Delirium assessment in adult intensive care units: do nursing practices hinder or help?

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Science in Nursing. Johannesburg, 2018.Background: Delirium is a well-recognised and severe problem in adult intensive care units. With a reported incidence as high as 80%, it has been associated with increased length of stay, higher costs of care, on-going cognitive impairment and increased mortality. International best practice guidelines recommend nurses perform frequent delirium assessments using validated screening tools for all intensive care patients. Lack of data exists in the South African context regarding nurses’ current sedation and delirium practices and their perceptions towards delirium assessments. Setting: The settings for the study were five adult intensive care units (ICUs) at one academic hospital in Johannesburg. These intensive care units were: trauma ICU, cardiothoracic ICU, coronary care, neurosurgical ICU and General ICU. Purpose: The purpose of this study was to determine nursing practices regarding delirium assessments in the adult intensive care units of an academic hospital in Johannesburg, to make recommendations for clinical practice and education. Design: A quantitative-descriptive and cross-sectional design was utilised in this study. The total sample (n = 105) of registered nurses from the adult intensive care units (n = 5) between the period of 1.08.2017 to 1.09.2017 was used. Non-probability convenience sampling was utilised and data were collected using a questionnaire developed by (Devlin et al., 2008). Results: Overall 100 (n = 100) nurses responded, which yielded a response rate of 95.2% for the study. Delirium assessment was less frequent than sedation assessment (20% vs. 51%; p<0.001). Only 21%, ranked delirium as the most important condition to evaluate, compared with the altered level of consciousness (41%), improper placement of invasive lines (18%) and presence of pain (16%). Preferred methods for assessing delirium included assessing the ability to follow commands (51%), checking for agitation-related situations (41%), the Confusion Assessment Method for the Intensive Care Unit (24%), the Intensive Care Delirium Checklist (15%) and psychiatric consultation (12%). The barrier to assessment included intubation (57%), sedation level (21%) and lack of confidence to use delirium assessment tools (22%).The majority of participants never received an education (56%) or attended a lecture (19%) on delirium. Conclusion: These findings provide further evidence of a theory-practice gap that is likely to exist in South Africa where best practice guidelines in the management of delirium in the ICU settings are not implemented. Recommendations are made for clinical practice and education of intensive care nurses. Key words: delirium assessment, CAM-ICU, intensive care unit, intensive care nurseLG201

Innovation platform and governance of local rice value chains in Benin: Between game of power and internal democracy?

In Benin, rice plays a major role in the food security of the poorest rural and urban populations. However, the rice value chains have failed to achieve their potential because of some systemic constraints. In recent years, innovation platforms (IPs) have received increasing focus as mechanisms for strengthening the interaction between the stakeholders in the rice value chains. Nevertheless, the issues of information asymmetry and power between stakeholders with often divergent interests suppress the expected effects of the implementation of IP approach. This article used thematic content analysis to assess the influence of IPs on the governance of the parboiled rice value chain. The findings reveal that local rice value chains are characterized by unequal access to resources and asymmetry of power, which generates inequalities within groups. Although their influence is less discernible, IPs have contributed to greater visibility for some emerging stakeholders and rebalanced stakeholders in terms of influence in value chains. Moreover, the perverse effects of financial and human resources management limit the impact of improvement actions in various value chains. Therefore, the development model of value chains may be oriented toward the “business idea approach” instead of the “project approach”

