A clinical audit of laparoscopic surgery for recto-vaginal endometriosis at a tertiary referral centre in KwaZulu-Natal.

Masters Degree. University of KwaZulu-Natal, Durban.Aim: The aim of the study was to evaluate the operative and post-operative complications, and outcomes of laparoscopic surgery using the Harmonic scalpel in patients with recto-vaginal endometriosis (RVE). Furthermore, pre-operative work up and referral patterns were evaluated. Design: Retrospective chart review. Method: Following ethical (BREC No. BE O42/11) and hospital regulatory approvals, a retrospective chart review of the hospital case records of all patients who underwent laparoscopic surgery for RVE using the Harmonic scalpel from January 2004 to December 2010 was performed. All relevant clinical information was captured on structured data sheets which were kept confidential and used strictly for the purposes of the audit. Results: The case records of 105 women who had laparoscopic surgery for endometriosis between January 2004 to December 2010 were identified Thirty-three (31.4%) patients with RVE were treated using the Harmonic scalpel as the main energy source. From this cohort of patients, there was one case which required conversion to laparotomy for rectal injury which was successfully repaired; one case required re-laparoscopy for suspected intra-operative bleeding and another required cystoscopy and double J stenting due to anuria of 21 hours post- surgery. The mean hospital stay was 4 days. 76% of women had improvement of pain after surgical intervention and concomitant adjuvant medical therapy was used in 30.3%. Conclusion: The usage of Harmonic scalpel as the energy source in the management of RVE appears to be safe and the morbidity is comparable to other energy sources reported in literature

A viable supranational court born from the experiences of the demise of the Southern African Development Community Tribunal

Does the effective disbandment of the SADC Tribunal and its mooted resurrection in a largely diminished capacity spell the end of any possibility of developing a supranational organ capable of adjudicating on disputes between SADC members, as well as disputes between natural persons and Member states as was originally envisioned in Article 15 of the Protocol on Tribunal & Rules Thereof ("the Protocol")? Background The basis of the research question stems from the effective disbandment of the SADC Tribunal arguably as a result of the Republic of Zimbabwe's controversial land redistribution program and the recent developments surrounding the SADC Tribunal following the redrafting of the Protocol ("the New Protocol") by the Ministers of Justice of each Member State. The disbandment in essence being as a result of the land reform program adopted by the Zimbabwean Government in 2000 which raised various issues both politically and socially, however it was the legal issues brought on by the litigation which ensued that caused the most debate. In Mike Campbell (Pvt) Ltd. and Others v. Republic of Zimbabwe (2008) SADCT 2/2007 ("the Campbell Case") the SADC Tribunal held that the Zimbabwean Government should pay the applicants fair compensation for their expropriated land, take all necessary measures to protect the possession, occupation, and ownership of the land and ensure that no action was taken to evict the farmers or interfere with their peaceful residence of their properties. Subsequent to the SADC Tribunal's finding as mentioned above, the applicants sought to have the SADC Tribunals rulings registered as an order of court in Zimbabwe in Gramara (Pvt) Ltd v. Government of the Republic of Zimbabwe (HC 33/09) [2010] ZWHHC [Harare High Court] which was dismissed by Zimbabwe's High Court. There is no doubt that the SADC Tribunals ruling in the Campbell Case and the prospective ramifications a ruling of that nature could have on each SADC states government policy reverberated through the office walls of each head of state. The Ruling showcasing perhaps a lack of appreciation with regards to what far reaching implications of subordinating a measure of sovereignty to a supranational body could have on government policy. In any case, subsequent to the Tribunals ruling in the Campbell Case followed an onslaught by the government of Zimbabwe regarding the Tribunals jurisdiction and its impartiality, all in an attempt to deligitimatise the institution. This onslaught succeeded in having the Tribunal disbanded, however in the wake of this a new Tribunal has been mooted to take its place. A New Protocol is currently being debated amongst regional leaders. The developments surrounding the SADC Tribunal following the signature of the New Protocol by 9 heads of state, is of concern considering the fact that Articles 14 and 35 of the New Protocol substantially moderate the jurisdiction and applicable law of the SADC Tribunal. The legal text in its current format is likely to vastly diminish the effectiveness of the SADC Tribunal reducing it to nothing more than a paper tiger. The research this paper intends on focusing on shall be with regards to what lessons can be learnt from the disbandment of the SADC tribunal by the SADC member states, with a view to establishing a supranational organism capable of adjudicating conflicts between member states whilst being cognizant of member states undertakings to observe human rights. Whilst also looking at the weaknesses of the old Tribunal, insofar as transposing a Eurocentric model into Africa , which has conditions not ideal for such a model

Modelling CD4 count and mortality in a cohort of patients initiated on HAART.

