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Education for sustainable healthcare: opportunities and barriers in undergraduate health professions education in South Africa
Get PDFThe escalating global crisis of climate change and environmental degradation is having severe public health impacts. One key response requires faculties of health sciences globally to review how they prepare their health professional graduates to address the changing needs of the communities they serve. Health professions education has generally not kept pace with changing societal needs, and current curricula are often too fragmented and static to prepare graduates as effective climate health leaders and agents of change. Education for sustainable healthcare (ESH) is a field in health professions education focused on the interdependence of human health and planetary ecosystems, and on making healthcare systems more environmentally sustainable. ESH incorporates the principles of planetary health, which recognises that informed stewardship of earth's natural systems is essential for human health and well-being. ESH also includes education about environmentally sustainable healthcare, which is high-quality healthcare that is less polluting and wasteful of natural resources than conventional healthcare. There is, however, little evidence about ESH from low- and middle-income countries, which are generally most impacted by climate and environmental breakdown. The aim of this thesis was to identify the opportunities and barriers to ESH in undergraduate health professions education in South Africa, illustrated by a case study at the University of Cape Town Faculty of Health Sciences (UCT FHS). A mixed methods study of three sequential phases addressed four objectives. Phase 1 was a national survey of key educators to assess the status of ESH-related teaching and learning activities in undergraduate health professions education in South Africa. Phase 2 recruited a national Delphi panel of educators for the second objective of appraising the ESH learning objectives, activities, and assessments proposed by the International Association for Health Professions Education (AMEE) Consensus in 2021. The Delphi panel also helped achieve the third objective, to assess perceptions of educators about the opportunities and barriers to ESH in South Africa. The third phase was a Planetary Health Report Card (PHRC) assessment of the UCT FHS, by interviewing key educators and completing standardised scorecards. This phase addressed the fourth objective, to assess perceptions of educators about the opportunities and barriers to ESH in the UCT FHS. The thesis is structured into seven chapters. Chapter 1 provides the rationale, aim, objectives, design, and structure of the thesis. Chapter 2 reviews the literature on the health impacts of climate change, and the contribution of ESH towards social and environmental accountability in health professions education. It presents the conceptual framework of the thesis for evaluating environmental accountability in health professions education institutions, derived from the Conceptualisation, Production, and Usability (CPU) model for socially accountable medical schools. Chapter 3 describes the national audit survey in Phase 1, which found that ESH curriculum development is emerging in South Africa and is enabled by strong institutional leadership and by staff and student involvement. Chapter 4 analyses the findings of the national Delphi panel in Phase 2. It reached consensus on a set of learning objectives, activities, and assessments for health professions education in South Africa and identified enablers of ESH curricular development, among them faculty leaders, capable educators, and multidisciplinary collaboration. Chapter 5 presents the baseline findings of the PHRC assessment of the curricula, research, community engagement, student leadership, and campus sustainability of the UCT FHS. The PHRC identified curriculum overload, “siloed” learning, limited educator capacity, and health system challenges as key barriers, and recommended longitudinal integration of ESH across all curricula. Chapter 6 presents the discussion of the overall findings of the study. It proposes a framework for guiding ESH curricular development, which integrates recommendations in six focus areas for faculty leaders and educators within three domains of the CPU model. The key barriers and enablers of ESH identified by this study, and examples of opportunities in the UCT FHS, are also discussed. Chapter 7 concludes with the contribution of the study to knowledge about ESH and the implications for future research. The thesis has helped to build the evidence about ESH from a LMIC perspective. It has identified barriers and opportunities within South African undergraduate health professions education, and has proposed learning objectives, activities, and assessments for the South African context. A PHRC assessed opportunities for ESH integration in the UCT FHS, a first in the global South. The thesis proposes an integrated ESH curricular development framework within a social accountability model for HPE institutions, with potential applicability to low- and middle-income countries
