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Contextualising black women's identity in South Africa through the apartheid archive's system of racial classification: an intersectional African feminist analysis of race, class, and gender within South Africa's political history.
Get PDFWriting against apartheid creates avenues for Black women to reconstruct the South African national history archive with their inclusion while making sense of gender roles in the context of oppressive mechanisms of racism, segregation, and neocolonialism. The critical analysis the formation of how Black women's identity exists at the intersectionality of race, class and gender has been historically refashioned and repurposed through periods of colonialism and the Apartheid system's legal instruments. This research is rooted in African feminist theory of STIWAnism and Nego- Feminism to draw on the structural and intersectional reality of both social and political systems that exist in the past and present African systems that seek to disenfranchise Black women. This research conceptualises Black woman through apartheid system's racial classification by centralising oral history archives as a decolonial methodological tool to understanding how Black women's lived experiences and identities become deeply embedded within the broader social and political systems. The data source for this research consisted of semi-structured open ended oral history interviews which were conducted with participants who are descendants of a Black woman who were racially classified as Coloured instead of Black or Native under the apartheid system of racial classification. Emphasis has been placed on Black women telling their stories and historical experiences by centering memory in revisiting the past as a fundamental contribution thereby building intersectional African feminist archives. Thus, to offer space to make sense of how the intersecting structural issue of oppression is possible in understanding how meaning is made which is extremely instrumental in writing Black women's agency into South Africa's national history. This research therefore aims to write into this literary reality by writing against the apartheid archive by establishing Black women's experiences and the effects of the apartheid system's racial classification in the national history archive. Only once the lived experiences of Black women throughout these oppressive periods of colonialism and Apartheid have been theorised can the process of African feminist emancipation be realised
Curriculum renewal in acute care: a South African based study for returning Cuban-trained students
Get PDFBackground: Emergency Care plays an integral role in Universal Health Coverage (UHC), yet several limitations have been identified in Low- and Middle-Income Countries (LMIC), one of which is the lack of dedicated, integrated curricula. In 1996 the Nelson Mandela Fidel Castro (NMFC) student program was developed in response to societal health needs for equitable health care in rural and under-served areas, affirmative action, and the low doctor-to-population ratios nationally. Cuban medical education is Primary Health Care focussed and not aligned with Acute Care competencies. This study explores the NMFC students' needs, the barriers to learning, and the role of transition in this process, as a first integral step in curriculum renewal in Acute Care. Methods: A qualitative approach of focus group interviews with 18 UCT NMFC students and semi-structured interviews with preceptors was conducted. Data was then analysed thematically and with the lens of the chosen theoretical framework framed by Transition theory and Situated Learning theory. Results: The findings indicate that skills and simulation-based teaching methodologies are favoured. A structured orientation within an Acute Care transition program and supervised and integrated workplace supervision is needed. Barriers to student learning include time, a perceived sense of ‘othering,' and educational ‘differences' to Cuban training. NMFC students were identified for their willingness to learn. Preceptors further identified a lack of dedicated time for Acute Care and a lack of resources as barriers to facilitation. Conclusions: As socially responsible educators we must be considerate of student needs and respond with a robust curriculum. The challenge is designing a curriculum in Acute Care that addresses the specific learning needs of a group of designated adult learners from previously disadvantaged backgrounds, transitioning between institutions with different educational outcomes, in the care of undifferentiated critically ill patients, within the short timeframes in resource-constrained educational and health institutions. Recommendations include the addition of a robust transition program to integrate, orientate and scaffold Acute Care knowledge and skills deficits. The curriculum must include skills and simulation-based methodologies for ‘hands-on' practice, opportunities for self-directed learning, and situated learning within supportive communities of practice
