Understanding leadership development within new medical schools in Africa

The transient and multifaceted nature of leadership in Health Professions Education has changed over time. Programme directors associated with medicine, pharmacy, nursing, allied health and those involved in a clinical setting typically serve as managers and leaders concurrently. Furthermore, managers in modern organisations are expected to fulfil leadership roles. Leader and leadership development are inter-reliant phenomena. Moreover, the growth of leaders, the mutual development within a group and the consequent development of an organisation in the context of health professions education HPE require framing. This is especially true when leaders are faced with an array of constraints in low- and middle-income countries. In order to appreciate leader development, we need to ask “what qualities do we need to develop in our leaders?” and for leadership development “what qualities do we need to develop in our organisation?”. Thus, within the context of the current study we essentially ask: “What qualities have developed in our leaders, organisation and the consortium?” The current study sought to understand leadership development of appointed and emergent leaders in new medical schools in Africa. A mixed-methods approach was employed and the data collection instruments included: a Likert scale survey, a multiple case study approach and a qualitative document analysis (QDA). A total of 29 surveys (64.5% response rate) were returned and 10 successful interviews were conducted after ethical approval and obtaining consent. Many of the participants fulfilled multiple roles as lecturer (linked to the basic medical sciences), departmental head and/or a clinical teaching position in the hospital. Their academic positions and seniority as leaders included deans, a deputy dean, a programme director, heads of departments (HODs), medical educationalists and lecturers. Any additional biographical information was excluded in the study in order to ensure anonymity of the participants. Finally, the QDA relied on a four-step Scott method and considered a total of 58 documents that ranged from meeting agendas and reports, scholarly works, book chapters, newsletters, external reports, conference proceedings, and the CONSAMS (Consortium of New Sub-Sahara African Medical Schools) constitution. Findings from the current study led to the development of a framework to navigate the complex nature of leadership development in new medical schools in Africa. The three-tier framework views leadership development of the individual, the institution and within the context of collaboration such as a consortium. Leadership development at an individual level is dependent on the interplay between an institutional climate, contextual forces and resultant responses of leaders. Five archetypes of leadership development were identified at an individual level: the leader in front, the strategist, the silenced leader, becoming a leader and the leader as manager. The archetypes are the result of biographical, programmatic, institutional and contextual forces. The leader subsequently interprets these forces in order to negotiate their roles, position and course of action. Leadership development at an institutional level occurs within a hierarchical system and can sometimes occur in isolation. Development is often hampered by day-to-day activities that are reactive in nature in a bid to negotiate the various forces. The formation of teams and coalitions are hampered by climate factors such as ineffective engagement of colleagues, poor bilateral communication, perceived misalignment of the values and unsuccessful collaboration. The formation of networks and alliances, as in the case of CONSAMS, drives the leadership development at a collaborative level. Within this context, leadership development is largely dependent on effective communication and feedback. Within a consortium, each participant contributes from the position of their dominant archetype, but are also temporarily freed from institutional constraints to think more strategically. The consortium generates a unique climate where the heterogeneity of leaders through their archetypes can be challenged, tested and strengthened. Interaction within the consortium permits freedom, more so than within the domain of an institution

