An exploration of the eThekwini Municipality's indigent policy and its administration with focusing on provision of basic services.

Masters Degree. University of KwaZulu-Natal, Durban.The execution of the indigent policy within eThekwini Metropolitan Municipality would help address the huge issue of the three-fold challenges of poverty, lack of employment and disparities, a core objective in consolidating and advancing developmental local governance in South Africa. These policies were designed to support poor households in an effect to uplift everyday living conditions. Nearly thirty years into democracy South Africa still has places where indigent programmes have not been enforced by state and district municipalities. While many studies have focused on poverty alleviation less attention has been paid to investigating how the indigency programmes can be improved to support struggling households. The research pursued to bridge this space in the literature by seeking to understand the eThekwini Municipality’s indigent policy execution strategy in meeting the needs of poor households in order to explore ways in which it can be improved. This study was conducted within the interpretive model which employs a qualitative research approach to explore the Indigent Policy within the eThekwini Metropolitan Municipality in Durban, South Africa and its administration with regards to the delivery of essential services to frame the solution for holistic execution of the policy. The study draws its participants from the municipal officials at the eThekwini municipality. A purposive sampling technique was adopted to identify eleven participants who had adequate knowledge regarding the execution of the indigent policy among poor households in eThekwini. The analysis of empirical findings shows various obstacles encountered by the municipality in the provision of indigent support to poor households. While a variety of perspectives were expressed by participants in the study on the execution of the policy in its current form, a common thread was that the policy execution was affected by various challenges that include inter alia insufficient funding, departments working in silos, the absence of an indigent register, lack of accountability and poor administration with no clear execution plan. The findings of this study pointed to a gap in the lack of internal control systems, a consolidated approach to execution and a dedicated office to deal with the roll out of the support. The results of this study show that to ensure successful indigent support is rendered poor communities need to be accordingly identified and that regular monitoring and evaluation is done to mitigate the lack of compliance with regulations aligned to indigent support programmes. The researcher recommends that the municipality develops a clear execution plan for the indigent policy and establishes a dedicated team and office to strengthen the activation of the indigent support. One of the core tasks suggested should be the drawing up of an indigent register

Effect of SGLT2 inhibitors on stroke and atrial fibrillation in diabetic kidney disease: Results from the CREDENCE trial and meta-analysis

BACKGROUND AND PURPOSE: Chronic kidney disease with reduced estimated glomerular filtration rate or elevated albuminuria increases risk for ischemic and hemorrhagic stroke. This study assessed the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on stroke and atrial fibrillation/flutter (AF/AFL) from CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) and a meta-Analysis of large cardiovascular outcome trials (CVOTs) of SGLT2i in type 2 diabetes mellitus. METHODS: CREDENCE randomized 4401 participants with type 2 diabetes mellitus and chronic kidney disease to canagliflozin or placebo. Post hoc, we estimated effects on fatal or nonfatal stroke, stroke subtypes, and intermediate markers of stroke risk including AF/AFL. Stroke and AF/AFL data from 3 other completed large CVOTs and CREDENCE were pooled using random-effects meta-Analysis. RESULTS: In CREDENCE, 142 participants experienced a stroke during follow-up (10.9/1000 patient-years with canagliflozin, 14.2/1000 patient-years with placebo; hazard ratio [HR], 0.77 [95% CI, 0.55-1.08]). Effects by stroke subtypes were: ischemic (HR, 0.88 [95% CI, 0.61-1.28]; n=111), hemorrhagic (HR, 0.50 [95% CI, 0.19-1.32]; n=18), and undetermined (HR, 0.54 [95% CI, 0.20-1.46]; n=17). There was no clear effect on AF/AFL (HR, 0.76 [95% CI, 0.53-1.10]; n=115). The overall effects in the 4 CVOTs combined were: Total stroke (HRpooled, 0.96 [95% CI, 0.82-1.12]), ischemic stroke (HRpooled, 1.01 [95% CI, 0.89-1.14]), hemorrhagic stroke (HRpooled, 0.50 [95% CI, 0.30-0.83]), undetermined stroke (HRpooled, 0.86 [95% CI, 0.49-1.51]), and AF/AFL (HRpooled, 0.81 [95% CI, 0.71-0.93]). There was evidence that SGLT2i effects on total stroke varied by baseline estimated glomerular filtration rate (P=0.01), with protection in the lowest estimated glomerular filtration rate (45 mL/min/1.73 m2]) subgroup (HRpooled, 0.50 [95% CI, 0.31-0.79]). CONCLUSIONS: Although we found no clear effect of SGLT2i on total stroke in CREDENCE or across trials combined, there was some evidence of benefit in preventing hemorrhagic stroke and AF/AFL, as well as total stroke for those with lowest estimated glomerular filtration rate. Future research should focus on confirming these data and exploring potential mechanisms

Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to 300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m 2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Clients driving construction innovation: Benefiting from innovation

The property and construction industry is highly volatile, responding to shifts in financial markets and economic futures as well as changing demographics, typically in a ‘boom and bust’ cycle. However, the construction industry has made significant change in adopting innovative technology and practices. A stark reminder of the speed of change within the construction industry is the emergent shift from paper-based drawings and records to sophisticated electronic systems such as 4D CAD in a few short years. Alinaitwee, Widen, Mwakali and Hanssen (2006) in their research examining innovation in construction suggest that efforts to promote innovation are at the core of current research in building as it is a critical mechanism to achieve greater productivity and competitiveness. With increasing expectations of the industry, especially regarding sustainable practices – environmental, social and economic – more work is needed. The research in this edited volume demonstrates how applied research can make a difference in delivering environmental, social and economic benefits to property, design, construction and facility management firms, the industry and the community. Increasingly, the sector is faced with demanding clients and these clients are shaping the principles, policies, practices and processes of the construction industry (Barlow 2000). However, it is recognised that while clients have a critical place in the construction sector, the extent and specification of their role is not well understood. It is timely then, to examine the benefits of innovation from a client point of view. Clients Driving Construction Innovation: Benefiting from Innovation outlines the results of leading-edge research and makes it accessible to the broader construction sector. Benefiting from Innovation brings research featuring clients, designers, constructors and facility managers to bear on delivering cutting-edge solutions to issues and problems in constructed facilities. It showcases applied and theoretical research that has particular relevance to the construction sector. Mitropolous and Tatum (2000) in their study of information and communication technologies (ICT) adoption and innovation in the construction sector identified four forces that drive innovation: capturing of competitive advantage, process problems, technological opportunity and institutional requirements. Innovative capacity can thus be sourced from conditions of both adversity and advantage. The research in this edited volume examines innovation in a range of settings and through a variety of methodological approaches and concurs with the findings of Mitropolous and Tatum (2000). These authors suggest that innovation forces emanate from changes in policy and legislative mandate in the institutional arena such as occupational health and safety requirements from large-scale industry leaders seeking greater advantage through technology such as eBusiness and increased market share, and by solving practical issues in organisational and supply chain arrangement

The use of lead indicators in safety culture research : measuring construction industry safety performance

This paper investigates the potential of the development and applicability of measuring safety performance in the Australian construction industry based on a newly devised 'tool', Safety Effectiveness Indicators (SEIs). Its development emanates from a recently commenced research project funded by the CRC for Construction Innovation in partnership with Leighton Contractors, John Holland Group, Thiess Contractors and the Office of the Federal Safety Commissioner (OFSC). Nationally the construction industry has far more injuries and ill-health impacts than the Australian average, and pays one of the highest workers' compensation premium rates in Australia. Similarly, notwithstanding improvement in their rates, fatalities are too high. Yet, other than lost time injuries (LTIs) or similar 'negative' 'lag' performance indicators, reliable comparable and standardised performance indicators are not available. An evaluation below of Positive Performance Indicators (PPIs) as an OHS performance measuring tool, based on a brief overview of its limited uptake in Australian industry, suggests that it does not reliably measure OHS performance. Similarly, other 'positive' or 'lead' indicators, which owing to word length limitations are not discussed in this paper, have parallel shortcomings. However, based on current workers' compensation claims and incidence of injury and illness there is a clearly demonstable need to accurately measure safety performance on construction sites in order to improve industry performance

Development of a practical guide to safety leadership : industry-based applications

This chapter reports on a project to continue development of the Construction Safety Competency Framework by formulating comprehensive implementation guide for the safety management tasks and safety-critical positions identified in the framework. Developmental issues, industry liaison processes, and stakeholder ownership issues are discussed as well as future implications for skill acquisition of safety-critical tasks, and recruitment and professional development concerns. The anticipated outcomes have the potential to enhance current safety skill and behaviour acquisitions in first-tier construction companies and greatly assist the strategic development, planning, and implementation of these skills and behaviours in second-tier construction companies and associated contractors