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Factors predicting outcome in adult trauma patients admitted to a Tertiary ICU
No full textIntroduction: Trauma remains an important cause of mortality and morbidity in South Africa. In our centre, intensive care unit access is under severe strain. There is limited data specifically in our centre documenting the factors contributing to mortality and increased length of stay in ICU. Objectives: To elucidate the outcome (as measured by mortality and length of stay) of patients that are admitted to Intensive care unit following trauma. Method: A cross-sectional study dating from 2011 to 2015. Ethical clearance obtained from University of the Free State committee: HSREC 46/2016. Data analysed by means of SPSS 15.0 with frequencies and percentages and standard deviations. Stepwise logistic regression analysis was performed and the odds ratios, 95% CI and p-values calculated for risk factors. A p-value of < 0.05 was considered statistically significant. Results: The most prevalent mechanism of injury was assault (31%). Burns had the highest mortality rate (80%), primary orthopaedic patients had the longest length of stay recorded (128 days). Age was shown to be an independent predictor of outcome (p-value =0.016). Patients transferred from non-trauma centres did not have a statistically significant worse outcome (p-value = 0.58). Mortality rate of trauma patients admitted to ICU was 57.6%. Conclusions: There is an association between neurosurgical admissions and poorer outcome. No correlation between non-trauma centres transfer-ins and worse outcome was established; this is possibly an indicator of adequate resuscitation, stabilisation and effective referral systems in place. Our mortality rate is higher than that of international centres and this would need to be further studied
Characteristics of patients with recurrent involuntary admissions for seventy-two hour assessment at Kimberley Hospital Complex, Northern Cape Province, Republic of South Africa
No full textIntroduction: Mental illness is common throughout the world, yet the true prevalence is
underestimated. Forty-three percent (43%) of all psychiatric admissions in South Africa are involuntary, with a cyclical rise in re-admission rates, referred to as the revolving door syndrome. There was a need to unravel this syndrome, and help identify early, those patients at high risk of it, so that appropriate interventions are implemented to optimise psychiatric care and stem this system failure.
Aim: The study aimed to quantify the frequency of re-admissions and recurrent re-admissions
and describe the demographic characteristics, social support systems, and clinical characteristics of patients admitted for involuntary seventy-two-hour observation at the Kimberley Hospital Complex, Department of Family Medicine in the Northern Cape Province of South Africa.
Method: This was a retrospective, hospital records- based cohort study, of all qualifying 1142
consecutive, involuntary admission episodes, from 614 patients at Kimberley Hospital from 01 January 2016 to 31 December 2017. There was a purposeful, non-random participant selection. Results: Fifty-four percent of the participants were admitted only once during the study period (n=614; 54%). The recurrent re-admission rate was two percent (n=28; 2%), with an average 6 admissions per each participant in the recurrent readmissions group, and the admissions ranging from five to sixteen (range 5 - 16). In between, the re-admissions decreased from a low risk rate of 32% (n=365) to high risk rate of 12% (n=135).
Conclusion: This study showed that recurrent re-admissions, also known as the revolving door syndrome, is as much a problem in the Northern Cape Province of South Africa as it is
across the rest of the world. The participant at a high risk of re-admission was more likely to be male, Black, young, unemployed, single, abusing substances, coming from a low-income area, with a previous history of involuntary admission, with a diagnosis of Schizophrenia and/or substance-use psychiatric disorder, be on antipsychotic medication, and with a long in hospital stay. Being of Coloured ethnicity, was a particular risk factor for recurrent re-admissions
Exploring the experiences of victimisation of the homeless
No full textDespite the contemporary status of South Africa, having gained its democracy over two decades ago, different population groups still live on the margins of society and are burdened by a myriad of social issues and often exposed to adverse conditions of multiple deprivations and victimisation. One such group is the homeless, a so-called „surplus population‟ which is frequently viewed as „disposable‟ and „deviant‟. These individuals could be viewed as symptom-bearers of prejudice, discrimination and conflict. Although more notorious for their roles as the perpetrators of crime, homeless individuals are frequently the victims of violent acts which are widely overlooked and seldom reported and they often become the targets of identity or hate-based crimes. With a history of discrimination and segregation of certain marginalised groups, researchers have noted that societal conditions within the South African context provide a breeding ground for criminal acts which are motivated by bias towards a certain group of people – particularly the homeless population. Similar biases are held against foreign nationals – this bias is presently a recognised hate crime category in the Hate Crime and Hate Speech Bill of South Africa.
Recent developments on the homelessness front include the incorporation of the status of homelessness under the protection of hate crime legislation in several jurisdictions in the United Sates. Should South Africa, however, make the necessary efforts to follow this example it could prove to be valuable in terms of policy implications and ultimately the reduction of homeless victimisation. Accordingly, through the use of various victimisation risk models, in conjunction with integrative elements from the socio-structural perspective and also key factors from the most prominent labelling theories, this study was broadly centred around the exploration of the experiences of victimisation of the homeless within the South African context and it explored the nature, patterns, impact and consequences of homelessness and the availability of support systems. This study also included some exploration of the plausibility of including the status of homelessness under the enhanced protection of the developing Hate Crime and Hate Speech Bill of South Africa. Guided by a qualitative methodological approach, this study pursued an in-depth exploration of homelessness, assessing this global phenomenon on a victimological, physiological, psychological, legal and social level. A theoretical purposive sample of 17 homeless individuals currently residing in shelters, situated in both Bloemfontein and Kimberley, were included in the study. The findings obtained during the course of this study indicated that a large percentage (76.5%) of homeless individuals who formed part of the research sample experienced some form of victimisation as well as other hardships while on the streets and sometimes, to a lesser, yet significant extent in shelters, usually with very little to no support offered to them. With reference to the causal and consequential factors of homelessness and the experience of victimisation, many experiences documented concurred with the existing literature and theoretical perspectives utilised and evaluated for the purposes of this study. However, there is still a limited understanding of this complex phenomenon and a number of grey areas, indicative of a real need which exists for more research of this nature in contemporary victimological research, especially in the South African context. Using the recommendations of this study as a guideline for future research, it is envisioned that with a greater understanding of the homeless and their experiences of victimisation, more can be done by prioritising the gaining of control of the frequency of experiences of victimisation among the homeless population. This can be achieved through the development of enhanced protective legislation for the status of homelessness (hate crime legislation) and ultimately the development and implementation of homeless population reduction strategies in order to reduce or eradicate homelessness on a domestic and eventually, a global scale
Investigating establishment, functionality and sustainability of primary school libraries
No full textThis research was conducted to examine and describe the status of the establishment of functional and sustainable libraries in primary schools of the Motheo District in the Free State province, South Africa. Within the South African context, research supports the view that libraries in schools contribute to improving literacy rates amongst learners in primary levels (Paton-Ash & Wilmot, 2013: 145). It has been argued that if a school has a functioning school library, learners’ performance in reading may improve by up to 8% (DG Murray Trust, 2015). As far as can be established, very few studies have been conducted on the establishment of functional and sustainable school libraries within the context of South Africa. Furthermore, it is significant that to date no research has been conducted that investigates the establishment, functionality or sustainability of primary school libraries in any of the education districts of the Free State. To address this apparent gap, this study focused on the status of primary school libraries in the Motheo District of the Free State province. It further explored whether these libraries fulfil their purpose, as set out by the National Guidelines for School Library and Information Services (DBE, 2012) and the Free State Department of Education Policy for Education, Library, Information Technological Services (FSDoE ELITS, 2002a).