MPhil in pulmonary haemorrhage in children in Cape Town
No full textIntroduction: Diffuse alveolar haemorrhage (DAH) is a rare condition in childhood which carries high morbidity and mortality. Outcomes are improved by initiating appropriate investigations to ensure early diagnosis and institute correct and timely management. Objectives: To understand the clinicopathological features of DAH and its management on the outcomes of children with this diagnosis. Methods: A descriptive study was conducted on children attending a tertiary centre pulmonology clinic from the period 2000-2022. A review of the clinical data, investigations and lung biopsy results was done and outcomes were reported. Results: Sixteen children were included in the study. The median age at presentation was 1.79 years (IQR 0.48-3.15). At presentation, the median haemoglobulin (Hb)was 5.4 (IQR 3.6-85). Five out of16(31%) had haemoptysis. Seven children showed a pulmonary IgA vasculitis on biopsy. Of the most recent spirometry 5/14 (38.46) had a restrictive pattern. At diagnosis 6/16 (37%) received intravenous methyl-prednisone and 10/16(63%) received oral prednisone as treatment. The children who received more than one immunosuppressant agent as management were 14/16 (87%). Ten out of 16 children are in remission. Conclusion: Early diagnosis of DAH and multidrug management seems to improve outcomes. The finding of isolated IgA vasculitis on lung biopsy associated with DAH has not been well described
Probing the mechanisms of action and resistance of mixed-ligand platinum(II) complexes with dual-stage antiplasmodium activity
Get PDFMalaria remains one of the largest parasitic disease burdens worldwide, with the vast majority of that burden occurring on the African continent. The ongoing high number of malaria cases and deaths is in part attributable to the emergence and spread of resistance to most clinical chemotherapeutics. With the reported development of partial resistance to the current front-line artemisinin-based combination therapies, there is an increased risk of malaria morbidity and mortality as limited replacement treatments are currently available. For that reason, it is essential to invest in the discovery of compounds with novel mechanisms of action (MoA), dual-stage activity, and with immutable targets. Until now, drug discovery has typically focused on the development of antimalarials that are entirely organic in composition. This has left the field of inorganic medicinal chemistry and transition metal-based chemotherapeutics underexplored and underrepresented
Bridging the past and the present “Rediscovering Prieska's forgotten cultural landscape”
Get PDFThe phrase “place of the lost she-goat,” derived from the Koran and associated with the Khoi people, originally referred to a location where farmers settled after rainstorms. This area, overseen by a village management board since 1882 and granted municipal status in 1892, became known for its semiprecious stones and as a vital crossing point for travelers (C K Rumboll & Partners, 2018). Historically, many locals worked at the nearby Koegas mine, which extracted blue asbestos. However, a phenomenon termed the “lost generation” has led to shifts in marginal spaces, with the Korana community noting rural-to-urban migration that diminished daily activity in these neighborhoods. Geospatial analyses suggest that the location of the lost she-goat has the potential to reshape the social geography and character of Prieska, a small town in the Northern Cape, which is the focus of this research. The physical and economic developments along “Loots Boulevard” (Main Road)—the main route to and from Prieska, crossing the Frans Loots Bridge—may serve as an urban spine, aiming to elevate the town's status relative to its surrounding areas. This study seeks to uncover Prieska's forgotten spaces, which are essential to its identity. These “lost spaces” (Trancik, 1999) include undeveloped areas in the town center, neglected pedestrian paths, abandoned railways, riverbanks and unmaintained memorial and aloe gardens. Key factors contributing to the town's fragmentation include outdated zoning policy, institutional neglect of the public urban environment and the abandonment of central industrial and military sites (Trancik, 1999). The research conclude in a design approach for a 2040 Framework, focused on reclaiming everyday spaces for Prieska's residents. Utilizing a family tree spanning four generations, the project emphasizes my personal childhood experiences through a narrative dialogue with family members. This study explores the complex process of reimagining Prieska—rich in cultural heritage yet marred by neglected sites—by transforming underutilized areas into vibrant, functional spaces that reflect and preserve the town's unique identity. The strategy aims to restore the town's physical environment while awakening the shared stories that define i
