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The psycho-social challenges of working at the forefront of the Covid-19 pandemic : a survey of emergency care services personnel in the Eastern Cape EMS
(2023-05) Mfanafuthi Mavuso, Patrick; Bhagwan, Raisuyah; Abdullah, Naseef
Introduction
The COVID-19 pandemic, which emerged in early 2020, has caused a surge in patient numbers
and crippled healthcare systems. South Africa has had more than 2.9 million positive COVID-19
cases, resulting in over 89 000 deaths. Healthcare workers (HCWs) have been under
insurmountable mental and psychological pressure, leading to depression, anxiety and ultimately,
burnout. Emergency Medical Services (EMS) personnel play a pivotal role in managing and caring
for ill and injured patients in the pre-hospital setting. These practitioners are at the forefront of the
fight against COVID-19. Despite the role they play in improving the health outcomes of these
patients, there is a paucity of research on the effect of COVID-19 on EMS personnel working and
living in the rural areas of low-and-middle-income countries like South Africa. Gaining insight into
the daily challenges faced by HCWs and the coping strategies adopted will assist EMS personnel
in mitigating physical and emotional stressors, as well as long-term psychological effects.
Aim of the study
To investigate the psycho-social influence of working at the forefront of the COVID-19 pandemic
amongst EMS personnel in the Eastern Cape.
Objectives
This study aimed to:
I. Identify the working conditions that exacerbate the stress of working within the context of
the COVID-19 pandemic;
II. Ascertain the factors that reduce stress amongst EMS personnel;
III. Identify the psychological stressors amongst EMS personnel in the Eastern Cape during
the COVID-19 pandemic;
IV. Identify the coping mechanisms/strategies used by EMS personnel in the Eastern Cape
during the COVID-19 pandemic; and
V. Make recommendations on providing support and improving the working conditions of
EMS personnel in the Eastern Cape.
Methodology
The study was conducted using a quantitative, cross-sectional descriptive survey design guided
by a post-positivist paradigm with a deductive approach. Data was collected from 368
participants who worked in the Eastern Cape during the start of the COVID-19 pandemic.
Participants were presented with an online survey questionnaire, which was subsequently
analysed using the Statistical Package for the Social Sciences (SPSS) statistics software, and
the results were presented by tables, charts and descriptive summaries.
Results
An overwhelming 80.4% (n=296) of EMS personnel showed dedication to their work (patient
care), despite working under immense pressure. The findings showed moderate agreement to
different stressors, indicating that EMS personnel do not suffer from existential fears but are
somewhat worried about their own risk of infection and that of their family. The main stress factors
included the availability of PPE, infection and treatment protocols, recognition of their work by
EMS management, and the perceived risk of infection to themselves and others. Motivational
factors that encourage EMS personnel to work in future outbreaks or pandemics were not
significantly related to attitudes within the context of the COVID-19 pandemic.
Conclusion
As a direct and immediate consequence of providing care to COVID-19-infected patients, frontline
HCWs put themselves at risk of various adverse physical and emotional effects. An already
stressful situation becomes extremely precarious as a result of the escalating negative impacts
on mental and physical health experienced by EMS personnel, a crucial demographic, used to
fight the pandemic. The findings of this study are consistent with what was already known from
previous studies conducted on HCWs during previous pandemics, thereby being relatively
predictable. This emphasizes the importance of basing pandemic planning and reactions on the
most current and reliable data.
A work integrated learning content framework for clinical neurophysiology technology in South African universities of technology
(2024-08) Van der Walt, Christelle; Orton, Penelope Margaret; Prakaschandra, Dorcas Rosaley; Marais, S
INTRODUCTION
Clinical technology (CT) is a group of seven specialist professions dealing with
diagnosis and monitoring of human organ system function and diseases. Clinical
neurophysiology (CN) is one of these professions and uses multi-modality test
investigations of the brain, peripheral and central nervous system, and muscular
system, to diagnose and monitor neurological disease.
Since the origin of formal training, specialist learning in one of these categories has
occurred during a period of work-integrated learning (WIL) after a combined didactic
period at one of the three South African universities of technology that offer this
qualification. The duration of this period has fluctuated over time. Currently this is set
at 3 840 hours over a 24-month placement period as per the South African
Qualifications Authority (SAQA) course registration documents.
No previous investigations have been conducted to determine the industry required
content of this WIL period or how the testing and monitoring modalities taught support
specialist learning. No category specific training frameworks exist to aid training units
at any of the current three universities offering this qualification.
AIMS AND OBJECTIVES
The purpose of this study was to determine the current industry requirements for
graduates to integrate into Clinical Neurophysiology private practice upon graduation.
