Understanding South Africa’s Role in Achieving Regional and Global Development Progress

As Africa’s most diversified, developed and (until recently) largest economy, South Africa occupies a unique position in the international development debate. It is an active player in global governance and development fora, maintains an extensive development partnership with its region, and is a member of the BRICS Forum of emerging powers (along with Brazil, Russia, India and China). The 2009 announcement of a new South African Development Partnership Agency (SADPA) has also generated interest among traditional donors to work more closely with South Africa in regional development. While questions remain about the scope and composition of SADPA, it is clear that South Africa’s role as a development actor is growing, and more needs to be done to understand the contribution it can make towards tackling poverty and promoting sustainable development at the regional and global levels.UK Department of International Developmen

The vegetation of the Roodeplaat Dam Nature Reserve. III. Phenological observations

The phenology of a number of phanerophytes, chamaephytes, hemi-cryptophytes, cryptophytes and therophytes was studied over a three-year period and it was found that certain phanerophytes exhibited activity as early as the second half of July. Most other species commence growing and/or flowering only in September, while the flowering phase of a number of species commences only in late summer or early winter

The effect of water stress on the germination of Citrullus lanatus seeds

The germination of Citrullus lanatus seeds is extremely sensitive to water stress. A decrease of 13,6 % in the total water content is sufficient for the complete inhibition of germination. Exposure of seeds to water stress at a very late stage of germination after normal incubation in water prevents radicle emergence. Prolonged water stress treatment does not induce secondary dormancy in these seeds. Water stress which completely inhibits germination does not appear to affect the conversion of phytochrome intermediates to Pfr or the photoreversibility of phytochrome during light treatments

A patient-centric Six-Sigma decision support system framework for continuous quality improvement in clinics

CITATION: Hlongwane, S., Ngongoni, C. & Grobbelaar, S. S. 2019. A patient-centric Six-Sigma decision support system framework for continuous quality improvement in clinics. South African Journal of Industrial Engineering, 30(3):224-237, doi:10.7166/30-3-2241.The original publication is available at http://sajie.journals.ac.zaENGLISH ABSTRACT: Primary health care facilities are widely regarded as the backbone of the South African healthcare system. For this reason, formalised standards such as the ‘ideal clinic’ and ‘national core standards’ dictate expected service levels for clinics. Although this is a big step towards the improvement of service delivery at the facilities, the level of uptake of and adherence to these standards is concerning. Service quality plays a huge role in the level of patient satisfaction, and emphasis is placed on the features of quality that are of importance to the patient. To this end, the focus on the patient is an important dimension in healthcare quality management in order to improve the service quality in healthcare facilities. This article provides an overview of quality and how it is managed in the context of clinics in South Africa. It outlines the gaps, aligned with how well quality is managed, from a patient perspective. The paper proposes a decision support framework aimed at continuous improvement of quality in clinics. The tool was developed using the Six Sigma methodology, complemented by service quality assessment instruments. The structure of the tool provides an integrated systematic approach that can assist the healthcare decision-maker in tracking the continuous improvement of processes and activities in clinics. The tool also takes the first step towards digitising a typical paper-based system.AFRIKAANS OPSOMMING: Primêre gesondheidsorgfasiliteite word wyd beskou as die ruggraat van die Suid-Afrikaanse gesondheidsorgstelsel. Om hierdie rede word formele standaarde deur die ‘ideale kliniek’ en ‘Nasionale kernstandaarde’ bepaal. Alhoewel dit ʼn groot stap is vir die verbetering van dienslewering by die fasiliteite, is die vlak van opname en nakoming van hierdie standaarde kommerwekkend. Diensgehalte speel ʼn groot rol in die vlak van pasiëntbevrediging, en klem word geplaas op die eienskappe van kwaliteit wat van belang is vir die pasiënt. Vir hierdie doel is die fokus op die pasiënt ʼn belangrike dimensie in gesondheidsorgkwaliteitsbestuur ten einde die diensgehalte in gesondheidsorgfasiliteite te verbeter. Hierdie artikel bied ʼn oorsig oor kwaliteit en hoe dit in die konteks van klinieke in Suid-Afrika bestuur word. Dit beskryf die gapings van hoe goed kwaliteit bestuur word, uit ʼn pasiëntperspektief. Die artikel stel ʼn besluitsteunraamwerk voor wat op deurlopende verbetering van gehalte in klinieke gemik is. Die instrument is ontwikkel met behulp van die Ses-Sigma metodologie, aangevul deur dienskwaliteit assesseringsinstrumente. Die struktuur van die instrument bied ʼn geïntegreerde sistematiese benadering wat die gesondheidsorgbesluitnemer kan help om die deurlopende verbetering van prosesse en aktiwiteite in klinieke te monitor. Die instrument neem ook die eerste stap in die rigting van digitalisering van ʼn tipiese papiergebaseerde stelsel.http://sajie.journals.ac.za/pub/article/view/2241Publisher's versio

