Patterns of care and outcomes for women with locally advanced cervical cancer, treated with curative intent, between 2013-2017 at a tertiary centre in South Africa

Objective Cervical cancer is the leading most common cause of cancer-related deaths in South Africa. The standard treatment guidelines of locally advanced cervical cancer (LACC) is external beam radiation followed by brachytherapy with concurrent platinum based chemotherapy. The aim of this study is to evaluate the patterns of care and outcomes for patients with LACC (Stage IB1 – IVA) treated with curative intent at a tertiary center in South Africa. Materials and Methods This is a retrospective study conducted at Groote Schuur Hospital (GSH) in Cape Town, South Africa between July 2013 – July 2017. Overall survival (OS) and disease free survival (DFS) were evaluated using the Kaplan–Meier method. Factors associated with outcomes were analyzed using Cox proportional hazards regression modeling. Logistic regression modeling was performed to assess factors associated with chemotherapy receipt and baseline hemoglobin ≥ 10 g/dL. Results A total of 278 women were eligible to participate in this study, of which 28.4% (n=79) were HIV infected and 71.6% (n=199) were HIV uninfected. Among the patients with HIV the median CD4 count was 441 cells/μL (IQR; 315-581 /μL) and all had been initiated ART before commencing treatment. The median age for all patients 51 years(IQR; 41-60). Most patients had stage II disease accounting for 48.6% (n=135) or stage III disease accounting for 45.3% (n=126). Majority of the patients had squamous cell carcinoma (SCC) 88.4% (n=246). Evaluation of baseline investigation showed median Hb for all patients was 11.3g/dL (IQR; 9.70-12.8). Patients who received concurrent chemotherapy were 64.8% (n=180) for a median of 5 cycles. Median EQD2 dose 74.5Gy (IQR;69-80.9). The 2-year OS and DFS in the entire population was 73.3% and 72.3% respectively. Factors associated with improved OS in our cohort were receipt of chemotherapy (HR 0.32, p=0.005) and higher baseline haemoglobin (HR 0.86; p=0.018). On multivariate logistic regression adjusting for age, stage, and HIV status, showed that patients with stage III/IV disease were less likely to receive chemotherapy (HR 48.17, p=10g/dL (HR 0.20, p<0.001). The 2- year OS was 87.4% for patients who received concurrent chemoradiotherapy (CCRT) vs. 52.8% for those who received radiotherapy (RT) alone (p<0.001). The 2-year DFS was 80.2% for those who received CCRT vs 58.3% for those who received radiotherapy alone(p=<0.001). Conclusion Concurrent chemotherapy is significantly associated with increased survival. In this study, patients with stage III and IV treated with curative intent did not receive chemotherapy, which was detrimental to their survival. Therefore, if performance status allows, it is essential for all to receive chemotherapy. However, patients with low Hb may require transfusion to necessitate they receive chemotherapy

Factors associated with health information systems that influence continuity of TB care between a District hospital and Primary Healthcare facilities

Background: South Africa is well known to have a high burden of Tuberculosis (TB) disease. The Western Cape has been identified as having one of the highest numbers of new infections of TB per year in South Africa. TB is the cause of significant mortality and morbidity and has substantial financial implications for patients and the health system. As a result of high levels of HIV, poverty and overcrowding TB has been difficult to eradicate. The significant burden of disease, the caseloads and staff shortages also contribute to challenges to successfully continuing care of TB patients. It has been noted that as much as 24% of TB patients may be lost to follow up (LTFU) in certain districts of the Western Cape. While previous studies have looked at factors that influence LTFU and continuity of care (COC), no studies have examined how the design and use of Health Information Systems (HIS) may influence these outcomes. This study aims to describe the current use of HIS in the discharge process of a TB patient at a district hospital in Western Cape and further aims to identify how HIS may facilitate or create barriers to successfully continuing a patient's TB treatment at primary healthcare level after discharge from a district hospital. Methods: The study was conducted through two phases. Phase 1, secondary data analysis of process maps previously created to understand the TB care pathways and the associated gaps in care within a district hospital and phase 2, a semi-structured interview process. Analysis of both phases involved qualitative thematic analysis attempting to identify and unpack Health Information Systems (HIS) challenges associated with TB care. Results: Barriers were identified which prevented seamless use of HIS and which did not promote COC. These included poor understanding of TB administrative and referral processes, and what is required to successfully link to TB care and continue care at primary healthcare (PHC) facilities. Further barriers were resources and usability of the HIS, as well as data integrity and fragmented HISs. The only facilitators identified was the availability of clinical information where access was possible and data was complete, as well as an electronic referral platform to TB hospitals. Conclusion: Obstacles exist to the effective utilization of HISs in ensuring continuity of TB care between district hospitals and community clinics. To mitigate some of these limitations, we propose that training on SOPs, HISs, and administrative procedures for TB management be intensified. Clarifying ambiguities regarding data, workflows, and HIS prerequisites that support COC could help HCWs better facilitate COC through HIS usage. Additionally, organizations should strive to minimize resource deficiencies hindering HIS utilization. Insights from the TB hospital referral system can be leveraged to enhance care linkage

