“Barriers to” and “Recommendations for” providing care and support for children living as AIDS orphans in township communities in the Eastern Cape South Africa: A cluster analysis

Background: Orphan-hood is a major consequence of the Acquired Immune Deficiency Syndrome (AIDS) pandemic globally. In South Africa most children who are AIDS orphans live in township communities. They are often uncared for and unsupported by the community, and experience recurrent psychological trauma and much personal suffering. Identifying the “barriers to” and “recommendations for” providing care and support to these vulnerable children is vital to enable the development of comprehensive implementations to meet these children's unique care and support needs. Objective: Using empirical data from health and social care professionals and cluster analysis to identify “barriers to” and “recommendations for” providing care and support to children living as AIDS orphans in township communities in Nelson Mandela Bay South Africa. Design: Data was collected using a descriptive phenomenology research design incorporated an exploratory, contextual and descriptive approach. In-depth unstructured interviews were used to collect data from participants. Participants: The primary health care nurses (PN) (n = 10) and social workers (SW) (n = 8) were selected using criterion-based purposive sampling, whilst snowball sampling was used to select psychologists (Psy) (n = 6). Participants are referred to as health and social care professionals. Setting: Participants were selected using purposive sampling (nurses and social workers) and snowball sampling (psychologists) from four primary health care clinics and twelve satellite health care clinics, all located in township communities in Nelson Mandela Bay, South Africa. The participants were all caring for and supporting children who are AIDS orphans living in these communities. Methods: In-depth individual interviews occurred between April and Nov 2013 which were recorded and transcribed verbatim. All data was then analysed using cluster analysis to identify “barriers to” and “recommendations for” providing care and support to these vulnerable children as identified by these research participants. Results: All “barriers to” and “recommendation for” are represented in this cluster analysis. There were six identified clusters illustrating “Barriers to” and four visualised clusters illustrating “Recommendations for”. The barriers can be identified using the following broad themes; B1, fundamental barriers; B2, primarily related to legislative and policy frameworks, B3, lack of human and financial resources also included stigma and communication. B4, grief, high risk behaviours and cumbersome bureaucratic processes and included loss of trust in adults; B5, barriers related to poverty B6, barriers related to poverty also included non-disclosure of HIV status. Regarding the “recommendations for” these can be identified using the following broad themes; R1, developing the resilience of health and social care professionals. R2, developing interventions, to meet the unique needs of these AIDS orphans. R3, developing, empowering and capacitating professionals and R4, facilitating an empowering working environment for professionals. Conclusions: Significant clusters emerged and the “barriers to” and “recommendations for” were identified in this research which could be used to inform the development of an intervention to provide “best practice” care and support to these vulnerable children living in these township communities

Photoresist patterned thick-film piezoelectric elements on silicon

A fundamental limitation of screen printing is the achievable alignment accuracy and resolution. This paper presents details of a thick-resist process that improves both of these factors. The technique involves exposing/developing a thick resist to form the desired pattern and then filling the features with thick film material using a doctor blading process. Registration accuracy comparable with standard photolithographic processes has been achieved resulting in minimum feature sizes of <50 ?m and a film thickness of 100 ?m. Piezoelectric elements have been successfully poled on a platinised silicon wafer with a measured d 33 value of 60 pCN?1

The experience of AIDS orphans living in a township

One of the challenges facing health care professionals today is the phenomenon of rendering care to children who have been orphaned in the AIDS pandemic. The number of AIDS orphans in South Africa has risen out of all proportion and is causing existing health and social structures to become stretched in providing care to this vulnerable population of children. The objectives of this study are to explore and to describe the lived experience of children living in a township who have become AIDS orphans and to develop broad guidelines for Primary Health Care Nurses (PHCN’s), related professionals and partners involved in the care of AIDS orphans living in a township. The theoretical grounding of this study is found in Kotze’s Theory on Nursing Accompaniment (Kotzé, 1998:3). The proposed research design was based upon a qualitative study using an explorative, descriptive, contextual and phenomenological strategy of inquiry. Data was collected by means of in-depth interviews from a purposively selected sample and then analysed using the steps of qualitative data analysis proposed by Tesch (in Creswell, 1994). Guba’s model was used to assess the trustworthiness of the qualitative data. Based upon the findings, guidelines were developed to assist PHCN’s related professionals and partners involved in the care of AIDS orphans living in a township. Through this study the goal of the researcher was to give a voice to AIDS orphans living in a township and to represent accurately their lived experience

Simulated accelerated evolution by modeling the rapid fixation of bacteria along an antibiotic gradient

