Asymptotic stability and blow up for a semilinear damped wave equation with dynamic boundary conditions

In this paper we consider a multi-dimensional wave equation with dynamic boundary conditions, related to the Kelvin-Voigt damping. Global existence and asymptotic stability of solutions starting in a stable set are proved. Blow up for solutions of the problem with linear dynamic boundary conditions with initial data in the unstable set is also obtained

A patient-centric Six-Sigma decision support system framework for continuous quality improvement in clinics

CITATION: Hlongwane, S., Ngongoni, C. & Grobbelaar, S. S. 2019. A patient-centric Six-Sigma decision support system framework for continuous quality improvement in clinics. South African Journal of Industrial Engineering, 30(3):224-237, doi:10.7166/30-3-2241.The original publication is available at http://sajie.journals.ac.zaENGLISH ABSTRACT: Primary health care facilities are widely regarded as the backbone of the South African healthcare system. For this reason, formalised standards such as the ‘ideal clinic’ and ‘national core standards’ dictate expected service levels for clinics. Although this is a big step towards the improvement of service delivery at the facilities, the level of uptake of and adherence to these standards is concerning. Service quality plays a huge role in the level of patient satisfaction, and emphasis is placed on the features of quality that are of importance to the patient. To this end, the focus on the patient is an important dimension in healthcare quality management in order to improve the service quality in healthcare facilities. This article provides an overview of quality and how it is managed in the context of clinics in South Africa. It outlines the gaps, aligned with how well quality is managed, from a patient perspective. The paper proposes a decision support framework aimed at continuous improvement of quality in clinics. The tool was developed using the Six Sigma methodology, complemented by service quality assessment instruments. The structure of the tool provides an integrated systematic approach that can assist the healthcare decision-maker in tracking the continuous improvement of processes and activities in clinics. The tool also takes the first step towards digitising a typical paper-based system.AFRIKAANS OPSOMMING: Primêre gesondheidsorgfasiliteite word wyd beskou as die ruggraat van die Suid-Afrikaanse gesondheidsorgstelsel. Om hierdie rede word formele standaarde deur die ‘ideale kliniek’ en ‘Nasionale kernstandaarde’ bepaal. Alhoewel dit ʼn groot stap is vir die verbetering van dienslewering by die fasiliteite, is die vlak van opname en nakoming van hierdie standaarde kommerwekkend. Diensgehalte speel ʼn groot rol in die vlak van pasiëntbevrediging, en klem word geplaas op die eienskappe van kwaliteit wat van belang is vir die pasiënt. Vir hierdie doel is die fokus op die pasiënt ʼn belangrike dimensie in gesondheidsorgkwaliteitsbestuur ten einde die diensgehalte in gesondheidsorgfasiliteite te verbeter. Hierdie artikel bied ʼn oorsig oor kwaliteit en hoe dit in die konteks van klinieke in Suid-Afrika bestuur word. Dit beskryf die gapings van hoe goed kwaliteit bestuur word, uit ʼn pasiëntperspektief. Die artikel stel ʼn besluitsteunraamwerk voor wat op deurlopende verbetering van gehalte in klinieke gemik is. Die instrument is ontwikkel met behulp van die Ses-Sigma metodologie, aangevul deur dienskwaliteit assesseringsinstrumente. Die struktuur van die instrument bied ʼn geïntegreerde sistematiese benadering wat die gesondheidsorgbesluitnemer kan help om die deurlopende verbetering van prosesse en aktiwiteite in klinieke te monitor. Die instrument neem ook die eerste stap in die rigting van digitalisering van ʼn tipiese papiergebaseerde stelsel.http://sajie.journals.ac.za/pub/article/view/2241Publisher's versio

University-driven inclusive innovations in the Western Cape of South Africa: Towards a research framework of innovation regimes

