An outbreak of New Delhi metallo-β-lactamase-1 (NDM-1) producing Enterobacteriaceae in a South African hospital: a case-control study

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, South Africa in partial fulfilment of the requirements for the Masters in Medicine in the branch of Public Health Medicine Johannesburg, 6 November 2014Objective: New Delhi metallo-β-lactamase (NDM)-producing Gram-negative bacteria have spread globally and pose a significant public health threat. There is a need to better define risk factors and outcomes of NDM-1 clinical infection. We assessed risk factors for nosocomial infection with NDM-1-producers and associated in-hospital mortality. Methods: A matched case-control study was conducted during a nosocomial outbreak of NDM-1-producers in South Africa. All patients from whom NDM-1-producers were identified were considered (n=105). Cases included patients admitted during the study period in whom NDM-1 producing Gram-negative bacteria were isolated from clinical specimens collected ≥48 hours after admission, and where surveillance definitions for healthcare-associated infections were met. Controls were matched for age, sex, date of hospital admission and intensive-care admission. Conditional logistic regression was used to identify risk factors for NDM-1 clinical infection and associated in-hospital mortality. Findings: 38 cases and 68 controls were included. Klebsiella pneumoniae was the most common NDM-1-producer (28/38, 74%). Cases had longer mean hospital stays (44.0 vs 13.3 days; P < 0.001) and ICU stays (32.5 vs 8.3 days; P < 0.001). Adjusting for co-morbid disease, the in-hospital mortality of cases was significantly higher than controls (55.3% vs 14.7%; AOR, 11.29; P < 0.001). Higher Charlson co-morbidity index score (5.2 vs 4.1; AOR, 1·59; CI 95 % 1.15 – 2.18), more mechanical ventilation days (7.47 vs 0.94 days; AOR, 1.32; CI 95 % 1.10 – 1.59) and piperacillin/tazobactam exposure (11.03 vs 1.05 doses; AOR, 1.08; CI 95 % 1.02 – 1.15) were associated with NDM-1 infection on multivariate analysis. Cases had a significantly higher likelihood of in-hospital mortality when the NDM-1-producer was Klebsiella pneumoniae (AOR, 16.57; CI 95 % 2.12 – 129.6), or when they had a bloodstream infection (AOR, 8.84; CI 95 % 1.09 – 71.55). Conclusion: NDM-1 infection is associated with significant in-hospital mortality. Risk factors for hospital-associated infection include the presence of co-morbid disease, mechanical ventilation and piperacillin/tazobactam exposure. Rational use of intensive care, medical devises and antibiotics are essential in reducing the transmission and emergence of NDM-1 and other drug resistance Gram-negative bacteria

Risk management in mining and minerals economics as well as minerals resource management

Student Number : 9910899R - MSc dissertation - School of Mining - Faculty of Engineering and the Built EnvironmentThe field of risk management has been growing in popularity over the last few years. Risk management is not a new concept but is becoming more important since the release of the Turnbull report. This research reviews all the risk management systems currently available in the mining industry. The focus of this research is from a Mining Economics as well as a Minerals Resource Management perspective. It is the Mineral Resource Managers primary task to ensure that the orebody is extracted in the most optimum method to ensure the maximum return for the shareholder. In order to do that, the Resource Manager needs a good understanding of the ore body as well as the extraction methods and the cost of mining. Recently it has become important to understand the risks around the mining process as well. It was found that the principal risk associated with mining is extracting the orebody sub economically and hence the research focus was on optimisation. Three tools have been designed to facilitate the determination of optimisation. The above three tools have been tested in practice. The first section of research focuses on how risk is defined in the industry. There is also an analysis what a Mining Economist and A Mineral Resource Manager will encounter in terms of risk. The second section covers the Basic Mining Equation (BME) and its uses. The research looks at using stochastic methods to improve optimisation and identifying risk. The @Risk software was used to analyse 5 years of historical data from an existing mine and predicting the future, using the distributions identified in the history. The third section is based on the use of the Cigarette Box Optimiser (CBO), where the cost volume curve and the orebody signature are used to determine optimality in returns. It also looks at various forms of the BME and how it can be used to identify risk. The section also covers quantification of risk from a probability perspective using systems reliability logic. The fourth section centres on the Macro Grid Optimiser (MGO), which considers the spatial differentiation of the orebody and determining the optimality through, an iterative process. The last section analyses risk from a Mining Economics perspective. It considers the use of the ‘S-curve’ to determine risk. The section also includes a high-level shaft infrastructure optimisation exercise. As an overall conclusion, it was found that the biggest risk associated with mining could be to extract the orebody sub economically. Some ore bodies could yield double the return that they intend to extract. In order for that to happen, the extraction program should undergo some form of optimisation. This will ensure that the optimal volume, cut-off, selectivity and efficiencies are met. There is no greater risk than to mine an ore body out without making an optimal profit. We are in mining to make money! Cash is king