School attendance at basic education in West Africa

The proportion of children entering primary school at the stipulated age in 2010 in Sub-Saharan Africa was 57%. For the same year, the net attendance ratios for primary and lower secondary education were 76% and 47% respectively. These figures are correlated in that delayed school enrolment increases the risk of dropout which in turn shortens the school life expectancy for children. These observations are the motivation behind this research. By writing this thesis, three substantive research questions have been explored: (1) what is Sierra Leone’s progress towards achieving universal basic education (2) what are the determinants of school attendance at basic education in West Africa and (3) does living in a community with more educated mothers enhance children’s school attendance at basic education. Three countries have been used: Sierra Leone, Liberia, and Ghana. Sierra Leone and Liberia have been used to reflect poor and post-conflict states with transitional and premature education systems respectively. Ghana is representative of middle income and politically stable countries with more advanced education systems in the region. The most recent Demographic and Health Survey for the three countries are used for analysis.Four empirical chapters are presented. The first chapter addresses research question 1. It applies simple statistical analyses to United Nations indicators for evaluating progress towards universal education. The second and third chapters answer the second research question and the final chapter answers the third research question. These three chapters employ multilevel statistical techniques to model the determinants of primary and junior secondary school attendance. The second empirical chapter focuses on the interaction between household and community poverty with the aim of investigating whether the attendance of poor children suffers more than affluent children by residing in a poor community. The third empirical chapter explores the determinants of junior secondary school attendance with the aim of deducing whether there are significant differences between post-conflict countries and more stable countries. The final chapter focuses on the relationship between mothers’ education and school attendance at basic education, arguing that living in a community with a high proportion of more educated mothers enhances the likelihood that a child will attend school, irrespective of the child’s background.The results from the first chapter show that the realisation of UBE is distant in Sierra Leone. There has been a decline in the number of children entering primary education; junior secondary education has however doubled although it remains low at 21%. Children from the poorest households are the most excluded from school followed by rural children and girls. The results from the second empirical chapter showed that there is a significant interaction between household and community poverty where poor children living in poor communities experience a greater depreciation in their probability of attending school than more affluent children who live in the same deprived environment in Sierra Leone. No such interaction was found in Liberia or Ghana. In the third empirical chapter, the sex of the child, agricultural livelihood within a community, household wealth and area of residence were significant in Sierra Leone and Liberia. In Ghana, sex of the household head and maternal orphanhood were significant. The hypothesis of the relationship between mothers’ community education and children’s school attendance for the final empirical chapter was confirmed

Transformation and mineralization of nitrogenous soil components in the gut of soil-feeding termites

This thesis consists of several studies that focused on the role of soil-feeding termites and termite gut microbiota in the transformation and mineralization of nitrogenous soil components. The results can be summarized into four subject matters, namely: 1. N mineralization and transformation during soil gut passage In order to better understand the role of soil-feeding termites in the dynamics of N in tropical soils, soil microcosms that received 15N tracers were incubated with termites. Here, our results demonstrated the importance of nitrogenous soil components (peptides) in the diet of soilfeeding termites, providing close to 50% of the termite’s carbon flux. The mineralization process, also results in the formation of enormous amounts of ammonia both in the gut (~150 mM) and the nest material. Additionally, we provided the first evidence for a termite-associated nitrification activity during the feeding activities of termites, which is coupled to denitrification and dissimilatory nitrate reduction to ammonia. At the ecosystem level, soil-feeding termites are estimated to contribute more towards N retention than to N loss in tropical soils. 2. Roles of termite gut microbiota in peptide breakdown and amino acids turnover Using gut homogenates, our studies revealed that termite gut microbiota play major roles in the hydrolysis and mineralization of peptidic components of soil organic matter. Both proteolytic and lysozyme activities were associated with termite tissues (i.e., salivary glands) and also the particulate fraction of the gut content. Together with the high alkalinity of the gut, soil peptides and microbial biomass are sequentially subjected to hydrolysis, solubilization, and extraction in the intestinal tract. Amino acids, which accumulate, are either directly absorbed by the insect or turned over by the dense hindgut microbiota, preferably by anaerobic amino-acid-fermenting bacteria. This underscores theimportant role of termite gut microbiota and the in situ physiological gut conditions, in enhancing the mineralization and utilization of peptidic components of soil organic matter by the termite. 3. Intestinal nitrate reduction leads to N2O and N2 emission Nitrate, a product of the nitrification activities in the gut, is reduced by the intestinal microbiota either to N2O and N2, or to ammonia. The reduction of nitrate to ammonia takes place mainly in the anterior gut region whereas denitrification occurs in the posterior hindgut. Virtually, no nitrate-reducing activities were present in the alkaline gut sections. Living termites emit both N2O and N2, but the emission of N2 rather than N2O seems to be the prevalent nitrogenous gas produced by soil-feeding termites. Nitrate reduction via denitrification represents ~26% of the total electrons flowing through methanogenesis in the intestinal tracts of soil-feeding termites. This study documents the first report on intestinal nitrate reduction to N2 and also provides the first evidence of soilfeeding termites as a source of the greenhouse gas N2O. 4. Excretion of ammonia via an “acid-trap” mechanism Soil-feeding termites preferentially utilize the peptidic components of soil organic matter. Consequently, ammonia levels in the hemolymph (~300 μM) and in the gut fluid accumulate to enormous concentrations. Using 15N tracers, we demonstrate that the alkalinity of the gut plays an important role removing ammonia by volatilizing NH4 + to NH3, which then diffuses into the hemolymph. Subsequently, NH3 is entrapped in the posterior hindgut with a circumneutral pH, most likely via an active transport mechanism. Finally, ammonia is egested through feces into the nest material. Also, preliminary evidence alludes to the role of Malpighian tubules in the excretion of ammonia as uric acid, a hitherto unknown function in soil-feeding termites

CT Pre-Operative Imaging of the Esophagus: Is Inclusion of Abdomen Necessary?

Background: Esophageal carcinoma is the third commonest tumor in Kenya with one of the highest mortality rates. Locally, the 2019 Kenya National Cancer Treatment Protocols recommend CT chest and abdomen as the basic imaging tool. The aim of this study was to determine the necessity of including the abdomen while scanning patients with cancer of the esophagus. Methods: Fifty consecutive patients with esophageal cancer who underwent CT imaging were included. Results: 32 male patients (64%) and 18 (36%) female patients. 4 patients (8%) had a CT diagnosis of upper third cancer of the esophagus; 20 patients (40%) had middle third cancer; and 26 patients (52%) had lower third cancer. Patients with middle and lower third esophagus tumors had nodal and distant metastases to the upper abdomen. Conclusion: Preoperative CT with the inclusion of abdomen is essential for patients with middle and lower third tumors. None of the patients with upper third tumors had metastases to the abdomen. Further studies with a larger sample size are needed to assess the necessity of including abdomen in CT scan in these patients. Keywords: Esophageal cancer, CT scan, Abdomen, Diagnostic yiel

An apparently aggressive craniofacial osteo-dysplastic lesion precipitating debilitating symptoms and signs: Case report

This is a case report of an 18 year old man with craniofacial fibro-osteo-dysplastic lesion which exhibited both exophytic and endophytic growth patterns. We discuss the extent of tumour growth and its associated secondary changes

Does living in a community with more educated mothers enhance children’s school attendance? Evidence from Sierra Leone

In Sierra Leone girls are 23.4% less likely to attend secondary education than boys. This difference between sexes increases the gender gap in educational attainment since women's education is positively associated with children's educational wellbeing. This paper investigates the relationship between children's school attendance, their mothers’ level of education, as well as the overall level of women's education at the community level in Sierra Leone using multilevel statistical modelling techniques and the country's 2008 Demographic and Health Survey data. The findings suggest that, regardless of a child's own mother's education, an increase in the proportion of mothers with secondary or higher education in a community by 10% improves the probability of attending junior secondary school significantly by 8%; a 50% increase improves the likelihood of attending school by 45%. There was no significant relationship between the proportion of better educated mothers in a community and primary school attendance. However, relative to children whose mothers had no formal education, children whose mothers had attained primary, secondary or higher education were 7%, 14% and 22% more likely to attend primary school respectively. Future policies should seek to promote girls’ education at post-primary education and develop community based programmes to enable the diffusion and transmission of educational messages

The Impact of Renewable Energy Consumption and Institution Quality on Economic Growth in Sub-Saharan Africa Countries

This paper investigates how renewable energy consumption impacts economic growth in Sub-Saharan Africa (SSA). In order to further enrich the debate around renewable energy policy direction and its corresponding effects on growth, we examine the interaction effect of renewable energy consumption and institutions quality on growth. In doing so, panel data set were collected for a sample of 45 SSA countries covering the period 1990-2020. The study employed a dynamic panel estimation technique with a view of evaluating the relative impact of the renewable energy consumption on growth. The results revealed that renewable energy consumption alone has very little impact on growth performance in SSA. However, the simultaneous interaction of renewable energy consumption with institutions quality brings about positive and significant impact on growth. This confirmed that the positive impact of renewable energy consumption on growth is conditional on the quality of institutions, especially as it relates to, government effectiveness, control of corruption, the rule of law and the regulatory quality. For policy, our results imply that governments in SSA should first strengthen their institutions while adopting gradual approach to green energy policies. Keywords: Renewable energy consumption, Institutions Quality, Economic Growth, Sub-Saharan Africa DOI: 10.7176/JESD/13-16-02 Publication date:August 31st 202

Structure de la recherche au Cameroun

Version anglaise disponible dans la Bibliothèque numérique du CRDI: Research structure in Cameroo

Activating institutional innovations for hunger and poverty reduction : potential of applied international agricultural research

