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Development of a novel mobile flexible hysteroscopy system for outpatient procedures without general anaesthesia
Get PDFIntroduction: Hysteroscopy is regarded as the gold standard for evaluating and treating abnormal uterine conditions and while typically performed in the operating room with general anaesthesia, office procedures without general anaesthesia has been proven to be safe and efficient. However, shortcomings with existing hysteroscopy systems, such as patient discomfort and equipment cost, impede the adoption and success of office hysteroscopy. This research project aimed to develop a new hysteroscopy system that was more accessible to gynaecologists by reducing cost, eliminating equipment requirements, and improving the patient experience. This increases the rate of office hysteroscopy and, as a result, improves patient access to the procedure. Materials & Methods: By reviewing the current hysteroscopy landscape, need criteria were determined and translated into design requirements to guide the design and development of the new hysteroscopy system. The design process followed an iterative prototyping approach where prototypes were built on the previous version until a system that met all the design requirements was developed. The prototype system then underwent verification testing to establish the design specifications to compare against the design requirements and, if successful, proceed to validation testing through a comparative usability trial. The trial protocol was developed according to the IEC 62366-1:2015 standard using an ISO 14971:2019 risk analysis as input. The trial involved 10 gynaecologists performing simulated procedures with the prototype and a standard system, thereafter, providing feedback through a System Usability Scale, a post-session questionnaire, and a procedure review form. Results & Discussion: The outcome of the design process was a mobile flexible hysteroscopy system with a single-use sheath with a channel for distention media. The prototype was all-in-one with a built-in camera, light source, and battery power source, and it could be operated single-handedly. It was verified to have a 260mm working length, 4.2mm diameter scope with a 236° bending range, 79 minutes of continuous usage, and the disposable sheath could isolate the system while fully submerged and supply saline solution at over 200 mmHg pressure. The trial results showed the prototype system to have higher usability than the standard, scoring 86 and 67, respectively. Furthermore, less experienced gynaecologists scored the prototype system much higher than the standard, indicating it was easier to use. This was further shown in the post-session questionnaire, where a Mann-Whitney U test determined the significance between ratings of the two systems, and the prototype system was found to be significantly easier to clean, set up, and use. Finally, the procedure review form confirmed all participants could perform a hysteroscopy procedure with the prototype system without using tools such as a speculum or tenaculum. The prototype system was therefore validated as a functional hysteroscopy system that successfully incorporated features to address the identified shortcomings of existing hysteroscopy systems. Conclusion: The research project, therefore, successfully achieved its aim, having developed the prototype hysteroscopy system that could increase the adoption of office hysteroscopy procedures. This is possible through the system requiring no additional equipment and sterilisation facilities while offering an improved user and patient experience through the user-friendly design, minimal diameter flexible scope, and not requiring tools during procedures. Future work could be aimed at refining the hysteroscopy system and preparing it for the first human testing to demonstrate clinical safety and efficacy
Mobilising restless radicals: the #AmINext movement and the formation of feminist digital counterpublics against gender-based violence and femicide in South Africa
Get PDFThe #AmINext movement in response to the sexual assault and murder of Uyinene Mrwetyana in 2019 reignited the public discourse of gender-based violence (GBV) and femicide in South Africa. The prevalent research on feminist hashtag activism has made critical links between the use of social media and the platforming of women's rage as a form of mobilising protests against GBV and femicide. However, less analysis has focused on the political significance of affects such as rage within feminist hashtag activism against GBV and femicide in South Africa. This research undertakes a literature review of feminist hashtag activism across the world to situate this form of mobilising in global feminist debates connected to how marginalised genders experience