Inter-district flow transfers : health and economic impacts : a thesis presented in partial fulfilment of the requirements for the degree of Master of Business Studies in Economics at Massey University, Albany, New Zealand

As part of the introduction of the New Zealand Public Health and Disabilities Act in 2000, the introduction of the Population Based Funding Formula led to a change in the flow of funds for transfer patients. Prior to the PBFF, for the years 2000-2003, healthcare events were contracted on a fee-for-service basis and thus were borne by the DHB of treatment. From 2003 onwards, the cost of transfer patients followed the transfer back to their DHB of domicile. This study replicates and extends work done by Shin (2013) in assessing the impacts of this change in funding flows on the level of transfer and patient health outcomes. I use OLS and logistic modelling to empirically assess these effects and draw conclusions as to the effectiveness of the policy change and any potential efficiencies that are gained. I find evidence of a focus in the probability of transfers after the change in funding, where the overall probability of transfer decreases and the probability of transfer to tertiary DHBs increases. Additionally, patient outcomes demonstrate a concentration effect whereby after the policy is implemented, the pool of transfers is less diluted by low severity patient transfers and thus displays poorer health outcomes on average for the transfer group. The concentration of health outcomes suggests that the transfer decision is being considered more carefully now that costs are aligned to the DHB of domicile. A novel addition to this research is the analysis of regional DHB pairs. The analysis of five secondary-to-tertiary transfer flows provides insight into the necessity of a decentralised healthcare system in New Zealand and is mostly consistent with the analysis at the national level. Overall, the introduction of Inter-District Flow transfer funding has increased the efficiency of the transfer mechanism and enabled a more streamlined redistribution of funds to tertiary providers. This is an important finding because it reinforces the necessity of the transfer mechanism, specialist providers and local provision in a healthcare system such as New Zealand’s

Prevalence of succinate dehydrogenase deficiency in paragangliomas and phaeochromocytomas at a tertiary hospital in Cape Town: a retrospective review

Introduction: A substantial proportion of phaeochromocytomas and paragangliomas are associated with underlying germline mutations, of which the majority are due to mutations in one of the genes in the succinate dehydrogenase (SDH) complex. A commercially available immunohistochemical stain for SDHB has excellent correlation with SDH gene mutation status when staining is lost. This abnormal loss of staining can identify potential familial tumours and tumours with a higher risk of malignant behaviour. The prevalence of SDH deficiency in the South African setting has not been published previously.Methods: A retrospective laboratory-based study at Tygerberg Hospital in Cape Town used immunohistochemistry on archived tumour tissue to assess loss of SDHB staining in phaeochromocytomas and paragangliomas submitted to the histopathology laboratory (National Health Laboratory Service) between 2005 and 2015.Results: Tumour tissue from 52 patients was tested. In total, 36% showed loss of staining. Loss of staining was significantly correlated with a younger age at presentation (z = −3.59, p < 0.001). The median age of those who showed loss of staining was 26 years (IQR 21–41), compared with 50.5 years (IQR 36–61) for those who showed retained staining. The interobserver agreement in the interpretation of the immunohistochemical stain was excellent (Cohen’s kappa = 0.917; 95% confidence interval, 0.81–1, p < 0.001).Conclusion: Approximately one-third of phaeochromocytomas and paragangliomas in our setting are likely to be associated with germline mutations in one of the SDH genes. Immunohistochemical testing of tumour tissue can identify this group to allow better prognostication and appropriate genetic testing and counselling

Effects of resistance training and neuromuscular electrical stimulation in knee osteoarthritis : a randomised control trial.

This study compared the effects of 6-week home-based resistance training (RT) and neuromuscular electrical stimulation (NMES) programs on self-reported disability, functional capacity, quadriceps strength and cross-sectional area (CSA), and expression of myosin heavy chain (MHC) isoforms and ubiquitin-protein ligases in older persons with moderate to severe knee osteoarthritis (OA). A total of 41 patients aged 55 to 75 years with arthroscopically or radiographically confirmed moderate to severe knee OA were randomised to a 6-week home RT program, a 6-week NMES program or a control group receiving standard care. The RT group performed quadriceps femoris strengthening exercises 3 times per week, while the NMES group used a portable garment stimulator for 20 minutes 5 times per week at the maximum intensity comfortably tolerated. Outcomes were assessed at baseline, post-intervention and 6 weeks post-intervention. The primary outcome measure was self-reported disability, measured using the Short Form Health Survey (SF-36) score and the Western Ontario McMaster Universities Arthritis (WOMAC) index. Secondary outcome measures were functional capacity (25m walk test, chair rise test, stair climb test), peak isometric and isokinetic quadriceps torque, quadriceps CSA, and expression of MHC isoforms, muscle atrophy F-box (MAFbx) and muscle RING finger-1 (MuRF). There was no significant change in any of the outcome measures in the control group. Compared to baseline, SF-36 scores, functional capacity and CSA increased significantly in the NMES and RT groups post-intervention. WOMAC scores increased significantly in the NMES group. Isometric peak torque did not change in any group. Adherence was 91% and 83% in the NMES and RT groups respectively (p=0.324). There were no between-group or withingroup differences in MHC isoforms, MAFbx and MuRF. At 6-week follow-up, functional improvements were maintained for both training groups, while most of the health score gains were lost. Home-based NMES is an acceptable alternative to exercise therapy in the management of knee OA, especially for patients who have difficulty complying with an exercise program

Osteoporotic Hip Fractures: The Burden of Fixation Failure

Osteoporotic hip fractures are a major cause of morbidity and mortality in the elderly. Furthermore, reduced implant anchorage in osteoporotic bone predisposes towards fixation failure and with an ageing population, even low failure rates represent a significant challenge to healthcare systems. Fixation failure in fragility fractures of the hip ranges from 5% in peritrochanteric fractures through to 15% and 41% in undisplaced and displaced fractures of the femoral neck, respectively. Our findings, in general, support the view that failed internal fixation of these fragility fractures carries a poor prognosis: it leads to a twofold increase in the length of hospital stay and a doubling of healthcare costs. Patients are more likely to suffer a downgrade in their residential status upon discharge with a consequent increase in social dependency. Furthermore, the marked disability and reduction in quality of life evident before salvage procedures may persist at long-term followup. The risk, of course, for the elderly patient with a prolonged period of decreased functioning is that the disability becomes permanent. Despite this, however, no clear link between revision surgery and an increase in mortality has been demonstrated in the literature

Rate Dependent Performance Related to Crystal Structure Evolution of Na0.67Mn0.8Mg0.2O2 in a Sodium-Ion Battery

Sodium-ion batteries are considered as a favorable alternative to the widely used lithium-ion batteries for applications such as grid-scale energy storage. However, to meet the energy density and reliability that is necessary, electrodes that are structurally stable and well characterized during electrochemical cycling need to be developed. Here, we report on how the applied discharge current rate influences the structural evolution of Na0.67Mn0.8Mg0.2O2 electrode materials. A combination of ex situ and in situ X-ray diffraction (XRD) data were used to probe the structural transitions at the discharged state and during charge/discharge. Ex situ data shows a two-phase electrode at the discharged state comprised of phases that adopt Cmcm and P63/mmc symmetries at the 100 mA/g rate but a predominantly P63/mmc electrode at 200 and 400 mA/g rates. In situ synchrotron XRD data at 100 mA/g shows a solely P63/mmc electrode when 12 mA/g charge and 100 mA/g discharge is used even though ex situ XRD data shows the p..

XPS and NEXAFS study of fluorine modified TiO2 nano-ovoids reveals dependence of Ti3+ surface population on the modifying agent

This article is licensed under a Creative Commons Attribution 3.0 Unported Licence (http://creativecommons.org/licenses/by/3.0/)Crystalline titanium dioxide was synthesised under mild conditions by the thermal degradation of peroxotitanic acid in the presence of a number of fluoride-containing surface modifying agents (NH4F, NH4BF4, NH4PF6, NBu4F, NBu4BF4, NBu4PF6). The resulting materials were characterised by PXRD, SEM, HRTEM, XPS and NEXAFS. Particle phase, size, and surface area were noticeably affected by the choice of surface modifying agent. Both the cation and anion comprising the modifying agent affect the surface Ti3+ population of the materials, with two apparent trends observed: F− > BF4− > PF6− and NBu4+ > NH4+. All materials displayed evidence of fluorine doping on their surfaces, although no evidence of bulk doping was observed

Health information quality of websites on periodontology

Aim: This study aimed to assess the quality of the information available on the Web on gum disease. Methods: The term ‘gum disease’ was searched in Google and in MedlinePlus. The first 200 websites were analysed by the Journal of the American Medical Association (JAMA) criteria and the Health On the Net Foundation (HONCode) certification, instruments for assessing quality of health information. Data was analysed through the Mann-Whitney test or KruskalWallis test, followed by the Dunn’s test, using the GraphPad Prism Software version 6. Results: MedlinePlus presented a significantly higher JAMA score than Google. Google’s first ten results had a higher JAMA score than the remaining websites. Journalism and health portals are the most reliable affiliations, while commercial and dental practices had low JAMA scores. JAMA score was significantly higher in websites with the HONCode certification compared to the ones without it. Conclusion: There are current concerns regarding patients’ use of the Internet for accessing health information. However, the conclusion we can make is that Google seems to favour websites with high quality information, at least in terms of JAMA score or HONCode accreditation. The JAMA score of dental practices’ websites could be improved by providing basic information such as authorship and date

Escargot maintains stemness and suppresses differentiation in Drosophila intestinal stem cells