The CGIAR system has made several attempts to improve its organizational structure, the latest being a reform process initiated in 2009. A key issue that has been debated over the years is how the CGIAR centres are best placed within the range of institutions involved in agricultural research and development. The CGIAR still faces the unresolved dilemma between a focus on upstream research that produces international public goods versus downstream activities that ensure impact. Therefore, there is a need to review the CGIARs position on this important question, and to obtain the views of centre scientists and other actors on this question. It is equally important to develop objective approaches to assess the comparative advantage of the CGIAR within the spectrum from upstream research on IPGs to downstream technology dissemination, taking context-specific factors, such as national capacities into account. Case studies are suitable to better understand what works in diverse circumstances and the conditions that have, so far, driven centres to engage in downstream activities. To fill these knowledge gaps, this study used a comparative qualitative case study approach focusing on the legume breeding program of the International Crops Research Institute for the Semi-Arid Tropics (ICRISAT). The studies were conducted in India, Malawi and Ethiopia, a set of countries that makes it possible to study variation in the capacity of national systems. Data was gathered using a combination of methods including a participatory mapping technique called Net-map, expert opinion interviews and a review of relevant documents. Respondents were purposively selected and included ICRISAT scientists, national partners, non-governmental organizations (NGOs), seed corporations, male and female farmers and other stakeholders involved in the research and promotion of improved groundnut and chickpea varieties. The narrative policy analysis confirms that there are contrasting views on whether the CGIAR should primarily focus on the production of IPGs, or also conduct more uptake-oriented activities. The dominant story is that the IPG concept is ideal for framing CGIAR research in a niche that would not be served by the private sector or national systems. The counterstory is that the CGIAR can only achieve impact if attention is paid to both research and development-oriented activities. In view of these contrasting views, which cannot easily reconciled, there is a need to develop objective and practical criteria for assessing the comparative advantage of the CGIAR, taking context-specific factors into account. Using the case studies to illustrate the transactions involved in the development and uptake of technologies, propositions are derived regarding the attributes of transactions for which international agricultural research centres (IARCs) have a comparative advantage over national systems. The analysis indicates that basic and strategic research transactions, such as molecular breeding, have high economies of scale and spillover potential and should ideally be carried out by IARCs. On the other hand, adaptive research, promotion and seed multiplication transactions have low economies of scale and spillover potential and should therefore be ideally assigned to national systems. Besides these two attributes, which are also highlighted in the literature on international public goods, the analysis revealed that transaction intensity and the scope for elite capture and corruption also influence the comparative advantage of the CGIAR centres. Applying this normative framework to the case studies, the influence of contextual factors, especially capacity of national systems, emerges as critical factor. Even though the legume varieties developed by ICRISAT fitted agro-ecological conditions in the target countries, the adoption of these varieties was hampered by institutional constraints. All legumes varieties included in the case studies remained on the shelf after their release until ICRISAT got itself involved in seed production and promotion. Capacity building in national systems should be an important role of the CGIAR to ensure that improved varieties are sustainably adopted on a large scale. However, organizations that fund development were found to have a tendency to avoid the difficult and long-term task of capacity strengthening of national systems, and instead use the centres to fill the capacity gaps, which induced the centers to engage in downstream activities. Decision-making and resource allocation for research under the CGIAR Research Programs (CRPs) should therefore take into account the issue of NARES capacity. The centers should constantly assess capacities of national systems to carry out activities that will