The ecological implications of sea-level rise and storms for sandy beaches in KwaZulu-Natal.

Thesis (M.Sc.)-University of KwaZulu-Natal, Westville, 2008.The aesthetic appeal of beaches has made coastal properties prime sites for development. However, this development has been mismanaged and is within the littoral active zone. Beaches retreat landwards as sea levels rise, but with current development trends, beaches are trapped in a coastal squeeze. Climate-change predictions include an increase in frequency and heightened intensity of storms, which can cause significant erosion. This study aimed to determine the ecological implications of sea-level rise and storms for beaches in KwaZulu-Natal (KZN), using geographic information systems (GIS) and beach sampling methods. The beaches were mapped in terms of physical and biological attributes. Spatial trends in these attributes showed that the coastline can be split into three – the northern, central and southern regions. Although 25 % of the coastline is protected by marine reserves, these are located in the Delagoa bioregion: 28 macrofauna species in the Natal bioregion are not protected. Storm impacts for beaches can be heterogeneous, depending on local coastal features, e.g., nearshore reef and sand dunes, and represented a temporary disturbance to macrofauna communities. A GIS-based coastal recession model was derived from Bruun’s rule, and applied for different scenarios of sea-level rise and coastal development. Coastal squeeze is concern, particularly in the southern region. Further, the 10-m elevation contour was not completely effective as a setback line, even for a low sea-level rise scenario. The coastal recession model was validated using data from a real event in KZN, where sea level rose temporarily by ~1.0 m. The model performed well, although the calibration possibly did not span a wide enough range of beach morphodynamic types, and under-predicted retreat for dissipative beaches. It was concluded that the Natal bioregion needs marine reserves, and that higher resolution spatial data are required for accurate beach modeling and the south coast railway line should be relocated proactively. Guidelines for sandy beach systematic conservation planning were outlined, and seated in a conceptual framework of managing beaches for resilience. Application of the proposed recommendations and frameworks could aid in determining a way forward in integrated coastal zone management for KZN, in the face of the uncertainties associated with climate change

Development and preliminary reliability testing of an assessment of patient independence in performing a treatment program: Standardized scenarios

BACKGROUND: Physical therapists often assess patient independence through observation, however it is not known if therapists make these judgments reliably. We have developed a standardized method to assess a patient’s ability to perform his or her treatment program independently. OBJECTIVES: To develop a standardized assessment of patient independence in performance of a treatment program and examine the intra- and inter-rater reliability decisions made by two physical therapists. DESIGN: Test-retest. METHODS: An assessment of patient independence in performance was developed. Standardized patient scenarios were used to assess the intra- and inter-tester reliability of two physical therapists. Percentage of agreement (%) and kappa’s coefficient (k and k(w)) indexed rater reliability. RESULTS: Intra-rater reliability of Therapist 1 was as follows: knowledge: %=95, k=.90; performance: %=95, k(w)=.82. Intra-rater reliability of Therapist 2 was as follows: knowledge: %=85, k=.68; performance: %=94, k(w)=.80. Inter-rater reliability for knowledge was %=91 and k=.79 and for performance was %=91 and k(w)=.72. CONCLUSION: Trained therapists displayed substantial to excellent intra-rater reliability and substantial inter-rater reliability in assessing a patient’s independence in a treatment program

Association of urinary uromodulin with kidney function decline and mortality: the health ABC study .

BackgroundUrine uromodulin (uUMOD) is a protein secreted by the kidney tubule. Recent studies have suggested that higher uUMOD may be associated with improved kidney and mortality outcomes.MethodsUsing a case-cohort design, we evaluated the association between baseline uUMOD levels and ≥ 30% estimated glomerular filtration rate (eGFR) decline, incident chronic kidney disease (CKD), rapid kidney function decline, and mortality using standard and modified Cox proportional hazards regression.ResultsThe median value of uUMOD was 25.8 µg/mL, mean age of participants was 74 years, 48% were women, and 39% were black. Persons with higher uUMOD had lower prevalence of diabetes and coronary artery disease (CAD), and had lower systolic blood pressure. Persons with higher uUMOD also had higher eGFR, lower urinary albumin to creatinine ratio (ACR), and lower C-reactive protein (CRP). There was no association of uUMOD with > 30% eGFR decline. In comparison to those in the lowest quartile of uUMOD, those in the highest quartile had a significantly (53%) lower risk of incident CKD (CI 73%, 18%) and a 51% lower risk of rapid kidney function decline (CI 76%, 1%) after multivariable adjustment. Higher uUMOD was associated with lower risk of mortality in demographic adjusted models, but not after multivariable adjustment.ConclusionHigher levels of uUMOD are associated with lower risk of incident CKD and rapid kidney function decline. Additional studies are needed in the general population and in persons with advanced CKD to confirm these findings.


Psychological characteristics of children with visual impairments: learning, memory and imagery

The performance of children (and sometimes adults) with visual impairments (VI) on a range of tasks that reflect learning, memory and mental imagery is considered in this article. Sometimes the evidence suggests that there are impairments in performance in comparison with typically developing children with vision and sometimes some advantages emerge. The author’s aim is to describe some of her own and others’ findings and explore what they tell us about the cognitive characteristics of such children, so that progress with practical interventions can be advanced through understanding. The article starts by focusing on social-cognitive development and in particular considers the potential benefits of language in that development. This is followed by a review of some studies of learning and memory performance which provide a coherent picture of development without vision and finally ends with a consideration of spatial mental imagery

Do psychological harms result from being labelled with an unexpected diagnosis of abdominal aortic aneurysm or prostate cancer through screening? A systematic review

Objective A potential psychological harm of screening is unexpected diagnosistextemdashlabelling. We need to know the frequency and severity of this harm to make informed decisions about screening. We asked whether current evidence allows an estimate of any psychological harm of labelling. As case studies, we used two conditions for which screening is common: prostate cancer (PCa) and abdominal aortic aneurysm (AAA).Design Systematic review with narrative synthesis.Data sources and eligibility criteria We searched the English language literature in PubMed, PsychINFO and Cumulative Index of Nursing and Allied Health Literature (CINAHL) for research of any design published between 1 January 2002 and 23 January 2017 that provided valid data about the psychological state of people recently diagnosed with early stage PCa or AAA. Two authors independently used explicit criteria to review and critically appraise all studies for bias, applicability and the extent to which it provided evidence about the frequency and severity of harm from labelling.Results 35 quantitative studies (30 of PCa and 5 of AAA) met our criteria, 17 (48.6 of which showed possible or definite psychological harm from labelling. None of these studies, however, had either appropriate measures or relevant comparisons to estimate the frequency and severity of psychological harm. Four PCa and three AAA qualitative studies all showed clear evidence of at least moderate psychological harm from labelling. Seven population-based studies found increased suicide in patients recently diagnosed with PCa.Conclusions Although qualitative and population-based studies show that at least moderate psychological harm due to screening for PCa and AAA does occur, the current quantitative evidence is insufficient to allow a more precise estimation of frequency and severity. More sensitive measures and improved research designs are needed to fully characterise this harm. In the meantime, clinicians and recommendation panels should be aware of the occurrence of this harm.Peer reviewe

Screening for Obstructive Sleep Apnea in Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force

