Key outcomes and lessons learned : drafting Cape Town's comprehensive integrated transport plan

The new Minimum Requirements for the Preparation of Integrated Transport Plan, 2016, promulgated by the National Department of Transport requires the following of the responsible Government Authority: 'The preparation of a transport plan or transport programme must include the consultation and participation of interested and affected parties required for the preparation of integrated development plans..' In recognition of this requirement, the City of Cape Town's Transport and Development Authority (TDA), undertook a focussed stakeholder consultation exercise on its proposed transport vision and long-term strategy. Although seemingly straightforward, the exercise was more complex than appears because of the requirement to convey TDA's concepts in a short session and to receive feedback that would be appropriate for use in drafting the City' s Comprehensive Integrated Transport Plan 2017-2022. This presentation elaborates on the details of the consultation undertaken, presents some key outcomes and lessons learnt.Papers presented at the 36th Southern African Transport Conference, CSIR International Convention Centre, Pretoria, South Africa on 10-13 July 2017.Transportation research board of the national academie

Learning from covid-19 tactical urbanism: challenges and opportunities for ‘infrastructure-lite’ in sub-saharan african cities

Tactical urbanism is a quick and affordable approach to piloting and practically demonstrating change in the built environment, led by either planning authorities or civil society. It identifies a current need, and then reallocates road or other public space using short-term, low-cost, and scalable interventions to catalyse long-term change. Such approaches were applied widely during the 2020 COVID-19 pandemic, to offer opportunities for physically distanced travel for both non-motorised and public transport. Yet piloting through tactical urbanism is not an approach readily used in Sub-Saharan Africa (SSA) cities to date, neither routinely nor during 2020. Instead, SSA governments focused on capacity-reducing requirements on road and rail-based public and paratransit transport rather than also introducing pop-up infrastructure to facilitate walking and cycling and, potentially, public transport reliability and frequency. This paper investigates why tactical urbanist approaches were rarely considered in SSA cities as a pandemic response, and considers further why ‘infrastructure-lite’ approaches to public and non-motorised transport, more generally, might not find favour in local contexts. Pilots, in this form, could have particular value for resource-constrained authorities that have multiple and contested demands on budget allocations, and a need to demonstrate the legitimacy of cycling and public transport spend. The paper synthesises a series of research reports led by both authors: ‘Learning from COVID-19 pop-up bicycle infrastructure: an investigation into flexible and user-led bicycle planning in Cape Town, Nairobi and Kampala’, and ‘Fast-tracking public transport priority: Investigating the potential of Tactical Transit Lanes in mitigating the impact of COVID-19 in cities in Sub-Saharan Africa’.Papers presented virtually at the 39th International Southern African Transport Conference on 05 -07 July 202

Potential transportation measures to reduce South Africa’s dependency on crude oil

Transportation, including the movement of people and freight, accounts for over 60% of all oil con-sumed globally, and the world’s transportation sys-tems are over 90% dependent on oil and oil by-products. Oil represents the single largest item on South Africa’s import account. Gasoline and diesel fuels, which are almost exclusively used for trans-portation services, form a significant proportion of these imports.Globally, transport systems have been built on an over-reliance on cheap oil, allowing towns, cities and the movement of people and goods to be designed around the automobile. People in most South African cities require the use of motorised transport in order to travel efficiently, as public transport systems either do not exist, are too sparse or are difficult to use in many areas. The predicted depletion of oil and thus rising prices will significantly affect the choice of trans-portation systems and their use, as well as increase South Africa’s vulnerability to ‘oil shocks’. Transport planning policies must, therefore, prepare for the likelihood of such shocks and ameliorate them via policy options. A precautionary approach needs to be adopted to reduce our dependency on oil. This paper addresses the global shift towards the reduction of transport’s dependency on, or reduc-tion in, oil consumption and describes potential ways in which South Africa can reduce its oil dependency along with an indication of a timeframe for implementation

Indolent Small Intestinal CD4+ T-cell Lymphoma Is a Distinct Entity with Unique Biologic and Clinical Features

Enteropathy-associated T-cell lymphomas (EATL) are rare and generally aggressive types of peripheral T-cell lymphomas. Rare cases of primary, small intestinal CD4+ T-cell lymphomas with indolent behavior have been described, but are not well characterized. We describe morphologic, phenotypic, genomic and clinical features of 3 cases of indolent primary small intestinal CD4+ T-cell lymphomas. All patients presented with diarrhea and weight loss and were diagnosed with celiac disease refractory to a gluten free diet at referring institutions. Small intestinal biopsies showed crypt hyperplasia, villous atrophy and a dense lamina propria infiltrate of small-sized CD4+ T-cells often with CD7 downregulation or loss. Gastric and colonic involvement was also detected (n = 2 each). Persistent, clonal TCRβ gene rearrangement products were detected at multiple sites. SNP array analysis showed relative genomic stability, early in disease course, and non-recurrent genetic abnormalities, but complex changes were seen at disease transformation (n = 1). Two patients are alive with persistent disease (4.6 and 2.5 years post-diagnosis), despite immunomodulatory therapy; one died due to bowel perforation related to large cell transformation 11 years post-diagnosis. Unique pathobiologic features warrant designation of indolent small intestinal CD4+ T-cell lymphoma as a distinct entity, greater awareness of which would avoid misdiagnosis as EATL or an inflammatory disorder, especially celiac disease