Snail family transcription factors are expressed in various stem cell types, but their function in maintaining stem cell identity is unclear. In the adult Drosophila midgut, the Snail homolog Esg is expressed in intestinal stem cells (ISCs) and their transient undifferentiated daughters, termed enteroblasts (EB). We demonstrate here that loss of esg in these progenitor cells causes their rapid differentiation into enterocytes (EC) or entero‐endocrine cells (EE). Conversely, forced expression of Esg in intestinal progenitor cells blocks differentiation, locking ISCs in a stem cell state. Cell type‐specific transcriptome analysis combined with Dam‐ID binding studies identified Esg as a major repressor of differentiation genes in stem and progenitor cells. One critical target of Esg was found to be the POU‐domain transcription factor, Pdm1, which is normally expressed specifically in differentiated ECs. Ectopic expression of Pdm1 in progenitor cells was sufficient to drive their differentiation into ECs. Hence, Esg is a critical stem cell determinant that maintains stemness by repressing differentiation‐promoting factors, such as Pdm1

The FRESHAIR4Life study:Global implementation research on non-communicable disease prevention targeting adolescents' exposure to tobacco and air pollution in disadvantaged populations

In the FRESHAIR4Life study, we aim to reduce the non-communicable disease (NCD) burden by implementing preventive interventions targeting adolescents’ exposure to tobacco use and air pollution (AP). This paper presents the methodology of FRESHAIR4Life and initial rapid review results. The rapid review showed variable NCD mortality rates related to tobacco use and AP exposure in the five participating countries. Tobacco is the predominant risk factor for NCD-related deaths in the Kyrgyz Republic, Greece, and Romania, whereas AP exposure causes most NCD-related deaths in Pakistan and Uganda. Adolescents’ risk factor exposure, sources of exposure, and trends also differ significantly. As the next step in FRESHAIR4Life, an in-depth situational analysis will inform the selection, adaptation, and integration of evidence-based interventions into the FRESHAIR4Life prevention package. Subsequently, this package will be implemented, evaluated, and iteratively refined. Throughout the research process, a strong emphasis is on co-creation, capacity building, and comprehensive communication and dissemination

Postmortem lung biopsies from four patients with COVID-19 at a tertiary hospital in Cape Town, South Africa

CITATION: Bruce-Brand, C. et al. 2020. Postmortem lung biopsies from four patients with COVID-19 at a tertiary hospital in Cape Town, South Africa. South African Medical Journal, 110(12):1195-1200, doi:10.7196/SAMJ.2020.v110i12.15290.The original publication is available at http://www.samj.org.zaPublication of this article was funded by the Stellenbosch University Open Access FundBackground. An outbreak of a novel coronavirus in China in late 2019 has resulted in a global pandemic. The virus (SARS-CoV-2) causes a severe acute respiratory syndrome and had been responsible for >14 000 deaths in South Africa (SA) at the time of writing, 30 August 2020. Autopsies in our setting have not been prioritised owing to the infective risks for staff, resulting in a lack of information on the histopathology of the disease in the SA setting. Postmortem biopsies are relatively quick and easy to perform and reduce the infective risk posed by full autopsies. Objectives. To determine whether postmortem biopsies of lung tissue could be used to determine cause of death in lieu of full autopsies in patients dying from COVID-19. Methods. We performed postmortem biopsies of lung tissue on 4 patients with SARS-CoV-2 confirmed by reverse transcriptase polymerase chain reaction who died in the Tygerberg Hospital (Cape Town, SA) intensive care unit (ICU) in June - July 2020, in order to determine their cause of death. The biopsies were performed in the ICU with the necessary personal protective equipment within 2 hours after death. Clinical information was obtained from the hospital records and the histopathology was reviewed by two consultant histopathologists. Microbiology and electron microscopy were also performed on this tissue. Results. All 4 patients were aged >50 years and had multiple comorbidities. Pulmonary pathology was present in only 3 cases, and the findings were surprisingly heterogeneous. One case demonstrated several findings including diffuse alveolar damage, extensive fibrin thrombi in pulmonary arteries with pulmonary infarction, organising pneumonia and bronchopneumonia. Other findings included type 2 pneumocyte hyperplasia, intra-alveolar macrophages and squamous metaplasia. An organising pneumonia was present in 2 other cases, although these findings were not deemed to be severe enough to be the cause of death. Fibrin thrombi were present in pulmonary arteries of 3 cases. One case showed no significant acute pulmonary pathology. The cause of death could only be determined in 1 case. Conclusions. The pulmonary findings we observed are in keeping with those described in the international literature. However, the pathology was surprisingly heterogeneous between cases, and was only deemed severe enough to be the cause of death in 1 of 4 cases. While lung-targeted, standardised postmortem biopsies may be safe, easy to perform and provide useful insights into the disease, they are not suitable to replace full autopsies in determining cause of death.http://www.samj.org.za/index.php/samj/article/view/13116Publisher's versio