Disabling seclusion: an integrated job empowerment and skills development centre for persons with intellectual disabilities

This document is submitted in partial fullfilment for the degree: Master of Architecture [Professional] at the University of the Witwatersrand, Johannesburg, South Africa, in the year 2015.People with intellectual disabilities are considered to be marginalised in our society. They continue to face prejudices, stigmas and are discriminated against resulting in social exclusion. This thesis develops a framework and methodology for pursuing inclusive environments and viable productivity within the workplace for persons with intellectual disabilities. The lack of opportunities within the workplace for individuals with intellectual disabilities intensi es their exclusion from society. The road to achieving inclusivity within the workplace has become a challenging one to navigate, as previous strategies which were developed to enable equality are far removed from what was intended. More often than ever before, employers are challenged from both a legal and political perspective for failing to diversify the workplace. Equality advocates as well as those who attempt to diversify their companies face obstacles within the workplace, namely inadequate resources or uncertainty about their appropriate role or approach in dealing with minorities. The building will serve as a learning hub, used by both persons with intellectual disabilities and people who are commonly referred to as able bodied. It will function as a level between education (if any) and the period before entering the workplace. The learning hub will afford persons with intellectual disabilities the opportunity to explore their capabilities in environments similar to that of a workplace and gain knowledge and experience prior to entering the workplace. The program envisaged in this thesis will demonstrate that this intervention is mutually bene cial to a company and the individual with an intellectual disability. In the first instance, the employer acquires knowledge and skills to act as a catalyst in enabling the transition of a person with an intellectual disability into the workplace to augment inclusivity. Secondly, the person with an intellectual disability through the program will be clothed with knowledge and expertise enabling meaningful participation amongst able-bodied employees. The transformation within workplaces as a result of the knowledge gained through this centre should create an enabling environment that incorporates the individual’s needs or one that best satis es their needs. The support by the employer is vital in the outcome and success of integrating people with disabilities into the social framework. The building is developed around a range of interactive programs between those with intellectual disabilities and people acting as the supervisors from workplaces. The supervisors, through training will be best placed to oversee progression and be empathetic toward staff with intellectual disabilities. This will enable them to transfer their knowledge and expertise of dealing with and accommodating employees with intellectual disabilities to their respective workplaces. A mock work environment will form the basis of the experiential training ground and in conjunction with job sampling will establish where a user will be best suited within the work environment. Public facilities encourage members of the public to become active participants within the space providing exposure and understanding towards those with intellectual disabilities. The centre is expected to be both accessible and lasting and will mediate experiential training and aligning it to workplace practices. The centre will be a vital space to enhance inclusion and for producing sustainable change for this marginalised group of persons. The building is located within an educational precinct on Melle Street, Braamfontein. The site which is in close proximity to the Central Business District allows for the centre to feed into businesses and vice versa. The location also allows for easy access to people from all over Johannesburg utilising various transport methods. The site being amid universities and schools ensures integration and optimum use, for educational facilities to link into this program. It also allows for social cohesion through exposure between the users of the building and other students in the surrounding area.EM201

KINERJA PEGAWAI NEGERI SIPIL DALAM PELAYANAN PUBLIK SAAT PANDEMI COVID-19 DI KANTOR KECAMATAN TIKALA KOTA MANADO

This study aims to find out and examine in depth about the performance of civil servants in public services at the Tikala Sub-District Office during the Covid-19 pandemic. The method used in this research is descriptive qualitative research method. Sources of data used in this study are divided into two types, namely primary data and secondary data. The steps used in data analysis techniques are editing, data classification, then drawing conclusions. The results showed that the performance of civil servants at the Tikala sub-district office was not as expected, because the service during the pandemic was not the same as before the Covid-19 pandemic. Working from home during the Covid-19 pandemic did not go as expected, because the service activities at the Tikala District office were work that had to be completed at the office, not at home

