Case studies on the socio-economic characteristics and lifestyles subsistence and informal fisheries in South Africa

To develop a management strategy for informal fishers, a necessary first step is information about the nature of these fishers, their numbers and their socio-economic status. To accomplish this, a survey of socio-economic conditions and use of marine resources was undertaken in 1999 at 20 localities where fishing occurs around the coast of South Africa, concentrating on subsistence or small- to micro-scale artisanal commercial fishers. In each locality, 16–31 “fisher households” were surveyed by questionnaires, focus-group discussions and interviews with key informants. Demographic analyses revealed a low level of migrancy (~5%), an average of 5.3 persons per household and a mean age of 27. Only ~20% of fishers were women and ~15% were children. Poverty was prevalent: unemployment averaged 40.3% (much higher than the national norm of 29.3%). Mean adult equivalent income per month spanned R193–R735 among regions, and was not correlated with size of settlement. Education levels were low, only ~33% of people >20 years old having completed primary school. Migrancy was highest in rural areas (but still much less than the national norm), intermediate in towns and least in metropolitan areas. Household size, participation of women and poverty all followed similar trends. Comparing regions, the East Coast and the province of KwaZulu-Natal had higher migrancy rates, larger household sizes, greater poverty, and greater participation by women in fishing, than on the South and West coasts. Household expenditure on food was ~R450 per month on the South-East and KwaZulu-Natal coasts and ~R750 on the West Coast, and exceeded 60% of income (a measure of “food security”) in about half the households surveyed. Harvested resources were sold, consumed or used as bait. In all regions, the two most frequently harvested resources were fish (mostly sold, predominantly fished by men) and intertidal rocky-shore invertebrates (largely consumed, and involving women to a greater degree). On the West Coast, rock lobster Jasus lalandii was the third-most important resource, but on the South and KwaZulu-Natal coasts this species was replaced by estuarine invertebrates. Abalone Haliotis midae, oysters, sandy-beach invertebrates and kelp or seaweeds made up the balance. Diversity of harvested resources increased west to east, following biogeographic trends. The resources could be divided into those of high value (rock lobsters, abalone and, to a lesser extent, fish) and those of lower value (such as limpets, mussels and bait organisms). It is argued that high-value resources are best used to create micro- and small-scale commercial enterprises that can serve to uplift poor fishers. Lowvalue resources constitute subsistence resources, for which preferential rights should be established for subsistence fishers, including development of exclusive-use zones where necessary. Emerging characteristics of fishing communities that were helpful in defining subsistence fishers in the South African context were poverty, harvest for self-use (whether by consumption or sale to meet basic needs of food security), use of low-technology gear, and concentration of effort on or from shores or in estuaries. At least portions of the catches of all resources are sold, and the majority of equipment is purchased, so any definition of subsistence fishers cannot exclude those who sell part of their catch or do not use hand-made equipment. Some success was evident with co-management, encouraging further exploration of this style of management for subsistence fishers. Keywords: informal fishers, socio-economics of fishers, subsistence fishersAfrican Journal of Marine Science 2002, 24: 439–46

Contour extracting networks in early extrastriate cortex

Neurons in the visual cortex process a local region of visual space, but in order to adequately analyze natural images, neurons need to interact. The notion of an ?association field? proposes that neurons interact to extract extended contours. Here, we identify the site and properties of contour integration mechanisms. We used functional magnetic resonance imaging (fMRI) and population receptive field (pRF) analyses. We devised pRF mapping stimuli consisting of contours. We isolated the contribution of contour integration mechanisms to the pRF by manipulating the contour content. This stimulus manipulation led to systematic changes in pRF size. Whereas a bank of Gabor filters quantitatively explains pRF size changes in V1, only V2/V3 pRF sizes match the predictions of the association field. pRF size changes in later visual field maps, hV4, LO-1, and LO-2 do not follow either prediction and are probably driven by distinct classical receptive field properties or other extraclassical integration mechanisms. These pRF changes do not follow conventional fMRI signal strength measures. Therefore, analyses of pRF changes provide a novel computational neuroimaging approach to investigating neural interactions. We interpreted these results as evidence for neural interactions along co-oriented, cocircular receptive fields in the early extrastriate visual cortex (V2/V3), consistent with the notion of a contour association field

High prevalence of abnormal Pap smears among young women co-infected with HIV in rural South Africa - implications for cervical cancer screening policies in high HIV prevalence populations

