The 'third mission' and 'triple helix mission' of universities as evolutionary processes in the development of the network of knowledge production : reflections on SME experiences in Thailand

This paper explores the 'third mission' and 'triple helix mission' of universities in Thailand. These functions of universities are often conflated, whereas conceptually they represent separate stages in the evolution of the sphere of knowledge production. The ‘third mission’ concept is presented as the antecedent to the 'triple helix mission', and involves relationships between institutional spheres, with the boundaries clearly delineated. In the 'triple helix system', institutional spheres converge and boundaries are blurred. The transition from the 'third mission' to the ‘triple helix system’—and the subsequent emergence of entrepreneurial universities—is expedited by the intervention of intermediary organisations that span boundaries and broker between institutional spheres to promote knowledge exchange. Analysis of experience in Thailand shows that the transition from the third mission' to the 'triple helix system' has been constrained by limited networking experience and weak social capital among the actors, particularly small and medium-sized enterprises

Structural holes, knowledge intermediaries and evolution of the triple helix system with reference to the hard disk drive industry in Thailand

This article explores the evolutionary process underlying the development of the triple helix innovation system and the role of knowledge intermediaries in the process. It draws on the experience of knowledge network development in an SME cluster in the Thai hard disk drive industry. Conceptually, the evolutionary process starts with inter-firm networks, which occur in the form of supply chain-based vertical links and trade association or cluster-based horizontal links. These evolve into triple helix networks and culminate into the triple helix innovation system through the agency of network dynamics. Intermediaries enhance network development as sponsors, providing funds; as brokers, closing and bridging structural holes that disconnect network players; and as boundary spanners, facilitating knowledge circulation. The case study suggests that knowledge network development in Thailand has a long way to go before morphing into the triple helix innovation system. Some evidence of network dynamics was nonetheless detected; but for lack of trust in the triple helix culture the fledgling network dynamics fizzled out when the government prop, which initiated the process, was withdrawn. The article concludes by highlighting the need for policy to promote the culture of trust among network players and for knowledge intermediaries to be robustly systemic in their organization and operation

Fungaemia in the neonatal unit at Chris Hani Baragwanath Hospital: risk factors, aetiology, susceptibility to antifungals and outcome.

Aim The aim was to determine the epidemiology of invasive fungal infections at Chris Hani Baragwanath Hospital. The specific objectives were to determine the 1) risk factors, 2) clinical presentation, 3) laboratory abnormalities, 4) organisms and their susceptibilities and 6) outcome in neonates with positive blood or CSF fungal cultures at Chris Hani Baragwanath Hospital. Methods This was a retrospective record review of patients who had positive blood or CSF cultures. Patients were identified by a computerized microbiological surveillance database. The data was collected over a three-year period from January 2002 to December 2004. Patient hospital files were reviewed for clinical signs, full blood count (FBC), C-reactive protein (CRP) and outcomes. Fungal culture results were reviewed for susceptibilities. To identify risk factors a convenient cohort was compared to the patients with fungal sepsis. The data was analysed using a Statistica software package. Results There were 150 patients with fungal sepsis among admissions over this 3 yearperiod giving an incidence of 1.3 per 100 admissions. Thirty-nine records were not found thus 111 patient records were reviewed. The median birthweight was 1280g and the gestational age 30 weeks. The median age of onset was 16 days and 6.3% had early onset fungal sepsis. There were 61 males. Twenty-eight percent of patients were born to HIV positive mothers. Candida parapsilosis was the commonest (56%) organism isolated followed by C. albicans (43%). All the C. albicans isolates and 93% of the C. parapsilosis isolates were susceptible to amphotericin B. Fluconazole susceptibilities were reported as, 96% for C. albicans, and 60% of the C. parapsilosis as being susceptible. Central venous catheters (CVCs) (p=<0.001), the use of TPN (p=<0.001) and third generation cephalosporins were identified as risk factors associated with fungal sepsis. The all-cause mortality and Candida–related mortality were 30% and 23% respectively. The non-survivors had lower platelet counts (p=0.007) than the survivors. Patients with Gram-negative sepsis had lower platelet counts than the fungal group (p=<0.001) on the repeat laboratory parameters. Conclusion The incidence is 1.3 per 100 admissions. Risk factors associated with fungal sepsis are very low birthweight and gestational age, the use of TPN, CVCs and third generation cephalosporins. Candida parapsilosis is the common organism causing fungal sepsis in neonates. Candida albicans was associated with a higher mortality. Thrombocytopenia is not organism specific to fungal sepsis