Merit, Expertise and Measuremen

Lessons from the hepatoblastoma-familial polyposis connection

Background. Approximately one-third of hepatoblastoma (HB) patients have associated congenital abnormalities, but familial recurrence is rare, except in association with familial adenomatous polyposis (FAP). This correlation may be missed if not actively sought, with implications for long-term outcome and management. Methods. We retrospectively investigated 3 families with an HB-familial polyposis connection, from a cohort of 113 FAP families (1989 - 2010). Data were analysed to assess clinical problem, treatment, complications and management. Long-term morbidity and functional outcome were analysed to identify management difficulties. Results. Three FAP families (2.65%) had an HB association. In one case, undiagnosed FAP at the time of HB diagnosis was only detected 5 years later, when the mother presented with advanced colorectal carcinoma. A chromosome 5 APC gene mutation (exon 15 codon 793 C→T) was then identified. In a second case, a non-related male child presented with a stage 4 multifocal HB with lung metastases. Genetic studies identified an APC gene mutation (exon 6 codon 232 C→T). Further family investigation showed >20 related FAP patients. A third HB-FAP association was identified in a known FAP family early in the study, prior to the availability of genetic testing. Conclusion. Although a rare association, a family history of FAP in HB patients is an important ‘hidden connection’. Germline variation may be outside the usual FAP gene site. Identifying families with unknown HB/FAP is important due to long-term management implications and follow-up

Lessons from the hepatoblastoma- familial polyposis connection

The original publication is available at http://www.samj.org.zaBackground. Approximately one-third of hepatoblastoma (HB) patients have associated congenital abnormalities, but familial recurrence is rare, except in association with familial adenomatous polyposis (FAP). This correlation may be missed if not actively sought, with implications for long-term outcome and management. Methods. We retrospectively investigated 3 families with an HB-familial polyposis connection, from a cohort of 113 FAP families (1989 - 2010). Data were analysed to assess clinical problem, treatment, complications and management. Long-term morbidity and functional outcome were analysed to identify management difficulties. Results. Three FAP families (2.65%) had an HB association. In one case, undiagnosed FAP at the time of HB diagnosis was only detected 5 years later, when the mother presented with advanced colorectal carcinoma. A chromosome 5 APC gene mutation (exon 15 codon 793 C→T) was then identified. In a second case, a nonrelated boy presented with a stage 4 multifocal HB with lung metastases. Genetic studies identified an APC gene mutation (exon 6 codon 232 C→T). Further family investigation showed >20 related FAP patients. A third HB-FAP association was identified in a known FAP family early in the study, prior to the availability of genetic testing. Conclusion. Although a rare association, a family history of FAP in HB patients is an important ‘hidden connection’. Germline variation may be outside the usual FAP gene site. Identifying families with unknown HB/FAP is important due to long-term management implications and follow-up

Haematopoietic stem cell transplantation in South Africa: Current limitations and future perspectives

The growing need for haematopoietic stem cell transplantation (HSCT) is reflected in the increasing number of transplants performed globally each year. HSCT provides life-changing and potentially curative therapy for a range of pathologies including haematological malignancies; other indications include certain congenital and acquired disorders of the haematopoietic system, autoimmune conditions and hereditary diseases. The primary goals of HSCT are either to replace haematopoietic stem and progenitor cells (HSPC) following myeloablative chemotherapy or to cure the original pathology with allogeneic HSPCs. Success depends on optimal outcomes at various stages of the procedure including mobilisation of marrow stem/progenitor cells for harvesting from the patient or donor, long-term and sustainable engraftment of these cells in the recipient, and prevention of graft-versus-host disease in the case of allogeneic HSCT. Challenges in South Africa include high cost, limited infrastructure and lack of appropriately trained staff, as well as limitations in securing suitable haematopoietic stem cell donors. This review aims to provide an overview of HSCT and some of the challenges that are faced in the South African context

Evaluation of nanopore sequencing for Mycobacterium tuberculosis drug susceptibility testing and outbreak investigation: a genomic analysis