“Foreign migrant women's perceptions of obstetric care in the Cape Town metro pole.”

This study explores the maternal healthcare experiences of nine foreign migrant women who received obstetric care in the Cape Town metropole. The Republic of South Africa's legislation enshrines the right to health for all who live within the country's borders, regardless of residency status. In practice however, foreign migrants can experience significant challenges and, in the Cape Town metropole how these women experience obstetric care has not been a focus of scholarly interrogation. With this study I hope to establish the factors that influence migrant women's experiences positively or negatively and to utilise the knowledge gained from their experiences to enhance pregnancy care of migrant women in the longer term. A literature review was performed covering the areas of migration to South Africa, migrant women's health, migrant's health challenges and official South African health care policies. Data was collected by doing one on one, open-ended and semi-structured interviews with nine foreign migrant women from seven different countries and with two key stakeholders employed at two of Cape Town's largest refugee centres. The interviews were recorded, professionally transcribed and then data inductively coded using thematic analysis. Thematic analysis was used since it is a way to extract descriptive information concerning the experiences of migrant women in Cape Town and to construct meaning, in order to understand their perceptions about the obstetric care. The findings indicate that the attitudes &amp; behaviours of staff, language, prior traumatic experiences, degree of assimilation and healthcare systemic issues are some of the chief factors that influence perception of care. Xenophobia and dismissive behaviour were the main issue with staff but that was juxtaposed against some excellent and compassionate care received. Some of the women struggled to communicate the nature of their problems and being understood but also found understanding local staff a significant barrier. Having had to endure staff attitudes and behaviours can reasonably be agreed to have delayed monitoring or intervention. Language barriers resulted in adherence issues with medications, potential missed appointments, issues around informed consent and missed opportunities at health promotion. The women had a poor understanding of the local healthcare system's design and had expecta tions in relation to their own experience of the system in origin countries. When these expectations were not met, it was perceived as poor. A key challenge was the failure of the facilities to recognise the asylum documentation and the rights afforded to those who had them. The reasons for fleeing their countries included warfare, geno cide, political turmoil and economic deprivation. The journeys to Cape Town were fraught with further trauma and this made the women vulnerable to mental health is sues which also impacted their perceptions of care. Further, a traumatic birth in Cape Town carried significant sway over how further births in Cape Town were viewed. It is clear from this study that multiple, complex factors influence the way foreign mi grant women perceive their care. These factors are personal and unique to each indi vidual but there were commonalities. Trained interpreters, cultural sensitivity training, education surrounding documentation, allowing birth partners to be present during visits and births, extra safety checks on perinatal mental health for first time births in Cape Town and a more robust, confidential and accountable complaints system were recommendations by this cohort

A design-based research perspective for multiple immersive digital conversations in academic research writing literacies

