Designing a case study protocol for application in IS research

A review of the literature has shown that there is a growing call for the use of the case research method in IS research. However, it has been noted that there are few guidelines on how to conduct case research in the field of IS, particularly with respect to the development of Case Study Protocols. This article therefore endeavours to overcome this shortcoming by presenting a set of guidelines that may be used by in the development of such protocols. In essence, a Case Study Protocol (CSP) is a set of comprehensive guidelines that is an integral part of the case research design and contains the procedures for conducting the research, the research instrument itself, and the guidelines for data analysis. By developing a CSP, researchers are forced to consider all issues relevant to their research and this in turn contributes to more rigorous (case) research that has greater internal and external validity

A comparative study of early-delayed skin grafting and late or non-grafting of deep partial thickness burns at the University Teaching Hospital

Objectives: To demonstrate the benefits of performing a split skin graft within 15 days post burn and explore thedifferences in duration of hospital stay, occurrence of infection and contracture formation in comparison to standard care currently provided at U.T.H (late or non split skin graft).Design: This was a prospective, non-randomized, interventional study involving patients with deep partial thickness burn wounds at UTH. Study subjects were to either receive an early-delayed skin graft, or the standard treatment at the time based on the surgical firm to which they were admitted.Results: Forty-three (55.1%) patients allocated to receive an early-delayed ssg while 35 (44.9%) were assigned to the late or non-ssg group. The proportion of males was 23 (29.5%) in the early-delayed group and 22 (28.2%) in the late or non ssg group while the proportion of females was 20 (25.6%) in the early-delayed group and 13 (16.7%) in the late or non ssg group. The participants' age range was 2 months to 84 years. Forty-nine (62.8%) were 5 years and below, eight (10.3%) were aged 6-10 years, ten (12.8%) were aged 11-20 years, and eleven (14.1%) were aged 21 and above years. The following were the main causes of burns, in their order of frequency, hot water (57%), flames (27%), hot food (i.e. cooking oil, porridge, beans [14%]), and chemicals (1%). In both groups the most common cause for burns was hot water, 19 (24%) in the earlydelayed skin graft group and 26 (33%) in the late or non ssg group. In forty seven (60%) patients burns were observed to affect multiple regions of the body. Mean total body surface area burn was 14%. Overall, 73 patients (93.6%) came from within Lusaka. It was also noted that 39(50%) were self referrals. Overall, 86% presented to the hospital within 24 hrs but  despite early presentation participants were reluctant to recieve an early skin graft due to lack of understanding of the procedure. Findings of this study found that at significance levels of 0.05 in the late or non SSG group hospital stay was significantly longer, (U = 305.500; p = 0.001) and infection higher (Chi Square = 4.510; p = 0.034).No significant difference was noted in contracture formation in the two groups (Chi square = 0.999; p = 0.258).Conclusions: Early–delayed split skin graft was found to statistically significantly reduce length of stay and occurence of infection as opposed to late or non ssg.No statistically significant relation could be established for occurence of contractures due to loss in follow up of patient valuable information was lost. This study shows that  even if early delayed SSG were to be offered at UTH there is need to carry out awareness campaigns to change  peoples attitudes towards the surgical procedure (SSG). This is an approved treatment world-wide which has not  gained wide acceptance amongst patients presenting to U.T.H that participated in this study. Patient attitudes and perceptions need to be changed as SSG currently is not seen as a curative treatment but as added injury to an  already injured patient.This study showed that SSG is possible and the few patients who underwent early grafting  showed good outcomes, shorter hospital stay and lower infection rates. Reduction in contracture formation may  have been determined if follow up was achieved

Sustainable management in the synfuels sector in South Africa

The debate about the decline in petroleum reserves, the worries over peak oil, the Middle East tension and oil price speculation challenges has made it important to focus on sustainable management and utilization of alternative fuels. The use of alternative fuels to supply the energy needs of the world is not a new concept. This paper reviews coal as a recoverable hydrocarbon-rich resource found in abundant quantities in South Africa (SA). This study review shows that coal will continue to provide a key for the unlocking many of the future global requirements for high-quality energy and chemical building blocks. The historical premise that coal is a dirty fuel is being countered with the continued development and operation of technology to significantly reduce the environmental footprint of coal-sourced energy is investigated. Conclusions are drawn. Firstly, the study brings to our attention that technology is available and is continually being improved to turn coal into synthetic natural gas, transportation fuels, chemicals, chemical intermediates and hydrogen in a way that reduces GHG emissions. Secondly, the study shows that there is a viable coal-to-liquids (CTL) industry in South Africa supplying high-quality middle distillates, in particular diesel fuel, jet kerosene and middle distillate blend stocks. The CTL economics, the potential role of the government and how large-scale development of this industry might impact the environment is analysed on sustainable management

Importance of Ethnicity, CYP2B6 and ABCB1 Genotype for Efavirenz Pharmacokinetics and Treatment Outcomes: A Parallel-group Prospective Cohort Study in two sub-Saharan Africa Populations.

