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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.
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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.
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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.
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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.
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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.