247 research outputs found
Incidence of severe late toxicities and quality of life in patients with locally advanced cervical cancer treated with concurrent chemoradiotherapy at Charlotte Maxeke Johannesburg Academic Hospital South Africa, 2014-2017
No full textA research submitted in partial fulfilment of the requirements for the degree of Master of Medicine in Radiation Oncology to the Faculty of Health Science, University of the Witwatersrand, Johannesburg, 2020Purpose The purpose of this study was to determine the incidence of bladder and gastrointestinal (GIT) complications in patients with severe-late cervical cancer (≥Grade 3 and >90 days after treatment completion) bladder and gastrointestinal complications; and to describe both the complication--related and sexual-health related quality of life experienced by these patients treated with chemoradiation for locally advanced cervical cancer.
Methods This is a retrospective analysis of prospectively collected study data from a Phase III randomised controlled trial (RCT). This RCT investigated the benefits of combining hyperthermia with chemoradiation in 76 patients with FIGO Stage IIB and III cervical cancer whom were selected from the control arm. The Kaplan Meier time-to-event analysis was used to determine actuarial probability of complications, while clinician reported morbidity was recorded using Radiation Therapy Oncology Group (RTOG) criteria and patient reported outcomes (PRO) were recorded using EORTC QLQ CX24 quality of life (QoL) questionnaires. These criteria were assessed at baseline, and then every three months post-treatment during the first year and every six months post-treatment in the second year. Results The mean age of the patients was 50 years (SD±10.6.). 50% were HIV positive with a mean age of 45.2 years (SD±9.3) and a median CD4 count of 518 (range 374-626). All patients completed the entire course of concurrent Cisplatin based chemotherapy and chemoradiation (CCRT) within 56 days. GIT complications were largely obstructive and appeared predominantly in the second year, and the risk of was similar independent of the presence of disease. Local rectal fistulas were more common in patients who ultimately died from disease progression. The predominant bladder complications were fistulas, where the highest risk of developing a fistula was in the first year and half as likely to develop in those with no evidence of disease (NED). In those with NED, 5.3% developed ≥Grade 3 bladder complications (Grade 3 n=1, Grade 4 n=2, Grade 5 fatality n=1) with an actuarial probability of 3.3% and
V
12.5% in the first and second year respectively. 3.5% of patients with NED developed ≥Grade 3 GIT complications (Grade 3 n=2, Grade 4 n=0, Grade 5 fatality n=2) with 0% in the first year and 23.1% actuarial risk during the second year. The probability of being alive with or without severe complications was not statistically different (ChiSquare 0.788 p=0.375 Log Rank: Mantel-Cox). It was noted that those without complications lived longer and the median survival had not been yet reached. Further to this, patients with complications reported more severe symptoms than those without complications (bladder 20% vs. 5% and GIT 21% vs. 8%), which tended to be complication specific symptoms e.g. incontinence in fistulas or related obstructive symptoms.
There was a large discordancy between clinician graded severe toxicity and PRO of toxicity in the GIT (7.9% vs.10%) and slightly different with bladder toxicity (9.2% vs. 7%). Clinician’s grading using the worst toxicity underestimated the duration and quality of life that patients endured with Grade 3/4 symptoms before a Grade 5 fatality.
Sexual worry and poor body image, were present in 60% of patients at baseline and this remained constant for the first year post-treatment but decreased in those who survived beyond a year to 35-40%. 11% of patients reported being sexually active at baseline but this doubled by six months post–treatment and plateaued to 30% of patients after nine months post-treatment. 21% of women under 30 years, 22% of those aged 31-50 years and 10% of patients over 50 years of age reported having sex in the previous four weeks. Out of the 72 reports of sexual activity, pain during intercourse was reported in 65% of patients while 77% found intercourse enjoyable and 51% of the patients found it both enjoyable and painful. 26% of patients reported enjoying intercourse without pain and 14% who did not enjoy intercourse reported pain.
The main vaginal symptom was discharge, which was almost twice as prevalent as vaginal discomfort throughout the first two years post-treatment (71% vs. 43% at baseline; 40% vs. 27% at 6 months; 23% vs. 14% at 18 months). However, there was a clear and noteworthy improvement over time.
Conclusion There is a high risk of developing severe complications in patients who survive the first year; and their quality of life outlook is significantly worse than those without complications. Monitoring patterns of tell-tale symptoms and their intensities reported by patients is, currently, the best ‘early-warning system’ to detect severe late complications. In light of the high fatality rate, a comprehensive multidisciplinary approach is needed for patients reporting the severest symptoms in order to rapidly avert complications and to support those who suffer the harrowing effects once they have developed complications. Providing care on a daily basis, but without the indepth understanding of what is most meaningful to patients, only widens the gap in the care of patients. These findings can help health professionals to shape patient expectations by paying closer attention to concerns about their bodies and sexual function, and to reassure patients that there are improvements over time.TL (2020
Presbyterian Indians in South Africa
No full textThis research is part of the
project, ‘African Christianity
and Development’, directed
by Prof. Dr Jerry Pillay,
Department of Church
History and Church Polity,
Faculty of Theology,
University of Pretoria,
South AfricaIn this article the author traces the origins and development of Indians in the Uniting
Presbyterian Church in Southern Africa. He acknowledges the work of the founder of the
Indian Presbyterian work, the Rev. Joseph Prakasim, looks at the expansion of Presbyterianism
among the Indian population in South Africa and shows how through various ministries these
congregations contributed to the development of the Indian communities in South Africa,
impacting on the country as a whole.http://www.hts.org.za/am2016Church History and Church Polic
Safety, strength and simplicity of efavirenz in pregnancy
No full textThe WHO recommends starting lifelong ART for all pregnant women with a CD4 count at or below 350 cells/mm³, which recognises the important component of ‘when to start’ and the role that timing of initiation plays in reducing mortality and disease progression. The data on ‘what to start’ are conflicting, and options for resource-limited settings are limited. The choice of an ART regimen for pregnant women is complicated by the need to take into account the health and safety of both the mother and baby. Particularly contentious is whether to use a nevirapine- (NVP) or efavirenz- (EFV) based regimen. This review presents the latest evidence on the safety and efficacy of EFV and NVP in pregnancy and offers recommendations for improving maternal and child health outcomes and avoid mother-to-child transmission as South Africa moves toward turning back the tide on its HIV epidemic
A descending chain condition for groups definable in o-minimal structures
No full textWe prove that if G is a group definable in a saturated o-minimal structure, then G has no infinite descending chain of type-definable subgroups of bounded index. Equivalently, G has a smallest (necessarily normal) type-definable subgroup G 00 of bounded index and G/G 00 equipped with the “logic topology” is a compact Lie group. These results give partial answers to some conjectures of the fourth author
The significance of social justice and diakonia in the Reformed tradition
No full textSpecial Collection: Agenda 2063 – The Africa We Want – Religious Perspectives, sub-edited by Jerry Pillay (University of Pretoria).The Reformed tradition, emerging in the 16th-century Reformation, consists of a variety of sources that often lead to complex and differing views about beliefs, doctrines and ethics. However, this tradition and theology have always stressed the significance of social justice and diakonia as important aspects of faith and ministry, even though its great sense of diversity has often nuanced and stressed different levels of understanding and engagement of social justice. This article aims to show that social justice and diakonia are integral to Reformed tradition and practice. Using mainly the methodologies of literature review and contextuality (the author's context), this article establishes that social justice is grounded in the history, theology, spirituality, confessions and polity of the Reformed faith. The latter aspects are also contained in the notion that to be Reformed is to be ecumenical. In this sense, Reformed tradition is concerned about the whole world and all creation.
CONTRIBUTION : The diverse and complex nature of Reformed tradition and theology often creates a sense of confusion on how Reformed Christians understand social justice and diakonia. This article offers a significant contribution to establishing that social justice is an integral aspect of Reformed tradition. By firmly grounding social justice in the history, theology, spirituality, confessions and polity of the Reformed faith, the author makes a significant contribution to a debate that has pervaded Reformed churches over many centuries.http://www.hts.org.zaam2023Church History and Church Polic
Book Review: Textbook of Global Health
No full textBook Title: Textbook of Global HealthBook Author: A-E Birn, Y Pillay and T.H. Holtz4th ed. New York: Oxford University Press, 2017. ISBN: 9780199392285
Utilizing a novel high-resolution malaria dataset for climate-informed predictions with a deep learning transformer model
No full textClimatic factors influence malaria transmission via the effect on the Anopheles vector and Plasmodium parasite. Modelling and understanding the complex effects that climate has on malaria incidence can enable important early warning capabilities. Deep learning applications across fields are proving valuable, however the field of epidemiological forecasting is still in its infancy with a lack of applied deep learning studies for malaria in southern Africa which leverage quality datasets. Using a novel high resolution malaria incidence dataset containing 23 years of daily data from 1998 to 2021, a statistical model and XGBOOST machine learning model were compared to a deep learning Transformer model by assessing the accuracy of their numerical predictions. A novel loss function, used to account for the variable nature of the data yielded performance around + 20% compared to the standard MSE loss. When numerical predictions were converted to alert thresholds to mimic use in a real-world setting, the Transformer’s performance of 80% according to AUROC was 20–40% higher than the statistical and XGBOOST models and it had the highest overall accuracy of 98%. The Transformer performed consistently with increased accuracy as more climate variables were used, indicating further potential for this prediction framework to predict malaria incidence at a daily level using climate data for southern Africa.長崎大学学位論文 学位記番号:博(医歯薬)甲第1602号 学位授与年月日:令和6年3月19日Author: Micheal T. Pillay, Noboru Minakawa, Yoonhee Kim, Nyakallo Kgalane, Jayanthi V. Ratnam, Swadhin K. Behera, Masahiro Hashizume & Neville SweijdCitation: Scientific Reports, 13, art. no. 23091; 2023Nagasaki University (長崎大学), 博士(医学) (2024-03-19
Utilizing a novel high-resolution malaria dataset for climate-informed predictions with a deep learning transformer model
No full textNagasaki University (長崎大学)博士(医学)Climatic factors influence malaria transmission via the effect on the Anopheles vector and Plasmodium parasite. Modelling and understanding the complex effects that climate has on malaria incidence can enable important early warning capabilities. Deep learning applications across fields are proving valuable, however the field of epidemiological forecasting is still in its infancy with a lack of applied deep learning studies for malaria in southern Africa which leverage quality datasets. Using a novel high resolution malaria incidence dataset containing 23 years of daily data from 1998 to 2021, a statistical model and XGBOOST machine learning model were compared to a deep learning Transformer model by assessing the accuracy of their numerical predictions. A novel loss function, used to account for the variable nature of the data yielded performance around + 20% compared to the standard MSE loss. When numerical predictions were converted to alert thresholds to mimic use in a real-world setting, the Transformer’s performance of 80% according to AUROC was 20–40% higher than the statistical and XGBOOST models and it had the highest overall accuracy of 98%. The Transformer performed consistently with increased accuracy as more climate variables were used, indicating further potential for this prediction framework to predict malaria incidence at a daily level using climate data for southern Africa.長崎大学学位論文 学位記番号:博(医歯薬)甲第1602号 学位授与年月日:令和6年3月19日Author: Micheal T. Pillay, Noboru Minakawa, Yoonhee Kim, Nyakallo Kgalane, Jayanthi V. Ratnam, Swadhin K. Behera, Masahiro Hashizume & Neville SweijdCitation: Scientific Reports, 13, art. no. 23091; 2023Nagasaki University (長崎大学), 博士(医学) (2024-03-19)doctoral thesi
Minding the gap between policy and practice amongst extension workers : lessons from KwaZulu Natal
No full textCITATION: Mohamed Sayeed, C.N., Reddy, P.S. & Pillay, P. 2015. Minding the gap between policy and practice amongst extension workers: Lessons from KwaZulu Natal. South African Journal of Agricultural Extension, 43(1):57-65.The original publication is available from http://www.scielo.org.za20 years into a post-apartheid South Africa, the National Development Plan (NDP) provides the contextual and institutional framework for all of governments activities. As a result, there is a call for extension to increasingly become associated with efficient and effective delivery of services in line with government policy to improve the quality of public services which are critical to achieving a transformed racially equitable public service. This article interrogates the issue of a gap between policy and implementation amongst Extension Workers by reflecting on the findings of research conducted as part of a doctoral study in Public Administration by the main author at the University of KwaZulu Natal. The article makes reference to the findings related to policy knowledge amongst Extension Workers and the challenges related to policy implementation in KwaZulu Natal, and seeks to use the findings of this research to present opportunities and challenges for the implementation of the NDP and concludes that whilst Extension Workers are now challenged to find a balance between their functionality within extension and as public servants, it is important for some consideration to be made by government and education institutions for the changing roles of Extension Workers.http://www.scielo.org.za/scielo.php?script=sci_abstract&pid=S0301-603X2015000100006&lng=en&nrm=iso&tlng=enPublisher's versio
- …
