The nature of english higher as a secondary school subject in the Transvaal 1942-1972

D issertation subm itted to the Faculty o f E ducation University o f the Witwate.-irand, Johannesburg for the Degiee of Master o f Education Pretoria 1973An investigation was made in to w hat constituted the subject o f English as first language in the Transvaal at w xtr.dary school level over a period o f thirty years, from 1942 to 1972, a period which was bounded by im portant changes o f syllabus. Inform ation for the study was obtained from official publications 0 1 the Transvaal Education D epartm ent during that period: syllabuses, Language R eports to the A dm inistrator, the Annual Reports, public exam ination papers and exam iners’ reports, and reports o f the Education Bureau. T he titles of the prescribed w orks for the period were collated and analysed. Som e o f the language tex t books in use in the Trans 'I at various times were analysed A sample o f internal exam ination papers in C om position and Com prehension for Std 8, set by Transvaal teachers at the end o f 1973, com pleted the source material. The study outlines different concepts o f the nature o f English as a school subject. Present and projected trends in English teaching in m ajor English speaking countries are described, as a background against which to interpret the changes noted in the teaching o f the subject in the Transvaal over the given period, and in order to throw light on possible future developm ents in the province. The source m aterials are analysed in chapters on Syllabuses, Prescribed Works, Public E xam inations and Internal E xam inations The analysis deals w ith aims, subject m atter, the ethos o f the subject, and the assum ption:, b o th explicit and implicit, o f the education authorities and the teachers. Ti e s.udy describes how changes have occurred in every aspect o f the subject over the thirty year period. Language teaching has changed from instruction in formal Latinate gramm ar, through a period o f rigorously proscriptive and prescriptive teaching, to a concern with ability to com m unicate in given circum stances and with the use of language in m odem society. Spoken Engl.sh has also developed from being confined chiefi.1 t j proscriptive speech training, to playing a bigger role in all English teaching Written English has changed slowly from form al essay and letter w riting to w ritten com m unication o f various kinds In the prescription o f set w orks there has been a shift away from the classics o f previous centuries to the work o f tw entieth century writers. These changes have been accom panied by a change in the subject m atter and ethos of English. T he language which pupils in the nineteen seventies are expected to study and produce no longer conform s to a V ictorian model, as it did thirty years ago. The subject m atter is no longer literary and dom inated by the British way o f life I he shill to subject n a tte r which i« o f interest to the contem porary child coincides with a shift in aims. Instead o f presenting the child w ith a culture which he must be able to reproduce, the teacher reeks to draw the child out. Personal developm ent and self-confidence in the use o f language are given priority. The investigation has shown the need for close co-ordination am ong the various authorities directing the subject, the exam iners and the teachers. There has been a lack o f com m on policy and sense o f direction, which is shown particularly by inconsistencies and fluctuations o f standard in the selection o f prescribed works, but is also apparent in 'h e erratic developm ent o f the subject over a wide front. Recom m endations for future curriculum developm ent in English are made

Opposing indirect effects of domestic herbivores on saltmarsh erosion

Herbivores can sometimes influence the geomorphology of landscapes, particularly in systems dominated by hydrology. Salt marshes deliver globally valuable benefits, including coastal protection, yet they sometimes rapidly erode. Triggers for erosion are often unknown, but livestock grazing is a suspected cause in many regions of the world where agricultural use of saltmarshes is pervasive. To understand the influence of grazing on saltmarsh erosion, we sampled the plant community, soil chemistry and soil mechanical properties along 2–5 creeks in grazed and ungrazed marshes. Erosion was quantified as: (1) the rates of erosion of extracted soil–plant cores in a hydrological flume and (2) the number of erosional break-offs (‘slump blocks’) per creek. We found that domestic herbivores influenced saltmarsh geomorphology via two indirect and opposing pathways: one involving soil mechanical properties and the other mediated by plant traits and bare soil cover, all within a soil physico-chemical environment. The net effect of grazing results in a reduction in saltmarsh lateral erodibility and thus an increase in marsh resilience. Our results highlight the role of herbivores not only as controllers of the flow of energy and materials through the trophic web, but also as modifiers of the abiotic environment. Managers and scientists must remain vigilant to both the obvious direct and the more nuanced indirect pathways, which can influence grazed ecosystems. This study calls for a closer look to the biological side of the equation when assessing biogeomorphic feedbacks and plant–soil–animal interactions