Computational modeling of the tissue mechanics in rheumatic heart disease patients
Get PDFNon-invasive measurements play a crucial role in advancing heart failure treatments, a leading global cause of mortality. Understanding the biomechanical characteristics of myocardial material behavior in both healthy and diseased hearts through finite element analysis offers valuable insights into cardiac function and potential interventions for diastolic abnormalities linked to ventricular hypertrophy and inflammation. This study aims to develop accurate, subject-specific computational models of the human bi-ventricle using high-resolution cardiovascular magnetic resonance (CMR) images from rheumatic heart disease patients (RHD) and healthy individuals. These models will facilitate the investigation of heart biomechanics, focusing on the impact of myocardial elastic material behavior, including compliance (stiffness), muscle fiber orientation angles, and directionally dependent properties (anisotropy coefficients). Using CMR images, three-dimensional (3D) finite element models (FEM) were constructed for both RHD patients and healthy subjects. The material parameter optimization uses inverse modeling based on the finite element method combined with the Levenberg-Marquardt method (LVM) by targeting subject-specific hemodynamics. The computational models describe the passive behavior of the myocardium by nonlinear, orthotropic, and nearly incompressible hyperelastic material constitutive equations. Parameter optimization of myocardial tissue stiffness, anisotropy coefficients, fiber angles, and diastolic pressures aimed to minimize the error between the Klotz curve and the simulated end-diastolic pressure-volume relationship (EDPVR) curve for each subject. Beginning with the unloaded left ventricular volume (V0), optimization progressed until the end-diastolic volume (EDV) was reached at the specified end-diastolic pressure (EDP). Objective functions were defined based on the difference between simulated and measured left ventricle (LV) and right ventricle (RV) EDVs. Additionally, two further objective functions were established: the first combining EDVs and global strains (circumferential, longitudinal, and radial), and the second combining EDVs with short-axis diameters. The study of elastic myocardial parameters between healthy subjects and RHD patients shows an elevated stiffness in diseased hearts. In particular, the anisotropic material behavior of the healthy and diseased cardiac tissue significantly differs. Furthermore, as the left ventricular ejection fraction (LVEF) decreases, the myocardial tissue stiffness and anisotropy coefficients increase. The LV myocardial circumferential and longitudinal stresses were negatively associated with LVEF. The sensitivity analysis results demonstrate that the observed significant difference between the elastic material parameters of diseased and healthy myocardium is not exclusively attributable to increased left ventricular end-diastolic pressure (LVEDP) in the diseased heart, but rather to the presence of fibrosis in the myocardium. Additionally, the sensitivity of elastic material parameters and muscle fiber angles with respect to the specific strain components included as targets in the objective function was reported on. Patient-specific computer simulations of EDV and strains for all objective functions agreed well with clinical data. The error difference between the predicted and clinical parameters is less than 0.1%. Qualitative and quantitative differences in stress and strain distributions for each parameter optimization target are presented. Lastly, the combination of EDV and cavity diameters to estimate elastic material parameters, fiber angles, and diastolic pressures was explored. The obtained results distinguish between the elastic material parameters and diastolic pressures of individuals with RHD and those of healthy controls. The study provides valuable insights into the biomechanical characteristics of the myocardium, advancing our understanding of cardiac function in health and disease and offering potential implications for clinical practice and future research directions
HIV-Polymyositis progressing to inclusion body myositis: clues to earlier diagnosis
