Closest Facility Research Articles

Пандемия коронавируса как фактор трансформационных процессов в городской креативной среде(по результатам социологического исследования)

The article reveals the specifics of transformational processes in the urban creative environment of modern Russian society in the context of the coronavirus pandemic. The results of a sociological study (method of expert interviews) conducted in 2021 in Saratov as an empirical basis were used. The purpose of this paper is to present the assessment of the various experts who are respondents in this study regarding the pandemic factor of changes in the creative space of a typical Russian city. Almost opposite assessments were revealed regarding the nature of the impact of the coronavirus pandemic on the urban creative environment as a whole and its individual components. The respondents point out both the negative aspects (for example, a sharp decrease in the volume of client flow in the creative industry of the city, the closure of individual creative facilities and projects), and the positive aspects (the prompt introduction of modern formats for the work of objects in the creative sphere, the creation of new creative projects) of the influence of the phenomenon under consideration. In general, the experts admit that most of the subjects of the urban creative space have somehow adapted to the new, unprecedented conditions and challenges of the external environment, and some of them even received additional opportunities for development. The creative space of the Russian city as a whole demonstrated its stability, flexibility and adaptability and constructive response to challenges. But due to the importance of the creative environment as a factor of improving the quality of life of the population, the state support is needed. The results of the study can be used as the basis for management activities to develop and support the urban creative environment of modern Russian society in difficult socio-economic conditions.

Kentucky's abortion landscape, 2010 to 2019: an analysis of pre-Dobbs abortion disparities in a rural, restrictive state

Since 2010, many US states have passed laws restricting abortion providers' ability to provide care. Such legislation has no demonstrated health benefits and creates inequitable barriers for patients. To examine how Kentucky's abortion policies coincided with facility closures and abortion utilisation, we conducted a review of state abortion policies from 2010 to 2019 using newspapers and websites. We calculated abortion rates (abortions per 1000 women ages 15-44) by state of residence and provision for Kentucky, the South, and the US using data from the CDC and Kentucky Department of Health. We calculated percentages leaving and from out-of-state, and analysed abortions by race, pregnancy duration, and method. Of 17 policies passed between 2010 and 2019, ten were enacted, including 20-week and telemedicine bans. One of Kentucky's two abortion facilities closed in 2017. The pooled average abortion rate in Kentucky (4.1) and for Kentuckians (5.8) was lower than national averages (11.8 and 11.1). An average of 38% of Kentuckians left their state for care, compared to 7% nationally. In 2019, the abortion rate in Kentucky was 5.8 times higher for Black patients than White patients (compared to 4.8 times nationally). The majority (62%) of abortions in Kentucky took place at 7-13 weeks' gestation. Abortions in Kentucky were less frequent than in the South and US. The larger Black-White abortion rate gap reflects race- and class-based structural inequities in healthcare. Without federal protections, abortion access in Kentucky will continue waning. This study was supported by a philanthropic foundation that makes grants anonymously.

Resiliency within the Socio-Ecological System of a Large Food Bank Network: Preparing, mitigating, responding, and recovering from Hurricane Florence

The network of a food bank consists of a complex web of entities. The entities may include the warehouses and charitable agencies. A food bank relies on the smooth interactions among these entities in distributing the donated food to the food-insecure population. In this study, we theorize that these entities and their complex interactions form a Socio-ecological System (SES). However, such an SES is vulnerable to disruptions, i.e., Hurricanes. We explore the behavior of the SES of our partner food bank, the Food Bank of Central and Eastern North Carolina (FBCENC), during Hurricane Florence, one of the deadliest hurricanes in the Carolinas. Specifically, we adopt a mixed-method research design to study the preparedness, mitigation, response, and recovery of the FBCENC SES over the lifecycle of Hurricane Florence. The design consists of quantitative methods (descriptive and statistical analyses), and qualitative methods (focus groups and semi-structured interviews). Our analysis reveals the preparation of the entities in terms of food flow within the SES, the impact of Hurricane Florence in terms of facility closure and inaccessibility, and the mitigation and response (studied together as “incidence”) of the entities through elevated activities, i.e, increase in received donations and distributions of relief items. Moreover, our analysis also reveals how the SES recovered through cooperation among the entities empowered by social capital. We also observe that new entities and connections were formed to recover from Hurricane Florence, providing a glimpse of how the FBCENC SES has been ”Built-Back-Better” after the hurricane.

