Asynchronous video-otoscopy with a telehealth facilitator

Objective: The study investigated whether video-otoscopic images taken by a telehealth clinic facilitator are sufficient for accurate asynchronous diagnosis by an otolaryngologist within a heterogeneous population. Subjects and Methods: A within-subject comparative design was used with 61 adults recruited from patients of a primary healthcare clinic. The telehealth clinic facilitator had no formal healthcare training. On-site otoscopic examination performed by the otolaryngologist was considered the gold standard diagnosis. A single video-otoscopic image was recorded by the otolaryngologist and facilitator from each ear, and the images were uploaded to a secure server. Images were assigned random numbers by another investigator, and 6 weeks later the otolaryngologist accessed the server, rated each image, and made a diagnosis without participant demographic or medical history. Results: A greater percentage of images acquired by the otolaryngologist (83.6%) were graded as acceptable and excellent, compared with images recorded by the facilitator (75.4%). Diagnosis could not be made from 10.0% of the video-otoscopic images recorded by the facilitator compared with 4.2% taken by the otolaryngologist. A moderate concordance was measured between asynchronous diagnosis made from video-otoscopic images acquired by the otolaryngologist and facilitator (kappa = 0.596). The sensitivity for video-otoscopic images acquired by the otolaryngologist and the facilitator was 0.80 and 0.91, respectively. Specificity for images acquired by the otolaryngologist and the facilitator was 0.85 and 0.89, respectively, with a diagnostic odds ratio of 41.0 using images acquired by the otolaryngologist and 46.0 using images acquired by the facilitator. Conclusions: A trained telehealth facilitator can provide a platform for asynchronous diagnosis of otological status using video-otoscopy in underserved primary healthcare settings

Human rights literacy: Moving towards rights-based education and transformative action through understandings of dignity, equality and freedom

The twentieth century has been characterised by the proliferation of human rights in the discursive practices of the United Nations (Baxi, 1997). In this article, we explore the continual process of rights-based education towards transformative action, and an open and democratic society, as dependent upon the facilitation of human rights literacy in teacher training. Our theoretical framework examines the continual process of moving towards an open and democratic society through the facilitation of human rights literacy, rights-based education and transformative action. We focus specifically on understandings of dignity, equality and freedom, as both rights (legal claims) and values (moral action) across horizontal and vertical applications, considering the internalisation and implementation of dignity, equality and freedom towards transformative action. Our analysis of data stemming from a project funded by the National Research Foundation (NRF) entitled ‘Human Rights Literacy: A quest for meaning’, brought student-teachers’ understandings into conversation with the proposed theoretical framework. In terms of understandings related to dignity, equality and freedom, participants seemingly understand human rights either as legal interests, or alternatively, as they pertain to values such as caring, ubuntu, respect, human dignity and equality. Legal understandings primarily focus on the vertical application of the Bill of Rights (RSA, 1996a) and the role of government in this regard, whereas understandings related to the realisation of values tended to focus on the horizontal applications of particularly dignity and equality as the product of the relation between self and other. We conclude the article by linking the analysis and the theoretical framework to education as a humanising practice within human rights as a common language of humanity. In so doing, we argue that human rights literacy and rights-based education transcend knowledge about human rights, moving towards transformative action and caring educational relations premised on freedom, dignity and equality. Finally, recommendations are made regarding human rights and rights-based education as transformative action within the South African context, towards an open and democratic society.Keywords: democracy; dignity; equality; freedom; human rights; human rights education; human rights literacy; rights based education; transformation; transformative actio

Origins of Sinuous and Braided Channels on Ascraeus Mons, Mars - A Keck Geology Consortium Undergraduate Research Project

Water has clearly played an important part in the geological evolution of Mars. There are many features on Mars that were almost certainly formed by fluvial processes -- for example, the channels Kasei Valles and Ares Vallis in the Chryse Planitia area of Mars are almost certainly fluvial features. On the other hand, there are many channel features that are much more difficult to interpret -- and have been variously attributed to volcanic and fluvial processes. Clearly unraveling the details of the role of water on Mars is extremely important, especially in the context of the search of extinct or extant life. In this project we built on our recent work in determining the origin of one channel on the southwest rift apron of Ascraeus Mons. This project, funded by the Keck Geology Consortium and involving 4 undergraduate geology majors took advantage of the recently available datasets to map and analyze similar features on Ascraeus Mons and some other areas of Mars. A clearer understanding of how these particular channel features formed might lead to the development of better criteria to distinguish how other Martian channel features formed. Ultimately this might provide us with a better understanding of the role of volcanic and fluvial processes in the geological evolution of Mars