Finite element model updating of concrete arch dams affected by alkali-silica reaction using ambient vibration monitoring and dam surveillance data
Get PDFDams are important structures whose safety in operation is critical owing to the socioeconomic impacts associated with their collapse. Alkali-Silica Reaction (ASR) is a deleterious chemical reaction that affects the performance and safety of numerous concrete dam structures around the world. To ensure dam safety, a well-structured dam surveillance program that includes ambient vibration monitoring is essential as it enables an in-depth understanding of the behaviour of a dam in operation. Additionally, structural behaviour analysis through numerical models such as finite element (FE) models, is a crucial aspect of dam safety evaluations that allows dam safety engineers to predict the current and future behaviour of dams under various load combinations. The challenge in finite element analysis (FEA) is generating an FE model that is representative of the observed behaviour and condition of the dam to be trusted and used for further study. This study sort to find the best updating parameters and finite element model updating approach to achieve representative and reliable finite element models for the safety assessment of arch dams affected by ASR. This was achieved through sensitivity analysis of the behaviour (both dynamic behaviour and static behaviour) of concrete arch dams to (i) geometrical properties, (ii) material properties and (iii) load effects on the dam-foundation-reservoir system, to identify the best updating parameters. Following which a model updating procedure was proposed and implemented. It was observed that the behaviour of concrete arch dams is subject to their geometric properties. Their dynamic behaviour was observed to be largely sensitive to the dam- foundation-reservoir system stiffness and water level whereas their thermal behaviour was sensitive to the system thermal properties. Additionally, it was observed that the dynamic response is not as sensitive to ASR loading as initially assumed. Based on these findings, the proposed finite element model updating procedure begins with the updating of the system stiffness using modal parameters, followed by the updating of the thermal properties, and then updating of the parameters critical to ASR modelling. The proposed multi-step model updating procedure was successfully implemented to update a finite element model for a case study double curvature arch dam affected by ASR achieving agreeable results between the measured and predicted behaviour observations
A qualitative study on South African policies governing youth access to alcohol
Get PDFAlcohol abuse among youth continues to be a major concern worldwide in the 21st century. It has been suggested in various studies that the age of onset is decreasing rapidly and that admissions to treatment centres are increasing as young people fall prey to substance abuse. This raises serious concerns as alcohol abuse is linked to adverse health outcomes such as physical and mental health problems, social and legal consequences, as well as economic burdens. Zwelihle, a township in Hermanus, is one such community that faces various social issues, including high rates of alcohol abuse amongst the youth. This study used a qualitative research design based on the interpretivist position. Data were collected from twenty participants using a semi-structured interview guide. Fifteen young participants (aged 18 to 35) took part in focus groups, and five professionals with experience working with Zwelihle's youth were interviewed one-on-one. Data were analyzed following Tesch's qualitative data analysis steps. The study results revealed that factors such as a lack of parental involvement, unemployment, socialisation and culture as well as the availability of limited recreational activities were identified to be prominent factors which led Zwelihle's youth to alcohol and the abuse thereof. Other factors, such as alcohol outlet concentration and density in Zwelihle were argued to be one of the factors that facilitates easy access to alcohol in Zwelihle. This is also caused by the plight which comes with heightened levels of unemployment in South Africa, which drives people to alcohol dependency to forget and escape their harsh realities, or people open shebeens as a response to the harsh economic realities. At the backdrop of these concerns were the various alcohol trading policies, which were said to be ineffective in regulating the alcohol trade, and which have resulted in almost every street in Zwelihle having someone trading in alcohol and selling it to young people. One of the reasons participants cited for the failing alcohol policies was due to unreliable law enforcement agencies who were perceived to be corrup
Evaluation of prognostic risk factors at diagnosis and treatment outcomes in adult patients with early-stage hodgkin lymphoma in Cape Town, South Africa
Get PDFThe National Comprehensive Cancer Network (NCCN) Guidelines are a recognized standard for prognostic staging in Hodgkin Lymphoma (HL). We aimed to determine if the NCCN staging system and its individual risk factors correlated with patient treatment outcomes in early-stage adult classical HL (cHL) patients. This retrospective study included 70 patients diagnosed with and treated for early-stage (stage I and II) cHL from 2010 to 2022, at Groote Schuur Hospital Radiation Oncology and Clinical Haematology Units. NCCN unfavourable risk factors assessed were mediastinal mass ratio, presence of bulky disease, B-symptoms, number of nodal regions involved and erythrocyte sedimentation rate. Patients were divided into early-stage favourable (no unfavourable factors) and early-stage unfavourable (any unfavourable factors). Kaplan-Meier curves and log-rank tests were used to compare treatment outcomes between groups. The median age at diagnosis was 35 years and 50% of the patients were male. Most patients had stage II disease (86%) and were classified as unfavourable (76%). During the study period, 6 patients died (9%) all of whom had stage II unfavourable disease. The 5-year overall survival for the favorable and unfavourable groups was similar (94% vs. 90%, P=0.599). Progression free survival at 5 years was also similar (83% vs. 88%, P=0.984). This study demonstrates excellent 5-year survival outcomes in early-stage cHL patients. These findings are comparable with those in higher income countries and were not affected by HIV status or unfavourable risk factors. This highlights the importance of early diagnosis and treatment while patients still have early-stage diseas
Exploring project-based learning: a case study of a first-year medical education course
Get PDFThis study describes the eleven-year period of preparation and implementation of a project-based learning programme within a first year course for medical students, at the University of Cape Town. The methodology was descriptive reflection using case study research. The study first describes current understandings of student approaches to learning, learning assumptions and styles of learning and the link with deep learning. Included is also a discussion on ways in which teaching approaches and methods can influence student learning. Linked to this is a review of notions of project-based learning and its place in the spectrum of teaching and learning activities encountered by students at university. The study then describes the challenges / issues that arose during the eleven-year period and the various ways in which they were responded to. The provided description also outlines ways in which the programme attempted to foster [or hinder] deep learning amongst students, since such learning is regarded as a key outcome of learning at university. The research ends with an attempt to address why the programme did not foster deep learning amongst students to the extent it could have. It proposed that for project-based learning to foster deep learning amongst students [and particularly amongst first year students] various key elements have to be in alignment. Secondly it argues for the fact that project-based learning amongst first year students should be viewed in terms of an 'apprenticeship in deep learning'. By viewing project-based learning in such terms the advantages advanced for project-based learning can be more candidly recognised. The research ends with 'implications for practice' for those prospective project-based learning practitioners who would like to harness the power of project-based learning to foster deep learning amongst their students
Reimagining loyalty rewards programmes via blockchain: usage, loyalty, and firm performance
Get PDFThe emergence of blockchain technology is poised to revolutionise the loyalty programme (LP) landscape. Still, there is a dearth of research exploring the factors that influence the acceptance and resultant loyalty creation of blockchain-based LPs. This study examines the relationship between technological acceptance, loyalty creation, redemption and word-of-mouth yielded by a blockchain-based loyalty programme (BBLP). Employing the Diffusion of Innovation Theory and the Technological Acceptance Model (TAM), the study investigates the intention to use a BBLP as influenced by the perceived ease of use and usefulness of a BBLP. An integrated model combining the theories of Watson et al. (2015), Davis (1985) and Rogers (1995) was analysed in three separate but interrelated, descriptive, cross-sectional survey studies. In Study One (N = 995), the factors which influence the perceived ease of use, perceived usefulness, and ultimate intention to utilise a BBLP were examined. Study Two (N= 756) focused on the factors which contribute to the development of behavioural and attitudinal loyalty towards a BBLP, and the relationship that the intention to use a BBLP has with behavioural and attitudinal loyalty. Lastly, Study Three (N = 1157) focused on the relationship between the intention to use a BBPL and attitudinal and behavioural loyalty, as well as the relationship that behavioural and attitudinal loyalty has with word-of-mouth (WoM) and redemption. Redemption is typically neglected in the literature as a specific outcome, with only a handful of studies examining it as a specific variable. The perceived value of cryptocurrency, trust in blockchain and cryptocurrency, are emerging antecedents that are focused upon. This study is one of few that the perceived value of cryptocurrency is examined as an LP reward, which influences both PEOU and PU. The data was analysed using PLS-SEM and the software SmartPLS 4. The intention to use a BBLP and both behavioural and attitudinal loyalty were found to influence each other and enhance WoM. Attitudinal loyalty influenced redemption, though no significant link was found between behavioural loyalty and redemption. Managers should carefully consider their incentive strategies for a BBLP by incorporating relative advantage, satisfaction, trust, and commitment to drive loyalty
The use of a calibrated three phase (solid-aqueous-gas) plant-wide wastewater treatment model to simulate data on mineral precipitation
No full textThe mass manufacture of novel chemicals, extensive use, and the release of micropollutants into the environment are inevitable occurrences in contemporary society. In reality, wastewater treatment plants are the primary means of spreading micropollutants, primarily because of their inadequate performance. However, efforts are being made to improve their efficiency and achieve an 80% reduction in micropollutant levels. Among the several methods used for the tertiary treatment of wastewater, adsorption stands out for its effectiveness in removing micropollutants. One popular adsorption material is activated carbon, however, the most common commercial version is expensive and made from coal, which is a scarce resource. As a result, we must immediately begin investigating potential substitute precursors that can produce effective activated carbon and are both easily accessible and inexpensive. Because of its high organic content, sludge from wastewater treatment plants is showing promise as an alternative. Stricter disposal restrictions make it more difficult to manage this sludge, a by-product of water treatment. Subsequently, the two varieties of carbon were employed in batch adsorption tests to determine the ideal conditions necessary for each carbon to attain the maximum removal of lead (II) ions from aqueous solutions. This entailed manipulating factors such as pH, adsorbent dosage, initial concentration of the adsorbate solution, and contact time. The optimum conditions that were obtained were 180 min contact time, 300 mg adsorbent dose, and pH of 8. Comparing the results obtained from these tests under optimal conditions for each adsorbent, it was determined that the percentage removal of lead (II) ions was as follows: GAC (99.91%) > HC-PS-WAS-Scr (97.25%), indicating that GAC exhibited a marginally superior performance in the removal of the pollutants compared to the other adsorbents. Adsorption behaviour could be described using the Langmuir and Freundlich isotherm model. Regardless of the adsorbent studied, Langmuir isotherm model fitted well with the adsorption data. The maximum adsorption capacity was found to be 66 mg/g for HC-PS-WAS and 60 mg/g for GAC. The adsorption kinetics could most likely be described with pseudo second order kinetic model for both adsorbents considered
Paediatric and Adolescent civilian gunshot injuries: a 10 year epidemiological study
No full textIntroduction: In South Africa, the prevalence of violent crime, especially involving firearms, poses a significant public health challenge, particularly when it affects children. Previous studies showed a decrease in paediatric civilian gunshot injuries following the introduction of the 2004 Firearms Control Act. This study examines the epidemiological trends of gunshot injuries in children from January 2011 to December 2020. Methods: A descriptive cross-sectional study was performed on children aged 0-12 years presenting to the Red Cross War Memorial Children's Hospital (RXH) in Cape Town with gunshot injuries from January 2011 to December 2020. The data were drawn from the ChildSafe database and hospital records. We evaluated demographics, injury specifics, and orthopaedic outcomes. Results: The number of gunshot wounds(GSW) in the observational record showed an increasing trend of +2.69 (95%CI 1.05 – 4.33) patients per year with a total of 236 patients affected. There was a male predominance (56.8%), with the largest age group affected being children aged 5-9 years (44%). Orthopaedic injuries were prevalent in 69 patients (29.2%), including fractures and injuries to the peripheral nerves and spinal cord. A total of 71 fractures were recorded, with 54 occurring in the extremities and 17 involving the spine or pelvis. The lower extremities were most affected, necessitating surgical interventions such as external fixators and/or femur nails. Peripheral nerve injuries and spinal cord injuries resulted in significant long-term morbidities. The severity and complexity of all assessed injuries often required multiple surgical procedures and extended hospital stays, with an admission length of ~10 days, with some patients requiring intensive care (17.37% of cases). Morbidity included complications like wound infections and long-term disabilities such as paralysis and traumatic brain injuries. Conclusion: Despite legislative measures aimed at reducing such incidents, this study reveals an upward trend in gunshot injuries among children in Cape Town. Gunshot injuries remain a significant and increasing public health challenge among paediatric populations in Cape Town, with profound implications for morbidity, mortality, and healthcare resource utilization. Addressing this issue requires a comprehensive and multi-sectoral approach that prioritizes prevention, early intervention, and addressing the underlying social determinants of violence
