Faculty of Engineering and the Built Environment School of Civil Engineering 9311276v / This research project has been prepared to satisfy the requirements of the University of the Witwatersrand, Faculty of Engineering and the Built Environment for the degree of Master of Science (Civil) in Geotechnical Engineering and Materials (50/50). Contained within the project is a review of international past and current tailings facility closure techniques. Guidelines and minimum requirements for successful closure have been developed and are presented.

Thesis (M Med (Family Medicine))--University of Limpopo (Medunsa Campus),2010. / BACKGROUND: Common preventable causes of maternal and perinatal mortality such as HIV, anaemia, gestational proteinuric hypertension, syphilis and Rhesus disorders can be identified early with simple antenatal screening, however this screening is not always efficiently and effectively done. It is critical to identify challenges and possible solutions to ensure effective implementation of the national antenatal screening guidelines for these conditions. Even within existing inadequate resources, there is always room for improved efficiency. METHODS: The aim of this study was to evaluate the implementation of the national guidelines for antenatal screening in the Acornhoek district, Mpumalanga. It was a prospective, cross-sectional study of the antenatal screening programme in the Acornhoek district. Data was collected from an analysis of antenatal and medical records of all women who received antenatal care in the Acornhoek district and ultimately delivered at Tintswalo Hospital, Acornhoek, during the study period of one calendar month. Standardised questionnaires were administered at each of the 15 antenatal clinics referring to Tintswalo Hospital to identify the challenges preventing the effective implementation of the national guidelines for antenatal screening that were experienced by the nurses at the clinics. RESULTS: 428 women were interviewed post partum. 335 were included in the study (87 had received antenatal care out of the district and 6 were unbooked). 85.7% of women had been tested for syphilis antenatally, 84.8% had been tested for anaemia, 72.8% had had blood taken for Rhesus factor and only 64.2% had had pre-test counselling for HIV. 14.3% of women did not have their blood pressure checked at every visit and over 31.4% did not have urine dipstick tests done at every visit. 27% of women booked before 20 weeks, however only 18% had their antenatal bloods taken before 20 weeks. Of the women who had had antenatal blood screening tests done, 18% had not received results by the time of delivery. There was considerable variation between the clinics. Challenges preventing the effective implementation of antenatal screening included variation in knowledge of antenatal screening requirements by clinic staff, barriers to HIV testing, poor infrastructure, equipment and supply problems, laboratory support issues, onsite testing challenges, poor support from the district and passive response to problem solving by clinic staff. CONCLUSIONS: Not all women receiving antenatal care in the Acornhoek district are being screened for HIV, anaemia, GPH, syphilis and Rhesus disorders. From the reasons identified above, interventions such as in-service training of clinic staff in antenatal screening, removing barriers to HIV testing such as appointing lay counsellors at every clinic and offering provider driven or opt-out testing for HIV, improving infrastructure such as installing telephones at every clinic, increasing the laboratory courier service to 5 days a week, introducing on site testing of syphilis, anaemia and Rhesus factor and a rapid pro-active approach to problem solving by district and clinic staff to manage barriers to antenatal screening such as broken equipment and out of stock supplies.

Background: There is strong level I evidence that in most patients, mechanical bowel preparation (MBP) is not required. Despite this, physician behaviour has been slow to change in favour of omitting preoperative MBP. Methods: A knowledge translation strategy including: guideline development, consensus, education by opinion leaders, audit and feedback and reminder cards, was used in this study. Results: Overall, 81.1% of patients in the “before” arm and 88.4% in the “after” arm received MBP in compliance with the guideline (p=0.038). Normal diet use was compliant with the guideline in 45.6% of the patients in the “before” arm and 55.8% in the “after” arm (p=0.080). The use of enemas was compliant with the guideline in 88.5% of “before” patients and 94.2% of “after” patients (p<0.001). Conclusions: The results of this study reveal that a tailored, multi-faceted knowledge translation strategy can be used to change surgeon behavior in this clinical scenario.

