Patient selection for transcatheter aortic valve implantation (TAVI) in South Africa

Patient selection is likely to be the most important determinant of a successful long term outcome of the TAVI procedure. It requires careful assessment of the indications for aortic valve replacement, clinical status of the patient, associated co-morbidities and, importantly, the cognitive function and motivation of the patient. This assessment must be made by a multi-disciplinary team consisting of at least a cardiologist, cardiac surgeon, anaesthetist and general physician. Careful imaging of the relevant anatomywith ultrasound and CT scanning is critical. Experience improves patient selection and ultimate outcome. Funding remains a challenge and many patients worthy of the procedure are denied because of costs

Conflict between International Treaties: failing to mitigate the effects of introduced marine species.

Humans have changed the face of the earth - we have intentionally altered the locations of species in order to achieve food and economic security (eg, aquaculture of the freshwater fish Tilapia and the marine algae Kappaphycus) while also appealing to our cultural and aesthetic values (eg, the introduction of gorse to New Zealand and Australia). We have accidentally spread pathogens and diseases beyond their natural ranges1 and we have improved our technologies (such as shipping) to such an extent that we can transit our planet in shorter and shorter timeframes. All of these activities have occurred over many hundreds of years and have led in one way or another, to an increasing number of species being introduced beyond their natural ranges. Such introductions are now considered one of the top five threats to native biological diversity. This paper examines how humans have impacted upon the marine environment through the introduction of species beyond their native ranges. Introduced species impact upon native biodiversity, spread diseases and pathogens, and have had economic and social impacts in their ‘new’ ecosystems. Because of the range and extent of introduced species impacts, numerous methods to mitigate the effects of introduced species have been developed and implemented. Within this paper we will examine how two international legal instruments, the Convention on Biological Diversity, 1992 (CBD) and the World Trade Organization’s General Agreement on Tariffs and Trade 1994 (GATT), in particular its associated Agreement on the Application of Sanitary and Phytosanitary Measures (SPS), deal with introduced species. In this context, the paper focuses on the potential for conflict that may arise with the application of these international legal instruments, thus causing a failure to effectively mitigate for the effects of introduced species

Conflict between International Treaties: Failing to mitigate the effects of introduced marine species

Humans have changed the face of the earth - we have intentionally altered the locations of species in order to achieve food and economic security (eg, aquaculture of the freshwater fish Tilapia and the marine algae Kappaphycus) while also appealing to our cultural and aesthetic values (eg, the introduction of gorse to New Zealand and Australia)

Predictors of 1-year survival in South African transcatheter aortic valve implant candidates

Background. Transcatheter aortic valve implantation (TAVI) has undergone rapid expansion internationally over the past 15 years. In view of resource constraints in developing countries, a major challenge in applying this technology lies in identifying patients most likely to benefit. The development of a risk prediction model for TAVI has proved elusive, with a reported area under the curve (AUC) of 0.6 - 0.65. The available models were developed in a First-World setting and may not be applicable to South Africa (SA).Objectives. To evaluate novel indicators and to develop a TAVI risk prediction model unique to the SA context. The current work represents the important initial steps of derivation cohort risk model development and internal validation.Methods. Seven-year experience with 244 successive TAVI implants in three centres in Western Cape Province, SA, was used to derive risk parameters. All outcomes are reported in accordance with the Valve Academic Research Consortium definitions. Multiple preprocedural variables were assessed for their impact on 1-year survival using univariate and multivariate models.Results. Factors found not to correlate with 1-year survival included age, renal function and aortic valve gradients. The commonly used surgical risk prediction models (Society of Thoracic Surgeons score and EuroSCORE) showed no correlation with outcomes. Factors found to correlate best with 1-year survival on multivariate analysis were preprocedural body mass index (BMI) (favouring higher BMI), preprocedural left ventricular end-diastolic dimension (LVED) and ejection fraction (EF) (favouring smaller LVED and higher EF), absence of atrial fibrillation, and three novel parameters: independent living, ability to drive a car, and independent food acquisition/cooking. Discriminant analysis of these factors yielded an AUC of 0.8 (95% confidence interval 0.7 - 0.9) to predict 1-year survival, with resubstitution sensitivities and specificities of 72% and 71%, respectively.Conclusions. Apart from existing predictors, we identified three novel risk predictors (independent living, ability to drive a car, and independent food acquisition/cooking) for 1-year survival in TAVI candidates. These novel parameters performed well in this early evaluation, with an AUC for predicting 1-year survival higher than the AUCs for many of the internationally derived parameters. The parameters are inexpensive and easy to obtain at the initial patient visit. If validated prospectively in external cohorts, they may be applicable to other resource-constrained environments.

