Background. Swaziland adopted the World Health Organization’s (WHO) guidelines for the inpatient treatment of severely malnourished children in 2007 to reduce case -fatality rates for childhood malnutrition. However, no follow-up studies have been conducted to determine the reduction in the case -fatality rate post-implementation of the guidelines. Objectives. To determine the case -fatality rate for childhood malnutrition post-implementation of the WHO treatment guidelines and determine the level of adherence to the guidelines at Mbabane Government Hospital. Methods. A retrospective observational study was undertaken. All children under 5 years admitted for inpatient treatment of malnutrition between January 2010 and December 2011 had their demographic-, anthropometric- and clinical characteristics recorded and analysed, as well as the outcome of admission. Results. Of the 227 children admitted during the study period, 179 (64.6%) were severely malnourished and 98 (35.4%) had moderate malnutrition. One-hundred-and-eleven children died during admission, an overall case -fatality rate of 40.1%. Mortality was significantly higher among severely malnourished children compared to those with moderate malnutrition, (46.9% vs 27.6%, OR 3.0 (95% CI 1.7 to 5.3)). Comorbid pneumonia and gastroenteritis were significant predictors of mortality – , OR 2.0 (95% CI 1.2 to 3.4) and 1.9 (95% CI 1.1 to 3.2) respectively. Conclusion. Case -fatality rates for childhood malnutrition remain high, despite adoption of the WHO treatment guidelines. A need exists for improved adherence to the WHO guidelines and periodic clinical audits to reduce deaths from childhood malnutrition to meet the WHO mortality target of less than 5% and improve child survival. / Dissertation (MSc)--University of Pretoria, 2013. / gm2014 / Clinical Epidemiology / unrestricted

This study presents a model that explains the traffic fatality by exploring the Poisson regression model using two types of explanatory variables – referred to as internal and external factors. Internal factors contain variables closely linked to traffic safety, such as speed limits and belt usage (Strandroth et al., 2012), whereas external factors comprise a set of variables that the Swedish Transport Administration cannot control, such as the economy and demographic change (Wiklund et al., 2012). The purpose of the study is to evaluate the impact that internal and external factors have on the traffic fatality. This is done by modeling the traffic fatality using internal factors and then assessing the contribution of adding external factors in the regression model with a forward variable selection strategy. This study uses Swedish traffic fatality data as monthly statistics. The main characteristics of the data are that fatalities have generally decreased with time. Also, the data is characterized by a long term cyclical pattern as well as a yearly cyclical pattern. For the purpose of modeling the impact of internal factors, a model inspired by Brüde (1995) has been adopted, using the variable time as the only explanatory variable. It is concluded that internal factors can be used to significantly explain the general trend of the development of traffic fatalities. The variables chosen to represent external factors were economic development, traffic exposure, demographic development and seasonal trend. The study concludes that the variables economic development, traffic exposure and demographic development significantly contribute to explain the long term cyclical trends, indicating that traffic fatality is a complex multivariate system where no single variable can solely explain its dynamics. The external factor seasonal trend has the most impact of the examined external factors and explains the yearly cyclical pattern by itself. The model presented in this study shows high explanatory power and overall good fit to fatality data, making it a promising tool for statistical analysis of factors contributing to fatality. Especially for the Swedish Transport Administration, the impact of external factors can be evaluated statistically. This study leaves room for further research to assess the impact of additional external factors as well as evaluating the model’s predictive power, both of interest to the Swedish Transport Administration. / Denna studie presenterar en modell som förklarar dödsfall i trafiken genom tillämpning av Poissonregression där två typer av förklaringsvariabler använts – interna och externa faktorer. Interna faktorer innefattar variabler som är direkt knutna till trafiksäkerhet, såsom hastighetsbegränsningar och användande av säkerhetsbälte (Strandroth et al., 2012). Externa faktorer är variabler som Trafikverket inte kan kontrollera, såsom landets ekonomi och demografiska förändringar (Wiklund et al., 2012). Syftet med denna studie är att evaluera påverkan av interna och externa faktorer på dödsfall i vägtrafik. Detta görs genom att analysera hur väl interna faktorer förklarar dödsfall i vägtrafik och sedan undersöka förbättringen av att införa