We evaluated the importance of ethnicity and pharmacogenetic variations in determining efavirenz pharmacokinetics, auto-induction and immunological outcomes in two African populations. ART naïve HIV patients from Ethiopia (n = 285) and Tanzania (n = 209) were prospectively enrolled in parallel to start efavirenz based HAART. CD4+ cell counts were determined at baseline, 12, 24 and 48 weeks. Plasma and intracellular efavirenz and 8-hydroxyefvairenz concentrations were determined at week 4 and 16. Genotyping for common functional CYP2B6, CYP3A5, ABCB1, UGT2B7 and SLCO1B1 variant alleles were done. Patient country, CYP2B6*6 and ABCB1 c.4036A>G (rs3842A>G) genotype were significant predictors of plasma and intracellular efavirenz concentration. CYP2B6*6 and ABCB1 c.4036A>G (rs3842) genotype were significantly associated with higher plasma efavirenz concentration and their allele frequencies were significantly higher in Tanzanians than Ethiopians. Tanzanians displayed significantly higher efavirenz plasma concentration at week 4 (p<0.0002) and week 16 (p = 0.006) compared to Ethiopians. Efavirenz plasma concentrations remained significantly higher in Tanzanians even after controlling for the effect of CYP2B6*6 and ABCB1 c.4036A>G genotype. Within country analyses indicated a significant decrease in the mean plasma efavirenz concentration by week 16 compared to week 4 in Tanzanians (p = 0.006), whereas no significant differences in plasma concentration over time was observed in Ethiopians (p = 0.84). Intracellular efavirenz concentration and patient country were significant predictors of CD4 gain during HAART. We report substantial differences in efavirenz pharmacokinetics, extent of auto-induction and immunologic recovery between Ethiopian and Tanzanian HIV patients, partly but not solely, due to pharmacogenetic variations. The observed inter-ethnic variations in efavirenz plasma exposure may possibly result in varying clinical treatment outcome or adverse event profiles between populations

The impact of preoperative oral nutrition supplementation on outcomes in patients undergoing gastrointestinal surgery for cancer in low- and middle-income countries:a systematic review and meta-analysis

Abstract Malnutrition is an independent predictor for postoperative complications in low- and middle-income countries (LMICs). We systematically reviewed evidence on the impact of preoperative oral nutrition supplementation (ONS) on patients undergoing gastrointestinal cancer surgery in LMICs. We searched EMBASE, Cochrane Library, Web of Science, Scopus, WHO Global Index Medicus, SciELO, Latin American and Caribbean Health Sciences Literature (LILACS) databases from inception to March 21, 2022 for randomised controlled trials evaluating preoperative ONS in gastrointestinal cancer within LMICs. We evaluated the impact of ONS on all postoperative outcomes using random-effects meta-analysis. Seven studies reported on 891 patients (446 ONS group, 445 control group) undergoing surgery for gastrointestinal cancer. Preoperative ONS reduced all cause postoperative surgical complications (risk ratio (RR) 0.53, 95% CI 0.46–0.60, P < 0.001, I 2 = 0%, n = 891), infection (0.52, 0.40–0.67, P = 0.008, I 2 = 0%, n = 570) and all-cause mortality (0.35, 0.26–0.47, P = 0.014, I 2 = 0%, n = 588). Despite heterogeneous populations and baseline rates, absolute risk ratio (ARR) was reduced for all cause (pooled effect −0.14, −0.22 to −0.06, P = 0.006; number needed to treat (NNT) 7) and infectious complications (−0.13, −0.22 to −0.06, P < 0.001; NNT 8). Preoperative nutrition in patients undergoing gastrointestinal cancer surgery in LMICs demonstrated consistently strong and robust treatment effects across measured outcomes. However additional higher quality research, with particular focus within African populations, are urgently required

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Towards a competency-based doctoral curriculum at the University of Zambia: lessons from practice

We describe a collaborative, iterative, and participatory process that we undertook to develop and adopt a competency-based doctoral curriculum framework at the University of Zambia. There needs to be more than the traditional unstructured apprenticeship of PhD training in a knowledge-based economy where PhD graduates are expected to contribute to industry problem-solving. The lack of industry-driven competencies and, to some extent, limited skills possessed by PhD graduates relative to the demands of employers has led to the misclassification of doctoral degrees as mere paper certificates. Further, under traditional PhD training without specific core competencies, it has led to criticisms of such PhD studies as a waste of resources. The calls to rethink doctoral development in broader employment contexts led many countries to redesign their PhD programs. Training has increasingly introduced industrial linkages and industry-defined research projects to increase the attractiveness of doctoral students. Whereas developed countries have made significant reforms towards competency-based PhD training, little or nothing has been done in developing countries, especially in sub-Saharan Africa. This against the demands that Africa needs more than 100,000 PhDs in the next decade to spur economic development. Against this background, the University of Zambia has developed an industry-driven structured competency-based PhD curriculum framework. The framework will guide and support the development of standardized program-specific PhD curricula, delivery, and assessment of competencies at the University of Zambia, ensuring that doctoral students acquire skills and demonstrate core competencies that are transferable and applicable in industry settings. This framework focuses on the development of specific competencies that are necessary for successful PhD completion. The competencies are divided into three main categories: research, teaching, and professional development. Each category is then broken down into ten core competencies from which respective doctoral programs will develop sub-competencies. It is from these core competencies and sub-competencies that learning outcomes, assessment methods, and teaching activities are developed. It is envisioned that this new competency-based doctoral curriculum framework will be a helpful tool in training a cadre of professionals and researchers who benefit the industry and contribute to economic and societal development

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially