Ultrasound and fluorescence optical imaging biomarkers for early diagnosis and prediction of rheumatoid arthritis

Prevention of rheumatoid arthritis (RA) is most desirable together with curative treatment which is, however, not yet available. Today, the correct timely diagnosis and early treatment interventions to prevent disease progression remain the best options for our patients. In this thesis, I explore the diagnostic and predictive value of musculoskeletal ultrasound (MSUS) and fluorescence optical imaging (FOI) in identifying biological features on images indicative of existing or emerging joint inflammation (synovitis). In study 1, we tested and compared the diagnostic utility of FOI with clinical examination and musculoskeletal ultrasound (MSUS) to detect active synovitis in 872 joints of 26 patients with different rheumatic diseases (46% early RA). Fluorescence optical imaging proved to be 80% sensitive and 96% specific, having a 77% positive predictive value (PPV) and 97% negative predictive value (NPV) for detecting silent synovitis. In study 2 we showed FOI’s ability to quantify digital disease activity (DACT) scores of 1326 joints in 39 early RA patients to be 81% sensitive and 90% specific, with 96% PPV and 61% NPV. These results justify FOI use in clinical practice, to assist the rheumatologist to make an earlier diagnosis with greater confidence. Unsupervised cluster differences emerged for seropositive and seronegative RA patients showing FOI’s ability to objectively quantify hand joint inflammation using novel DACT scoring methods. In study 3 we report good association among the two ultrasound semi-quantitative scoring (SQS) methods to that of a novel quantitative scoring (QS) measure of color Doppler pixel counts in 37 established RA patients. Although SQS well correlated with QS to assess active synovitis, the SQS methods lacked visual perceptions of raters to distinguish between grade cut-offs which may help to further revise the criteria used to objectively quantify disease activity. In study 4, we show the value of ultrasound and immune-inflammatory biomarkers in predicting arthritis onset in individuals positive for Anti-CCP with musculoskeletal complaints at risk of RA development. We propose the recognition of a high-risk RA phase characterized by presence of certain ACPA reactivities, IL15-Rα, IL6; and ultrasound detected tenosynovitis, and possibilities to identify (low and high) risk groups for arthritis progression. Overall, our findings on imaging contribute towards a) silent synovitis detection despite negative clinical investigation, b) objective quantitative measures to monitor the effects of RA therapy and c) early identification of certain predictive imaging and biological features/biomarkers that precede arthritis development (tenosynovitis and/or bursitis) in individuals at risk for developing RA, enabling closer monitoring and early diagnosis

An evaluation of personality traits associated with job satisfaction among South African anaesthetists using the Big Five Inventory

Background: Job satisfaction is a vital contributor to occupational well-being and may be instrumental in mitigating stress and the adverse effects thereof. This is particularly pertinent in anaesthesiology, which is an inherently stressful field. There are myriad factors, including personality traits, shown to influence job satisfaction. Personality testing is conducted in many industries prior to recruitment; however, this is not the case in medicine. Currently the prevailing tool for the aforementioned purpose is the Big Five Inventory based on the well-described Five Factor Model of personality.Methods: A cross-sectional survey was utilised with electronic questionnaires distributed to all 1 509 members of the South African Society of Anaesthesiologists in 2016. Specialists, registrars, diploma-qualified and full-time general practitioner anaesthetists working in both the private and public sectors were included.Results: A response rate of 31% was achieved. Statistical analysis demonstrated that Neuroticism was the strongest and most consistent negative correlate of job satisfaction, while Agreeableness was positively associated with job satisfaction. Encouragingly, a mean of 65.6% was recorded for job satisfaction using a visual analogue scale. Socio-demographic variables positively associated with job satisfaction included increasing age, male gender, private practice and specialist/diploma qualification.Conclusions: Information gleaned from this study may prove useful in vocational counselling with the aim of improving occupational well-being, thereby reducing burnout and maladaptive behaviour among South African anaesthetists.Keywords: anaesthetists, big five inventory, five factor model, job satisfaction, personality trait

Incidence and hospital mortality of vascular surgery patients with perioperative myocardial infarction (PMI) or myocardial injury after non-cardiac surgery (MINS)

