Rockingham Community College

ABSTRACT The forests of South Africa and the neighbouring countries, including Lesotho, eSwatini, Namibia, Botswana, Zimbabwe, and Mozambique (south of the Zambezi River), were mapped and classified according to the global system of biomes. The new four-tier hierarchical biome system suggested in this paper includes zonobiome, global biome, continental biome (all recognised earlier), and regional biome – a novel biome category. The existing spatial coverages of the forests were revised and considerably improved, both in terms of forest-patch coverage and mapping precision. Southern Africa is home to three zonal forest types, namely Subtropical Forests (Zonobiome I), Tropical Dry Forest (TDF; Zonobiome II) and Afrotemperate Forests (Zonobiome X). These three biomes are characterised by unique bioclimatic envelopes. Five, two, and eight regional biomes, respectively, have been recognised within these zonal biomes. Recognition of the Zonobiome I and the global biome Tropical Dry Forests in southern Africa is novel and expands our knowledge of the biome structure of African biotic communities. The system of the azonal regional biomes is also new and comprehensively covers the variability of the azonal helobiomes (riparian woodlands and swamp forests), mangroves, and azonal coastal forests. In total, 11 azonal regional biomes have been recognised in the study area. The forest biomes in southern Africa were captured in our electronic map in the form of more than 60 000 polygons, covering 42 416 km2 (1.27% of the study area). No less than 83% of these forests occur in the territory of southern Mozambique. Abbreviations: for the abbreviation of the biome units, see Table 1; CE: centre of endemism; IOCB: Indian Ocean Coastal Belt; MBSA: the area of the Map of Biomes of Southern Africa; VegMap2006 and VegMap2018: Vegetation Map of South Africa, Lesotho and Swaziland (as released in respective years); for the meaning of the codes of the biome units see Table 1, and for the meaning of the abbreviations of climatic characteristics see Appendix S1

Abstract Background:Outpatient clinics play a vital role in assessing and treating patients. They traditionally involve face-to-face consultation with a clinician to diagnose and treat many medical and surgical conditions. During the COVID-19 pandemic many of these traditional methods were replaced with telemedicine to minimise patient interaction and therefore potential exposure. This study utilises data from patient questionnaires with the aim of determining patient satisfaction in regard to telemedicine.Method:A list of patients who attended the Rockingham General hospital outpatient Orthopaedic phone clinic was obtained between 23rd of March and 30th of May, this list was then filtered into a randomised generator to provide a call list of patients. Patients were contacted and verbal consent was obtained to participate in satisfaction questionnaire that was completed via phone.Results: A total of 100 patients completed the questionnaire - 50 from elective surgery clinics and 50 from fracture clinics. The mean time for participants’ one-way commute to the hospital was 21 minutes (2 to 60 minutes). Only 4% of telehealth consultations resulted in patients being forced to miss work or school. 13% of patients were required to attend the hospital on the day of their consultation for either radiological imaging or for application or removal of casts or splint. We observed consistently high satisfaction scores across all parameters, in both elective and fracture clinics, culminating in a mean score of 9.08/10 on the Likert scale. In the qualitative component of the questionnaire, patients frequently acknowledged a high quality of care despite adverse circumstances.Conclusion:Telemedicine continues to develop and become a more widely accessible tool in the provision of outpatient orthopaedic care. With its ever-increasing availability and acceptance, it should play a more central role in delivering effective and efficient healthcare to all patients.

Psychotropic medication use occurs in 8% of pregnancies, with rates increasing, and often multiple medications prescribed. This study aims to determine if the use of psychotropic medication, in a cohort of women with severe mental illness, increases rates of special care nursery admission and reports differences between antidepressant and antipsychotic medication use either alone or in combination. A retrospective database analysis from a cohort with severe mental illness in pregnancy identified 268 pregnant women who were grouped according to medication type. Demographic, obstetric and neonatal variables were analysed using t-tests, χ2 , analysis of variance and logistic regression analysis for special care nursery admission. The medication groups consisted of: women taking no psychotropic medications (n=67); those taking antipsychotics (n=87); those taking antidepressants (n=55); those taking and a combination of antidepressants/antipsychotics (n=59). Rates of special care nursery admission in women who took psychotropic medication (41.3%) were elevated compared to those who did not (26.9%) (P=0.035), and were significantly raised when compared to the general population (P<0.000). No significant difference occurred between the medication groups. A significant adjusted odds ratio of 2.79 (95% CI 1.286-6.049) was found for special care nursery and psychiatric admission during pregnancy but not for psychotropic medication. Rates of special care nursery admission are elevated in neonates of women with severe mental illness taking psychotropic medication, but were not different for monotherapy or polytherapy when prescribing antidepressants or antipsychotic medication. Additional vulnerability occurs in the neonates of women with a mental illness and paediatric presence at delivery isrecommended.

The poor physical health of people with a severe mental illness is well documented and health professionals' attitudes, knowledge and skills are identified factors that impact on clients' access to care for their physical health needs. An evaluation was conducted to determine: (i) mental health nurses' attitudes and beliefs about providing physical health care; and, (ii) the effect that participant demographics may have on attitudes to providing physical health care. It was hypothesized that workplace culture would have the largest effect on attitudes. Nurses at three health services completed the "Mental health nurses' attitude towards the physical health care of people with severe and enduring mental illness survey" developed by Robson and Haddad (2012). The 28-item survey measured: nurses' attitudes, confidence, identified barriers to providing care and attitudes towards clients smoking cigarettes. The findings demonstrated that workplace culture did influence the level of physical health care provided to clients. However, at the individual level, nurses remain divided and uncertain where their responsibilities lie. Nursing leadership can have a significant impact on improving clients' physical health outcomes. Education is required to raise awareness of the need to reduce cigarette smoking in this client population.

The Tactics Development Framework (TDF) is a tactics modelling application that extends the Prometheus Design Tool with tactics design patterns, plan diagrams, a mission concept, and richer goal hierarchies.

I am writing to express support for the editorial titled "Avoiding the Critical Care Nursing Brain Drain"1 The brain drain can be limited with the implementation of greater incentives for nurses who strive to obtain a higher level of education.I am currently studying for my baccalaureate degree in nursing. After participating in several class discussions, I have noticed there is a common opinion that baccalaureate- or higher-level nursing education is a gateway to new roles that are distanced from bedside nursing. Such roles include, but are not limited to, division management and discharge planning. Your editorial reinforces the importance of highly educated nurses continuing in the clinical setting in order to influence professional nursing practice in critical care.As a critical care nurse, I have collaborated with nurses of every educational and skill level. I am writing to advocate for an increase in the proportion of highly educated nurses at the bedside, especially in critical care areas. The point that "more education improves practice, but does not devalue those who do not yet have a baccalaureate degree"1 specifically hit home with me. I entered critical care nursing with an associate degree and my role as a staff nurse has evolved into charge nurse and preceptor.This editorial has given me a new perspective on furthering my education. It has opened my eyes to the importance of using my baccalaureate degree as a means to improve patient outcomes while remaining at the bedside. Additional education will allow me to enhance my technical skills.Hospitals should provide greater incentives that encourage nurses with higher levels of education to remain in direct patient care. Currently, the only incentives for obtaining a higher degree are nursing roles that require pulling away from the bedside.Thank you for writing this editorial. I have an enriched attitude toward furthering my education and believe nurses should continuously seek opportunity to become better-rounded. Our evolving health care system makes it imperative that a higher proportion of nurses with more than technical skills are at the bedside. If hospitals improve incentives for nurses to obtain higher levels of education, there will be less of a "brain drain."