The incomplete cone in carcinoma in situ of the cervix : a prospective study in a developing country

The original publication is available at http://www.samj.org.zaThe diagnostic procedures and treatment of carcinoma in situ and severe dysplasia of the cervix are becoming more conservative. In a developing country special problems make such an approach more hazardous. During a 15-months period the diagnosis in 25 of 206 patients (12,1%) with a smear positive for carcinoma in situ could not be confirmed histologically at Tygerberg Hospital. A prospective study of 147 cases (71,4%) in which the diagnosis was confirmed revealed that they were mostly young patients of relatively high gravidity. The difficulty of assessing the completeness of a cervical cone and of evaluating a postconization smear is confirmed. The danger of a too conservative approach in our patients is confirmed by the fact that only 8,2% of patients came for regular follow-up examinations and that 34,7% did not return for follow-up smears. The high incidence of total hysterectomy (51,7%) as the definitive form of treatment is defended, and a more conservative future approach of confirming the diagnosis and reducing the incidence of cervical conization is suggested.Publishers' versio

Why Read (Diffractively)?

Academics should produce quality scholarly research. However, the demands of the marketised, neoliberal higher education institution and the increase in the academic’s bureaucratic and administrative tasks do not allow for adequate engagement with the deep work and slow forms of scholarship that are needed to produce cutting-edge and insightful research. Many academics find it challenging to think critically and creatively under such conditions, yet they are unwilling to fill their time with shallow work instead. Thus, they are torn between producing an institutionally-determined number of research outputs, and striving towards producing quality scholarly work that advances knowledge in the academic’s discipline. Reading groups serve to rework this tension by providing a communal and scheduled place and mind-space for reading major academic works. Reading takes time and persistence. We find that setting aside time and creating creative spaces for reading groups offer an opportunity for silent revolt against the pressures of the higher education institution. In this (post)qualitative inquiry we diffractively read – “through one another” – two autoethnographical accounts to experiment with our experiences of various reading groups over a period of three years while positioning ourselves in relation to Barad’s notion of diffraction. This speculative experimentation entails a myriad of ideas and methods that serve to decentre hegemonic, monolithic knowledge systems through seeking alternative ways of knowing, and recognises the importance of the entanglement of matter and meaning in tracing (and countering) the social relations produced in neoliberalist contexts. Such (re)thinking is thus a vital counterpoint to the neoliberal obsessions of the higher education context, (re)directing the scholar to new non-autonomous and mutable landscapes

The Role of CT-Based Attenuation Correction and Collimator Blurring Correction in Striatal Spect Quantification

Purpose. Striatal single photon emission computed tomography (SPECT) imaging of the dopaminergic system is becoming increasingly used for clinical and research studies. The question about the value of nonuniform attenuation correction has become more relevant with the increasing availability of hybrid SPECT-CT scanners. In this study, the value of nonuniform attenuation correction and correction for collimator blurring were determined using both phantom data and patient data. Methods. SPECT imaging was performed using 7 anthropomorphic phantom measurements, and 14 patient studies using [I-123]-FP-CIT (DATSCAN). SPECT reconstruction was performed using uniform and nonuniform attenuation correction and collimator blurring corrections. Recovery values (phantom data) or average-specific uptake ratios (patient data) for the different reconstructions were compared at similar noise levels. Results. For the phantom data, improved recovery was found with nonuniform attenuation correction and collimator blurring corrections, with further improvement when performed together. However, for patient data the highest average specific uptake ratio was obtained using collimator blurring correction without nonuniform attenuation correction, probably due to subtle SPECT-CT misregistration. Conclusions. This study suggests that an optimal brain SPECT reconstruction (in terms of the lowest bias) in patients would include a correction for collimator blurring and uniform attenuation correction

WhatsApp-propriate? A retrospective content analysis of WhatsApp use and potential breaches in confidentiality among a team of doctors at a district hospital, South Africa

