COPC analysis of intersectoral HIV AIDS work in Okhahlamba

No Abstract. South African Family Practice Vol. 47(6) 2005: 35-3

Advocacy: Are we teaching it?

Background. Health advocacy has been identified as a key outcome competency in the undergraduate curriculum for a number of health professions by the Health Professions Council of South Africa (HPCSA) and the University of KwaZulu-Natal (UKZN), Durban, SA. Despite health advocacy and activism playing a strong role in the student body and civil society, there has been only limited engagement with the manner in which to teach health advocacy in the health professions literature.Objectives. To assess how the faculty in health professions programmes at UKZN understood health advocacy and how it was covered in the curriculum.Methods. Focus group discussions were held with faculty from undergraduate health professions programmes at the university regarding how health advocacy was understood and how it was being integrated into the current curriculum. A thematic analysis was performed on the transcripts of the focus groups.Results. A range of ways in which health advocacy was understood became apparent in the focus groups, with a few disciplines indicating that they do not cover health advocacy explicitly in the curriculum. Three main focus areas of health advocacy training were identified: for the profession (particularly in the smaller health professions groups); for services within the health system; and for patients or communities. The main points of departure for health advocacy were ethics and human rights and to a much lesser degree social justice. There was generally limited experience of how health advocacy could be taught as a skill and little consensus between the participating disciplines regarding the scope and content of health advocacy training. Advocacy itself was also seen as potentially risky, which could undermine the relationship between the university and the service platform. Similarly, the potential risk to whistle-blowers and the institutional culture in universities and public sector services were also seen as limitations.Conclusions. Ample opportunities were identified for the potential teaching of health advocacy in complex professional and public sector interactions. Dual loyalty was seen to be a key dilemma for how to approach advocacy as part of work-based learning, and linked to considerable risk to the institution, educators and students. The current review offers an exciting opportunity to define more clearly what the outcome competencies of health advocacy are, particularly in the context of transformative health professions education – and how these can be operationalised in the overall curriculum

The value of internal medicine outreach in rural KwaZulu-Natal, South Africa

Background. Sustainable multifaceted outreach is crucial when equity between specialist services available to different sections of South Africa (SA)’s population is addressed. The healthcare disadvantage for rural compared with urban populations is exemplified in KwaZulu-Natal (KZN). Outreach to rural hospitals has reduced the need for patients to undergo journeys to regional or tertiary hospitals for specialist care.Objectives. Multifaceted outreach visits to seven district hospitals in western KZN by a specialist in the Pietermaritzburg Department of Internal Medicine were analysed for the period 2013 - 2014.Methods. Church of Scotland, Vryheid, Dundee, Charles Johnson Memorial, Rietvlei, Estcourt and Greytown hospitals were visited. During each visit, data were collected on data collection forms, including patient numbers, gender and age, whether out- or inpatient, whether referred, and diagnostic categories.Results. During 113 visits, of 1 377 contacts made, 631 were outpatients and 746 were inpatients. Females formed the majority overall, but for inpatients males outnumbered females. The majority of patients were aged >40 years, but over half of inpatients seen were aged ≤40 years. A modest 15% of patients seen were referred to hospitals with specialist services. Overall, cardiovascular disease, predominantly among outpatients, was the biggest diagnostic category. Infectious diseases followed, primarily among inpatients, and then general medicine. No other category reached 10%.Conclusions. The analysis showed differences between diagnostic categories, especially when outpatients and inpatients were separated out. Referral patterns, age-distribution and gender distinctions were made. The value of a good database was confirmed. The multifaceted outreach may have suggested useful outcomes as well as output. The vulnerability v. sustainability of outreach programmes was emphasised

The social and clinical characteristics of patients on antiretroviral therapy who are ‘lost to follow-up’ in KwaZulu-Natal, South Africa: a prospective study