In the South African higher education context, academic writing support at the postgraduate level presents significant challenges for institutions. The conventional dyadic models of writing support, typically offered by writing centres, are increasingly viewed as inadequate in addressing the multifaceted nature of academic writing and literacy challenges. This study advocates for a shift towards a more inclusive and holistic approach, promoting trialogic and multi-lateral conversations within writing centres to address these challenges. The study's methodology is deeply rooted in literature and adopts Reeves' (2006) four-phase model to guide the Design-Based Research (DBR) approach. Through two iterative intervention cycles, the study integrates efforts from writing centres and subject lecturers to facilitate immersive conversations aimed at academic research literacy development. The third phase of DBR intensively focuses on testing and refining the interventions to address directly identified obstacles. The effectiveness of these interventions is measured through qualitative data collection methods, including surveys, interviews, observations, and document analysis. The study aims to answer the question: What are the design principles for facilitating multiple immersive digital conversations in academic research writing literacies? To answer this question, the study creates a dynamic and interactive environment where students can engage in meaningful dialogues and collaborative activities by integrating digital tools like Google Drive into the learning process. The study develops an integrated theoretical framework for multiple immersive digital conversations for academic research writing that interlinks linguistic, cognitive, and social elements. The study's participants include Bachelor Honours students and Advanced Diploma students, writing centre practitioners, and academic supervisors at a university in South Africa. The theoretical contribution of the study is a model of refined design principles for developing a robust intervention for multiple immersive digital conversations in academic research writing literacies. These principles advocate for pedagogies that respect and incorporate students' identities, aligning with adaptive and culturally inclusive teaching practices. In the realm of academic writing instruction, these principles have the potential to improve support systems significantly, enhancing students' academic achievements and advancing their research literacy skills

Under the skin of a culture: perceptions of fake leopard skin alternatives in the Shembe Baptist Church

Since prehistoric times, big cats such as leopards have had symbolic importance in human culture. They are prized as symbols of power, nobility, ferocity and very often, masculinity. Religious groups have also been known to wear animal skin as part of their ceremonial regalia, typically for aesthetic, superstitious and spiritual reasons. However, throughout much of their historical distribution, leopards have been actively hunted, poached or killed in retaliation for livestock losses so extensively that many of their populations are now under direct threat. Despite attempts to control illegal harvesting and trade through international conservation organizations such as CITES the use of and trade in leopard products remains commonplace throughout their range. In Southern Africa one of the most widespread and obvious users of leopard skins are members of the Shembe Nazareth Baptist Church. The Shembe church, which has approximately 6 million followers, was founded by Prophet Isaiah Shembe on 1910 in Durban, South Africa. This modern take on Zionist beliefs integrates aspects of Christianity and traditional Zulu beliefs. Followers wear white, full length garments when praying and a diverse array of animal skins when engaging in traditional dance. The most popular and prestigious animal skin is that of a leopard. Given concerns around the increasing demand for leopard skins, Panthera (cat conservation NGO) initiated the Furs for Life project in 2013, introducing synthetic leopard skin alternatives to real skins. These ‘faux' skins were donated to the Shembe church for dissemination among their followers, with the hope that this would ultimately reduce demand for real skins. While approximately 24,000 faux furs have been distributed within the Shembe church to date, little is known about how well these have been received or how effective this conservation intervention has been. In this brief, exploratory study 100 randomly selected recipients of faux furs were surveyed to address concerns pertaining to: faux fur use, demand for real skins, consumer satisfaction, knowledge of conservation and policy perceptions, through a descriptive statistics and basic generalised linear model framework. We found that after a period of three years, at least 90% of the respondents still have their fake furs, have been using them approximately six times a year and were positive about the product they received from Panthera. More than 60% of respondents are aware of leopard population trends, and 66% of respondents believed that the government should intervene in leopard conservation. Faux leopard furs have been very successful, reporting a higher than 50% usage in Shembe gatherings, with most respondents indicating how aesthetic and durable faux furs are as well as how similar they are to real leopard fur. As this was a pilot study with only 100 respondents so statistical power was limited given the number of variables, we suggest a similar study done on a larger scale to understand the efficacy of the intervention