Background: Perioperative myocardial infarction (PMI) and prognostically relevant myocardial injury following non-cardiac surgery (MINS) increases perioperative mortality. Studies in vascular patients show an increased incidence and mortality from PMI. However, there remains limited data on the relative prognostic importance of PMI and MINS in South African vascular surgical patients. The primary objective was to evaluate the incidence and prognosis of PMI and MINS in vascular surgical patients admitted to intensive care. The secondary objective was to identify predictors of PMI and hospital mortality.Methods: A retrospective electronic patient record review of all patients aged at least 45 years admitted to Inkosi Albert Luthuli Central Hospital (IALCH) intensive care unit (ICU) following vascular surgery between 1 January 2011 and 31 December 2013 was carried out.Results: A total of 140 vascular patients were reviewed; 24.3% of the patients had a PMI and a further 25% had MINS. PMI was associated with significantly increased hospital mortality of 58.8% (p < 0.01) and MINS was not (20%, p = 1.00). Increasing age, the highest postoperative B-type natriuretic peptide (BNP) and a blood transfusion within the first three days postoperatively were independent predictors of PMI. PMI and a history of congestive cardiac failure were independent predictors of hospital mortality.Conclusion: PMI and MINS are present in nearly 50% of vascular patients admitted to intensive care postoperatively. PMI but not MINS in these patients was significantly associated with hospital mortality. MINS requires strict diagnostic criteria in the intensive care where other non-ischaemic pathologies may be associated with myocardial injury.Keywords: brain natriuretic peptide, critical illness, myocardial injury after non-cardiac surgery, perioperative myocardial infarction, vascular surger

The frequency and perceptions of academic dishonesty among graduate students: a literature review and critical anaylsis [sic]

Includes bibliographical references

An exploratory investigation into the perceptions of consumers based on the quality of customer service received with specific reference to Ola Milky Lane - Midlands Liberty Mall.

Thesis (M.Comm.)-University of KwaZulu-Natal, Pietermaritzburg, 2008.Due to the growth of our economy and our rising standards of living, customers of today have a larger variety of products to choose from than in the past. This causes an increase in competition which has raised customer expectations on the quality of goods and services they receive (Palmer, 2001 p26). Along with this, the modern customer has become sophisticated, educated, confident and well informed. Hence, they have raised their expectations of the service they intend on receiving. This has placed enormous pressure on service organization's to improve the way they do business with these customers. This "customer transformation" has placed an increasing emphasis on customer service as a means of gaining a competitive advantage. As a consequence of competition becoming global and more intense, many organizations have come to the realization that they cannot compete on price alone. Hence, the level of customer service has a direct impact on an organization's market share, as it determines not only whether consumers will become customers but also whether existing customers will become loyal ones. If service quality is to become the cornerstone of an organisation's marketing strategy, marketers should have the means to measure it. Although research in this field exists, the researcher proposed the need for further research specifically in the area of customer perceptions toward the quality of service they receive. The issues addressed in this study will be of importance to both service managers and future researchers as a customer's evaluation of service quality and, the resulting level of satisfaction is thought to determine the likelihood of a repurchase and ultimately the success of the business. This dissertation is based on the perceptions of customers of Ola Milky Lane and the level of quality customer service they receive. Looking at the business from the customer's viewpoint will help the researcher investigate how current customers feel about the organization as well as their attitude toward the business. The expectations of these customers together with their levels of satisfaction, which shape their perceptions of the customer service, serve as the foundation on which service quality will be evaluated. Moreover, the research study hopes to assist the participating organisation establish whether gaps in service delivery exist, the reasons for their presence and identify possible solutions which can be implemented to close or prevent those gaps from further widening. This will benefit the organization as it can be used as a tool to understand customer perceptions, which can equip them to gauge the effectiveness and efficiency of their relationship programmes. With this motivation in mind, the research study takes a strategic look at the importance of customer service as perceived by customers by means of determining whether the organisation is or is not meeting their expectations

Modelización de la aparición de larvas en estadio de postflexión de un pez estuárico dependiente en los estuarios templados de Sudáfrica