A travel behaviour change framework for the city of Cape Town

Rapid increase in car ownership, and associated externalities, have motivated Transport for Cape Town (TCT) to develop strategies to curb growth in car use, particularly growth in Single Occupancy Vehicles (SOVs) in and out of the city centre. This paper reports upon the results of a project which sought to develop a framework to guide TCT?s Travel Demand Management (TDM) strategy, based upon a review of theory and a meta-analysis of empirical evidence. This framework includes a TDM strategy scenario in which a set of phased interventions seek to reduce the share of weekday SOV traffic into the city centre by 10% after five years. It is argued, from a theoretical perspective, that the keys to effective TDM intervention include: identifying which trip decision elements should be targeted in the short and long term; recognising which TDM measures are likely to have the greatest impact upon these decision elements; understanding which groups are most susceptible to change so that TDM measures might be targeted strategically; understanding the triggers which lead individuals to deliberately reappraise their travel decisions; influencing the variables that create the necessary circumstances that prompt decisions leading to the desired pattern of ?asymmetry?; and ?locking in? the vehicle kilometres travelled and other benefits, when they accrue. On the basis of the meta-analysis of secondary data, it is contended that financial charging can be expected to register the highest reduction in SOV mode use share, at around 15% at a precinct scale, followed by financial incentives, regulatory and voluntary measures at around 5%, 3% and 2% respectively. It is suggested that with the correct packaging, sequencing, targeting and resourcing, a 10% reduction in the SOV mode share of traffic travelling in and out of the city centre could be achieved.Paper presented at the 34th Annual Southern African Transport Conference 6-9 July 2015 "Working Together to Deliver - Sakha Sonke", CSIR International Convention Centre, Pretoria, South Africa.The Minister of Transport, South AfricaTransportation Research Board of the US

Barriers and facilitators to combined ART initiation in pregnant women with HIV: lessons learnt from a PMTCT B+ pilot program in Swaziland

In January 2013, Swaziland launched a PMTCT B+ implementation study in rural Shiselweni. We aimed to identify patient and health service determinants of combined antiretroviral therapy (ART) initiation, to help guide national implementation of PMTCT B+

A pragmatic randomised controlled trial of hydrotherapy and land exercises on overall well being and quality of life in rheumatoid arthritis

Background \ud Hydrotherapy is highly valued by people with rheumatoid arthritis yet few studies have compared the benefits of exercises in heated water against exercises on land. In particular, data on quality of life is rarely reported. This is especially important because patients treated with hydrotherapy often report an enhanced sense of well-being. We report a randomised controlled trial in which we compared the effects of hydrotherapy with exercises on land on overall response to treatment, physical function and quality of life in patients with rheumatoid arthritis. \ud \ud Methods \ud One hundred and fifteen patients with RA were randomised to receive a weekly 30-minute session of hydrotherapy or similar exercises on land for 6 weeks. Our primary outcome was a self-rated global impression of change – a measure of treatment effect on a 7-point scale ranging from 1(very much worse) to 7 (very much better) assessed immediately on completion of treatment. Secondary outcomes including EuroQol health related quality of life, EuroQol health status valuation, HAQ, 10 metre walk time and pain scores were collected at baseline, after treatment and 3 months later. Binary outcomes were analysed by Fisher's exact test and continuous variables by Wilcoxon or Mann-Whitney tests. \ud \ud Results \ud Baseline characteristics of the two groups were comparable. Significantly more patients treated with hydrotherapy (40/46, 87%) were much better or very much better than the patients treated with land exercise (19/40, 47.5%), p < 0.001 Fisher's exact test. Eleven patients allocated land exercise failed to complete treatment compared with 4 patients allocated hydrotherapy (p = 0.09). Sensitivity analyses confirmed an advantage for hydrotherapy if we assumed non-completers would all not have responded (response rates 70% versus 38%; p < 0.001) or if we assumed that non-completers would have had the same response as completers (response rates 82% versus 55% p = 0.002). Ten metre walk time improved after treatment in both cases (median pre-treatment time for both groups combined 10.9 seconds, post-treatment 9.1 s, and 3 months later 9.6 s). There was however no difference between treatment groups. Similarly there were no significant differences between groups in terms of changes to HAQ, EQ-5D utility score, EQ VAS and pain VAS. \ud \ud Conclusion \ud Patients with RA treated with hydrotherapy are more likely to report feeling much better or very much better than those treated with land exercises immediately on completion of the treatment programme. This perceived benefit was not reflected by differences between groups in 10-metre walk times, functional scores, quality of life measures and pain scores