This study was informed by an interpretivist paradigm and was qualitative in nature. To collect data, I employed the following methods: a literature review, policy analysis, structured observation and semi-structured interviews. A literature review was conducted to determine the importance of school libraries as well as to explore to what extent other countries managed to sustain the functionality of libraries despite their own challenges. Secondly, a policy analysis was conducted to determine the South African policy framework for the establishment of functional and sustainable libraries in schools. In this regard, a content analysis of both the National Guidelines for School Library and Information Services (DBE, 2012) and Free State Department of Education Policy for Education, Library, Information, Technological Services (FSDoE ELITS, 2002a) was conducted. Thirdly, structured observations were employed in twelve primary schools situated in the ten areas of the Motheo District. These structured observations were carried out during the initial phase of data collection to generate questions for the interviews that would follow, as well as to identify relevant research participants. Participants were identified at four primary schools and invited to clarify contributing and inhibiting factors of establishing and maintaining functional school libraries. Thematic analysis was employed to analyse both the semi-structured interview and structured observation data. Data analysis revolved around the three themes of library establishment, functionality and sustainability. This study provides a general description of the status of the establishment and functionality of libraries in primary schools in the Motheo District in the Free State province
Neonatal Candidaemia at Universitas Academic Hospital, Bloemfontein, South Africa
No full textBACKGROUND: Candida remains the most common cause of morbidity and mortality
during the neonatal period. Knowledge of epidemiology of candida species and their antifungal
profile is important to guide empiric therapy. The aim of the study was to characterise and
evaluate the antifungal susceptibility of candida species causing neonatal bloodstream
infections at Universitas Hospital. Vitek 2 automated system is used for yeast identification
and antifungal susceptibility. To determine the accuracy of the results generated, the antifungal
susceptibility results were compared to those generated at the reference laboratory in
Johannesburg.
METHODS: A retrospective, laboratory based study was conducted over a one year period.
Isolates from neonates with candidaemia were identified to species-level and antifungal susceptibility testing was performed. Vitek 2 yeast cards were used for identification and
antifungal susceptibility testing. Antifungal susceptibility to fluconazole, amphotericin B, and
caspofungin obtained in our laboratory were compared to those obtained at the reference
laboratory. At the reference laboratory, broth microdilution susceptibility testing was
performed. Categorical agreement was calculated for susceptibility results.
RESULTS: Overall a total of 45 candida species were detected. Non- albicans candida
accounted for 73% of neonatal candidaemia, with Candida parapsilosis being the most
prevalent (60%). Candida albicans was the second most common isolate (27%).
Overall 23 (85 %) of the Candida parapsilosis isolates tested were resistant to fluconazole.
When Vitek 2 antifungal susceptibility was compared to broth microdilution performed at the reference laboratory, CA was 100% for amphotericin B and caspofungin. However, for Candida parapsilosis, the CA for fluconazole was 50% with 4 (18%) major errors and 7 (32%)
minor errors.
CONCLUSIONS:
Candida parapsilosis is the major cause of candidaemia amongst the neonate in this study.
Amphotericin B is currently the appropriate empirical drug of choice for treatment of this
infection
Investigation into the effect of fatty acids on the yield and replication of rotavirus in cell culture
No full textRotavirus (RV) remains one of the leading causes of severe dehydrating diarrhoea in infants and young children. The successful replication of RV relies on the formation of viroplasms, which consist of several viral proteins and host lipid droplets (LDs). Several studies have indicated that the absence of LDs or fatty acids (FAs) for the formation of LDs prevent the formation of viroplasms and subsequently severely hamper RV replication. Lipid droplets are well-known for their storage of fatty acids and their downstream metabolites that can play roles in immunological response toward invading pathogens. Furthermore, the type of FAs within LDs plays critical roles in shaping both the type and strength of immune responses.