SG-APSIC1200: Infection prevention control along the fast track: Supporting the construction, operation, and closure of a COVID-19 community treatment facility in an F1 Pit

Objectives: The infection prevention team (IPT) was tasked with providing technical guidance for the construction and setup of a community treatment facility in 3 weeks at a Formula 1 (F1) racing pit to house elderly SARS-CoV-2–positive cases. Methods: The facility was setup with 737 beds including an isolation unit and a resuscitation bay. The multidisciplinary team decided on zone segregation (ie, green and hot zones) and discussed the clean–dirty workflow. IPC measures were revisited, especially regarding the layout of the donning and doffing station, as the facility expanded to accommodate patients with more comorbidities and those who needed dialysis. IPC training for nominated infection control liaison officers (ICLOs) was conducted using a “train the trainer” approach for mask fitting, hand hygiene, donning and doffing of personal protective equipment (PPE). Enhanced IPC measures, including weekly audit and staff surveillance, were mandatory, and monitoring was performed according to MOH guidelines. Linen and waste management and the cleaning and disinfection process were established at the beginning of the project. Results: Construction was completed within 3 weeks. The setup was completed in November 2021 for 737 beds. There were 758 admissions during the 4-month operation. In total, 12 trained ICLOs oversaw the training of 200 healthcare workers. They conducted 12 IPC audits and provided feedback to all staff. Compliance with PPE practices was inconsistent, and findings were shared during daily after-action reviews for improvement. The greatest challenges were converting the F1 facility to a healthcare facility, training staff with no IPC knowledge, and monitoring IPC on the ground. The trained ICLOs were successful in implementing, practicing, and monitoring IPC measures with minimal assistance from the infection prevention team. Conclusions: Operation began on November 5, 2021, and ceased on March 9, 2022. The community treatment facility construction, setup, and operations were completed within a short timeframe due to the efforts of various stakeholders. We faced many challenges, but we managed to implement and uphold IPC standards from beginning to end.

Measuring Accessibility to Health Care Centers in the City of Al-Mafraq Using Geographic Information Systems

This study aims at measuring, analyzing, and evaluating accessibility to health care centers in the city of Al-Mafraq in order to determine their distribution efficiency and their spatial suitability for residential neighborhoods in the city using geographic information systems. It also aims at analyzing the geographical characteristics of the health centers locations in the city and determine their service ranges at the level of the residential neighborhoods in the city (Service Areas, Closest Facility, Location-Allocation, Multiple Ring Buffers). The study found that there is a significant difference and disparity in the ease of access to the health centers in the city of Mafraq. Most of the residential neighborhoods on the outskirts of the city suffer from difficult accessibility to the health centers such as the Industrial City, King Abdullah, Prince Hamzah and Al-Mazzeh neighborhoods in the south; and, Al-Nasr and Al-Jundi neighborhoods in the north. The study also found that the locations of Al-Hussein neighborhood health center and the Southern neighborhood health center were the easiest to reach compared to the other health centers in the city based on the distance and time factors. This research contributes to a better understanding of the geographical accessibility of the population to health care center, helping to identify polarization trends. The results obtained can help decision-makers develop urban planning strategies and optimize investments in health care infrastructure. Future studies will consider the use of other means of transport and other time slots.

Production optimization in the time of pandemic: an SIS-based optimal control model with protection effort and cost minimization.

The COVID-19 pandemic wreaks havoc in supply chains by reducing the production capacity of some essential suppliers, closure of production facilities or the absence of infected workers. In this paper, we present three decision support models for a plant manager to help in deciding on (a) the level of protection of the workforce against the spread of the virus in the absence of regional protection measures, (b) on the duration of the protection, and (c) the level of protection of the workforce with regional protection measures enforced by health authorities. These decision models are based on a SIS epidemiological model which takes into account the possibility that a worker can infect others but also that even when recovered can be infected again. The first and third models prescribe how, in time, the protection effort in terms of prophylactic measures must be deployed. The second model extends the first one as it also determines the length the protection effort must be deployed. The proposed models have been applied to the case of a meat processing plant that must satisfy the demand of a large-scale retailer. Clearly, to achieve production targets and satisfy customers' demand, plants in this labor-intensive industry rely on the number of healthy workers and the service level of suppliers. Our results indicate that these models provide managers with the tools to understand and measure the impact of an infection on production and the corresponding cost. Along the way, this work illustrates the ripple effect as suppliers affected by the pandemic are unable to fulfill the processing plant requirements and so the retailer's orders. Our findings provide normative guidance for supply chain decision support systems under risk of pandemic induced disruptions using a quantitative model-based approach.

