A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Public Health in the field of Hospital Management July, 2014 / BACKGROUND: The World Health Organization (WHO) has acknowledged the importance of maternal care and listed it as part of its Millennium Development Goals (MDGs). The 5th goal is focused on improving maternal health by reducing the maternal mortality rate by 75% by 2015. South Africa has aligned itself with the MDGs. The Gauteng Department of Health and Social Development has also embraced the MDGs and decided to improve its maternal health services. It has decided to target Intra-partum period for interventions to improve maternal health because intra-partum period is associated with a high rate of perinatal death from intra-partum hypoxia (4.8 per 1000 births) (National Department of Health, 2000), as well as a significant number of maternal death (8.7%) (NCCEMD, 2007). This study was planned to systematically study the clinical procedure performed during the intra-partum period at the Heidelberg Hospital (a semi - rural district hospital in the Lesedi Sub – district of Sedibeng District in Gauteng Province). AIM: To describe the clinical procedures and factors related to these procedures and maternal and neonatal health outcomes for the mothers admitted and delivered in the Maternity unit at Heidelberg hospital during one year period (1st April 2010 to 31st March 2011) METHODOLOGY: The setting of this study was the Maternity unit of the Heidelberg Hospital. A cross sectional study design was used based on retrospective review of routinely collected data for 12 months (2010 April 1st to 2011 March 31st). No intervention was done as a part of this study. The study variables included different clinical procedures (such as normal vaginal delivery, assisted vaginal delivery, caesarean section, evacuation of uterus, caesarean hysterectomy), socio-demographic profile of patients (such as age, gender, ethnicity, medical aid), clinical profile (such antenatal diseases, booking status, intra-partum complications, postpartum complications) and maternal and perinatal outcomes. RESULTS: The study found highest number of deliveries (78.6%) were normal vertex deliveries and a very few (1%) assisted and breech deliveries. The caesarean section rate was high (20.4%) as compared to the normal national target (12, 5%). Fetal distress and CPD was the main indications for caesarean section. The majority of women who delivered at Heidelberg Hospital maternity came from poor socio-economic class, mostly single, teenagers, and unemployed. They were the most vulnerable group in the Society. The majority of women were booked and referred from PHC clinic where they were booked for antenatal check-up. Pregnancy induced hypertension was the commonest obstetric problem encountered during antenatal period. Most women who delivered at Heidelberg hospital during the period were discharged without complications, no maternal deaths were reported. There were 8.1% preterm deliveries but a relatively high still birth rate which is of concern. CONCLUSION: The study was the first of its kind to be done at Heidelberg Hospital and the Sedibeng Health District. The study systematically analysed routinely collected data and identified high risk patients, who would require special attention. This study would hopefully assist the Hospital Management to realise the high rate of CS and to develop appropriate measures to reduce unnecessary C/S being done, and to strengthen referral systems. In addition, further study is necessary at clinic level in the sub-district to identify work-loads in the feeder clinics.