patriarchy differently in diverse contexts. A thematic analysis of 1,600 tweets is employed to investigate how affects form these movements through activists' responses to #AmINext. It uses theories of feminist digital counterpublics to show that digital responses to GBV and femicide may be new, but they are connected to histories of women's resistance. This study argues that #AmINext mobilises rage and grievability to contest the assumptions of how GBV and femicide operate within the coloniality of gender. It found that rage and grievability circulated by activists in #AmINext work to counter hegemonic discourses that render GBV and femicide as extraordinary, reflecting how stories of injustice are bound with emotions that make individuals act politically in ways they would not otherwise
#ReclaimTheCity: the use of Facebook to engage the state and the public on affordable housing delivery in Cape Town, South Africa
Get PDFThe global increase in the use of social media has enabled the real-time connection of people across localities, the fast sharing of information and the mobilisation of communities for a common cause. Social movements are increasingly leveraging this phenomenon to expand their activism to the digital space to reach a wider audience. This is true in the South African context as well where Reclaim the City (RTC) and Ndifuna Ukwazi (NU) – the two cases for this research – utilise a social media platform, namely, Facebook, to engage with the State and the public on affordable housing delivery in Cape Town. To understand how Facebook is utilised by these organisations, a qualitative research approach was adopted. First, a systematic review of posts published between 2017 and 2020 on the Facebook pages of RTC and NU was undertaken, excluding the contents of comments to the posts. Second, five semi-structured interviews – three with participants from RTC and two from NU – were also conducted. Lastly, non-participant observation was also undertaken at three events organised by the organisations to understand the link between their online and offline engagements. The findings indicate that RTC and NU have played significant roles in highlighting the need and urgency for affordable housing delivery in Cape Town's well-located areas. This has been achieved through in-person and online campaigns and activities. Focusing specifically on the digital realm, the findings indicate that Facebook serves as a complementary space of engagement for both RTC and NU. In this space, RTC shares personal stories on housing struggles and promotes its offline campaign events to raise public awareness and support. They also share information that provides insight into the State's obligations, promises and failures regarding affordable housing issues. NU, on the other hand, leverages its social media platforms to mostly educate the public on affordable housing delivery through the dissemination of housing research findings, providing information about tenancy rights and available support against eviction, as well as providing updates on state policies, projects and ongoing housing-related court cases. The findings illustrate that Facebook is an essential space for public sensitisation and mobilisation. However, as the findings further indicate, online campaigns are designed to support offline campaigns and in-person activities by mobilising the public. Yet, as the findings further indicate, the stated audience of RTC's Facebook page – the poor and working class – faces significant challenges in the form of high data costs which limit their engagement with the Facebook posts of RTC and NU. Thus, the findings intimate that social media serves as a complementary space of participation and primarily facilitates engagement with the upper working class and middle class
Patients with severe cutaneous adverse drug reactions have extremely high hair cortisol concentrations that do not correlate with presence of depression.
No full textBackground: Hair cortisol concentrations (HCC) +/- DHEA, a depression and stress biomarker has not been studied in severe cutaneous adverse drug reactions (SCAR). Objective: To determine DHEA/HCC correlation with SCAR-associated depression and compare the ratio with published values. Methods: Depression was assessed using M.I.N.I. and DHEA/HCC measured in epidermal necrolysis (EN) and DRESS patients at a South African tertiary hospital. PubMed search was conducted for publications documenting DHEA/HCC. Results: 22/37 participants enrolled were depressed, significantly higher in EN than DRESS. HCC, DHEA or DHEA/HCC were not different between SCAR; depressed versus non-depressed; and presence versus absence of suicidal ideation. DHEA/HCC was unaffected by HIV or TB status. HCC was high in all SCAR patients, regardless of gender. HCC in SCAR was extremely high compared to published healthy controls [309.33 (28.9 - 1835.7) vs. 46.1 (17.7 - 153.2), p = <0.01]; depressed subjects [1349.67 (SD 1935.59) vs. 7.26 (SD 0.47), p = <0.01] and depressed HIV positive males [1479.61 (SD 2313.74) vs. 18.02 (SD 9.37), p =0.0003]. Conclusions: HCC was high and sustained in SCAR irrespective of HIV, TB, or depression status. No association existed between DHEA/HCC ratio and depression. Sustained high cortisol levels potentially impact long-term SCAR-associated outcomes