St-elevation myocardial infarction systems of care in Africa

Objectives: The aim of the study is to describe and summarise the body of literature pertaining to ST-Elevation Myocardial Infarction Systems of Care (STEMI SOC), as well as barriers and solutions to STEMI SOC implementation in the African context. Methods: The Scoping Review has been designed following the PRISMA-ScR Guidelines. The search strategy consisted of three elements: STEMI Systems of Care, STEMI, and Africa. These three elements were combined to compile a comprehensive search strategy to answer the main research question. EbscoHost, Medline via PubMed, and Google Scholar databases were searched. All study types that collected primary data or that ran an analysis on an existing data set, conference abstracts, reports, and unpublished ‘grey' literature were included. Studies not in English and where a full text was not available were excluded. Two reviewers independently assessed the studies for eligibility based on title, abstract, and full text. Included full-text articles were interrogated in the same manner. Data was extracted from the included literature and were subjected to descriptive analysis to develop a summary description of the main themes. Results: A total of 656 articles were identified through the database search, 607 articles were excluded after duplications removal and full text screening. A total of 49 articles met the inclusion criteria for full review. The articles originated from studies conducted in South Africa 39%, Egypt 12%, Kenya 10%, Tunisia 10%, Ethiopia 8%, Ivory Coast 6%, Cameroon 4%, and one study each from Sudan, Tanzania, Libya, Nigeria, and the combined Maghreb Region. The literature on STEMI systems of Care in Africa is scarce with only Egypt, Tunisia, and South Africa reporting some information on their systems. STEMI patients in Africa are generally younger than their Western counterparts, present late to healthcare facilities, have low education levels, insufficient healthcare insurance, and are non-adherent to discharge medication. Emergency Medical Services are lacking, there's a shortage of PCI-facilities, EDs are disorganised, STEMI reperfusion times are delayed, data collection and quality assurance initiatives are inadequate, and STEMI referral networks and -registries are left wanting. In addition, there's a deficiency of ECG and telemetry, a shortage of healthcare workers, a lack of adherence to guideline recommended therapy, and a perceived hesitancy of medical personnel to administer fibrinolytics, suggestive of a need for more clinical education. Conclusion: A myriad of barriers has been reported in this review, as well as potential facilitators in the implementation of these networks. The coordination and introduction of a STEMI Systems of Care in African settings potentially holds great advantages as has been witnessed in other LMICs and HICs

Strategies for real estate brokers to compete in an increasingly technology-driven market: exploring the value of information search and transaction management

This research examines the evolving role of real estate brokers in South Africa in the context of advancing technology, specifically focusing on Information Search and Transaction Management services. With the traditional information asymmetry enjoyed by brokers being eroded by technological advancements, the study explores how these changes affect the perceived value of brokerage services. Employing a quantitative approach, including a literature review and online surveys targeting consumers and brokers, the study aims to understand the impact of technology on real estate brokerage services and identify effective strategies for brokers to remain competitive in a technology-driven market. The findings indicate a significant evolution in brokerage services, particularly in enhancing information search efficacy, owing to technological integration. The study also reveals that specific elements like negotiation skills and property-client matching significantly contribute to service value. Interestingly, areas like conflict resolution still heavily rely on the broker's human skills, suggesting a balanced need for technological and human elements in brokerage services. The research concludes that successful real estate brokers in a technology-driven market are those who effectively blend technology with their unique human capabilities. The study's implications point to the necessity for continual adaptation and technological integration by brokers, while also emphasizing their irreplaceable human elements. Future research directions include exploring effective technologies in various brokerage service aspects and potential advancements in currently underserved areas like transaction conflict resolution

The 2.7 resolution cryo-EM reconstruction of Mycobacterium tuberculosis encapsulin nanocompartment containing DyP peroxidase

Mycobacterium tuberculosis has evolved many persistence factors in response to the host generated immune response as a means of survival. One such immune response generated by humans is the use of reactive oxygen species (ROS) such as H2O2 to cause damage to M. tuberculosis. Encapsulin (from here on referred to as Enc) nanocompartments and the cargo proteins within have been implicated as persistence factors and decreased viability of cells has been shown when they are knocked out. Previous research has found that dye-decolorizing peroxidase (DyP) is encapsulated by these Enc nanocompartments, as has been shown in Mycobacterium smegmatis. This is done by way of a C-terminal targeting peptide, with Enc and DyP also being part of the same operon in the genome of M. tuberculosis. However, not much is understood about the structure and function of this system. Both encapsulin and DyP were expressed and purified recombinantly in E. coli. Cryo- EM particle processing and EM map reconstruction was carried in an attempt to generate a density map of encapsulated DyP along with model building. Native expression and purification were carried out followed by negative-stain EM on this sample.Successful recombinant expression and purification of DyP and Enc was achieved, with a high-resolution 2.7 Å cryo-EM structure of the Enc nanocompartment obtained, but no encapsulated DyP was visualized. A model of both the Enc monomer and multimer was built, with comparisons to M. smegmatis in charge around the fivefold pore showing differences. The purification of Enc from M. tuberculosis was successful and a negative stain reconstruction of the nanocompartment was obtained. 2D classes showed what could have been DyP but it did not show up in any 3D models. Ferritin was shown to only be outside of the nanocompartment. The high-resolution map showed high similarity to other T=1 Enc nanocompartments. The multimer model built called into question the exact function of this nanocompartment as the charge distribution differed from closely related M. smegmatis. When these charge changes are correlated to findings of catalytic analysis done in the same lab, it indicates that more research is needed to understand the exact function of this system in M. tuberculosis. The 2D classes showed that DyP is the only cargo protein that appears to be present in M. tuberculosis nanocompartments, with ferritin being identified outside the nanocompartment