Background: There is strong level I evidence that in most patients, mechanical bowel preparation (MBP) is not required. Despite this, physician behaviour has been slow to change in favour of omitting preoperative MBP. Methods: A knowledge translation strategy including: guideline development, consensus, education by opinion leaders, audit and feedback and reminder cards, was used in this study. Results: Overall, 81.1% of patients in the “before” arm and 88.4% in the “after” arm received MBP in compliance with the guideline (p=0.038). Normal diet use was compliant with the guideline in 45.6% of the patients in the “before” arm and 55.8% in the “after” arm (p=0.080). The use of enemas was compliant with the guideline in 88.5% of “before” patients and 94.2% of “after” patients (p<0.001). Conclusions: The results of this study reveal that a tailored, multi-faceted knowledge translation strategy can be used to change surgeon behavior in this clinical scenario.

The importance in finding components that may result in won market advantages for an organization has increased in the latest decade, as a result of the increasing competition across a range of industries. One factor that has been shown leading to efficient products and benefits in terms of time- and resource savings has been an implementation of user experience interaction guidelines, UXIG. These are guidelines with the purpose to improve the products within an organization out of a holistic perspective and increase the interaction between the product and its user, in a positive way. This study has been conducted at GE Healthcare Life Sciences, in Uppsala, focusing at chromatography. The purpose of this study was to investigate how to create and implement UXIG at this, large, international organization – with a heterogeneous product portfolio. In order to come up with recommendations in these questions a benchmarking study, interviews and a questionnaire was made. The purpose with the interviews and questionnaire was to find out how other organizations and their employers had been acting and thinking when reasoning about these questions whereas the benchmarking study consisted of a comparison of famous UXIGs. The result of this study shows that e.g. preparation, an overall clarity from the creators/management, a strong communication channel between the management, creators of the UXIG, its users and the users of the systems, how they are matching to the organization, their availability and structure, are important components in order to create/ develop UXIG in a successful way.

Although Attention-Deficit/Hyperactivity Disorder (ADHD) is a common disorder amongst school going children, it is often misdiagnosed, misunderstood and mismanaged. This state of affairs does not bode well for the development of the ADHD learner and often leads to long-term impairments in terms of the learner's social and emotional development, academic performance and future vocational success. Therefore, it is essential that teachers fully understand the disorder and know how to optimally accommodate ADHD learners in their classrooms. The aims of the research were as follows: to determine whether a significant difference exists between teachers' ratings of the importance of certain didactic approaches, behaviour management strategies and parental involvement in accommodating ADHD learners in "regular” classrooms on the one hand, and the frequency of teachers' implementation thereof on the other; and to determine how variables such as gender, age, teaching experience and qualifications affect (1) teachers' ratings of the importance of certain didactic approaches, behaviour management strategies and parental involvement for accommodating ADHD learners in "regular" classrooms and (2) the frequency of teachers' implementation thereof. A dual research approach was followed to achieve the aims of the research. First, a literature study was done on ADHD with reference to its aetiology, prevalence, symptoms, co-morbid features and treatment options. The implications of accommodating ADHD learners in "regular” classrooms were discussed against the background of the inclusive educational approach. Second, an empirical investigation was undertaken to determine how important teachers rate various inclusive didactic approaches and strategies and how frequently they implement them. The effect that variables such as gender, age, qualifications and teaching experience could have on teachers' ratings of the importance and frequency of implementation of these inclusive didactic approaches and strategies were also investigated. A structured questionnaire was distributed amongst 115 intermediate phase teachers who are teaching in ex-Model C primary schools in the Klerksdorp and Potchefstroom school districts. The data was statistically analysed and the following conclusions were drawn: Although teachers are aware of the importance of certain didactic approaches, behaviour management strategies and parental involvement for the optimal inclusion of ADHD learners in "regular" classrooms, in practice they do not implement these aspects so frequently. Female teachers rate the implementation of certain didactic approaches, strategies related to teacher behaviour and parental involvement more important for accommodating ADHD learners in their classrooms than their male counterparts, and implement them more frequently than male teachers. In general, variables such as gender, age, teaching experience and qualifications do not significantly affect (1) teachers' ratings of the importance of certain didactic approaches, behaviour management strategies and parental involvement for accommodating ADHD learners in regular classrooms, or (2) the frequency of teachers' implementation thereof. Resulting from the findings of the research, practical guidelines were recommended to enhance the teaching and inclusion of ADHD learners in "regular" classrooms. / Thesis (M.Ed.)--North-West University, Potchefstroom Campus, 2006.

