Cochlear implantation in South Africa (part 2)

Cochlear implantation is a timeous and cost-effective solution for severe-to-profound sensorineural hearing loss (SNHL) and has transformed the lives of many individuals with significant hearing loss. The advent of cochlear implantation has meant that, for the first time, one of the senses (hearing), having been entirely lost, can be restored. The previous article in this series sketched the problem of severe-toprofound SNHL, and how cochlear implantation can overcome this, how a cochlear implant (CI) works, the history of cochlear implantation and the principles of the multidisciplinary CI team. The current status of cochlear implantation in South Africa (SA) is the subject of discussion in this article, the second of this two-part series on cochlear implantation. It comprises a study of the best available current data on the status of CI in SA

Analysis of time to regulatory and ethical approval of SATVI TB vaccine trials in South Africa

Background. Tuberculosis (TB) vaccine trials in South Africa must be approved by the Medicines Control Council (MCC) and by a human research ethics committee (HREC). Delays in regulatory and ethical approval may affect operational and budget planning and clinical development of the product. Aim. Our aim was to analyse the time to regulatory and ethical approval for TB vaccine trials conducted by the South African Tuberculosis Vaccine Initiative (SATVI) and to evaluate factors that influence time to final approval. Method. Sixteen new TB vaccine clinical trials conducted by SATVI between 2004 and 2012 on infants, children, and adults were included. The period between submission and final approval was determined for protocols submitted to the MCC and the University of Cape Town HREC. Results. Median approval time following first submission to the MCC was 122 days (IQR 112 - 168; range 71 - 350), and for protocol amendments 103 days (interquartile range (IQR) 76 - 141; range 23 - 191; n=30). Median time following first submission for HREC approval was 60 days (IQR 33 - 81; range 18 - 125), and for amendments 6 days (IQR 4 - 13; range 1 - 37; n=30). There was no significant difference in approval time by trial phase, year of submission, revisions required, study population, sample size, or whether a clinical research organisation (CRO) was used. Conclusion. The time needed for regulatory and ethics approval was highly variable, but MCC approval for first submissions took twice as long as HREC approval and was the primary determinant of time to final approval. National regulatory capacity should be strengthened to facilitate the conduct of new TB vaccine trials in this country with its high burden of TB

A comparison of private and public sector intensive care unit infrastructure in South Africa

Background. Intensive care units (ICUs) are designed to care for patients who are often at increased risk of acquiring healthcare-associated infections. The structure of ICUs should be optimally designed to facilitate the care of these critically ill patients, and minimise their risk of infection. National regulations (R158) were developed to govern the building and registration of private hospitals, and until recently equivalent regulations were not available for public hospitals.Objective. To assess and compare the compliance of ICUs in the private and public sectors with the R158 regulations.Methods. A cross-sectional study design was used to assess the infrastructure of 25 private sector and 6 public sector ICUs in eThekwini Health District, KwaZulu-Natal Province, South Africa. We used the R158 checklist, which was developed by the KwaZulu-Natal Department of Health Private Licensing Unit and Infection Prevention and Control Unit. The aspects covered in the R158 checklist were categorised into the design, general safety and patient services of the ICUs.Results. Most of the ICUs in both sectors met the general safety requirements. There were varying levels of compliance with the design criteria. Only 7 (28.0%) and 1 (16.7%) of the private and public ICUs, respectively, had sufficient space around the beds. Twenty-two private ICUs (88.0%) and 4 public ICUs (66.7%) had isolation rooms, but only some of these isolation rooms (15 private and 2 public) had appropriate mechanical ventilation. None of the ICUs had clinical hand-wash basins in the nurse stations and dirty utility rooms. The majority of the ICUs had the required number of oxygen and electric outlets at the bedside. None of the public ICUs met the light intensity requirement over the bed area.Conclusions. Adequate spacing in ICUs is an issue in many cases. Interventions need to be put in place to ensure that ICUs meet the relevant design standards. There is an urgent need to revise the R158 regulations to reflect current best practices, particularly with regard to infection control. The same standards should be applied to ICUs in the private and public health sectors to maintain quality of care to patients.

A unification in the theory of linearization of second order nonlinear ordinary differential equations

In this letter, we introduce a new generalized linearizing transformation (GLT) for second order nonlinear ordinary differential equations (SNODEs). The well known invertible point (IPT) and non-point transformations (NPT) can be derived as sub-cases of the GLT. A wider class of nonlinear ODEs that cannot be linearized through NPT and IPT can be linearized by this GLT. We also illustrate how to construct GLTs and to identify the form of the linearizable equations and propose a procedure to derive the general solution from this GLT for the SNODEs. We demonstrate the theory with two examples which are of contemporary interest.Comment: 8 page

Risky behaviour and psychosocial correlates in adolescents - is there a link with tuberculosis?