The work in this thesis makes connections between statistical mechanics and genotype frequencies in population sizes, and how mutation of the bacteria E. coli helps to increase its resistance to the antibiotic ciprofloxacin. The objective of this thesis is to use existing models in statistical mechanics as a basis in order to create a new program to simulate how an antibiotic gradient affects the rate of mutation of a bacterial population, and what influence the shape of the gradient has on the evolutionary rate. In addition, several other factors affecting the evolutionary rate are identified as well. Overall, a steeper antibiotic gradient will result in accelerated evolution as long as the initial growth of bacteria is not in the presence of antibiotic. It was observed that by allowing for initial bacterial growth in the absence of antibiotic, followed by migration towards an increasing gradient of antibiotic results in accelerated mutation

The use of machine learning/deep learning in PET/CT interpretation to aid in outcome prediction in lymphoma

Lymphoma is a haematopoietic malignancy consisting of two broad categories: Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). These categories can be further split into subtypes with classical HL (cHL) and diffuse large B cell lymphoma (DLBCL) being the commonest subtypes. The gold standard imaging modality for staging and response assessment for cHL and DLBCL is 2-deoxy-2-[fluorine-18]fluoro-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT), with patients having a worse prognosis if they do not demonstrate complete metabolic response (CMR). However, approximately 15% of patients will relapse even after CMR. Therefore, being able to identify patients who are likely to relapse it may be possible to stratify treatment early to improve patient outcomes. The aim of this project is to develop and test image derived predictive models based on the baseline PET/CT to risk stratify patients pre-treatment

Immunological markers in hairy-cell leukaemia

The dissertation consists of six chapters. Chapter 1 presents a brief introduction on immunological markers. Chapter 2 describes the discovery of a previously unrecognised marker in hairy-cell leukaemia (HCL), a receptor for IgM. The rosette method used to reveal this receptor, and the conditions affecting rosette formation are described. A kinetic study of this receptor is used to provide a measure of membrane turnover in HCL. The distribution of the IgM receptor among normal and malignant haemic cells is investigated. Chapter 3 considers a variety of other immunological markers in HCL. Previous controversy in the literature concerning the presence of a receptor for complement on hairy cells is resolved and new information is provided about the presence of other markers on hairy cells. Chapter 4 presents experiments designed to investigate conflicting evidence regarding the nature of the hairy cell. Monocytic properties are measured and weighed against features of hairy cells which align them with the B-lymphocyte series. The presence of intrinsic surface immunoglobulin (Sig) is used as evidence for the B-cell nature of HCL. The results obtained showing only IgG on the surface of some cases of HCL, and multiple heavy chain isotypes on others, provide a solution to the confused literature regarding the presence of SIg on hairy cells. Two unusual cases of immunoproliferative diseases are extensively investigated in Chapter 5 in order to demonstrate some of the problems associated with immunological marker studies. Chapter 6 reviews the thesis and draws conclusions about the nosology of HCL. A possible position for HCL in schemes of B-cell differentiation is given. Several papers of unconnected work submitted during the period of research for the dissertation are also included for consideration by the Examiners.Digitisation of this thesis was sponsored by Arcadia Fund, a charitable fund of Lisbet Rausing and Peter Baldwi

Obesity, Complexity, and the Role of the Health System

As obesity continues to increase throughout the world, there is still no well-defined solution to the issue. Reducing obesity poses a significant challenge for the health care system because it is a complex problem with numerous interconnections and elements. The complexity of obesity challenges traditional primary care practices that have been structured to address simple or less complicated conditions. Systems thinking provides a way forward for clinicians that are discouraged or overwhelmed by the complexity of obesity. At any given level, individuals matter and system functioning is optimized when our capacity is well matched to the complexity of our tasks. Shifting paradigms around the causes of obesity is essential for creating a health care system that promotes innovative and collaborative practice for healthcare practitioners and individuals dealing with obesity

Strategies to provide holistic care and support to children who are AIDS orphans living in township communities