A thesis submitted to the Faculty of Health Sciences University of the Witwatersrand Johannesburg in fulfilment of the requirements for the degree of Doctor of Philosophy October 2015 / This study investigated students’ experiences of integration of learning in the undergraduate medical programme at the University of the Witwatersrand. There is evidence that integration of learning, also referred to as “integrative learning”, assists students to assimilate and apply what they have learnt more effectively, and thus enhances the goal of achieving professional competence. From 2003, Years 3 and 4 of the undergraduate programme were redesigned to be presented as integrated system-based blocks, using problem-based learning as the main learning strategy. From 2005, Years 5 and 6 were also redesigned. Although clinical rotations in specific disciplines still formed the main learning strategy, a number of integrating activities – and even rotations – were included in the new programme in these years. From 2006 Years 1 and 2 of the programme (which were still discipline-based) were reviewed in terms of course content and integration of learning, and new courses were added to those years to facilitate integration of learning. As a result of the reforms outlined above, the six years of the undergraduate medical programme at the University of the Witwatersrand now contain a rich variety of features designed to advance integration of learning. However, the ways in which students and teachers experience these kinds of integration are not known, neither is the effect that they are having on student learning. Investigating student and teacher experiences of a variety of events designed to promote integration of learning deepens the understanding of the many and varied effects of such integration activities, and contributes to the body of knowledge on integration of curricula in medical education. This study also contributes to a generic understanding of the phenomenon of integration in the process of learning, potentially enhancing knowledge and practice in the field of medical education. This is a qualitative study which used phenomenography, a research approach with an educational interest. The phenomenon of integration of learning is one which exists in the understanding of persons involved in the learning process, as teachers or students and, for this reason, an approach which clarifies that understanding was followed. The principal sampling approach was purposive. Data collection spanned 27 months (March 2012 to June 2014) and a total sample of 25 students and 10 teachers were the respondents, providing information through in-depth interviews and small focus group discussions. The semi-structured interviews were conducted using a tool that introduced an entry question such as “What is your understanding of ……?” Subsequent dialogue followed on angles of responses, leading to the development of different categories of how the phenomenon is experienced. Interviews were recorded using a voice recorder. Focus group discussions and further individual interviews were used to refine ideas and not necessarily to increase the size of the original sample. For analysis, the researcher used qualitative data analysis software, MAXQDA11. Excerpts that conveyed the most significant information were selected, de-contextualised and compared, followed by grouping and re-grouping of them until the outcome space was formulated. Three categories of description made up the outcome space. The categories that emerged represent the qualitatively different experiences of the students and teachers who were interviewed: conceptions of meaning and processes of integration of learning; conceptions of how to integrate learning and development of integration ability; and conceptions of the links between integration ability and educational experiences. The outcome space was constituted using as a guide the framework of the anatomy of awareness and the structure of experience as espoused by Marton and Booth (1997). The lowest level of conception is that integration of learning is a vague and abstract concept which happens passively while an ability to integrate learning is conceived of as an atomistic acquisition of fragmented facts. The respective act of learning is experienced as knowledge increase. A conception of increasing appreciation of the phenomenon is that it is important to consciously link concepts through identifying essential detail. This is a perception of higher value as it includes the ability to remember everything. A conception of higher value is that subjects are related as they contribute to each other. Understanding one leads to the understanding of another. The concept of integrative learning is introduced and this happens during studying. The most sophisticated conception is that integration of learning happens automatically as students accumulate knowledge and experience. Integration of learning, therefore, becomes a way of thinking, an unconscious competence for life in an integrated career. Students adopt strategies that enable learning for meaning while drawing on all knowledge and skills. When the outcome space is translated graphically, a model of how students develop the ability to integrate learning is revealed. From the model, it was apparent that students embark on a journey of integration of learning through taking steps that increase in complexity and hierarchical inclusivity. The integration of learning takes a relatively long time to develop, occurring from the first year to the sixth year, but starting from minimal to highly complex acts of learning, to be able to cope in a complex career in a complex world. The affective constructs towards the phenomenon also change over the years from negative to positive. All this happens in an environment that is regulated by affective constructs and motivation factors. The acquisition of the ability to integrate learning is conceived to take long depending on the effects of affective constructs and the external horizon. From the model, four factors emerge that are critical for integration of learning in that they either promote it or prevent it from occurring effectively. The factors can be grouped according to whether they involve the teacher, curriculum, student and studying. Recommendations for application of the model were drawn around interventions that impact on improvements specific to each of the factors identified. This is a proposed developmental model which is a logical presentation of integration of learning. The proposed model requires additional research to provide further empirical justification. Gibbs (1994) refers to a proposition that research on student learning has something substantial to feed back into the context within which it is undertaken. The researcher makes specific reference to Harden’s (2000) integration ladder as a benchmark for curriculum integration strategies that strengthen integration of learning in institutions of Higher Education. KEYWORDS Integration of learning Integrative learning Curriculum integration Phenomenographic research into integrative learning Learning approaches 21st century learning theories Learning according to phenomenography Pedagogies of integration of learning Anatomy of awareness

ABSTRACT To develop a more efficient way of informing potential clinical trial volunteers of exactly what they could expect during (and after) their participation in a clinical trial as well as the sponsor’s expectations from the volunteer. A multiple choice questionnaire, which was based on the criteria as specified by Guideline 5 of the International Conference of Harmonization (ICH), was administered to 28 Volunteers after only reading the Patient Information Leaflet/Informed Consent Document (PIL/PIL/ICD), to 21 Volunteers who had read the PIL/ICD and attended a question and answer session, to 17 Volunteers who had read the PIL/ICD and attended a presentation and 19 Volunteers who had read the PIL/ICD and attended a presentation and a question and answer session. In total, 85 Volunteers completed the questionnaire. The average calculated percentage* of volunteers who had only read the PIL/ICD was 61%, 63% for Volunteers who had read the PIL/ICD and attended a question and answer session, 73% for Volunteers who had read the PIL/ICD and attended a presentation and 68% for Volunteers who had read the PIL/ICD and attended a presentation and question and answer session. In total, the average calculated percentage was 66%. Eighty four percent of the total number of volunteers answered the question on withdrawal consequence incorrectly, 43% of Volunteers answered questions on side effects incorrectly and 100% of the Volunteers answered the question on the duration of storage of samples incorrectly. Despite increasing regulatory and ethical scrutiny, deficiencies still exist in Volunteer comprehension of the research in which they participate, as well as differences in how comprehension is measured and assessed. Results indicated that any successful consent process should, at a minimum, include a visual communication mode. Concepts that are not well understood within the South-African context are withdrawal consequence, methodology such as double-blind or single blind, side effects, duration of archiving, treatment alternatives and the role of the investigator. *calculated % for each volunteer = score out of 25 x 100

No description available.