externa faktorer som förklaringsvariabler genom användande av en forward variable selection-strategi. Denna studie använder månatlig data över dödsfall i svensk trafik. Dessa data karaktäriseras av en nedgående trend. Dynamiken av dödsfall visar på ett långt cykliskt mönster samt ett kortare, årligt mönster. I syfte att modellera påverkan av interna faktorer har en modell inspirerad av Brüde (1995) tillämpats. Denna modell använder enbart variabeln tid som förklaringsvariabel. Studien konstaterar att interna faktorer kan användas för att signifikant beskriva en generell trend för utvecklingen av dödsfall i vägtrafik. Variablerna som har valts att representera externa faktorer är ekonomisk utveckling, trafikarbete, demografi samt en säsongstrend. Studien konstaterar att variablerna ekonomisk utveckling, trafikarbete och demografi beskriver det långa cykliska mönstret, vilket tyder på att dödsfall i vägtrafik är av komplex natur och kan inte beskrivas av en ensam variabel. Den externa faktorn säsongstrend förbättrar modellen mest av de externa faktorerna och kan ensam förklara det kortsiktiga cykliska mönstret. Den modell som presenteras i denna studie har hög förklaringsgrad och en överlag bra modellanpassning, vilket gör den till ett lovande verktyg för statistisk analys av faktorer bidragande till dödsfall i trafiken. Modellen är av särskilt intresse för Trafikverket då den tillåter statistisk utvärdering av externa faktorers påverkan. Denna studie lämnar utrymme för framtida forskning att utvärdera påverkan av ytterligare externa faktorer samt att evaluera modellens förmåga att prognostisera framtida antal dödsfall i vägtrafik, vilka båda är intresseområden för Trafikverket.

A significant proportion of automobile collisions with cyclists occur because automobile drivers do not see the cyclists until too late to prevent an accident. In the United States, despite years of flawed utilization of traffic safety technology and procedures and waning interest in the increase in traffic fatalities, cyclists remain very vulnerable, with little improvement in safety on the road, and they are dying preventable deaths. For example, even though Americans drove less in 2020 during the Pandemic, fatalities of cyclists on the road in the United States increased five percent to 891 in that year [1]. Why is it worth studying the subject of decreasing cycle crashes with automobiles to decrease the mortality and disability of cyclists in the United States? I believe it is more than a casual attitude toward cycle safety on the driver's part but a general attitudinal malaise to traffic safety on the part of the American public. The United States had 38,680 fatalities on the road in 2020, up from 7.2% of fatalities in 2019 [2]. By contrast, the European Commission reported that 18,800 people were killed on the road, a decrease of 17% from 2019, making Europe the safest region in the world in traffic safety [3]. There has been almost no awareness of this on the part of the public, nor has there been a public outcry in the United States. The only way that cyclists can increase their chances of surviving on the road is to proactively take action to make themselves more visible to motorists because, according to Laurie Beck, an epidemiologist from the Centers for Disease Control and Prevention, 'Nationwide, you're more than twice as likely to die while riding a bike than riding a car, per trip,' in the United States [4]. [From: Introduction]

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The 2010 earthquake in Haiti, which killed an estimated 316,000 people, offered many lessons in mass-fatality management (MFM). The dissertation defined MFM in seeking information and in recovery, preservation, identification, and disposition of human remains. Specifically, it examined how mass fatalities were managed in Haiti, how affected individuals sought information about fatalities, and what needs motivated them. Data from 28 in-depth, partially structured interviews, conducted during two field visits ending 21 weeks after the earthquake, were included in a case study. The data analysis revealed the MFM was severely inadequate. One interviewee, a senior UN official, stated, "There was no fatality management." The analysis also indicated a need to learn whereabouts of the deceased motivated individuals to visit spots the deceased were last seen at. It sought to illumine information-seeking practices, as discussed in the works of J. David Johnson and others, by developing a new model of information flow in MFM. In addition, it reaffirmed Donald Case and Thomas Wilson's theoretical proposition – that need guides any seeking of information – in the case of Haiti. Finally, it produced recommendations regarding future directions in MFM for emergency managers and information scientists, including possible use of unidentified body parts in organ transplants. Overall, the dissertation, which was supported by two grants of the National Science Foundation, attempted to add to relatively scanty literature in information seeking in MFM.

