Learning experiences of students during integrated management of childhood illness (IMCI) training

Published ArticleThe aim of the study on which this article is based was to reflect on the learning experiences of students during integrated management of childhood illness (IMCI) training in an undergraduate programme. IMCI is a set of guidelines that was established by the World Health Organisation (WHO) for cost-effective quality care for children younger than five to prevent diseases and death (WHO, 2004). Skilled primary healthcare workers are required to provide quality care at first contact with these children. The IMCI package was presented as an integral part of the second-year module that focuses on primary healthcare. In order to improve the quality of health services and refocus the health system on primary health-care (South Africa Department of Health, 2010), students have to demonstrate that they have achieved competence. According to Killen (2000:188), competence is a holistic term and focuses on knowledge, skills and values instead of competencies, which refer to specific capabilities. Primary health-care workers who act competently will integrate foundational IMCI knowledge with skills and values as well as with the ability to verify their decisions (Killen, 2000:188). Aqualitative, exploratory and descriptive research design was used to investigate the IMCI learning experiences. Such experiences are one of the indications whether training has been successful and how it can be improved (Suski, 2004:222). Data was collected by means of nominal-group technique (NGT) interviews with second-year nursing students of the training school who complied with the criteria for inclusion. NGT interviews were used effectively to evaluate clinical interaction, education and training.The findings reflected the different emotions experienced during teaching and learning as having been positive, negative or neutral. The consideration of negative emotions will assist with the improvement of IMCI teaching and learning, but all these findings can be useful for other higher-education institutions that present or plan to present IMCI training

An evaluation of the assessment tool used for extensive mini-dissertations in the Master’s Degree in Family Medicine, University of the Free State

Background: Family Medicine became a speciality in South Africa in 2007. Postgraduate studies in Family Medicine changed from part-time Master of Family Medicine (MFamMed) to a full-time Master of Medicine (Family Medicine) [MMed(Fam)] degree, with changes in the curriculum and assessment criteria. The overall goal of this study was to evaluate the current assessment tool for extensive mini-dissertations in the  postgraduate programme for Family Medicine, at the University of the Free State, and if necessary, to produce a valid and reliable assessment tool that is user-friendly.Method: An action research approach was used in this study, using mixed methods. Firstly, marks given by 15 assessors for four mini-dissertations using the current assessment tool were analysed quantitatively. In Phase 2, the regulation of the assessment bodies and the quantitative results of Phase 1 were discussed by assessors during a focus group interview, and data were analysed qualitatively. An adapted, improved assessment tool (Phase 3) was developed and re-evaluated in Phase 4.Results: The current assessment tool complied with the regulations of the assessment bodies. The scores allocated to specific categories varied with a median coefficient of variation of more than 15% in four of the possible 12 assessment categories. During the focus group interview, reasons for this were identified and the assessment tool adapted accordingly. During reassessment of the tool, individual assessors were identified as the  reason for poor reliability.Conclusion: The current assessment tool was found to be valid, but was not reliable for all assessment categories. The adapted assessment tool  addressed these areas, but identified lack of training and experience in the assessment of extensive mini-dissertations by certain assessors as the main reason for unreliable assessment

Floristic analysis of the Mountain Zebra National Park, Eastern Cape

As part of a larger project to assess the vegetation dynamics and conservation potential of the enlarged Mountain Zebra National Park, a checklist was produced to determine the plant species richness for this area. Six hundred and eighty species, represented by 333 genera and 87 families were identified. One hundred and eighty species belong to the Monocotyledoneae and 479 species to the Dicotyledoneae. By far the largest families are the Asteraceae with 129 and the Poaceae with 82 species. Thirteen Red Data species were recorded. A number of fynbos elements were encountered, the most noteworthy being two families endemic to the Cape Floristic Region, the Penaeaceae and Grubbiaceae. A very high species to square kilometre ratio of 5.05 supports the area’s rich floristic composition

The time to extinction for an SIS-household-epidemic model

We analyse a stochastic SIS epidemic amongst a finite population partitioned into households. Since the population is finite, the epidemic will eventually go extinct, i.e., have no more infectives in the population. We study the effects of population size and within household transmission upon the time to extinction. This is done through two approximations. The first approximation is suitable for all levels of within household transmission and is based upon an Ornstein-Uhlenbeck process approximation for the diseases fluctuations about an endemic level relying on a large population. The second approximation is suitable for high levels of within household transmission and approximates the number of infectious households by a simple homogeneously mixing SIS model with the households replaced by individuals. The analysis, supported by a simulation study, shows that the mean time to extinction is minimized by moderate levels of within household transmission