Vuvuzela - good for your team, bad for your ears

Vuvuzela is synonymous with the vibrant atmosphere at South African soccer matches. The intensity of the sound however, is dangerously loud according to occupational noise exposure standards. Preventative measures, such as public awareness and hearing protection, should be prioritized, especially in lieu of the upcoming World Cup in 2010

Paediatric trauma care

Paediatric trauma care varies in different countries. In South Africa injury is the leading cause of death in the 5 - 14-yearold age group - 1,5 - 3,8 times higher than in the USA. In 1978 the Child Safety Centre was established and prospectively collected data on paediatric injuries. The various types of injuries are discussed. Trauma is responsible for the highest percentage of years of life lost but the least amount of money is being spent on research and prevention of injuries. The Child Accident Prevention Foundation of Southern Africa has been constituted to research, prevent and reduce the risk factors of the injuries and to improve facilities for the injured child

Clinical and pathological features of acral melanoma in a South African population: A retrospective study

Background. Acral melanoma (AM) is a rare subtype of cutaneous melanoma (CM) that disproportionately affects skin of colour and carries a poorer prognosis than other melanoma subtypes. The poor prognosis is attributed to late diagnosis and subsequent relatively high Breslow thickness, but also to an intrinsic biological aggressiveness. Scientific data on AM from the developing world are limited and a need exists to characterise the disease further in the South African (SA) population.Objectives. To describe the clinical and pathological features of AM in an SA population.Methodology. A retrospective chart review characterised the demographics, clinical features and histological data of 66 patients diagnosed with AM between January 2010 and June 2016 at Tygerberg Academic Hospital, Cape Town, SA.Results. Sixty-six patients with AM were identified from 335 patients diagnosed with CM during the set time frame. The mean age (standard deviation (SD)) was 61.5 (12.5) years. Forty-two (63.6%) of the patients were female (male/female ratio 1:1.75). The majority of patients diagnosed with AM were black (48.5%), and the proportion of AM in black patients with CM was 80.0%. Fifty-six AMs (84.8%) were located on the foot and 10 (15.2%) on the hand. The median duration of the lesion before diagnosis was 10 months (range 2 - 84) and the mean (SD) tumour size was 3.8 (2.2) cm at diagnosis. The mean Breslow thickness of all AMs at diagnosis was 5.2 mm (median 4.2  mm, range 0 - 22). Stage of disease was known in 41 patients, 23 (56.1%) of whom had at least stage III disease at diagnosis. Mean Breslow thickness for foot and hand melanomas was 4.9 mm (range 0 - 22) and 6.9 mm (range 0 - 13.3), respectively (p=0.2552). The mean Breslow thickness in the black population was 6.3 mm compared with 4.2 mm and 4.3 mm, respectively, in the white and coloured populations (p=0.178). Patients from outside the Western Cape Province (WC) presented with a mean Breslow thickness of 6.6 mm (range 0 - 14.5) and patients from the WC with a mean Breslow thickness of 4.9 mm (range 0 - 22) (p=0.3602).Conclusions. AMs accounted for a significant proportion of all CMs diagnosed. Patients presented with an advanced stage of disease at diagnosis, and further studies are needed to further investigate the reasons for delayed diagnosis.Â

Innovation in the Context of Audiology and in the Context of the Internet

Purpose: This article explores different meanings of innovation within the context of audiology and the internet. Case studies are used to illustrate and elaborate on the new types of innovation and their levels of impact.Method: The article defines innovation, providing case studies illustrating a taxonomy of innovation types.Results: Innovation ranges from minor changes in technology implemented on existing platforms to radical or disruptive changes that provide exceptional benefits and transform markets. Innovations within the context of audiology and the internet can be found across that range. The case studies presented demonstrate that innovations in hearing care can span across a number of innovation types and levels of impact. Considering the global need for improved access and efficiency in hearing care, innovations that demonstrate sustainable impact on a large scale, with the potential to rapidly upscale this impact, should be prioritized.Conclusions: It is unclear presently what types of innovations are likely to have the most profound impacts on audiology in coming years. In the best case, they will lead to more efficient, effective, and widespread availability of hearing health on a global scale