In public health, prevention is a fundamentally political process as both the selection of problems to be addressed and solutions recommended reflect decisions that are informed by economic, social and cultural forces. Yet prevention is often presented as a monolithic enterprise, an objective and scientific discourse that does not take sides. Behind this facade of political neutrality, diversely positioned individuals and groups often fail to find and/or sustain a common ground for shared prevention initiatives. Increasingly, many prevention awareness campaigns focus upon true accounts or injury narratives that serve both as a catalyst to build multipartite consensus through developing shared collaborative prevention discourses and practices and to mobilize public support for health and safety issues. While the use of the true account form is a recommended strategy in the public health literature directed toward practitioners, the engagement of true accounts in prevention campaigns has not been adequately problematised and examined from a critical social theoretical perspective. A qualitative, sociologically oriented case study of the use of the true account form, the commemorative, in young worker safety campaigns is proposed to deepen our understanding of this particular type of prevention intervention in particular and prevention as an enterprise more generally. The study investigates the socio-historical context in which the Young Worker Memorial LifeQuilt, a Canadian young worker educational initiative, emerged and unraveled as a multipartite prevention campaign centered upon the true account form of consensus commemoratives. A key finding is that true accounts of young workers killed on the job are socially mediated to diffuse blame and build consensus between diversely positioned occupational health and safety practitioners and the family survivors of workplace tragedies. What is included and excluded from these true accounts of workplace injuries, as socially constructed narratives in multipartite prevention awareness campaigns, may be, in part, a product of the terms and conditions negotiated between lead players. The true accounts included in collaborative, cross-institutional prevention campaigns, while referencing real events, may be told in ways that accommodate and harmonize the political perspectives of diversely positioned stakeholders. Conversely, the true account form is a potentially problematic strategy for collaborative prevention discourses and practices, as consensus commemoratives can be retold as critical remembrances of workplace death, with the result that the unifying narrative of a shared, collective memory project is undermined. This dissertation finds that the activity of collaboration shapes prevention as a socio-political activity/practice.

In public health, prevention is a fundamentally political process as both the selection of problems to be addressed and solutions recommended reflect decisions that are informed by economic, social and cultural forces. Yet prevention is often presented as a monolithic enterprise, an objective and scientific discourse that does not take sides. Behind this facade of political neutrality, diversely positioned individuals and groups often fail to find and/or sustain a common ground for shared prevention initiatives. Increasingly, many prevention awareness campaigns focus upon true accounts or injury narratives that serve both as a catalyst to build multipartite consensus through developing shared collaborative prevention discourses and practices and to mobilize public support for health and safety issues. While the use of the true account form is a recommended strategy in the public health literature directed toward practitioners, the engagement of true accounts in prevention campaigns has not been adequately problematised and examined from a critical social theoretical perspective. A qualitative, sociologically oriented case study of the use of the true account form, the commemorative, in young worker safety campaigns is proposed to deepen our understanding of this particular type of prevention intervention in particular and prevention as an enterprise more generally. The study investigates the socio-historical context in which the Young Worker Memorial LifeQuilt, a Canadian young worker educational initiative, emerged and unraveled as a multipartite prevention campaign centered upon the true account form of consensus commemoratives. A key finding is that true accounts of young workers killed on the job are socially mediated to diffuse blame and build consensus between diversely positioned occupational health and safety practitioners and the family survivors of workplace tragedies. What is included and excluded from these true accounts of workplace injuries, as socially constructed narratives in multipartite prevention awareness campaigns, may be, in part, a product of the terms and conditions negotiated between lead players. The true accounts included in collaborative, cross-institutional prevention campaigns, while referencing real events, may be told in ways that accommodate and harmonize the political perspectives of diversely positioned stakeholders. Conversely, the true account form is a potentially problematic strategy for collaborative prevention discourses and practices, as consensus commemoratives can be retold as critical remembrances of workplace death, with the result that the unifying narrative of a shared, collective memory project is undermined. This dissertation finds that the activity of collaboration shapes prevention as a socio-political activity/practice.