Adult age-at-death estimation using the pulp/tooth area ratio (PAR) method: a South African validation study using periapical radiography and stereomicroscopy

Conventional skeletal age-at-death estimation methods employed for South African adults are deficient, facing several limitations. Dental ageing techniques remain under-researched for the population. In this study, I aimed to evaluate the applicability of the pulp/tooth area ratio (PAR) ageing method when applied to maxillary canines from a South African cadaveric sample. I explored the utility of under-researched methodological approaches for the method: mesiodistal radiographs, stereomicroscopic tooth section images and PARs excluding the enamel area. To maximise sample size, only maxillary canines were considered, which demonstrate several research advantages (e.g. relatively long functional survival and high accuracy rates). Following extraction, 52 adult teeth were radiographed, sectioned and analysed using stereomicroscopy. Labiolingual and mesiodistal radiographs and labiolingual stereomicroscopic tooth section images were captured and analysed using ImageJ to obtain PARs. Age estimation linear regression models were developed for ratios obtained from each image type, including and excluding the enamel area. Models were compared for performance and accuracy using best subsets regression and cross-validation analyses. The accuracy of international standards was also assessed using the study sample. The PAR method showed promising results. It demonstrated excellent observer reproducibility and sex-independence. Sample-specific models derived from tooth section images had the best performance and accuracy, obtaining cross-validation mean absolute errors (MAEs) and standard error of the estimates (SEEs) of approximately 7 - 8 years and 10 - 11 years, respectively. Labiolingual radiographic models (MAEs = 10 years; SEEs = 12 years) showed better performance and accuracy than mesiodistal radiographic models (MAEs = 12 years; SEEs = 16 2 years). Models excluding the enamel area performed better, producing slightly better cross validation error values. Standard PAR models performed relatively poorly and were inappropriate for the study sample. This research suggests that the PAR method is a suitable technique to complement and inform standard adult skeletal age analyses in South Africa. The labiolingual radiographic approach is most practical as it is relatively accurate, minimally invasive and efficient. This study contributes knowledge to the limited pool of data on dental ageing techniques for South African adults. It informs practitioners of ideal/optimal methodological approaches for the PAR method using maxillary canines

Teachers' integration of technology in classrooms: a case study of school readiness, barriers, and opportunities in Nelson Mandela Bay District

Among the problems that public schools face in the Nelson Mandela Bay District of Eastern Cape, South Africa is teachers' lack of technology integration in curriculum delivery. The study explored teachers' Technology Pedagogical and Content Knowledge (TPACK) to understand the school readiness, barriers, and opportunities for technology integration in selected public schools in the Nelson Mandela Bay District. The study used a qualitative approach with an interpretivism paradigm. TPACK framework was used to guide the formulation of the study. Semi-structured interviews were conducted with 10 teachers who were engaged in educational technology integration in their schools. Informed consent was obtained before the start of the interviews. The findings of the study showed that teachers were trained in technology integrations. The teachers showed knowledge of using technology in curriculum delivery and were passionate about using technology. The study also revealed that teachers could select suitable technology for integration in the classroom. However, they did not always consider selecting ubiquitous technologies such as mobile phones which are accessible to learners. The study also found that teachers' knowledge of technology was narrowed to desktops, computers, and projectors. This may be cemented by the kind of training they received. The study found that teachers used the following technologies: (1) YouTube videos to explain difficult concepts, (2) Microsoft PowerPoint, for lesson presentations, and (3) WhatsApp for blended learning and communication. The study identified several barriers to teacher technology integration in the classrooms including insufficient technological resources, electricity insecurity, and inadequate training. Eliminating these berries can enhance the integration of technology in schools