Engineering of a Collagen-glycosaminoglycan copolymer dermal regeneration matrix

Background: Tissue engineering and its contribution to regenerative medicine has advanced through the years. It has proven its efficacy especially in the treatment of advanced full thickness burn wounds. Tissue engineering is the synergy between biology and engineering. This fairly young science has one common goal and that is to regenerate new tissue. Various commercially available products have appeared on the market and this due to the ground-breaking work of many. One such well known product is Integra® which is the brain child of Yannas and Burke. This is a collagen-glycosaminoglycan copolymer which serves as a bioactive regeneration template or extracellular matrix analogue. Advanced wound healing is promoted along with the prevention of scar tissue formation and consequent contractures. Aims:</p This study provides an extensive review on the development of this dermal regeneration matrix and also aims to develop an equivalent product. Attention will be paid to: the biological building blocks and the motivation for their use; the essential production steps; and the final processing required in order to deliver a sterile product. Materials and Methods: A collagen and chondroitin 6-sulphate coprecipitate was prepared and subjected to either controlled or uncontrolled freezing. The frozen slurry was dried under vacuum for 17 hours after which each sample was coated with a thin silicone film. Glutaraldehyde crosslinking followed after which the product was thoroughly rinsed. The packaged products were then subjected to terminal sterilisation via gamma irradiation under various conditions. Various tests were conducted to evaluate the newly formed regeneration matrices and included scanning electron microscopy, enzymatic degradation by collagenase, and a cytotoxicity assay. Scanning electron microscopic analysis was done in order to reveal the adequacy of the scaffold architecture. Collagenase degradation of the scaffolds was used to project the rate of degradation of each template. Integra® served as the gold standard for each test. Quantifiable data was statistically analysed and any comparison made included the calculation of means, standard deviations and p-values (confidence interval of 95%). Results: Results indicated that highly porous bioactive tissue engineering matrices were obtained by either controlled freezing or uncontrolled freezing. The average pore diameter of the most homogenous scaffolds ranged between 52.47 and 136.44 µm with a mean of 87.34 µm. These templates were formed by using a 0.5% collagen concentration and a controlled freeze rate of 0.92 °C/min. Uncontrolled freezing (1.3 °C/min) of a 0.5% collagen concentration resulted in the formation of an irregular scaffold with an average pore diameter of 174.08 µm. It was found that the architecture of the most equivalent scaffold compared well with that of Integra® with p = 0.424. Scaffolds prepared using higher collagen concentrations (1.0%) and controlled freezing resulted in dense sponges with average pore diameters of 56.51 µm. Statistical analysis upon comparison indicated a significant difference p = 0.000 in the micro architecture. The rate of degradation of the most equivalent scaffold was 1.9 times that of Integra®. This implicates that the crosslinking was insufficient and due to one of the following: poor collagen quality; method of crosslinking; and degradation due to terminal sterilization. The rate of scaffold degradation can be extended, either by additional crosslinking or the prevention of degradation induced by irradiation. Temperature vacuum dehydration crosslinking through esterification or amide formation can be used as an initial crosslinking method in further studies. This form of crosslinking will complete the conventional glutaraldehyde crosslinking that reacts with the free amine groups of lysine or hydroxylysine of the protein backbone of collagen. It should be stressed that the determination of an in vivo degradation rate, in the form of an animal study, will aid to confirm the efficacy of the biologically active regeneration matrix.Dissertation (MSc)--University of Pretoria, 2008.Anatomyunrestricte

Microbes, molecular mimicry and molecules of mood and motivation

The hypothesis proposed is that functional disorders, such as irritable bowel syndrome, chronic fatigue syndrome and anorexia nervosa are caused by auto-antibodies to neuronal proteins induced by molecular mimicry with microbial antigens. The age incidence of these conditions, the marked female excess, increase with economic and technological advance, precipitation by infection, and the paucity of histological changes are all consistent with the hypothesis. It can be tested directly using human sera to search for cross reaction with brain proteins in model systems such as Drosophila melanogaster. The conditions might be amenable to treatment using pooled immunoglobulin. Identification and elimination from the microbial flora of the bacteria that express the cross reacting antigens should be possible

The use of reflective practice to promote pharmacy students’ metacognition in a foundation anatomy course

Students’ ability to characterise their learning approaches has the potential to enhance their overall educational experience and guide educators to tailor their pedagogical approaches. The aim here, through students’ reflective practice, is to promote their metacognition. Also, to gain insights to pharmacy students’ initial approaches to studying anatomy and their perceived value of anatomy as a subject. The study also aimed to contextually capture students’ perceptions on their transition from secondary to tertiary education. This cross-sectional study entailed the use of reflective practice to promote metacognition in first year pharmacy students (Bachelors of Pharmacy students (n = 67)), at the University of Namibia’s School of Pharmacy. Results of this study indicate the initial learning approaches of most students to be haphazard. Students used varied, non-departmental resources to guide their learning whilst a few followed structured learning approaches. Results further indicate that students’ gradual transition and evolving metacognition appear to start during the initial few months of tertiary education. This transition appears to include feelings of apprehension, uncertainty and distress. Reflective practice creates awareness amongst students of possible gaps in their learning approaches and promote the value of anatomy as an  undergraduate subject. Data suggests that the formal incorporation of reflective practice as a metacognitive learning activity promotes students’metacognition by elucidating possible gaps in their learning approaches.Keywords: Learning approaches, anatomy, pharmacy students, reflective practice, metacognitio

Reappraisal of the anatomy of the accessory internal thoracic artery

The accessory internal thoracic artery (AITA) is a variably large branch of the initial portion of the internal thoracic artery (ITA). The AITA has been neglected as an important anatomical structure and has been identified as the culprit for the “steal-syndrome” of coronary blood flow after the use of the ITA in coronary artery revascularisation. A cadaveric study of 50 cadavers was performed to investigate the occurrence of the AITA. We found 10 (20%) out of the 50 cadavers examined, presented with AITAs either bilaterally (4%) or unilaterally (16%). Five of the eight unilateral specimens showed a left-sided appearance of the AITA. Fourteen percent of the AITAs were found in cadavers of Mixed-race (Coloured) and 6% in individuals of African descent. Knowledge of the AITA is essential for any thoracic surgeon, during the preparation of the ITA for coronary revascularisation. Data from this study supports the notion that the AITA is a highly variable structure with little correlates based on ethnicity. The AITA appear to be found more often on the left in unilateral specimens.Key Words: Accessory, Internal Thoracic arter