A descriptive study of the prevalence of Acute Foot and Ankle complaints/injuries of adults attending a public sector secondary hospital orthopaedic clinic in South Africa over a 12-week period
Get PDFBACKGROUND: Orthopaedic trauma places a substantial cost burden on health systems around the world, and may also lead to mobility impairment, disability, and chronic pain in patients, especially when affecting the foot and ankle. The epidemiology of foot and ankle injuries has previously not been well reported in South Africa. In order to gain a greater understanding into the degree of health burden represented by conditions of the foot and ankle as well as the associated risk factors and types of injury, we aimed to describe and evaluate the patient population presenting at a public health hospital over a specified time period. Insights into the epidemiology specific to the South African context may aid health care resource planning and contribute to improved patient care. METHODS: A prospective, descriptive study was conducted to determine the prevalence, characteristics and risk factors of adults presenting to the orthopaedic acute clinic at Prince Mshiyeni Memorial Hospital with acute foot and ankle complaints/injuries between December 2022 to March 2023 (12-week period). Demographic (sex, age, height, weight, BMI) and clinical (type of injury, pain scores, management) data were collected and analysed using percentages, Mann-Whitney U Test, t test and Chi-square analysis. RESULTS During the 12-week period, 14% of the 615 lower limb cases were referred for Foot and Ankle injuries specifically. The cohort comprised 80 participants with an average age of 43 years with 64% (n=51) (being) female. Ankle fractures were the most common presenting injury (54%), with females more affected than males, 31 (61%) vs.12 (41%)) respectively. Males suffered more foot fractures than females, 12 (41%) vs. 5 (10%) respectively (p< 0.05). Foot fractures represented 21% of all foot and ankle injuries. Ankle sprains made up 15% of all injuries which interestingly was similar to that of midfoot sprains (15%). The highest number of injuries were noted within the age range 30-39 (34%) with no significant difference noted between sex and age presentation, but a significant difference was noted for mechanism of injury and sex (p< 0.001), no significant differences were noted for BMI between the sexes with a median of 25kg.m2 for both. Low energy fall was the most common mechanism of injury described affecting 66% of all participants and 74% (39) of females. Road traffic accidents (RTA) accounted for 21% (17) and direct trauma/assault 6% (5) of all mechanisms of injury. Fifty percent (40) of participants were managed conservatively by means of plaster of Paris, 40% (32) with plaster backslab, and 6% (5) admitted for surgical intervention. CONCLUSION: Foot and ankle pain is a prevalent problem which constitutes a high number of traumatic bony and soft tissue injuries. Within this cohort, more females presented with ankle fractures and males with foot fractures, with the 30-39-year age group most affected. Low energy fall mechanisms were most commonly reported within females, while males suffered more direct trauma and sports injury-related mechanisms. Only a small percentage of patients were admitted for surgery. The researchers recommend more epidemiological studies across major trauma centres with greater participant numbers and longer follow up to give a better scope into the full extent of the burden of foot and ankle pain/injuries in South Africa, and expand database registrations, hereby impacting policy making and budget allocation to improve patient care and outcome
Girl interrupted! The impact of child marriage on women's educational attainment in Zambia