Objective. To establish the relationship between HIV infection and cervical  dysplasia in young women in rural South Africa,Methods. This cross"sectional study was conducted at a primary health care clinic in Vulindlela, KwaZulu-Natal. Standardised questionnaires were used  to collect sociodemographic and clinical presentation data from women attending family planning and other reproductive health services. Pap  smears were done using standard methods. Pap smear data were linked to HIV serostatus.Results. Four hundred and sixty-six women were included in the study. The median age was 24.3 years (range 15 -55 years),and 80% were younger than 30 years. The HIV prevalence .rate was 24.5% (95% confidence interval: 20.7 - 28.7%) and the prevalence of abnormal Pap smears was 16.9- 6.4% ASCUS (atypical squamous cells of undetermined significance), 9.2% LGSIL (low-grade squamous intra epithelial lesions), and 1.3% HGSIL (high-grade squamous intraepitheliallesions). The association between BIV seropositivity and abnormal Pap results was statistically significant (p < 0.05).Conclusion. There is a need for more data on cervical changes in HIV  co-infected women and for review of guidelines on selective Pap smear screening in high HIV prevalence settings such as sub-Saharan Africa and  where access to antiretroviral treatment remains limited

The medium-term sustainability of organisational innovations in the national health service

Background: There is a growing recognition of the importance of introducing new ways of working into the UK's National Health Service (NHS) and other health systems, in order to ensure that patient care is provided as effectively and efficiently as possible. Researchers have examined the challenges of introducing new ways of working-'organisational innovations'-into complex organisations such as the NHS, and this has given rise to a much better understanding of how this takes place-and why seemingly good ideas do not always result in changes in practice. However, there has been less research on the medium-and longer-term outcomes for organisational innovations and on the question of how new ways of working, introduced by frontline clinicians and managers, are sustained and become established in day-to-day practice. Clearly, this question of sustainability is crucial if the gains in patient care that derive from organisational innovations are to be maintained, rather than lost to what the NHS Institute has called the 'improvement-evaporation effect'. Methods: The study will involve research in four case-study sites around England, each of which was successful in sustaining its new model of service provision beyond an initial period of pilot funding for new genetics services provided by the Department of Health. Building on findings relating to the introduction and sustainability of these services already gained from an earlier study, the research will use qualitative methods-in-depth interviews, observation of key meetings, and analysis of relevant documents-to understand the longer-term challenges involved in each case and how these were surmounted. The research will provide lessons for those seeking to sustain their own organisational innovations in wide-ranging clinical areas and for those designing the systems and organisations that make up the NHS, to make them more receptive contexts for the sustainment of innovation. Discussion: Through comparison and contrast across four sites, each involving different organisational innovations, different forms of leadership, and different organisational contexts to contend with, the findings of the study will have wide relevance. The research will produce outputs that are useful for managers and clinicians responsible for organisational innovation, policy makers and senior managers, and academics

Phase transitions in contagion processes mediated by recurrent mobility patterns

Human mobility and activity patterns mediate contagion on many levels, including the spatial spread of infectious diseases, diffusion of rumors, and emergence of consensus. These patterns however are often dominated by specific locations and recurrent flows and poorly modeled by the random diffusive dynamics generally used to study them. Here we develop a theoretical framework to analyze contagion within a network of locations where individuals recall their geographic origins. We find a phase transition between a regime in which the contagion affects a large fraction of the system and one in which only a small fraction is affected. This transition cannot be uncovered by continuous deterministic models due to the stochastic features of the contagion process and defines an invasion threshold that depends on mobility parameters, providing guidance for controlling contagion spread by constraining mobility processes. We recover the threshold behavior by analyzing diffusion processes mediated by real human commuting data.Comment: 20 pages of Main Text including 4 figures, 7 pages of Supplementary Information; Nature Physics (2011

Understanding innovators' experiences of barriers and facilitators in implementation and diffusion of healthcare service innovations: A qualitative study