enable impact in their target locations, and for their mandate crops. Finally, the centres should also manage learning from their involvement in research, as well as complementary activities.Die CGIAR hat mehrfach versucht, ihre Organisationsstruktur zu verbessern zuletzt durch einen Reformprozess, welcher im Jahre 2009 angestoßen wurde. Ein Hauptthema, welches in den letzten Jahren vermehrt diskutiert wurde, beschäftigt sich mit der Frage, wie sich die CGIAR-Zentren innerhalb der Vielzahl an Institutionen, welche in die Agrarforschung und -entwicklung eingebunden sind, am besten positionieren können. Die CGIAR steht somit vor der Wahl, einen Forschungsschwerpunkt zu verfolgen, welcher internationale öffentliche Güter hervorbringt oder Aktivitäten zu fördern, die unmittelbare lokale Wirkungen herbeiführen. Vor diesem Hintergrund ist es nicht nur notwendig, die Einstellung der CGIAR zu untersuchen, sondern auch die Perspektiven anderer Wissenschaftler und Akteure besser zu verstehen. Hierzu ist eine Entwicklung objektiver Ansätze unabdingbar, um die komparativen Vorteile der CGIAR zu bewerten. Fallstudien erscheinen besonders gut dafür geeignet, um besser verstehen zu können, was unter vielfältigen Umständen funktioniert und welche Faktoren die Entscheidungen der Zentren letztlich beeinflussen. Die vorliegende Studie versucht diese Forschungslücke zu schließen, indem sie vergleichende Fallstudien als qualitativen Forschungsansatz verfolgt, um das Leguminosen-Züchtungsprogramm des International Crops Research Institute for the Semi-Arid Tropics (ICRISAT) zu untersuchen. Um Variabilität in der Leistungsfähigkeit der nationalen Forschungssysteme herzustellen, wurde die Studie in Indien, Malawi und Äthiopien durchgeführt. Daten wurden anhand mehrerer Methoden erhoben, z.B. durch die partizipatorische Methode Netmap, Interviews und Auswertung von Dokumenten. Die Befragten, welche durch eine bewusste Stichprobe ausgewählt wurden, umfassten Forscher von ICRISAT, nationale Partner, Nichtregierungsorganisationen (NROs), Saatgut-Unternehmen, Landwirte (männlich und weiblich) sowie andere Akteure, welche in die Forschung und Förderung von verbesserten Erdnuss- und Kichererbsen-Sorten involviert sind. Die narrative Politikfeldanalyse bestätigte, dass eine Kontroverse besteht hinsichtlich der Frage, ob sich die CGIAR vorrangig auf die Förderung von internationalen öffentlichen Gütern spezialisieren sollte oder ob diese auch vermehrt Aktivitäten übernehmen sollte, welche die eigentliche Anwendung von Produkten vor Ort fördern. Es hat sich einerseits herausgestellt, dass das Konzept der internationalen öffentlichen Güter treffend ist, um die CGIAR-Forschung zu beschreiben, da diese weder durch den Privatsektor noch durch nationale Systeme abgedeckt wird. Eine gegensätzliche Perspektive ist, dass die CGIAR nur Wirkungen erreichen kann, wenn das Augenmerk sowohl auf Forschung als auch auf entwicklungsorientierten Maßnahmen, die lokale Anwendung fördern, gerichtet wird. Basierend auf den Fallstudien, welche die beteiligten Transkationen verdeutlichen, werden Vorschläge bezüglich der Eigenschaften von Transaktionen erarbeitet, für welche die Internationalen Agrarforschungszentren (IARCs) einen komparativen Vorteil gegenüber nationalen Systemen besitzen. Grundlegende und strategische Transaktionen, wie molekulare Züchtung, haben eine hohe Spezifität, Skaleneffekte sowie Übertragungspotential und sollten deshalb idealerweise durch die IARCs ausgeführt werden. Hingegen haben anpassungsfähige Forschung sowie Saatgutvermehrung eine hohe Transaktionsintensität und sollten deshalb idealerweise den nationalen Systemen zugewiesen werden. Bei der Anwendung dieses normativen konzeptionellen Rahmens auf die Fallstudien wurde deutlich, dass kontextspezifische Faktoren - insbesondere die Leistungsfähigkeit nationaler Systeme - eine wichtige Rolle spielen. Obwohl die von ICRISAT entwickelten Leguminosen-Sorten an die agrarökologischen Bedingungen der Zielländer angepasst sind, so wird ihr tatsächlicher Einsatz häufig durch institutionelle Hindernisse eingeschränkt. Alle Leguminosen-Sorten blieben nach ihrer Freigabe zunächst eingelagert, bis ICRISAT Akteure explizit dazu aufforderte, die Saatgutproduktion weiter voranzutreiben. Bei der Förderung von Handlungskompetenzen und Wissen sollte die CGIAR eine wichtige Rolle spielen, um sicherzustellen, dass verbesserte Sorten nachhaltig und in großem Maßstab verwendet werden. Es konnte jedoch beobachtet werden, dass Entwicklungshilfeorganisationen davor zurückschrecken, Kapazitäten aufzubauen, zumal es sich hier erfahrungsgemäß um einen langwierigen Prozess handelt. Letztlich könnten die Zentren durch ihre Einbindung in angewandte Forschung und die damit verbundenen Aktivitäten lernen