Care of the Hospitalized Patients with Kidney Failure during COVID-19 Pandemic: Lessons Learned.

Care of the Hospitalized Patients with Kidney Failure during COVID-19 Pandemic: Lessons Learned.

The Impact of the Deterioration on Wood by Chlorine: An Experimental Study.

The use of disinfection and cleaning chemicals in several municipal facilities, such as swimming pools and drinking water treatment plants, causes the degradation of various types of wood, which leads to failures in equipment and the corresponding need for maintenance. This degradation creates added costs for municipalities, as well as the closure of certain facilities due to curative or preventive maintenance and, in many cases, public health issues, due to the water being contaminated with deteriorating products. Through a thorough study of the degradation effect on the products, more resistant materials can be found which are able to withstand these adversities and increase the lifespan of wood in regular contact with chemical agents. This is achievable by the determination of the cost-effectiveness of the substitute material to replace these components with alternative ones, with properties that better resist the deterioration effects promoted by aggressive environments. No studies have been found so far strictly focused on this matter. The objective of this study is to evaluate the degradation presented by two types of wood, beech and oak, which are exposed to the action of chlorine in municipal facilities. This degradation varies according to the chlorine content and the materials' time of contact with the chemical agent, allowing the selection of new materials which will provide an extended lifetime of the components, reducing maintenance drastically, as well as costs for the facilities and the risk to public health. The performed experimental tests have shown that the oak wood has the best results regarding chlorine degradation resistance.

Cardiorespiratory fitness levels and body mass index of pre-adolescent children and older adults during the COVID-19 pandemic.

The social and behavioral effects of the COVID-19 pandemic have impacted the health and physiology of most people, including those never diagnosed with COVID-19. While the impact of the pandemic has been felt across the lifespan, its effects on cardiorespiratory fitness (commonly considered a reflection of total body health) of older adults and children may be particularly profound due to social distancing and stay-at-home advisories, as well as the closure of sport facilities and non-essential businesses. The objective of this investigation was to leverage baseline data from two ongoing clinical trials to determine if cardiorespiratory fitness and body mass index were different during COVID-19 relative to before COVID-19 in older adults and children. Healthy older individuals (N = 593; 65-80 years) and 200 typically developing children (8-10 years) completed a graded maximal exercise test and had their height and weight measured. Results revealed that older adults and children tested during COVID-19 had significantly lower cardiorespiratory fitness levels than those tested before COVID-19 shutdowns (older adults: 30% lower; children: 53% lower; p's ≤ 0.001). In addition, older adults and children tested during COVID-19 had significantly higher BMI (older adults: 31.34 ± 0.57 kg/m2, p = 0.004; children: 19.27 ± 0.44 kg/m2, p = 0.05) than those tested before COVID-19 shutdowns (older adults: 29.51 ± 0.26 kg/m2, children: 18.13 ± 0.35 kg/m2). However, these differences in BMI did not remain significant when controlling for cardiorespiratory fitness. Results from this investigation indicate that the COVID-19 pandemic, and behavior changes taken to reduce potential exposure, may have led to lower cardiorespiratory fitness levels in older adults and children, as well as higher body mass index. These findings provide relevant public health information as lower cardiorespiratory fitness levels and higher body mass indexes recorded during the pandemic could have far-reaching and protracted health consequences. Public health guidance is needed to encourage physical activity to maintain cardiorespiratory fitness and healthy body composition. Older adults: https://clinicaltrials.gov/ct2/show/NCT02875301, identifier: NCT02875301; Children: https://clinicaltrials.gov/ct2/show/NCT03592238, identifier: NCT03592238.

The US Supreme Court and Future of Financing Dialysis Care.

The US Supreme Court and Future of Financing Dialysis Care.

Health Research and Education during and after the COVID-19 Pandemic: An Australian Clinician and Researcher Perspective.