Electronic cigarettes for smoking cessation

Background Electronic cigarettes (ECs) are handheld electronic vaping devices which produce an aerosol formed by heating an e‐liquid. Some people who smoke use ECs to stop or reduce smoking, but some organizations, advocacy groups and policymakers have discouraged this, citing lack of evidence of efficacy and safety. People who smoke, healthcare providers and regulators want to know if ECs can help people quit and if they are safe to use for this purpose. This is an update of a review first published in 2014. Objectives To examine the effectiveness, tolerability, and safety of using electronic cigarettes (ECs) to help people who smoke achieve long‐term smoking abstinence. Search methods We searched the Cochrane Tobacco Addiction Group's Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO to 1 February 2021, together with reference‐checking and contact with study authors. Selection criteria We included randomized controlled trials (RCTs) and randomized cross‐over trials in which people who smoke were randomized to an EC or control condition. We also included uncontrolled intervention studies in which all participants received an EC intervention. To be included, studies had to report abstinence from cigarettes at six months or longer and/or data on adverse events (AEs) or other markers of safety at one week or longer. Data collection and analysis We followed standard Cochrane methods for screening and data extraction. Our primary outcome measures were abstinence from smoking after at least six months follow‐up, adverse events (AEs), and serious adverse events (SAEs). Secondary outcomes included changes in carbon monoxide, blood pressure, heart rate, blood oxygen saturation, lung function, and levels of known carcinogens/toxicants. We used a fixed‐effect Mantel‐Haenszel model to calculate the risk ratio (RR) with a 95% confidence interval (CI) for dichotomous outcomes. For continuous outcomes, we calculated mean differences. Where appropriate, we pooled data from these studies in meta‐analyses. Main results We included 56 completed studies, representing 12,804 participants, of which 29 were RCTs. Six of the 56 included studies were new to this review update. Of the included studies, we rated five (all contributing to our main comparisons) at low risk of bias overall, 41 at high risk overall (including the 25 non‐randomized studies), and the remainder at unclear risk. There was moderate‐certainty evidence, limited by imprecision, that quit rates were higher in people randomized to nicotine EC than in those randomized to nicotine replacement therapy (NRT) (risk ratio (RR) 1.69, 95% confidence interval (CI) 1.25 to 2.27; I2 = 0%; 3 studies, 1498 participants). In absolute terms, this might translate to an additional four successful quitters per 100 (95% CI 2 to 8). There was low‐certainty evidence (limited by very serious imprecision) that the rate of occurrence of AEs was similar) (RR 0.98, 95% CI 0.80 to 1.19; I2 = 0%; 2 studies, 485 participants). SAEs occurred rarely, with no evidence that their frequency differed between nicotine EC and NRT, but very serious imprecision led to low certainty in this finding (RR 1.37, 95% CI 0.77 to 2.41: I2 = n/a; 2 studies, 727 participants). There was moderate‐certainty evidence, again limited by imprecision, that quit rates were higher in people randomized to nicotine EC than to non‐nicotine EC (RR 1.70, 95% CI 1.03 to 2.81; I2 = 0%; 4 studies, 1057 participants). In absolute terms, this might again lead to an additional four successful quitters per 100 (95% CI 0 to 11). These trials mainly used older EC with relatively low nicotine delivery. There was moderate‐certainty evidence of no difference in the rate of AEs between these groups (RR 1.01, 95% CI 0.91 to 1.11; I2 = 0%; 3 studies, 601 participants). There was insufficient evidence to determine whether rates of SAEs differed between groups, due to very serious imprecision (RR 0.60, 95% CI 0.15 to 2.44; I2 = n/a; 4 studies, 494 participants). Compared to behavioral support only/no support, quit rates were higher for participants randomized to nicotine EC (RR 2.70, 95% CI 1.39 to 5.26; I2 = 0%; 5 studies, 2561 participants). In absolute terms this represents an increase of seven per 100 (95% CI 2 to 17). However, this finding was of very low certainty, due to issues with imprecision and risk of bias. There was no evidence that the rate of SAEs differed, but some evidence that non‐serious AEs were more common in people randomized to nicotine EC (AEs: RR 1.22, 95% CI 1.12 to 1.32; I2 = 41%, low certainty; 4 studies, 765 participants; SAEs: RR 1.17, 95% CI 0.33 to 4.09; I2 = 5%; 6 studies, 1011 participants, very low certainty). Data from non‐randomized studies were consistent with RCT data. The most commonly reported AEs were throat/mouth irritation, headache, cough, and nausea, which tended to dissipate with continued use. Very few studies reported data on other outcomes or comparisons and hence evidence for these is limited, with confidence intervals often encompassing clinically significant harm and benefit. Authors' conclusions There is moderate‐certainty evidence that ECs with nicotine increase quit rates compared to ECs without nicotine and compared to NRT. Evidence comparing nicotine EC with usual care/no treatment also suggests benefit, but is less certain. More studies are needed to confirm the size of effect, particularly when using modern EC products. Confidence intervals were for the most part wide for data on AEs, SAEs and other safety markers, though evidence indicated no difference in AEs between nicotine and non‐nicotine ECs. Overall incidence of SAEs was low across all study arms. We did not detect any clear evidence of harm from nicotine EC, but longest follow‐up was two years and the overall number of studies was small. The evidence is limited mainly by imprecision due to the small number of RCTs, often with low event rates. Further RCTs are underway. To ensure the review continues to provide up‐to‐date information, this review is now a living systematic review. We run searches monthly, with the review updated when relevant new evidence becomes available. Please refer to the Cochrane Database of Systematic Reviews for the review's current status