Anatomical aspects of Mycobacterium tuberculosis–associated destructive cranial lesions

The authors report two cases of destructive cranial lesions associated with Mycobacterium tuberculosis–HIV coinfection in a male and female cadaver. Both cadavers were of African origin, from the Western Cape, South Africa. The authors present grossly abnormal tuberculosis–associated lesions of the anterior and middle cranial fossae, involving the ethmoid and sphenoid bones. Both individuals presented with tubercular intrasellar masses and obliteration of the paranasal sinuses. Current literature on cases such as these are extremely rare and others typically focus on lesions of the calvarium. Here we report on the gross anatomical findings as well as the relevant anatomical aspects of the probable aetiology. Both cases presented here hold interest for medical professionals in Africa and other geographic regions. It further illustrates the importance of understanding the venous drainage of the paranasal sinuses when considering the manifestation and treatment of extrapulmonary TB

A rare combined variation of the coeliac trunk, renal and testicular vasculature

The authors report a rare variation of the coeliac trunk, renal and testicular vasculature in a 27-year old male cadaver. In the present case, the coeliac trunk and superior mesenteric artery was replaced by a modified coeliacomesenteric trunk formed by hepato-gastric and superior mesenteric arteries. Here the hepato-gastric artery or trunk contributed towards the total hepatic inflow as well as a gastro-duodenal artery. A separate right gastric artery and an additional superior pancreaticoduodenal artery was also found in addition with a retro-aortic left renal vein and a bilateral double renal arterial supply. The aforementioned coeliac trunk variation, to our knowledge, has never been reported before and this variation combined with the renal vasculature requires careful surgical consideration

Health Care, Hospitals and Racial Hygiene in German Colonial Windhoek (1890-1915)

The gradual progress of health care within Namibia (formerly known as German South-West Africa), coincided with the three major historic periods: colonial settlement, the Herero-Nama genocide (1904-1907), and the transition of administration of the colony after the First World War. Here the authors draw upon primary and secondary sources to provide insights on the development of hospitals, health care and racial hygiene in in the colony with specific reference to Windhoek. The aim here is to contribute towards the lacking historiography of the medical landscape of Windhoek. Health care during the period of German colonial rule was centralised and segregated, and this trend prevailed when South Africa undertook administration of the colony. The initial strategy under German rule was to increase the formal treatment facilities within Swakopmund and Windhoek during the 1890s. The early growth of health care and hospitals was chiefly aimed at the needs of the white Europeans and driven by principles of racial hygiene

Thoracolumbar transitional vertebrae : quantitative differentiation and associated numeric variation in the vertebral column using skeletal remains

DATA AVAILABILITY : Data is available on the University of Pretoria public database.Transitional vertebrae at the thoracolumbar region are called thoracolumbar transitional vertebrae (TLTV) and retain physical features from the thoracic and lumbar regions. Since TLTV were first classified 40 years ago, there has been much discrepancy regarding its features, identification and clinical relevance. Vertebral body levels are used in the medical field as a frame of reference to locate specific organs, vessels, nerves or landmarks. Any numeric variation or deviation in the vertebral column may lead to clinical errors. Previous findings have suggested a high association between numeric variation and the presence of TLTV. Therefore, the aim of this study was to identify the types of TLTV observed and to identify any possible associated numeric variation in the vertebral column. This study also aimed to validate the established technique to quantitatively differentiate TLTV from T12 and L1 at the thoracolumbar junction using skeletal remains from a South African population group. Skeletal remains (n= 187) remains from the Pretoria bone collection were assessed. Measurements were taken of the angle of the superior zygapophyseal processes of the last thoracic vertebra (T12), the first lumbar (L1), and identified TLTV. The results indicate a TLTV prevalence of 35% (n= 66/187). The results show that each vertebral type (T12, L1, TLTV) fall into independent confidence intervals: T12 is 188° ± 9.22 (CI: 187° <μ< 189.6°), 110° ± 7.52 (CI: 109.2° <μ< 111.3°) in L1, and 135° ± 24.51 (CI: 130.4° <μ< 139.1°) in the TLTV. This study observed that 70% of cases with TLTV was associated with numeric variation in the spine, both homeotic and meristic and that TLTV has a 35% prevalence. The results clearly show that quantitative morphometric analysis can effectively differentiate TLTV from other vertebral types at the thoracolumbar junction in skeletal remains.http://www.wileyonlinelibrary.com/journal/joaAnatom