This article is made available through the Brunel Open Access Publishing Fund - Copyright @ 2011 Barnett et al.Background: Healthcare service innovations are considered to play a pivotal role in improving organisational efficiency and responding effectively to healthcare needs. Nevertheless, healthcare organisations encounter major difficulties in sustaining and diffusing innovations, especially those which concern the organisation and delivery of healthcare services. The purpose of the present study was to explore how healthcare innovators of process-based initiatives perceived and made sense of factors that either facilitated or obstructed the innovation implementation and diffusion. Methods: A qualitative study was designed. Fifteen primary and secondary healthcare organisations in the UK, which had received health service awards for successfully generating and implementing service innovations, were studied. In-depth, semi structured interviews were conducted with the organisational representatives who conceived and led the development process. The data were recorded, transcribed and thematically analysed. Results: Four main themes were identified in the analysis of the data: the role of evidence, the function of inter-organisational partnerships, the influence of human-based resources, and the impact of contextual factors. "Hard" evidence operated as a proof of effectiveness, a means of dissemination and a pre-requisite for the initiation of innovation. Inter-organisational partnerships and people-based resources, such as champions, were considered an integral part of the process of developing, establishing and diffusing the innovations. Finally, contextual influences, both intra-organisational and extra-organisational were seen as critical in either impeding or facilitating innovators' efforts. Conclusions: A range of factors of different combinations and co-occurrence were pointed out by the innovators as they were reflecting on their experiences of implementing, stabilising and diffusing novel service initiatives. Even though the innovations studied were of various contents and originated from diverse organisational contexts, innovators' accounts converged to the significant role of the evidential base of success, the inter-personal and inter-organisational networks, and the inner and outer context. The innovators, operating themselves as important champions and being often willing to lead constructive efforts of implementation to different contexts, can contribute to the promulgation and spread of the novelties significantly.This research was supported financially by the Multidisciplinary Assessment of Technology Centre for Healthcare (MATCH)

Conceptualizing pathways linking women's empowerment and prematurity in developing countries.

BackgroundGlobally, prematurity is the leading cause of death in children under the age of 5. Many efforts have focused on clinical approaches to improve the survival of premature babies. There is a need, however, to explore psychosocial, sociocultural, economic, and other factors as potential mechanisms to reduce the burden of prematurity. Women's empowerment may be a catalyst for moving the needle in this direction. The goal of this paper is to examine links between women's empowerment and prematurity in developing settings. We propose a conceptual model that shows pathways by which women's empowerment can affect prematurity and review and summarize the literature supporting the relationships we posit. We also suggest future directions for research on women's empowerment and prematurity.MethodsThe key words we used for empowerment in the search were "empowerment," "women's status," "autonomy," and "decision-making," and for prematurity we used "preterm," "premature," and "prematurity." We did not use date, language, and regional restrictions. The search was done in PubMed, Population Information Online (POPLINE), and Web of Science. We selected intervening factors-factors that could potentially mediate the relationship between empowerment and prematurity-based on reviews of the risk factors and interventions to address prematurity and the determinants of those factors.ResultsThere is limited evidence supporting a direct link between women's empowerment and prematurity. However, there is evidence linking several dimensions of empowerment to factors known to be associated with prematurity and outcomes for premature babies. Our review of the literature shows that women's empowerment may reduce prematurity by (1) preventing early marriage and promoting family planning, which will delay age at first pregnancy and increase interpregnancy intervals; (2) improving women's nutritional status; (3) reducing domestic violence and other stressors to improve psychological health; and (4) improving access to and receipt of recommended health services during pregnancy and delivery to help prevent prematurity and improve survival of premature babies.ConclusionsWomen's empowerment is an important distal factor that affects prematurity through several intervening factors. Improving women's empowerment will help prevent prematurity and improve survival of preterm babies. Research to empirically show the links between women's empowerment and prematurity is however needed

Financial considerations in the conduct of multi-centre randomised controlled trials: evidence from a qualitative study.

National Coordinating Centre for Research Methodology; Medical Research Council, UK Department of Health; Chief Scientist OfficeNot peer reviewedPublisher PD

Small bowel Crohn’s disease: MR enteroclysis and capsule endoscopy compared to balloon-assisted enteroscopy

New modalities are available to visualize the small bowel in patients with Crohn’s disease (CD). The aim of this study was to compare the diagnostic yield of magnetic resonance enteroclysis (MRE) and capsule endoscopy (CE) to balloon-assisted enteroscopy (BAE) in patients with suspected or established CD of the small bowel. Consecutive, consenting patients first underwent MRE followed by CE and BAE. Patients with high-grade stenosis at MRE did not undergo CE. Reference standard for small bowel CD activity was a combination of BAE and an expert panel consensus diagnosis. Analysis included 38 patients, 27 (71%) females, mean age 36 (20–74) years, with suspected (n = 20) or established (n = 18) small bowel CD: 16 (42%) were diagnosed with active CD, and 13 (34%) by MRE with suspected high-grade stenosis, who consequently did not undergo CE. The reference standard defined high-grade stenosis in 10 (26%) patients. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value of MRE and CE for small bowel CD activity were 73 and 57%, 90 and 89%, 88 and 67%, and 78 and 84%, respectively. CE was complicated by capsule retention in one patient. MRE has a higher sensitivity and PPV than CE in small bowel CD. The use of CE is considerably limited by the high prevalence of stenotic lesions in these patients