The occurrence and removal of algae (including cyanobacteria) and their related organic compounds from source water in Vaalkop Dam with conventional and advanced drinking water treatment processes

Cyanobacterial bloom formation in freshwaters, such as rivers, lakes and dams, is known to occur throughout the world. The Vaalkop Dam, which serves as source to the Vaalkop drinking water treatment works (DWTW), is no exception. Blooms of cyanobacteria occur annually in Vaalkop Dam as well as in dams from which Vaalkop is replenished during low-rainfall periods. These blooms during the summer months are associated with the production of cyanotoxins and taste and odour compounds such as geosmin and MIB. The Vaalkop DWTW uses a combination of conventional and advanced water treatment processes to deal with the cyanobacteria and their related organic compounds in the source water. The overall objectives of this study were to: (i) investigate the occurrence of algae (including cyanobacteria) and cyanotoxins in the Vaalkop Dam; (ii) establish which environmental variables are responsible for the development and onset of algae, and (iii) determine whether the Vaalkop DWTW is able to eliminate the influence that algae (including cyanobacteria) may have on the drinking water. Multivariate statistical analyses revealed seasonal variation in algal assemblages in the raw water. The risk of cyanobacteria bloom formation proved to be especially high during the summer months as the nutrients needed for cyanobacterial growth are available and the temperature range is optimal, causing the production of geosmin, MIB and microcystin. The presence of Ceratium hirundinella (O.F. Müller) Dujardin, in the source water appears to exacerbate the negative effect that cyanobacteria have on the drinking water treatment process. When Ceratium hirundinella is present, floc formation is inhibited, causing more of the problematic algae to penetrate into the drinking water. Even though advanced treatment options such as ozone and granular activated carbon filters are used at Vaalkop DWTW, the effects of the organic compounds produced by cyanobacteria are not entirely eliminated during the treatment process.Keywords: potable water treatment, geosmin, MIB (2-methylisoborneol), microcystin, granular activated carbon (GAC), ozon

Orthopaedic referrals using a smartphone app: Uptake, response times and outcome

Background. It is well established that South Africa (SA) suffers an immense burden of violence and injuries. The responsibility of providing care for these injuries falls mainly on public health services, resulting in overloading of the health system. Prior to a recent intervention, the large burden had been exacerbated by limitations in the traditional referral system that highlighted the need for a better referral system. Vula’s smartphone app was introduced at Tygerberg Hospital in August 2016. This study evaluated the uptake, response times and outcomes using this app.Objectives. The main objectives of the study were to describe: (i) the number of referrals; (ii) referral response times; (iii) referring facilities; and (iv) referral outcomes. Secondary objectives were to: (i) evaluate whether the referral outcome pathway was appropriate; and (ii) assess professional conduct and evidence of upskilling.Methods. This retrospective, descriptive study investigated Vula app referrals to the Division of Orthopaedic Surgery at Tygerberg Hospital between 1 August 2016 and 31 March 2017. Vula was advertised to key facilities in the hospital’s referral network. All referrals to the division during the study period were systematically included in the analysis of operational outcomes, although some were excluded from the subsequent referral outcome analysis. Operational outcomes included the number of referrals, referring facilities and referral response times. Referral outcome analysis included the clinical diagnosis, referral pathway, whether the referral was used for upskilling and whether it was conducted in a professional manner.Results. A total of 2 275 referrals from 39 different facilities were received during the study period from 238 individual users; 50% of referrals received a response within 11 minutes, while a small percentage received no response. Clinical and demographic characteristics of 1 985 patients included in the referral outcome analysis indicated that the majority of trauma and emergency referrals involved males, with closed fractures being the most frequent clinical presentation. Although the most common referral outcome was immediate transfer, one-third of the patients were treated at the referring hospital with advice only.Conclusions. The large volume of orthopaedic referrals received through the Vula app suggests that Vula represents a successful alternative to traditional referral methods. Referrals managed by advice only could suggest that Vula facilitates some relief for the overburdened trauma services. Future research could further explore Vula’s role in strengthening the public health system, including interventions for high-volume referral areas and upskilling of referring health workers.