This study aimed to determine the core testing modalities to include in an
undergraduate clinical technology qualification and how each modality can support
learning of related modalities. Related to this, this investigation also aimed to determine
embedded skills, knowledge, and personal graduate attributes required for mastering
of each of the core modalities.
The final objective was to design a learning framework based on the interconnected
learning affinity of modalities that incorporates all the required graduate skills that drive
achievement of graduate level outcome skill levels as determined by industry
requirements. METHODOLOGY
A Delphi research study was designed to firstly investigate the historic development of
the profession and training, and secondly determine the core testing modalities and
related knowledge and skills a current industry aligned qualification should include.
A round of unstructured interviews and desk research was undertaken to identify all
modalities currently included in university of technology course documents. A total of
23 modalities were identified. This round of data gathering was followed by two Delphi
questionnaires.
The first questionnaire (Q1) provided clinical neurophysiologists (CNPs) currently in
private practice an opportunity to select their preferred core modalities from the list of
modalities identified during the first data gathering round. Participants were also able
to contribute current industry required outcome skill levels and embedded skills and
knowledge required to master each modality. Fifty participants identified a list of 15
modalities as potential core modalities and contributed approximately 1 600 comments
on prerequisite skills and embedded knowledge and graduate attributes.
The second questionnaire (Q2) reported the findings of the first and provided the 36
participants with the opportunity to evaluate the learning and prerequisite dependence
or affinity of interrelated modalities. The participants also reevaluated the required
outcome practice skill level for each modality and how knowledge and practical skills
from Q1 drive learning of the core modalities.
RESULTS
At the end of the second questionnaire a total of 13 modalities were identified as core
modalities that are essential to master during undergraduate WIL. It was determined
that students must be able to perform, report, and interpret the results of the 13 core
modalities.
Dependence affinity of the 13 core modalities for learning of related modalities was
confirmed and the embedded and prerequisite skills driving the mastering of each
modality were combined into a learning framework. Results confirmed the historic foundational importance of electroencephalography (EEG) as a prerequisite to learning
all the other core modalities.
CONCLUSION
This was the first study investigating industry required graduate outcome skills for an
undergraduate qualification in clinical technology. Through a Delphi study 13 core
outcome modalities were identified and the required outcome skills level for integrating
into private practice was determined. Participant skills and knowledge contributions
were drawn upon to design a driver-based learning framework that can guide the
universities and training units in structuring the WIL period for most efficient clinical
training time management to achieve the required graduate skills outcomes during the
3 840 clinical training hours.
Speckle tracking evaluation of right ventricular function post left-sided valve replacement
(2024-08) Dlamini, Nompilo; Prakaschandra, Dorcas Rosaley; Koshe, J J; Gojo, Mawande Khayalethu Edson
Background: The right ventricle dilates due to increased pulmonary wedge pressure
caused by mitral and/or aortic valve disease, which lowers the right ventricular (RV)
ejection fraction. This dilation can lead to tricuspid regurgitation (TR) with secondary
right ventricular volume overload. Surgically correcting the left heart valves is thought
to result in more favourable RV reverse remodelling, however, a growing number of
patients have been observed in the cardiac unit at Port Elizabeth Provincial Hospital
(PEPH) with worsening symptoms after left valvular correction. Due to the idea that
tricuspid regurgitation (TR) would disappear after the original left-sided valve
disease was corrected, surgical correction of the tricuspid valve (TV) has, up to now,
been avoided in patients with secondary STR at the time of left valvular surgical
correction. Much too little is known about how critical right ventricular (RV) function is
and how it affects the cardiovascular patient’s prognosis. When selecting surgical
procedures for the mitral valve (MV) and/or aortic valve (AO), RV performance is not
the key determining factor.
Aims: To determine changes in the right heart after mitral and/or aortic valve surgery,
as well as to determine predictors of early signs of tricuspid regurgitation progression
post-left valve surgery using two-dimensional Doppler and speckle tracking
echocardiography.
Study population and design: This study included 30 patients, 12 males and 18
females between the ages of 18 and 65. This was a prospective clinical study on the
preoperative and postoperative echocardiographic parameters and their interaction in
patients with severe mitral and/or aortic valve disease who were candidates for valve
surgical correction. All echocardiographic examinations were conducted in the cardiac
clinic of Port Elizabeth (Gqeberha) Hospital in the years 2020 to 2022.
Subjects and methods: Participants were subjected to complete clinical examination
and transthoracic echocardiography using the Ultra-Premium Aloka Prosound F75
Hitachi system, equipped with S3 transducer under very strict COVID-19 protocols.
