Narratiewe terapie aan die seksueel mishandelde kli?nt: gevalstudie ter illustrasie van die herskryf van die verhaal van 'n kli?nt met 'n "ander seksuele versteuring"

Narrative therapy as a discourse for dealing with sexual abuse: rewriting the own story. Sexual abuse changes the victim's life. All forms of sexual abuse leave a scar, regardless of race or gender. It does not impact in the same way on the lives of all people, but victims are able to report extensively on exactly how such an event has changed their lives; how the incident has caused problems in various facets of their lives. When the question is turned around and the victims are asked to explain how they have handled these problems, what influence they exercise over the problems, the storytelling often ends just there - revealing their inability to cope. When problems are articulated, the possibility arises that victims may be helped. The aim is to re-establish victims as persons with integrity and to enable them to resume control of their lives after the traumatic event. They are en couraged to write an alternative life story based on their newly found inner strength and on what they desire for their lives. The current research, in which a client who presented with "Sexual disorder not otherwise specified" was helped to create an alternative story, suggests that it is possible to substitute 'unwanted' parts of such a client's life story with a rewritten narrative with which he / she can identify. South African Journal of Education Vol.23(4) 2003: 297-30

Developing an outcomes-based charter to direct teaching and assessment of medical professionalism

Background. Components of professionalism in undergraduate medical studies at the University of  Pretoria (UP) were previously defined as nine ‘Golden Threads’. Although specific outcomes were  formulated for the threads, the need for more explicit professional standards became increasingly evident. The restructuring of the health system in South Africa contributed to the need for more explicit standards. The Charter for Medical Professionalism was developed during 2006 - 2008 as a reference document within the local context to serve as a standard for professionalism in the medical curriculum. Another aim was to guide academics in medical studies to act as good role models of professional behaviour.Objective. To document the development of the Charter for Medical Professionalism and to evaluate  lecturer and student perceptions on the formulation of the Charter to make appropriate changes and increase acceptance.Methods. The project took the form of action research, and a working group comprising academics from UP’s Faculty of Health Sciences developed the Charter from relevant source documents, employing thematic and content analysis and recursive abstraction. An online survey was conducted to assess lecturer and student acceptance of the Charter.Results. The outcomes-based approach was perceived as acceptable and appears to broaden the scope of assessment of professionalism.Conclusion. Inclusion of outcomes proposed by other work groups relating to research, practice   management, teaching, mentoring and leadership roles of the medical doctor may be considered in future

Decline in acute coronary syndrome hospitalisation rates during COVID-19 lockdown in private hospitals in South Africa

We conducted a study of admission rates of acute coronary syndrome (ACS) in all Mediclinic hospitals in South Africa. The aim of the study was to quantify the extent of change in admission rates of ACS subtypes and to establish the degree of change in subtype proportions in the private sector assumed to be related to COVID-19 and/or lockdown implementation. Time intervals were demarcated by lockdown measures (March: pre-lockdown versus April: post-lockdown implementation), and comparisons were performed with equitable time periods (2019 versus 2020). For the comparison of proportions, data for April and May were summated

The correlation between C-reactive protein and toxic granulation of neutrophils in the peripheral blood

Background. During inflammation, the serum concentrations of granulocyte colony-stimulating factor (G-CSF), plasma interleukin-6 (IL-6), and C-reactive protein (CRP) increase. A positive correlation between CRP and the percentages of neutrophils exhibiting toxic granulation during inflammation has been demonstrated, and that the fluctuations of CRP and toxic granulation of neutrophils were similar. Objectives. We studied whether grading of toxic granulated neutrophils can be used as a surrogate marker for infection or inflammation, and also be an easier method than previously described methods. Materials and methods. We graded 357 consecutive peripheral blood slides from patients on whom a full blood count with differential count and CRP level was performed, according to intensity of toxic granulation in the neutrophil population, according to a newly proposed grading system. Results. The CRP range was between 1 and 530.3 mg/l. The results confirm the association between a rise in CRP and progressive intensity of toxic granulation in neutrophils in peripheral blood. Kruskal-Wallis equality of populations rank test showed a statistically significant difference between the graded categories (p=0.0001). The Trend test was also statistically significant (p=0.000). Conclusion. The proposed system can be applied to patients with inflammatory or infectious conditions, where grading of toxic granulation of neutrophils can possibly be used as a surrogate marker to assess infection or inflammation and their response to treatment. It may be of particular use in cases where traditional infectious or inflammatory markers cannot be used, owing to inherent problems associated with the respective conditions