The reliability of physical examination in diagnosing arterial injury in penetrating trauma to extremities: A first look at different anatomical regions and injury mechanisms

Background. The accuracy of physical examination to exclude arterial injury in penetrating trauma to extremities has been well established. Objectives. To determine whether the accuracy of physical examination to exclude arterial injury is similar to that of a computed tomography arteriogram (CTA) for different anatomical regions and mechanisms of injury, and in patients with concomitant fractures compared with those without. Methods. A retrospective review was conducted on all patients who underwent CTA for penetrating injuries to an extremity between 1 June 2016 and 30 June 2017. The presence of arterial injuries was noted, and these were grouped into anatomical areas. Clinical notes were reviewed for the presence of hard signs of arterial injury at initial examination. Results. A total of 220 lower limb and 133 upper limb CTAs were included. The mean patient age was 28.9 years (range 11 - 68). The overall sensitivity of physical examination in detecting a CTA-confirmed arterial injury was 95.3% (95% confidence interval (CI) 88.4 - 98.7), with a specificity of 93.9% (95% CI 90.2 - 96.4). Physical examination of the thigh had the highest specificity of 96.4% (95% CI 91.8 - 98.8), followed by the lower leg at 94.4% (95% CI 81.3 - 99.3), the upper arm at 89.6% (95% CI 79.7 - 95.7) and the forearm at 77.8% (95% CI 40.0 - 97.2). For gunshot wounds the specificity was 96.1% (95% CI 92.4 - 98.3), while for stab wounds it was 86.8% (95% CI 74.7 - 94.5). Conclusions. This study agrees with current literature indicating that physical examination has high specificity in detecting arterial injury in the setting of penetrating trauma to an extremity. However, it shows that the specificity is not equal for all anatomical regions or mechanisms of injury

The reliability of physical examination in diagnosing arterial injury in penetrating trauma to extremities: A first look at different anatomical regions and injury mechanisms

Background. The accuracy of physical examination to exclude arterial injury in penetrating trauma to extremities has been well established.Objectives. To determine whether the accuracy of physical examination to exclude arterial injury is similar to that of a computed tomography arteriogram (CTA) for different anatomical regions and mechanisms of injury, and in patients with concomitant fractures compared with those without.Methods. A retrospective review was conducted on all patients who underwent CTA for penetrating injuries to an extremity between 1 June 2016 and 30 June 2017. The presence of arterial injuries was noted, and these were grouped into anatomical areas. Clinical notes were reviewed for the presence of hard signs of arterial injury at initial examination.Results. A total of 220 lower limb and 133 upper limb CTAs were included. The mean patient age was 28.9 years (range 11 - 68). The overall sensitivity of physical examination in detecting a CTA-confirmed arterial injury was 95.3% (95% confidence interval (CI) 88.4 - 98.7), with a specificity of 93.9% (95% CI 90.2 - 96.4). Physical examination of the thigh had the highest specificity of 96.4% (95% CI 91.8 - 98.8), followed by the lower leg at 94.4% (95% CI 81.3 - 99.3), the upper arm at 89.6% (95% CI 79.7 - 95.7) and the forearm at 77.8% (95% CI 40.0 - 97.2). For gunshot wounds the specificity was 96.1% (95% CI 92.4 - 98.3), while for stab wounds it was 86.8% (95% CI 74.7 - 94.5).Conclusions. This study agrees with current literature indicating that physical examination has high specificity in detecting arterial injury in the setting of penetrating trauma to an extremity. However, it shows that the specificity is not equal for all anatomical regions or mechanisms of injury

The genetic relatedness of E. coli associated with post- collection drinking water contamination in rural households

Rural households are often dependent on rivers, springs, boreholes or standpipes some distance from their homes for their daily water requirements. Water for drinking and domestic use is consequently stored in containers in-house which are prone to post-collection contamination. The objective of the study was to determine the most likely origin or place of introduction of E. coli associated with post-collection contamination in rural households, by assessing the degree of genetic relatedness of E. coli present in the stored water and other environmental samples. E. coli isolates were obtained using either mFC agar with confirmation of indole production (44 isolates) or Colilert®-18 (52 isolates). Amplified fragment length polymorphism (AFLP) fingerprinting was applied to determine the genetic relatedness of E. coli isolated from in-house storage containers, drinking cups, hand-swab samples, cattle dung and from the source water (spring water). DNA fingerprints of E. coli produced a number of clusters (>85% similarity scores calculated with the cosine coefficient). Identical E. coli genetic patterns were observed at closely linked points within the domestic pathway of water handling, such as between hand-swab and drinking-cup samples, between storage container and source isolates, and between drinking cups, source water and storage containers. The results indicated that AFLP fingerprinting could be applied to determine the genetic relatedness of E. coli isolated from closely linked points within the domestic pathway of water use within a household. However, the high genetic diversity observed for E. coli bacteria isolated from the difffferent water and environmental samples tested in this study, hampered the identification of post collection points of contamination.Keywords: typing, fingerprinting, amplified fragment length polymorphism, E. coli, water quality, genetic relatedness, AFL