A significant proportion of those initiating antiretroviral treatment (ART) for HIV infection are lost to follow-up. Causes (including HIV symptoms, quality of life, depression, herbal treatment and alcohol use) for discontinuing ART follow-up in predominantly rural resource-limited settings are not well understood. This is a prospective study of the treatment-naïve patients recruited from three (one urban, one-semi-urban and one rural) public hospitals in Uthukela health district in KwaZulu-Natal from October 2007 to February 2008. The aim of this study was to investigate predictors of loss to follow-up or all caused attrition from an ART programme within a cohort followed up for over 12 months. A total of 735 patients (217 men and 518 women) prior to initiating ART completed a baseline questionnaire and 6- and 12-months’ follow-up. At 12-months follow-up 557 (75.9%) individuals continued active ART, 177 (24.1%)were all cause attrition, there were 82 deaths (13.8%), 58 (7.9%) transfers, 7 (1.0%) refused participation, 8 (1.1%) were not yet on ARTand 22 (3.0%) could not be traced. Death by 12-months of follow-up was associated with lower CD4 cell counts (risk ratio, RR=2.05, confidence intervals, CI=1.20 - 3.49) and higher depression levels (RR=1.05, CI=1.01 - 1.09) at baseline assessment. The high early mortality rates indicate that patients are enrolling into ART programmes with far too advanced immunodeficiency; median CD4 cell counts 119 (IQR=59 - 163). Causes of late access to the ART programme, such as delays in health care access (delayed health care seeking), health system delays, or inappropriate treatment criteria, need to be addressed. Differences in health status (lower CD4 cell counts and higher depression scores) should be taken into account when initiating patients on ART. Treating depression at ART initiation is recommended to improve treatment outcome

Bridging the gap: exploring the attitudes and beliefs of nurses and patients about coexisting traditional and biomedical healthcare systems in a rural setting in KwaZulu-Natal

Objectives: Health care in South Africa takes place within a diverse cultural context and includes perceptions about health that strongly link to cultural beliefs and values. Biomedical healthcare professionals, particularly nurses, are exposed to and expected to cope with cultural challenges on a daily basis, with little or no training on how to do so. In this paper, we explore nurse and patient attitudes to and beliefs about how the systems of health care coexist, what issues this raises and how nurses and patients address these issues in their daily practice.Design: The study employed an exploratory, qualitative research design.Setting and subjects: Four in-depth focus group discussions were conducted with nurses and patients at a deep rural, district hospital in northern KwaZulu-Natal. Participants were selected based on their availability and willingness to contribute to the discussion.Results: Traditional and biomedical healthcare systems coexist and are used simultaneously with the healthcare- seeking pattern of patients traversing multiple systems of care. Currently, patients and nurses have developed strategies to address this by steering a pragmatic course to minimise risks, and by doing so, bridging the gap between the two healthcare mediums.Conclusion: Further research is required to understand which illnesses are primarily seen as traditional, how this gap can be effectively addressed, and how different healthcare co-delivery models can best be utilised and evaluated.Keywords: health worker, traditional health care, biomedical health care, cultur

Cross-cultural medical education: Using narratives to reflect on experience

Introduction. Educating students in a multi-cultural society is a challenge as teachers, students and the community they serve all tend to representvarious social groups. Skills alone are not adequate for competency in understanding cultural aspects of consultations. A combination of knowledge, skills and attitude is the most widely accepted current approach to teaching culturally competent communication to medical students. Collaborative reflection on narratives of experienced clinicians’ cultural encounters served to construct an understanding of how to develop these attributes.Process. An interest group of medical teachers met to address the specific needs of teaching a relevant cross-cultural curriculum. Participants offerednarratives from their professional life and reflected on these encounters to understand how to improve the current curriculum to better address theneeds of the students and patients they serve.Results. Through narratives, participants were able to reflect on how their experience had allowed them to develop cultural awareness. All storiesrepresented how attitudes of respect, curiosity and unconditional positive regard were held above all else. The process of collaborative reflection withpeers unpacked the complexity and potential in the stories and different learning opportunities were discovered. Learning was personalised becausethe stories were based on real experiences.Conclusion. The use of collaborative reflection on narratives of clinical encounters could facilitate insights about cultural aspects of medical practice. Elements such as curiosity, respect and unconditional positive regard are illustrated in a unique way that allows students to appreciate the real-life aspects of cross-cultural clinical encounters