Importance: Many adverse health outcomes are associated with obstructive sleep apnea (OSA). Objective: To review primary care-relevant evidence on screening adults for OSA, test accuracy, and treatment of OSA, to inform the US Preventive Services Task Force. Data Sources: MEDLINE, Cochrane Library, EMBASE, and trial registries through October 2015, references, and experts, with surveillance of the literature through October 5, 2016. Study Selection: English-language randomized clinical trials (RCTs); studies evaluating accuracy of screening questionnaires or prediction tools, diagnostic accuracy of portable monitors, or association between apnea-hypopnea index (AHI) and health outcomes among community-based participants. Data Extraction and Synthesis: Two investigators independently reviewed abstracts and full-text articles. When multiple similar studies were available, random-effects meta-analyses were conducted. Main Outcomes and Measures: Sensitivity, specificity, area under the curve (AUC), AHI, Epworth Sleepiness Scale (ESS) scores, blood pressure, mortality, cardiovascular events, motor vehicle crashes, quality of life, and harms. Results: A total of 110 studies were included (N = 46 188). No RCTs compared screening with no screening. In 2 studies (n = 702), the screening accuracy of the multivariable apnea prediction score followed by home portable monitor testing for detecting severe OSA syndrome (AHI ≥30 and ESS score >10) was AUC 0.80 (95% CI, 0.78 to 0.82) and 0.83 (95% CI, 0.77 to 0.90), respectively, but the studies oversampled high-risk participants and those with OSA and OSA syndrome. No studies prospectively evaluated screening tools to report calibration or clinical utility for improving health outcomes. Meta-analysis found that continuous positive airway pressure (CPAP) compared with sham was significantly associated with reduction of AHI (weighted mean difference [WMD], -33.8 [95% CI, -42.0 to -25.6]; 13 trials, 543 participants), excessive sleepiness assessed by ESS score (WMD, -2.0 [95% CI, -2.6 to -1.4]; 22 trials, 2721 participants), diurnal systolic blood pressure (WMD, -2.4 points [95% CI, -3.9 to -0.9]; 15 trials, 1190 participants), and diurnal diastolic blood pressure (WMD, -1.3 points [95% CI, -2.2 to -0.4]; 15 trials, 1190 participants). CPAP was associated with modest improvement in sleep-related quality of life (Cohen d, 0.28 [95% CI, 0.14 to 0.42]; 13 trials, 2325 participants). Mandibular advancement devices (MADs) and weight loss programs were also associated with reduced AHI and excessive sleepiness. Common adverse effects of CPAP and MADs included oral or nasal dryness, irritation, and pain, among others. In cohort studies, there was a consistent association between AHI and all-cause mortality. Conclusions and Relevance: There is uncertainty about the accuracy or clinical utility of all potential screening tools. Multiple treatments for OSA reduce AHI, ESS scores, and blood pressure. Trials of CPAP and other treatments have not established whether treatment reduces mortality or improves most other health outcomes, except for modest improvement in sleep-related quality of life

Dispersal and coastal geomorphology limit potential for mangrove range expansion under climate change

Latitudinal range limits for mangroves on high-energy, wave-dominated coasts are controlled by geomorphological features and estuarine dynamics. Mangroves reach a southern global range limit along the South African coastline, but the distribution is patchy, with stands occurring in only 16% of the estuaries in the region. Yet, the persistence of forests planted \u3e50 years ago beyond the natural distribution limit suggests that additional estuaries could support mangroves. Understanding regional drivers is necessary to inform global-scale estimates for how this important ecosystem is predicted to respond to climate change. Here, we combine species distribution modelling (MaxEnt), Lagrangian particle tracking using an eddy- and tide-resolving numerical ocean model, and connectivity matrices, to identify suitable mangrove habitats along the South African coastline at present, as well as under the IPCC RCP4.5 and RCP8.5 climate scenarios. Within the current South African distribution range (±900 km), eight more estuaries were identified to be suitable under contemporary conditions. When considering potential range extension (±110 km), an additional 14 suitable estuaries were identified. Connectivity matrices suggest limited long-distance dispersal, stranding mostly at or near the release location, and a decreased probability of connectivity towards the range limit. Under both future climate scenarios, 30% of estuaries currently supporting mangroves are predicted to become unsuitable, while an additional six estuaries beyond the current distribution are predicted to become suitable. However, there is limited connectivity between these new sites and established forests. Synthesis. This study shows that dispersal substantially limits mangrove distribution at the southern African range limit and highlights the importance of including this process in species distribution models. Ultimately, our results provide new insight into mangrove conservation and management at range limits that are not controlled predominantly by temperature, as it has been assumed that mangroves will largely expand to higher latitudes under climate change

Examining human rights and mental health among women in drug abuse treatment centers in Afghanistan

Denial of human rights, gender disparities, and living in a war zone can be associated with severe depression and poor social functioning, especially for female drug abusers. This study of Afghan women in drug abuse treatment (DAT) centers assesses (a) the extent to which these women have experienced human rights violations and mental health problems prior to entering the DAT centers, and (b) whether there are specific risk factors for human rights violations among this population. A total of 176 in-person interviews were conducted with female patients admitted to three drug abuse treatment centers in Afghanistan in 2010. Nearly all women (91%) reported limitations with social functioning. Further, 41% of the women indicated they had suicide ideation and 27% of the women had attempted suicide at least once 30 days prior to entering the DAT centers due to feelings of sadness or hopelessness. Half of the women (50%) experienced at least one human rights violation in the past year prior to entering the DAT centers. Risk factors for human rights violations among this population include marital status, ethnicity, literacy, employment status, entering treatment based on one’s own desire, limited social functioning, and suicide attempts. Conclusions stemming from the results are discussed