Background. There has been a steady increase in the use of electronic media and instant messaging among healthcare professionals, where it has been almost universally adopted in the workplace. The use of WhatsApp and its perceived benefits in healthcare have been extensively studied; however, there are concerns regarding the potential for ethical breaches in confidentiality through shared electronic patient information.Objectives. To identify the usage characteristics and incidence of shared patient information with WhatsApp use in a team of medical doctors in an unobserved and unregulated setting.Methods. We conducted a retrospective cross-sectional content analysis of WhatsApp messages (n=3 340) among a team of 20 doctors in a South African district hospital over 6 months. All messages found within this time period were allocated unique identifiers. The text and image messages were thematically grouped into four categories, i.e. clinical care, resource allocation, social and administrative. Messages that contained patient-identifying information were included in the analysis.Results. Of a total of 3 340 messages sent, 220 (6.6%) contained patient-identifying information. Of these, 109 (3.3%) contained non-anonymised patient information, while in 111 (3.3%) messages, the information was anonymised. The likelihood of sharing patient identifiers was proportionally much higher in shared images (odds ratio (OR) 5.1; 95% confidence interval (CI) 3.2 - 8.2; p<0.0001) compared with text messages, and in messages that related to clinical care (OR 9.3; 95% CI 2.2 - 38.8; p=0.0023) compared with those sent for resource allocation, and social or administrative purposes.Conclusions. Non-anonymised patient identifiers were found in 3.3% of messages, constituting the potential for breaching patient confidentiality. While WhatsApp groups have significant utility in co-ordinating aspects of clinical care, resource allocation, as well as social and administrative functions, the safe use of WhatsApp should be promoted to ensure that patient confidentiality is maintained

Dealing with a traumatic past: the victim hearings of the South African truth and reconciliation commission and their reconciliation discourse

In the final years of the twentieth and the beginning of the twenty-first century, there has been a worldwide tendency to approach conflict resolution from a restorative rather than from a retributive perspective. The South African Truth and Reconciliation Commission (TRC), with its principle of 'amnesty for truth' was a turning point. Based on my discursive research of the TRC victim hearings, I would argue that it was on a discursive level in particular that the Truth Commission has exerted/is still exerting a long-lasting impact on South African society. In this article, three of these features will be highlighted and illustrated: firstly, the TRC provided a discursive forum for thousands of ordinary citizens. Secondly, by means of testimonies from apartheid victims and perpetrators, the TRC composed an officially recognised archive of the apartheid past. Thirdly, the reconciliation discourse created at the TRC victim hearings formed a template for talking about a traumatic past, and it opened up the debate on reconciliation. By discussing these three features and their social impact, it will become clear that the way in which the apartheid past was remembered at the victim hearings seemed to have been determined, not so much by political concerns, but mainly by social needs

A simplified approach for producing Tier 2 enteric-methane emission factors based on East African smallholder farm data

Context: Accurate reporting of livestock greenhouse-gas (GHG) emissions is important in developing effective mitigation strategies, but the cost and labour requirements associated with on-farm data collection often prevent this effort in low- and middle-income countries. Aim: The aim of this study was to investigate the precision and accuracy of simplified activity data collection protocols in African smallholder livestock farms for country-specific enteric-methane emission factors. Method: Activity data such as live weight (LW), feed quality, milk yield, and milk composition were collected from 257 smallholder farms, with a total herd of 1035 heads of cattle in Nandi and Bomet counties in western Kenya. The data collection protocol was then altered by substituting the actual LW measurements with algorithm LW (ALG), feed quality (FQ) data being sourced from the Feedipedia database, reducing the need for daily milk yield records to a single seasonal milk measurement (MiY), and by using a default energy content of milk (MiE). Daily methane production (DMP) was calculated using these simplified protocols and the estimates under individual and combined protocols were compared with values derived from the published (PUBL) estimation protocol. Key results: Employing the algorithm LW showed good agreement in DMP, with only a small negative bias (7%) and almost no change in variance. Calculating DMP on the basis of Feedipedia FQ, by contrast, resulted in a 27% increase in variation and a 27% positive bias for DMP compared with PUBL. The substitutions of milk (MiY and MiE) showed a modest change in variance and almost no bias in DMP. Conclusion: It is feasible to use a simplified data collection protocol by using algorithm LW, default energy content of milk value, seasonal single milk yield data, but full sampling and analysis of feed resources is required to produce reliable Tier 2 enteric-methane emission factors. Implications: Reducing enteric methane emissions from the livestock is a promising pathway to reduce the effects of climate change, and, hence, the need to produce accurate emission estimates as a benchmark to measure the effectiveness of mitigation options. However, it is expensive to produce accurate emission estimates, especially in developing countries; hence, it is important and feasible to simplify on-farm data collection

