arrhythmias could contribute to preventing in-hospital cardiac arrest. Research suggests that nurses and nursing students lack competence in electrocardiogram (ECG) interpretation. The aim of this study was to compare the effects of two training strategies on nursing students’ acquisition of competence in ECG interpretation. Materials and methods: A controlled randomised trial with 98 nursing students. Divided in groups of 12–16, participants were randomly allocated to one of the following 3-h teaching intervention groups: 1) traditional instructor-led (TILG), and 2) flipped classroom (FCG). Participants’ competence in ECG interpretation was measured in terms of knowledge (%), skills (%) and self-efficacy (%) using a specifically designed and previously validated toolkit at pre-test and post-test. Two-way MANOVA explored the interaction effect between ‘teaching group’ and ‘time of assessment’ and its impact on participants’ competence. Within-group differences at pre-test and post-test were explored by carrying out paired t-tests. Between-group differences at pre- and post-test were examined by performing independent t-test analysis. Results: There was a statistically significant interaction effect between ‘teaching group’ and ‘time of assessment’ on participants’ competence in ECG interpretation (F(3,190) = 86.541, p = 0.001; Wilks’ Λ = 0.423). At pre-test, differences in knowledge (TILG = 35.12 ± 12.07; FCG = 35.66 ± 10.66), skills (TILG = 14.05 ± 10.37; FCG = 14.82 ± 14.14), self-efficacy (TILG = 46.22 ± 23.78; FCG = 40.01 ± 21.77) and all other variables were non-significant (p > 0.05). At post-test, knowledge (TILG = 55.12 ± 14.16; FCG = 94.2 ± 7.31), skills (TILG = 36.90 ± 16.45; FCG = 86.43 ± 14.32) and self-efficacy (TILG = 70.78 ± 14.55; FCG = 79.98 ± 10.35) had significantly improved, regardless of the training received (p < 0.05). Nonetheless, participants in the FCG scored significantly higher than participants in the TILG in knowledge, skills and self-efficacy (p < 0.05). Conclusion: Flipping the classroom for teaching ECG interpretation to nursing students may be more effective than using a traditional instructor-led approach in terms of immediate acquisition of competence in terms of knowledge, skills and self-efficacy. Further research on the effects of both teaching strategies on the retention of the competence will be undertaken.

Effects of two teaching strategies on the relationship between nursing students’ self-efficacy and performance in BLS/AED

Purpose: Nurses and nursing students are often first responders to in-hospital cardiac arrest events; thus they are expected to perform Basic Life Support (BLS) and use an automated external defibrillator (AED) without delay. The aim of this study was to explore the relationship between nursing students’ self-efficacy and performance before and after receiving a particular training intervention in BLS/AED. Materials and methods: Explanatory correlational study. 177 nursing students received a 4-h training session in BLS/AED after being randomized to either a self-directed (SDG) or an instructor-directed teaching group (IDG).1 A validated self-efficacy scale, the Cardiff Test and Laerdal SkillReporter® software were used to assess students’ self-efficacy and performance in BLS/AED at pre-test, post-test and 3-month retention-test. Independent t-test analysis was performed to compare the differences between groups at pre-test. Pearson coefficient (r) was used to calculate the strength of the relationship between self-efficacy and performance in both groups at pre-test, post-test and retention-test. Results: Independent t-tests analysis showed that there were non-significant differences (p-values > 0.05) between groups for any of the variables measured. At pre-test, results showed that correlation between self-efficacy and performance was moderate for the IDG (r = 0.53; p < 0.05) and the SDG (r = 0.49; p < 0.05). At post-test, correlation between self-efficacy and performance was much higher for the SDG (r = 0.81; p < 0.05) than for the IDG (r = 0.32; p < 0.05), which in fact was weaker than at pre-test. Finally, it was found that whereas the correlation between self-efficacy and performance increased from the post-test to the retention-test to almost reach baseline levels for the ILG (r = 0.52; p < 0.05), it slightly decreased in this phase for the SDG (r = 0.77; p < 0.05). Conclusion: Student-directed strategies may be more effective than instructor-directed strategies at promoting self-assessment and, therefore, may help to improve and maintain the relationship between nursing student self-efficacy and actual ability to perform BLS/AED.

Are we teaching our students what they need to know about ageing? Results from the National Survey of Undergraduate Teaching in Ageing and Geriatric Medicine

Introduction - Learning about ageing and the appropriate management of older patients is important for all doctors. This survey set out to evaluate what medical undergraduates in the UK are taught about ageing and geriatric medicine and how this teaching is delivered. Methods – An electronic questionnaire was developed and sent to the 28/31 UK medical schools which agreed to participate. Results – Full responses were received from 17 schools. 8/21 learning objectives were recorded as taught, and none were examined, across every school surveyed. Elder abuse and terminology and classification of health were taught in only 8/17 and 2/17 schools respectively. Pressure ulcers were taught about in 14/17 schools but taught formally in only 7 of these and examined in only 9. With regard to bio- and socio- gerontology, only 9/17 schools reported teaching in social ageing, 7/17 in cellular ageing and 9/17 in the physiology of ageing. Discussion – Even allowing for the suboptimal response rate, this study presents significant cause for concern with UK undergraduate education related to ageing. The failure to teach comprehensively on elder abuse and pressure sores, in particular, may be significantly to the detriment of older patients.