Background: The proportion of older individuals in the driving population is predicted to increase in the next 50 years. This has important implications for driving safety as abilities which are important for safe driving, such as vision (which accounts for the majority of the sensory input required for driving), processing ability and cognition have been shown to decline with age. The current methods employed for screening older drivers upon re-licensure are also vision based. This study, which investigated social, behavioural and professional aspects involved with older drivers, aimed to determine: (i) if the current visual standards in place for testing upon re-licensure are effective in reducing the older driver fatality rate in Australia; (ii) if the recommended visual standards are actually implemented as part of the testing procedures by Australian optometrists; and (iii) if there are other non-standardised tests which may be better at predicting the on-road incident-risk (including near misses and minor incidents) in older drivers than those tests recommended in the standards. Methods: For the first phase of the study, state-based age- and gender-stratified numbers of older driver fatalities for 2000-2003 were obtained from the Australian Transportation Safety Bureau database. Poisson regression analyses of fatality rates were considered by renewal frequency and jurisdiction (as separate models), adjusting for possible confounding variables of age, gender and year. For the second phase, all practising optometrists in Australia were surveyed on the vision tests they conduct in consultations relating to driving and their knowledge of vision requirements for older drivers. Finally, for the third phase of the study to investigate determinants of on-road incident risk, a stratified random sample of 600 Brisbane residents aged 60 years and were selected and invited to participate using an introductory letter explaining the project requirements. In order to capture the number and type of road incidents which occurred for each participant over 12 months (including near misses and minor incidents), an important component of the prospective research study was the development and validation of a driving diary. The diary was a tool in which incidents that occurred could be logged at that time (or very close in time to which they occurred) and thus, in comparison with relying on participant memory over time, recall bias of incident occurrence was minimised. Association between all visual tests, cognition and scores obtained for non-standard functional tests with retrospective and prospective incident occurrence was investigated. Results: In the first phase,rivers aged 60-69 years had a 33% lower fatality risk (Rate Ratio [RR] = 0.75, 95% CI 0.32-1.77) in states with vision testing upon re-licensure compared with states with no vision testing upon re-licensure, however, because the CIs are wide, crossing 1.00, this result should be regarded with caution. However, overall fatality rates and fatality rates for those aged 70 years and older (RR=1.17, CI 0.64-2.13) did not differ between states with and without license renewal procedures, indicating no apparent benefit in vision testing legislation. For the second phase of the study, nearly all optometrists measured visual acuity (VA) as part of a vision assessment for re-licensing, however, 20% of optometrists did not perform any visual field (VF) testing and only 20% routinely performed automated VF on older drivers, despite the standards for licensing advocating automated VF as part of the vision standard. This demonstrates the need for more effective communication between the policy makers and those responsible for carrying out the standards. It may also indicate that the overall higher driver fatality rate in jurisdictions with vision testing requirements is resultant as the tests recommended by the standards are only partially being conducted by optometrists. Hence a standardised protocol for the screening of older drivers for re-licensure across the nation must be established. The opinions of Australian optometrists with regard to the responsibility of reporting older drivers who fail to meet the licensing standards highlighted the conflict between maintaining patient confidentiality or upholding public safety. Mandatory reporting requirements of those drivers who fail to reach the standards necessary for driving would minimise potential conflict between the patient and their practitioner, and help maintain patient trust and goodwill. The final phase of the PhD program investigated the efficacy of vision, functional and cognitive tests to discriminate between at-risk and safe older drivers. Nearly 80% of the participants experienced an incident of some form over the prospective 12 months, with the total incident rate being 4.65/10 000 km. Sixty-three