The medium-long term impact of cross-border investments into Sub- Saharan Africa by listed South African companies

Research into whether the medium-long term impact on shareholders’ value of acquiring companies engaged in cross-border merger and acquisition transactions (CBMA) into Sub-Saharan Africa. By focussing on companies listed on the Johannesburg Securities Exchange (“JSE”) and testing the general hypothesis whether the shareholders of acquiring companies earn statistically significant positive or negative returns within the medium-long term after the announcement date of a cross-border merger and acquisition transaction. Out of a total of 10,167 merger and acquisition transactions over the eight-year period between 2000 and 2007, only 12 cross-border mergers and acquisitions into Sub-Saharan Africa satisfied all the selection criteria. By exhaustive application of the single-factor market model to calculate the regression formula using 4 years of historical share price performance data, the results suggested that statistically significant negative weighted average abnormal returns for shareholders are consistently present over the event window. The study on the medium-long term event window starting 21 days prior to the first public announce of the transactions and continued up to 252 trading days after the announcement date. Thus it satisfied common critique by researchers about the true value of short term event studies for companies and their shareholders. CopyrightDissertation (MBA)--University of Pretoria, 2010.Gordon Institute of Business Science (GIBS)unrestricte

Effect of photoperiod on sexual development, growth and production of quail (coturnix coturnix japonica)

The aim of the study was to determine the effect of photoperiod on production of quail in South Africa. Day old chicks were randomly divided into two groups. One group (n=74) received continuous light (LL) while the other group (n=77) received 13 h of light (LD) per day. Traits measured were sexual characteristics (age at sexual maturity and testis weight, egg production and egg weight) and growth (body weight) development in males and females respectively. Significant differences in growth existed between sexes; females were 171.44±17.15 and 182.91±17.75 g compared to the 151.77±13.20 and 155.00±16.86 g for males in both LL and LD groups respectively. Both males and females in the LL group initially outperformed the LD group in growth rate but, by day 72 the LD group had compensated and were 4.6% heavier than the LL group. A similar trend was observed for sexual maturity between the LL and LD groups. However, photoperiod did significantly influence initial egg production in favour of the LL group. The LL group had 80% of the females in production by day 44 compared to the 60% of the LD group. The initial egg weight of the LL group was 14 % higher than those of the LD group. Quail subjected to continuous light attained earlier sexual maturity and production with lower final weight compared to quail subjected to an intermediate photoperiod. The application of a longer photoperiod would therefore favour an egg production system

Safe use of radiopharmaceuticals in patients with chronic kidney disease:A systematic review

BACKGROUND: Patients with chronic kidney disease (CKD) may need to have their radiopharmaceutical dosage adjusted to prevent adverse effects and poor outcomes, but there are few recommendations on radiopharmaceutical dosing for this group of patients. The aim of this study is to provide an overview of the available information on radiopharmaceutical dose recommendations for patients with CKD. METHODS: We performed a systematic literature review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We conducted a literature search in the MEDLINE (PubMed) and Embase databases and screened potentially relevant studies using inclusion and exclusion criteria. We independently assessed the included observational studies’ methodologies and extracted relevant data. RESULTS: Of the 5795 studies first identified, 34 were included in this systematic review. These studies described three radiopharmaceuticals: [(131)I]sodium iodine, [(18)F]fludeoxyglucose, and [(131)I]iobenguane. Twenty-nine studies (85.3%) reported data on patients with CKD stage 5, while only three studies mentioned CKD patients in other stages (8.8%). CONCLUSION: We found no consistent recommendations for radiopharmaceutical dosing in patients with CKD. Although some studies do mention dosing difficulties in patients with CKD, information is available for only a few radiopharmaceuticals, and recommendations are sometimes contradictory. Further research on radiopharmaceutical dosing in patients with CKD is needed to determine whether these patients require specific dosing, especially for therapeutic radiopharmaceuticals where a non-optimised dose may lead to an increased risk of toxicity for non-targeted organs. Including patients with CKD in studies and providing specific information about dosing in these patients should be a priority for the radiopharmaceutical community