MSc, School of Chemical and Metallurgical Engineering, Faculty of Engineering and the Built Environment / A study has been conducted into the synthesis of 10wt% diamond/ mullite composites through two methods: First through the hot press sintering of alumina and silica in stoichiometric composition for 3:2 mullites (mullite formed in situ) at 1400, 1450 and 1500oC. Second through the sol/ gel process. The sol/ gel method only provided the basis for future development with no further discussion of the results while the hot press sintering method yielded composites with residual cristobalite and corundum phases. Achieved densities of the composites were 93.7, 94.6 and 95.8% of the theoretical density with respect to sintering temperatures of 1400, 1450 and 1500oC for compact samples by the first method. Hardness – measured by Vickers indentation – of the composites decreased with increase in temperature with 15.5 ± 0.33GPa achieved at the lowest sintering temperature investigated. The decrease in hardness was attributed to the structural degradation of diamond to non-diamond carbon forms with increase in temperature as observed from Raman spectra of each of the composites. X-ray traces showed an increase in the mullite content with increase in temperature. The fracture toughness of compacts initially hot press sintered from alumina and silica in stoichiometric composition for 3:2 mullite with no diamond added decreased with increase in sintering temperature with 4.75 ± 0.10MPa·m1/2 achieved at the lowest sintering temperature investigated. Further discussion to the structure and physical properties is presented.

Faculty of Health Science School of Public Health 0418444d benido_impouma@yahoo.com / Study objectives The objective of this meta-analysis was to review the comparative efficacy and tolerance of sulfadoxine-pyrimethamine (SP) given alone or in combination with one (SPAS1) or three (SPAS3) doses of artesunate in children with uncomplicated P. falciparum malaria, aged 6 months to 10 years. Specifically, it assessed cure rate, fever and parasite clearance time, gametocyte carriage and tolerability. Methods The methodology used was a systematic review and a meta-analysis of four randomised controlled trials. The primary endpoint was the parasitological cure rate at day 28. Secondary endpoint included the parasitological cure rate at day 14, time to fever and parasite clearance, gametocyte carriage and occurrence of adverse events. Results Cure rate at day 28 corrected by PCR was 2.5 times higher in the combination of SPAS3 than in SP alone (pooled OR=2.55, 95% CI 1.93 to 3.37). There was no difference in cure rate at day 28 corrected by PCR between the combination of SPAS1 and SP alone (pooled OR=1.06 95% CI 0.98 to 1.15). Fever and parasite clearance times were significantly faster in both SPAS1 and SPAS3 compared to SP alone (p<0.001). By day 28 all children on the combination therapy were agametocytaemic as opposed to those on SP alone (p<0.001). All drug regimens were well tolerated and safe. Conclusion The combination of SPAS3 is more efficacious than SP alone in treatment of children with uncomplicated P. falciparum malaria. The combination is recommended for adoption as a replacement for SP alone in areas where malaria is endemic.

The purpose of the study was to identify variables for use in a future instrument assessing the quality of life of adults with learning disabilities. The study focused on the social validation of select variables addressed by the research. Consumer input was solicited to determine which variables would be most important to include on a future instrument. Of particular interest in the study were perceptions of adults with learning disabilities from four-year institutions. / Demographic information and opinions about the participants' perception of important variable items to be included on a future instrument for assessing quality of life were gathered via the Quality of Life Variable Verification Survey (QOL-VVS). Two hundred fifty-two individuals agreed to participate in the study. There were three sample groups comprised of adults with learning disabilities (32) who had graduated from three state universities in Florida, as well as current students with learning disabilities (112) and postsecondary service providers (108) from the same universities. The majority of the participants were White (55%) females (52%) between the ages of 18-30 (53%). / Multivariate analysis of variance (MANOVA) procedures were used to compare and analyze sample group ratings. Descriptive analyses were used to identify additional variables participants considered important to be included on an instrument assessing quality of life. Discriminant analysis procedures were employed to identify variables that would be good predictors of quality of life for adults with learning disabilities. These procedures were also used to identify effective classification models of quality of life for adults with learning disabilities. / Results indicated that participants in all three sample groups rated 83% of the variable items from important to extremely important. Few significant differences were identified between group ratings. Variables related to education of others, self-esteem, and available services were reported five times or more, by at least two of the sample groups, to be included on an instrument assessing quality of life. Only four variable items were found to have significant differences in discriminating adults with learning disabilities into a high or low quality of life group. No effective classification model was identified. / Source: Dissertation Abstracts International, Volume: 56-11, Section: A, page: 4294. / Major Professor: Bruce Menchetti. / Thesis (Ph.D.)--The Florida State University, 1995.