Although Attention-Deficit/Hyperactivity Disorder (ADHD) is a common disorder amongst school going children, it is often misdiagnosed, misunderstood and mismanaged. This state of affairs does not bode well for the development of the ADHD learner and often leads to long-term impairments in terms of the learner's social and emotional development, academic performance and future vocational success. Therefore, it is essential that teachers fully understand the disorder and know how to optimally accommodate ADHD learners in their classrooms. The aims of the research were as follows: to determine whether a significant difference exists between teachers' ratings of the importance of certain didactic approaches, behaviour management strategies and parental involvement in accommodating ADHD learners in "regular” classrooms on the one hand, and the frequency of teachers' implementation thereof on the other; and to determine how variables such as gender, age, teaching experience and qualifications affect (1) teachers' ratings of the importance of certain didactic approaches, behaviour management strategies and parental involvement for accommodating ADHD learners in "regular" classrooms and (2) the frequency of teachers' implementation thereof. A dual research approach was followed to achieve the aims of the research. First, a literature study was done on ADHD with reference to its aetiology, prevalence, symptoms, co-morbid features and treatment options. The implications of accommodating ADHD learners in "regular” classrooms were discussed against the background of the inclusive educational approach. Second, an empirical investigation was undertaken to determine how important teachers rate various inclusive didactic approaches and strategies and how frequently they implement them. The effect that variables such as gender, age, qualifications and teaching experience could have on teachers' ratings of the importance and frequency of implementation of these inclusive didactic approaches and strategies were also investigated. A structured questionnaire was distributed amongst 115 intermediate phase teachers who are teaching in ex-Model C primary schools in the Klerksdorp and Potchefstroom school districts. The data was statistically analysed and the following conclusions were drawn: Although teachers are aware of the importance of certain didactic approaches, behaviour management strategies and parental involvement for the optimal inclusion of ADHD learners in "regular" classrooms, in practice they do not implement these aspects so frequently. Female teachers rate the implementation of certain didactic approaches, strategies related to teacher behaviour and parental involvement more important for accommodating ADHD learners in their classrooms than their male counterparts, and implement them more frequently than male teachers. In general, variables such as gender, age, teaching experience and qualifications do not significantly affect (1) teachers' ratings of the importance of certain didactic approaches, behaviour management strategies and parental involvement for accommodating ADHD learners in regular classrooms, or (2) the frequency of teachers' implementation thereof. Resulting from the findings of the research, practical guidelines were recommended to enhance the teaching and inclusion of ADHD learners in "regular" classrooms. / Thesis (M.Ed.)--North-West University, Potchefstroom Campus, 2006.

Acute low back pain is a commonly occurring symptom that can impact considerably upon a person's life. It is poorly defined, difficult to classify and challenging to measure. However, due to the high prevalence rates of the symptom, cited in the epidemiological literature, and the costs incurred by individuals, health services and society in general, it is vital that clients are encouraged to take more responsibility for their health. This thesis is concerned with perceptions of control in people with acute low back pain. It is about how they respond to this symptom and the way it impacts upon their lives. The underpinning literature is drawn from both medical and social science research, as the work crosses faculty boundaries. Problems are addressed from a physiotherapeutic and social science perspective, as links are formed between the different disciplines. From this literature, a significant theoretical development was the creation of a framework, which enabled the systematic review of existing outcome measures. A number of instruments, relevant to clients with acute low back pain, were reviewed using this framework, for the dimensions of control, function, pain and anxiety. The findings were used to inform the selection of outcome measures in this research. Four studies were then undertaken, all linked to studying clients with acute low back pain. The first study was a survey of general practitioners in Southampton and the New Forest, which identified their strategies for managing clients with acute low back pain. The second study focused on clients' experiences and was a randomized controlled trial, which tested the effectiveness of an information leaflet, designed to encourage clients to take more responsibility for their own health. The third study primarily focused on clients' perceptions of control over time, addressing the question of how these perceptions change during a one-year period. Finally, since recruitment of clients by their doctors was problematic throughout this research, a follow-up survey was undertaken with these health professionals to establish the reasons for this. The results of these studies are used to discuss the importance of clients' perceptions of control and the implications for clinical practice.

