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Background: Targeted new-born hearing screening, based on high risk factors is recommended in the absence of universal new-born hearing screening in resource-constrained settings. The relevance of risk factors listed in the guidelines of high-income countries and used by low-middle income countries remains relatively unknown. Risk factors consistent with the epidemiological profile, evolution of risks and disease burden in these countries need to be considered. Objectives: This study aimed to profile the frequency of risk factors and their manifestation in hearing outcomes of young children in the KwaZulu-Natal province of South Africa. Method: A chart review of N = 1433 patients’ archival audiology records was conducted, conveniently sampled from a single tertiary hospital (n = 351), a provincial assessment and therapy centre (n = 649), a university clinic (n = 291), and two schools for the deaf (n = 142). Results: Overall, 56% of the participants presented with either a conductive, sensorineural or a mixed hearing loss; 62% of the children had between 1 and 2 risk factors present (Mean [M] = 1.1; standard deviation [s.d.] = 0.98). Admission to neonatal intensive care unit, maternal infections, bacterial and viral infections and chemotherapy, from the Joint Committee on Infant Hearing list of high risk factors were significantly associated with hearing loss (p 0.05). Known non-JCIH risks, emerging risks and other statistically significant contextually relevant risk factors were also noted. Conclusion: Understanding the profile of high risk factors in a given context has implications for prevention, early hearing identification and intervention services. Contribution: Targeted new-born hearing screening needs to be based on risk factors that are contextually relevant. This study is one of the first profiling high risk factors for hearing loss in children in KZN, the province with the second highest population in South Africa.

Background: The use of face masks and/or shields can pose a challenge during communication. They block facial expressions thus removing visual cues and affect sound transmission making it difficult to hear speech clearly. Given the widespread use of face coverings, it seems reasonable to clarify if communication in typical speakers and listeners has significantly differed. Health science students as future practitioners need to understand challenges that arise from using face coverings. Objective: This study aimed to determine health sciences students’ perception of the communicative impacts of face coverings. Method: The study employed a descriptive, self-administered online survey, obtaining information from 96 health science undergraduate students. Results: All participants changed their manner of speaking in that they spoke louder when wearing masks and focused more on eye contact when someone was wearing masks. These were statistically significant (p = 0.450 and p = 0.035 respectively). Fifty-three percent reported using more listening effort and feeling anxious when communicating. Approximately 33% indicated that it was challenging to read emotions, such as sad or unhappy, when someone wore a mask. Most, 61%, were positive or very positive about wearing masks. The level of difficulty differed depending on the listening environment. It was harder to understand the doctor, nurse, or other healthcare workers when they wore face coverings than when listening to their friends and family, which had little effect, this being statistically significant (p = 0.025). Conclusion: Challenges envisaged in practice included frequent communication breakdowns, inability to connect and build trust between patient and practitioner, and communicating in noisy environments. Coping strategies, future clinical and research implications were proposed, and limitations acknowledged.

Hardware Trojans in Integrated Circuits (ICs), that are inserted as hostile modifications in the design phase and/or the fabrication phase, are a security threat since the semiconductor manufacturing process is increasingly becoming globalized. These Trojans are devised to stay hidden during standard structural and functional testing procedures and only activate under pre-determined rare conditions (e.g., after a large number of clock cycles or the assertion of an improbable net). Once triggered, they can deliver malicious payloads (e.g., denial-of-service and information leakage attacks). Current literature identifies a collection of logic Trojans (both trigger circuits and payloads), but minimal research exists on memory Trojans despite their high feasibility. Emerging Non-Volatile Memories (NVMs), such as Resistive RAM (RRAM), have special properties such as non-volatility and gradual drift in bitcell resistance under a pulsing voltage input that make them prime targets to deploy hardware Trojans. In this paper, we present two delay-based and two voltage-based Trojan triggers using emerging NVM (ENTT) by utilizing RRAM’s resistance drift under a pulsing voltage input. Simulations show that ENTTs can be triggered by reading/writing to a specific memory address N times (N could be 2,500–3,500 or a different value for each ENTT design). Since the RRAM is non-volatile, address accesses can be intermittent and therefore stay undetected from system-level techniques that can identify continuous hammering as a possible security threat. We also present three reset techniques to de-activate the triggers. The resulting static/dynamic power overhead and maximum area overhead incurred by the proposed ENTTs are 104.24 μW/0.426 μW and 9.15 μm2, respectively in PTM 65 nm technology. ENTTs are effective against contemporary Trojan detection techniques and system level protocols. We also propose countermeasures to detect ENTT during the test phase and/or prevent fault-injection attacks during deployment.