BACKGROUND: Mycobacterium tuberculosis whole-genome sequencing (WGS) has been widely used for genotypic drug susceptibility testing (DST) and outbreak investigation. For both applications, Illumina technology is used by most public health laboratories; however, Nanopore technology developed by Oxford Nanopore Technologies has not been thoroughly evaluated. The aim of this study was to determine whether Nanopore sequencing data can provide equivalent information to Illumina for transmission clustering and genotypic DST for M tuberculosis. METHODS: In this genomic analysis, we analysed 151 M tuberculosis isolates from Madagascar, South Africa, and England, which were collected between 2011 and 2018, using phenotypic DST and matched Illumina and Nanopore data. Illumina sequencing was done with the MiSeq, HiSeq 2500, or NextSeq500 platforms and Nanopore sequencing was done on the MinION or GridION platforms. Using highly reliable PacBio sequencing assemblies and pairwise distance correlation between Nanopore and Illumina data, we optimise Nanopore variant filters for detecting single-nucleotide polymorphisms (SNPs; using BCFtools software). We then used those SNPs to compare transmission clusters identified by Nanopore with the currently used UK Health Security Agency Illumina pipeline (COMPASS). We compared Illumina and Nanopore WGS-based DST predictions using the Mykrobe software and mutation catalogue. FINDINGS: The Nanopore BCFtools pipeline identified SNPs with a median precision of 99.3% (IQR 99.1-99.6) and recall of 90.2% (88.1-94.2) compared with a precision of 99.6% (99.4-99.7) and recall of 91.9% (87.6-98.6) using the Illumina COMPASS pipeline. Using a threshold of 12 SNPs for putative transmission clusters, Illumina identified 98 isolates as unrelated and 53 as belonging to 19 distinct clusters (size range 2-7). Nanopore reproduced 15 out of 19 clusters perfectly; two clusters were merged into one cluster, one cluster had a single sample missing, and one cluster had an additional sample adjoined. Illumina-based clusters were also closely replicated using a five SNP threshold and clustering accuracy was maintained using mixed Illumina and Nanopore datasets. Genotyping resistance variants with Nanopore was highly concordant with Illumina, having zero discordant SNPs across more than 3000 SNPs and four insertions or deletions (indels), across 60 000 indels. INTERPRETATION: Illumina and Nanopore technologies can be used independently or together by public health laboratories performing M tuberculosis genotypic DST and outbreak investigations. As a result, clinical and public health institutions making decisions on which sequencing technology to adopt for tuberculosis can base the choice on cost (which varies by country), batching, and turnaround time. FUNDING: Academy for Medical Sciences, Oxford Wellcome Institutional Strategic Support Fund, and the Swiss South Africa Joint Research Award (Swiss National Science Foundation and South African National Research Foundation)

Water and CSP - linking CSP water demand models and national hydrology data to sustainably manage CSP development and water resources in arid regions

CITATION: Duvenhage, D. Frank et al. 2020. Water and CSP - linking CSP water demand models and national hydrology data to sustainably manage CSP development and water resources in arid regions. Sustainability, 12(8): 3373, doi:10.3390/su12083373.The original publication is available at: https://www.mdpi.comENGLISH ABSTRACT: A systematic approach to evaluate Concentrating Solar Power (CSP) plant fleet deployment and sustainable water resource use in arid regions is presented. An overview is given of previous work carried out. Once CSP development scenarios, suitable areas for development, and the water demand from CSP operations were evaluated, appropriate spatiotemporal CSP performance models were developed. The resulting consumptive patterns and the impact of variable resource availability on CSP plant operation are analysed. This evaluation considered the whole of South Africa, with focus on the areas identified as suitable for CSP, in order to study the impact on local water resources. It was found that the hydrological limitations imposed by variable water resources on CSP development are severe. The national annual theoretical net generation potential of wet-cooled Parabolic Trough decreased from 11,277 to 120 TWh, and that of wet-cooled Central Receiver decreased from 12,003 to 170 TWh. Dry cooled versions also experience severe limitations, but to a lesser extent—the national annual theoretical net generation potential of Parabolic Trough decreased from 11,038 to 512 TWh, and that of Central Receiver decreased from 11,824 to 566 TWh. Accordingly, policy guidelines are suggested for sustainable CSP development and water resource management within the context of current South African water use regulation.Publisher's versio

SILICONE ARTHROPLASTY FOR TRAPEZIOMETACARPAL ARTHRITIS

Twenty-three patients who had undergone trapeziectomy and Helal silicone rubber ball interposition for trapeziometacarpal arthritis were reviewed. The average age at operation was 63 (range 48-84) years and the mean follow-up was 59 (range 12-138) months. Of the 23 patients reviewed, two had pain at rest and four had some discomfort on exertion. Mean post-operative thumb extension was 371 whilst mean palmar abduction was 401. Mean post-operative grip strength was 19 kg and thumb-pinch strength was 4.0 kg, 77% and 78% of the age-and sex-matched normal values. There were no cases of prosthetic dislocation, prosthetic fracture or silicone synovitis