Get PDFHuman capital acquisition is not only pivotal for overall growth and development, but also plays a critical role in advancing the economic empowerment of women and young girls. However, significant barriers continue to impede girls and women from pursuing further education in developing countries. Among the various factors affecting women's education, child marriage frequently emerges as a significant inhibitor. Despite ongoing efforts to eliminate the practice, it remains prevalent in Sub-Saharan Africa and South Asian countries. Utilising data from the 2018 Demographic and Health Survey (DHS), this dissertation investigates the effects of child marriage on educational outcomes for women in Zambia. Adopting an instrumental variable methodology to account for endogeneity and reverse causality, this paper explores whether marrying below the age of 18 disrupts educational attainment and, consequently, impedes the development of human capital among young Zambian women. Consistent with previous studies on child marriage and education, the results from this paper suggest that being a child bride significantly reduces educational attainment by 1.4 years and reduces the probability of secondary school completion for girls in Zambia by 21 percentage points. In terms of educational attainment, girls married between the age of 10-14 are the most adversely affected
Financing diamond
No full textIssues with data: discrepancies across different databases, lack of integrated data, misleading location information, inactive websites, incomplete online information, inactive online information, inactive, duplicate and out of date records
Investigating SARS-CoV-2 immune responses in children
No full textSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infec<on causes a highly transmissible respiratory disease, coronavirus disease 2019 (COVID-19), with variable disease outcomes. Children infected with SARS-CoV-2 are more likely to exhibit asymptoma<c or mild illness compared to severe clinical outcome, oSen observed in adults. A severe manifesta<on of SARS-CoV-2 infec<on in children is mul<system inflammatory syndrome (MIS-C), a delayed hyperinflammatory disease that occurs aSer exposure to SARS-CoV-2 and shares clinical features with Kawasaki disease (KD). MIS-C develops in a small propor<on of children who have been previously exposed to SARS-CoV-2. Poten<al contributors to the reduced COVID-19 clinical outcome in children compared to adults, includes less comorbidi<es, differences in the expression of viral entry factors, robust innate immunity, age-associated differences in humoral and cellular immunity, and pre-exis<ng immunity against endemic human coronaviruses (HCoVs). Notably, a cri<cal role for T cells in controlling COVID-19 severity, has been well documented. The immune mechanisms for the differences in disease progression between children and adults remain to be fully understood and studies evalua<ng SARS-CoV2 immune responses of paediatric popula<ons in Africa are s<ll rare. This thesis aims to inves<gate why children were ini<ally spared from severe COVID-19 outcomes, whether T cell responses are maintained in children as seen in adults, and why a small frac<on of children develop MIS-C aSer SARS-CoV-2 infec<on. Overall, this thesis focused on characterizing SARS-CoV-2-specific immune responses in pediatric cohorts, determining the durability of T cell responses over a 16-month period, and finally assessing cross-reac<ve immunity to SARS-CoV-2 variants of concern (VOC) in children. In Chapter 3, we aimed to inves<gate the SARS-CoV-2-specific T cell responses in unvaccinated asymptoma<c children (median age: 7 years) who were seroposi<ve (n=41) or seronega<ve (n=30) for SARS-CoV-2. Our results showed that the magnitude of SARS-CoV-2-specific CD4+ and CD8+ T cell responses was comparable between SARS-CoV-2 seroposi<ve and seronega<ve children. However, the func<onal profiles of SARS-CoV-2-specific CD4+ T cells were dis<nct, with seroposi<ve children displaying a higher propor<on of polyfunc<onal T cells, whereas seronega<ve children had predominantly monofunc<onal T cells. Addi<onally, the frequency of SARS-CoV-2-specific CD4+ T cells in seronega<ve children was moderately associated with endemic HCoV-HKU1 an<body responses. Sugges<ng that SARS-CoV-2- reac<ve T cells in seronega<ve children may be due to pre-exis<ng immunity from prior infec<on with endemic HCoVs. We also demonstrated that seroposi<ve children had lower frequency of SARS-CoV-2-specific CD4+ and CD8+ T cell responses, in comparison to COVID19 convalescent (n=30, median age: 38 years) adults. A limita<on of this cohort was that the children did not have an exact <me of SARS-CoV-2 infec<on by PCR confirma<on, whereas the adults had PCR-confirmed SARS-CoV-2 infec<on. Therefore, the lower magnitude of responses in children might be due to more distant infec<on compared to the adults. Taken together, these findings provide insight into SARS-CoV-2 immunity in children. In Chapter 4, we aimed to extend previous findings with another larger cohort of 73 matched household mother (median age: 33 years)-child (median age: 7 years) pairs, to address the limita<on of the poten<al differing <me of SARS-CoV-2 infec<on between children and adults in the previous cohort in Chapter 3. A small propor<on (36%) of children living in the same household