Perinatal outcome of maternal deaths at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa, January 2014 - June 2019

Background. Maternal death is a tragic event. Of maternal deaths worldwide, 99% occur in low- and middle-income countries. Perinatal outcome is related to maternal wellbeing. Maternal death has a negative impact on fetal and neonatal outcome in the short and long term. Objectives. To determine the perinatal outcomes of pregnancies that ended in a maternal death at Chris Hani Baragwanath Academic Hospital (CHBAH), Johannesburg, South Africa, over a 5-year period, to describe the causes of maternal death, and to determine the stillbirth rate (SBR) and early neonatal death (ENND) rate in this population. Methods. This was a retrospective cross-sectional study of maternal deaths in women with a viable pregnancy from January 2014 to June 2019 at CHBAH. All maternal deaths with gestation >26 weeks or fetal weight >500 g were included in the study. Information on demographics, booking status, antenatal care, pregnancy outcome, and fetal and neonatal outcome was extracted from maternal and neonatal files. Results. Of a total of 183 maternal deaths during the study period, 147 were included in the study. The institutional maternal mortality ratio was 135 deaths per 100 000 live births. Hypertension was the main direct cause of death (36.5%; n=27/74), followed by pregnancy related sepsis (27.4%; n=21/74) and obstetric haemorrhage (20.6%; n=15/74). Non-pregnancy-related infections, of which 91.4% were HIV and HIV-related complications, comprised 47.9% (n=35/73) of indirect causes of death, followed by medical and surgical disorders. Of a total of 151 babies, including two sets of twins and one set of triplets, 137 were delivered and 14 were undelivered at the time of maternal death. Ninety-one babies (61.9%) were born alive and 51 (34.6%) were stillbirths. Of the 91 liveborn infants, 6 (6.5%) had an ENND. Of the 51 stillbirths, 14 (27.5%) were undelivered and 11 (21.6%) were delivered by perimortem caesarean section. The SBR was 347 per 1 000 maternal deaths and the ENND rate 66 per 1 000 live births. The perinatal mortality rate (PMR) was 388 per 1 000 maternal deaths, which is 12 times higher than the PMR per 1 000 live births for the general population. Conclusion. Women who experience maternal death have babies with very poor perinatal outcomes, with a very high SBR, ENND rate and PMR. The health of the mother has a direct and significant effect on fetal and neonatal outcomes

Le stress au travail et l’épuisement professionnel du personnel soignant de l’Hôpital Général de Ré-férence de Gemena/Sud-Ubangi en République Démocratique du Congo

De nos jours, les problèmes liés au stress ne sont plus des cas isolés, mais ils constituent un défi de taille pour la gestion des ressources humaines dans la plu-part des organisations. Cette recherche s’oriente uniquement à l’hôpital géné-ral de référence de Gemena où il y a des ressources humaines membres du per-sonnel soignant vivant la situation de stress au travail et l’épuisement profes-sionnel. Disons qu’au sein des organisations, personne n’est à l’abri des stress, au regard des conditions de travail, le climat social, l’environnement du lieu de service et d’autres charges de travail trop lourdes et contraignantes. Quel que soit le secteur d’activité, le gestionnaire doit se montrer vigilant, tant pour lui-même que pour ses collaborateurs. Le stress au travail et l’épuisement profes-sionnel ont un caractère insidieux car ils sont difficiles à percevoir dans l’orga-nisation tout comme dans la structure sanitaire dont il est question ici. Cette recherche démontre les différents facteurs déclenchant les stress au travail ainsi que les effets de ces deniers sur la vie de l’hôpital et ses salariés.De nos jours, les problèmes liés au stress ne sont plus des cas isolés, mais ils constituent un défi de taille pour la gestion des ressources humaines dans la plu-part des organisations. Cette recherche s’oriente uniquement à l’hôpital géné-ral de référence de Gemena où il y a des ressources humaines membres du per-sonnel soignant vivant la situation de stress au travail et l’épuisement profes-sionnel. Disons qu’au sein des organisations, personne n’est à l’abri des stress, au regard des conditions de travail, le climat social, l’environnement du lieu de service et d’autres charges de travail trop lourdes et contraignantes. Quel que soit le secteur d’activité, le gestionnaire doit se montrer vigilant, tant pour lui-même que pour ses collaborateurs. Le stress au travail et l’épuisement profes-sionnel ont un caractère insidieux car ils sont difficiles à percevoir dans l’orga-nisation tout comme dans la structure sanitaire dont il est question ici. Cette recherche démontre les différents facteurs déclenchant les stress au travail ainsi que les effets de ces deniers sur la vie de l’hôpital et ses salariés

