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Clinical presentation and outcomes of anomalous left coronary artery from the pulmonary artery: a retrospective study from January 1998 - August 2019 at the Department of Paediatrics Cardiology, Universitas Hospital
No full textBACKGROUND: Anomalous left coronary artery from the pulmonary artery (ALCAPA) or Bland-White-Garland syndrome is a rare congenital anomaly that has profound effects on heart function. Patients with ALCAPA present with non-specific symptoms like irritability, feeding difficulties and signs and symptoms of cardiac failure. If left untreated, ALCAPA has a 90% mortality rate in the first year of life, primarily due to myocardial ischemia and heart failure. It is therefore important to diagnose them in time and offer surgery. OBJECTIVES: The primary objective of the study was to determine the clinical presentation and severity of symptoms using the Ross classification and to describe the clinical status of the patients at last follow up, including the clinical outcome (Ross classification) and survival. METHODS: This was a retrospective descriptive study at the Department of Pediatric Cardiology between January 1998 and August 2019. All patients with the diagnosis of ALCAPA during the study period were included. Medical records of patients referred from Free State, Northern Cape and Lesotho were reviewed. Data collection included demographics of patients, clinical presentations, referral diagnosis, echocardiography before and after surgery, catheterization data, surgical data, clinical presentation at last follow up and ECHO at last follow up. Data was captured using the REDCap® online database. The researchers considered a Ross classification of more than two as clinically diagnostic of heart failure. The SF ranges were classified as follows: SF >28% = normal, SF 20-25% = mild, SF 15-20% = moderate and SF <15% =severe. RESULTS: During the study period a total of 30 patients presented to Universitas Paediatric Cardiology Unit with the diagnosis of ALCAPA. At presentation, 89% (n=25) of patients were in cardiac failure with a Ross classification for age of more than two. The diagnosis of ALCAPA was made primarily by echocardiography in 75.8% (n=22) of patients. Most patients 83.3% (n=25) had a dilated heart at presentation, with a median LVEDD z-score of 6.4 and 37% (n=11) had severe LV dysfunction (SF <15%). About half of the patients, 43% (n=13) had severe MR. ALCAPA repair was done in 76.6% (n=23) of our patients. The median age at surgery was 35 months (range: 1 day - 73 months), with a median weight of 6kg (range: 4kg - 20kg). The median days from diagnosis to the day of surgery was 11 days (range: 1 day to 6 years). Most patients had re-implantation of the anomalous left coronary artery except for two where the left coronary artery was tied off. One child required a left ventricular assist device (LVAD) for 7 days post operatively and survived. Immediately post-surgery there was some improvement on left ventricular function with 17% (n=4) of patients demonstrating normal SF and 13% (n=3) had mild left ventricular dysfunction. Heart failure symptoms (Ross) at follow-up improved significantly from original presentation (p < 0,01): forty five percent, (n=8) of our patients had no symptoms of cardiac failure, with Ross classification of two and less. At last follow a marked improvement on LV function was observed with 73% (n=11) patients having a normal SF. SF at last follow up showed a statistically significant difference compared to, at presentation with a p-value of 0.014. Seventy eight percent (n=18) of patients were alive at the end of the study and mortality post-surgery was 22% (n=5). CONCLUSION: Our results show that most children in central South Africa present in the first year of life with clinical features of heart failure. The most common echocardiographic features at presentation are impaired systolic function, dilated left ventricles and mitral regurgitation. Furthermore, surgery results in significant clinical and echocardiographic improvement. It is of paramount importance to have a high index of suspicion based on the clinical presentation and ECHO to ensure early referral, so corrective surgery may be offered timeously
Ultrasound thyroid nodule size and histological findings