In this thesis, we introduce a novel model based on the idea of autoencoders. Different from a classic autoencoder which reconstructs its own inputs through a neural network, our model is closer to Kernel Canonical Correlation Analysis (KCCA) and reconstructs input data from another data set, where these two data sets should have some, perhaps non-linear, dependence. Our model extends traditional KCCA in a way that the non-linearity of the data is learned through optimizing a kernel function by a neural network. In one of the novelties of this thesis, we do not optimize our kernel based upon some prediction error metric, as is classical in autoencoders. Rather, we optimize our kernel to maximize the "coherence" of the underlying low-dimensional hidden layers. This idea makes our method faithful to the classic interpretation of linear Canonical Correlation Analysis (CCA). As far we are aware, our method, which we call a Kernel Coherence Encoder (KCE), is the only extent approach that uses the flexibility of a neural network while maintaining the theoretical properties of classic KCCA. In another one of the novelties of our approach, we leverage a modified version of classic coherence which is far more stable in the presence of high-dimensional data to address computational and robustness issues in the implementation of a coherence based deep learning KCCA.

Thesis. 1979. M.S. cn--Massachusetts Institute of Technology. Dept. of Mechanical Engineering. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND ENGINEERING. / Includes bibliographical references. / by Craig C. Selvage. / M.S.cn

筆者在論文中引入一個名為加權距離檢驗的雙變項統計。此檢驗方法用於比較兩個隨機變數的集中趨勢。其優勢在於在有偏度的數據中，仍能穩定地控制第一型錯誤，並同時提供可觀的統計檢力。加權距離檢驗利用冪函數修正在偏度數據中的不對稱現象。與一般的冪函數轉換法不同，加權距離檢驗將冪值限制在0和1之間。文中亦提供了一個有效決定冪值的方法，以方便在實際運算中使用。 / 筆者總結了四個主流的雙變項統計方法，並利用蒙地卡羅模擬法在正態分佈、同程度偏度分佈以及不同程度偏度分佈三個情況中比較了它們與加權距離檢驗的表現。結果顯示，加權距離檢驗雖然沒有在任何一個情況中勝出，但卻於兩方面表現了其優勢。首先，它在任何情況下都能把第一型錯誤控制在合理水平之下；其次，它在任何情況下都不至於表現得太差。反觀其他四個檢驗方法總會在某些情況下表現失敗。由此可見，加權距離檢驗比起其他檢驗方法更能提供一個穩定而簡單的方法去比較集中趨勢。 / A new bivariant statistics, namely the weighted distance test, for comparing two groups were introduced. The test aims at providing reliable type I error control and reasonable statistical power across different types of skewed data. It corrects the skewness of the data by applying power transformation with power index ranged between 0 to 1. I also proposed in this thesis a possible way of deciding the power index by considering the skewness difference between the two groups under comparison. / I reviewed 4 commonly used inferential statistics for two-group comparison and compared their performances with the weighted distance test under 1) normal distribution, 2) skewed distribution with equal skewness across groups, and 3) skewed distribution with unequal skewness across groups. Monte Carlo simulations were ran to evaluate the 5 tests. Results showed that the weighted distance test was not the best test in any particular situation, but was the most stable test in the sense that 1) it provided accurate type I error control and 2) it did not produce catastrophically small power in any scenario. All other 4 tests failed in some of the simulated scenario for either inflated type I error, or unsatisfactory power. Therefore, I suggested that the weighted distance test could be one easy-to-use test that works fairly well across a wide range of situation. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Lee, Yung Ho. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 31-33). / Abstracts also in Chinese. / Chapter Chapter One --- : Introduction --- p.1 / Common methods in comparing central tendency --- p.2 / T-test --- p.2 / Median and rank --- p.3 / Trimming --- p.3 / Power transformation --- p.4 / Chapter Chapter Two --- : Weighted distance statistic --- p.5 / Definition --- p.5 / Statistical properties --- p.5 / Specification of Lambda λ --- p.7 / Estimation and inference --- p.7 / Chapter Chapter Three --- : Simulation --- p.10 / Study 1 --- p.12 / Study 2 --- p.15 / Study 3 --- p.18 / Chapter Chapter Four --- : Discussion --- p.21 / Summary --- p.21 / Limitation --- p.22 / Further development --- p.23 / Chapter Appendix I --- : Proofs of theorems of weighted distance statistic --- p.24 / Chapter Appendix II --- : Table of numerical results of simulations --- p.26 / Bibliography --- p.30