A focus group study on primary health care in Johannesburg Health District: “We are just pushing numbers”

Objectives: South Africa is striving towards a strong primary healthcare system. Since 2007, departments of family medicine have been   established in Gauteng to improve quality of care through improved access to doctors, the coordination of health services and better referrals. There have been anecdotal difficulties around clinical quality, the role of the increasing number of doctors and the value of family medicine as a new speciality in Johannesburg since these changes. This study aimed to explore Johannesburg stakeholder views on clinical priorities, the role of doctors and family medicine in primary care.Design: The study design comprised qualitative focus group discussions.Setting and subjects: Groups of nurse clinicians, clinic managers, senior managers, doctors and interns within the Johannesburg Health District.Outcome measures: The content was thematically analysed and a model developed.Results: There were nine focus groups, with 6-13 participants per group. Addressing staff burnout and poor management were viewed as clinical priorities in primary care. Discussing the role of doctors reflected deep conflict between doctors and nurses. Nurses and managers expected doctors to help to “push the queues”. It took some time for further roles, such as helping with referrals, training, research and administration, to emerge. There was initial confusion and tension when participants were asked about family medicine. However, its role was seen as useful.Conclusion: Nurses appeared to suffer from burnout and resented the increasing burden placed on them with regard to primary care in  Johannesburg. There appeared to be confusion with respect to the role of doctors, with doctor-nurse conflict and poor teamwork. This may threaten attempts to re-engineer primary health care in order to increase the  presence of doctors at clinic level. The discipline of family medicine can make a difference, but reorganisation of the system is required

Corrections to updated analyses of the results from the Island Closure Feasibility Study for the Dassen/Robben Island pair given in Appendix A of MARAM/IWS/DEC14/Peng/B12

DAFF have recently advised of detection of errors in the data agreed to be used to provide results from the island closure feasibility study to be presented to the Panel, as listed in document MARAM/IWS/DEC14/Peng/C1. This involves the recruit survey biomass series advised; the errors are corrected in a revised Table provided in MARAM/IWS/DEC14/Peng/C4. These errors affect only the results for method (iv) for Dassen and Robben Islands which were reported in Appendix A of MARAM/IWS/DEC14/Peng/B12. These analyses have consequently been repeated with the corrected data

Normal, Abby Normal, Prefix Normal

A prefix normal word is a binary word with the property that no substring has more 1s than the prefix of the same length. This class of words is important in the context of binary jumbled pattern matching. In this paper we present results about the number $pnw(n)$ of prefix normal words of length $n$, showing that $pnw(n) =\Omega\left(2^{n - c\sqrt{n\ln n}}\right)$ for some $c$ and $pnw(n) = O \left(\frac{2^n (\ln n)^2}{n}\right)$. We introduce efficient algorithms for testing the prefix normal property and a "mechanical algorithm" for computing prefix normal forms. We also include games which can be played with prefix normal words. In these games Alice wishes to stay normal but Bob wants to drive her "abnormal" -- we discuss which parameter settings allow Alice to succeed.Comment: Accepted at FUN '1

Challenges and Solutions for Functional Neurosurgery in Developing Countries.

Functional neurosurgery techniques remain integral to the neurosurgical treatment armamentarium but data on global implementation remains scarce. In comparison to high-income countries (HIC), low- and middle-income countries (LMIC) suffer from an increased prevalence of diseases like epilepsy, which may be amenable to functional techniques, and therefore, LMIC may benefit from an increased utilization of these treatment modalities. However, functional techniques tend to be expensive and thus difficult to implement in the LMIC setting. A review was performed to assess the current status of functional neurosurgical techniques in LMIC as a starting point for future initiatives. For methodology, a review of the current body of literature on functional neurosurgery in LMIC was conducted through the United States National Library of Medicine Pubmed search engine. Search terms included "functional neurosurgery," "developing countries," "low and middle income," and other related terms. It was found that though five billion people lack access to safe surgical care, the burden of disease amenable to treatment with functional neurosurgical procedures remains unknown. Increasingly, reports of successful, long-term, international neurosurgical collaborations are being reported, but reports in the sub-field of functional neurosurgery are lacking. In conclusion, awareness of global surgical disparities has increased dramatically while global guidelines for functional techniques are currently lacking. A concerted effort can harness these techniques for wider practice. Partnerships between centers in LMIC and HIC are making progress to better understand the burden of disease in LMIC and to create context-specific solutions for practice in the LMIC setting, but more collaborations are warranted

