Conflicts in the role of business as a social partner in the South African economy : a study of skills development in the Border-Kei region

This thesis analyses conflicts in the role of business as a social partner in the South African economy by studying skills development in the Border-Kei Region. Skills development is a key component of the South African government’s programme of labour market regulation and is founded on a participatory approach. The skills development framework requires the participation and co-operation of multiple social partners but relies heavily on the role of business in the attainment of national and sectoral skills development objectives. Unfortunately, however, there are significant conflicts in the role which business is expected to play which consequently hinder the efficiency of the framework and the likelihood that that these objectives will be realised. One of the most pertinent examples of these conflicts is the voluntary nature of the skills development framework, which incentivises but does not compel organisations to invest in training and development. Other conflicts include dissonances between national and employer led strategies and organisational disincentives to engage in training and development. This qualitative study uses an interpretive approach to study how and to what extent the Skills Development Act is implemented in selected organisations in Buffalo City as well as studying the issues pertaining to the implementation process. By using a purposive sampling approach, this research includes both primary data in the form of semi-structured interviews and secondary data in the form of documentary sources. The data represents the perspectives of business, labour and government and provides significant depth of insight into the discussions and issues surrounding skills development in Buffalo City. This dissertation argues that South Africa’s vocational training system, institutionalised through appropriate legislation, may not be sufficient to mobilise social partners, and of primary concern in this research – business – to invest in skills development. It suggests that extensive reliance on business is an insufficient way in which to upskill the labour market. However, with few alternatives to this approach, it is subsequently essential that business is encouraged to buy into the collective interest of skills development objectives. This primarily entails overcoming the challenges that embody the framework and increasing state emphasis on skills development

Sensory Integration and Autistic Spectrum Disorder - What is the evidence?

Occupational Therapists are concerned with the ability to perform everyday living skills. Poor sensory processing can influence skills that support performance, engagement and attention, as well as skills that enable the learning of new motor skills (Cosby, 2010, Jasmin, 2009). These may include skills needed for tasks such as tooth brushing, eating, tolerating clothes, learning to dress, learning to swim, pedalling a bike, sitting in class, and coping with a supermarket. To utilize scarce resources effectively we need to understand the evidence base

Implementation of an ST-Segment Elevation Myocardial Infraction Bypass Protocol in the Northern United Arab Emirates

Objective: The aim was to evaluate the translation of an ST-segment elevation myocardial infraction (STEMI) bypass protocol to the outcomes of patients with acute coronary syndrome in the Emirate of Ras al-Khaimah in the United Arab Emirates (UAE). Methods: A prospective cohort study was conducted, which included all patients who had a prehospital 12-lead electrocardiogram (ECG) performed by ambulance crews. Analysis of those who were identified as having STEMI and who subsequently underwent percutaneous coronary intervention (PCI) was performed. Results: A total of 152 patients had a 12-lead ECG performed during the pilot study period (February 24, 2016-August 31, 2016) with 118 included for analysis. Mean patient age was 52 years. There were 87 male (74%) and 31 female (26%) patients. Twenty-nine patients suffered a STEMI, and data were available for 11 who underwent PCI. There was no mortality, and no major adverse cardiac events were reported. The median door-to-balloon (D2B) time was 73 min (range 48-124), and 81% of patients had a D2B time \u3c90 min. Discharge data were available for six patients: All were discharged home with no impediments to rehabilitation. Conclusion: This pilot study has demonstrated agreement with the existing literature surrounding prehospital ECG and PCI activation in an unstudied STEMI population and in a novel clinical setting. It has demonstrated a D2B time of \u3c90 min in over 80% of STEMI patients, and a faster mean D2B time than self-presentations (mean 77 min vs. 113 min), with no associated mortality or major adverse cardiac events

Developmental coordination disorder, psychopathology and IQ in 22q11.2 deletion syndrome

Background 22q11.2 Deletion Syndrome (22q11.2DS) is associated with high rates of neurodevelopmental disorder, however the links between developmental coordination disorder, intellectual function and psychiatric disorder remain unexplored. Aims Establish the prevalence of indicative Developmental Coordination Disorder (DCD) in children with 22q11.2DS, and examine associations with IQ, neuro-cognition and psychopathology. In-home neuro-cognitive assessments and psychiatric interviews of 70 children with 22q11.2DS (mean age=11.24, s.d=2.2) and 32 control siblings (mean age=11.5, s.d=2.1). Nine children with 22q11.2DS and indicative DCD were subsequently assessed in an occupational therapy clinic. Results Indicative DCD was found in 81.4% of children with 22q11.2DS, compared to 6.3% in control siblings (OR=36.7, p<0.001). Eight of nine (89%) children with indicative DCD met DSM-5 criteria for DCD. Poorer coordination was associated with increased numbers of anxiety, (p<0.001), Attention Deficit Hyperactivity Disorder (ADHD) (p<0.001) and Autism Spectrum Disorder (ASD) symptoms (p<0.001) in children with 22q11.2DS. Furthermore, 100% of children with 22q11.2DS and ADHD had indicative DCD, as did 90% of children with anxiety disorder and 96% of children who screened positive for ASD. DCDQ score was related to sustained attention (p=0.006), even after history of epileptic fits (p=0.006) and heart problems (p=0.009) was taken into account

Understanding the support experiences of families of children with autism and sensory processing difficulties: A qualitative study.