This study sought to determine the effects that supplementation of MA104 cells with FAs of varying saturation could have on RV replication. The effects of supplementing MA104 cells with albumin (as control), stearic acid (SA, 18:0), oleic acid (OA, 18:1) and γ-linolenic acid (GLA, 18:2) on the lipid profile of M104 cells were determined using gas chromatography. Results indicated that each supplementation was able to change the lipid profile of MA104 cells in unique ways. Albumin supplementation showed no significant difference from the unsupplemented and uninfected control, while SA supplementation appeared to lower/increase some FAs, but not itself, when compared to unsupplemented and uninfected control. Oleic acid supplementation increased the relative percentage of itself, while GLA supplementation increased both the relative percentage of itself and arachidonic acid (AA) compared to the unsupplemented and uninfected control. The subsequent infection of supplemented MA104 cells further modulated the lipid profile of MA104 cells. Infection, of cells supplemented with GLA, showed an increase in the relative percentage of both GLA and AA when compared to the supplemented uninfected control. Interestingly, the study found that RV decreased the amount of GLA and AA in cells supplemented with GLA, possibly indicating that the metabolism of these FAs is driven to produce prostaglandin E2 (PGE2), a well-known modulator for immunity. The use of tissue culture infection doses 50 (TCID50) showed that the supplementation of M104 cells with unsaturated FAs (OA and GLA) increased the rate of RV replication when compared to the unsupplemented and infected control. In particular, the supplementation of GLA showed to be an effective enhancer of RV replication. In contrast, supplementation with albumin and saturated FAs (SA) showed no significance in rate of replication when compared to the unsupplemented and uninfected controls.
Detection of PGE2 using ELISA showed that RV can increase the production of PGE2 regardless of supplementation. However, the supplementation of MA104 cells with GLA led to a 2-fold increase in the amount of PGE2 compared to unsupplemented and infected MA104 cells. By using confocal laser scanning microscopy, it was shown that LDs, PGE2 and NSP2 (viral protein present in viroplasms) co-localized in supplemented and uninfected MA104 cells. Co-localization between NSP2 and PGE2 was also observed for the first time during the study indicating a possible role for viroplasms during the increased production of PGE2.
Together, results from this study shows that unsaturated FAs (OA and GLA) can increase the replication of RV. Although the exact mechanism behind this effect remains unknown, data indicates that there could be a role for PGE2. Thus, by elucidating the mechanism by which unsaturated FAs (and possibly PGE2) increase the replication rate of RV, novel anti-viral strategies against RV could be developed.Poliomyelitis Research Foundation (PRF)National Research Foundation (NRF)University of the Free Stat
Religious communities and South African politics: the case of South African Council of Churches from 1994 - 2016
No full textDespite much research conducted on the case of the South African Council of Churches
(SACC) since its inception in the 1960s, with particular focus on its role in South Africa ahead
of its first democratic elections in 1994 and subsequently, the overall image painted by
theological and secular academic scholars of the SACC is negative. As a result, much doubt
has been cast on the role of the SACC in South Africa, in particular the role of the SACC in
South African politics since the advent of democracy in 1994. In this study, an attempt has
been made to investigate and demonstrate that contrary to popular opinion concerning its role
in South Africa, the SACC has remained an instrument and servant of South African churches
and has demonstrated true commitment to serving and uniting the people of South Africa,
particularly in politics and matters of national concern. By adopting a resolution in 1994 on
critical solidarity with the democratically elected government of the Republic of South Africa,
it is true that the SACC has changed its approach or scope of dealing with South African
politics, but it has not abandoned its commitment to serving the people of South Africa nor is
it silent in matters of public concern. Thus the South African Council of Churches (SACC) is
still relevant in South Africa. This study employs a multiplicity of methods which includes
critical discourse analysis, heuristic method, hermeneutical tradition, hermeneutic
phenomenology, literature and historical approach. This is a qualitative research since it will
be used to gain more understanding of the work of South African Council of Churches (SACC)
and provide perception against the SACC’ s problem of silence in South African politics since