O museu virtual Google Art Project : um estudo de caso em contexto de ensino-aprendizagem da educação visual

A educação na arte e pela arte confere a todos os seus intervenientes a estimulação da sua criatividade e da sua consciência cultural, proporcionando meios para se exprimirem e participarem ativamente no mundo que nos rodeia. A integração das tecnologias de informação e comunicação no processo de ensino-aprendizagem veio alargar o papel que a arte pode desempenhar neste processo, promovendo novas formas de aprender, de ensinar e de pensar. Assim, a utilização de ambientes virtuais em contexto educativo tem revelado um enorme potencial, sobretudo ao nível da comunicação e da interação entre alunos e obras de arte. Neste sentido, considerou-se importante desenvolver um estudo de caso em contexto de sala de aula da Educação Visual, promovendo uma aprendizagem baseada na articulação entre a observação, interpretação e análise da obra de arte e o museu virtual. Assim o principal objetivo deste estudo foi avaliar as potencialidades do Google Art Project, enquanto objeto de aprendizagem, na promoção da aprendizagem na área da literacia em artes. Para além disso, procurámos ainda avaliar se a utilização de ferramentas multimédia como o referido Google Art Project e o Quadro Interativo, constituem fatores de motivação na aprendizagem da disciplina de Educação Visual. Do ponto de vista metodológico desenvolvemos uma estratégia baseada na investigação-ação. Procurámos, por um lado, descobrir e compreender o significado de uma realidade vivida por um grupo de alunos e, por outro lado, refletir sobre a prática educativa com o intuito de a melhorar e transformar. Este estudo envolveu cinco turmas do sexto ano do ensino público. Para a recolha de dados utilizámos técnicas baseadas na conversação e na observação, no questionário e nas notas de campo. Os resultados deste estudo revelam que as ferramentas tecnológicas utilizadas podem efetivamente contribuir para a promoção da aprendizagem dos alunos na área da Educação Visual, mais concretamente ao nível do domínio da literacia artística, da representação e da interpretação visual.

Are Videogames Art?

My dissertation defends a positive answer to the question: “Can a videogame be a work of art? ” To achieve this goal I develop definitions of several concepts, primarily ‘art’, ‘games’, and ‘videogames’, and offer arguments about the compatibility of these notions. In Part One, I defend a definition of art from amongst several contemporary and historical accounts. This definition, the Intentional-Historical account, requires, among other things, that an artwork have the right kind of creative intentions behind it, in short that the work be intended to be regarded in a particular manner. This is a leading account that has faced several recent objections that I address, particular the buck-passing theory, the objection against non-failure theories of art, and the simultaneous creation response to the ur-art problem, while arguing that it is superior to other theories in its ability to answer the question of videogames’ art status. Part Two examines whether games can exhibit the art-making kind of creative intention. Recent literature has suggested that they can. To verify this a definition of games is needed. I review and develop the most promising account of games in the literature, the over-looked account from Bernard Suits. I propose and defend a modified version of this definition against other accounts. Interestingly, this account entails that games cannot be successfully intended to be works of art because games are goal-directed activities that require a voluntary selection of inefficient means and that is incompatible with the proper manner of regarding that is necessary for something to be an artwork. While the conclusions of Part One and Part Two may appear to suggest that videogames cannot be works of art, Part Three proposes and defends a new account of videogames that, contrary to first appearances, implies that not all videogames are games. This Intentional-Historical Formalist account allows for non-game videogames to be created with an art-making intention, though not every non-ludic videogame will have an art-making intention behind it. I then discuss examples of videogames that are good candidates for being works of art. I conclude that a videogame can be a work of art, but that not all videogames are works of art. The thesis is significant in several respects. It is a continuation of academic work that has focused on the definition and art status of videogames. It clarifies the current debate and provides a positive account of the central issues that has so far been lacking. It also defines videogames in a way that corresponds better with the actual practice of videogame making and playing than other definitions in the literature. It offers further evidence in defense of certain theories of art over others, providing a close examination of videogames as a new case study for potential art objects and for aesthetic and artistic theory in general. Finally, it provides a compelling answer to the question of whether videogames can be art. This project also provides the groundwork for new evaluative, critical, and appreciative tools for engagement with videogames as they develop as a medium. As videogames mature, more people, both inside and outside academia, have increasing interest in what they are and how to understand them. One place many have looked is to the practice of art appreciation. My project helps make sense of which appreciative and art-critical tools and methods are applicable to videogames.

