DesignWork : a study of public works programmes in South African architectural projects

Increasingly in South Africa, architects are requested to design buildings that meet the job-creation and training goals of the Expanded Public Works Programme (EPWP), a government-led poverty relief initiative. In so doing, they have a mandate both to design buildings and to design work for the poorest of the poor. This unique context of architectural practice is herein termed DesignWork, and the links between these designs and their measurable work outcomes will be the focus of this Case Study Research. Architects can be key agents in shaping economic empowerment for participants and architectural quality within these projects. This thesis investigated how architects addressed three key goals of increasing wage transfer through labour-intensive construction, enabling skill development through relevant in-situ technical training, and creating quality assets. With the 2030 National Development Plan anticipating the growth of the EPWP in the coming decades, the development of effective architectural strategies within this context is of great significance. Evidence from semi-structured interviews, site visits, archival documents, direct observation, and data collection were used to interrogate the architectural design strategies and work outcomes within two select projects. What emerges is a focused view of the central challenges of achieving the EPWP programme goals, baseline data for future research, and an understanding of the foreseeable challenges for architects designing in this context

HOME MECHANICAL VENTILATION OF CHILDREN

The medical records of 89 ventilator-assisted children followed at the University of Michigan Medical Center from 1978 to 1993 were reviewed. The status of these children was remarkably stable. Parameters of communication, nutrition, education, and mobility changed very little over time, and fewer than half had to be rc-admitted. Children aged 9 to 12 years had the most nursing hours; in terms of diagnosis, those with spinal cord injury and bronchopulmonary dysplasia had the most. The younger children had the longest initial hospital stay and the most re-admissions. The authors conclude that appropriate rehabilitation during the initial hospitalization can minimize later changes, instability and rehospitalizations, and that careful follow-up and periodic evaluation can improve the patients' health and function. R SUM Ventilation assist e a domicile chez enfant: param tres ďune volution durant quinze ans ďexp rience Les dossiers m dicaux de 89 enfants ayant b n fici ďune ventilation assist e et suivis par le Centre M dical de Universit du Michigan entrc 1978 et 1993 ont t examines. tat de ces enfants est apparu remarquablement stable. Les param tres de communication, alimentation. ducation et d placements volu rent tr s peu et moms de la moiti des enfants devaient tre r hospitalis e. Les enfants de 9 12 ans cxigeaient le plus ďheures ďinfirmi re; de m me, en terme de diagnostic, les enfants avec lesions de la moelle epiniere ou une dysplasie broncho-pulmonaire. Les enfants les plus jeunes exigeaient le temps hospitalier initial le plus long et les r hospitalisations les plus fr quentes. Les auteurs concluent qu'une prise en charge appropri e durant hospitalisation initiate peut att nuer les modifications ult rieures, instabilit ou la r hospitalisation, et qu'un suivi soigneux et des valuations p riodiques peuvent am liorer la sant et les capacit s des patients. ZUSAMMENFASSUNG Heimbeatmimg von Kindern: Ver ndemngen nach 15 Jaliren Erfalirung Die Krankengeschichten von 89 Kindern mit assistierter Beatmung, die von 1978 zu 1993 in der Universitatsklinik von Michigan betreut wurden, sind durchgesehen worden. Der Zustand dieser Kinder war bemerkenswert stabil. Die Parameter f r Kommunikation, Ern hrung, Erziehung und Mobilit t nderten sich in diesem Zeitraum kaum und weniger als die H lfte mu ten wieder aufgenommen werden. Kinder im Alter zwischen 9 und 12 Jahren brauchten die meisten Pflegestunden, unter Ber cksichtigung der Diagnose hatten Kinder mit Riickenmarksverletzungen und bronchopulmonaler Dysplasie die meisten. Die j ngeren Kinder warcn am l ngsten in der Klinik und mu tcn am h ufigsten wieder aufgenommen werden. Die Autoren schlie en daraus, da eine ausreichende Rehabilitation beim ersten Krankenhausaufenthalt sp tere Ver nderungen, Instabilit ten und Rehospitalisierungen reduzieren und sorgf ltige Kontrollen und periodische Beurteilungen die Gesundheit und Funktion der Patienten verbessern k nnen. R SUM Ventilaci n mec nica de ni os a domicilio: par metros de cambio en una experiencia de quince a as Se revisaron las historias cl nicas de 89 ni os con ventilaci n asistida, seguidos en el Medical Center de la Universidad de Michigan dcsde 1978 a 1993. El estado de estos ni os era notablemente estable. Los par metros de comunicaci n, nutrici n, educaci n y movilidad cambiaron muy poco a lo largo del tiempo y s 1o tuvieron que reingresar menos de la mitad de ellos. Los ni os de 9 a 12 a os ten an el mayor numero de horas decuidados y en t rminos de diagn stico los ni os con lesion medular y displasia broncopulmonar necesitaban el m ximo de cuidados. Los ni os m s peque os presentaban el estadio inicial hospitalario m s largo y el mayor n mero de reingresos. Los autorcs concluyen que una apropiada rehabilitaci n durante el inicio de la hospitalizaci n puede minimizar los cambios posteriores, la inestabilidad y las rehospitalizaciones. Igualmente un seguimiento cuidadoso y evaluaciones peri dicas pueden mejorar la salud y la funcion de los pacientes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66446/1/j.1469-8749.1996.tb12140.x.pd