Patterns of analgesic use, pain and self-efficacy: a cross-sectional study of patients attending a hospital rheumatology clinic

Background: Many people attending rheumatology clinics use analgesics and non-steroidal anti-inflammatories for persistent musculoskeletal pain. Guidelines for pain management recommend regular and pre-emptive use of analgesics to reduce the impact of pain. Clinical experience indicates that analgesics are often not used in this way. Studies exploring use of analgesics in arthritis have historically measured adherence to such medication. Here we examine patterns of analgesic use and their relationships to pain, self-efficacy and demographic factors. Methods: Consecutive patients were approached in a hospital rheumatology out-patient clinic. Pattern of analgesic use was assessed by response to statements such as 'I always take my tablets every day.' Pain and self-efficacy (SE) were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Arthritis Self-Efficacy Scale (ASES). Influence of factors on pain level and regularity of analgesic use were investigated using linear regression. Differences in pain between those agreeing and disagreeing with statements regarding analgesic use were assessed using t-tests. Results: 218 patients (85% of attendees) completed the study. Six (2.8%) patients reported no current pain, 26 (12.3%) slight, 100 (47.4%) moderate, 62 (29.4%) severe and 17 (8.1%) extreme pain. In multiple linear regression self efficacy and regularity of analgesic use were significant (p < 0.01) with lower self efficacy and more regular use of analgesics associated with more pain. Low SE was associated with greater pain: 40 (41.7%) people with low SE reported severe pain versus 22 (18.3%) people with high SE, p < 0.001. Patients in greater pain were significantly more likely to take analgesics regularly; 13 (77%) of those in extreme pain reported always taking their analgesics every day, versus 9 (35%) in slight pain. Many patients, including 46% of those in severe pain, adjusted analgesic use to current pain level. In simple linear regression, pain was the only variable significantly associated with regularity of analgesic use: higher levels of pain corresponded to more regular analgesic use (p = 0.003). Conclusion: Our study confirms that there is a strong inverse relationship between self-efficacy and pain severity. Analgesics are often used irregularly by people with arthritis, including some reporting severe pain

Proximal Sessile Serrated Adenomas Are More Prevalent in Caucasians, and Gastroenterologists Are Better Than Nongastroenterologists at Their Detection

Background and Aim. Proximal sessile serrated adenomas (PSSA) leading to colorectal cancer (CRC) represent an alternate pathway for CRC development. In this study, we aim to determine the prevalence of PSSAs and the impact of patient, colonoscopy, and endoscopist-related factors on PSSA detection. Methods. Patients ≥ 50 years of age undergoing a screening colonoscopy between 2012 and 2014 were included. Detection rates based on patient gender, race, colonoscopy timing, fellow participation, bowel preparation quality, and specialty of the endoscopist were calculated. t-tests were used to compare detection rates and a multivariate-adjusted analysis was performed. Results. 140 PSSAs were detected from 4151 colonoscopies, with a prevalence of 3.4%. Detection rate was higher in Caucasians compared to African-Americans (AA) (3.7 ± 4.1 versus 0.96 ± 3.5; p<0.001). Gastroenterologists detected more PSSAs compared to nongastroenterologists (3.9 ± 3.5 versus 2.2 ± 3.0; p=0.028). These findings were still significant after adjusted multivariate analysis. The rest of the factors did not make significant difference in PSSA detection rate. Conclusions. PSSAs are more prevalent in Caucasians compared to AAs. Racial difference in prevalence of PSSAs is intriguing and warrants further investigation. Gastroenterologists have a significantly higher PSSADR compared to nongastroenterologists. Educational measures should be implemented in nongastroenterologists to improve their PSSA detection rates

Gender differences in beliefs about health:A comparative qualitative study with Ghanaian and Indian migrants living in the United Kingdom

Background There is a well-established association between migration to high income countries and health status, with some groups reporting poorer health outcomes than the host population. However, processes that influence health behaviours and health outcomes across minority ethnic groups are complex and in addition, culture ascribes specific gender roles for men and women, which can further influence perspectives of health. The aim of this study was to undertake a comparative exploration of beliefs of health among male and female Ghanaian and Indian migrants and White British participants residing in an urban area within the UK. Methods Thirty-six participants (12 each Ghanaian, Indian and White British) were recruited through community settings and participated in a semi-structured interview focusing on participant’s daily life in the UK, perceptions of their own health and how they maintained their health. Interviews were analyzed using a Framework approach. Results Three super ordinate themes were identified and labelled (a) beliefs about health; (b) symptom interpretation and (c) self-management and help seeking. Gender differences in beliefs and health behaviour practices were apparent across participants. Conclusions This is the first study to undertake a comparative exploration of health beliefs among people who have migrated to the UK from Ghana and India and to compare with a local (White British) population. The results highlight a need to consider both cultural and gender-based diversity in guiding health behaviours, and such information will be useful in the development of interventions to support health outcomes among migrant populations