A simplified approach for producing Tier 2 enteric methane emission factors based on East African smallholder farm data

Context: Accurate livestock greenhouse gas (GHG) emissions reporting is important in developing effective mitigation strategies, but the cost and labor requirements associated with on-farm data collection often prevent this effort in low-and-middle-income countries. Aim: The aim of this study was to investigate the precision and accuracy of simplified activity data collection protocols in African smallholder livestock farms for country-specific enteric methane emission factors. Method: Activity data such as live weight (LW), feed quality, milk yield, and milk composition were collected from 257 smallholder farms with a total herd of 1,035 heads of cattle in Nandi and Bomet counties in Western Kenya. The data collection protocol was then altered by substituting actual LW measurements with algorithm LW (ALG), feed quality (FQ) data sourced from the Feedipedia database, reducing the need for daily milk yield records to a single seasonal milk measurement (MiY), and using a default energy content of milk (MiE). Daily methane production (DMP) was calculated using these simplified protocols and the estimates under individual and combined protocols were compared with values derived from the published (PUBL) estimation protocol. Key results: Employing the algorithm LW showed good agreement in DMP with only a small negative bias (7%) and almost no change in variance. Calculating DMP based on Feedipedia FQ, by contrast, resulted in a 27% increase in variation and a 27% positive bias for DMP compared to PUBL. The substitutions of milk (MiY and MiE) showed a modest change in variance and almost no bias in DMP. Conclusion: It is feasible to use a simplified data collection protocol by using algorithm LW, default energy content of milk value, seasonal single milk yield data, but full sampling and analysis of feed resources is required to produce reliable Tier 2 enteric methane emission factors. Implications: Reducing enteric methane emissions from the livestock is a promising pathway to reduce the effects of climate change hence the need to produce accurate emissions estimates as benchmark to measure the effectiveness of mitigation options. However, it is expensive to produce accurate emission estimates especially in developing countries, hence important and feasible to simplify on-farm data collection

Farm-level emission intensities of smallholder cattle (Bos indicus; B. indicus–B. taurus crosses) production systems in highlands and semi-arid regions

Ruminants are central to the economic and nutritional life of much of sub-Saharan Africa, but cattle are now blamed for having a disproportionately large negative environmental impact through emissions of greenhouse gas (GHG). However, the mechanism underlying excessive emissions occurring only on some farms is imperfectly understood. Reliable estimates of emissions themselves are frequently lacking due to a paucity of reliable data. Employing individual animal records obtained at regular farm visits, this study quantified farm-level emission intensities (EIs) of greenhouse gases of smallholder farms in three counties in Western Kenya. CP was chosen as the functional unit to capture the outputs of both milk and meat. The results showed that milk is responsible for 80–85% of total CP output. Farm EI ranged widely from 20 to >1 000 kg CO$_{2}$-eq/kg CP. Median EIs were 60 (Nandi), 71 (Bomet), and 90 (Nyando) kg CO$_{2}$-eq/kg. Although median EIs referenced to milk alone (2.3 kg CO$_{2}$-eq/kg milk) were almost twice that reported for Europe, up to 50% of farms had EIs comparable to the mean Pan-European EIs. Enteric methane (CH$_{4}$) contributed >95% of emissions and manure ∼4%, with negligible emissions attributed to inputs to the production system. Collecting data from individual animals on smallholder farms enabled the demonstration of extremely heterogeneous EI status among similar geographical spaces and provides clear indicators on how low EI status may be achieved in these environments. Contrary to common belief, our data show that industrial-style intensification is not required to achieve low EI. Enteric CH$_{4}$ production overwhelmingly drives farm emissions in these systems and as this is strongly collinear with nutrition and intake, an effort will be required to achieve an “efficient frontier” between feed intake, productivity, and GHG emissions

Comparing the Cardio Stress Index of a training population with university students

Results obtained from the study indicate that the Cardio Stress Index (CSI) readings of both male and female university students were significantly higher (p < 0.05) than that of the training population. University students were found to have a 50.31% population risk, whilst 31.50% of the recruit population indicated risk.This paper was initially delivered at the Annual Congress of the Biological Sciences Division of the South African Academy for Science and Art, ARC-Plant Protection Research Institute, Roodeplaat, Pretoria, South Africa on 01 October 2010.http://www.satnt.ac.zaam2014ay201