Background: There is slow progress in early hearing detection and intervention (EHDI) services within South Africa. Audiologists are EHDI gatekeepers and can provide valuable insights into the barriers and facilitators that can progressively move EHDI towards best practice in South Africa. Objectives: The study aimed to determine the barriers and facilitators to EHDI in KwaZulu-Natal as reported by audiologists/speech therapists and audiologists (A/STAs). Method: A descriptive qualitative approach was used. Telephonic interviews were conducted with 12 A/STAs working in public and private healthcare facilities, using the strengths, weaknesses, opportunities, threats (SWOT) conceptual framework. Data was analysed using thematic analysis in conjunction with NVivo software. Results: One of the main barriers perceived by A/STAs, affecting EHDI was the lack of resources in healthcare facilities. The participants indicated that although there was a guideline in place to guide practice, it may be more suited to an urban area versus a rural area. Poor knowledge and awareness of EHDI was also identified as a barrier. Information provided from A/STAs at grassroots level, in the various provinces, may benefit in developing a more contextually relevant and practical guideline. Facilitators included; development of task teams specifically for EHDI programmes, creation of improved communication networks for collaboration and communication, training of healthcare professionals and improving data management systems. Conclusion: Strategies such as an increase in resources, further education and training, development of contextually relevant, culturally, and linguistically diverse practices and protocols need to be in place to improve EHDI implementation. Further research, clinical implications and limitations are provided emanating from the study.

Objectives To analyse the amount, reporting and handling of missing data, approach to intention-to-treat (ITT) principle application and sensitivity analysis utilisation in randomised clinical trials (RCTs) of rheumatoid arthritis (RA). To assess the trend in such reporting 10 years apart (2006 and 2016).Methods Parallel group drug therapy RA RCTs with a clinical primary endpoint.Results 176 studies enrolling a median of 160 (IQR 62–339) patients were eligible. In terms of actual analysis: 81 (46%) RCTs conducted ITT, 42 (23.9%) conducted modified ITT while 53 (30.1%) conducted non-ITT analysis. Only 58 of 97 (59.8%) RCTs reporting an ITT analysis actually performed it. The median (IQR) numbers of participants completing the trial and included in analysis for primary outcome were 86% (74%–91%) and 100% (97.1%–100%), respectively. 53 (32.7%) and 65 (40.1%) RCTs had >20% and 10%–20% missing primary outcome data, respectively. Missing data handling was unreported by 58 of 171 (33.9%) RCTs. When reported, vast majority used simple imputation methods. No significant trend towards improved reporting was seen between 2006 and 2016. Sensitivity analysis numerically improved from 2006 to 2016 (14.7% vs 21.4%).Conclusions There is significant discrepancy in the reported and the actual performed analysis in RA drug therapy RCTs. Nearly one-third of RCTs had >20% missing data. The reporting and methods of missing data handling remain inadequate with high usage of non-preferred simple imputation methods. Sensitivity analysis utilisation was low. No trend towards better missing data reporting and handling was seen.

Emerging Non-Volatile Memories (NVMs) such as Magnetic RAM (MRAM), Spin-Transfer Torque RAM (STTRAM), Phase Change Memory (PCM) and Resistive RAM (RRAM) are very promising due to their low (static) power operation, high scalability and high performance. However, these memories bring new threats to data security. In this paper, we investigate their vulnerability against Side Channel Attack (SCA). We assume that the adversary can monitor the supply current of the memory array consumed during read/write operations and recover the secret key of Advanced Encryption Standard (AES) execution. First, we show our analysis of simulation results. Then, we use commercial NVM chips to validate the analysis. We also investigate the effectiveness of encoding against SCA on emerging NVMs. Finally, we summarize two new flavors of NVMs that can be resilient against SCA. To the best of our knowledge, this is the first attempt to do a comprehensive study of SCA vulnerability of the majority of emerging NVM-based cache.

Background: Audiologists have a clinical and ethical responsibility to create a working environment, designed to reduce the potential for cross-contamination or transmission of infections. Objectives: To describe the infection prevention and control (IPC) measures utilised and the opinions of audiologists and speech therapists, and audiologists (A/STAs) towards IPC in public healthcare facilities in KwaZulu-Natal province, South Africa. Method: A quantitative, descriptive survey was utilised and entailed completing an online questionnaire. The Cronbach’s alpha (0.82) indicated good internal consistency of the tool. Forty-nine A/STAs from 29 public healthcare facilities responded. Results: Most participants (82%) followed a generic Department of Health policy on IPC, while 67% alluded to a discipline-specific policy. Participants had received training in infection control but indicated that further instruction was required for audiology-specific infection control procedures. Only 57% indicated that they ‘sometimes’ wore gloves with every patient during direct clinical contact. An association between the healthcare facility level and the wearing of gloves was found to be statistically significant (p = 0.025). Participants at regional and tertiary levels contended that gloves should be worn during most procedures versus those at district levels of care. While 96% washed their hands after each patient, only 76% washed their hands before each patient. Twenty-nine per cent indicated that they only ‘sometimes’ wore masks when in contact with patients with communicable diseases. Approximately one-third disinfected touch surfaces and toys, based on the clinician’s discretion. The majority (86%) of participants, however, always followed the correct protocol for medical waste disposal. Despite training and the availability of policies, some practitioners displayed poor IPC practices in terms of universal precautions, personal protective equipment, handwashing and sterilisation. Conclusion: Further education, training and awareness related to appropriate IPC measures are recommended for audiologists. It is envisaged that this will lead to more effective IPC measures in audiology practice thereby reducing the risk of infection transmission.

Background: Audiologists, globally, are generally challenged when assessing and creating intervention plans to help patients suffering from tinnitus. Tinnitus is very common among individuals and may significantly affect one’s quality of life, especially if not addressed by health care professionals. In South Africa, there seems to be limited published studies regarding the current practices of tinnitus management by audiologists. This is mainly because of limited training and a lack of guidelines and strategies for the management of tinnitus. In particular, some participants reported being unfamiliar on how to approach the identification of tinnitus and difficulty is also encountered when counselling tinnitus patients. Aim: The aim of this study was to describe the preparedness, perspectives and practices of audiologists who manage adult patients with tinnitus. Method: Two hundred and forty-three registered Health Professions Council of South Africa (HPCSA) participants were involved in the study by responding to an electronic questionnaire survey. Data were collected online from Survey Monkey and were exported to Statistical Packages for the Social Sciences (SPSS) (Version 23) for statistical analysis. Data were analysed using descriptive and inferential statistics. Closed-ended questions were analysed within a quantitative framework and thematic analysis for open-ended questions that were descriptively quantified. Results: The results of the study are presented according to the objectives. Approximately 44% of participants (44.3%) disagreed that the undergraduate university training had sufficiently prepared them to manage adult patients with tinnitus. Very few (12.3%) had the opportunity to attend specialist training on how to assess patients with tinnitus. Similarly, only 11.6% received any specialist training with regard to tinnitus intervention. With regard to its overall management, 49.4% felt adequately informed in the assessment of patients with tinnitus, while a further 39.2% rated their experience as being limited with regard to tinnitus intervention. There is no statistical significance relationship between participants’ years of experience and tinnitus intervention (p = 0.075). Most participants did not follow any standard guidelines for its management. Some participants (26.8%) reported that further education and training are required in the overall management of patients with tinnitus, while a further 17.7% required training in all areas of tinnitus. Conclusion: The feedback relating to the study suggests that overall management of tinnitus seems to be a challenge among South African audiologists, irrespective of their years of experience. Audiologists in the study perceived that tinnitus services are limited mainly because of a lack of or limited knowledge, training and guidelines, these being affected by contextual restraints.

