SASS: South African Simulation Survey a review of simulation-based education

Background: Simulation-based education (SBE) has been shown to be an effective and reproducible learning tool. SBE is used widely internationally. The current state of SBE in South Africa is unknown. To the best of our knowledge this is the first survey that describes the use and attitudes towards SBE within South Africa. Methods: An online survey tool was distributed by email to: i) the South African Society of Anaesthesiologists (SASA) members; and ii) known simulation education providers in South Africa. The respondents were grouped into anaesthesia and non-anaesthesia participants. Descriptive statistics were used to analyse the data. Ethics approval was obtained: HREC REF 157/2017. Results: The majority of the respondents provide SBE and integrate it into formal teaching programmes. There is a will amongst respondents to grow SBE in South Africa, with it being recognised as a valuable educational tool. The user groups mainly targeted by SBE, were undergraduate students, medical interns, registrars and nurses. Learning objectives targeted include practical skills, medical knowledge, critical thinking and integrated management. Amongst anaesthesia respondents: the tool most commonly used to assess the quality of learner performance during SBE, for summative assessment, was ‘expert opinion’ (33%); the most frequent methods of evaluating SBE quality were participant feedback (42%) and peer evaluation (22%); the impact of SBE was most frequently assessed by informal discussion (42%) and learner feedback (39%). In anaesthesia SBE largely takes place within dedicated simulation facilities on site (47%). Most respondents report access to a range of SBE equipment. The main reported barriers to SBE were: finance, lack of trained educators, lack of equipment and lack of protected time. A limited number of respondents report engaging in SBE research. There is a willingness in both anaesthesia and non-anaesthesia groups (96% and 89% respectively) to collaborate with other centres. Conclusion: To the best of our knowledge this publication provides us with the first cross sectional survey of SBE in anaesthesia and a selection of non-anaesthetic respondents within South Africa. The majority of respondents indicate that SBE is a valuable education tool. A number of barriers have been identified that limit the growth of SBE within South Africa. It is hoped that with a commitment to ongoing SBE research and evaluation, SBE can be grown in South Africa

Frame Augmentation for Imbalanced Object Detection Datasets

A major challenge in most object detection datasets is class imbal-ance. It is especially apparent in uncurated datasets where framesoriginate from a real-world setup such as a set of cameras col-lecting data from fixed locations. In that case, the dataset classdistribution mirrors the real-world distribution, causing a bias to-wards over-represented classes if used for model training. In thispaper we propose a synthesis technique for balancing the dataset,which exploits having sets of frames from the same camera view.The result is synthesized frames containing only rare objects, whileguaranteeing realistic object placement both in terms of scene con-text and perspective. We train a deep learning object detectionmodel on the augmented dataset and compare its performance toa model trained on the original, imbalanced dataset. Results showthat including the synthesized frames in the training results in asignificant performance boost for the rare classes

On the physics behind coastal morphodynamic patterns

Peer ReviewedPostprint (published version

Lane Discovery in Traffic Video

Video sensing has become very important in Intelligent Transportation Systems (ITS) due to its relative low cost and non-invasive deployment. An effective ITS requires detailed traffic information, including vehicle volume counts for each lane in surveillance video of a highway or an intersection. The multiple-target, vehicle-tracking and counting problem is most reliably solved in a reduced space defined by the constraints of the vehicles driving within lanes. This requires lanes to be pre-specified. An off-line pre-processing method is presented which automatically discovers traffic lanes from vehicle motion in uncalibrated video from a stationary camera. A moving vehicle density map is constructed, then multiple lane curves are fitted. Traffic lanes are found without relying on possibly noisy tracked vehicle trajectories

Who does what in enabling ambidexterity? Individual Actions and HRM practices

In this paper, we explain how ambidexterity, the simultaneous pursuit of exploration and exploitation, is enabled at the individual level of analysis. Research on ambidexterity has been dominated by theoretical approaches focusing on the organisational level; however, we know little about how ambidexterity is enacted by employees. There is also limited work on the multilevel aspects of individual employee actions, for example, particular roles and specifically the level of seniority of the role. We address these gaps by asking: Which individual actions are undertaken by employees at particular levels of seniority in the organization to enable ambidexterity? In order to answer this question we draw on previous research to construct reliable measures of the individual actions that enable ambidexterity. The hypothesized mediation effect of these individual actions is confirmed on the basis of survey data from 212 employees from a UK-based Professional Service Firm. The findings indicate that senior employees are more likely to use ‘integration’, ‘role expansion’ and ‘tone setting’, whilst employees with specialist knowledge about their clients use ‘gap filling’ to enable ambidexterity. Finally, we draw together these findings with 35 interviews conducted to present the HRM practices which support ambidexterity

Understanding coastal morphodynamic patterns from depth-averaged sediment concentration

This review highlights the important role of the depth-averaged sediment concentration (DASC) to understand the formation of a number of coastal morphodynamic features that have an alongshore rhythmic pattern: beach cusps, surf zone transverse and crescentic bars, and shoreface-connected sand ridges. We present a formulation and methodology, based on the knowledge of the DASC (which equals the sediment load divided by the water depth), that has been successfully used to understand the characteristics of these features. These sand bodies, relevant for coastal engineering and other disciplines, are located in different parts of the coastal zone and are characterized by different spatial and temporal scales, but the same technique can be used to understand them. Since the sand bodies occur in the presence of depth-averaged currents, the sediment transport approximately equals a sediment load times the current. Moreover, it is assumed that waves essentially mobilize the sediment, and the current increases this mobilization and advects the sediment. In such conditions, knowing the spatial distribution of the DASC and the depth-averaged currents induced by the forcing (waves, wind, and pressure gradients) over the patterns allows inferring the convergence/divergence of sediment transport. Deposition (erosion) occurs where the current flows from areas of high to low (low to high) values of DASC. The formulation and methodology are especially useful to understand the positive feedback mechanisms between flow and morphology leading to the formation of those morphological features, but the physical mechanisms for their migration, their finite-amplitude behavior and their decay can also be explored

Changes in beverage purchases following the announcement and implementation of South Africa's Health Promotion Levy: an observational study

BACKGROUND: In 2016, South Africa announced an intention to levy a tax on sugar-sweetened beverages (SSBs). In 2018, the country implemented an SSB tax of approximately 10%, known as the Health Promotion Levy (HPL). We aimed to assess changes in the purchases of beverages before and after the HPL announcement and implementation. METHODS: We used Kantar Europanel data on monthly household purchases between January, 2014, and March, 2019, among a sample of South African households (n=113 653 household-month observations) from all nine provinces to obtain per-capita sugar, calories, and volume from taxable and non-taxable beverages purchased before and after the HPL announcement and implementation. We describe survey-weighted means for each period, and regression-controlled predictions of outcomes and counterfactuals based on pre-HPL announcement trends, with bootstrapped 95% CIs, and stratify results by socioeconomic status. FINDINGS: Mean sugar from taxable beverage purchases fell from 16·25 g/capita per day (95% CI 15·80-16·70) to 14·26 (13·85-14·67) from the pre-HPL announcement to post-announcement period, and then to 10·63 g/capita per day (10·22-11·04) in the year after implementation. Mean volumes of taxable beverage purchases fell from 518·99 mL/capita per day (506·90-531·08) to 492·16 (481·28-503·04) from pre-announcement to post announcement, and then to 443·39 mL/capita per day (430·10-456·56) after implementation. Across these time periods, there was a small increase in the purchases of non-taxable beverages, from 283·45 mL/capita per day (273·34-293·56) pre-announcement to 312·94 (296·29-329·29) post implementation. When compared with pre-announcement counterfactual trends, reductions in taxable beverage purchase outcomes were significantly larger than the unadjusted survey-weighted observed reductions. Households with lower socioeconomic status purchased larger amounts of taxable beverages in the pre-announcement period than did households with higher socioeconomic status, but demonstrated bigger reductions after the tax was implemented. INTERPRETATION: The announcement and introduction of South Africa's HPL were followed by reductions in the sugar, calories, and volume of beverage purchases. FUNDING: Bloomberg Philanthropies, International Development Research Centre, South African Medical Research Council, and the US National Institutes of Health

Economic evaluation of Cytosponge®-trefoil factor 3 for Barrett esophagus: A cost-utility analysis of randomised controlled trial data.

BACKGROUND: Esophageal adenocarcinoma has a very poor prognosis unless detected early. The Cytosponge-trefoil factor 3 (TFF3) is a non-endoscopic test for Barrett esophagus, a precursor of esophageal adenocarcinoma. Randomised controlled trial data from the BEST3 trial has shown that an offer of Cytosponge-TFF3 in the primary care setting in England to individuals on medication for acid reflux increases detection of Barrett esophagus 10-fold over a year compared with standard care. This is an economic evaluation of Cytosponge-TFF3 screening versus usual care using data from the BEST3 trial which took place between 20th March 2017 and 21st March 2019. METHODS: A Markov model with a one-year cycle-length and a lifetime time horizon was created, adapting previous modeling work on Cytosponge screening. The impact of one round of Cytosponge screening was modelled in patients with a median age of 69 years (based on BEST3 trial population). Cost-effectiveness was expressed as an incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were conducted on model parameters. FINDINGS: Per person, one round of Cytosponge-TFF3 screening, including confirmatory endoscopy and treatment, in the intervention arm costed £82 more than usual care and generated an additional 0.015 quality-adjusted life-years (QALYs) at an ICER of £5,500 per QALY gained. Probabilistic sensitivity analysis gave an ICER of £5,405 (95% CI -£6,791 to £17,600). The average QALY gain per person is small because the majority of patients in the model will not develop BE and therefore will have no resulting change in their utility, however the small proportion of patients who are identified with BE dysplasia or cancer derive large benefit. At a willingness-to-pay threshold of £20,000 per QALY, the probability that Cytosponge-TFF3 was cost-effective was over 90%. INTERPRETATION: Using data from a pragmatic randomised trial, one-off Cytosponge-TFF3 screen is cost-effective relative to usual care for patients with gastro-esophageal reflux disease, despite relatively low uptake and an older population in this trial setting than previously modelled. Improving Cytosponge-TFF3 uptake and targeting younger patients is likely to further improve cost-effectiveness