Burden, spectrum and outcomes of children with tuberculosis diagnosed at a district-level hospital in South Africa

CITATION: Du Preez, K., et al. 2018. Burden, spectrum and outcomes of children with tuberculosis diagnosed at a district-level hospital in South Africa. International Journal of Tuberculosis and Lung Disease, 22(9):1037-1043, doi:10.5588/ijtld.17.0893.The original publication is available at https://www.ingentaconnect.com/content/iuatld/ijtldSETTING: The Khayelitsha subdistrict has the highest burden of reported tuberculosis (TB) cases in Cape Town, Western Cape Province, South Africa. OBJECTIVES: To characterise the TB burden, spectrum and treatment outcomes among children managed at a district-level hospital, the Khayelitsha District Hospital. DESIGN: Retrospective medical record review of all children (age <13 years) diagnosed with TB in January–July 2014. A lay health care worker completed daily surveillance and supported linkage to TB care. Symptoms and investigations at presentation, TB disease spectrum, referral pathways and outcomes were reported. RESULTS: Most children were aged ≤2 years (84/99, 85%), 18/96 (19%) were infected with the human immunodeficiency virus, 31/91 (34%) were malnourished and 80/99 (81%) had pulmonary TB only. The majority of the children (63/80, 79%) presented with cough of acute onset (<2 weeks). Only 5/36 (14%) eligible child contacts had documentation of receiving isoniazid preventive therapy. Twelve (13%) children had bacteriologically confirmed pulmonary TB. Overall, 93/97 (96%) children successfully continued TB care after hospital discharge. Favourable TB treatment outcomes were recorded in only 77 (78%) children. CONCLUSIONS: Children with TB managed at this district-level hospital were young, and frequently had acute symptoms and substantial comorbidities. Missed opportunities for TB prevention were identified. Linkage to care support resulted in excellent continuation of TB care; however, treatment outcomes could be further improved.https://www.ingentaconnect.com/content/iuatld/ijtld/2018/00000022/00000009/art00012Publisher's versio

Tuberculous meningitis in children: reducing the burden of death and disability

Tuberculous meningitis disproportionately affects young children. As the most devastating form of tuberculosis, it is associated with unacceptably high rates of mortality and morbidity even if treated. Challenging to diagnose and treat, tuberculous meningitis commonly causes long-term neurodisability in those who do survive. There remains an urgent need for strengthened surveillance, improved rapid diagnostics technology, optimised anti-tuberculosis drug therapy, investigation of new host-directed therapy, and further research on long-term functional and neurodevelopmental outcomes to allow targeted intervention. This review focuses on the neglected field of paediatric tuberculous meningitis and bridges current clinical gaps with research questions to improve outcomes from this crippling disease

Utilizing formal innovation models to support and guide industry innovation projects

CITATION: van Zyl, H., du Preez, N.D., & Schutte, C. 2007. Utilizing formal innovation models to support and guide industry innovation projects. South African Journal of Industrial Engineering 18(2): 203-219, doi: http://dx.doi.org/10.7166/18-2-127.The original publication is available at http://sajie.journals.ac.zaENGLISH ABSTRACT: The high failure rate of innovation projects indicates that many companies are not getting the full benefit from their innovation projects [1], [2]. A research project was carried out during 2005 that explored and compared the existing formal models for supporting innovation, in order to address the identified problem. It proposed guidelines for improving and refining innovation projects. A case study that focused on the front-end of product innovation in the wine industry and the applicability of the formal W-model [3] to innovation activities was used to evaluate how formal innovation models can indeed effectively support industry innovation projects. The innovation life cycle was used to categorize a number of innovation frameworks for product, process, and enterprise innovation. Further research should focus on extending the case study to other industries, such as the automotive sector.AFRIKAANSE OPSOMMING: Die groot aantal onsuksesvolle innovasie projekte dui daarop dat maatskappye nie die volle voordele uit hul innovasie projekte kry nie [1], [2]. ’n Navorsingsprojek is gedurende 2005 uitgevoer om bestaande formele innovasie modelle te evalueer, ondersoek, en vergelyk, met die doel om bogenoemde probleem aan te spreek en riglyne voor te stel wat innovasie sal bevorder en verfyn. ’n Gevallestudie, wat fokus op produkinnovasie in die wyn-industrie, is uitgevoer om die toepaslikheid en effektiewe ondersteuning van die formele W-model [3] op spesifieke innovasie aktiwiteite te evalueer. Die innovasie-lewensiklus is ook gebruik om ’n aantal innovasie-raamwerke te kategoriseer in afdelings vir produk-, onderneming- en proses-innovasie. Toekomstige navorsing behoort te fokus op ’n uitbreiding van die gevallestudie na ander industrië soos die motorindustrie.http://sajie.journals.ac.za/pub/article/view/127Publisher's versio