No full textIntroduction: Thyroid nodules occur in 4-7% of adults with a malignancy risk of 5-15%. Ultrasound plays an important role in the clinical workup of patients with solitary thyroid nodules to differentiate malignant from benign disease. Objectives: To determine if ultrasound single thyroid nodule size can predict the probability of thyroid malignancy. Method: Retrospective cross-sectional study of all thyroidectomies done (benign and malignant) from 2010 to 2016. Ethical clearance was obtained from University of the Free State (HSREC 0664/2017). Data was analyzed by means of descriptive statistics, namely frequencies and percentages for categorical data, medians, and percentiles for numerical data, were calculated. Associations regarding cancer were done for numerical data by means of Kruskal-Wallis test and contingency tables by means of Chi-square or Fischer’s exact test. A p-value of < 0.05 was considered statistically significant. Diagnostic test statistics were calculated, namely sensitivity, specificity, positive and negative predictive values, and likelihood ratios. Results: The overall incidence of thyroid cancer was 24.6%. The median age of thyroid cancer patients was 52.9 years and for benign disease 54 years. Female patients with thyroid cancer were 78.7% and for benign disease 90.1%. Male patients with cancer were 21.2%, for benign disease 9.9%. Papillary thyroid cancer remains the most common type of cancer at 87.8 % and follicular thyroid cancer 12.1%. The average size of thyroid cancer on histology was 2.1 cm and 3.2 cm for the non-cancer group, statistically significant with p-value of 0.0015. Ultrasound nodular size for cancer was 1.7 cm; and 1.9 cm for non-cancer group with p-value 0.209. The association between ultrasound size and histology size for cancer group were not significant with p-value 0.99. Size difference for non-cancer group between histology and ultrasound was significant with p-value 0.02. Conclusions: The study did not prove our hypothesis that ultrasound single nodule size alone, can predict the risk of thyroid cancer. Diagnostic test results with 95% CI reveals a sensitivity of 96%, but a low specificity of 22% to predict the risk of thyroid cancer
The resuscitation of historically disadvantaged universities: the case of University of Fort Hare
No full textThe South African higher education system has experienced many disparities that include racial and systemic classification of higher education institutions. Historically, universities in South Africa were located according to the apartheid states and Bantustans, and as a result created racially classified institutions which are now known as Historically Advantaged Universities (HAIs) and Historically Disadvantaged Universities (HDIs). While HAIs are established in city centres, HDIs, like the University of Fort Hare, are remotely located in the outskirts of cities, marginalised and isolated in rural communities. This study sought to analyse the role of the University of Fort Hare (UFH) in advancing the development of rural communities; and whether or not the university has adopted strategies to ensure if students partake in community engagement activities that ensure active interaction between the university’s students and its communities. Through the application of the Sustainable Livelihoods Framework, the study measured sustainability on programmes currently being implemented at the University of Fort Hare, particularly from two departments: Management and Commerce; and Social Science and Humanities. Overall, the study found that much effort is placed on an urban UFH campus, and rural activities are neglected. Apart from the academic and community engagement activities of the university, the constant protests and closure of the institution debilitate its functioning. The study recommends that the university implements more activities at the UFH Alice campus to ensure integration of learning and community engagement to be used to assist in the rural development of its community.National Education Collaboration Trus
Die wonderbare Heilige Gees én die Vader van liefde: 'n Missionêre teologie
No full textDie Heilige Gees, as die Gees van Christus, bring die volheid van die heil in Christus na ons. Hy verheerlik Jesus Christus, Hy maak geloof moontlik en Hy vestig die kerk. Die Heilige Gees is daarom totaal uniek en wonderbaar. Dit is vir die sending essensieel om vanuit die Gees te lewe en so Jesus
Christus as Here te erken. Daarmee saam hang natuurlik die getuienis dat die Vader oneindige liefde in sy Seun Jesus Christus betoon. Juis nou dat die teologie die tydsgees navolg, moet onomwonde in die krag van die Gees getuig word dat Jesus die Here is en dat die Vader die Vader van liefde is.