Lessons from the hepatoblastoma-familial polyposis connection

Background. Approximately one-third of hepatoblastoma (HB) patients have associated congenital abnormalities, but familial recurrence is rare, except in association with familial adenomatous polyposis (FAP). This correlation may be missed if not actively sought, with implications for long-term outcome and management. Methods. We retrospectively investigated 3 families with an HB-familial polyposis connection, from a cohort of 113 FAP families (1989 - 2010). Data were analysed to assess clinical problem, treatment, complications and management. Long-term morbidity and functional outcome were analysed to identify management difficulties. Results. Three FAP families (2.65%) had an HB association. In one case, undiagnosed FAP at the time of HB diagnosis was only detected 5 years later, when the mother presented with advanced colorectal carcinoma. A chromosome 5 APC gene mutation (exon 15 codon 793 C→T) was then identified. In a second case, a non-related male child presented with a stage 4 multifocal HB with lung metastases. Genetic studies identified an APC gene mutation (exon 6 codon 232 C→T). Further family investigation showed >20 related FAP patients. A third HB-FAP association was identified in a known FAP family early in the study, prior to the availability of genetic testing. Conclusion. Although a rare association, a family history of FAP in HB patients is an important ‘hidden connection’. Germline variation may be outside the usual FAP gene site. Identifying families with unknown HB/FAP is important due to long-term management implications and follow-up

Lessons from the hepatoblastoma- familial polyposis connection

The original publication is available at http://www.samj.org.zaBackground. Approximately one-third of hepatoblastoma (HB) patients have associated congenital abnormalities, but familial recurrence is rare, except in association with familial adenomatous polyposis (FAP). This correlation may be missed if not actively sought, with implications for long-term outcome and management. Methods. We retrospectively investigated 3 families with an HB-familial polyposis connection, from a cohort of 113 FAP families (1989 - 2010). Data were analysed to assess clinical problem, treatment, complications and management. Long-term morbidity and functional outcome were analysed to identify management difficulties. Results. Three FAP families (2.65%) had an HB association. In one case, undiagnosed FAP at the time of HB diagnosis was only detected 5 years later, when the mother presented with advanced colorectal carcinoma. A chromosome 5 APC gene mutation (exon 15 codon 793 C→T) was then identified. In a second case, a nonrelated boy presented with a stage 4 multifocal HB with lung metastases. Genetic studies identified an APC gene mutation (exon 6 codon 232 C→T). Further family investigation showed >20 related FAP patients. A third HB-FAP association was identified in a known FAP family early in the study, prior to the availability of genetic testing. Conclusion. Although a rare association, a family history of FAP in HB patients is an important ‘hidden connection’. Germline variation may be outside the usual FAP gene site. Identifying families with unknown HB/FAP is important due to long-term management implications and follow-up

Implementing 'universal' access to antiretroviral treatment in South Africa:a scoping review on research priorities

‘Universal’ access to antiretroviral treatment (ART) has become the global standard for treating people living with HIV and achieving epidemic control; yet, findings from numerous ‘test and treat’ trials and implementation studies in sub-Saharan Africa suggest that bringing ‘universal' access to ART to scale is more complex than anticipated. Using South Africa as a case example, we describe the research priorities and foci in the literature on expanded ART access. To do so, we adapted Arksey and O’Malley’s six-stage scoping review framework to describe the peer-reviewed literature and opinion pieces on expanding access to ART in South Africa between 2000 and 2017. Data collection included systematic searches of two databases and hand-searching of a sub-sample of reference lists. We used an adapted socio-ecological thematic framework to categorize data according to where it located the challenges and opportunities of expanded ART eligibility: individual/client, health worker–client relationship, clinic/community context, health systems infrastructure and/or policy context. We included 194 research articles and 23 opinion pieces, of 1512 identified, addressing expanded ART access in South Africa. The peer-reviewed literature focused on the individual and health systems infrastructure; opinion pieces focused on changing roles of individuals, communities and health services implementers. We contextualized our findings through a consultative process with a group of researchers, HIV clinicians and programme managers to consider critical knowledge gaps. Unlike the published literature, the consultative process offered particular insights into the importance of researching and intervening in the relational aspects of HIV service delivery as South Africa’s HIV programme expands. An overwhelming focus on individual and health systems infrastructure factors in the published literature on expanded ART access in South Africa may skew understanding of HIV programme shortfalls away from the relational aspects of HIV services delivery and delay progress with finding ways to leverage non-medical modalities for achieving HIV epidemic control

Incidence of Tuberculosis amongst HIV positive individuals initiating antiretroviral treatment at higher CD4 counts in the HPTN 071 (PopART) trial in South Africa.