Systems, methods and computer program products for prediction of defect-related failures in integrated circuits

Systems, methods and computer program products for predicting defect-related failures in integrated circuits produced by an integrated circuit fabrication process identify objects in a circuit layout for the integrated circuit design, each object having a location in the circuit layout and a reliability connectivity in the integrated circuit design. Sample object defects are generated for the identified objects, each sample object defect representing a defect produced in an object by the integrated circuit fabrication process and having a defect magnitude associated therewith. An accelerated life defect influence model is identified for each sample object defect, relating the lifetime of an object to the defect magnitude of a defect in the object. Sample object lifetimes are generated from the defect magnitudes associated with the sample object defects according to the corresponding identified accelerated life defect influence models. A prediction of the reliability of integrated circuits is generated from the sample object lifetimes according to the reliability connectivity of the associated objects in the integrated circuit design. Preferably, the accelerated life defect influence models include log-linear regression models, which may include deterministic object lifetime functions, each relating the defect magnitude of the at least one sample object defect to one object lifetime value, and log-linear object lifetime distributions, each relating the defect magnitude of a sample object defect to a plurality of object lifetime values

Lactic acidosis, risk factors and predictive laboratory markers: a nested case control study in South Africa

Background: The incidence of antiretroviral therapy (ART)-induced lactic acidosis and its associated mortality may be reduced by appropriate  dosing, risk stratification and early detection.Objectives: To describe the epidemiology of lactic acidosis, define the risk factors and identify predictive laboratory markers in the context of the roll-out of ART in South Africa.Design: A nested case control study. Risk factor analysis was adjusted for the established risk factors of weight and gender.Setting and subjects: Persons commenced on stavudine-containing  therapy between 2004 and 2007 at Port Shepstone Hospital in  KwaZulu-Natal were included. Persons with a body weight above 60 kg received Stavudine 40 mg twice daily, and those with a body weight below 60 kg, 30 mg twice daily.Outcome measures: Assessed risk factors included weight, gender, age, alanine transaminase (ALT), urea, creatinine, albumin, cholesterol, triglyceride (TG) levels, CD4 counts and viral loads.Results: Lactic acidosis occurred in 79 (17 per 1 000 person-years) of 1 762 people living with HIV on ART. Significant factors were being female [adjusted odds ratio (AOR) of 5.4] and increased body weight (adjusted OR of 1.1 per kg). The risk of lactic acidosis increased 6.6, 6.9 and 95 times (adjusted ORs) as weight increased from a baseline weight of < 60 kg to 60-69 kg, 70-79 kg or > 80 kg, respectively. Six months into therapy, predictors of developing lactic acidosis were an ALT > 50 IU/l (adjusted OR of 11.1) and a higher TG (adjusted OR of 8.8 per mmol/l). No associations were found with regard to age, CD4 count, viral load, and creatinine or albumin levels.Conclusion: Obese females are at greatest risk of lactic acidosis, with an exponential increase in risk above 80 kg. The 30-mg dose may be preferable, given that a sharp increase in risk occurred at 60 kg, was most likely dose related, and that 30 mg has been shown to provide adequate virological suppression. Additional risk factors for lactic acidosis include a high ALT and TG levels at treatment

Do catch-based indices provide a reliable index of annual recruitment for the South African anchovy population