Master of Science in Statistics. University of KwaZulu-Natal. Durban, 2018.Longitudinally measured data and time-to-event or survival data are often associated in some ways, and are traditionally analyzed separately (Asar et al., 2015). However, separate analyses are not applicable in this case because they may lead to inefficient or biased results. To remedy this, joint models optimally incorporate all available information (longitudinal and survival data) simultaneously (Wulfsohn & Tsiatis, 1997). Furthermore incorporating all sources of data improves the predictive capability of the joint model and lead to more informative inferences for the purpose of decision-making (Seyoum & Temesgen, 2017). The primary goal of this analysis was to determine the effect of repeatedly measured CD4 counts on mortality. The standard time-to-event models require that the time-dependent covariates of interest are external; where the value of the covariate at a future time point is not affected by the occurrence of the event. This requirement would not be fulfilled in this setting, since the repeatedly measured outcome is directly related to the mortality mechanism. Hence, a joint modeling approach was required. We applied the methods developed in this thesis to the CAPRISA AIDS Treatment program (CAT). We also sought to determine if the patients’ baseline BMI (Body mass index), baseline age, gender, baseline viral load, baseline CD8 count, baseline TB status and clinic site, influence the evolution of the CD4 count over time. Various linear mixed models were fitted to the CD4 count, adjusting for repeated measurements, as well as including intercept and slope as random effects. Different types of covariance structures were assessed and the spatial spherical correlation structure was found to be the best fit. The Cox PH model was employed to model mortality. Finally the joint model for longitudinal and time-to-event data was fitted. Out of the 4014 patients, 1457 (36.30%) were male. There were more patients presenting without TB at ART initiation, 3042 (75.78%) compared to those with prevalent TB, 972 (24.22%). Results from the multivariable random effects model showed that the patients gender, age, baseline viral load and baseline CD8 cell count had statistically significant influences on the rate of change in CD4 cell count over time. The un-adjusted and adjusted hazards regression both found CD4:CD8 ratio, viral load, gender and age of patients to be significant predictors of mortality. The result from the joint model in this study indicated that CD4 count change due to HAART and mortality had been influenced jointly by gender, age, baseline viral load, baseline CD8 count, time (in years) , CD4:CD8 ratio and by the interaction effects of time (in years) with TB status, baseline viral load and baseline CD8 cell count. CD4 count proved to be significantly associated with mortality, after adjusting for age, gender and other potential confounders Model diagnostics were performed for validating model assumptions, and our joint model fitted quite well with fairly good diagnostic attributes. The methods that were developed in this thesis were applied to the CAPRISA AIDS Treatment program (CAT) between June 2004 to December 2013

Students’ reflection on co-design: A cross-disciplinary collaboration between two SADC countries

This reflective article responds to the question: “What values and lessons can be gained from co-design in a culturally and disciplinarily diverse cross-university student project?” The Polar Project is regarded as just such an initiative and was intended to boost innovative product development across fields of study between two higher education institutions (HEIs) located in Southern African Development Community (SADC) region countries.As lecturers, facilitators and mentors, the article’s authors adopted a qualitative and interpretive approach for analysing student “reflections-in-action”, using both reports and reflective questionnaires during the project’s co-design process. We formulated our own analysis methods for the process of critical reflection, based on Schön’s (1987) “reflection-on-action” model, to establish a way forward for the project. Through these reflections, the following critical themes were identified: (1) rewards for cross-cultural exchange; (2) multiple appreciations for collaboration; and (3) communication and miscommunication in cross-disciplinary groups.These themes provide an account of the practical implications for extracurricular activities geared towards the agenda of internationalising higher educational practices, such as those applied in conducting this project. The contribution we hope to make is that, as HEIs enter onto internationalisation agendas, the voices and experiences of students should be recognised if, as important beneficiaries of the university system, they are to be properly considered

Professional development for subject librarians in KwaZulu-Natal.

Master of Social Science in Information Studies. University of KwaZulu-Natal, Pietermaritzburg,2019.Professional development (PD) is an important consideration for academic librarians. The broad purpose of the study was to investigate the PD of subject librarians in four selected academic institutions in the Province of KwaZulu-Natal (KZN). The four institutions were the University of KwaZulu-Natal (UKZN), the University of Zululand (UZ), Durban University of Technology (DUT) and the Mangosuthu University of Technology (MUT). The Maintaining Professional Competence Model provided the conceptual theoretical framework for the study. The model highlights the roles of both individual and organisational factors in what it refers to as “updating activities”. In terms of the methodology, the population numbered 50 subject librarians from the four institutions of which 48 responded giving a response rate of 96%. Both quantitative and qualitative research methods were applied. The former comprised a questionnaire survey administered by email to all 48 participants while a focus group discussion constituted the qualitative method. Eight subject librarians from the Pietermaritzburg Campus of the UKZN participated in the focus group. In terms of the findings, PD was seen in a positive light by the vast majority of the respondents. Attendance of workshops and conferences and furthering studies were shown to be the leading forms of PD opportunities offered at the institutions and the prominent forms of PD activities. There was evidence of a “mismatch” in certain instances between what subject librarians thought was needed concerning PD and what management thought. Information communication technologies (ICTs) and information management skills emerged as the most sought after by the respondents. As expected, finance was identified as the major challenge and there was overwhelming support for the use of webinars in PD. The study confirmed that there is a strong support for PD taking the form of in-house training and workshops. The subject librarians perceived PD in a positive light being seen as both important and beneficial. Conclusions were made and recommendations put forward. Some of these include the need for management to recognise the importance of PD and ensure that they are supportive of it; to make more use of PD activities which had less financial costs (such as webinars using the Internet); to focus on the skills identified as needed by the subject librarians (including teaching and training skills); and to be sensitive to age and gender of their subject librarian staff with regard to PD. Finally, various suggestions for further research were made