percent reported having a near miss and 28% had a minor incident. The results from the prospective diary study indicate that the current vision screening tests (VA and VF) used for re-licensure do not accurately predict older drivers who are at increased odds of having an on-road incident. However, the variation in visual measurements of the cohort was narrow, also affecting the results seen with the visual functon questionnaires. Hence a larger cohort with greater variability should be considered for a future study. A slightly lower cognitive level (as measured with the Mini-Mental State Examination [MMSE]) did show an association with incident involvement as did slower reaction time (RT), however the Useful-Field-of-View (UFOV) provided the most compelling results of the study. Cut-off values of UFOV processing (>23.3ms), divided attention (>113ms), selective attention (>258ms) and overall score (moderate/ high/ very high risk) were effective in determining older drivers at increased odds of having any on-road incident and the occurrence of minor incidents. Discussion: The results have shown that for the 60-69 year age-group, there is a potential benefit in testing vision upon licence renewal. However, overall fatality rates and fatality rates for those aged 70 years and older indicated no benefit in vision testing legislation and suggests a need for inclusion of screening tests which better predict on-road incidents. Although VA is routinely performed by Australian optometrists on older drivers renewing their licence, VF is not. Therefore there is a need for a protocol to be developed and administered which would result in standardised methods conducted throughout the nation for the screening of older drivers upon re-licensure. Communication between the community, policy makers and those conducting the protocol should be maximised. By implementing a standardised screening protocol which incorporates a level of mandatory reporting by the practitioner, the ethical dilemma of breaching patient confidentiality would also be resolved. The tests which should be included in this screening protocol, however, cannot solely be ones which have been implemented in the past. In this investigation, RT, MMSE and UFOV were shown to be better determinants of on-road incidents in older drivers than VA and VF, however, as previously mentioned, there was a lack of variability in visual status within the cohort. Nevertheless, it is the recommendation from this investigation, that subject to appropriate sensitivity and specificity being demonstrated in the future using a cohort with wider variation in vision, functional performance and cognition, these tests of cognition and information processing should be added to the current protocol for the screening of older drivers which may be conducted at licensing centres across the nation.

My proposed PhD, titled Zola's Naturalism in The Rougon-Macquart: The Fatality of Sexuality, aims to study the basics of the naturalistic novel in the second half of the nineteenth-century France. Firstly, I have looked back at previous critical studies that were dedicated to the themes of sexuality and/or fatality in Zola's writing. This introductory chapter helped me understand how far critics have gone and what a long way we still have to go before we can fully appreciate the importance of these themes in the context of naturalism. Throughout the twenty novels that make The Rougon-Macquart series, I studied the fictional characters in their being, their appearance and their evolution in space and time. I therefore investigated whether or not these characters were masters or slaves of their space and time and beyond that, what influences they had on each other. Afterwards, I questioned the fecundity of the theme of sexuality in Zola's work to find out both the aspects of originality in his writing and his contribution to the modern novel. Nevertheless, I have criticized Zola on a wider angle as an emeritus writer with his own "weaknesses". Methodologically, I have largely used the semiotics approach along with psychoanalysis due to the specificity of sexuality. Despite the wide range of critical studies on Zola's novels, in my sense, most of them have so far failed to tackle naturalism at its foundations, i.e. sexuality. In fact, if one attempted to free The Rougon-Macquart from the theme of sexuality, neither the Rougon-Macquart family would exist nor the twenty novels they generated. Studying sexuality therefore appeared to be essential to the understanding of the naturalistic theory. However, and surprisingly so, most of Zola's critics have avoided that inescapable theme, perhaps more likely for reasons of decency rather than for scientific ones. It is in such context that I have decided that it was time to bring it to light for the sake of truth about the knowledge of Zola.

