The use of electronic discovery and cloudcomputing technology by lawyers in practice: Lessons from abroad

In the present electronically driven world, it is vitally important for lawyers to understand advancing or new technology and to have adequate computer literacy in order to best represent their clients. The so-called “e-information explosion” requires lawyers to request, produce and manage electronic documents in order to protect their clients’ interests and to obtain a strategic advantage over their opponents. Lawyers or legal practitioners should adapt to technological changes, develop an awareness of the unique challenges posed by the advances in technology, and embrace technology’s role in both their practices and the legal system. This article examines issues pertaining to electronic discovery and cloud-computing technology in civil practice in South Africa, the United States of America and the United Kingdom. The article also examines current electronic discovery (e-discovery) practices and the use of cloud-computing technology in the United States of America and the United Kingdom to ascertain whether useful lessons can be gleaned from these jurisdictions for possible incorporation into South African law. The study notes that, while South African law has taken great strides to address advancing technology, useful lessons from abroad can be adopted such as, inter alia, the need for greater preservation of electronic evidence; the use of a wider definition of the term ‘document’ to include all types of electronic information and future technological developments; the amendment of the rules to include the discovery of electronically stored information; the use of the proportionality principle in trials, and the incorporation of the cost-shifting regime. The article concludes that lawyers need to learn more about relevant law such as the ECT Act and POPI, and embrace advancing technology more enthusiastically, yet responsibly, in order to succeed in their new competitive and changing legal environments and to provide the best service for their clients

Addressing the Challenges Posed by Cybercrime: a South African Perspective

The South African common law has proven to be ineffective in addressing cybercrime. The Electronic Communications and Transactions Act, Act 25 of 2002 (“ECTâ€) was introduced to address inter alia cybercrime in South Africa. Whilst the advent of the ECT is lauded, there is room for improvement. To illustrate this, section 15 of the ECT which facilitates the admission of information in electronic format is laudable, but the criminal sanctions in the Act appear to be inadequate. Recent case law also reveals that the courts are adopting a cautious approach towards cybercrime cases. A call for a more clear and concise judicial guidance is required. The South African banking sector is also vulnerable to cybercrime. However, the establishment of organisations such as SABRIC to combat cybercrime in the banking industry is welcomed. Although South Africa has adopted the Council of Europe’s Convention in Cybercrime, it has not ratified the treaty. It is recommended that South Africa should ratify the treaty to avoid becoming an easy target for International cybercrime. This paper will deal with measures addressing cybercrime in South Africa and the way forward

Prevalence and clinical risk factors for morphometric vertebral fractures in older subjects in KwaZulu-Natal

Objectives: There are limited data on vertebral fractures (VFs) in South Africa (SA). Therefore a study was undertaken to compare the demographic profile, clinical risk factors and bone mineral density (BMD) in subjects aged 60 years and over with and without morphometric VFs.Patients and methods: In a descriptive case-controlled study, demographic data, clinical risk factors (CRF) and BMD were collected. Morphometric VFs were identified using the semi-quantitative Genant method. Descriptive analysis was undertaken using Student’s t-test, the Mann–Whitney U-test and the chi-square test.Results: In the 197 subjects enrolled, the median age was 72.0 years (IQR 67.0–78.5 years) and morphometric VFs were identified in 41 subjects (20.8%). The prevalence of VFs increased with age, and while more common in women compared with men (23.8% vs. 13.0%), this was not significant (p 0.095). There was no difference in the prevalence of VFs between African and Indian subjects (23.4% vs. 17.4%; p 0.240), nor CRFs between subjects with and without VFs. Subjects with a VF had a significantly lower BMD at the spine (p = 0.020), but not at the neck of femur and total hip.Conclusion: This study highlights the need for adequate screening and management protocols for osteoporosis in all ethnic groups in SA

Prevalence of vitamin D deficiency in older South Africans with and without hip fractures and the effects of age, body weight, ethnicity and functional status

Background: Vitamin D plays an important role in many physiological and pathological processes, including bone metabolism. Vitamin D deficiency is common worldwide, but there are few data in older South Africans.Objectives: This study aimed to determine vitamin D status in older adults with and without hip fractures and the effect of demography, body mass index (BMI) and functional status on vitamin D levels.Methodology: In a secondary analysis, the association between 25(OH) vitamin D levels, obtained from 327  subjects (151 with fractures and 176 controls), and age, gender, ethnicity, BMI and functional status, was  explored using Student’s t-test, a chisquare test, regression analysis and ANOVA.Results: In the total cohort, vitamin D deficiency and insufficiency was present in 27% and 38%, respectively. While vitamin D levels decreased with age, this was not significant (p = 0.082). There was a significant  association between vitamin D and BMI (p = 0.023), the physical maintenance scale (p = 0.002) and independent activities of daily living (p = 0.001). Mean vitamin D levels in fracture subjects was significantly lower than  controls (39.4 ± 23.1 nmol/l vs. 50.1 ± 23.3 nmol/l, p = 0.00) and vitamin D deficiency and/or insufficiency was significantly more common in the fracture group compared with controls (75.5% vs. 56.8%, p = 0.00). There was no association with gender or ethnicity.Conclusions: Vitamin D deficiency is common in this population, especially in those with hip fractures. Contrary to other studies, increasing BMI was associated with higher vitamin D levels. This suggests that poor health status as indicated by a low BMI and poorer functional status is associated with lower vitamin D levels. The high prevalence of vitamin D deficiency and/or insufficiency in the cohort strongly argues for universal vitamin D supplementation in older adults, especially those at risk for osteoporotic fractures

Recommendations for the acute and long-term medical management of low-trauma hip fractures

