Civil society leadership in the struggle for AIDS treatment in South Africa and Uganda

Includes abstract.Includes bibliographical references.This thesis is an attempt to theorise and operationalise empirically the notion of ‘civil society leadership’ in Sub-Saharan Africa. ‘AIDS leadership,’ which is associated with the intergovernmental institutions charged with coordinating the global response to HIV/AIDS, is both under-theorised and highly context-specific. In this study I therefore opt for an inclusive framework that draws on a range of approaches, including the literature on ‘leadership’, institutions, social movements and the ‘network’ perspective on civil society mobilisation. This framework is employed in rich and detailed empirical descriptions (‘thick description’) of civil society mobilisation around AIDS, including contentious AIDS activism, in the key case studies of South Africa and Uganda. South Africa and Uganda are widely considered key examples of poor and good leadership (from national political leaders) respectively, while the Treatment Action Campaign (TAC) and The AIDS Support Organisation (TASO) are both seen as highly effective civil society movements. These descriptions emphasise ‘transnational networks of influence’ in which civil society leaders participated (and at times actively constructed) in order to mobilise both symbolic and material resources aimed at exerting influence at the transnational, national and local levels

Outcome Following Non-Operative Management in Blunt Aortic Trauma

Purpose: Aortic injury following blunt trauma is an indication for urgent thoracic aortic repair. Reports from centers using thoracic endografts have suggested that the strategy of delayed aortic repair can improve survival in these patients. Experience has also demonstrated that non-operative management without aortic repair is appropriate in selected patients. The purpose of this study was to determine the outcome of patients with blunt aortic injury managed non-operatively. Methods: All patients admitted to a single institution Level I trauma center were prospectively enrolled in a registry. Those patients identified with blunt aortic injury that were managed non-operatively between January 2005 to December 2010 were reviewed. In-hospital mortality, length of stay and survival following discharge were assessed in this patient cohort. Results: A total of 53 patients were identified with blunt aortic injury during the study period. Thirty of the patients were managed operatively; 17 underwent open repair and 13 endovascular repair. Twenty-four patients (45%) were managed non-operatively and underwent further analysis. The male to female ratio was 15:8 with an average age of 44 (range 18-85) years. In hospital mortality occurred in only 1 patient (4%) managed non-operatively. This patient expired in the first 24 hours due to multiple co-morbidities and extensive associated traumatic injuries. The mean length of hospital stay in the remaining 23 survivors was 20 days. Follow-up was available in 22 of 23 patients following discharge. All patients were alive at the last time of contact, mean 19 (range 1 to 67) months. Conclusions: Improved survival with endografts for blunt aortic injury is felt related to strategies of delayed repair. The present study demonstrates patients can be managed medically with excellent survival. Therefore, when considering delayed aortic repair for blunt aortic injury, medical management should be considered in selected patients

Outcome Following Non-Operative Management in Blunt Aortic Trauma

Purpose: Aortic injury following blunt trauma is an indication for urgent thoracic aortic repair. Reports from centers using thoracic endografts have suggested that the strategy of delayed aortic repair can improve survival in these patients. Experience has also demonstrated that non-operative management without aortic repair is appropriate in selected patients. The purpose of this study was to determine the outcome of patients with blunt aortic injury managed non-operatively. Methods: All patients admitted to a single institution Level I trauma center were prospectively enrolled in a registry. Those patients identified with blunt aortic injury that were managed non-operatively between January 2005 to December 2010 were reviewed. In-hospital mortality, length of stay and survival following discharge were assessed in this patient cohort. Results: A total of 53 patients were identified with blunt aortic injury during the study period. Thirty of the patients were managed operatively; 17 underwent open repair and 13 endovascular repair. Twenty-four patients (45%) were managed non-operatively and underwent further analysis. The male to female ratio was 15:8 with an average age of 44 (range 18-85) years. In hospital mortality occurred in only 1 patient (4%) managed non-operatively. This patient expired in the first 24 hours due to multiple co-morbidities and extensive associated traumatic injuries. The mean length of hospital stay in the remaining 23 survivors was 20 days. Follow-up was available in 22 of 23 patients following discharge. All patients were alive at the last time of contact, mean 19 (range 1 to 67) months. Conclusions: Improved survival with endografts for blunt aortic injury is felt related to strategies of delayed repair. The present study demonstrates patients can be managed medically with excellent survival. Therefore, when considering delayed aortic repair for blunt aortic injury, medical management should be considered in selected patients