We use commercial magnetic memory to realize morphable security primitives, a Physically Unclonable Function (PUF) and a True Random Number Generator (TRNG). The PUF realized by manipulating the write time and the TRNG is realized by tweaking the number of write pulses. Our analysis indicates that more than 75% bits in the PUF are unusable without any correction due to their inability to exhibit any randomness. We exploit temporal randomness of working columns to fix the unusable columns and write latency to fix the unusable rows during the enrollment. The intra-HD, inter-HD, energy, bandwidth and area of the proposed PUF are found to be 0, 46.25%, 0.14 pJ/bit, 0.34 Gbit/s and 0.385 μm2/bit (including peripherals) respectively. The proposed TRNG provides all possible outcomes with a standard deviation of 0.0062, correlation coefficient of 0.05 and an entropy of 0.95. The energy, bandwidth and area of the proposed TRNG is found to be 0.41 pJ/bit, 0.12 Gbit/s and 0.769 μm2/bit (including peripherals). The performance of the proposed TRNG has also been tested with NIST test suite. The proposed designs are compared with other magnetic PUFs and TRNGs from other literature.

Background: In South Africa, primary health care is the first point of contact with the health system for at least 85% of the population, yet early hearing detection and intervention continues to be elusive in these settings. Nurses at community level may, therefore, be missing an opportunity to identify prelingual infants with hearing losses and alter their developmental trajectory. Aim: To determine primary health care nurses’ experiences, practices and beliefs regarding hearing loss in infants. Setting: The study was conducted in the eThekwini District of KwaZulu-Natal, South Africa. Methods: A descriptive survey was used with quantitative methods of analysis. Fourteen primary health care clinics from the eThekwini district were selected, from which 75 nurses participated by completing a self-administered questionnaire. Results: At least one-third of primary health care nurses had never screened a child for hearing loss, and most clinics did not have access to basic hearing screening equipment or materials. Only 49% of nurses had access to an otoscope, while 31% used the Road to Health Development screener to check for hearing loss. None of the clinics had access to an otoacoustic emission screener nor the Swart questionnaire. Although nurses reported that they would refer to audiology services for some of the risk factors, as indicated on the Joint Committee on Infant Hearing (JCIH) 2007 list, they were less likely to refer if the child was in a neonatal intensive care unit (ICU) longer than five days, had neurodegenerative disorders, meningitis, hyperbilirubinaemia requiring blood transfusion or were undergoing chemotherapy. Less than a third of nurses always referred if the child displayed additional non-JCIH risk factors or those pertinent to the South African context. Approximately 38% reported that communities believed that hearing loss could be because of some form of spiritual or supernatural causes. Conclusion: This study demonstrates that hearing screening and referral practices at primary health care clinics need to be strengthened. Nurses need to be capacitated to conduct basic screening, make necessary referrals, provide information to caregivers and understand community beliefs about hearing loss in order to counsel caregivers appropriately and facilitate the process of early hearing detection and intervention.

The quartz stone available in different parts of Pakistan has never been studied before as precious mineral resource for acquiring Metallurgical Grade Silicon (MGS). During this research, quartz reserves of around 600 million metric ton (MMT) in different parts of Pakistan have been studied first and then in order to proceed mines of Jhangshahi, Sindh were selected where more than 150 MMT of proven quartz reserves are available. In this research samples of quartz stone from Jhangshahi, Sindh mines acquired for detail elemental analysis which proved presence of more than 95% Silicon Dioxide. This elemental analysis further strengthens the concept of MGS extraction from locally available quartz. During this research work, a comparatively less used technique of using magnesium element as reductant for MGS extraction is developed indigenously by using magnesium as reducing agent was developed. In order to validate the results of experiment, eight different experiments were performed around 950OC. After performing eight all the eight experiments, all extracted products were characterized by using Scanning Electron Microscope - Energy Dispersive X-Ray Spectroscopy (SEM-EDS) techniques. This technique validated the presence of around 95% of MGS in all the extracted products.