M.Tech. (Business Administration, Faculty of Management Sciences), Vaal University of Technology. / The majority of mine health and safety authorities around the world agree that the quality of safety standards is of increasing importance to the mining industry across the world (Kleyn & du Plessis 2016:309). Mining companies in many countries such as New Zealand, (an island country in the south-western Pacific Ocean), Australia, South Africa and China have taken up the challenges of guaranteeing liability and improving performance of the safety and health of their workers, aware that many workers are injured, if not fatally. These incidents result in production loss. This study provides not only an opportunity to evaluate the status of the safety control measures of the work system in a mining company, but also enables management to pinpoint the causes of poor safety performance and implement efforts that ensure safety improvement. The primary objectives of this study were to examine factors influencing the adherence and employee perceptions towards safety control measures in a mining company. Furthermore, the governments in many countries have tried to implement legislation to try to curb the scourge of industrial accidents. Safety disclosures of the annual reports from the Department of Mineral Resources (DMR) of South African mining organisations, discloses 10 major mining accidents that happened in 2015 at Northern Cape mining companies. Six of these accidents occurring from a small mining sector and four from a large mining sector, except previous year’s safety records as detailed in this study. A quantitative approach was adopted for the study. The data were collected using a sample of 200 participants in which a survey questionnaire was administered to permanent mine employees and full time contractors in the mine. A simple sampling technique was used and data were then analysed using the Statistical Package for the Social Science (SPSS) version 25.0 to formulate frequency tables and descriptive analysis graphs. Furthermore, one-way analysis of variance (ANOVA) and t-test were utilised to analyse the data and examine significant differences between employee perceptions and attitudes towards safety control measures, age and length of service (Willemse 2009:118-121). The results reveal that although the mine was considered compliant, with its employees showing a positive attitude towards safety control measures, ANOVA revealed different perceptions of employees based on their age and years of experience. However, no differences were found in relation to gender and occupation. Based on the findings, this study further recommends future studies to be conducted in order to explore the effectiveness of implementing an internal system of self-evaluation as a starting point in any safety improvement process. An effective system of internal self-evaluation will trademark the mining sector internationally and improve workers’ safety by improving effectiveness and assurance of the control measures and the level of control performance criteria. The system should create the awareness of adherence to safety control measures and deal with employee perception towards safety adherence in mining. In addition it should be a system that ensures a structured and standardised approach to learning from incidents and that all necessary steps are followed to safeguard against repeats of incidents and accidents through an effective incident investigation process (Van den Berg 2014:11). The findings of the study revealed that the leadership in the mine has a strong, positive and significant influence on the performance of safety. In this regard, this study recommends that an effective employee engagement system to be developed and that mine managers establish a safety control charter that must be understood by the mine workers, develop a code of ethics that requires ethical and honest behaviour from all employees in order to improve safety performance and learn from these accomplishments. Mine workers will take their cue from the attitude and example displayed by management, therefore, it is recommended that mine management develop an organisational culture, which assigns authority and responsibility to employees and organises and develops employees with direction provided by management that determines the type of culture in that mine. To minimise or reduce the risk of health exposure of each activity as highlighted under Regulation 9 of the Mine Health and Safety Act (29 of 1996), it is recommended that mine manager’s enforce the use of protective equipment. The leadership and human resources, mine workers and all persons who may be affected by the mining activities in the surrounding area of operation need to be aware of the factors that can impact their well-being. The study also presented managers, mine owner and other decision makers within the mining company with important insight on key areas of factors that may require particular attention in order to enhance their operational strategies towards zero harm in the mine.