Tribesman, trader, peasant and proletarian: The process of transition from pre-capitalist 'Natural Economy' to a capitalist mode of production in the Hinterland of the Kimberley Diamond Fields during the 19th century.

African Studies Seminar series. Paper presented October, 1978The concern of this paper is to attempt a critical investigation of the significance and implications of the penetration of capitalism and the colonial state into the geographical area of Griqualand West and British Bechuanaland in the 19th Century. The focus will be on the nature of the transition (‘transitional conjuncture’, ‘articulation of modes of production’) from pre-capitalist ‘natural economy’ to capitalist modes of production in the context of the industrializing political economy centred on the Kimberley Diamond Fields. More specifically, an attempt will be made to look at the evolving relationships between that emergent capitalist 'centre' and the immediate hinterland, examining the effects of the penetration of merchant capital (+- 1760-1860s), and of the industrialization process (from 1870 to 1900) on the societies and peoples of that region

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

F.S. Malan, the Cape liberal tradition, and South African politics 1908-1924

African Studies Seminar series. Paper presented May, 1975The nature of the Cape 'liberal' tradition has long posed problems for historians. It can be regarded, in broad terms, as a particular approach to parliamentary government in the South African context, an important defining element being the attitude held by those who claimed to be adherents towards "native policy" and the franchise. That the extent of that 'liberalism' on the question of race policies was often suspect, has been clearly shown in recent years

History in senior secondary school CAPS 2012 and beyond: a comment.

History Education has been a neglected aspect of the great educational debate in South Africa in recent times. Despite its high profile in anti - apartheid education the subject has not received the same attention as science and maths in the post 1994 debates, and was to a large extent sidelined by Curriculum 2005 and OBE reforms because of the emphasis on constructivist notions of knowledge which devalued formal historical learning. Although partially rescued by Asmal’s reforms in the Revised National Curriculum Statement (RNCS) of 2002, it has taken the CAPS curriculum of 2010-2011 to put it back at the centre of the educational picture by recognising the importance of history as a key aspect of the worthwhile knowledge to be offered at school. This article looks at the new CAPS curriculum for senior school (Grades 10-12) and recognises its value but also turns a critical eye to question the credibility of the new curriculum in terms of knowledge criteria and pedagogic viability