Quality as a strategy to improve customer satisfaction : a six sigma approach.

Thesis (MBA)-University of Natal, Durban, 2003.In the face of increased competition compounded by globalisation, the challenge facing many South African companies is the need to develop a competitive advantage that will secure and grow its market share. This study explores the concept of customer satisfaction as the means to create that competitive advantage. Customers today are more demanding and are exposed to wider choices. The challenge facing management is to define strategies to "delight customers" - customers do not just want to be pleased they want to be delighted, they want to feel that the company exists to ensure that their expectations are not only met, but exceeded. This study further explores quality as a strategy to enhance customer satisfaction. The Six Sigma approach to quality management has been chosen as the focus. This study has been based on a medium sized South African Information Technology (IT) company, called Business Connexion. The IT industry is characterised by many challenges, the most significant being that it is currently in a slow growth phase after being in a boom in the late 1990s. The management of IT companies, today need to develop strategies to retain their customers and to attract new ones. The challenge facing Business Connexion, who is a relatively new entrant to the market, is to develop a competitive advantage that will put it ahead of its competitors who come in the form of large internationally listed companies. This study explores the option of Business Connexion defining its differentiator based on the capacity to offer its customers a superior quality service at a price lower than that of its competitors. The Six Sigma approach is suggested because it focuses on the elements such as: defining customer needs, creating processes to meet and exceed customer expectations, investigating methods to reduce costs and creating a quality-focused culture within the company. These elements are critical to achieving competitive advantage

Lead poisoning in shooting-range workers in Gauteng Province, South Africa: Two case studies

Background. Lead exposure constitutes a major public health concern globally. Relative to developed nations, lead exposure is understudied and poorly addressed in Africa, and there is a dearth of information available to inform lead poisoning prevention strategies, even in highrisk groups such as workers in shooting ranges who are potentially exposed to lead daily.Methods. Two workers at a private shooting range in Gauteng, South Africa (SA), had blood lead levels and exposure histories taken.Results. Workers had highly elevated blood lead levels and clinical symptoms associated with elevated blood lead levels.Conclusion. Workers in private SA shooting ranges are vulnerable to lead exposure and poisoning, and scaled-up action is required to protect them and their families, as well as shooting-range users, from lead and the related health risks

The prevalence of intentional and unintentional injuries in selected Johannesburg housing settlements

Intentional and unintentional injuries were reported to be the second leading cause of Disability Adjusted Life Years in South Africa in 2000. We present household experiences of such injuries in 5 impoverished housing settlements in Johannesburg, Gauteng Province. Data for this study were extracted from the database of the Health, Environment and Development (HEAD) project. The incidence of reported intentional injuries was determined to be double that of unintentional injuries. Households in the Hospital Hill and Riverlea settlements reported the highest prevalence of stabbing and gunshot incidents. We concluded that impoverished South African neighbourhoods bear a high burden of intentional injury; surveillance mechanisms are  required to inform prevention strategies at an individual, a community and a societal level.S Afr Med J 2011;101:835-838

Assessments and improvement of filter media cleanliness in rapid gravity sand filters

Introduction: Rapid sand filtration is an essential unit process in the water purification process. It captures and removes coagulated and flocculated material and other suspended matter not removed during the preceding treatment processes. The pores in the filter bed gradually become clogged and the media progressively collects deposit through the continuous use and life of the filter. During normal operations cleaning is initiated by excessive head loss, deterioration in filtrate quality or when the predetermined time for a filter run has elapsed. Air scour, to remove deposit from filter media by vigorous agitation, and wash water, to remove this deposit from the filter bed, are applied. The combined action of air and water should quickly return the media to its original perfectly clean state for the cycle to continue. However, on inspection it is often found that filter sand on purification plants is unacceptably dirty and backwash systems are clearly incapable of cleaning the media to its initial state of cleanliness. It is at times possible to relate the dirty filter media to faulty designs or poor operating procedures, but often the reasons for the media deterioration remain elusive and the media becomes dirtier the longer it is in use. As there was an almost complete lack of published or agreed upon procedures to measure the cleanliness of filter media, rudimentary methods for measuring filter media cleanliness and backwash efficiency were developed. Thereafter filter media from full-scale treatment plants was analyzed with these methods at regular intervals to establish some benchmarks for these determinants. These methods were also applied during the laboratory and pilot plant phases of the project

A Case of Emmonsiosis in an HIV-Infected Child

Opportunistic fungal infections can cause significant morbidity and mortality in immunocompromised patients. We describe a paediatric case of an unusual disseminated fungal infection. A three-year-old HIV-infected child with severe immunosuppression (CD4+ T-cell count 12 × 106/L) was admitted to hospital with pneumonia, gastroenteritis and herpes gingivostomatitis. Despite antibacterial and antiviral therapy, he experienced high fevers and developed an erythematous maculopapular rash and abdominal tenderness. The child’s condition progressively worsened during the admission. A thermally dimorphic fungus was cultured from bone marrow and identified as an Emmonsia species on DNA sequencing. The patient made a good recovery on amphotericin B deoxycholate and antiretroviral therapy. Itraconazole was continued for a minimum of 12 months, allowing for immune reconstitution to occur. This case is the first documented description of disseminated disease caused by a novel Emmonsia species in an HIV-infected child in South Africa

Genetic variation of the HIV-1 subtype C transmitted/founder viruses long terminal repeat elements and the impact on transcription activation potential and clinical disease outcomes