Climate change and tourism: the level of preparedness of tourism operators to the threat of climate change in the Greater Kruger area
Get PDFTourism is a significant contributor to the South African economy, providing employment opportunities and supporting community development as well as funding vital conservation efforts. However, tourism is both a perpetrator and a victim of climate change This research aims to investigate the level of preparedness of tourism operators in the Greater Kruger area to the potential threat of climate change. This is done by conducting a review of existing research on the topic in southern Africa, South Africa, and the Greater Kruger area. The research considers the current policy environment of South Africa and conducts semi-structured in-depth interviews with tourism operators in the Greater Kruger area. While tourism is responsible for as much as 10% of global greenhouse gas emissions, it is also threatened by climate change. Climate change impacts are already being experienced and are predicted to continue to be experienced and possibly worsen, which could have detrimental impacts on tourism operations. The desktop research and interviews confirm that impacts of climate change are already being experienced, and yet there is little sectoral knowledge on the topic and low urgency has been placed on adapting to these impacts or mitigating any further impacts caused by climate change. While there are government-led policies and regulations aimed at minimising the impacts of climate change and encouraging adaptation and mitigation efforts, development and implementation are limited. Any efforts made by operators to become sustainable have for the most part been self-implemented on an ad hoc basis. Greater focus on the challenges presented by climate change, knowledge sharing, and collaboration across all stakeholders is essential to ensure that tourism is prepared for the threat of climate change so that the natural resources of the Greater Kruger area can be enjoyed by generations to come
Fully moral artificial agents: future or fiction
Get PDFThe rapid technological progress has resulted advancements in technology that includes the development of Artificially Intelligent agents (AI) for various purposes. The extensive progress in AI has reached a point where the introduction of AI agents as android robots or humanoids into society is plausible. This highlights the evolving relationship between humans and technology. This thesis explores the multidimensional aspects of artificial intelligence (AI) by examining the intersection of machine ethics, ethical theories, and deep learning. The central focus is on assessing the compatibility of ethical theories with the rapid advancements in technology, particularly the potential development of fully moral artificial agents. The aim of this thesis is to address the ethical concerns associated with the evolution of AI, particularly the introduction of artificially intelligent agents into various societal roles, such as care robots in healthcare. The need for an impartial approach to address these concerns is identified, leading to the proposal of machine ethics as a framework. Machine ethics, defined as ensuring moral behaviours in AI, provides a basis for evaluating the ethical capabilities of artificially intelligent agents. As technology continues to progress, the demand for a comprehensive ethical framework for AI decision-making becomes increasingly apparent. Machine ethics offers insights into the ethical processes involved in AI decision-making, allowing a closer examination of computational abilities and ethical capacities. The primary inquiry revolves around whether AI agents can achieve full morality and if existing ethical theories can govern their behaviour effectively. To explore these questions, the thesis draws upon three ethical theories—Utilitarianism, Deontology, and African Ubuntu Ethics—and their applicability to the development of fully moral artificial agents. It employs deep learning as a critical component in understanding moral agency within the context of AI. The analysis unfolds in four parts: first, providing a background on AI concepts; second, examining recent AI progress and the potential for ethical AI agents; third, exploring the future of AI in relation to morality through ethical theories; and fourth, establishing criteria for considering AI agents as moral agents. In conclusion, the thesis argues that, with the advancements in technology and the insights provided by machine ethics and ethical theories, the development of fully moral artificial intelligent agents is possible