African Immigrants in South Africa

According to the South African Forced Migration Studies Programme, there are between one and three million African immigrants currently residing in South Africa ( Jolly, 2008). There were 57,899 official refugees and 219,368 registered asylum seekers as of January 2012, which is the highest number of asylum seekers out of any country in Africa and the world (UNCHR, 2012). Immigration from other African countries into South Africa has implications for the economy, politics, health and education services, South Africa’s role in the greater African continent, and ideas about human rights. As such, African immigration, both documented and undocumented, is an increasingly prominent national issue. This study seeks to answer two core questions. First, what are the general experiences of African immigrants in South Africa? Secondly, what social tensions exist between immigrants and South African Coloreds and Blacks 1? Drawing from my own localized, qualitative findings and national studies and statistics, I explore the challenges immigrants face, the violence that sometimes erupts, the nature of social and economic tensions between immigrants and South African Coloreds and Blacks, and the factors that contribute to economic competition

Towards a Somatosensory Neuroprosthesis: Characterizing Microstimulation of the DRG and Spinal Cord for Sensory Restoration

Restoring sensation is key to making prostheses more functional. While there have been important advances in the design and actuation of prosthetic limbs, these devices lack a means for providing direct sensory feedback. As such, users must infer information about limb state from cues like pressure on the residual limb, resulting in diminished control of prostheses, and reduced adoption and use of these technologies. The dorsal root ganglia (DRG) are an attractive target for a somatosensory neural interface. The DRG are enlargements of the spinal nerve that house the cell bodies of primary sensory neurons and provide access to a heterogenous population of somatosensory fibers. Importantly, the separation of motor and sensory pathways at the spinal roots allows recruitment of sensory afferents without coactivating motor efferents which may otherwise contaminate a myoelectric control interface. This dissertation examines a novel way of interfacing with the DRG and dorsal roots using epineural electrodes, that takes us a step closer towards developing a somatosensory neuroprosthesis. I begin with an animal model to compare the recruitment properties of epineural and penetrating electrodes when stimulating afferents in the lumbar DRG. In the next section, I develop a computational model to explain the mechanism of recruitment of afferents. Finally, I describe a series of experiments in human upper-limb amputees to characterize the modality and utility of sensations evoked when the cervical spinal cord and spinal roots were stimulated

A systematic review of controlled trials on visual stress using Intuitive Overlays or the Intuitive Colorimeter

Claims that coloured filters aid reading date back 200 years and remain controversial. Some claims, for example, that more than 10% of the general population and 50% of people with dyslexia would benefit from coloured filters lack sound evidence and face validity. Publications with such claims typically cite research using methods that have not been described in the scientific literature and lack a sound aetiological framework. Notwithstanding these criticisms, some researchers have used more rigorous selection criteria and methods of prescribing coloured filters that were developed at a UK Medical Research Council unit and which have been fully described in the scientific literature. We review this research and disconfirm many of the more extreme claims surrounding this topic. This literature indicates that a minority subset of dyslexics (circa 20%) may have a condition described as visual stress which most likely results from a hyperexcitability of the visual cortex. Visual stress is characterised by symptoms of visual perceptual distortions, headaches, and eyestrain when viewing repetitive patterns, including lines of text. This review indicates that visual stress is distinct from, although sometimes co-occurs with, dyslexia. Individually prescribed coloured filters have been shown to improve reading performance in people with visual stress, but are unlikely to influence the phonological and memory deficits associated with dyslexia and therefore are not a treatment for dyslexia. This review concludes that larger and rigorous randomised controlled trials of interventions for visual stress are required. Improvements in the diagnosis of the condition are also a priority

Editorial - Ethics of clinical research

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Clinical research: A personal perspective

Research ought to be inculcated as an attitude during the formative years of every health-care professional. The core elements of research are curiosity, observation, reasoning, and experimentation. These suggestions are supported with suitable examples. Medical advisers in the pharmaceutical industry are in a unique position to act as facilitators of such a process. The tools they can use are also suggested

On research in clinical practice

Clinical research implies advancing current knowledge about health care by continually developing and testing new ideas about diseases, products, procedures, and strategies. Although this trait is inherent in human nature, it needs to be encouraged, nurtured, groomed, and channelized by creating a suitable atmosphere for it, providing the necessary resources, inculcating the necessary conceptual and manual skills, and rewarding the efforts and achievements suitably. Language, logic, statistics, and psychology play an important role in acquiring and developing research capability. To be socially relevant and economically viable, clinical research will need to partner with patients and their doctors in identifying what their goals of health care are, what they value, and what they are willing to "buy" in terms of goods and services. Besides, clinical research will need to bring on one platform the sponsors, the researchers, the patients, the payers, and the regulators to ensure that they do not work at cross purposes, that the cost of developing health care measures is scaled down through innovative approaches such as large simple trials, sequential trials, early marketing conditional on post-marketing surveillance, and so on. All these will be possible if day-to-day practice is slowly and systemically transformed into the largest laboratory of clinical research, which it ought to be, by forming networks of research-oriented practices, and popularizing the use of data collection and analysis tools such as Epi Info which are in the public domain

The penumbra of randomized control trials

Pre-occupation with randomized control trials as the basis of evidence-based medicine has increasingly shadowed other study designs over the last half a century. These include surveys, case-control studies, and case-cohort studies. They have the potential to overcome several ethical and cost constraints, but depend on the embedding of research in routine practice, emphasis on relevant but limited, accurate, and complete data, harnessing of information technology for this purpose, and epidemiological and statistical literacy among clinicians. Only then will it be possible to nurture and network research-oriented practices by therapeutic areas. Given these, the alternative study designs can pave the way to regulatory reforms that will ultimately benefit the discoverers, approvers and users of health-care tools