The movement of postflexion larvae of marine estuarine-dependent species into estuaries is critical for the survival of fishes reliant on estuaries as nurseries. However, detailed studies focused on environmental variability experienced by postflexion larvae entering a range of estuary types under varying conditions are rare. This study assessed the in situ conditions (temperature, salinity and water clarity) under which the southern African endemic fish Rhabdosargus holubi (Sparidae) recruits into estuaries. Postflexion larvae were sampled in three biogeographic regions (cool temperate, warm temperate and subtropical boundary), which included three estuary types (permanently open estuaries (POEs), temporarily open/closed estuaries and estuarine lake systems) on a seasonal basis, independent of each other. Rhabdosargus holubi larvae were more abundant in spring and summer, in POEs in the warm temperate region. Models predicted that higher larval occurrence in estuaries is a function of lower salinity (e.g. mesohaline zones of 5-17.9 salinity) and lower water clarity (e.g. 0-0.2 Kd, light extinction coefficient), particularly for warm, temperate POEs. This re-emphasizes the importance of freshwater for optimal nursery functioning, which may be compromised by impoundments, abstraction and climate change in water-short countries like South Africa.En las especies de peces dependientes de los estuarios marinos como zonas de cría, el movimiento de las larvas en estadio de postflexión hacia el interior de los estuarios es un proceso crítico para su supervivencia. Sin embargo, son raros los estudios detallados que analicen la variabilidad ambiental experimentada por estas larvas en diversos ambientes estuáricos. Este estudio evaluó las condiciones in situ (temperatura, salinidad y claridad del agua) bajo las que Rhabdosargus holubi (Sparidae), pez endémico de África meridional, recluta en los estuarios. Las larvas en postflexión se muestrearon estacionalmente en tres regiones biogeográficas, independientes entre sí, (templada-fría, templada-cálida y subtropical), que incluían tres tipos de estuarios (POE: estuarios permanentemente abiertos, TOC: estuarios temporalmente abiertos/cerrados y ELS: sistemas de lagos estuarinos). Las larvas de Rhabdosargus holubi fueron más abundantes durante la primavera y el verano, en POEs de la región templada-cálida. Los modelos predijeron que la mayor aparición de larvas en los estuarios es función de una menor salinidad (por ejemplo, zonas mesohalinas de 5-17.9 salinidad) y una menor claridad del agua (por ejemplo con coeficiente de extinción de luz de 0-0.2 Kd), particularmente para POEs templado-cálidos. Esto reafirma la importancia del agua dulce para el funcionamiento óptimo como zona de cría, que puede verse comprometida por los embalses, la extracción de agua y el cambio climático en países con escasez de agua como Sudáfrica

Drama, spirituality and healing : towards a contextual exploration of dramatic methodologies for healing black gay men in the greater Pietermaritzburg area.