Implementing shared decision-making in nutrition clinical practice: A theory-based approach and feasibility study

<p>Abstract</p> <p>Background</p> <p>There are a growing number of dietary treatment options to choose from for the management of many chronic diseases. Shared decision making represents a promising approach to improve the quality of the decision making process needed for dietary choices that are informed by the best evidence and value-based. However, there are no studies reporting on theory-based approaches that foster the implementation of shared decision making in health professions allied to medicine. The objectives of this study are to explore the integration of shared decision making within real nutritional consultations, and to design questionnaires to assess dieticians' intention to adopt two specific behaviors related to shared decision making using the Theory of Planned Behavior.</p> <p>Methods</p> <p>Forty dieticians will audiotape one clinical encounter to explore the presence of shared decision making within the consultation. They will also participate to one of five to six focus groups that aim to identify the salient beliefs underlying the determinants of their intention to present evidence-based dietary treatment options to their patients, and clarify the values related to dietary choices that are important to their patients. These salient beliefs will be used to elaborate the items of two questionnaires. The internal consistency of theoretical constructs and the temporal stability of their measurement will be checked using the test-retest method by asking 35 dieticians to complete the questionnaire twice within a two-week interval.</p> <p>Discussion</p> <p>The proposed research project will be the first study to: provide preliminary data about the adoption of shared decision making by dieticians and theirs patients; elicit dieticians' salient beliefs regarding the intention to adopt shared decision making behaviors, report on the development of a specific questionnaire; explore dieticians' views on the implementation of shared decision making; and compare their views regarding the implementation of shared decision making in different clinical settings.</p> <p>It is anticipated that the results generated by the proposed research project will significantly contribute to the emergence of shared decision making in nutrition through a theory-based approach.</p

Exploring dietitians' salient beliefs about shared decision-making behaviors

<p>Abstract</p> <p>Background</p> <p>Shared decision making (SDM), a process by which health professionals and patients go through the decision-making process together to agree on treatment, is a promising strategy for promoting diet-related decisions that are informed and value based and to which patients adhere well. The objective of the present study was to identify dietitians' salient beliefs regarding their exercise of two behaviors during the clinical encounter, both of which have been deemed essential for SDM to take place: (1) presenting patients with all dietary treatment options for a given health condition and (2) helping patients clarify their values and preferences regarding the options.</p> <p>Methods</p> <p>Twenty-one dietitians were allocated to four focus groups. Facilitators conducted the focus groups using a semistructured interview guide based on the Theory of Planned Behavior. Discussions were audiotaped, transcribed verbatim, coded, and analyzed with NVivo8 (QSR International, Cambridge, MA) software.</p> <p>Results</p> <p>Most participants stated that better patient adherence to treatment was an advantage of adopting the two SDM behaviors. Dietitians identified patients, physicians, and the multidisciplinary team as normative referents who would approve or disapprove of their adoption of the SDM behaviors. The most often reported barriers and facilitators for the behaviors concerned patients' characteristics, patients' clinical situation, and time.</p> <p>Conclusions</p> <p>The implementation of SDM in nutrition clinical practice can be guided by addressing dietitians' salient beliefs. Identifying these beliefs also provides the theoretical framework needed for developing a quantitative survey questionnaire to further study the determinants of dietitians' adoption of SDM behaviors.</p

