An investigation into the challenges and limitations of implementing universal pulse oximetry screening for critical congenital heart disease in asymptomatic newborns

Neonatal pulse oximetry has been identified as an important screening tool for critical congenital heart disease. This oximetry screening, although mandatory in many developed countries, is not routinely implemented in South African hospitals.The objective of this study was therefore to determine the feasibility of implementing pulse oximetry in a typical level 2 hospital in the province of KwaZulu-Natal. Challenges and limitations experienced in implementing the screening were documented.The study was an observational analytical descriptive study which was conducted in the postnatal ward of Addington Hospital, Durban. Nursing staff were educated regarding the importance of pulse oximetry screening and were subsequently trained to perform the procedure.A total of 2 453 newborns were admitted to the hospital from January to August 2016 with 599 of these being eligible for enrolment in the study. Consent and screening were initially performed by participating nursing staff. During the last 4 months, consent was obtained by a dedicated research assistant. Of the 599 eligible newborns, 22 were excluded resulting in 577 being available for analysis. There were 29 newborns who fulfilled criteria for a second screening, however, in 21 of these newborns, the protocol was not appropriately followed.This study suggests that while routine neonatal saturation monitoring appears to be a simple, cost-effective tool to detect critical congenital heart disease, several barriers to its implementation were detected. The main barriers were inadequate staffing and infrastructure. This, in turn, highlighted the need for appropriate human resource provision and training as well as adequate infrastructure. These may not be easily achievable in a resource constrained environment

Exploring Teachers’ Lived Experiences on the Integration of Values Education in South African High Schools

Values education has become a necessary tool in response to the rise in moral deterioration in an average South African society today. The school is viewed as one of the key players in nurturing children into adulthood. The teaching of values that can give the growing generation, necessary moral development is one of the responsibilities of the schools. Hence, this study aims at exploring teachers’ experiences on how they integrate values education into South African learners in various high schools. This qualitative study engaged five schools in its case study, where five teachers from each of the schools were purposively selected for semi-structured focus group interviews, to share their experiences on the integration of moral values in schools. Moral development theory was used to underpin the study. Findings from the inductive thematic analysis from the participants from both rural and urban schools indicated a misunderstanding of the concept of values education by some teachers, which affects its effective integration. The study established that role modelling of learners by teachers and parents are inevitable to save the society from moral decadence, while some participants indicted overpopulation, single parenthood, social media as some of the challenges to the integration of value education in schools. The study, therefore, recommends capacitation of teachers through various professional development programmes, to integrate values education and adequate parental support as some of the strategies to promote effective integration of values education in schools

Managing Solid Waste In School Environment Through Composting Approach

This study aimed at improving solid waste disposal in schools by using the composting approach. The theory that underpinned this study was Reduce, Reuse, and Recycle (3R) theory, while the necessary data were gathered by using a synthesis and integration approach. The following three research questions were framed to guide the conduct of the study: How important is solid waste management in schools? What pedagogical techniques are most effective for promoting environmental sustainability by teaching composting in schools? What are the challenges involved in the composting process at school?  The synthesis and integration approach assisted in integrating concepts from different sources and synthesizing those concepts to create a comprehensive and cogent argument in accordance with emerging themes. It was discovered that solid waste management in schools was particularly crucial since schools produced a lot of rubbish and that waste may affect the environment negatively. Composting is essential to improve school solid waste because it enhances soil health, decreases waste, and encourages sustainable agricultural methods. Three pedagogical techniques that could be utilized to facilitate the teaching and learning of composting in schools have evolved based on the theoretical framework and the literature provided. Project-based learning (PBL), hands-on learning, and inquiry-based learning were some of the new pedagogical strategies. However, some of the challenges with the composting process were identified as follows: difficulty in regulating the moisture level of the compost, keeping the proper balance of carbon and nitrogen in the compost pile, and inability to educate students and staff about the composting process