Hip fractures are the most serious complication of osteoporosis and are associated with high morbidity and mortality. Generally, patients who sustain osteoporotic hip fractures are older adults who have a number of comorbiddiseases which predispose them to perioperative complications, disability and death. Furthermore, patients who survive a hip fracture are at higher risk of a subsequent fracture. The morbidity and mortality of hip fractures can be substantially reduced by a structured multidisciplinary approach to pre- and postoperative management. This review will focus on the epidemiology of hip fractures, predictors of mortality and the acute and long-term management of hip fractures

Photomyogenic response in Niemann–Pick type C: a case report

Contains fulltext : 98214.pdf (publisher's version ) (Closed access)1 maart 201

The potential for quality assurance systems to save costs and lives:the case of early infant diagnosis of HIV

OBJECTIVES: Scaling up of point-of-care testing (POCT) for early infant diagnosis of HIV (EID) could reduce the large gap in infant testing. However, suboptimal POCT EID could have limited impact and potentially high avoidable costs. This study models the cost-effectiveness of a quality assurance system to address testing performance and screening interruptions, due to, for example, supply stockouts, in Kenya, Senegal, South Africa, Uganda and Zimbabwe, with varying HIV epidemics and different health systems. METHODS: We modelled a quality assurance system-raised EID quality from suboptimal levels: that is, from misdiagnosis rates of 5%, 10% and 20% and EID testing interruptions in months, to uninterrupted optimal performance (98.5% sensitivity, 99.9% specificity). For each country, we estimated the 1-year impact and cost-effectiveness (US$/DALY averted) of improved scenarios in averting missed HIV infections and unneeded HIV treatment costs for false-positive diagnoses. RESULTS: The modelled 1-year costs of a national POCT quality assurance system range from US$ 69 359 in South Africa to US$334 341 in Zimbabwe. At the country level, quality assurance systems could potentially avert between 36 and 711 missed infections (i.e. false negatives) per year and unneeded treatment costs between US$ 5808 and US$ 739 030. CONCLUSIONS: The model estimates adding effective quality assurance systems are cost-saving in four of the five countries within the first year. Starting EQA requires an initial investment but will provide a positive return on investment within five years by averting the costs of misdiagnoses and would be even more efficient if implemented across multiple applications of POCT

Acute posthypoxic myoclonus after cardiopulmonary resuscitation

<p>Abstract</p> <p>Background</p> <p>Acute posthypoxic myoclonus (PHM) can occur in patients admitted after cardiopulmonary resuscitation (CPR) and is considered to have a poor prognosis. The origin can be cortical and/or subcortical and this might be an important determinant for treatment options and prognosis. The aim of the study was to investigate whether acute PHM originates from cortical or subcortical structures, using somatosensory evoked potential (SEP) and electroencephalogram (EEG).</p> <p>Methods</p> <p>Patients with acute PHM (focal myoclonus or status myoclonus) within 72 hours after CPR were retrospectively selected from a multicenter cohort study. All patients were treated with hypothermia. Criteria for cortical origin of the myoclonus were: giant SEP potentials; or epileptic activity, status epilepticus, or generalized periodic discharges on the EEG (no back-averaging was used). Good outcome was defined as good recovery or moderate disability after 6 months.</p> <p>Results</p> <p>Acute PHM was reported in 79/391 patients (20%). SEPs were available in 51/79 patients and in 27 of them (53%) N20 potentials were present. Giant potentials were seen in 3 patients. EEGs were available in 36/79 patients with 23/36 (64%) patients fulfilling criteria for a cortical origin. Nine patients (12%) had a good outcome. A broad variety of drugs was used for treatment.</p> <p>Conclusions</p> <p>The results of this study show that acute PHM originates from subcortical, as well as cortical structures. Outcome of patients admitted after CPR who develop acute PHM in this cohort was better than previously reported in literature. The broad variety of drugs used for treatment shows the existing uncertainty about optimal treatment.</p

Comparison of physical fitness between healthy and mild‐to‐moderate asthmatic children with exercise symptoms: A cross‐sectional study

.Objective Asthma is a chronic disease that may affect physical fitness, although its primary effects on exercise capacity, muscle strength, functionality and lifestyle, in children and adolescents, are still poorly understood. This study aimed to evaluate the differences in cardiorespiratory fitness, muscle strength, lifestyle, lung function, and functionality between asthmatics with exercise symptoms and healthy children. In addition, we have analyzed the association between clinical history and the presence of asthma. Study Design Cross-sectional study including 71 patients with a diagnosis of asthma and 71 healthy children and adolescents (7–17 years of age). Anthropometric data, clinical history, disease control, lifestyle (KIDMED and physical activity questionnaires), lung function (spirometry), exercise-induced bronchoconstriction test, aerobic fitness (cardiopulmonary exercise test), muscle strength and functionality (timed up and go; timed up and down stairs) were evaluated. Results Seventy-one patients with asthma (mean age 11.5 ± 2.7) and 71 healthy subjects (mean age 10.7 ± 2.5) were included. All asthmatic children had mild to moderate and stable asthma. EIB occurred in 56.3% of asthmatic children. Lung function was significantly (p < .05) lower in the asthmatic group when compared to healthy peers, as well as the cardiorespiratory fitness, muscle strength, lifestyle and functionality. Moreover, asthmatic children were more likely to have atopic dermatitis, allergic reactions, food allergies, and a family history of asthma when compared to healthy children. Conclusions Children with mild-to-moderate asthma presenting exercise symptoms show a reduction in cardiorespiratory fitness, muscle strength, lung function, functionality, and lifestyle when compared to healthy peers. The study provides data for pediatricians to support exercise practice aiming to improve prognosis and quality of life in asthmatic children.S