Orthopaedic referrals using a smartphone app : uptake, response times and outcome

CITATION: Morkel, R. W., et al. 2019. Orthopaedic referrals using a smartphone app : uptake, response times and outcome. South African Medical Journal, 109(11):859-864, doi:10.7196/SAMJ.2019.v109i11.13986.The original publication is available at http://www.samj.org.zaBackground. It is well established that South Africa (SA) suffers an immense burden of violence and injuries. The responsibility of providing care for these injuries falls mainly on public health services, resulting in overloading of the health system. Prior to a recent intervention, the large burden had been exacerbated by limitations in the traditional referral system that highlighted the need for a better referral system. Vula’s smartphone app was introduced at Tygerberg Hospital in August 2016. This study evaluated the uptake, response times and outcomes using this app. Objectives. The main objectives of the study were to describe: (i) the number of referrals; (ii) referral response times; (iii) referring facilities; and (iv) referral outcomes. Secondary objectives were to: (i) evaluate whether the referral outcome pathway was appropriate; and (ii) assess professional conduct and evidence of upskilling. Methods. This retrospective, descriptive study investigated Vula app referrals to the Division of Orthopaedic Surgery at Tygerberg Hospital between 1 August 2016 and 31 March 2017. Vula was advertised to key facilities in the hospital’s referral network. All referrals to the division during the study period were systematically included in the analysis of operational outcomes, although some were excluded from the subsequent referral outcome analysis. Operational outcomes included the number of referrals, referring facilities and referral response times. Referral outcome analysis included the clinical diagnosis, referral pathway, whether the referral was used for upskilling and whether it was conducted in a professional manner. Results. A total of 2 275 referrals from 39 different facilities were received during the study period from 238 individual users; 50% of referrals received a response within 11 minutes, while a small percentage received no response. Clinical and demographic characteristics of 1 985 patients included in the referral outcome analysis indicated that the majority of trauma and emergency referrals involved males, with closed fractures being the most frequent clinical presentation. Although the most common referral outcome was immediate transfer, one-third of the patients were treated at the referring hospital with advice only. Conclusions. The large volume of orthopaedic referrals received through the Vula app suggests that Vula represents a successful alternative to traditional referral methods. Referrals managed by advice only could suggest that Vula facilitates some relief for the overburdened trauma services. Future research could further explore Vula’s role in strengthening the public health system, including interventions for high-volume referral areas and upskilling of referring health workers.http://www.samj.org.za/index.php/samj/article/view/12758Publisher's versio

Role of widows in the heterosexual transmission of HIV in Manicaland, Zimbabwe, 1998–2003

BACKGROUND: AIDS is the main driver of young widowhood in southern Africa. METHODS: The demographic characteristics of widows, their reported risk behaviours and the prevalence of HIV were examined by analysing a longitudinal population-based cohort of men and women aged 15-54 years in Manicaland, eastern Zimbabwe. The results from statistical analyses were used to construct a mathematical simulation model with the aim of estimating the contribution of widow behaviour to heterosexual HIV transmission. RESULTS: 413 (11.4%) sexually experienced women and 31 (1.2%) sexually experienced men were reported to be widowed at the time of follow-up. The prevalence of HIV was exceptionally high among both widows (61%) and widowers (male widows) (54%). Widows were more likely to have high rates of partner change and engage in a pattern of transactional sex than married women. Widowers took partners who were a median of 10 years younger than themselves. Mathematical model simulations of different scenarios of sexual behaviour of widows suggested that the sexual activity of widow(er)s may underlie 8-17% of new HIV infections over a 20-year period. CONCLUSIONS: This combined statistical analysis and model simulation suggest that widowhood plays an important role in the transmission of HIV in this rural Zimbabwean population. High-risk partnerships may be formed when widowed men and women reconnect to the sexual network