Outcome Following Non-Operative Management in Blunt Aortic Trauma

Purpose: Aortic injury following blunt trauma is an indication for urgent thoracic aortic repair. Reports from centers using thoracic endografts have suggested that the strategy of delayed aortic repair can improve survival in these patients. Experience has also demonstrated that non-operative management without aortic repair is appropriate in selected patients. The purpose of this study was to determine the outcome of patients with blunt aortic injury managed non-operatively. Methods: All patients admitted to a single institution Level I trauma center were prospectively enrolled in a registry. Those patients identified with blunt aortic injury that were managed non-operatively between January 2005 to December 2010 were reviewed. In-hospital mortality, length of stay and survival following discharge were assessed in this patient cohort. Results: A total of 53 patients were identified with blunt aortic injury during the study period. Thirty of the patients were managed operatively; 17 underwent open repair and 13 endovascular repair. Twenty-four patients (45%) were managed non-operatively and underwent further analysis. The male to female ratio was 15:8 with an average age of 44 (range 18-85) years. In hospital mortality occurred in only 1 patient (4%) managed non-operatively. This patient expired in the first 24 hours due to multiple co-morbidities and extensive associated traumatic injuries. The mean length of hospital stay in the remaining 23 survivors was 20 days. Follow-up was available in 22 of 23 patients following discharge. All patients were alive at the last time of contact, mean 19 (range 1 to 67) months. Conclusions: Improved survival with endografts for blunt aortic injury is felt related to strategies of delayed repair. The present study demonstrates patients can be managed medically with excellent survival. Therefore, when considering delayed aortic repair for blunt aortic injury, medical management should be considered in selected patients

Screening for Harassment, Abuse, and Discrimination among Surgery Residents: An EAST Multicenter Trial

Estimating the prevalence of harassment, verbal abuse, and discrimination among residents is difficult as events are often under-reported. The purpose of this study was to determine the prevalence of discrimination and abuse among surgical residents using the HITS (Hurt, Insulted, Threatened with harm or Screamed at) screening tool. A multicenter, cross-sectional, survey-based study was conducted at five academic teaching hospitals. Of 310 residents, 76 (24.5%) completed the survey. The HITS screening tool was positive in 3.9 per cent. The most common forms of abuse included sexual harassment (28.9%), discrimination based on gender (15.7%), and discrimination based on ethnicity (7.9%). There was a positive correlation between individuals who reported gender discrimination and racial discrimination (r = 0.778, n = 13, P = 0.002). Individuals who experienced insults were more likely to experience physical threats (r = 0.437, n = 79, P \u3c 0.001) or verbal abuse (r = 0.690, n = 79, P \u3c 0.001). Discrimination and harassment among surgical residents in academic teaching hospitals across the United States is not uncommon. Further research is needed to determine the impact of these findings on resident attrition

Screening for Harassment, Abuse, and Discrimination among Surgery Residents: An EAST Multicenter Trial

Estimating the prevalence of harassment, verbal abuse, and discrimination among residents is difficult as events are often under-reported. The purpose of this study was to determine the prevalence of discrimination and abuse among surgical residents using the HITS (Hurt, Insulted, Threatened with harm or Screamed at) screening tool. A multicenter, cross-sectional, survey-based study was conducted at five academic teaching hospitals. Of 310 residents, 76 (24.5%) completed the survey. The HITS screening tool was positive in 3.9 per cent. The most common forms of abuse included sexual harassment (28.9%), discrimination based on gender (15.7%), and discrimination based on ethnicity (7.9%). There was a positive correlation between individuals who reported gender discrimination and racial discrimination (r = 0.778, n = 13, P = 0.002). Individuals who experienced insults were more likely to experience physical threats (r = 0.437, n = 79, P \u3c 0.001) or verbal abuse (r = 0.690, n = 79, P \u3c 0.001). Discrimination and harassment among surgical residents in academic teaching hospitals across the United States is not uncommon. Further research is needed to determine the impact of these findings on resident attrition