Reasons for the increase in incidence of Tuberculosis (TB) in late adolescence are poorly understood. One hypothesis is that psychological and behavioural variables associated with adolescence may increase risk of developing TB. The study aimed to determine whether psychosocial and behavioural variables affect incidence of TB disease in adolescents. Methods: A case control study design was used in adolescents who were participants in a TB epidemiological study. Cases were adolescents diagnosed with TB disease. Approximately half of the controls had no TB disease but a positive TST indicative of latent TB. Half had neither TB disease nor latent TB. A self-administered questionnaire was completed by participants. The questionnaire consisted of a combination of standardised psychosocial instruments. Results: Of 292 participants, 62 were cases, 112 had latent TB and 118 neither TB disease nor latent TB. There were no significant differences in instrument scores between cases and controls. There was a trend for certain adverse life events to be more common in the TB-disease group. Conclusion: In adolescents, a trend for association between TB incidence and psychosocial and behavioural variables was not statistically significant. Given the trend, research with larger samples, and more comprehensive assessment of the relationship between stressors and TB, is warranted

Symmetry, singularities and integrability in complex dynamics III: approximate symmetries and invariants

The different natures of approximate symmetries and their corresponding first integrals/invariants are delineated in the contexts of both Lie symmetries of ordinary differential equations and Noether symmetries of the Action Integral. Particular note is taken of the effect of taking higher orders of the perturbation parameter. Approximate symmetries of approximate first integrals/invariants and the problems of calculating them using the Lie method are considered

Wear in metal-on-metal total disc arthroplasty

The wear of a model metal-on-metal ball-and-socket total disc arthroplasty was measured in a simulator. The ball had a radius of 10 mm, and there was a radial clearance between ball and socket of 0.015 mm. The model was subjected to simultaneous flexion–extension, lateral bending, axial rotation (frequency: 1 Hz) and compression (frequency: 2 Hz, maximum load: 2 kN). Throughout the tests, the models were immersed in calf serum diluted to a concentration of 15 g protein per litre, at a controlled temperature of 37 °C. Tests were performed on three models. At regular intervals (0, 0.5, 1, 2, 3, 4 and 5 million cycles), mass and surface roughness were determined; mass measurements were converted into the volume lost as a result of wear. All measurements were repeated six times. Wear occurred in two stages. In the first stage (duration about 1 million cycles), there was a linear wear rate of 2.01 ± 0.04 mm3 per million cycles; in the second stage, there was a linear wear rate of 0.76 ± 0.02 mm3 per million cycles. Surface roughness increased linearly in the first million cycles and then continued to increase linearly but more slowly. </jats:p

Analysis of time to regulatory and ethical approval of SATVI TB vaccine trials in South Africa

Background. Tuberculosis (TB) vaccine trials in South Africa must be approved by the Medicines Control Council (MCC) and by a human research ethics committee (HREC). Delays in regulatory and ethical approval may affect operational and budget planning and clinical development of the product. Aim. Our aim was to analyse the time to regulatory and ethical approval for TB vaccine trials conducted by the South African Tuberculosis Vaccine Initiative (SATVI) and to evaluate factors that influence time to final approval. Method. Sixteen new TB vaccine clinical trials conducted by SATVI between 2004 and 2012 on infants, children, and adults were included. The period between submission and final approval was determined for protocols submitted to the MCC and the University of Cape Town HREC. Results. Median approval time following first submission to the MCC was 122 days (IQR 112 - 168; range 71 - 350), and for protocol amendments 103 days (interquartile range (IQR) 76 - 141; range 23 - 191; n=30). Median time following first submission for HREC approval was 60 days (IQR 33 - 81; range 18 - 125), and for amendments 6 days (IQR 4 - 13; range 1 - 37; n=30). There was no significant difference in approval time by trial phase, year of submission, revisions required, study population, sample size, or whether a clinical research organisation (CRO) was used. Conclusion. The time needed for regulatory and ethics approval was highly variable, but MCC approval for first submissions took twice as long as HREC approval and was the primary determinant of time to final approval. National regulatory capacity should be strengthened to facilitate the conduct of new TB vaccine trials in this country with its high burden of TB

Realizations of Real Low-Dimensional Lie Algebras

Using a new powerful technique based on the notion of megaideal, we construct a complete set of inequivalent realizations of real Lie algebras of dimension no greater than four in vector fields on a space of an arbitrary (finite) number of variables. Our classification amends and essentially generalizes earlier works on the subject. Known results on classification of low-dimensional real Lie algebras, their automorphisms, differentiations, ideals, subalgebras and realizations are reviewed.Comment: LaTeX2e, 39 pages. Essentially exetended version. Misprints in Appendix are correcte

COVID-19 and its effects on the food production industry of South Africa

No abstract availablehttp://www.occhealth.co.zapm2021Medical MicrobiologyParaclinical Science