as their SARS-CoV-2 seroposi<ve mother, were seronega<ve for SARS-CoV-2, despite the likelihood of shared SARS-CoV-2 exposure. The apparent resistance of infec<on in these children may be due to three reasons, namely 1) cross-reac<ve immunity to endemic HCoVs, 2) early aborted SARS-CoV-2 infec<on in children and/or 3) possibly early rapid viral clearance by innate immunity. Despite the serostatus, children in comparison to matched mothers displayed lower frequency of SARS-CoV-2-specific T cell responses. The overall func<onal profile of SARS-CoV-2-specific T cells were comparable between children and mothers, sugges<ng although lower, the quality of the T cell response is equivalent during SARS-CoV-2 infec<on. When comparing the memory differen<a<on profile of SARS-CoV-2- specific T cells, we found that children and mothers had early differen<ated (ED) memory profile as the dominant memory subset of SARS-CoV-2-specific T cells, which is associated with long-term immunity. The reduced SARS-CoV-2-specific T cell responses found in children compared to adults raised the ques<on of whether these responses would be durable and cross reac<ve to SARS-CoV-2 VOCs. We therefore evaluated of the maintenance of SARS-CoV2-specific T cell responses over 16-month period since the ini<al visit. This analysis was somewhat confounded by possible repeated exposures to SARS-CoV-2 during the Delta and/or Omicron BA.1/2, BA.4/5 waves preceding the second sampling visit. Nonetheless, the predominant ED memory subsets at the 16-month sampling does suggest poten<al durability albeit in the context of an ongoing pandemic. Lastly, we reported that, T cell responses were cross-reac<ve to SARS-CoV-2 Delta and BA.1 VOC, demonstra<ng T cells are preserved across variants of concern in South African unvaccinated children. Finally, in Chapter 5, we inves<gated the underlying immune pathology of MIS-C, by quan<fying SARS-CoV-2-specific T cell responses in children with MIS-C compared to SARSCoV-2 seroposi<ve children with clinically similar paediatric febrile diseases (non-MIS-C) and healthy SARS-CoV-2 seroposi<ve children (HC). The magnitude of SARS-CoV-2-specific T cell responses was comparable in children with MIS-C, non-MIS-C and HC. However, healthy SARSCoV-2 seroposi<ve children had a higher propor<on of polyfunc<onal SARS-CoV-2-specific CD4+ T cells compared to children with MIS-C and those with other inflammatory or infec<ous diagnoses, who both presented a largely monofunc<onal SARS-CoV-2-specific CD4+ T cell profile. Addi<onally, children with MIS-C displayed a higher frequency of TCR V21.3+ SARSCoV-2-specific CD4+ T cells compared to HC but similar to non-MIS-C controls. The skewed T cell profile in children with MIS-C and non-MIS-C controls could be due to sustained systemic inflamma<on inducing T cell exhaus<on and/or superan<gen-like responses inducing polyclonal expansion of V21.3+ T cells to SARS-CoV-2 spike protein. Overall, this thesis provides important relevant data for understanding the adap<ve immunity of SARS-CoV-2 in children compared to adults and provides insights into the cross-reac<ve immunity that may provide protec<on against re-infec<ons in children. Despite the end of the COVID-19 pandemic as a global health emergency and decrease in MIS-C incidence rates over the last 3 years, SARS-CoV-2 con<nues to circulate and may possibly evolve into endemi seasonal waves of infec<on. This exposes children, the vulnerable and least vaccinated popula<on to increasing respiratory viral coinfec<ons. Future work includes inves<ga<ng systemic and local immune responses against respiratory syncy<al virus (RSV) in the context of recent or concurrent SARS-CoV-2 infec<on in children to beher understand the immunological mechanisms contribu<ng to the increased RSV disease severity observed aSer the COVID-19 pandemi
High flow nasal oxygen versus mechanical ventilation as initial respirator support in severe COVID-19 ARDS at Groote Schuur Hospital : a propensity score analysis
Get PDFOBJECTIVE: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic placed an unprecendented burden on global health care resources, and on intensive care unit (ICU) resources in particular. Due to ICU resource limitations, high flow nasal oxygen (HFNO), a novel ventilation strategy, was implemented as an alternative to mechanical ventilation (MV) at Groote Schuur Hospital in Cape Town, South Africa, during the first COVID wave. Patient received MV if HFNO failed. The purpose of this study was to compare outcomes of this “HFNO first” strategy to a “MV first” strategy. METHODS: This was a secondary analysis of two propsective cohort studies conducted during the COVID first wave at Groote Schuur Hospital. Propensity score matching was used to compare outcomes between HFNO as initial ventilation strategy and MV as