Background: Support, such as information, advice and therapies, can play a vital role in the lives of families of autistic children. However, little is known about the support experiences of UK parents and carers. Aim: To explore experiences of and access to support for families of children with autism and sensory processing difficulties, from the perspective of parents and carers. Methods: Semi‐structured, timeline‐assisted interviews were conducted with parents/carers of 30 children aged 5–11, exploring experiences of support. Framework analysis was used to identify themes in the interview data. Results: Support varied widely and was not accessed equitably. Specialist autism support, together with support from other parents and voluntary organizations, was perceived as more useful than statutory and nonspecialist provision. Unmet support needs included an ongoing point of contact for information and advice for parents, and access to direct therapy and specialist mental health provision for children

Exploring critical intervention features and trial processes in the evaluation of sensory integration therapy for autistic children

Background: We evaluated the clinical and cost-effectiveness of manualised sensory integration therapy (SIT) for autistic children with sensory processing difficulties in a two-arm randomised controlled trial. Trial processes and contextual factors which may have affected intervention outcomes were explored within a nested process evaluation. This paper details the process evaluation methods and results. We also discuss implications for evaluation of individual level, tailored interventions in similar populations. Methods: The process evaluation was conducted in line with Medical Research Council guidance. Recruitment, demographics, retention, adherence, and adverse effects are reported using descriptive statistics. Fidelity of intervention delivery is reported according to the intervention scoring manual. Qualitative interviews with therapists and carers were undertaken to explore the acceptability of the intervention and trial processes. Qualitative interviews with carers explored potential contamination. Results: Recruitment, reach and retention within the trial met expected thresholds. One hundred thirty-eight children and carers were recruited (92% of those screened and 53.5% of those who expressed an interest) with 77.5% retained at 6 months and 69.9% at 12 months post-randomisation. The intervention was delivered with structural and process fidelity with the majority (78.3%) receiving a ‘sufficient dose’ of intervention. However, there was considerable individual variability in the receipt of sessions. Carers and therapists reported that trial processes were generally acceptable though logistical challenges such as appointment times, travel and COVID restrictions were frequent barriers to receiving the intervention. No adverse effects were reported. Conclusions: The process evaluation was highly valuable in identifying contextual factors that could impact the effectiveness of this individualised intervention. Rigorous evaluations of interventions for autistic children are important, especially given the limitations such as limited sample sizes and short-term follow-up as faced by previous research. One of the challenges lies in the variability of outcomes considered important by caregivers, as each autistic child faces unique challenges. It is crucial to consider the role of parents or other caregivers in facilitating access to these interventions and how this may impact effectiveness. Trial registration: This trial is registered as ISRCTN14716440. August 11, 2016

Implementation of an ST-segment elevation myocardial infarction bypass protocol in the Northern United Arab Emirates

Objective: The aim was to evaluate the translation of an ST-segment elevation myocardial infarction (STEMI) bypass protocol to the outcomes of patients with acute coronary syndrome in the Emirate of Ras al-Khaimah in the United Arab Emirates (UAE). Methods: A prospective cohort study was conducted, which included all patients who had a prehospital 12-lead electrocardiogram (ECG) performed by ambulance crews. Analysis of those who were identified as having STEMI and who subsequently underwent percutaneous coronary intervention (PCI) was performed. Results: A total of 152 patients had a 12-lead ECG performed during the pilot study period (February 24, 2016–August 31, 2016) with 118 included for analysis. Mean patient age was 52 years. There were 87 male (74%) and 31 female (26%) patients. Twenty-nine patients suffered a STEMI, and data were available for 11 who underwent PCI. There was no mortality, and no major adverse cardiac events were reported. The median door-to-balloon (D2B) time was 73 min (range 48–124), and 81% of patients had a D2B time < 90 min. Discharge data were available for six patients: All were discharged home with no impediments to rehabilitation. Conclusion: This pilot study has demonstrated agreement with the existing literature surrounding prehospital ECG and PCI activation in an unstudied STEMI population and in a novel clinical setting. It has demonstrated a D2B time of < 90 min in over 80% of STEMI patients, and a faster mean D2B time than self-presentations (mean 77 min vs. 113 min), with no associated mortality or major adverse cardiac events