The ability of catch-based measures (both catch itself and measures of catch-rate/CPUE such as catch-per-set) to provide reliable indices of abundance of the annual anchovy recruitment on the South African west coast is investigated. Ground truthing is provided by the annual acoustic surveys of this abundance and corresponding estimates provided when this information is utilised in population assessments. The measures considered for the fishery as a whole reflect at most a 30% increase across the turn of the century, way below the some three-fold increase from before to after that time indicated by the surveys and assessment. The same is true for similar measures from catches made close to Robben or to Dassen Island, except when catches within 10 nm of these islands are considered, though surprisingly then this result of a similar increase to the survey results does not extend to catches within 20 nm. Nevertheless the CVs about the catch within 10 nm – recruitment relationships are some 70%, which is hopelessly too large for such measures to provide meaningful and reliable predictions of anchovy recruitment. Thus this study has failed to reveal any evidence to support the suggestion that anchovy catch- related measures might provide meaningful indices of anchovy recruitment abundance

Important causes of chronic kidney disease in South Africa

In hypertensive patients without chronic kidney disease (CKD) the goal is to keep blood pressure (BP) at ≤140/90 mmHg. When CKD is present, especially where there is proteinuria of ≥0.5 g/day, the goal is a BP of ≤130/80 mmHg. Lifestyle measures are mandatory, especially limitation of salt intake, ingestion of adequate quantities of potassium, and weight control. Patients with stages 4 - 5 CKD must be carefully monitored for hyperkalaemia and deteriorating kidney function if angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) are used, especially in patients >60 years of age with diabetes or atherosclerosis. BP should be regularly monitored and, where possible, home BP-measuring devices are recommended for optimal control.Guidelines on the use of antidiabetic agents in CKD are presented, with the warning that metformin is contraindicated in patients with stages 4 - 5 CKD.There is a wide clinical spectrum of renal disease in the course of HIV infection, including acute kidney injury, electrolyte and acid-base disturbances, HIV-associated glomerular disease, acute-on-chronic renal disease and side-effects related to the treatment of HIV

Haemorrhaging lesion in the breast: is there a role for embolisation?

Angiosarcoma of the breast is an extremely rare condition. This case illustrates the use of embolisation as a modality of treatment for primary breast angiosarcoma. No other case has been reported on the use of embolisation for this disorder

The prevalence of burnout among registrars in the School of Clinical Medicine at the University of the Witwatersrand, Johannesburg, South Africa

Background. Burnout is a response to prolonged stress and consists of three elements: emotional exhaustion (EE), depersonalisation (DP), and feelings of personal accomplishment (PA). The existence of burnout in doctors is often not acknowledged but has major consequences for personal and professional life. Only limited research has been done on the prevalence of burnout among registrars in South Africa (SA).Objectives. To describe the prevalence of burnout in a cohort of SA registrars, and assess relationships between burnout and sociodemographic factors.Methods. A cross-sectional descriptive internet survey was conducted. Respondents were registrars in departments of the School of Clinical Medicine at the University of the Witwatersrand, Johannesburg, SA. The Maslach Burnout Inventory (MBI) was used to measure burnout. Relationships were assessed by the independent-samples t-test and analysis of variance.Results. A total of 585 emails were delivered to registrars, of whom 201 started the survey (response rate 34%); 170 questionnaires were analysed. The mean age of the respondents was 33 years, and the male/female ratio was 1:1.8. The mean (standard deviation) score for EE was 3.5 (1.2), for DP 2.7 (1.1) and for PA 4.1 (1.1). The overall level of burnout was 84%. None of the respondents scored low over all categories. No significant association between sociodemographics (age, sex, discipline, year in the programme and experience) and MBI dimensions was found.Conclusions. The prevalence of burnout in this study was higher than that reported in the national and international literature. Levels of DP were extremely high and are worrying, as DP affects professionalism and engagement of doctors. In keeping with the literature, no associations were found between sociodemographic factors and burnout, suggesting that the cause of burnout should be sought in the work environment. Efforts to improve autonomy in the workplace, development opportunities and promoting peer collaboration are needed to prevent burnout