Eureka and beyond: mining's impact on African urbanisation

This collection brings separate literatures on mining and urbanisation together at a time when both artisanal and large-scale mining are expanding in many African economies. While much has been written about contestation over land and mineral rights, the impact of mining on settlement, notably its catalytic and fluctuating effects on migration and urban growth, has been largely ignored. African nation-states’ urbanisation trends have shown considerable variation over the past half century. The current surge in ‘new’ mining countries and the slow-down in ‘old’ mining countries are generating some remarkable settlement patterns and welfare outcomes. Presently, the African continent is a laboratory of national mining experiences. This special issue on African mining and urbanisation encompasses a wide cross-section of country case studies: beginning with the historical experiences of mining in Southern Africa (South Africa, Zambia, Zimbabwe), followed by more recent mineralizing trends in comparatively new mineral-producing countries (Tanzania) and an established West African gold producer (Ghana), before turning to the influence of conflict minerals (Angola, the Democratic Republic of Congo and Sierra Leone)

The Social and Political Dimensions of the Ebola Response: Global Inequality, Climate Change, and Infectious Disease

The 2014 Ebola crisis has highlighted public-health vulnerabilities in Liberia, Sierra Leone, and Guinea – countries ravaged by extreme poverty, deforestation and mining-related disruption of livelihoods and ecosystems, and bloody civil wars in the cases of Liberia and Sierra Leone. Ebola’s emergence and impact are grounded in the legacy of colonialism and its creation of enduring inequalities within African nations and globally, via neoliberalism and the Washington Consensus. Recent experiences with new and emerging diseases such as SARS and various strains of HN influenzas have demonstrated the effectiveness of a coordinated local and global public health and education-oriented response to contain epidemics. To what extent is international assistance to fight Ebola strengthening local public health and medical capacity in a sustainable way, so that other emerging disease threats, which are accelerating with climate change, may be met successfully? This chapter considers the wide-ranging socio-political, medical, legal and environmental factors that have contributed to the rapid spread of Ebola, with particular emphasis on the politics of the global and public health response and the role of gender, social inequality, colonialism and racism as they relate to the mobilization and establishment of the public health infrastructure required to combat Ebola and other emerging diseases in times of climate change

Circum-Antarctic Coastal Environmental Shifts During the Late Quaternary Reflected by Emerged Marine Deposits

This review assesses the circumpolar occurrence of emerged marine macrofossils and sediments from Antarctic coastal areas in relation to Late Quaternary climate changes. Radiocarbon ages of the macrofossils, which are interpreted in view of the complexities of the Antarctic marine radiocarbon reservoir and resolution of this dating technique, show a bimodal distribution. The data indicate that marine species inhabited coastal environments from at least 35000 to 20000 yr sp, during Marine Isotope Stage 3 when extensive iceberg calving created a \u27meltwater lid\u27 over the Southern Ocean. The general absence of these marine species from 20000 to 8500 yr sp coincides with the subsequent advance of the Antarctic ice sheets during the Last Glacial Maximum. Synchronous re-appearance of the Antarctic marine fossils in emerged beaches around the continent, all of wh ich have Holocene marine-limit elevations an order of magnitude lower than those in the Arctic, reflect minimal isostatic rebound as relative sea-level rise decelerated. Antarctic coastal marine habitat changes around the continent also coincided with increasing sea-ice extent and outlet glacial advances during the mid-Holocene. in view of the diverse environmental changes that occurred around the Earth during this period, it is suggested that Antarctic coastal areas were responding to a mid-Holocene climatic shift associated with the hydrological cycle. This synthesis of Late Quaternary emerged marine deposits demonstrates the application of evaluating circum-Antarctic phenomena from the glacial-terrestrial-marine transition zone

Is There Such a Thing as a Post-apartheid City?

In an introductory section, this paper considers briefly the achievements and problems of urban governance in post-apartheid South Africa through an assessment of three categories: administrative reform, developmental issues and conflicts over service delivery issues. It then goes on to assess continuity and change in South African cities. Continuity is the norm in understanding urban history with change understood as a series of accretions and as a layering of features, unless major economic shifts or revolutionary political shifts are in place. Using the example of Durban, a series of changes is highlighted, which fit into what the deracialized growth path allows and encourages. The paper argues that thus far, the ANC government has shown little capacity or desire to discipline capital along the lines suggested, for instance, by the reconstruction and development programme's section on public transport. Larger changes are thus limited by the predilections and established discourses of the business world and the absence of more dynamic and structured public intervention

Urban informality as a site of critical analysis

Across the Global South, the realities of urban informality are changing, with implications for how we understand this phenomenon across economic, spatial, and political domains. Recent accounts have attempted to recognise the diversity of informality across contexts and dimensions, as well as its everyday lived realities. Reviewing key debates in the sector, and drawing upon the new empirical studies in the papers presented here, we argue for a shift away from seeing urban informality narrowly as a setting, sector, or outcome. We suggest that reconsidering informality as a site of critical analysis offers a new perspective that draws on and extends political economy approaches, and helps us to understand processes of stratification and disadvantage. We seek to highlight the significance of the informal-formal continuum at the same time as challenging this dichotomy, and to explore emerging theoretical and empirical developments, including changing attitudes to informality; the increasing salience of agency; and informality as strategy both for elite and subaltern groups