Sentraal hierin staan die kruisdood en opstanding van Jesus Christus wat deur die Heilige Gees bevestig word. Daarmee word dikwels teen die stroom ingeswem, maar hierdie getuienis moet onomwonde gelewer word. Daarvan moet die sending steeds en meer en meer getuig.Fakulteit Teologie en Religie (Departement Praktiese en Missionale Teologie)
National Research Foundation (NRF
Feasibility of interactive diabetes workshops for primary health care nurses in a Free-State sub-district
No full textThe health care system of South Africa is driven by the primary health care (PHC) system approach, of which nurses are the backbone of health care service provision. The aim of the PHC approach is to ensure universal accessibility of health care services in an environment characterised by an ever-increasing prevalence of non-communicable diseases, including diabetes. Research has revealed that, in a Free State sub-district, PHC nurses have decreased levels of motivation for and limited knowledge of the management of diabetes. This study forms part of a complex intervention research programme that followed a phased approach, which allowed researchers to assess the feasibility of a health dialogue model that had been designed in previous research. The aim of this study was to establish the feasibility of interactive diabetes workshops for PHC nurses in a Free State sub-district. In order to ensure achievement of the aim, four objectives were developed: a) development of an interactive workshop programme according to previously identified key diabetes-related messages; b) determination of diabetes-related knowledge by means of a pretest and posttest; c) facilitation of interactive diabetes workshops; and d) assessment of the feasibility of these workshops for PHC nurses post the interactive workshops. An exploratory experimental pretest-posttest control group design was used in this study. A random sampling method was used to select 10 PHC clinics in a sub-district of the Free State, with five PHC clinics for each of the experimental (Thaba Nchu) and control (Botshabelo) sites. Each of the five PHC clinics in both the experimental and control groups were in a 15 km radius of each of Thaba Nchu and Botshabelo towns. A convenience sampling method was used at the 10 PHC clinics to select nurses. The sample size of the experimental and control groups was 21 nurses each. Data used for the development of the interactive workshop programme was collected through a systematic search of literature using the first three steps of a systematic review process. Data of diabetes-related knowledge was collected using a pre/posttest questionnaire. A five-point Likert scale was used for collection of data on assessment of the interactive diabetes workshops. Descriptive statistics were used for data analysis. Results obtained from the systematic literature search revealed that, for workshops to be engaging, interactive activities should be used during facilitation. Interactive activities can include scenarios, small-group discussions, role playing, Kagan’s rally coach, rally robin and timed pair share strategies. Statistically significant results from pre/post-testing in the experimental group indicated improved knowledge related to peripheral sensation (0.03) and depression (<0.01). Across the experimental and control groups, results for questions related to insulin use (0.04) and depression (0.001) were found to be statistically significant. In order for interactive workshops to be feasible, the participants and the facilitator should have consensus about time for facilitation. Interactive workshops should be considered as a training platform for diabetes refresher training courses for nurses at PHC clinics. The content of the workshops should cover the key diabetes messages, and the facilitation should include interactive activities that are likely to enhance learning and participant engagement. In conclusion, the researcher considers interactive diabetes workshops to be a feasible training platform for PHC nurses in a Free State sub-district. The training events could empower nurses with knowledge and skills, leading to improved health care services for diabetes patients
The influence of angled survey lines on the data and results of 2D ERT surveys using the Wenner (α) array
No full textThe electrical resistivity method was first developed in the 1920s but has been widely used since the
1970s due to advances in the technology to collect, analyse and process data (Loke, 1999). This
geophysical technique is one of the main methods used to investigate the subsurface resistivity
distribution. Until recently, electrical resistivity surveys were mostly conducted in a one-dimensional
(1D) mode, either by performing vertical electrical sounding (VES) where resistivity variations with
depth are investigated, or horizontal profiling where lateral resistivity variations are studied.
However, 1D surveys have several limitations. VES allows the modelling of only horizontally layered
earths and it does not provide tangible information for the interpretation of structures and the extent
of subsurface features (Loke et al., 2013). Horizontal profiling, in turn, assumes a constant depth of
investigation along the profile, which is not strictly true since the depth of investigation is dependent
on the subsurface resistivities. To overcome the limitations of a 1D surveying, two-dimensional (2D)
and three-dimensional (3D) resistivity methods were developed. These methods are more accurate,
convenient, and field worthy, since they are more technologically advanced and easier to use than the
1D modes of investigation.
The 2D electrical resistivity tomography (ERT) method has become one of the most widely used
geophysical technique in investigating near-surface structures. This method was developed to satisfy
the need for new technologies that can generate high-resolution sections of the sub-surface (Daily et
al., 2005). The ERT method is based on the fact that different geological units or structures in the
earth’s subsurface are more or less sensitive to electrical current flow and that different geological
units have different electrical conductivity (Milsom and Ericksen, 2011).
During 2D ERT surveys, apparent resistivity data are collected by using numerous collinear
electrodes inserted into the earth along a straight line. The measured resistivity data are later edited,
processed, and inverted using 2D inversion software to yield models of the subsurface resistivity
distribution. The 2D ERT technique has been recently applied to address a number of engineering,
geological and geo-hydrological problems such as detection of faults and fractured zones,
investigation of the slope stability, and delineation of cave systems (Yadav, 1988; Kumar, 2012; Obi,
2012; Mohamaden and Ehab, 2017)
In geohydrological studies, the main applications of the ERT technique are to investigate 1) the
presence of geological structures potentially associated with groundwater, 2) the movement of
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groundwater and 3) the presence and migration of contaminants in the subsurface. The technique has
been widely used in this field because quality water resources have become a primary concern in
many societies due to increasing population and industrialisation (Donnenfeld et al., 2018). To
increase water supply and sustain industrial demands, economic growth and growing population, all
potential water resources should be appropriately utilised and managed. Groundwater often forms a
large component of the total water supply to communities. However, unlike surface water that can be
seen or measured, groundwater is generally not visible from surface. In addition, the occurrence of
groundwater is localised and often associated with geological structures. The ERT method may be
used to investigate the subsurface and locate sites where production boreholes have a high probability
of intersecting high-yielding aquifer systems, thereby avoiding the wasteful expenditure of drilling
unsuccessful production boreholes.
Studies conducted by Woodford and Chevallier (2002) in the Karoo Basin, show that dolerite
intrusions (dykes and sills) are considered as the main targets for groundwater exploration. Dolerite
dykes in the Karoo Basin are linear or circular (ring-dykes) geological bodies that intruded the
sedimentary country rock during the Jurassic Age. According to Makhokha and Fourie (2016), the
intrusions were associated with the high temperatures and pressures, causing fractured zones along
the margins of the intrusive bodies. Moreover, the fractured zones are often associated with
significant permeability and high-yielding aquifers (Woodford and Chevallier, 2002).
Since large resistivity contrasts generally exist between the dolerite intrusives and the sedimentary
country rock, the 2D ERT method is well-suited to locating and delineating such intrusives. However,
a major assumption of the method is that the survey lines are straight and electrodes are collinear.