Outsourcing or insourcing: a case study of regional hospitals in public health within eThekwini District.

Masters Degree. University of KwaZulu-Natal, Durban.Outsourcing has been adopted by public health to improve the efficiency and quality of health care services. Essentially, outsourcing of services such as catering, believed to be a non-core function, has become vital element to afford management time to focus on improving performance on the clinical function. Traditionally, non-core services have been rendered in-house and thus the role of government as the employer and service provider has been altered. Many countries in the world, including South Africa, have come under pressure resulting from scarce financial resources, increased patient demands, high unemployment, and increased health care costs. Thus, the need to control expenditure and provision of high quality service has led hospitals to sought relief from financial pressure by outsourcing non-clinical functions. This study has cross-examined two regional hospitals including Addington and R K Khan situated in EThekwini District to investigate the advantages and disadvantages of outsourcing and insourcing as well as the impact thereof on cost saving, human resource and efficiency in service delivery, specifically in catering services. The study is qualitative in nature and a case study research design is employed to explore whether a relationship existed between outsourcing and insourcing and efficiency. Semi structured interviews were used to collect data. A total number of 14 government officials including managers and employees directly involved with catering in the hospital were interviewed. On one hand, findings from the study show that outsourcing unit displayed added advantage of offering catering services with stable monthly expenditure, improved performance, and quality of service. On the other hand, insourcing unit proved to have an advantage of being the preferred by the employer. The recommendations stemming from the study concludes that if insourcing is to be adopted as a strategy that is efficient and effective, skilled employees should be employed, and a training fund should be allocated for the existing employees and does away with single source supplier of food to allow for better negotiations. For outsourcing, improved conditions of employment should be implemented through clearly stated contract terms and stricter monitoring tools should be implemented. In its final analysis, the study concludes that public health could benefit by marrying the two strategies

Management of co-morbidity of depression and chronic non- communicable diseases in Rwanda

Background: Chronic non-communicable diseases (NCDs) are a major global health problem of the 21 stcentury. They are now the world’s leading cause of disease burden and high mortality. An even more alarming health problem is when depression coexists with chronic NCDs, as is frequently the case. Management of this co-morbidity with collaborative care has become a global topic of interest, with the World Health Organization (WHO) recommending implementation of collaborative care for this purpose. The study investigated existing protocols and/or interventions for managing this co-morbidity in Rwandan district hospitals.Methods: The study used an action research design involving a research team of 14 health care professionals to collaboratively identify existing protocols or interventions for managing co-morbidity of depression and NCDs in Rwanda. Focus group discussion using a structured interview guide was used to collect qualitative data, followed by qualitative content analysis using inductive approach.Results: We found no particular protocols or interventions in place to manage the co-morbidity of depression and chronic NCDs. Depression and chronic NCDs were found to be treated separately, in separate health care settings and by different health professionals.Conclusion: The findings revealed a gap in management of co-morbid depression and chronic NCDs in Rwanda district hospitals. We recommend that health care providers follow the WHO collaborative care advisory for better quality care and better patient improvement in management of this co-morbidity.Keywords: Chronic NCDs,depression, co-morbidity, managemen

The conservation of nature: More than just human survival to the Zulu people

The Zulu language is particularly rich in its use of idioms related to the natural environment. A sample of these idioms is given and the relationship of environment to language is commented upon

Extremely extended dust shells around evolved intermediate mass stars: probing mass loss histories, thermal pulses and stellar evolution