1994
A general disease and parasite survey of commercially important fishes of the Free State
No full textEnglish: Inland aquaculture has started to receive increased interest in South Africa and indeed the Free State Province. This is a means to diversify agriculture production, the creation of jobs and contributing towards food security. Sharptooth catfish/baber Clarias gariepinus, common carp Cyprinus carpio and rainbow trout Oncorhyncus mykiss have been identified as commercially viable species in the Free State, although the latter species was not collected during the current study. Parasitological data was collected from the above mentioned host species as well as other species of interest from impoundments in the Free State. Under aquaculture conditions susceptible hosts are usually in close proximity, for intensive culture thereby facilitating the transmission and establishment of parasites and diseases. As such, parasites and diseases of fish are regarded as significant constraints to the development of inland aquaculture in the province. The present study was a disease and parasite survey of commercially important fishes of the Free State Province. Herein we qualitatively assess the risk to sustainable development of a fresh water aquaculture industry based on parasitic data collected from field surveys in the Free State Province carried out over a period of two years 2013 and 2014 and parasitic data collected from the Agricultural Technology Demonstration Centre in Gariep Dam during 2016. The taxa collected included; the alien parasitic crustaceans Lernaea cyprinacea and Argulus japonicus; monogeneans Quadriacanthus aegypticus, Dactylogyrus sp 1 and Dactylogyrus sp 2.; the alien cestode, Schyzocotyle acheilognathi; peritrich ciliophorans Trichodina centrostrigeata, Tripartiella lechridens as well as the alien species Trichodina nigra and Trichodinella epizootica. Although some of the above species have been shown to cause mass mortalities of fish hosts both in the wild and in aquaculture, during the current study mortalities as a direct result of parasite infestations/infections were not encountered. The study found that parasites and diseases can indeed be constraints to aquaculture development in the province, coupled with factors such as access to markets, profits and economic value of the species being farmed.Afrikaans: Binnelandse akwakultuur is besig om toenemende belangstelling in Suid-Afrika te toon veral in die Vrystaat Provinsie. Dit word gedoen om landbouproduksie te diversifiseer, werkskepping te bevorder en om tot voedselsekuriteit by te dra. Die skerptandbaber Clarias gariepinus, gewone karp Cyprinus carpio, en reënboogforel Oncorhyncus mykiss is as kommersiële lewensvatbare spesies in die Vrystaat geïdentifiseer, alhoewel laasgenoemde spesie nie tydens die studie versamel is nie. Parasitologiese data is van bogenoemde gasheerspesies versamel, asook van ander visspesies van belang, in damme in die Vrystaat. Onder intensiewe akwakultuurtoestande is vatbare gasheerspesies gewoonlik in kontak met mekaar, wat die oordrag en vestiging van parasiete en siektes vergemaklik. As gevolg van die kwesbaarheid van visse vir parasiete en siektes onder akwakultuur omstandighede, word dit as ‘n beduidende beperking in die ontwikkeling van binnelandse akwakultuur in die provinsie beskou. Die huidige studie was 'n siekte- en parasietopname van kommersieel belangrike visspesies in die Vrystaatse Provinsie. In die studie is die parasitiese data wat versamel was van visse in Vrystaat damme oor ‘n periode van twee jaar (2013-2014), asook data van die Landbou Tegnologie Demonstrasie Sentrum in Gariep Dam, gebruik om die risiko’s te identifiseer wat die akwakultuurontwikkeling kan benadeel. Die spesies wat versamel was sluit die volgende in: uitheemse parasitiese krustaseë Lernaea cyprinacea en Argulus japonicus; verteenwoordigers van die Monogenea Quadriacanthus aegypticus, Dactylogyrus sp 1 en Dactylogyrus sp 2.; die uitheemse lintwurm Schyzocotyle acheilognathi; peritrich siliate Trichodina centrostrigeata, Tripartiella lechridens asook die uitheemse Trichodina nigra en Trichodinella epizootica. Alhoewel sommige van bogenoemde spesies al grootskaalse vissterftes in natuurlike asook akwakultuur omstandighede veroorsaak het, was daar tydens die studie geen vissterftes opgemerk as gevolg van direkte parasietinfeksies nie. Die studie het bevind dat parasiete en siektes inderdaad beperkings kan inhou vir ontwikkeling van akwakultuur in die provinsie, asook faktore soos die beskikbaarheid van ’n mark, winsgrens en ekonomiese waarde van die spesies wat geteel word.National Research Foundation (NRF)Department of Agriculture Forestry and FisheriesFree State Department of Agriculture and Rural DevelopmentUniversity of the Free Stat
A new method for modeling groundwater flow problems: fractional-stochastic modeling