Standard 2D, M-mode, right ventricular global longitudinal strain, right ventricular free
wall longitudinal strain, and Doppler echocardiography in the parasternal and apical
views were recorded. Results: The population comprised 30 patients undergoing cardiac surgery for severe
mitral and or aortic valve surgery. The study’s results revealed that the mean age of
patients was 45.83 years with the majority being females (60%) and males at 40%.
The predominant aetiology of valve diseases was degenerative valve disease (43.3%),
and the most common valve disease was mitral regurgitation and aortic regurgitation,
respectively at 23.3%. Tricuspid valve replacement reduced tricuspid regurgitation
significantly, however, due to the small number of patients (n = 1) who progressed to
significant tricuspid regurgitation further analysis was not undertaken. All correlations
between tricuspid valve annulus, right ventricular systolic pressures and right
ventricular diameter 6 months post-op were significant with a p-value of < 0.001.
There were significant differences in left ventricular end-diastolic diameter (LVEDD)
[5.46 ±.867vs 5.11 ±.850, (p=0.027)] as well as ejection fraction (EF) [65.33 ± 11.902
vs 61.50 ± 15.543, (p=0.037)] 6 months post op. There was no significant global
longitudinal strain (GLS) change demonstrated in right ventricular function using
speckle tracking imaging [-5.02 ± 7.400 vs -6.07 ± 9.373, p>0.005). The study
demonstrated a significant decline in regional basal inferior septum (BIS) segments at
6 months follow-up [-9.67 ± 19.626 vs -4.86 ± 23.126 (p 0.034)]. The study also
demonstrated a significant decrease in right ventricular function measured with TAPSE
[23.20 ± 6.483 vs 19.182 ± 5.7738 (p<0.001) and FAC [60.63 ± 17.76 vs 41.33 ± 19.62
(p=0.18) 6 months post-op, with an immediate decline in mean measurements directly
(72 hours) after surgery, a slight gradual mean increase was noted at 6 months follow
up after surgery. A significant negative correlation was seen between RV dimensions
and TAPSE 6 months post-op. There was no correlation seen between EF and GLS
and TAPSE, LVEDD and GLS 72 hours post-op and again 6 months post-op (p >0.05).
Conclusion: The global and/or regional systolic RV function was appropriately
estimated using the 2D Doppler measurements and speckle tracking imaging.
Together, these echocardiographic parameters measurements allowed for an accurate
RV evaluation, improving disease diagnosis and management. Immediately following
surgery, a thorough examination that includes TAPSE, S', and RVFAC assessment
should be conducted. This examination should be repeated in three and six months to verify whether RV longitudinal function may have fully recovered and to enhance early management of RV failure.
Transition from inflation to dark energy in Superfluid Vacuum Theory
(MDPI AG, 2025-2-8) Zloshchastiev, Konstantin G.
The laminar constant-velocity super flow of a physical vacuum modelled by logarithmic quantum Bose liquid is considered. We demonstrate that this three-dimensional non-relativistic quantum flow generates a four-dimensional relativistic quinton system, which comprises the dilation and quintom (a combination of the quintessence and tachyonic phantom fields); all three fields are thus shown to be projections of the dynamical evolution of superfluid vacuum density and its fluctuations onto the measuring apparatus of a relativistic observer. The unified model describes the transition from the inflationary period in the early universe to the contemporary accelerating expansion of the universe, commonly referred to as the “dark energy” period. The quintessence and tachyonic scalar components of the derived model turn out to be non-minimally coupled, which is a hitherto unexplored generalization of cosmological phantom models.
Comparison of density matrix and state vector approaches to dissipative evolution of hyperfine levels coupled to optical and radio-frequency fields in the two-level approximation
(Informa UK Limited, 2024-12-14) Zloshchastiev, Konstantin G.
We consider a three-level atom interacting with two optical and one microwave fields in the adiabatic approximation resulting in a simplified description in the terms of a two-level system. Working within the reduced density operator framework, we assume this two-level system to be affected by two types of environment, described by some ad hoc non-Hermitian Hamiltonian and Gorini-Kossakowski-Sudarshan-Lindblad’s models. We compare the three types of dissipative evolution which can occur: driven by equations for a normalized density matrix, a non-normalized density matrix and a normalized state vector. Using the latter type, we derive an effective Hamiltonian, which encodes information about not only the Hamiltonian part of an original master equation but also its non-Hamiltonian (Liouvillian) part. The Hamiltonian turns out to be dependent on the wavefunction itself: the effects of above-mentioned environments induce, respectively, cubic and quintic nonlinear terms. For evolutions driven by density operators, we study various indicators of quantum purity. It is shown that if a trace of density operator is not conserved then conventional von Neumann entropy
can no longer be used as a purity indicator; therefore we introduce the purity-normalized definition of quantum statistical entropy.