Cochlear function in patients with chronic kidney disease

Objective: To evaluate cochlear functioning in patients (18 - 45 years old) with varying stages of chronic kidney disease (CKD). Using purposive sampling, 50 participants, 10 in each of the 5 stages of CKD, were selected and underwent pure tone audiometric testing and distortion product otoacoustic emissions (DPOAEs). Results: Significant differences (p<0.05) were found between pure tone audiometry and DPOAEs in detecting early cochlear dysfunction in the high-frequency range in stages 3 (6 000/5 000 Hz; p=0.00), 4 (6 000/5 000 Hz; p<0.03) and 5 (4 000/3 333 Hz; p<0.01, 8 000/6 667 Hz:p<0.05) with DPOAEs being more sensitive in identifying early cochlear dysfunction. Patients in stages 1 and 2 presented with normal puretone thresholds and DPOAEs, suggesting that cochlear functioning in these patients was normal. Early cochlear dysfunction, thereby indicating a subclinical hearing loss, was identified in stages 3, 4 and 5 by DPOAE testing. In addition, blood test results, drug intake and concomitant conditions were recorded and analysed which suggested a relationship between reduced cochlear functioning and increased electrolyte levels, treatment regimens and concomitant conditions. Conclusion: Participants in the later stages of CKD presented with early cochlear dysfunction, presenting with subclinical hearing loss. It was postulated that this subclinical hearing loss resulted from a combination of electrolytic, urea and creatinine imbalances, together with concomitant medical conditions and ototoxic drug intake. It was concluded that audiological monitoring be included in the management of patients with CKD and that DPOAEs be introduced as part of the test battery to monitor cochlear function in patients with varying degrees of CKD

The effects of combined exposure of solvents and noise on auditory function - A systematic review and meta-analysis.

BACKGROUND:  Chemical substances can negatively affect the auditory system. Chemical substances alone or combined with high-level noise have recently become a major concern as a cause of occupational hearing loss. OBJECTIVE:  To assess the combined effect of solvents and noise versus solvents only, or noise only, on the auditory function of workers. METHOD:  Published articles which included noise and/or solvent exposure or combined effects of solvents and noise, studies conducted on human beings only and the use of audiological tests on participants. RESULTS:  Thirteen papers were eligible for inclusion. The participants' ages ranged from 18 to 68 years. Results revealed that 24.5% presented with hearing loss as a result of noise exposure only; 18% presented with hearing loss owing to solvent exposure only; and a total of 43.3% presented with hearing loss owing to combined noise and solvent exposure. Furthermore, the prevalence of hearing loss in the noise and solvent group was significantly (p < 0.001) higher than the other groups in 10 out of the 13 studies analysed, with a pooled odds ratio (OR) of 2.754. Of the 178 participants (total of all participants exposed to solvents), a total of 32 participants presented with auditory pathology as a result of exposure to solvents only. There was a significantly higher pooled odds of hearing loss in noise and solvent-exposed group compared to solvent-only group (pooled OR = 2.15, 95% CI: 1.24-3.72, p = 0.006). CONCLUSION:  The findings revealed significantly higher odds of acquiring hearing loss when workers were exposed to a combination of solvents and noise as opposed to solvents only, motivating for its inclusion into hearing conservation programmes

Preventive audiology

This book is an original scholarly book that introduces the concept of preventive audiology, with a specific focus on the African context, which is in line with the South African re-engineered primary healthcare strategy as well as the World Health Organisation’s approach. The book reflects on contextually relevant and responsive evidence-based perspectives, grounded in an African context on preventive audiology, in four major ear and hearing burdens of disease within the South African context: (1) early hearing detection and intervention, (2) middle ear pathologies, (3) ototoxicity, and (4) noise-induced hearing loss. The book represents innovative research, seen from both a South African and global perspective. It offers new discourse and argues for a paradigm shift in how audiology is theorised and performed, particularly in low-and-middle-income country contexts. The goal of this book is to motivate a paradigm shift in how the ear and hearing care is approached within this low-and-middle-income country context while arguing for Afrocentric best practice evidence that leads to next practice

Preventive audiology

This book is an original scholarly book that introduces the concept of preventive audiology, with a specific focus on the African context, which is in line with the South African re-engineered primary healthcare strategy as well as the World Health Organisation’s approach. The book reflects on contextually relevant and responsive evidence-based perspectives, grounded in an African context on preventive audiology, in four major ear and hearing burdens of disease within the South African context: (1) early hearing detection and intervention, (2) middle ear pathologies, (3) ototoxicity, and (4) noise-induced hearing loss. The book represents innovative research, seen from both a South African and global perspective. It offers new discourse and argues for a paradigm shift in how audiology is theorised and performed, particularly in low-and-middle-income country contexts. The goal of this book is to motivate a paradigm shift in how the ear and hearing care is approached within this low-and-middle-income country context while arguing for Afrocentric best practice evidence that leads to next practice