The human immunodeficiency virus/acquired immune-deficiency syndrome pandemic (HIV/AIDS) continues to increase in prevalence worldwide, particularly in South Africa. “AIDS, (Acquired Immune Deficiency Syndrome), has devastated the social and economic fabric of African societies, made orphans of a whole generation of children and become the epicentre of the HIV/AIDS pandemic” (Fassin, 2007: 76). Like the virus itself, the AIDS crisis mutates rapidly. Children who are AIDS orphans living in South Africa, as in other African countries, suffer from recurrent psychological trauma. It starts with the illness and death of their parents and is followed by cycles of poverty, malnutrition, stigma, exploitation, sickness and often sexual abuse. The figures concerning those affected, which are staggering, offer various predictions regarding the number of orphans left in the wake of the pandemic. Between 1990 and 2003, the number of orphaned children rose from fewer than 1 million to more than 12 million in sub-Saharan Africa (UNICEF, 2005: 68). South Africa is severely affected by the AIDS pandemic, with the largest number of HIV infections in the world, a total of 5.7 million (RSA, 2010: 10), affecting approximately 3.2 million women and 280 000 children aged from 0 to14 years. There is a significant variation in HIV prevalence per province, with the Eastern Cape (EC) reportedly having an average prevalence rate of 28 percent. Hence South Africa is likely to be the country with highest percentage of children orphaned by AIDS within its population. Orphanhood is a major consequence of the AIDS pandemic in South Africa with an estimated 2.2 million AIDS-orphaned children, 11,188 per 100,000 by 2015. Most children who are AIDS orphans living in township communities live predominantly uncared for and unsupported. Therefore the purpose of this research study was to develop strategies to provide care and support to children who are AIDS orphans living in township communities. To achieve the purpose of this research study, a qualitative, exploratory, descriptive and contextual design was used by the researcher to gain insight from health and social care practitioners who render care and support to children who are AIDS orphans living in these communities. The data from in-depth interviews with the health and social care practitoners was used by the researcher to develop strategies to provide care and support to children who are AIDS orphans living in township communities. The study comprised the following four phases: Phase One: During this phase, the researcher will present an overview of the current legislative framework policies at an international, national and provincial level, regarding the the rights of children living in South Africa. Phase Two: During this phase data from two research populations were collected and analysed. As the research process of this study dealt with two groups of participants, namely in group one health care practitioners and group two comprised social workers and psychologists, who work in the township communities to provide care and support to children who are AIDS orphans living in these communities. The researcher discussed each group separately in the discussion of phase two of the study. Phase Three: Comprised the themes identified in the data gathered from the transcribed in-depth interviews, the field notes as well as the reflective journals were cross-validated to ensure trustworthiness of the data which was then organised into a conceptual framework. The conceptual framework was used to clarify the relationships of the concepts and the themes identified during the research process and also used to link the gathered data to previously established models and theories (Schneider, 2004: 133). Phase Four: The last phase of the research design, focused on the development of the “Steps of progression strategies” to provide holistic care and support to children who are AIDS orphans living in township communities. This was done making use of the themes identified during data analysis and the literature sources used throughout this research process. The evaluation criteria of Chinn and Kramer (2008: 237-248) were used to evaluate the strategies. It is therefore concluded that the researcher succeeded in achieving the purpose of this study because strategies which were understandable, clear, simple, applicable and significant to nursing practice have been developed for use by the Department of Health and Department of Social Development as well as primary health and social care practitioners to provide holistic care and support to children who are AIDS orphans living in township communities in South Africa

Bronchial Artery Embolisation for Massive Haemoptysis: Immediate and Long-Term Outcomes-A Retrospective Study.

INTRODUCTION: Bronchial artery embolisation (BAE) is an established treatment method for massive haemoptysis. The aim of this study is to evaluate the impact of BAE on in-hospital outcomes and long-term survival in patients with massive haemoptysis. METHODS: Retrospective review of all cases of acute massive haemoptysis treated by BAE between April 2000 and April 2012 with at least a 5 year follow up of each patient. Targeted BAE was performed in cases with lateralising symptoms, bronchoscopic sites of bleeding or angiographic unilateral abnormal vasculature. In the absence of lateralising symptoms or signs, bilateral BAE was performed. RESULTS: 96 BAEs were performed in 68 patients. The majority (64 cases, 67%) underwent unilateral procedures. 83 (86.5%) procedures resulted in immediate/short term control of haemoptysis which lasted for longer than a month. The mean duration of haemoptysis free period after embolisation was 96 months. There were three major complications (cardio-pulmonary arrest, paraparesis and stroke). 38 (56%) patients were still alive at least 5 years following their BAE. Benign causes were associated with significantly longer haemoptysis free periods, mean survival 108 months compared to 32 months in patients with an underlying malignant cause (p = 0.005). An episode of haemoptysis within a month of the initial embolisation was associated reduced overall survival (p = 0.033). CONCLUSION: BAE is effective in controlling massive haemoptysis. Long-term survival depends on the underlying pulmonary pathology. Strategies are required to avoid incomplete initial embolisation, which is associated with ongoing haemoptysis and high mortality despite further BAE