Clinical, legal and ethical implications of the intra-ocular (off-label) use of bevacizumab (Avastin) – a South African perspective

Choroidal neovascularisation is a potentially visually devastating element of various forms of eye pathology. Recent research has focused on neurovascular age-related macular degeneration (AMD) as a cause. AMD can be classified as being exudative (wet) or atrophic (dry). Wet AMD is characterised by a pathological process in which new bloodvessels develop in the choroids, causing leakage of fluid andhaemorrhage under the retina and leading to localised serousdetachment and loss of central vision. Vascular endothelialgrowth factor (VEGF) stimulates growth of neovascularmembranes. Treatments have until recently yieldeddisappointing results.Ophthalmologists are using intra-ocular injections ofbevacizumab (Avastin), an anti-VEGF, to treat AMD. Avastinappears to be safe and effective in the short term, but its intraocularadministration is entirely off-label. Avastin is registeredfor treating metastatic colorectal and breast cancer.The off-label use of medication is an important partof mainstream, legitimate medical practice worldwide.Lawyers representing plaintiffs injured by drugs increasinglyencounter off-label use claims. From a legal/ethical pointof view the off-label use of medication represents a delicatebalance between the statutory regulation of medication and a physician’s prerogative to prescribe medication that in his or her medical opinion will be beneficial to the patient. The main reason for the controversy created by the off-label use of Avastin is that there are anti-VEGF drugs on the market that have formal approval for the treatment of AMD (and other eye conditions). Lucentis, for example, is extremely expensive, with treatment cost approximately 50 times that of Avastin. Many patients suffering from AMD and macular oedemacannot afford the registered product. The off-label use of Avastin has passed the innovative or experimental stages, as ophthalmologists have used it regularly and openly for a long time, with good success.Such use therefore cannot be considered careless, imprudent or unprofessional. We submit that an ophthalmologist who omits to inform a patient of the availability of Avastin for this form of treatment may be found to be negligent. Protocols developed by the South African Vitreoretinal Society and endorsed by the Ophthalmological Society ofSouth Africa for administering Avastin and other intra-ocular medication intravitreally should be strictly adhered to

The contribution of energy efficiency towards the success of industrial organisations in South Africa

The original publication is available at http://sajie.journals.ac.zaENGLISH ABSTRACT: Internationally, governments and lobby groups increasingly put pressure on organisations to reduce their impact on the environment. To this end, various studies show the drivers, barriers, and contributions of energy efficiency towards a more sustainable environment, particularly through reduced greenhouse gas emissions and other by-products. In the study summarised in this paper, the factors that drive organisational success were compared with the effects that energy efficiency projects have on organisations. Methods, policies, and strategies on the application of energy efficiency were also studied. The findings are that, in general, most organisations have energy efficiency policies and strategies in place, and they include internal and external stakeholders in their energy efficiency efforts. These efforts also show a positive correlation with the factors that contribute to the perceived success of organisations in the South African industrial sector. These strategies must be maintained in the longer term, as energy efficiency will play a more important role in the future.AFRIKAANSE OPSOMMING: Organisasies, wêreldwyd, word toenemend onder druk geplaas deur regerings- en aksiegroepe om hul impak op die omgewing te verminder. Na aanleiding hiervan toon verskeie studies die drywers, struikelblokke en bydraes van energie-doeltreffendheid na ʼn meer volhoubare omgewing, veral ten opsigte van groenhuisgas-emissies en ander neweprodukte. In hierdie studie is die faktore wat die sukses van organisasies dryf vergelyk met die effek van die toepassing van energiedoeltreffendheidsprojekte op organisasies. Metodes, beleid en strategieë in terme van die toepassing van energiedoeltreffendheid is ook bestudeer. Die bevindinge is dat die meeste organisasies, oor die algemeen, beleid en strategieë in plek het in terme van energiedoeltreffendheid; dié organisasies sluit interne en eksterne belanghebbendes in waar hulle strewe na energiedoeltreffendheid. Hierdie aktiwiteite toon ʼn positiewe korrelasie met die faktore wat waarde bydra ten opsigte van die oënskynlike sukses van organisasies in die Suid-Afrikaanse industriële sektor. Dus moet hierdie strategieë in plek gehou word in die langtermyn, aangesien energiedoeltreffendheid ʼn belangriker rol sal speel in die toekoms

Antimicrobial-resistant Klebsiella species isolated from free-range chicken samples in an informal settlement

Sub-therapeutic doses of antimicrobial agents are administered routinely to poultry to aid growth and to prevent disease, with prolonged exposure often resulting in bacterial resistance. Crossover of antibiotic resistant bacteria from poultry to humans poses a risk to human health. In this study, 17 chicken samples collected from a vendor operating in an informal settlement in the Cape Town Metropolitan area, South Africa were screened for antimicrobial-resistant Gram-negative bacilli using the Kirby Bauer disk diffusion assay. In total, six antibiotics were screened: ampicillin, ciprofloxacin, gentamicin, nalidixic acid, tetracycline and trimethoprim. Surprisingly, Klebsiella ozaenae was identified in 96 and K. rhinoscleromatis in 6 (n = 102) of the samples tested. Interestingly, ~40% of the isolated Klebsiella spp. showed multiple resistance to at least three of the six antibiotics tested. Klebsiella ozaenae and K. rhinoscleromatis cause clinical chronic rhinitis and are almost exclusively associated with people living in areas of poor hygiene.Web of Scienc

The use of ultraviolet radiation as a non-thermal treatment for the inactivation of alicyclobacillus acidoterrestris spores in water, wash water from a fruit processing plant and grape juice concentrate