first-line therapy. Eligible patients were adults (> 18 years) with severe respiratory failure and confirmed COVID-19 pneumonia. The primary endpoint was survival to hospital discharge and secondary analysis assessed duration of respiratory support. RESULTS: After propensity score matching, 110 patients (55 in each group) were included in the final analysis. Survival to hospital discharge was significantly higher in patients treated with HFNO first compared to MV first; 31/55 (56%) versus 17/55 (31%), p=0.007. After adjustment for other covariates, the “HFNO first” group had a 71% increased chance of survival to hospital discharge when compared to the “MV first” group; OR=0.28, 95% CI [0.13 – 0.63], p=0.0018. There was a non-significant trend in patients treated with HFNO group requiring less time on respiratory support (p= 0.06). CONCLUSION: This study supports the evidence for the use of HFNO as an initial ventilation strategy for patients with COVID-19-related acute respiratory distress syndrome (ARDS). Survival rates in the “HFNO first” cohort were significantly higher, even in those that subsequently required ventilation, compared to the “MV first” strategy. This study adds important evidence to the debate on the potential benefits and harms of HFNO as well as highlighting its advantages in a resource-constrained setting. The efficacy and implementation of HFNO as an initial ventilation strategy require further investigation. The “HFNO first” strategy employed at Groote Schuur Hospital in the first wave of the COVID-19 pandemic demonstrated a markedly higher survival rates. This suggests that HFNO is highly effective as an initial ventilation strategy in COVID-19 ARDS in a resource-limited settin
The Role of the Lessor s Tacit Hypothec and Accession as Common Law Protection Measures for Landowners in Solar Energy Power Purchase Agreements
Get PDFThe demand for renewable solar energy in private businesses is becoming a key component in everyday operations given today's energy climate in South Africa. A hurdle in integrating solar energy into a private business is the capital outlay required by the landowner to install the necessary solar infrastructure. The renewable energy industry provides an alternative to private landowners, making the benefits of solar energy available without requiring any capital outlay to fund solar installations. These opportunities for private landowners are typically governed by Power Purchase Agreements (PPAs) between the landowner and the Independent Power Producer (IPP). The PPA provides the contractual relationship between the landowner and the IPP for the buying and selling of solar energy, respectively. The PPA also outlines the parameters between the landowner and the IPP specific to the site as well as the performance obligations of each party. Problems may arise if the IPP fails to comply with its performance obligations. This dissertation investigates the possibility of applying common law protection measures against the IPP, should the latter fail in specific performance obligations set out in the PPA. The study focuses specifically on two common law protection measures, namely the lessor's tacit hypothec and the law of accession. The study has the following objectives: 1. Determine the legal criteria to rely on the lessor's tacit hypothec and accession respectively; 2. Investigate how the principles of the lessor's tacit hypothec can be utilised as a protection measure for landowners against non-performing IPPs in the context of a PPA; and 3. Investigate to what extent landowners can rely on the law of accession as an alternative protection measure against non-performing IPPs where the lessor's tacit hypothec is not a viable legal option. Following a multiple case-study approach, PPAs provided by participating IPPs are reviewed to determine to what extent the PPAs address issues relevant to the application of the lessor's tacit hypothec and accession. Furthermore, research participants are interviewed to collect data on the technicalities regarding the method of attachment of the solar infrastructure to the landowner's property as well as the general life span of these solar systems in relation to the PPAs signed by both parties. The study also identifies the challenges in the application of the two protection measures in the context of a PPA. The findings illustrate that the provisions of each PPA must be considered when determining the possibility of applying these protection measures against the non-performing IPP. Each PPA is project-specific, creating subtle nuances to the PPA. These subtle differences may support or exclude the application of the two protection measures. The dissertation makes recommendations regarding issues that should be addressed in a PPA. It also highlights aspects for future research in this context