The significance of accumulated oropharyngeal secretions and swallowing frequency in predicting aspiration

This study retrospectively investigated the value of both endoscopically visible oropharyngeal secretions in the hypopharynx and swallowing frequency in the prediction of aspiration of food and liquid. Fiberoptic endoscopic evaluation of swallowing (FEES) was performed on a total of 69 individuals that included hospitalized elderly, nonhospitalized elderly, and young normal subjects. A four-level rating scale for determining the severity of accumulated orpharyngeal secretions was developed and employed to rate subjects prior to the presentation of food or liquid during the FEES. Spontaneous dry swallows were also counted during the observation period of the FEES. It was found that the accumulation of endoscopically visible oropharyngeal secretions located within the laryngeal vestibule was highly predictive of aspiration of food or liquid. There were significantly fewer spontaneous swallows in hospitalized subjects when compared with nonhospitalized subjects. There was also a significant decrease in the frequency of spontaneous swallows in aspirating hospitalized subjects when compared with nonaspirating hospitalized subjects. Results are discussed in terms of integrating this information with clinical bedside examination techniques.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41360/1/455_2004_Article_BF00417898.pd

Accuracy and clinical utility of comprehensive dysphagia screening assessments in acute stroke: A systematic review and meta‐analysis

IntroductionNurses and other nonspecialists in dysphagia are often trained to screen swallowing poststroke. There are many basic tools that test water only, they are usually conservative, and patients that fail the test remain nil by mouth until a speech and language therapy assessment. More comprehensive tests also allow nonspecialists to recommend modified oral intake. Little is known about the accuracy, clinical utility and cost‐effectiveness of these tests.MethodsFollowing PRISMA guidelines, a systematic review was conducted to describe comprehensive swallowing tests that are available for use in acute stroke by nurses or other nonspecialists in dysphagia. A meta‐analysis was performed to evaluate accuracy and the clinical utility of the tests was considered. Searches and analyses, conducted by two reviewers, included MEDLINE, Embase, trial registries and grey literature up to December 2018. Validated studies were assessed for quality and risk of bias using QUADAS‐2.ResultsTwenty studies were included, describing five different tests, three of which had undergone validation. The tests varied in content, recommendations and use. There was no test superior in accuracy and clinical utility. Three studies validating the Gugging Swallow Screen provided sufficient data for meta‐analysis, demonstrating high sensitivity; 96% (95% CI 0.90–0.99), but low specificity, 65% (95% CI 0.47–0.79), in line with many water swallow tests. Results should be interpreted with caution as study quality and applicability to the acute stroke population was poor.ConclusionsThere is no comprehensive nurse dysphagia assessment tool that has robustly demonstrated good accuracy, clinical utility and cost‐effectiveness in acute stroke.Relevance to Clinical PracticeNurses and other clinicians can develop competencies in screening swallowing and assessing for safe oral intake in those with poststroke dysphagia. It is important to use a validated assessment tool that demonstrates good accuracy, clinical utility and cost‐effectiveness

The Oklahoma Daily

Student newspaper of the University of Oklahoma in Norman, Oklahoma that includes national, local, and campus news along with advertising

The Oklahoma Daily

Student newspaper of the University of Oklahoma in Norman, Oklahoma that includes national, local, and campus news along with advertising

The Oklahoma Daily

Student newspaper of the University of Oklahoma in Norman, Oklahoma that includes national, local, and campus news along with advertising

The Oklahoma Daily

Student newspaper of the University of Oklahoma in Norman, Oklahoma that includes national, local, and campus news along with advertising