Neurons Responsive to Global Visual Motion Have Unique Tuning Properties in Hummingbirds

Neurons in animal visual systems that respond to global optic flow exhibit selectivity for motion direction and/or velocity. The avian lentiformis mesencephali (LM), known in mammals as the nucleus of the optic tract (NOT), is a key nucleus for global motion processing [1–4]. In all animals tested, it has been found that the majority of LM and NOT neurons are tuned to temporo-nasal (back-to-front) motion [4–11]. Moreover, the monocular gain of the optokinetic response is higher in this direction, compared to naso-temporal (front-to-back) motion [12, 13]. Hummingbirds are sensitive to small visual perturbations while hovering, and they drift to compensate for optic flow in all directions [14]. Interestingly, the LM, but not other visual nuclei, is hypertrophied in hummingbirds relative to other birds [15], which suggests enhanced perception of global visual motion. Using extracellular recording techniques, we found that there is a uniform distribution of preferred directions in the LM in Anna’s hummingbirds, whereas zebra finch and pigeon LM populations, as in other tetrapods, show a strong bias toward temporo-nasal motion. Furthermore, LM and NOT neurons are generally classified as tuned to ‘‘fast’’ or ‘‘slow’’ motion [10, 16, 17], and we predicted that most neurons would be tuned to slow visual motion as an adaptation for slow hovering. However, we found the opposite result: most hummingbird LM neurons are tuned to fast pattern velocities, compared to zebra finches and pigeons. Collectively, these results suggest a role in rapid responses during hovering, as well as in velocity control and collision avoidance during forward flight of hummingbirds

Rational Modification of a Metallic Substrate for CVD Growth of Carbon Nanotubes

Citation: Li, X., Baker-Fales, M., Almkhelfe, H., Gaede, N. R., Harris, T. S., & Amama, P. B. (2018). Rational Modification of a Metallic Substrate for CVD Growth of Carbon Nanotubes. Scientific Reports, 8(1). https://doi.org/10.1038/s41598-018-22467-7Growth of high quality, dense carbon nanotube (CNT) arrays via catalytic chemical vapor deposition (CCVD) has been largely limited to catalysts supported on amorphous alumina or silica. To overcome the challenge of conducting CNT growth from catalysts supported on conductive substrates, we explored a two-step surface modification that involves ion beam bombardment to create surface porosity and deposition of a thin AlxOy barrier layer to make the surface basic. To test the efficacy of our approach on a non-oxide support, we focus on modification of 316 stainless steel (SS), a well-known inactive substrate for CNT growth. Our study reveals that ion beam bombardment of SS has the ability to reduce film thickness of the AlxOy barrier layer required to grow CNTs from Fe catalysts to ∼ 5 nm, which is within the threshold for the substrate to remain conductive. Additionally, catalysts supported on ion beam-damaged SS with the same AlxOy thickness show improved particle formation, catalyst stability, and CNT growth efficiency, as well as producing CNTs with higher quality and density. Under optimal reaction conditions, this modification approach can lead to CNT growth on other nontraditional substrates and potentially benefit applications that require CNTs be grown on a conductive substrate

Calomplification — the power of generative calorimeter models

Motivated by the high computational costs of classical simulations, machine-learned generative models can be extremely useful in particle physics and elsewhere. They become especially attractive when surrogate models can efficiently learn the underlying distribution, such that a generated sample outperforms a training sample of limited size. This kind of GANplification has been observed for simple Gaussian models. We show the same effect for a physics simulation, specifically photon showers in an electromagnetic calorimeter

Risk Prediction of Cardiovascular Disease in Type 2 Diabetes: A risk equation from the Swedish National Diabetes Register

OBJECTIVE—Risk prediction models obtained in samples from the general population do not perform well in type 2 diabetic patients. Recently, 5-year risk estimates were proposed as being more accurate than 10-year risk estimates. This study presents a diabetes-specific equation for estimation of the absolute 5-year risk of first incident fatal/nonfatal cardiovascular disease (CVD) in type 2 diabetic patients with use of A1C and clinical characteristics