IntroductionComorbidities influence the prognosis, clinical outcomes, disease activity, and treatment response in rheumatoid arthritis (RA). RA patients have a high-comorbidity burden necessitating their study. Comorbidity indices are used to measure comorbidities and to study their impacts on different outcomes. A large number of such indices are used in clinical research. Some indices have been specifically developed in RA patients.AimThis review aims to provide an overview of generic and specific comorbidity indices commonly used in RA research.MethodsWe performed a critical literature review of comorbidity indices in RA using the PubMed database.Results/discussionThis non-systematic literature review provides an overview of generic and specific comorbidity indices commonly used in RA studies. Some of the older but commonly used comorbidity indices like the Charlson comorbidity index and the Elixhauser comorbidity measure were primarily developed to estimate mortality risk from comorbid diseases. They were not specifically developed for RA patients but have been widely used in rheumatology comorbidity measurement. Of the many comorbidity indices available, only the rheumatic disease comorbidity index (RDCI) and the multimorbidity index have been specifically developed in RA patients. The functional comorbidity index was developed to look at functional disability and has been used in RA patients considering that morbidity is more important than mortality in such patients. While there is limited data comparing these indices, available evidence seems to favor the use of RDCI as it predicts mortality, hospitalization, disability, and healthcare utilization. The choice of the index, however, depends on several factors such as the population under study, outcome of interest, and sources of data. More research is needed to study the RA-specific comorbidity measures to make evidence-based recommendations for the choice of a comorbidity measure.

Competitive pressure to maximize the current bibliometric measures of productivity is jeopardizing the integrity of the scientific literature. Efforts are underway to address the 'reproducibility crisis' by encouraging the use of more rigorous, confirmatory methods. However, as long as productivity continues to be defined by the number of discoveries scientists publish, the impact factor of the journals they publish in and the number of times their papers are cited, they will be reluctant to accept high quality methods and consistently conduct and publish confirmatory/replication studies. This exploratory study examined a sample of rigorous Phase II-IV clinical trials, including unpublished studies, to determine if more appropriate metrics and incentives can be developed. The results suggest that rigorous procedures will help reduce false positives, but to the extent that higher quality methods are accepted as the standard of practice, the current bibliometric incentives will discourage innovative studies and encourage scientists to shift their research to less informative studies of subjects that are already being more actively investigated. However, the results also suggest that it is possible to develop a more appropriate system of rewards. In contrast to the current bibliometric incentives, evaluations of the quality of the methods and reproducibility of the results, innovation and diversity of thought, and amount of information produced may serve as measures and incentives that maintain the integrity of the scientific literature and maximize scientific progress.

Self-ear cleaning is the insertion of objects into the ear canal to clean it, a widespread practice that has the potential to compromise its integrity as a natural, selfcleansing mechanism, and a risk factor for possible injuries. The practice is common among young adults and highest in university than any other graduates. This study aimed to determine the self-ear cleaning practices and associated risk of injury and related symptoms in undergraduate students at KwaZulu-Natal University. The descriptive survey utilized a self-administered questionnaire. Of the 206 participants that responded, 98% engaged in self-ear cleaning, with 75% indicating that it was beneficial. The commonest method (79.6%) being the use of cotton buds, with an associated injury rate of 2.4%. There was no statistically significant associations between those who used or did not use cotton buds and the symptoms experienced. The complications indicate that self-ear cleaning does pose a risk for injury, necessitating more community information and education.

The aim of the paper is to describe the knowledge of mothers in Durban, South Africa, regarding risk factors of hearing loss in infants and their awareness of audiology services, and to describe their cultural beliefs about the risk factors for hearing loss in infants. A descriptive survey design with quantitative methods of analysis were used. Conveniently sampled mothers (n=102) receiving postnatal care for their infants from eight provincial clinics within Durban consented to participate, yielding a response rate of 48%. A questionnaire was used to collect the data and the Cronbach α was calculated yielding a score of 0.835, indicating good internal consistency and reliability of the questionnaire. Sixty percent of the mothers were aware of risk factors, such as middle ear infections, ototoxic medication and consumption of alcohol during pregnancy. Seventy percent were unaware that NICU/mechanical ventilation for more than 5 days, prematurity, rubella and jaundice are considered risk factors for hearing loss, implying a need to create awareness amongst mothers regarding such risk factors. Sixty percent (n=62) believed that bewitchment and ancestral curses can cause hearing loss. Cultural beliefs were associated with hearing loss, therefore, health professionals need to demonstrate cultural competence when providing audiology services, especially in a culturally and linguistically diverse countries such as South Africa. Although the mothers had an average knowledge about risk factors, two thirds did not know which professional to seek help from. There is a need to create awareness amongst mothers regarding the risk factors of infant hearing loss as well as audiology services in order to facilitate early detection and intervention. There is a need for health professionals to demonstrate cultural competence when working with their patients.