Tunable Blood Shunt for Neonates With Complex Congenital Heart Defects

Despite advancements in procedures and patient care, mortality rates for neonatal recipients of the Norwood procedure, a palliation for single ventricle congenital malformations, remain high due to the use of a fixed-diameter blood shunt. In this study, a new geometrically tunable blood shunt was investigated to address limitations of the current treatment paradigm (e.g., Modified Blalock-Taussig Shunt) by allowing for controlled modulation of blood flow through the shunt to accommodate physiological changes due to the patient’s growth. First, mathematical and computational cardiovascular models were established to investigate the hemodynamic requirements of growing neonatal patients with shunts and to inform design criteria for shunt diameter changes. Then, two stages of prototyping were performed to design, build and test responsive hydrogel systems that facilitate tuning of the shunt diameter by adjusting the hydrogel’s degree of crosslinking. We examined two mechanisms to drive crosslinking: infusion of chemical crosslinking agents and near-UV photoinitiation. The growth model showed that 15–18% increases in shunt diameter were required to accommodate growing patients’ increasing blood flow; similarly, the computational models demonstrated that blood flow magnitudes were in agreement with previous reports. These target levels of diameter increases were achieved experimentally with model hydrogel systems. We also verified that the photocrosslinkable hydrogel, composed of methacrylated dextran, was contact-nonhemolytic. These results demonstrate proof-of-concept feasibility and reflect the first steps in the development of this novel blood shunt. A tunable shunt design offers a new methodology to rebalance blood flow in this vulnerable patient population during growth and development

South African teachers’ perspectives on support received in implementing curriculum changes

South African education has experienced significant curricular reform since the mid-1990s, but its implementation has not matched expectations. This study explores teachers’ perspectives on implementing these reforms in schools, with the aim of ascertaining the challenges they faced in the process, and the kind of support, guidance and professional development programmes they received from the Department of Basic Education to facilitate the changes. This article focuses on their experiences of the government-based Foundations for Learning Campaign in schools in the uThungulu district, KwaZulu-Natal, South Africa. Teachers from grades One to Six teaching languages and Mathematics were targeted, and a sample of 20 was purposefully selected. Using an interpretive qualitative research approach, data was collected by means of in-depth interviews, with open-ended questions, and classified by themes. The findings revealed that teachers felt inadequately provided with sustainable professional development programmes, and had minimal meaningful opportunities for classroom support, guidance and monitoring to assist in implementing the changes required. This small-scale investigation offers a stepping-stone for further analysis of assistance being offered to teachers across the country in times of curriculum reform, and thereby contributes towards preparing the ground for a new and integrated framework offering much-needed effective, systematic, ongoing professional development programmes that translate into improved teaching practice and learning success.Keywords: continuing professional development; curriculum implementation; curriculum reform; Foundations for Learning Campaign; monitoring; suppor

Evaluation of outcomes-based assessment in the intermediate phase

M.Ed.The purpose of this study was to evaluate Outcomes- Based Assessment in the Intermediate Phase. Curriculum 2005 is a new education curriculum that is driving the process of education transformation. It is fundamentally different from the school curriculum of the past which was divided into discrete subject areas and largely content- based and teacher- driven. One of the major shifts in the new curriculum is how learners are assessed. Outcomes - Based Assessment therefore is a daunting task and is not familiar for the majority of the educators in the Intermediate Phase. This study involved I 0 primary schools in the Richards Bay Circuit. 60 educators from the Intermediate Phase completed a questionnaire related to Outcomes - Based Assessment. The researcher also used observation as one of the research instruments in collecting data. 60 educators from the Intermediate Phase from the I 0 primary schools in the Richards Bay Circuit were closely observed. An observation checklist was completed by the researcher during class visits of the sampled schools. A close examination of 6 learners' portfolios, 2 from each grade and 6 from each school, together with the schools' Assessment Policy were evaluated by the researcher through the observation technique. 12 facilitators responsible for conducting workshops in Outcomes- Based Assessment for the Lower Umfolozi District were personally interviewed by the researcher. The researcher sought to evaluate Outcomes - Based Assessment in the Intermediate Phase, to identify measures as to empower educators to grasp a better understanding and determine areas of need regarding Outcomes - Based Assessment. The study has evaluated and reviewed the process, structure, design and implementation of Outcomes -Based Assessment in the Intermediate Phase, with a view to understanding what needs to be done to improve it, and make it successful. The major findings from the study pointed to the extent that Outcomes - Based Assessment is not widely understood at the classroom level. OutcomesBased Assessment definitely needs attention, that is, more clarity and a clear focus. Detailed guidelines and procedures from Departmental level needs to be instilled. This is the major contributing factor towards the failure to understand the process of Outcomes - Based Assessment