Impact of Mesoporous Silicon Template Pore Dimension and Surface Chemistry on Methylammonium Lead Trihalide Perovskite Photophysics

© 2020 Wiley-VCH GmbH In influencing fundamental properties—and ultimately device performance—of lead halide perovskites, interfacial interactions play a major role, notably with regard to carrier diffusion and recombination. Here anodized porous Si (pSi) as well as porous silica particles are employed as templates for formation of methylammonium lead trihalide nanostructures. This allows synthesis of relatively small perovskite domains and comparison of associated interfacial chemistry between as-prepared hydrophobic hydrideterminated functionalities and hydrophilic oxide-terminated surfaces. While physical confinement of MAPbBr3 has a uniform effect on carrier lifetime, pore size (7–18 nm) of the silicon-containing template has a sensitive influence on perovskite photoluminescence (PL) wavelength maximum. Furthermore, identity of the surface functionality of the template significantly alters the PL quantum efficiency, with lowest PL intensity associated with the H-terminated pSi and the most intense PL affiliated with the oxideterminated pSi surface. These effects are explored for green-emitting MAPbBr3 as well as infrared-emitting MAPbI3. In addition, the role of silicon surface chemistry on the time-dependent stability of these perovskites packaged within a given mesoporous template is also evaluated, specifically, a lack of miscibility between MAPbI3 and the H-terminated pSi template results in a diffusion of this specific perovskite composition eluting from this porous matrix over time

The use of low-cost simulation in a resource-constrained teaching environment

BACKGROUND. To improve the management of chest trauma at the University of Botswana, Gaborone, Botswana, we incorporated simulation into a theorybased chest trauma module by developing procedural guides, checklists and low-cost simulation. OBJECTIVES. To assess the suitability of low-cost simulation-based training and its impact on students’ proficiency, as well as its general acceptability. METHODS. A total of 39 medical students who completed their surgical rotation and 20 intern doctors in their first clinical rotation participated. A checklist was used in a pre- and post-test design to assess procedural proficiency, and a rating system categorised scores. Thirteen content-based items assessed the students’ knowledge relating to the diagnosis and management of a chest injury and one item assessed their ability to perform the procedure correctly. A questionnaire was administered after the second assessment to evaluate the acceptability of the training module. Findings were summarised by median, proportion and range, and pre- and post-test outcomes were compared by Student’s paired t-test. RESULTS. Pre- and post-test assessment scores differed significantly (median (range) 11.3 (4.5 - 21.0) and 19.5 (15.5 - 23.0), respectively (p<0.001)). The proportions of participants’ scores categorised as ‘full proficiency’ rose from 7% to 42%, and ‘reasonable proficiency’ from 30% to 60%, while both ‘some proficiency’ and ‘poor proficiency’ decreased from 50% and 20% to 0%. Most (93%) participants ‘strongly agreed’ that the training module was acceptable. CONCLUSION. Our results demonstrate the suitability of low-cost simulation for training and assessment in resource-constrained settings

Selective Constraints on Amino Acids Estimated by a Mechanistic Codon Substitution Model with Multiple Nucleotide Changes

Empirical substitution matrices represent the average tendencies of substitutions over various protein families by sacrificing gene-level resolution. We develop a codon-based model, in which mutational tendencies of codon, a genetic code, and the strength of selective constraints against amino acid replacements can be tailored to a given gene. First, selective constraints averaged over proteins are estimated by maximizing the likelihood of each 1-PAM matrix of empirical amino acid (JTT, WAG, and LG) and codon (KHG) substitution matrices. Then, selective constraints specific to given proteins are approximated as a linear function of those estimated from the empirical substitution matrices. Akaike information criterion (AIC) values indicate that a model allowing multiple nucleotide changes fits the empirical substitution matrices significantly better. Also, the ML estimates of transition-transversion bias obtained from these empirical matrices are not so large as previously estimated. The selective constraints are characteristic of proteins rather than species. However, their relative strengths among amino acid pairs can be approximated not to depend very much on protein families but amino acid pairs, because the present model, in which selective constraints are approximated to be a linear function of those estimated from the JTT/WAG/LG/KHG matrices, can provide a good fit to other empirical substitution matrices including cpREV for chloroplast proteins and mtREV for vertebrate mitochondrial proteins. The present codon-based model with the ML estimates of selective constraints and with adjustable mutation rates of nucleotide would be useful as a simple substitution model in ML and Bayesian inferences of molecular phylogenetic trees, and enables us to obtain biologically meaningful information at both nucleotide and amino acid levels from codon and protein sequences.Comment: Table 9 in this article includes corrections for errata in the Table 9 published in 10.1371/journal.pone.0017244. Supporting information is attached at the end of the article, and a computer-readable dataset of the ML estimates of selective constraints is available from 10.1371/journal.pone.001724