Get PDFInflammatory myopathies in Human Immunodeficiency Virus (HIV)-positive patients may include polymyositis (PM), dermatomyositis and inclusion body myositis (IBM). Although PM is still mentioned, it is thought to be rare since the discovery of myositis autoantibodies. In the last few years it has been reported that several cases who were initially diagnosed as HIV-associated PM (HIV-PM) clinically and on muscle biopsy, change into a treatment-resistant HIV-IBM clinical phenotype. These cases are referred to as HIV-PM/IBM overlap syndrome. In recent years at Groote Schuur Hospital (GSH), we have also encountered patients with HIV-PM/IBM. Aims The aims of our study were: (1) to describe the demographic, clinical and laboratory findings in patients that were being treated for refractory “PM” and in whom the clinical diagnosis was changed from HIV-PM to HIV-IBM at the neurology unit, Groote Schuur Hospital (GSH) (2) to identify the earliest clues for this progression from HIV-PM to HIV-IBM. Methods A retrospective folder review was conducted for nine patients with HIV-IBM who interacted with the neurology service at GSH from 1 January 2000 to 30 November 2023. The duration between the diagnosis of PM and when they first satisfied the diagnostic criteria of IBM by their case notes were recorded. Results All the patients were female with a median age of 50 years at IBM diagnosis. Proximal lower limb weakness was the initial complaint of all of our patients with median age of 36 years. The median maximum CK recorded was 2500 IU/L. None of the patients had a recorded CK of more than 15 times the upper limit of normal. The median interval between symptom onset to IBM diagnosis was 11 years (range: 6-15) and the median interval between PM diagnosis and IBM diagnosis was 9 years (range: 3-14). Patients were examined after a median symptom duration of 12 years. After approximately 1.5 years of follow up, two of six patients already satisfied the ENMC 2011 clinical criteria for IBM. Of the most severely affected muscles in the lower limbs with Medical Research Council (MRC) muscle power grades of 0-2 (out of 5), the knee extensors were most frequent (≥ 90% of cases). In the upper limbs, the finger flexors were the most involved with moderately weak muscles in 50% of cases. Four (44.4 %) patients reported mild dysphagia at IBM diagnosis visit. Seven of nine patients received immunotherapy. All patients who received any form of immunosuppressive therapy received prednisone (median duration: 137 months [(range: 24-180)]). The median number of immunosuppressants used by patients who received any form of immunotherapy (n=7) was four. All nine patients had muscle biopsies between 12 and 35 months after onset of symptoms. The most important findings were that all patients had evidence of inflammatory infiltrates. An increase in MHC 1 expression and mitochondrial abnormalities (i.e COX – /SDH + fibres) were noted in all four patients in whom immunohistochemical staining and combined SDH and COX staining were performed. At the visit to neurology, five patients could be categorized as clinically defined IBM and four were defined as clinically probable IBM. Conclusions Earlier recognition of this progression from HIV-PM to HIV-IBM was not possible due to poor awareness of this entity. Three of our HIV-IBM patients were younger than the age criteria for non-HIV sporadic IBM at the IBM visit. As all these patients had otherwise typical IBM features but were younger, the age criteria of ENMC 2011 may not be applicable to HIV-IBM patients. Only four patients subjectively and objectively responded to immunosuppressive treatment for a short median period of 22 months (range: 8-53). Drug refractoriness should alert the clinicians of this clinical progression from HIV-PM to HIV-IBM. A relatively high CK but less than 15 times the upper limit of normal is another clue for this clinical entity. In this study all the patients who had COX/SDH staining showed marked COX negative and SDH positive fibres and hence this test should be performed in all inflammatory myopathy muscle biopsy samples for earlier recognition of HIV-IBM
Going national: universal jurisdiction and the principle of complementarity in the Rome Statute of the International Criminal Court
Get PDFIn a historical moment, after a couple of decades of development from Nuremberg to the ad hoc tribunals for the former Yugoslavia and Rwanda, the permanent International Criminal Court (ICC) set to work in The Hague in 2002, to fight impunity for the most atrocious crimes against international law, having an impact on the international community as a whole.1 This has been welcomed with high expectations from the civil society.2 However, negotiations on an international multilateral level require compromise, and compared to the ideal of a Court with unlimited resources and jurisdiction, the final form of the ICC does not seem to be able to live up to the expectations. The budget of this international institution is very limited, and could and should only cover the costs of proceedings for the very masterminds of crimes,3 which are in turn all too often only possible because of the participation of so many individual criminals
Exploring the role of DFI s in developing township economies