A study of urinary tract infections in renal transplant patients

Background: Sepsis remains a serious complication in renal transplant recipients. Urinary tract infections (UTI's) are the most common bacterial infection occurring in these patients. The aim of the study was to document the clinical experience of UTI in renal transplant patients. Methods: A descriptive study of UTI occurring in consecutive renal transplant patients attending the transplant clinic, Tygerberg Hospital between 1st January and 31st July 1995 was undertaken. A UTI was defined as a positive organism culture of > 100 000 cfu/ml on a single urine sample. Data were assessed to determine patient demographics, clinical presentation, risk factors and outcome. The infecting organisms and their antibiotic sensitivity spectrum were determined. Results: Of 166 patients, 76 female and 90 male, urinary tract infections were diagnosed in 43 patients. The incidence of UTI was 26% during the study. In the subgroup of patients who received their renal allograft during the study period the cumulative incidence of UTI was 40% at one month, 53% at three months and 55% at six months post-transplantation. Asymptomatic bacteriuria was present in the majority of patients. Symptoms occurred in 18% predominantly in the early post-transplant (6 months) post-transplant period. Gram-negative organisms were more than 80% sensitive to only gentamicin or ofloxacin. Gram-positive organisms, sensitive to penicillin or cloxacillin, accounted for 22% of infections predominantly in the late post-transplant period. Urinary tract infections complicated by systemic sepsis were associated with a poor outcome. Conclusions: A high incidence of UTI complicates renal transplantation especially during the early post-transplant period. The risk factors observed are relevant to the local experience. An important observation was the antibiotic sensitivity spectrum of the infecting urinary organisms. This may have bearing on management in the renal transplant patient

A randomised, crossover study on an electronic vapour product, a nicotine inhalator and a conventional cigarette. Part B: Safety and subjective effects

AbstractAn Electronic Vapour Product (EVP) has been evaluated for short-term safety parameters and subjective effects in a 2-part study, in smokers. Part 1 compared the EVP with unflavoured (UF) and flavoured (FL) e-liquid at 2.0% nicotine to a conventional cigarette (CC; JPS Silver King Size, 0.6 mg) and a licensed nicotine inhalator (Nicorette®, 15 mg). Part 2 assessed the effect of increasing concentrations of nicotine in the e-liquid used with the EVP (0%, 0.4%, 0.9%, 2.0%). The study was designed as a randomised, controlled, crossover trial. Outcomes included adverse events (AEs), vital signs, exhaled carbon monoxide (CO), clinical laboratory parameters, smoking urges and withdrawal symptoms. In both study parts, only mild non-serious AEs were reported. No major differences were observed in AEs between the EVPs and Nicorette®. Exhaled CO levels only increased for CC. All products appeared to decrease smoking urges and nicotine withdrawal symptom scores to a similar extent. The EVP had a similar short-term safety profile to Nicorette® and relieved smoking urges and nicotine withdrawal symptoms to a similar extent as Nicorette® and CC. Unlike nicotine replacement therapies, the EVP may offer an alternative for those finding it difficult to quit the behavioural and sensorial aspects of smoking

E-Cigarette Aerosol Deposition and Disposition of [C-11]Nicotine Using Positron Emission Tomography : A Comparison of Nicotine Uptake in Lungs and Brain Using Two Different Nicotine Formulations

Smoking is a cause of serious disease in smokers. Electronic cigarettes, delivering aerosolized nicotine, offer adult smokers a potentially less harmful alternative to combustible cigarettes. This explorative PET/CT study investigated the distribution and deposition of inhaled [C-11]nicotine using the myblu (TM) e-cigarette with two nicotine formulations, freebase and lactate salt. Fifteen healthy adult smokers participated in the two-part study to assess the distribution and accumulation of [C-11]nicotine in the respiratory pathways and brain. Time-activity data for the respiratory pathways, lungs, oesophagus and brain were derived. 31-36% of both inhaled tracer formulations accumulated in the lung within 15-35 s. [C-11]Nicotine(freebase) exhibited higher uptake and deposition in the upper respiratory pathways. For [C-11]nicotine(lactate), brain deposition peaked at 4-5%, with an earlier peak and a steeper decline. A different kinetic profile was obtained for [C-11]nicotine(lactate) with lower tracer uptake and accumulation in the upper respiratory pathways and an earlier peak and a steeper decline in lung and brain. Using nicotine lactate formulations in e-cigarettes may thus contribute to greater adult smoker acceptance and satisfaction compared to freebase formulations, potentially aiding a transition from combustible cigarettes and an acceleration of tobacco harm reduction initiatives