Institutional barriers to an intermodal integrated public transport system in the City of Cape Town

Across the world, public transport is acknowledged as a crucial feature of any major city. In many countries, an efficient public transport system has been achieved by establishing an intermodal integrated transport system. In other words, integrating public transport modes for better coordination and efficiency. However, public transport in the City of Cape Town is inefficient and lacks coordination. Thus, the City of Cape Town experiences high volumes of congestion as a result of increased private car use. Over the years, the City has produced many plans and policies in line with the national and provincial legislation to create an intermodal integrated transport system. However, this transport system has yet to materialise. Therefore, this study aims to investigate the institutional barriers that impact the extent to which an urban public transport system can be integrated. The aim was achieved through collecting data from several interviews with public and private professionals involved with transport in the City of Cape Town. The interview data was analysed in relation to literature and policy documents. The results of this study show that fragmentation of the ownership of public transport modes is one of the most significant and overarching barriers to integration. Solving this fragmenting has proved difficult due to continuous institutional restructuring at local and national government levels, which results in the draining way of leadership and capacity. Another significant barrier to integration is the unique difficulties of integrating the paratransit (minibus taxi) sector as it is fragmented, operates at an enormous scale, experiences resistance to integration and is characterised by instability as a result of violence. Political tensions between opposing political parties at different levels of government and within the City of Cape Town also acted as barriers since they resulted in instability and a lack of coordination. Funding constraints for various aspects of integration are also a barrier. Finally, one of the most profound barriers was that although there are plenty of policies for integration throughout the three spheres of government, the findings suggest a lack of common vision and political will behind policies hinders implementation. This is coupled with siloed planning and old mindsets. Some also argue that many overarching policy visions for integration may be entirely incorrect in the first place

Adverse effects profile of multidrug-resistant tuberculosis treatment in a South African outpatient clinic

Background: Highly active antiretroviral therapy (HAART) and drugs that are used to treat multidrug-resistant tuberculosis have potentially overlapping adverse effects. Few South African studies have documented adverse effects in the multidrugresistant tuberculosis population. This study examined the adverse effects profile in a sample of the outpatient population at the King George V Hospital Multidrug-Resistant Tuberculosis Clinic in Durban, KwaZulu-Natal.Method: The method was an anonymous, retrospective record review of 350 patients with multidrug-resistant tuberculosis, who were attending the King George V Hospital Multidrug-Resistant Tuberculosis Clinic (2010-2011). Adverse effect profiles in patients with multidrug-resistant tuberculosis only, and those who were co-infected with the human immunodeficiency virus (HIV) who were on and not on HAART, were documented and analysed.Results: Adverse events were recorded for 80.6% of patients. These included hearing loss (28.7%); peripheral neuropathy (23.2%); diarrhoea, nausea and vomiting (20.5%); arthralgia (15.9%); rashes and dermatological effects (excluding Stevens-Johnson syndrome) (14%); abdominal pain and dyspepsia (10.3%); and psychoses and confusion (8.3%). In this study population, 72.6% of patients were HIV positive, and 85% were concomitantly on HAART and multidrug-resistant tuberculosis treatment. Adverse events were significantly more common in patients who were HIV positive than in patients who were HIV negative with regard to peripheral neuropathy (p-value < 0.001), psychosis and confusion (p-value = 0.04), hearing loss (p-value = 0.047), and thyroid disease (p-value < 0.001). The use of HAART in patients who were HIV positive and on multidrug-resistant tuberculosis treatment was not significantly associated with the overall incidence of adverse events (p-value = 0.432). However, the calculated likelihood ratios of several individual adverse events occurring in these patients was greater. Patients who were HIV negative experienced the least adverse events.Conclusion: The high percentage of patients in the sample population (45%) who was found to be multidrug-resistant tuberculosis positive de novo or while on standard tuberculosis treatment suggests that drug sensitivity testing for all patients with tuberculosis should be considered. The findings of  this study support the current national policy that all patients with tuberculosis should be tested for HIV, and that all patients who are HIV positive and with multidrug-resistant tuberculosis should be on HAART. Clinicians should be supported in their function of examining, managing and recording adverse events. Reporting adverse events to the Department of Health should be encouraged. The development of a standardised recording instrument may mitigate the under-reporting of adverse events. The adverse effects profile in this study population differs from that reported in other studies

Post-laparotomy haemoptysis due to broncho-abdominal fistula caused by retained abdominal surgical swab

The case presented describes the migration of a surgical swab across the left hemidiaphragm over four years. The patient had at least two episodes of haemoptysis in that period and was misdiagnosed and treated for Pulmonary Tuberculosis. When the proper diagnosis was made and a lobectomy was planned for removal of the swab, the act of anaesthesia revealed a major bronchoabdominal fistula that was resolved by simply isolating that lung with an endobronchial tube. According to our search, such a left-sided broncho-abdominal fistula has, to date, not been described in the literature.Keywords: broncho-abdominal fistula, gossypibom

A Comparison of Two Disability Coding Systems for Hearing-Impaired Rehabilitation Clients

Non

The complex relationship between pediatric cardiac surgical case volumes and mortality rates in a national clinical database

ObjectiveWe sought to determine the association between pediatric cardiac surgical volume and mortality using sophisticated case-mix adjustment and a national clinical database.MethodsPatients 18 years of age or less who had a cardiac operation between 2002 and 2006 were identified in the Society of Thoracic Surgeons Congenital Heart Surgery Database (32,413 patients from 48 programs). Programs were grouped by yearly pediatric cardiac surgical volume (small, <150; medium, 150–249; large, 250–349; and very large, ≥350 cases per year). Logistic regression was used to adjust mortality rates for volume, surgical case mix (Aristotle Basic Complexity and Risk Adjustment for Congenital Heart Surgery, Version 1 categories), patient risk factors, and year of operation.ResultsWith adjustment for patient-level risk factors and surgical case mix, there was an inverse relationship between overall surgical volume as a continuous variable and mortality (P = .002). When the data were displayed graphically, there appeared to be an inflection point between 200 and 300 cases per year. When volume was analyzed as a categorical variable, the relationship was most apparent for difficult operations (Aristotle technical difficulty component score, >3.0), for which mortality decreased from 14.8% (60/406) at small programs to 8.4% (157/1858) at very large programs (P = .02). The same was true for the subgroup of patients who underwent Norwood procedures (36.5% [23/63] vs 16.9% [81/479], P < .0001). After risk adjustment, all groups performed similarly for low-difficulty operations. Conversely, for difficult procedures, small programs performed significantly worse. For Norwood procedures, very large programs outperformed all other groups.ConclusionThere was an inverse association between pediatric cardiac surgical volume and mortality that became increasingly important as case complexity increased. Although volume was not associated with mortality for low-complexity cases, lower-volume programs underperformed larger programs as case complexity increased

A Phenomenological Study of International Students in US Graduate Programs Through the Lens of Personal Growth Initiative Construct

Humans, unlike other creatures, have an inherent desire to develop and grow. This desire to grow, Personal Growth Initiative, is an intentional way that humans cognitively and behaviorally navigate their environment and resources to effect change. While many researchers argue that this construct works only in individualistic cultures, others contend that the construct is applicable to collectivist cultures as well. We therefore undertook an exploration of the lived experiences of eight international students from predominantly collectivist cultures, through the lens of the Personal Growth Initiative theory. Using a phenomenological qualitative methodology, we interviewed these doctoral students via semi-structured interview questions. Results of the data indicated that participants cycled through the four factors in the construct to handle both successes and challenges in school. Recommendations for international students’ offices and recruitment agencies are provided