A genetic bottleneck is a hallmark of HIV-1 transmission such that only very few viral strains, termed transmitted/founder (T/F) variants establish infection in a newly infected host. Phenotypic characteristics of these variants may determine the subsequent course of disease. The HIV-15' long terminal repeat (LTR) promoter drives viral gene transcription and is genetically identical to the 3' LTR. We hypothesized that HIV-1 subtype C (HIV-1C) T/F virus LTR genetic variation is a determinant of transcriptional activation potential and clinical disease outcome. The 3'LTR was amplified from plasma samples of 41 study participants acutely infected with HIV-1C (Fiebig stages I and V/VI). Paired longitudinal samples were also available at one year post-infection for 31 of the 41 participants. 3' LTR amplicons were cloned into a pGL3-basic luciferase expression vector, and transfected alone or together with Transactivator of transcription (tat) into Jurkat cells in the absence or presence of cell activators (TNF-α, PMA, Prostratin and SAHA). Inter-patient T/F LTR sequence diversity was 5.7% (Renge: 2-12) with subsequent intrahost viral evolution observed in 48.4% of the participants analyzed at 12 months post-infection. T/F LTR variants exhibited differential basal transcriptional activity, with significantly higher Tat-mediated transcriptional activity compared to basal (p<0.001). Basal and Tat-mediated T/F LTR transcriptional activity showed significant positive correlation with contemporaneous viral loads and negative correlation with CD4 T cell counts (p<0.05) during acute infection respectively. Furthermore, Tat-mediated T/F LTR transcriptional activity significanly correlated positively with viral load set point and viral load; and negatively with CD4 T cell counts at one year post infection (all p<0.05). Lastly, PMA, Prostratin, TNF-α and SAHA cell stimulation resulted in enhanced yet heterologous transcriptional activation of different T/F LTR variants. Our data suggest that T/F LTR variants may influence viral transcriptional activity, disease outcomes and sensitivity to cell activation, with potential implications for therapeutic interventions

Stereoselective synthesis towards unnatural proline-based amino acids

A catalytic diastereoselective Mannich reaction promoted by chiral bifunctional urea-type organocatalysts has been developed. Treatment of N-Boc-3-ketoproline with N-Boc-aldimines under mild conditions afforded the corresponding unnatural proline based amino acid derivatives with excellent diastereoselectivities (up to 99:1) and enantioselectivities (up to 97% ee). The relative configuration of the chiral reaction products was deduced by the comparsion of the experimentally observed ECD spectra to that obtained theorectically

Prevalence of tobacco use in selected Johannesburg suburbs

Background. Tobacco smoking is estimated to kill more than 44 000 South Africans every year. Studies have shown that since the introduction of tobacco control measures, national smoking prevalence has declined in South Africa (SA).Objective. To determine the prevalence of tobacco smoking over a 7-year period in five impoverished neighbourhoods in Johannesburg, SA.Methods. Data were collected through the annual administration of a prestructured questionnaire to one adult respondent in preselected dwellings from 2006 to 2012. Information was collected on socioeconomic status, smoking practices and health status.Results. Over the 7-year period of the analysis, smoking levels remained unchanged. The proportion of households with one or more smokers varied significantly across the five study neighbourhoods. Approximately 20% of households in Hillbrow and as many as 77% in Riverlea had a member who smoked.Conclusions. Despite a national downward trend in smoking levels, tobacco use remains high and persistent in certain vulnerable communities, requiring scaled-up action to reduce the risk of a range of tobacco-related diseases.

Risk factors and outcomes of contrast-induced nephropathy in hospitalised South Africans

Background. Despite ranking third as a cause of hospital-acquired acute kidney injury (AKI), iatrogenic contrast-induced nephropathy (CIN) impacts significantly on morbidity and mortality and is associated with high hospital costs. In  sub-Saharan Africa, the rates and risk factors for CIN and patient outcomes remain unexplored.Methods. We conducted a prospective observational study at the Charlotte Maxeke Johannesburg Academic Hospital, South Africa, from 1 July 2014 to 30 July 2015. Hospitalised patients undergoing computed tomography scan contrast media administration and angiography were consecutively recruited to the study and followed up for development of AKI. CIN was defined as an increase in serum creatinine &gt;25% or an absolute increase of &gt;44 μmol/L from baseline at 48 - 72 hours post exposure to contrast media. Outcome variables were the occurrence of CIN, length of hospitalisation and in-hospital mortality.Results. We recruited 371 hospitalised patients with a mean (standard deviation) age of 49.3 (15.9). The rates of CIN, assessed using an absolute or relative increase in serum creatinine from baseline, were 4.6% and 16.4%, respectively. Anaemia was an independent predictor for the development of CIN (risk ratio (RR) 1.71, 95% confidence interval (CI) 1.01 - 2.87; p=0.04). The median serum  albumin was 34 g/L (interquartile range (IQR) 29 - 39.5) and 38 g/L (IQR 31 - 42) in the CIN and control groups, respectively (p=0.01), and showed a significant trend for CIN development (RR 1.68, 95% CI 0.96 - 2.92; p=0.06). Mortality was  significantly increased in the CIN group (22.4% v. 6.8%; p&lt;0.001), and CIN  together with anaemia increased mortality twofold (RR 2.39, 95% CI 1.20 - 4.75; p=0.01) and threefold (RR 3.32, 95% CI 1.48 - 7.43; p=0.003), respectively.Conclusions. CIN has a relatively high incidence in sub-Saharan Africa and predicts poorer clinical outcomes. The presence of CIN and anaemia positively predicted mortality. Caution should be exercised in patients with hypoalbuminaemia and anaemia undergoing contrast media administration