INTRODUCTION: Antiretroviral treatment (ART) guidelines recommend lifelong ART for all HIV positive individuals. This study evaluated TB incidence on ART in a cohort of HIV positive individuals starting ART regardless of CD4 count in a programmatic setting at three clinics included in the HPTN 071 (PopART) trial in South Africa. METHODS: A retrospective cohort analysis of HIV-positive individuals aged ≥18 years starting ART, between January 2014 and November 2015, was conducted. Follow up was continued until 30 May 2016 or censored on the date of i) incident TB ii) loss to follow up from HIV care or death or iii) elective transfer out; whichever occurred first. RESULTS: The study included 2423 individuals. Median baseline CD4 count was 328 cells/µL (IQR 195-468), TB incidence rate was 4.41/100 PY (95% CI 3.62-5.39). The adjusted hazard ratio of incident TB was 0.27 (95% CI 0.12 - 0.62) when comparing individuals with baseline CD4 > 500cells/µL and ≤ 500cells/µL. Amongst individuals with baseline CD4 count > 500cells/µL there were no incident TB cases in the first three months of follow up. Adjusted hazard of incident TB was also higher amongst men (aHR 2.16; 95% CI: 1.41 - 3.30). CONCLUSION: TB incidence after ART initiation was significantly lower amongst individuals starting ART at CD4 counts above 500cells/µL. Scale up of ART, regardless of CD4 count, has the potential to significantly reduce TB incidence amongst HIV-positive individuals. However, this needs to be combined with strengthening of other TB prevention strategies that target both HIV positive and HIV negative individuals

SILICONE ARTHROPLASTY FOR TRAPEZIOMETACARPAL ARTHRITIS

Twenty-three patients who had undergone trapeziectomy and Helal silicone rubber ball interposition for trapeziometacarpal arthritis were reviewed. The average age at operation was 63 (range 48-84) years and the mean follow-up was 59 (range 12-138) months. Of the 23 patients reviewed, two had pain at rest and four had some discomfort on exertion. Mean post-operative thumb extension was 371 whilst mean palmar abduction was 401. Mean post-operative grip strength was 19 kg and thumb-pinch strength was 4.0 kg, 77% and 78% of the age-and sex-matched normal values. There were no cases of prosthetic dislocation, prosthetic fracture or silicone synovitis

Hydrogen Epoch of Reionization Array (HERA)

The Hydrogen Epoch of Reionization Array (HERA) is a staged experiment to measure 21 cm emission from the primordial intergalactic medium (IGM) throughout cosmic reionization ($z=6-12$), and to explore earlier epochs of our Cosmic Dawn ($z\sim30$). During these epochs, early stars and black holes heated and ionized the IGM, introducing fluctuations in 21 cm emission. HERA is designed to characterize the evolution of the 21 cm power spectrum to constrain the timing and morphology of reionization, the properties of the first galaxies, the evolution of large-scale structure, and the early sources of heating. The full HERA instrument will be a 350-element interferometer in South Africa consisting of 14-m parabolic dishes observing from 50 to 250 MHz. Currently, 19 dishes have been deployed on site and the next 18 are under construction. HERA has been designated as an SKA Precursor instrument. In this paper, we summarize HERA's scientific context and provide forecasts for its key science results. After reviewing the current state of the art in foreground mitigation, we use the delay-spectrum technique to motivate high-level performance requirements for the HERA instrument. Next, we present the HERA instrument design, along with the subsystem specifications that ensure that HERA meets its performance requirements. Finally, we summarize the schedule and status of the project. We conclude by suggesting that, given the realities of foreground contamination, current-generation 21 cm instruments are approaching their sensitivity limits. HERA is designed to bring both the sensitivity and the precision to deliver its primary science on the basis of proven foreground filtering techniques, while developing new subtraction techniques to unlock new capabilities. The result will be a major step toward realizing the widely recognized scientific potential of 21 cm cosmology.Comment: 26 pages, 24 figures, 2 table