Get PDFTownships are hubs of entrepreneurship with many micro and small businesses which provide opportunities for employment and poverty alleviation. The township economy, by virtue of our past, is often overlooked and underserved regarding economic development. The government has over the past few decades introduced initiatives to promote SMME development, particularly for township enterprises. Development Finance Institutions (“DFIs”) have emerged as significant facilitators in utilising their resources and financial know-how for direct investment into the township economy. DFIs have emerged as valuable institutions in supporting the township economy, bridging the gap between financial exclusion, and needed economic development. The research explores the role and effectiveness of DFIs in supporting the township economy. The study employed a qualitative research approach covering a sample of 3 representatives of the DFIs and 10 township entrepreneurs operating in Gauteng province from four townships of Tembisa, Soweto, Katlehong and Mamelodi using a semi-structured questionnaire for in-depth interviews. The study found that DFIs have a mandate to promote economic growth by providing financial and non-financial support where the market has failed to invest adequately. DFIs face a challenge as business support depends on the strict bankability factors resulting in a high failure rate for township businesses. In the absence of grants their performance is limited by their limited capacity and available capital. These factors limit penetration thus affecting the ability to materially transform the township economy. While there is evidence of considerable investments, job creation and value add administered into the townships because of DFI participation. SMMEs experience challenges in working with the DFIs which poses a risk to their overall effectiveness. SMMEs want to be part of the solutions and not to have the solutions presented to them. Based on the findings, it is recommended that to unlock the full potential of DFIs, they must adopt an integrated and inclusive approach, which focuses on the needs of the SMMEs being served. Policy reforms, legislation, and programs to create a favourable environment for local township SMMEs must be designed with their full participation. The government needs to invest in more innovative ways to improve bankability for the township entrepreneur. Given the low penetration rate, the focus should rather be on bankability incorporating special programs to incubate businesses. The government should make an allocation in its budget for grants towards DFIs as this will enable these institutions to make more advances at risk-free rates to boost economic growth
Anterior temporal lobectomy. A cross-sectional observational study of potential surgical candidates at a single institute
Get PDFBackground: Epilepsy is a common neurological disorder, associated with serious cognitive and psychosocial burdens, especially when poorly controlled. Mesial temporal lobe epilepsy (mTLE) is the most common form of human focal epilepsy. It is often refractory to antiepileptic drugs, and the most amenable to surgical treatment which often renders patients seizure free. Furthermore, surgery for mTLE has low procedural risk, is cost-effective and best performed early in the disease course for maximal benefit. It is surprising, therefore, that mTLE surgery remains widely under-utilised, in both well and poorly resourced settings. Objectives: The aim of this study was to establish the frequency of occurrence of patients with electroencephalographic epileptiform discharges consistent with mTLE attending a neurophysiology laboratory at a tertiary hospital in South Africa, and determine whether these patients may be candidates for anterior temporal lobectomy, the most commonly performed surgery for mTLE. Methods: This was a quantitative audit of all scalp electroencephalograms (EEG) performed at the Groote Schuur Neurophysiology laboratory during the period January 1st 2017 to December 31st 2019. Where CT and MRI brain scans had been performed, these were assessed for corroborative evidence of mTLE. Results: Over the three-year period, 4 342 EEGs were assessed. A total of 411 (11%) showed epileptiform discharges consistent with all epilepsy types. Of these, 327 (69%) were of focal onset and 108 (2% of the total number of EEGs performed) were consistent with mTLE. Of the patients with electroencephalographic features of mTLE, only 27 (25%) had had MRI brain scans performed according to an epilepsy surgery protocol. Of these, 6 exhibited MRI findings confirming mTLE, identifying them as potential surgical candidates. Over three years, 75% of patients with electroencephalographic evidence suggesting mTLE did not receive appropriate work-up for epilepsy surgery. Conclusion: Surgery, especially anterior temporal lobectomy, is widely acknowledged to be an efficacious and cost-effective intervention in patients with medically refractory mTLE. The findings of our study suggest that patients with mTLE are under-investigated for potential surgical management, and that epilepsy surgery is under-utilised in South Africa. These findings are in line with similar studies in both well-resourced and resourceconstrained countries. We hope that our study will highlight the utility of EEG as a screening tool to identify patients with drug-resistant epilepsy due to mTLE, who may be candidates for anterior temporal lobectomy