Title from PDF of title page (University of Missouri--Columbia, viewed on May 30, 2012).The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file.Dissertation advisor: Dr. Angela K. SpeckVita.Ph. D. University of Missouri--Columbia 2011."December 2011"Intermediate mass stars ($0.8 - 8 solar masses), at the asymptotic giant branch phase (AGB) suffer intensive mass loss, which leads to the formation of a circumstellar shell (s) of gas and dust in their circumstellar envelope. At the end of the AGB phase, the mass-loss decreases or stops and the circumstellar envelope begins to drift away from the star. If the velocity of the AGB phase wind has been relatively constant, then dust or molecular emission furthest from the star represents the oldest mass loss, while material closer to the star represents more recent mass loss. Therefore, the history of mass loss during the AGB phase is imprinted on the dust shells of the post-AGB envelope. Thus, by studying the distribution of material in the form of dust emission in the circumstellar shells of late evolved stars (i.e. the post AGB phases are pre - planetary nebula (PPN) and the planetary nebula (PN)) we can gain a better understanding of the mass-loss processes involved in the evolution of intermediate mass stars. I studied two groups of intermediate mass stars, namely six oxygen rich and six carbon rich candidates. In this thesis a study of evolution of intermediate mass stars is confronted by means of observations, in which far - infrared (FIR) images, are used to study the physical properties and the material distribution of dust shells of AGB and post AGB circumstellar envelope. Infrared radiation from thermal dust emission can be used to probe the entire dust shell because, near to mid-infrared radiation arises solely from the hottest regions close to the star; while the outer regions away from the star are cool such that they emit at longer infrared wavelengths. Essentially, radiation in the FIR to sub-millimeter wavelengths is emitted by the entire dust shell and hence can be used to probe the entire dusty envelope. Therefore far-infrared emission by late evolved stars can be used to probe the large scale - structure of AGB and post - AGB circumstellar shells. Our results from space observations indicated the following: The sizes of the circumstellar dust shell observed in oxygen rich stars are within$>$1 pc. We derived the dust masses derived from far infrared ISO PHT 32 observation of oxygen rich stars that are between 1.7 -- 4 x 10-4 solar masses. These results provides us with a lower limit in the progenitor masses of stars estimated to be within 0.56 -- 0.76 solar masses. These results indicate that the initial main sequence masses fro oxygen rich stars are within 1 - 3.5 solar masses. The time scales derived since the oldest mass was ejected during the evolution of oxygen rich stars are 4 - 13 x 104 years. For the carbon rich stars: The size of the circumstellar dust shells are within 1 - 1.6 pc. The masses of dust in the shells are a approximated to be within 0.1 - 1.44 x 10-4 solar masses. A lower limit to the progenitor masses of carbon rich stars that are between 0.61 - 0.9 solar mass, suggesting that these stars evolved from the main sequence masses between 2. - 6 solar masses.Includes bibliographical reference

Aquaponics production simulations using the decision-making tool

Aquaponics have related food and nutrition security benefit that are important for this country (South Africa). The aim of this study was to apply  aquaponics decision-making tool to provide potential aquaponics production data and information for South Africa. This study was designed as  2×3×3 factorial study giving 18 interactions. Because aquaponics are the production of fish and crops concurrently, yield production had two levels-  fish and crop, fish stocking density had three levels- low, optimum and higher and aquaponics scale of production had 3 levels- hobby, subsistence  and commercial scale. The summary of data of aquaponics variables from the literature was used as optimum level, lower and higher levels were  based on experimental design. Yield production (kg) of both fish and plants increased significantly (p<0.05) as fish stocking density was increased. In  hobby scale, plants yield was higher than fish yield in all levels of fish stocking density, the plant-fish yield (kg) was 40-33, 80-67 and 150-133,  respectively. In subsistence scale, fish-plant yield (kg) was 240-200, 300-267 and 400-333, respectively. In commercial scale, fish-plant yield (kg) was  600-533, 1 100-1 000, 1 500-1 333, respectively. Daily fish feed increased significantly with increase in fish stocking density across all scale of  aquaponics production (hobby<subsistence<commercial). In hobby scale, at low fish stocking, 0.65kg feed produced 1 kg fish, at optimum, 0.65kg  feed produced 1 kg fish and at higher fish stocking, 0.37kg feed produced 1 kg fish. In subsistence scale at low fish stocking density, 0.38kg feed  produced 1 kg fish, at optimum level, 0.63kg feed produced 1 kg fish and at higher level, 0.65kg feed produced 1 kg fish. In commercial scale, in low  fish stocking, 0.64kg feed produced 1 kg fish, at optimum, 0.63kg feed produced 1 kg fish and at higher fish stocking, 0.64kg feed produced 1 kg  fish. Plant culture have more yield output than fish culture in all aquaponics scale of production. Hobby scale produced the lowest yield than  subsistence than commercial scale of production. Hobby scale practise could not produce sufficient yield to support human subsistence. Fish feed  closely mirrored yield production. Lower fish stocking density maybe adopted in subsistence scale. Higher fish stocking density maybe adopted in  commercial scale. Fish feed could become an economic sustainability constraint in aquaponics production, particularly in a developing country like South Africa. Water availability and quality effects on yield was not determine especially in African context