Due to the presence of surface infrastructure or other surface constraints (e.g. rivers, vegetation, large
outcrops, and steep topographic gradients) it is not always possible to conduct 2D ERT surveys along
straight lines. The study investigates the influence of angled survey lines on the data recorded and the
resistivity models obtained when using the Wenner (α) array. This array is one of the most commonly
used arrays in resistivity surveying and has a high signal-to-noise ratio compared to the other
commonly used arrays
Modelling the vertical flow of groundwater in a saturated-unsaturated medium
No full textThe classical equation developed to replicate the vertical groundwater flow through the saturatedunsaturated zone is based on the concept of rate of change. While a lot of success has been achieved using this concept, researchers discovered that only classical mechanical homogenous problems with no memory could be depicted using these mathematical tools. Therefore, a need to formulate new mathematical tools that can be used to depict non-conventional behaviour was urgent as some physical problems were not understandable. For this reason, we introduced to the saturatedunsaturated groundwater flow equation differential operators that are based on the power-law kernel, exponential decay kernel and Mittag-Leffler function to develop new models. These operators are the Caputo, Riemann-Liouville, Caputo-Fabrizio and the Atangana-Baleanu. Some of these operators are local and unable to model problems that display fractal behaviours. To account for this, we used the recently introduced fractal-fractional approach to develop more models. However, the above differential operators are based on sets of constant parameters/coefficients and largely ignore random fluctuations that are likely to occur in nature. To account for randomness, a stochastic approach is used. However, this approach is unable to capture fading memory and long-range behaviour. To help us capture problems with randomness, fading memory and long-range behavior we used the recently established stochastic-fractional approach to generate more models that give us a better understanding of the complex flow. The numerical solutions and stability analysis for all the models are detailed. We also suggested a new approach for modelling groundwater flow based on the Sumudu and Laplace transform. The new models presented in this thesis will be relevant to the majority if not all problems associated with unsaturated-saturated groundwater flow. For this reason, we have not focused on any specific problem/study area, however, theoretical parameters and assumptions are presented to illustrate the effectiveness of the new models, in which readers can make possible modifications to parameters and assumptions to match their specific groundwater problem/study area
The influence of Lesotho Grade R teachers' science content knowledge on their classroom practices
No full textPrevious research has identified teachers’ knowledge as a strong factor in influencing classroom practice, hence teachers are regarded as the main locus in the education system. Accordingly, a number of studies have focused on teachers’ content knowledge and how it shapes learners’ performance. The focus has tended to be on higher levels of education, ignoring teachers in early childhood sectors. Despite research on Grade R teachers’ science content knowledge (TSCK), little is known about how it influences classroom practices, and vice versa. This is therefore the focus of the study, notably in Lesotho. The study aims to contribute to the existing body of knowledge in Early Childhood Education sector as well as science teaching. Shulman’s Teacher Knowledge Framework and Content Knowledge for Teaching (CTK) framework form the framework of this study. A mixed methods approach, based on a sequential explanatory design, was followed, with a survey of 100 Grade R teachers’ science content knowledge measured in the first phase to inform the second phase. Four teachers from the main sample were purposely and conveniently selected to be interviewed and observed to participate. The observed and interviewed participants’ lesson plans were analysed to add to the credibility of the study. Descriptive and inferential statistics were used in quantitative part, while the qualitative interviews, observations and document analysis were used to triangulate qualitative findings. The findings suggest that teachers’ CK was fragmented; they had expected common content knowledge, limited specialised content knowledge and adequate horizon content knowledge. The study also found that Grade R teachers’ content knowledge had weak or no influence on their classroom practices. In conclusion, it re-affirms the importance of Grade R teachers’ science content knowledge and that they may be other factors not discovered by this study that influence their practices. The study recommends that the teacher training institutions and the Ministry of Education and Training organise ECD programmes such that teachers are enriched with content above the level they teach in order to enhance their CK.University of the Free State (UFS
Investigation of interspersed shrubland patches along different topographical conditions within Afromontane grasslands, and their potential as conservation hotspots
No full textSmaller, isolated shrubland patches are often overlooked in the context of their ecosystem functions and potential for conserving biodiversity, particularly in relation to small scale areas of diversity importance within a specific conservation area. The mountainous Golden Gate Highlands National Park (GGHNP) possesses a number of these smaller, isolated shrubland patches, providing several habitat types over a relatively small geographical area. While these shrubland patches have been acknowledged as areas of possible significance in the GGHNP, information on arthropod assemblages in these patches remains limited. This thesis investigates arthropod assemblages in these smaller shrubland patches, in response to various environmental factors, and provides a preliminary view of the current state of gene flow among five ubiquitous spider species. Three aims were selected to investigate environmental factors and their influence on arthropod assemblages, while a fourth addressed gene flow and genetic diversity of spider species. In Chapter 2, we evaluate the effect of elevation and vertical stratification on arthropod species diversities and assemblages in shrubland patches present in the GGHNP. The results indicated differing environmental pressures between and within the sampled sites brought about by elevation and stratification. However, due to the relatively short elevational range and high heterogeneity of the localities, it is not conclusive as to whether elevation was the only factor responsible for differences in population diversities across the sites. Contrastingly, vertical habitat stratification influenced arthropod assemblage richness and composition despite the small vertical distance between strata. The study suggests that multiple contributing factors, together with stratification, affect arthropod assemblages. Investigations into seasonal variation and temporal change on arthropod populations may provide insight into the protective nature of smaller shrubland patches against environmental change and disturbance. Chapter 3 aimed to determine how arthropod assemblages vary with seasonal changes in three vertical habitat strata in these smaller shrubland patches, representing isolated shrublands in a grassland dominated montane environment subject to seasonal variation. Environmental variable changes temporally affected arthropod assemblages to differing degrees in each stratum, dependent on the level of disturbance. Beta-diversity was observed to gradually decrease for leaf litter across the localities. The study suggests that, depending on the level of protection of these patches, shrubland sites may act as high diversity zones during seasonal change as well as periods of disturbance. Chapter 4 investigated the differences in composition of soil arthropod assemblages, and their species association, with a number of isolated shrubland patches and their immediate surrounding grasslands. The results indicated a higher association of soil biota with shrubland patches compared to the adjacent grasslands while functional feeding groups were not discernibly different between the two habitat types. Results suggest that different soil arthropods are associated with shrubland patches of the GGHNP, hinting at their significance as areas of priority management for certain taxa and their importance in conservation strategies. The final study (Chapter 5), analysed the state of gene flow and inferred migratory capability of five spider species between shrubland patches of the GGHNP. Relatively low nucleotide diversity, with a correspondingly high genetic diversity, was observed within populations for all species except one. Differing genetic differentiation indicated gene flow as being maintained, to a certain degree, between populations of the spider species, despite the mountainous terrain of the park. Additionally, the presence of possible species complexes was inferred by phylogenetic analyses, highlighting a need for taxonomic revision of these species from a South African perspective. The results of this thesis provide a unique insight into the state of arthropod diversity, and their association with shrubland patches of the GGHNP, by investigating arthropod assemblage responses, and determining the current state of gene flow and genetic diversity of spider species.Afromontane Research Unit (ARU)Masonic Charitable Foundatio
The role of microfinance on entrepreneurial development: the case of urban Maseru
No full textSmall, Medium and Micro Enterprises have been identified as one of the key components to advancing growth and development in Lesotho. This study assessed the role of microfinance on entrepreneurial development with the aim to identify the key inhibitors for Small, Medium and Micro Eenterprises (SMMEs) to have access to microfinance services. The study was conducted in Urban Maseru, Lesotho with the aim to assess the challenges faced by SMMEs in Urban Maseru in accessing microfinance services, then examine the impact of micro-finance on the output of SMMEs in Urban Maseru and further examine the contribution of microfinance on business growth of selected SMMEs in Urban Maseru. The study made use of quantitative research method and questionnaires for collection of primary data and analysed by using Statistical Package for Social Sciences (SPSS) and tables and figures for the presentation of results. A descriptive variable sampling technique was employed and the Solvin’s formula was used in selecting the sample of 400 respondents from SMMEs in Urban Maseru that have benefited from microfinance services between 2016 and 2019. The study concludes that there are various barriers that impede entrepreneurs’ development. The fundamental impediment faced by SMMEs is the burdensome procedure that is related to access for credit of which high- interest rates and collateral security are major setbacks. The study submits that microfinance has had a positive influence on entrepreneurial performance measured in terms of output. In the same vein, the study concludes that microfinance has had a significantly positive effect on the business growth of the SMMEs sampled in Urban Maseru. To this end, SMMEs need to be assisted to use the identified factors to promote growth in order to realise full potential of microfinance contribution on SMMEs development. As such Microfinance Institutions (MFIs) need to review their policies on the terms of credit extension and other finance related development to SMMEs to enhance accessibility to finance by SMMEs. Furthermore, government’s support through appropriate policies and business extension services is necessary for SMMEs’ capacity development