The People And Customer Effects Of Bus Reforms In South Africa

Bus reforms in South Africa have had a dramatic impact on people (employees) and customers (passengers), especially during the last five to ten years. These so-called soft issues are sometimes overlooked in favour of the policy and structural issues. The main focus of this paper is on the people and customer effects of the bus reforms and not on the operational effects. These effects also had an impact on travel patterns, service levels, etc and although customers were on the receiving end of such changes, most of these issues fall outside the scope of this paper. An attempt is made to critically evaluate these effects and to propose solutions. The following are some of the more important effects that have become noticeable throughout the commuter bus industry: · Pre- and post tender pressures resulted in a substantial rationalisation of services and organisations. · The demarcation of tenders resulted in smaller operating entities, which in turn have a dramatic impact on people and management practices. · Large numbers of people were retrenched. Managing a downsized operation has become the key challenge. · Manpower costs have become a source of competitive advantage to secure tenders with negative effects on the continued employment of high calibre staff. · Organised labour fiercely resists reforms that could lead to further job losses and practices that weaken the position of employees. · Former training and development functions were severely rationalised or discontinued as a result of cost pressures. · Accelerated Black Economic Empowerment (BEE) has become a national policy focus. The industry made considerable progress on the BEE agenda. · The penalty system of tendered contracts redefined customer focus. · Fewer people employed in the bus industry and more demanding customers have become the key challenges. Proposed solutions include closer cooperation with organised labour, replacement of a career orientation with an entrepreneurial orientation, accelerated training and development, reassessment of the impact of lower remuneration, full implementation of the tender system, multi skilling, more focused customer care training and further research to substantiate the people and customer effects of bus reforms

Subcortical Structures in Humans Can Be Facilitated by Transcranial Direct Current Stimulation

Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that alters cortical excitability. Interestingly, in recent animal studies facilitatory effects of tDCS have also been observed on subcortical structures. Here, we sought to provide evidence for the potential of tDCS to facilitate subcortical structures in humans as well. Subjects received anodal-tDCS and sham-tDCS on two separate testing days in a counterbalanced order. After stimulation, we assessed the effect of tDCS on two responses that arise from subcortical structures; (1) wrist and ankle responses to an imperative stimulus combined with a startling acoustic stimulus (SAS), and (2) automatic postural responses to external balance perturbations with and without a concurrent SAS. During all tasks, response onsets were significantly faster following anodal-tDCS compared to sham-tDCS, both in trials with and without a SAS. The effect of tDCS was similar for the dominant and non-dominant leg. The SAS accelerated the onsets of ankle and wrist movements and the responses to backward, but not forward perturbations. The faster onsets of SAS-induced wrist and ankle movements and automatic postural responses following stimulation provide strong evidence that, in humans, subcortical structures - in particular the reticular formation - can be facilitated by tDCS. This effect may be explained by two mechanisms that are not mutually exclusive. First, subcortical facilitation may have resulted from enhanced cortico-reticular drive. Second, the applied current may have directly stimulated the reticular formation. Strengthening reticulospinal output by tDCS may be of interest to neurorehabilitation, as there is evidence for reticulospinal compensation after corticospinal lesions

Balance and gait in neurodegenerative disease: what startle tells us about motor control

The aim of this thesis was to evaluate the safety, feasibility and potential efficacy of autologous bone marrow mononuclear cell injection in patients with chronic ischemic heart disease. For this purpose, 30-100 million autologous bone marrow cells were injected into the ischemically-damaged myocardium of 50 patients with chronic ischemic heart disease. The results of the current studies demonstrate that intramyocardial injection of autologous bone marrow mononuclear cells in patients with chronic ischemic heart disease is feasible and safe. In particular, the electrophysiological properties of the injected myocardium remain unchanged and aggravation of coronary atherosclerosis is not observed. Moreover, autologous bone marrow cell injection seems to be associated with a beneficial effect on anginal symptoms, myocardial perfusion and left ventricular (systolic and diastolic) function. The beneficial effects of cardiac cell therapy appear to be sustained over a longer period of follow-up

Towards Personalized Rehabilitation for Gait Impairments in Parkinson's Disease

Contains fulltext : 200482.pdf (Publisher’s version ) (Open Access)Non-pharmacological interventions are essential in the management of gait impairments in Parkinson's disease. The evidence for these interventions is growing rapidly. However, studies evaluating these interventions do generally evaluate a one-size-fits-all concept, and do usually not distinguish between subgroups, treatment dose and delivery mode. For two main reasons, this approach will not reach the full potential of gait rehabilitation. First, non-pharmacological interventions (e.g., external cueing) can improve gait in certain patients, but have no effect or sometimes even exacerbate gait deficits in others. Second, the success and benefit of gait rehabilitation relies on therapy adherence and training intensity achieved, and multi-target therapy not tailored to the individual runs the risk of hitting nothing. Hence, to apply non-pharmacological interventions in an individualized and evidence-based manner, clinicians and therapists need to know which patient characteristics predict the efficacy of various training modes and what type of training delivery works best. Current evidence is not sufficient to develop such personalized rehabilitation programs. In this viewpoint, however, we describe how tailored use of gait rehabilitation can be reached within a 20-year time frame

[Identification and interpretation of abnormal walking patterns: a symptom-based approach for walking problems]

Item does not contain fulltextIdentification and interpretation of abnormal walking patterns is important, for the diagnosis as well as the treatment of the underlying condition. Since walking pattern changes can often be clinically observed at an early stage, their identification can help with timely diagnosis. Clinical training makes use of comprehensive descriptions of walking abnormalities that list all possible characteristics of a classic syndrome. However, patients rarely present at the office with all clinical symptoms of a specific disease, certainly not in the earliest stages. Especially in the beginning, patients often display only one or at best a few abnormal walking characteristics. None of these individual characteristics is specific for a certain disease, but may instead be seen in combination with several different disorders. For this reason, we have developed a practical diagnostic approach which allows making a differential diagnosis for each abnormal walking characteristic. Focused history taking and physical examination can then be used to make an accurate diagnose or to refer the patient for further diagnostics

Biphasic Levodopa-Induced Freezing of Gait in Parkinson's Disease

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Deliberate gait scissoring to overcome freezing of gait in Parkinson disease

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Perceptions of Compensation Strategies for Gait Impairments in Parkinson's Disease: A Survey Among 320 Healthcare Professionals

Contains fulltext : 226797.pdf (Publisher’s version ) (Open Access