ABSTRACT
Aim: This study aimed to evaluate whether changes in practice and patient behaviour due to the covid-19 pandemic impacted the presentation, management, and outcomes of patients with deep neck space infections (DNSI). Method: Retrospective cohort study including all adults presenting to the otolaryngology department at a tertiary UK centre with a DNSI during the first 12 months of the covid-19 pandemic (n = 27), and those from the previous 12-month period (n = 26). Patients with peritonsillar abscess which did not involve deep neck spaces radiologically were excluded. Results: The covid-19 pandemic cohort tended to present later after onset of symptoms (5.96 days vs 3.25 days, p = 0.0277), have abscess formation rather than inflammation only (77.8% vs 34.6%, p < 0.01), and develop complications (33.3% vs 7.7%, p = 0.0394). Not reaching statistical significance, the covid-19 pandemic cohort also had larger volume abscess (25.18cm3 vs 14.5cm3, p = 0.291), longer hospital stays (14.48 days vs 6.35 days, p = 0.114), and longer intensive care stay (7.88 days vs 1.78 days, p = 0.0992). Non-significant changes were noted in management, with the covid-19 pandemic cohort being seven times more likely to undergo tracheostomy (25.9% vs 3.8%, p = 0.0504), and more likely to undergo trans-cervical drainage (37% vs 19.2%, p = 0.224) and hot tonsillectomy (11.1% vs 0%, p = 0.236). Conclusion: This study demonstrates the covid-19 pandemic led to delayed presentation and more severe infection, requiring more radical management in patients with DNSI.
ABSTRACT
Acute land scarcity in Rwanda limits poor people's ability to accumulate and move out of poverty. Options for livelihood diversification are restricted by the absence of a vibrant and job-rich non-farm rural economy, and by high rural-urban inequality which makes the urban economy somewhat inaccessible, particularly given the regulated nature of the urban informal sector, limiting opportunities for migration. Competition for employment is made more challenging by low capabilities, which place high-return jobs beyond reach for many poor people. This paper relies on mixed methods research to explore a land-education-jobs nexus and identify the linked human capital and livelihood determinants of poverty escapes to understand the factors slowing poverty reduction in Rwanda. The quantitative analysis uses three waves of nationally representative panel data between 2010/11 and 2016/17 to investigate correlates of poverty trajectories. The qualitative analysis uses content analysis to explore life histories, focus group discussions and key informant interviews from 14 study sites to explore factors driving change in livelihoods and well-being. Our findings show that the triple challenges of acute land scarcity, low capabilities and a sluggish non-farm economy lock together to form a nexus which limits sustained poverty escapes. In the regression analysis, households headed by primary school graduates are half as likely to be poor as those headed by a primary school dropouts while secondary completion or higher virtually eliminates the risk of poverty. Despite demand, secondary school completion in the fieldwork is beyond the reach of most children from poor households, limiting their later options for livelihood diversification. Near landlessness constrains accumulation and Rwanda's thin rural non-farm economy provides few jobs or opportunities for self-employment. Rebooting poverty reduction in Rwanda particularly following the Covid-19 pandemic will require finding ways to sustain poverty escapes through fuelling job-rich 'growth from below' by generating additional demand in the rural economy, continuing to boost agricultural productivity and including even the poorest peasant farmers in that, creating a more conducive business environment for small enterprises and continuing to stimulate investment in job-rich enterprise. Underpinning these strategies should be strengthened efforts to enhance capabilities, education quality, and progression into secondary education.
ABSTRACT
After the unprecedented changes experienced in higher education due to the Covid-19 pandemic, there is a need to integrate initial thoughts and reflective experience to decide on the way forward. This study aimed to reflect on, and make sense of the events related to South African higher education institutions HEIs at the onset of the COVID-19 pandemic by using the Cynefin framework. Data from a rapid review of online media at the onset of the Covid-19 pandemic and a collaborative autoethnography session 1 year since lockdowns were implemented are used to present perspectives for the sense-making process. This offers insights to both ends of the spectrum as it highlights the evolution of processes taking place at multiple levels from government policies to institutional practices, as well as how this impacted on both staff and students. The Cynefin framework demonstrated sense-making efforts in the disordered, to the chaotic, to the complex, then to the complicated and eventually to the simple domain. Each domain ushered in its peculiarities and highlighted the issues ranging from vulnerabilities experienced in the higher education sector, to trying to reconfigure the academic year, to dealing with wicked problems, to eventually relying on expert assistance to navigate the virtual university space. Trying to establish causality in the simple domain proved challenging as the information available during the time was sparse. Despite these challenges, the lessons learnt include the importance of the sense-making process among all academic staff, the significance of collaboration and team efforts and the need to adapt leadership and self-leadership approaches to the changed ways of working in higher education institutions.