Introduction: The COVID-19 pandemic had an unprecedented global effect on teaching and education. This review discusses research, education and diagnostics from the perspectives of four academic clinicians and researchers across different facilities in Australia. Materials and methods: The study adopted a literature review and an Australian researcher's perspective on the impact of the COVID-19 pandemic on health education, research and diagnostics. Results: At the start of the pandemic, medical facilities had to adhere urgently to major work restrictions, including social distancing, mask-wearing rules and/or the closure of facilities to protect staff, students and patients from the risk of COVID-19 infection. Telemedicine and telehealth services were rapidly implemented and adapted to meet the needs of medical education, the teaching of students, trainee doctors, nursing and allied health staff and became a widely accepted norm. The impact on clinical research and education saw the closure of clinical trials and the implementation of new methods in the conducting of trials, including electronic consents, remote patient assessments and the ability to commence fully virtual clinical trials. Academic teaching adapted augmented reality and competency-based teaching to become important new modes of education delivery. Diagnostic services also required new policies and procedures to ensure the safety of personnel. Conclusions: As a by-product of the COVID-19 pandemic, traditional, face-to-face learning and clinical research were converted into online formats. An hybrid environment of traditional methods and novel technological tools has emerged in readiness for future pandemics that allows for virtual learning with concurrent recognition of the need to provide for interpersonal interactions.

Introduction to the special issue on mobility, climate change, and economic inequality

Introduction to the special issue on mobility, climate change, and economic inequality

Pharmacy Deserts and Pharmacies' Roles Post-Extreme Weather and Climate Events in the United States: A Scoping Review.

The effects of climate change are seen with a rise of extreme weather and climate events (EWCEs) which lead to the closures of many healthcare facilities, such as community pharmacies. Pharmacists in community pharmacies are seen as the most accessible healthcare professional to the public and are responsible for the continued delivery of care to patients. However, amid closures due to EWCEs and the emergence of pharmacy deserts, there is decreased access to pharmacies and a disruption of care. It is important to address the preparedness and accessibility of pharmacies post-EWCEs to guide future research and policy. Additionally, to tackle health disparities that arise due to pharmacy deserts, the populations most affected by a decreased access to pharmacies should be identified. We conducted a scoping review to assess the preparedness and accessibility of pharmacies post-EWCEs and to identify populations most affected by pharmacy deserts. We searched PubMed, Embase, and Web of Science from January 1, 2012 to September 30, 2022 and included all English-language, peer-reviewed primary literature that examined the preparedness and accessibility of community pharmacies in the United States post-EWCEs and addressed disparities within pharmacy deserts. Studies meeting these criteria were screened of their titles and abstracts by the first author and discrepancies were resolved with co-authors. We used Covidence for data extraction. A total of 472 studies were identified (196 duplicates removed) and after screening, 53 studies were assessed for eligibility. The results of included publications (N = 26) showed that pharmacists and pharmacies are not equipped with the necessary emergency protocols which could lead to decreased access of pharmacies in the wake of EWCEs. Pharmacy deserts disproportionately affect residents living in rural, lower income, and Black/African American and Hispanic/Latino neighborhoods. The lack of preparedness of pharmacies post-EWCEs could worsen medication access. This scoping review addresses challenges impacting pharmacies and patients post-EWCEs and within pharmacy deserts. In times of increased need, these challenges implicate the well-being of communities affected by EWCEs by breaking the continuum of care and access to medications. Here we offer suggestions for future research and directions for policy change.

Realizacja prawa pacjenta do świadczeń zdrowotnych w czasie pandemii COVID-19

With the outbreak of the COVID-19 pandemic, Polish public authorities faced the difficult task of preventing the spread of the coronavirus, providing medical assistance to infected people and securing the health needs of the rest of the population. The measures taken by the public authorities involved the need to introduce numerous restrictions on human and civil liberties and rights, including those of the patient. One of the patient's rights whose realization during the COVID-19 pandemic was hampered and sometimes even impossible is the patient's right to health services. Restrictions on the availability of health services were mainly due to the cancellation of scheduled appointments and procedures, the suspension of patient admissions to some hospital wards and the designation of selected hospital wards or entire hospitals exclusively for patients infected or suspected of being infected with coronavirus. The solution for providing health care services despite the closure of numerous medical facilities was to switch to a system of teleportation as the primary form of performing outpatient treatment. Unfortunately, such a measure did not significantly improve access to health care, especially for the elderly, the deaf and hard of hearing, and often the blind. The patient's right to health care services has been the most frequently violated right for years, and the COVID-19 pandemic has demonstrated this even more clearly. However, improving this state of affairs requires reforms to the entire health care system, including measures to address staffing, financial and premises problems.