Ending malnutrition in all its forms requires scaling up proven nutrition interventions and much more: a 129-country analysis.

BackgroundSustainable Development Goal (SDG) 2.2 calls for an end to all forms of malnutrition, with 2025 targets of a 40% reduction in stunting (relative to 2012), for wasting to occur in less than 5% of children, and for a 50% reduction in anaemia in women (15-49 years). We assessed the likelihood of countries reaching these targets by scaling up proven interventions and identified priority interventions, based on cost-effectiveness.MethodsFor 129 countries, the Optima Nutrition model was used to compare 2019-2030 nutrition outcomes between a status quo (maintained intervention coverage) scenario and a scenario where outcome-specific interventions were scaled up to 95% coverage over 5 years. The average cost-effectiveness of each intervention was calculated as it was added to an expanding package of interventions.ResultsOf the 129 countries modelled, 46 (36%), 66 (51%) and 0 (0%) were on track to achieve the stunting, wasting and anaemia targets respectively. Scaling up 18 nutrition interventions increased the number of countries reaching the SDG 2.2 targets to 50 (39%), 83 (64%) and 7 (5%) respectively. Intermittent preventative treatment of malaria during pregnancy (IPTp), infant and young child feeding education, vitamin A supplementation and lipid-based nutrition supplements for children produced 88% of the total impact on stunting, with average costs per case averted of US$103, US$267, US$556 and US$1795 when interventions were consecutively scaled up, respectively. Vitamin A supplementation and cash transfers produced 100% of the total global impact on prevention of wasting, with average costs per case averted of US$1989 and US$19,427, respectively. IPTp, iron and folic acid supplementation for non-pregnant women, and multiple micronutrient supplementation for pregnant women produced 85% of the total impact on anaemia prevalence, with average costs per case averted of US$9, US$35 and US$47, respectively.ConclusionsPrioritising nutrition investment to the most cost-effective interventions within the country context can maximise the impact of funding. A greater focus on complementing nutrition-specific interventions with nutrition-sensitive ones that address the social determinants of health is critical to reach the SDG targets

The complex challenge of governing food systems: The case of South African food policy

International experience reveals that food policy development often occurs in silos and offers few tangible mechanisms to address the interlinked, systemic issues underpinning food and nutrition insecurity. This paper investigated what South African government policies cover in terms of different aspects of the food system, who is responsible for them, and how coordinated they are. Policy objectives were categorized into seven policy domains relevant to food systems: agriculture, environment, social protection, health, land, education, economic development, and rural development. Of the ninety-one policies reviewed from 1947–2017, six were identified as being "overarching" with goals across all the domains. About half of the policies focused on agriculture and the environment, reflecting an emphasis on agricultural production. Policies were formulated and implemented in silos. As a result, learning from implementation, and adjusting to improve impact has been limited. Particularly important is that coordination during implementation, across these complex domains, has been partial. In order to achieve its stated food and nutrition outcomes, including Sustainable Development Goal (SDG) 2, South Africa needs to translate its policies into tangible, practical plans and processes guided by effective coordination and alignment. Key recommendations are practically to align policies to a higher-level "food goal", establish better coordination mechanisms, consolidate an effective monitoring and evaluation approach to address data gaps and encourage learning for adaptive implementation. Actively engaging the existing commitments to the SDGs would draw stated international commitments together to meet the constitutional commitment to food rights into an overarching food and nutrition security law