Depression, a sequela of stroke, is underrecognized and underreported. The American Heart/Stroke Association estimated 1/3 of patients develop depression after a stroke. Depression after a stroke has negative influence on stroke recovery through decreased participation in rehabilitation, and increased morbidity and mortality. The American Heart/Stroke Association recommended that depression screening be conducted on stroke patient; however, there is a lack of guidance regarding the optimal time and tools for depression screening. The practice problem identified was the absence of depression screening in poststroke patients at the project site. The project question focused on identifying evidence-based approaches for depression screening in poststroke patients. The goal of the project was to develop clinical practice guidelines for depression screening poststroke. The framework used to develop the project was the John Hopkins Evidence-Based Nursing model. An expert panel was used to evaluate the developed clinical practice guidelines. Serving as participants, expert panelist were selected based on their background in stroke care management. Panelists evaluated the guidelines using the Appraisal of Guidelines for Research and Evaluation Instrument II standard instrument tool. Twenty-five percent of reviewers recommended using the guidelines and 75% recommended using the guidelines with minor modifications. Implementation of clinical practice guidelines support depression screening after stroke leading to increased awareness, education, recognition and reporting. The findings of this project have the potential for positive social changes by improving depression screening in stroke patients and increasing early recognition and reporting of depression poststroke.

While many clinical practice guidelines that use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach have ample published evidence to support their recommendations, certain situations (e.g. rare, rapidly emerging, or understudied diseases) may be limiting. As a result, it is common for guideline developers to seek out indirect evidence from other areas to fill in these evidence gaps. The GRADE evidence-to-decision (EtD) framework, which offers a structured and transparent development process for guidelines, includes additional research evidence domains (e.g. feasibility, acceptability, equity) for panels to consider in their decision-making process. This confluence of both considerations of indirect information and increasing literature domain sources to draw from when making decisions weighs on the simplicity of literature presentation. Herein, firstly, we described an example of specific decision-rules for including indirect evidence and the implications of the rules for presenting results to decision-makers. Secondly, we provided a comprehensive overview of how guideline developers currently report economic information across GRADE evidence-to-decision frameworks. Lastly, we ranked the most important study characteristics suggested in the literature by economists to consider as decision-rules when assessing indirectness (transferability) of economic evaluations chosen as research evidence in a GRADE guideline. We conclude that developers, with the help of their panels, should work to establish and report clear decision-rules and the rationale for indirect evidence that they select for their clinical practice guidelines. This has the potential to simplify the presentation of indirect evidence for panels and developers, as well as, to reduce decision-making confusion, time demands and guideline funder costs. / Thesis / Candidate in Philosophy / While many clinical practice guidelines have ample published evidence to support their recommendations, certain situations (e.g. rare, rapidly emerging, or understudied diseases) may be limiting the available literature. As a result, it is common for guideline developers to seek out indirect evidence from other, but related areas, to fill in these evidence gaps. Selection of available indirect evidence may be better than basing decisions on no evidence, in particular in situations of clinical equipoise. However, including all potentially relevant indirect evidence may represent an overuse of evidence. Indirect evidence refers to information sources with related populations, interventions, outcomes or comparisons, which could reasonably be extrapolated; but, are not entirely specific to the research topic at hand. This confluence of both indirect information considerations and desire by many for increasing literature sources to draw from weighs on the simplicity of an overall summary of literature presented during a guideline recommendation decision-making process. Herein, firstly, we described an example of explicit decision-rules for including indirect evidence that were specific and the implications of the rules for presenting results to decision-makers. Secondly, we provided a comprehensive overview of how guideline developers currently report economic information across guideline frameworks, in particular with respect to indirectness. Lastly, we described the most important study characteristics suggested by economists to consider as decision-rules when assessing economic evaluations for use as research evidence in a guideline. This work presents important concepts for guideline developers to consider when choosing indirect evidence sources in their clinical practice guidelines. Our findings have the potential to simplify the presentation of indirect evidence for guideline panels and developers, as well as, to reduce decision-making confusion, time demands and guideline funder costs.