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

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

Gender-based discrimination and underrepresentation of female judges in the superior courts in South Africa – a critical analysis of international and domestic laws and policies on the protection of women's rights

Gender stereotypes, patriarchal ideologies and discriminatory cultural beliefs have resulted in continuous discrimination against women in all spheres of life. Throughout the years, women around the globe were denied basic human rights such as the rights to equality, safety, dignity, education, equal economic opportunities, and the right to vote among others. Today, despite the robust efforts under international, regional and domestic law to eliminate discrimination against women in all its forms, gender stereotypes remain the primary factor contributing to the disparity in the representation of women judges in the Superior Courts in South Africa. This dissertation examines the issues of gender-based discrimination in the appointment of female judges to the Superior Courts in South Africa and the underrepresentation of women in senior positions in the post-apartheid independent judiciary. It addresses the question of whether women in the judiciary in South Africa are adequately protected by the laws and policies enacted on an international, regional, and domestic level on the protection of women's rights and the promotion of gender equality. It argues that while significant progress has been made over the years to ensure gender diversity on the bench, women in South Africa continue to face gender based discrimination before and during judicial appointment processes in the Superior Courts and remain highly unrepresented in senior judicial positions. While the current international and regional human rights instruments provide a relatively extensive protection of women's right to equality in various spheres of life, they have omitted to address crucial factors in the achievement of gender equality in the workplace. Furthermore, South Africa has failed to fully implement de facto equality between women and men and to eliminate the key factors contributing to gender inequality on the Bench – namely, the harmful gender stereotypes and patriarchal attitudes deeply entrenched in the South African society

Long-term changes in the incidence and characteristics of plastic ingested by White-chinned Petrels

Environmental plastic floating at sea is difficult to measure due to its high spatial and temporal variation. White-chinned Petrels Procellaria aequinoctialis are surface-foraging seabirds found in the Southern Ocean that often ingest plastic. They are susceptible to being caught on fishing gear, providing large numbers of carcasses that can be used to monitor changes in the incidence and characteristics of plastic floating at sea. Of the 2477 White-chinned Petrels caught off South Africa between 1979 and 2023, 56% contained plastic. Data were grouped into time periods to determine temporal variation while accounting for unequal yearly sample sizes. The proportion of birds containing plastic has remained between 47% and 63% since 1979. Changes in the number of plastic items ingested were determined by fitting the data with a negative binomial regression model. The number of plastic items ingested has significantly increased since 1979, although not consistently, with the lowest average load in 1979–85 (1.86 ± 3.79 items per bird) and the highest in 2017–23 (6.81 ± 18.51). Although the average ingested plastic load was greatest in the last 7 years, the sample size is smallest for this period due to reduced bycatch rates, so more data are needed to confirm the recent increase in ingested plastic. The proportion of pellets declined from 25% to 14%, with the average number of pellets per bird following a similar trend until two highly impacted birds were found in 2022 and 2023 containing 48 and 22 pellets respectively, possibly reflecting recent large pellet spills at sea off South Africa. The proportion of flexible plastics (fibres and films) ingested is high compared to other seabirds and has increased over time, potentially due to their behaviour of scavenging behind ships. Some birds contain fibrous gastroliths up to 20 mm in diameter. Recording plastic loads in White-chinned Petrels killed accidentally on fishing gear offers a useful method to monitor long-term changes in floating plastic at sea

A Review of Women with Epithelial Ovarian Carcinoma in a Middle-Income setting: Groote Schuur Hospital, Cape Town, South Africa: Demographics, Treatment and Outcomes of Patients between 2005 and 2015

Background: In 2020 there were 313 959 new cases of Ovarian carcinoma worldwide.1 It is one of the most challenging female gynaecological cancers to manage with a poor prognosis for latestage disease and high recurrence rates. Ovarian Carcinoma ranks 8th amongst new cancer cases in women and accounts for 4.7% of reported cancer deaths.1 Women often present late with advanced disease of which the prognosis remains poor. The 5-year survival rate of stage 3 disease being 52-59% and only 17% for stage 4B disease.2 Overall the 5-year survival rate of many malignancies have improved over the past 30 years due to advances in screening, diagnosis and treatment, but despite these advances the survival rate of ovarian carcinoma has shown only a modest improvement.3 Methods: The study is a retrospective descriptive study of patients with epithelial ovarian carcinoma treated at Groote Schuur Hospital in Cape Town between 2005 and 2015. The study included all patients with epithelial ovarian carcinoma registered with and treated at our combined multidisciplinary clinic. There were 168 patients included in this study. Data was collected from patient folders and an existing cancer database(R016/2013). Data collection sheets were used and the data was entered into a secure database for analysis Results: The study population included 168 patients. The mean age was 59.4 years (standard deviation 11.6). High grade serous ovarian carcinoma was the most prominent histology accounting for 64.3% of cases. Endometroid and Mucinous histology was reported in 12.5% and 11.9% of cases respectively. Only 33.9% of patients presented with early-stage disease. Patients with advanced stage disease accounted for 66.1% of our study population. Of the 163 patients who underwent primary cytoreductive surgery, 72 (44.2%) patients were completely debulked with no residual disease, 18 (11%) were optimally debulked to less than 1cm residual disease and 72 (44.2%) still had gross residual disease. A complete response was achieved in 62.5% of our patients, 60 (57.1%) of these patients had recurrent disease with a median time to recurrence of 11.5 months. The median overall survival was 27.2 months with 5-year overall survival of 21%. The 5-year disease specific survival was 27%. Conclusion: Ovarian carcinoma remains one of the most challenging gynaecological malignancies to manage even in high resource settings. Rates of complete cytoreductive surgery were lower at our unit than reported in high income settings. Recurrence rates were high with shorter time to recurrence. The median survival of our patients was also much shorter than reported in literature. This may reflect the limitations in limited resource setting when managing patients with epithelial ovarian carcinoma