Thesis (M.A.)-University of Natal, Pietermaritzburg, 2000.This study explores the interconnectedness of drama, spirituality and healing among an established group of black gay males in the Pietermaritzburg area who agreed to work with me towards self-empowerment through drama. It examines, through a synthesis of educational drama methodology, community theatre methodology and drama therapy methodology, an appropriate and contextual way to use drama as a means of educating (educational drama methodology), conscientising (community theatre methodology) and therapy (drama therapy methodology) to some of the dis-ease reported by members of this group. Drama and therapy are closely interwoven (Moreno, 1970) and it is possible to create a dramatic context within which both individual and community development can be enhanced. Boal (1995) observes that our personal and corporate identities are ordered by a variety of oppressive social systems. Similarly, Graham (1992) argues that these social systems organise our psyches and our behaviours into patterns of domination and subordination. There are many theorists and practitioners in the field of drama (educational drama, community theatre and drama therapy) who have researched, implemented and published dramatic techniques and methodologies, some of which are taught at various institutions and implemented with various groups of people. However, according to my knowledge, there are no drama practitioners who have focussed on using the medium of drama to bring about social change in the lives of black gay males in the Pietermaritzburg area. It is against this background that I undertook this experiential study which is primarily aimed at assisting black gay males to move away from personal and social alienation towards individual and communal integration. This study is structured into two parts. Part I develops a theoretical overview of sexuality, spirituality and drama. It argues, in Chapter One that the Church has had a history of intolerance and judgement towards gays and continues to repress them from a traditional, negative stance on homosexuality. In Chapter Two, the issue of femininity and masculinity is examined, arguing that traditional patriarchal, and heterosexual masculinity [and femininity] is a socially constructed behaviour which is similar to the way in which gay masculinity [and femininity] is constructed. Chapter Three investigates the educational, conscientising and therapeutic origins of drama, with an aim of implementing some of these dramatic methodologies with the drama group. Part II concentrates on the application of the theory discussed in Part I to the practice of drama as an educational, conscientising and therapeutic means with a black gay drama group. It provides an analysis of the exercises and improvisations in practice; observations, evaluations and conclusions based on the drama practise with this particular group. Chapter Four provides a detailed summary of thirty black gay male's profiles in the Pietermaritzburg area. This portrait of black gay males provides one with a clearer contextual understanding of these gays, especially in the areas of culture, spirituality, identity and sexuality. Chapter Five provides a detailed outline of a sequence of exercises and improvisations for each of the nine sessions, which were tailored to engage the drama group in productive educational, conscientising and therapeutic activities. These activities may also have applicability to other groups of gays (i.e. Indians, Coloureds, Whites and multi-racial / multi-cultural groups), and/or black, and/or male persons in other localities. Chapters Five, Six and Seven, focus respectively on my experiences of planning, implementing and evaluating the drama workshops and the various drama methodologies that were introduced in Chapter Three and employed by the participants. These chapters, especially Chapter 6, focus specifically on the participants' evaluation of the actual workshops. In conclusion, this study argues that drama, if contextrialised, can offer a unique educational, conscientising and therapeutic potential among black gay males that I worked with in the Pietermaritzburg area

Efecto de la hipersalinidad sobre el crecimiento y anomalías esqueléticas en juveniles de sargo del Cabo, Rhabdosargus holubi (Sparidae)

Estuarine organisms are exposed to hypersaline conditions for prolonged periods during drought conditions and under severely restricted river flow resulting from freshwater abstraction and impoundments. Consequently, marine estuarine-dependent fish such as Rhabdosargus holubi may be subjected to extreme conditions, such as hypersalinity prevailing for long periods ( > 2 months). Hypersalinity may impact the energetic demands of fish due to osmoregulation leading to compromised growth. This study assessed the impact of high salinity on the growth and skeletal development of R. holubi juveniles. Skeletons of juveniles grown at different salinities in the wild and in aquaria were analysed for anomalies. The impact of hypersaline conditions on juvenile R. holubi growth was also determined in aquaria. Aquarium experiments indicated that hypersalinity of 50 did not significantly impact growth rates over two months. Overall, anomalies were rare and vertebral-related anomalies specifically did not differ significantly between salinities. However, fin rays were significantly impacted in fish growing at higher salinities in the wild. It was concluded that the strong osmoregulatory ability of R. holubi offers protection against hypersalinity affecting internal structures, but external structures may remain vulnerable. As such, from a locomotory standpoint, R. holubi may be vulnerable to long periods of exposure to hypersaline conditions.Los organismos que habitan en estuarios están expuestos a condiciones de hipersalinidad durante períodos de sequía y en momentos en los que el aporte de agua fluvial se reduce de forma importante por substracción de aguas o presencia de embalses. Así, los peces marinos que dependen de los estuarios, como Rhabdosargus holubi, pueden estar expuestos a condiciones extremas, tales como una hipersalinidad de larga duración ( > 2 meses). La hipersalinidad puede afectar los requerimientos energéticos de los peces debido al proceso de osmoregulación y comprometer el correcto crecimiento del individuo. Este estudio investigó el impacto de altas salinidades sobre el crecimiento y el desarrollo esquelético en juveniles de Rhabdosargus holubi. Se analizó el esqueleto de juveniles crecidos en diferentes salinidades, tanto en el medio natural como en acuarios, para detectar la presencia de anomalías esqueléticas. Además, se estudió el impacto de condiciones de hipersalinidad en acuarios, sobre el crecimiento de juveniles de Rhabdosargus holubi. Los experimentos en acuario indicaron que una exposición de 2 meses a hipersalinidad de 50 no afectaron significativamente las tasas de crecimiento. La presencia de anomalías esqueléticas fue escasa y en concreto, las relativas a las vértebras fueron similares entre los grupos expuestos a las diferentes salinidades. Sin embargo, si se detectó un impacto significativo sobre el desarrollo de los radios de las aletas en los peces expuestos a altas salinidades en el medio natural. En conclusión, los resultados del estudio sugieren que la fuerte capacidad osmoreguladora de R. holubi le protege contra los efectos de la hipersalinidad sobre las estructuras internas, pero no sobre las estructuras externas, que permanecerían vulnerables a estas condiciones. Así, desde el punto de vista de la locomoción, R. holubi sería vulnerable a una exposición prolongada a condiciones de hipersalinidad