MULTI-UNIT ACCIDENT CONTRIBUTIONS TO U.S. NUCLEAR REGULATORY COMMISSION QUANTITATIVE HEALTH OBJECTIVES: A SAFETY GOAL POLICY ANALYSIS USING MODELS FROM STATE-OF-THE-ART REACTOR CONSEQUENCE ANALYSES

The U.S. Nuclear Regulatory Commission implemented a safety goal policy in response to the 1979 Three Mile Island accident. This policy addresses the question “How safe is safe enough?” by specifying quantitative health objectives (QHOs) for comparison with results from nuclear power plant (NPP) probabilistic risk analyses (PRAs) to determine whether proposed regulatory actions are justified based on potential safety benefit. Lessons learned from recent operating experience—including the 2011 Fukushima accident—indicate that accidents involving multiple units at a shared site can occur with non-negligible frequency. Yet risk contributions from such scenarios are excluded by policy from safety goal evaluations—even for the nearly 60% of U.S. NPP sites that include multiple units. This research develops and applies methods for estimating risk metrics for comparison with safety goal QHOs using models from state-of-the-art consequence analyses to evaluate the effect of including multi-unit accident risk contributions in safety goal evaluations.

Investigating the effects of cognitive apprenticeship-based instructional coaching on science teaching efficacy beliefs

The overall purpose of this collected papers dissertation was to examine the utility of a cognitive apprenticeship-based instructional coaching (CAIC) model for improving the science teaching efficacy beliefs (STEB) of preservice and inservice elementary teachers. Many of these teachers perceive science as a difficult subject and feel inadequately prepared to teach it. However, teacher efficacy beliefs have been noted as the strongest indicator of teacher quality, the variable most highly correlated with student achievement outcomes. The literature is scarce on strong, evidence-based theoretical models for improving STEB.^ This dissertation is comprised of two studies. STUDY #1 was a sequential explanatory mixed-methods study investigating the impact of a reformed CAIC elementary science methods course on the STEB of 26 preservice teachers. Data were collected using the Science Teaching Efficacy Belief Instrument (STEBI-B) and from six post-course interviews. A statistically significant increase in STEB was observed in the quantitative strand. The qualitative data suggested that the preservice teachers perceived all of the CAIC methods as influential, but the significance of each method depended on their unique needs and abilities. ^ STUDY #2 was a participatory action research case study exploring the utility of a CAIC professional development program for improving the STEB of five Bahamian inservice teachers and their competency in implementing an inquiry-based curriculum. Data were collected from pre- and post-interviews and two focus group interviews. Overall, the inservice teachers perceived the intervention as highly effective. The scaffolding and coaching were the CAIC methods portrayed as most influential in developing their STEB, highlighting the importance of interpersonal relationship aspects in successful instructional coaching programs. The teachers also described the CAIC approach as integral in supporting their learning to implement the new inquiry-based curriculum. ^ The overall findings hold important implications for science education reform, including its potential to influence how preservice teacher training and inservice teacher professional development in science are perceived and implemented. Additionally, given the noteworthy results obtained over the relatively short durations, CAIC interventions may also provide an effective means of achieving improvements in preservice and inservice teachers’ STEB more expeditiously than traditional approaches.^

Organizations in time:history, theory, methods

Book review: Organizations in Time, edited by R Daniel Wadhwani and Marcelo Bucheli, Oxford University Press, 2014. The title of this edited volume is slightly misleading, as its various contributions explore the potential for more historical analysis in organization studies rather than addressing issues associated with time and organizing. Hopefully this will not distract from the important achievement of this volume—important especially for business historians—in further expanding and integrating business history into management and organization studies. The various contributions, elegantly tied together by R. Daniel Wadhwani and Marcelo Bucheli in their substantial introduction (which, by the way, presents a significant contribution in its own right), opens up new sets of questions, especially in terms of future methodological and theoretical developments in the field. This book also reflects the changing institutional location of business historians, who increasingly make their careers in business schools rather than history departments, especially in Europe, reopening old questions of history as a social science. There have been several calls to teach more history in business education, such as the Carnegie Foundation report (2011) that found undergraduate business education too narrow in focus and highlighted the need to integrate more liberal arts teaching into the curriculum. However, in the contemporary research-driven environment of business and management schools, historical understanding is unlikely to permeate the curriculum if historical analysis cannot first deliver significant theoretical contributions. This is the central theme around which this edited volume revolves, and it marks a milestone in this ongoing debate. (In the spirit of full disclosure, I should add that even though I did not contribute to this volume, I have coauthored with several of its contributors and view this book as central to my current research practice.)