Integration of oncology and palliative care : a Lancet Oncology Commission

Full integration of oncology and palliative care relies on the specific knowledge and skills of two modes of care: the tumour-directed approach, the main focus of which is on treating the disease; and the host-directed approach, which focuses on the patient with the disease. This Commission addresses how to combine these two paradigms to achieve the best outcome of patient care. Randomised clinical trials on integration of oncology and palliative care point to health gains: improved survival and symptom control, less anxiety and depression, reduced use of futile chemotherapy at the end of life, improved family satisfaction and quality of life, and improved use of health-care resources. Early delivery of patient-directed care by specialist palliative care teams alongside tumour-directed treatment promotes patient-centred care. Systematic assessment and use of patient-reported outcomes and active patient involvement in the decisions about cancer care result in better symptom control, improved physical and mental health, and better use of health-care resources. The absence of international agreements on the content and standards of the organisation, education, and research of palliative care in oncology are major barriers to successful integration. Other barriers include the common misconception that palliative care is end-of-life care only, stigmatisation of death and dying, and insufficient infrastructure and funding. The absence of established priorities might also hinder integration more widely. This Commission proposes the use of standardised care pathways and multidisciplinary teams to promote integration of oncology and palliative care, and calls for changes at the system level to coordinate the activities of professionals, and for the development and implementation of new and improved education programmes, with the overall goal of improving patient care. Integration raises new research questions, all of which contribute to improved clinical care. When and how should palliative care be delivered? What is the optimal model for integrated care? What is the biological and clinical effect of living with advanced cancer for years after diagnosis? Successful integration must challenge the dualistic perspective of either the tumour or the host, and instead focus on a merged approach that places the patient's perspective at the centre. To succeed, integration must be anchored by management and policy makers at all levels of health care, followed by adequate resource allocation, a willingness to prioritise goals and needs, and sustained enthusiasm to help generate support for better integration. This integrated model must be reflected in international and national cancer plans, and be followed by developments of new care models, education and research programmes, all of which should be adapted to the specific cultural contexts within which they are situated. Patient-centred care should be an integrated part of oncology care independent of patient prognosis and treatment intention. To achieve this goal it must be based on changes in professional cultures and priorities in health care

A realist analysis of hospital patient safety in Wales:Applied learning for alternative contexts from a multisite case study

Background: Hospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms. Objectives: This study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes. Design: We used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+ patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction. Setting: Welsh Government and NHS Wales. Participants: Interviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety. Main outcome measures: Identification of the contextual factors pertinent to the local implementation of the 1000 Lives+ patient safety programme in Welsh NHS hospitals. Results: An innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme. Conclusions: Heightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented. Funding: The National Institute for Health Research Health Services and Delivery Research programme

Attitudes Towards Geographical Renaming in South Africa

Changes to place names comprise a relatively small proportion of geographical names approved every year. This can be ascribed to lack of leadership and guidance, a lack of political sophistication, ignorance and conservatism. Three kinds of name changes have been made since 1994: changing of historical and recent personal names; changing of non-personal names in European languages and Afrikaans; and changes to spelling. The names that have been substituted are, in turn, names of historical or more recent persons; old, non-personal names or more recent, inventive, names; or translations into African languages. Most of the controversies over changing names concern history: should one version of history be wiped out by another, and how accurate are arguments based on versions of history? Whether or not to change the spelling of names to make them conform to current orthographies is debatable. United Nations guidelines advise against it, but concede that offensive names should be changed, and black people see older spellings as offensive, whatever the reason for them. Some spellings have been changed, and more are to come, but language specialists have not yet settled every aspect of the orthographies of the official languages. Changing names can be divisive, as episodes since 1994 illustrate. Government authorities have at times acted in a triumphalist way and ignored the requirement for consultation, but ANC leaders have acknowledged white sensitivities. Whites concede the right of Africans to their place names, but express reservations that sometimes cloak conservative resistance. Government authorities could do more to allay the fears of whites. Some name changes suggest that generosity of spirit and good humour will prevail