Sustainable plant-derived coagulating agents in a heterogeneous platform for front-end water purification.

Masters Degree. University of KwaZulu-Natal, Durban.Chemical coagulants have been associated with having adverse economic, health and environmental impacts. Many rural communities do not have access to specialised coagulating agents and infrastructure for water treatment and resort to consuming water from unprotected sources. It is therefore of utmost importance to develop a simplistic, low-cost, easily accessible and environmentally friendly technique of water treatment that can be applied in rural communities. Although homogeneous coagulating agents, derived from plant species, have been investigated for this purpose, their use results in increased organic matter in the treated water, and the production of flocs with poor settling characteristics. Therefore, homogeneous coagulant proteins, from Glycine max, Cicer arietinum, Vigna unguiculata and Vigna mungo, were loaded onto silica substrates to produce a heterogeneous coagulant product, which would act as a binding site for suspended inorganic and organic matter and lead to improved floc settling characteristics. Experimentation was conducted to compare the efficiency of heterogeneous coagulants derived from biomass sources in turbidity removal and thereafter to establish the optimum conditions for front-end water treatment. The active components were extracted from the seeds of each plant species via aqueous extraction (using distilled water as the extraction medium) and salt-extraction (using sodium chloride salt solutions as the extraction medium). The salting-in process, which involved increasing the salt concentration of the extraction medium, was employed to improve protein extraction into solution. The optimum salting-in concentration for extraction was 0.4M, 0.8M, 0.5M and 0.3M for Vigna unguiculata, Cicer arietinum, Glycine max and Vigna mungo respectively. In order to improve protein loading, the salt concentration was raised to facilitate the salting-out process. The optimum salting-out concentration was 0.4M, 0.825M, 0.6M and 0.75M for Vigna unguiculata, Cicer arietinum, Glycine max and Vigna mungo respectively. In order to establish the optimum dose of the heterogeneous coagulating agent, turbidity removal experiments were conducted by means of a jar test. This involved the preparation of synthetic turbid water samples (at an initial turbidity of 200 NTU ± 0.5 NTU) and varying the dose of the aqueous extracted heterogeneous coagulant and the salt-extracted heterogeneous coagulant. The results of the jar test revealed that the optimum dose and corresponding average turbidity removal of aqueous extracted heterogeneous coagulant derived from Vigna unguiculata, Cicer arietinum, Glycine max and Vigna mungo was 15g/l and 80%, 15g/l and 78.2%, 20g/l and 79.1% and 10g/l and 82.3% respectively. The optimum dose and corresponding average turbidity removal of salt-extracted heterogeneous coagulating agent was 5g/l and 89.6%, 10g/l and 80.4%, 10g/l and 87.4% and 5g/l and 89.6% for Vigna unguiculata, Cicer arietinum, Glycine max and Vigna mungo respectively. This proved that higher turbidity removal efficiencies can be achieved at lower salt-extracted coagulant doses. From the study, the heterogeneous coagulant derived from Vigna mungo was deemed the most effective due to its high turbidity removal efficiency at low doses and low salt concentration requirements for extraction and loading. In addition, its drought-resistance, versatility, short maturity period, simple harvesting requirements, non-toxicity and biodegradability makes this plant species an ideal candidate for front-end water treatment