No full textTo date, groundwater flow problems are still increasingly becoming a great environmental concern worldwide. This is among some of the reasons that many researchers from various fields of science have focused much of their attention in formulating new mathematical equations and models that could be used to capture and understand the behavior of groundwater flow with respect to space and time. The main aim of this study was to develop a new concept for modeling groundwater flow problems. The approach involved coupling of differential operators with stochastic approach. Literature proves that each of these two concepts has shown a great success in modeling complex real-world problems. But we argued that differential equations with constant coefficient are not fit to capture complexities with statistical setting. Therefore, to solve such a problem in this study, we considered a classical one-dimensional advection-dispersion equation for describing transport in porous medium and then applied stochastic approach to convert groundwater velocity (v), retardation (R) and the dispersion (D) constant coefficients into probability distribution. The next step was to employ the concept of fractional differentiation where we substituted the time derivative with the time fractional differential operator. Thereafter, we applied the Caputo, Caputo-Fabrizio and the Atangana-Baleanu fractional operators and derived conditions under which the exact solution for each derivative can be obtained. We then suggested the numerical solutions using the newly established numerical scheme of the Adams-Bashforth in the case of the aforementioned three (3) different types of differential operators. By combining the two concepts, we developed a new method to capture groundwater flow problems that could not be possible to capture using differential operators or stochastic approach alone. This new approach is believed to be a future technique for modeling complex groundwater flow problems. After solving the new model numerically, the condition for stability was also tested using the Von Neumann stability analysis method. Lastly, we presented numerical simulations using a software package called MATLAB
Estimation of hydraulic conductivity in shallow unconfined aquifers using concrete-lined large-diameter hand-dug wells
No full textThesis (Ph.D.(Geohydrology))--University of the Free State, 2019Large-diameter hand-dug wells are the main source of water supply for drinking, domestic and irrigation uses in many rural areas of sub-Saharan African countries and other developing countries of the world. In many rural areas of developing sub-Saharan African countries, the use of unscreened lining is the most common method of protecting large-diameter hand-dug wells against collapsing and pollution due to the simplicity and affordability of the method. This method prevents horizontal water flow to the well and water flow to the well through the well base, which makes the existing methods inapplicable for estimating hydraulic conductivity in screened hand-dug wells. The method developed involved to derive horizontal hydraulic conductivity (K) from apparent hydraulic conductivity (Ka). To demonstrate the viability of the developed method, field recovery tests were conducted in twelve (12) unscreened concrete-lined and screened lined large-diameter hand-dug wells based on the accessibility of the wells at test site to estimate apparent hydraulic conductivity (Ka) and horizontal hydraulic conductivity (K). The geophysical study of the test site was aimed to estimate the aquifer type, depth to water table and identification of strata and vadose zone thickness. The hydrogeochemical studies involved the collection and analysis of water samples from twenty (20) large-diameter hand-dug wells at the test site during rainy and dry seasons and was aimed at monitoring the groundwater quality and groundwater type of the test site. The results showed that the estimated apparent hydraulic conductivity Ka were lower than the horizontal hydraulic conductivity K, which indicated the effect of the unscreened concretelining. A relationship between Ka and K was established to make a correction factor for estimation of K from Ka by a regression analysis which showed a significant strong relationship of 0.00 between Ka and K using a bivariate Pearson correlation coefficient. This study has formulated a method that can be used to estimate aquifer hydraulic conductivity in unscreened concrete-lined large-diameter hand-dug wells. This will help to estimate the yield potential of the wells and evaluate the amount of water that can be abstracted or pumped from the wells in the rural areas of the developing world where unscreened concrete-lined largediameter hand-dug wells are being used. Further studies are recommended to quantify the amount of energy loss in flow as a result of non-horizontal water flow into the well