Self-avoiding walks and connective constants

The connective constant $\mu(G)$ of a quasi-transitive graph $G$ is the asymptotic growth rate of the number of self-avoiding walks (SAWs) on $G$ from a given starting vertex. We survey several aspects of the relationship between the connective constant and the underlying graph $G$. $\bullet$ We present upper and lower bounds for $\mu$ in terms of the vertex-degree and girth of a transitive graph. $\bullet$ We discuss the question of whether $\mu\ge\phi$ for transitive cubic graphs (where $\phi$ denotes the golden mean), and we introduce the Fisher transformation for SAWs (that is, the replacement of vertices by triangles). $\bullet$ We present strict inequalities for the connective constants $\mu(G)$ of transitive graphs $G$, as $G$ varies. $\bullet$ As a consequence of the last, the connective constant of a Cayley graph of a finitely generated group decreases strictly when a new relator is added, and increases strictly when a non-trivial group element is declared to be a further generator. $\bullet$ We describe so-called graph height functions within an account of "bridges" for quasi-transitive graphs, and indicate that the bridge constant equals the connective constant when the graph has a unimodular graph height function. $\bullet$ A partial answer is given to the question of the locality of connective constants, based around the existence of unimodular graph height functions. $\bullet$ Examples are presented of Cayley graphs of finitely presented groups that possess graph height functions (that are, in addition, harmonic and unimodular), and that do not. $\bullet$ The review closes with a brief account of the "speed" of SAW.Comment: Accepted version. arXiv admin note: substantial text overlap with arXiv:1304.721

Numerical Study of a Field Theory for Directed Percolation

A numerical method is devised for study of stochastic partial differential equations describing directed percolation, the contact process, and other models with a continuous transition to an absorbing state. Owing to the heightened sensitivity to fluctuationsattending multiplicative noise in the vicinity of an absorbing state, a useful method requires discretization of the field variable as well as of space and time. When applied to the field theory for directed percolation in 1+1 dimensions, the method yields critical exponents which compare well against accepted values.Comment: 18 pages, LaTeX, 6 figures available upon request LC-CM-94-00

The Community PrEP Study: a randomized control trial leveraging community-based platforms to improve access and adherence to pre-exposure prophylaxis to prevent HIV among adolescent girls and young women in South Africa—study protocol

Background HIV incidence among South African adolescent girls and young women (AGYW) remains high, but could be reduced by highly effective pre-exposure prophylaxis (PrEP). Unfortunately, AGYW report significant barriers to clinic-based sexual and reproductive health services. Even when AGYW access PrEP as an HIV prevention method, poor prevention-effective use was a serious barrier to achieving its optimal HIV prevention benefits. Determining the acceptability and feasibility of community-based platforms to increase AGYW’s access to PrEP, and evaluating behavioural interventions to improve prevention-effective use of PrEP are needed. Methods We propose a mixed-methods study among AGYW aged 16–25 years in Eastern Cape Province, South Africa. In the first component, a cross-sectional study will assess the acceptability and feasibility of leveraging community-based HIV counselling and testing (CBCT) platforms to refer HIV-negative, at-risk AGYW to non-clinic-based, same-day PrEP initiation services. In the second component, we will enrol 480 AGYW initiating PrEP via our CBCT platforms into a three-armed (1:1:1) randomized control trial (RCT) that will evaluate the effectiveness of adherence support interventions to improve the prevention-effective use of PrEP. Adherence will be measured over 24 months via tenofovir-diphosphate blood concentration levels. Qualitative investigations will explore participant, staff, and community experiences associated with community-based PrEP services, adherence support activities, study implementation, and community awareness. Costs and scalability of service platforms and interventions will be evaluated. Discussion This will be the first study to assess the acceptability and feasibility of leveraging CBCT platforms to identify and refer at-risk AGYW to community-based, same-day PrEP initiation services. It will also provide quantitative and qualitative results to inform adherence support activities and services that promote the prevention-effective use of PrEP among AGYW. By applying principles of implementation science, behavioural science, and health economics research, we aim to inform strategies to improve access to and prevention-effective use of PrEP by AGYW. Trial registration ClinicalTrials.gov NCT03977181 . Registered on 6 June 2019—retrospectively registered

Phase Transitions on Nonamenable Graphs

We survey known results about phase transitions in various models of statistical physics when the underlying space is a nonamenable graph. Most attention is devoted to transitive graphs and trees