Neurodevelopmental Impairment in Children After Group B Streptococcal Disease Worldwide: Systematic Review and Meta-analyses.

BACKGROUND: Survivors of infant group B streptococcal (GBS) disease are at risk of neurodevelopmental impairment (NDI), a burden not previously systematically quantified. This is the 10th of 11 articles estimating the burden of GBS disease. Here we aimed to estimate NDI in survivors of infant GBS disease. METHODS: We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data on the risk of NDI after invasive GBS disease in infants <90 days of age. We did meta-analyses to derive pooled estimates of the percentage of infants with NDI following GBS meningitis. RESULTS: We identified 6127 studies, of which 18 met eligibility criteria, all from middle- or high-income contexts. All 18 studies followed up survivors of GBS meningitis; only 5 of these studies also followed up survivors of GBS sepsis and were too few to pool in a meta-analysis. Of meningitis survivors, 32% (95% CI, 25%-38%) had NDI at 18 months of follow-up, including 18% (95% CI, 13%-22%) with moderate to severe NDI. CONCLUSIONS: GBS meningitis is an important risk factor for moderate to severe NDI, affecting around 1 in 5 survivors. However, data are limited, and we were unable to estimate NDI after GBS sepsis. Comparability of studies is difficult due to methodological differences including variability in timing of clinical reviews and assessment tools. Follow-up of clinical cases and standardization of methods are essential to fully quantify the total burden of NDI associated with GBS disease, and inform program priorities

Therapeutic hypothermia for neonatal hypoxic ischaemic encephalopathy should not be discontinued in low- and middle-income countries

Perinatal asphyxia is a major cause of death and disability in children. Therapeutic hypothermia (TH) has become a standard of care for newborn infants who have sustained hypoxic ischaemic encephalopathy (HIE) due to perinatal asphyxia. There is compelling evidence to support this approach. A Cochrane systematic review of 11 prospective randomised controlled trials including 1 505 newborns showed that TH started within 6 hours of birth in infants with HIE significantly decreased mortality and neurodevelopmental disability in survivors.http://www.samj.org.zadm2022ImmunologyPaediatrics and Child Healt

Challenges in the implementation of the NeoOBS study, a global pragmatic observational cohort study, to investigate the aetiology and management of neonatal sepsis in the hospital setting

Neonatal sepsis is a significant cause of mortality and morbidity in low- and middle-income countries. To deliver high-quality data studies and inform future trials, it is crucial to understand the challenges encountered when managing global multi-centre research studies and to identify solutions that can feasibly be implemented in these settings. This paper provides an overview of the complexities faced by diverse research teams in different countries and regions, together with actions implemented to achieve pragmatic study management of a large multi-centre observational study of neonatal sepsis. We discuss specific considerations for enrolling sites with different approval processes and varied research experience, structures, and training. Implementing a flexible recruitment strategy and providing ongoing training were necessary to overcome these challenges. We emphasize the attention that must be given to designing the database and monitoring plans. Extensive data collection tools, complex databases, tight timelines, and stringent monitoring arrangements can be problematic and might put the study at risk. Finally, we discuss the complexities added when collecting and shipping isolates and the importance of having a robust central management team and interdisciplinary collaborators able to adapt easily and make swift decisions to deliver the study on time and to target. With pragmatic approaches, appropriate training, and good communication, these challenges can be overcome to deliver high-quality data from a complex study in challenging settings through a collaborative research network