Patient-Reported Adverse Events of Radiopharmaceuticals:Development and Validation of a Questionnaire

Introduction Radiopharmaceuticals may cause adverse events. Knowledge about adverse events from a patient's perspective could help healthcare professionals to detect, understand, and manage adverse events more efficiently when using radiopharmaceuticals. Researchers need a validated questionnaire that can be used in patients to assess adverse events with radiopharmaceuticals. Objective The aim of this study was to develop, validate the content of, and perform initial testing of a questionnaire assessing patient-reported adverse events of radiopharmaceuticals. Methods Based on existing literature, six professionals drafted and evaluated a first version of the questionnaire. Further content validation was performed using cognitive interviews with six patients undergoing a nuclear medicine examination. After adaptations, the questionnaire was developed into a web-based questionnaire. One hundred patients undergoing nuclear examination tested this version, and the results were used to assess its acceptability and evaluate reported adverse events. Results Questions and answer options were revised in the initial questionnaire to improve clarity. In addition, some questions were removed. The final version consisted of 18 questions. In the test phase, the acceptability of the questionnaire was demonstrated (e.g. 79% of the patients who received the questionnaire completed it, and the median time to complete the questionnaire was 12 min for patients who reported an adverse event). Of the 100 patients (53% men, median age 64 years), 12 reported a total of 22 adverse events. One of these adverse events had a high causal association. Conclusion After validation and testing, the developed questionnaire to study patient-reported adverse events of radiopharmaceuticals is a suitable and valid instrument which can be used in future research

Recommendations to improve the National Development Plan for Health

In November 2011, a draft National Development Plan (NDP) was released that addresses two of South Africa’s major challenges: poverty and inequity. Health and economic development are interdependent, presenting an important opportunity through the NDP to integrate health within goals of broader socio-economic development. Reviewing the NDP identified gaps based on evidence and the epidemiological risk profile of South Africa. Recommendations to improve the NDP and to deal with poverty and inequity should focus on prevention and addressing the social determinants of health, including: (i) a multisectoral approach to establish a comprehensive early childhood development programme; (ii) fiscal and legislative policies to bolster efforts to reduce the burden of non-communicable diseases; (iii) promoting and maintaining a healthy workforce; (iv) and promoting a culture of evidence-based priority setting. Achieving the goal of ‘a long and healthy life for all South Africans’ will require healthy public policies, well functioning institutional and physical infrastructure, social solidarity, and an active and conscientious civil society

Perceptions, experiences, barriers and facilitators regarding nutritional intake of patients with chronic limb threatening ischemia:a qualitative study

Objective: Patients with chronic limb threatening ischemia (CLTI) are at high risk for amputation and other cardiovascular adverse events. Nutrition-related symptoms and malnutrition are common in the CLTI population, and lead to worse clinical outcomes. Understanding of the factors influencing nutritional intake is required to determine whether optimization of nutritional intake in this population requires interventions. Therefore, this study aimed to describe perceptions and experiences on nutrition of patients with CLTI, and to identify perceived barriers and facilitators influencing their nutritional intake.Methods: In this phenomenological qualitative study, individual semi-structured, face-to-face interviews were conducted with patients with CLTI who lived independently. Interviews were transcribed verbatim, and reflexive thematic analysis was performed.Results: Twelve participants were interviewed. Five themes were generated: (1) lack of nutritional risk perception, (2) role of nutrition for health, functioning and surviving, (3) multiple factors influencing nutritional intake, (4) limited nutritional advice, and (5) no intention to change current nutritional intake.Conclusion: Patients with CLTI perceive nutritional intake as a necessity to survive and function. Patients express limited risk perception regarding adequate nutritional intake and undernutrition. Nutritional intake is mainly based on non-health related factors, as habits and taste, and multiple barriers hinder nutritional intake. Patients received no or only limited nutritional advice. Together this leads to an expressed lack of intention to change nutritional intake. Findings of this study stress the urgency for patient-centered nutritional support, to increase nutrition-related knowledge and motivation, to prevent or treat undernutrition, and may improve clinical outcomes in patients with CLTI

Using soil-specific partition coefficients to improve accuracy of the new South African guideline for contaminated land

Please read abstract in the article.http://www.wrc.org.zatm201