Alicyclobacillus acidoterrestris is a non-pathogenic, spore-forming bacterium that can survive the commercial pasteurisation processes commonly used during fruit juice production. Surviving bacterial endospores germinate, grow and cause spoilage of high acid food products. Fruit juices can be treated using ultraviolet light (UV-C) with a wavelength of 254 nm, which has a germicidal effect against micro-organisms. In this study, A. acidoterrestris was inoculated into water, used wash water from a fruit processing plant and grape juice concentrate. Ultraviolet dosage levels (J L−1) of 0, 61, 122, 183, 244, 305 and 367 J L−1 were applied using a novel UV-C turbulent flow system. The UV treatment method was shown to reliably achieve in excess of a 4 log10 reduction (99.99%) per 0.5 kJ L-1 of UV-C dosage in all the liquids inoculated with A. acidoterrestris. The applied novel UV technology could serve as an alternative to thermal treatments of fruit juices for the inactivation of Alicyclobacillus spores as well as in the treatment of contaminated wash water used in fruit processing.Department of HE and Training approved lis

Multiple wavelength SPR sensor analysis

Surface Plasmon Resonance (SPR) sensors based on Gold thin films are typically illuminated by 633 nm laser sources. In this work we investigate illuminating SPR sensors with longer wavelength lasers. We use a model based on Fresnel's equations to achieve this. We also investigate the ability to use a single thickness of Gold film for interrogation over multiple laser wavelengths

Patient Satisfaction with a Pilot Chronic Pain Management Programme in Cape Town, South Africa

Background: The goals of a chronic pain management clinic includeincreasing patient knowledge about pain, developing pain management skillsand increasing patients’ confidence in their pain management abilities.A Chronic Pain Management Programme (CPMP) based on evidence basedguidelines was developed at a chronic pain management clinic to facilitatepatient discharge to a primary healthcare level. Aim: The aim of this study was to explore patient satisfaction with, acceptability of and the perceived success which could be due to the CPMP developed at the Chronic Pain Management Clinic of Groote Schuur Hospital,Cape Town.Methods: Patients (n=14) were referred to the pilot study from the Chronic Pain Management Clinic. A s a pilot, four courses were run over a period ofone year. In order to reach the research aim, an eleven-question, structuredopen-ended interview was conducted with all participants. Results: Fourteen patients enrolled in the CPMP. Responses were favourable with participants emphasising the roleof increased knowledge about pain, the role of exercise and of stress management techniques. Participants also recog-nised a positive change in behaviours and attitudes following participation in the CPMP.Conclusions: Findings suggest that participants found the format of the course acceptable as regards course content,structure and delivery. Participant responses suggest that the course was acceptable and perceived as useful. However,future courses would benefit from refresher courses or structured support groups

Patient satisfaction with a pilot chronic pain management programme in Cape Town, South Africa

Background: The goals of a chronic pain management clinic includeincreasing patient knowledge about pain, developing pain management skillsand increasing patients’ confidence in their pain management abilities.A  Chronic Pain Management Programme (CPMP) based on evidence basedguidelines was developed at a chronic pain management clinic to facilitatepatient discharge to a primary healthcare level. Aim: The aim of this study was to explore patient satisfaction with, acceptability of and the perceived success which could be due to the CPMP developed at the Chronic Pain Management Clinic of Groote Schuur Hospital,Cape Town.Methods: Patients (n=14) were referred to the pilot study from the Chronic Pain Management Clinic. A s a pilot, four courses were run over a period ofone year. In order to reach the research aim, an eleven-question, structuredopen-ended interview was conducted with all participants. Results: Fourteen patients enrolled in the CPMP. Responses were favourable with participants emphasising the roleof increased knowledge about pain, the role of exercise and of stress management techniques. Participants also recog-nised a positive change in behaviours and attitudes following participation in the CPMP.Conclusions: Findings suggest that participants found the format of the course acceptable as regards course content,structure and delivery. Participant responses suggest that the course was acceptable and perceived as useful. However,future courses would benefit from refresher courses or structured support groups

Commission des Communautes Europeennes: Groupe du Porte-Parole = Commission of European Communities: Spokesman Group. Spokesman Service Note to National Offices Bio No. (81) 276, 8 July 1981

This paper presents a novel approach for multi-lingual sentiment classification in short texts. This is a challenging task as the amount of training data in languages other than English is very limited. Previously proposed multi-lingual approaches typically require to establish a correspondence to English for which powerful classifiers are already available. In contrast, our method does not require such supervision. We leverage large amounts of weakly-supervised data in various languages to train a multi-layer convolutional network and demonstrate the importance of using pre-training of such networks. We thoroughly evaluate our approach on various multi-lingual datasets, including the recent SemEval-2016 sentiment prediction benchmark (Task 4), where we achieved state-of-the-art performance. We also compare the performance of our model trained individually for each language to a variant trained for all languages at once. We show that the latter model reaches slightly worse – but still acceptable – performance when compared to the single language model, while benefiting from better generalization properties across languages

The challenges of achieving high training coverage for IMCI: case studies from Kenya and Tanzania

Health worker training is a key component of the integrated management of childhood illness (IMCI). However, training coverage remains low in many countries. We conducted in-depth case studies in two East African countries to examine the factors underlying low training coverage 10 years after IMCI had been adopted as policy. A document review and in-depth semi-structured interviews with stakeholders at facility, district, regional/provincial and national levels in two districts in Kenya (Homa Bay and Malindi) and Tanzania (Bunda and Tarime) were carried out in 2007–08