Spectrum of Population Availing COVID-19 Teleconsultation Services during COVID-19 Pandemic: A Cross-Sectional Study in a Tertiary Care Center of Eastern India.

The COVID-19 pandemic has created a defining situation globally, and the outpatient services were also affected due to the closure of many healthcare facilities. The study was conducted to know the spectrum of the population availing teleconsultation and their needs for consultation. A cross-sectional study conducted in AIIMS Bhubaneswar, India, from May 2021 to June 2021in which the beneficiaries availing of the COVID-19 teleconsultation service were taken as study was participants and a total of 423 participants participated in the study. The proportion of participants who availed of the services in the age group 20-39 years was 67.8%. The participants from the urban area were 81%. Very few or almost nil participation were observed in the category of semiskilled, unskilled, and unemployed occupations. The reasons for availing of teleconsultation services were, for the treatment of COVID-19 disease (45%), distressed consultation for the medication (21%), and seeking advice for testing (13%), related to COVID-19 vaccination (6%) and 9% consulted to know the prognosis of the disease. Steps should be taken to expand the teleconsultation services to the underserved rural community and the people with lower educational status.

СОЦИАЛЬНО-ЭКОНОМИЧЕСКАЯ ПОЛИТИКА ПО ЗАКРЕПЛЕНИЮ МОЛОДЕЖИ НА СЕЛЕ В РЕСПУБЛИКЕ ТАТАРСТАН

Young people represent a huge resource of Russian society and opportunities for the development of regions, rural areas and the country as a whole. With the help of youth and state policy, it is possible to increase the social, economic and cultural level of rural development. The study of the youth environment contributes to the development of an effective social policy of the state in relation to young people. The study of the factors of migration of rural youth is an urgent aspect today, because these reasons are the guiding changes in adaptation strategies that young people seek to reduce. The negative factors affecting the migration of rural youth in Russia are the closure of agricultural production, the closure of social infrastructure facilities, which is accompanied by unemployment and the degradation of the younger generation in rural areas. Such trends pose a serious security threat for some regions and the country as a whole.

ПЛАЦДАРМ «БОЛЬШОЙ НЕФТИ»: ПЕРВЫЙ ПОСЁЛОК ГЕОЛОГОРАЗВЕДЧИКОВ В СУРГУТЕ

The article considers the process of formation of the first settlement of prospectors who arrived in Surgut in 1957 to organize oil exploration. Special attention is paid to the creation of industrial and settlement infrastructure based on the memoirs of “shadow actors” collected by the author – direct participants in the events, newspaper publications and archival materials. The importance of the first settlement of geologists is noted as the main springboard for future geological exploration in one of the promising oil areas of the Middle Ob region. The author notes that the infrastructure of the exploration village was compactly created in close proximity to the main life support facilities of the Surgut district center. This circumstance made it possible to compensate for the difficulties that arose as a result of the unsettled nature of geologists. A positive aspect was the proximity of the village to the main transport hub – the Ob River. This ensured the successful construction of transport logistics with other settlements in the region and the main base of the expedition, located in Novosibirsk. This circumstance in subsequent years made it possible to organize oil prospecting operations in the districts adjacent to Surgut, where separate parties of geologists were located. The bridgehead of the Surgut oil exploration expedition became the main resource center, where the material and technical arsenal for the rest of the geological units of the region, required for the search and discovery of the first oil fields, was accumulated and distributed.

Meta-Analysis the Effects of Education, Pregnancy Planning, Husband Support, and Distance to Health Facilities on the Utilization of Antenatal Care Service

Background: Antenatal care (ANC) is comprehensive and quality antenatal care provided to pregnant women in the form of antenatal checks to prevent causes of morbidity and mortality in pregnant women and children. The decrease in the number of visits of pregnant women to health facilities has resulted in high maternal mortality due to complications of pregnancy and childbirth. This study aimed to analyze the effect of education, pregnancy planning, husband's support, and distance to health facilities on the utilization of ANC. Subjects and Method: This was a meta-analysis. Population was pregnant women. Intervention: higher education, planned pregnancies, strong husband support, and distance to close facilities. Comparison: low education, unplanned pregnancies, weak spousal support, and long distances to facilities. Outcome: utilization of ANC. The articles used were obtained from Google Scholar, BMC Pregnancy and Childbirth, PubMed, and Science Direct. The keywords used “Antenatal Care” AND “Utilization of ANC” AND “Husband Support and ANC”. The articles used were full text in English from 2009 to 2022. Articles were selected using the PRISMA diagram and analyzed using the Review Manager 5.3 application. Results: 14 cross-sectional studies showed that mothers with higher education (aOR=2.93; 95% CI=1.93 to 4.45; p=0.001); planned pregnancy (aOR= 1.99; 95% CI= 1.26 to 3.15; p=0.003); had husband support (aOR=2.89; 95% CI= 1.23 to 6.81; p=0.020); and closer distance to health facilities (aOR=3.07; 95% CI=1.43 to 6.55; p=0.003) had high and significant posibility to utilize ANC. Conclusion: Higher education, pregnancy planning, husband's support, and proximity to health facilities influence the utilization of antenatal care. Keywords: antenatal care, pregnant women, morbidity.

Mental health of working parents during the COVID-19 pandemic: can resilience buffer the impact of psychosocial work stress on depressive symptoms?

BackgroundThe COVID-19 pandemic has confronted working parents with an accumulation of stressors regarding changes in work, family, and social life, putting their mental health at risk. Stressors include altered working conditions such as working from home or changes in working hours as well as the difficulty to reconcile work and childcare due to the closure of childcare facilities. The present study examined the relationship of psychosocial work stress (i.e., work-privacy conflict and effort-reward imbalance at work) and depressive symptoms in working parents and whether this association was moderated by individual resilience.MethodsData of the present study (n = 452) were collected in Germany between May and June 2020 as part of the DREAMCORONA study. A subsample of working mothers (n = 191) and fathers (n = 261) completed the subscale for work-privacy conflict (WPC) of the Copenhagen Psychosocial Questionnaire, the Effort-Reward Imbalance (ERI) Questionnaire, the Connor-Davidson Resilience Scale (CD-RISC), and the Edinburgh Postnatal Depression Scale (EPDS). Multiple linear regression analyses including moderation were performed, controlling for gender, working hours per week, and a lifetime history of depression as potential confounders.ResultsBoth WPC (β = 0.336, p < .001) and ERI (β = 0.254, p < .001) were significantly associated with depressive symptoms. Resilience moderated the relationship between ERI and depressive symptoms (β = − 0.101, p = .018), indicating that higher resilience weakened the relationship. However, this effect was not found regarding the relationship between WPC and depressive symptoms (β = 0.055, p = .167).ConclusionsThe results highlight the need for measures to reduce psychosocial work stressors such as WPC and ERI during the COVID-19 pandemic on the one hand and to promote resilience on the other hand. The findings partially support the potential protective role of resilience buffering the association between psychosocial stress and mental health in working parents. Longitudinal studies are needed to confirm this effect.

Impact of COVID-19 on Self-Directed Learning: Perspectives of Rural English First Additional Language Teachers

Since the advent of the COVID-19 pandemic, there have been changes in the ways teaching and learning occur in most classrooms, including English first additional language classrooms. Teachers spent less contact class time with their English FAL learners to comply with the COVID-19 safety protocols, such as social distancing. More than ever, learners in rural schools faced the responsibility of learning independently for extended periods. The focus in this article is on how the learners’ efforts to learn independently were disrupted and how teachers assisted these learners in overcoming these challenges amid the pandemic. The article explores the impact of the COVID-19 pandemic on rural English FAL learners’ self-directed learning. The findings confirm the existence of COVID-19-induced challenges that impeded rural English FAL learners’ self-directed learning. These included a lack of motivation and a negative attitude towards self-directed learning, closure of learning facilities and a lack of learning material, overdependence on the teacher, poor physical learning environments and limited parental support. The study also reports on strategies that English FAL teachers used to enhance learners’ self-directed learning during the COVID-19 pandemic. These included strengthening home-school partnerships, providing emotional support, and simplifying learning activities. The article concludes that the COVID-19 pandemic negatively impacted self-directed learning in South Africa.