Description of surgical and anaesthetic services provided at two district hospitals in KwaZulu-Natal in relation to the surgical norms and standards outlined in the Service Package for District Hospitals

Background: Provision of surgical services at district hospitals (DHS) is cost effective and important. The District Hospital Service Package for South Africa (package of services) specifies the services that a district hospital should provide. The aim of this study was to document the surgical services provided at two DHS in KwaZulu-Natal and to compare this with the recommendations in the package of services. Methods: In a retrospective quantitative study, data from 2008 were collected from the theatre register at two DHS. Data were analysed and results compared with the norms and standards in the package of services. Results were presented to staff at the hospitals, who then commented on the challenges of providing surgical services at DHS.Results: Only 60% and 30% respectively of procedures listed in the package of services were being carried out at the two hospitals. In total, 3 900 procedures were carried out over the year. Dundee Hospital offered a broader range of surgical procedures and anaesthetics than the Church of Scotland Hospital (COSH). COSH has a large obstetric burden, with 3 666 deliveries each year. A large number of procedures were being carried out by a single operator. Conclusions: Many surgical procedures are being carried out even though neither hospital provides the full complement of surgical services as specified in the package of services. The wide variation between the surgical services offered reflects the surgical and anaesthetic skills at the respective hospitals. Potential medico-legal hazards that require urgent attention were identified. A review of the package of services is essential to identify core procedures that must be provided at DHS.Keywords: surgical services, anaesthetic

Review of final-year medical students’ rural attachment at district hospitals in KwaZulu-Natal: student perspectives

Objectives: This study aimed to investigate the views of students involved in rural community-based medical attachments during their final year at medical school. The programme has been in existence for some time, but no formal evaluation thereof has yet taken place. This paper describes the first two phases of what is described as a quality improvement project:namely to describe the problem state and to discuss possible activities to improve the programme.Design, setting and subjects: The study adopted a mixture of quantitative and qualitative type research. Data were collected by means of a  self-administered questionnaire which students at Nelson R Mandela Medical School, University of KwaZulu-Natal, completed at the end of their Family Medicine rotation. Consent was obtained from the participants andethical approval granted by the University of KwaZulu-Natal Humanities and Social Science Ethics Committee.Results: Students were generally positive about their rural attachment experience. The majority (86%) believed that their skills adequately prepared them to enter the community. Allocation of a supervisor and rostering were found to be of great importance. Academic activities provided adequate learning opportunities. The majority (76%) of students who used hospital accommodation found it to be satisfactory, although it was an area that needed attention. Technological support was lacking. Fewer than 50% of students had access to such facilities.Conclusion: Students’ responses were generally positive about the rural attachment experience, but logistical and technological support issues, as well as that of accommodation, need to be addressed if the programme is to flourish. Community-based education in a rural district hospital can provide unique learning opportunities for students if the opportunities are identified and the programme is well managed

The stransverse mass, MT2, in special cases

This document describes some special cases in which the stransverse mass, MT2, may be calculated by non-iterative algorithms. The most notable special case is that in which the visible particles and the hypothesised invisible particles are massless -- a situation relevant to its current usage in the Large Hadron Collider as a discovery variable, and a situation for which no analytic answer was previously known. We also derive an expression for MT2 in another set of new (though arguably less interesting) special cases in which the missing transverse momentum must point parallel or anti parallel to the visible momentum sum. In addition, we find new derivations for already known MT2 solutions in a manner that maintains manifest contralinear boost invariance throughout, providing new insights into old results. Along the way, we stumble across some unexpected results and make conjectures relating to geometric forms of M_eff and H_T and their relationship to MT2.Comment: 11 pages, no figures. v2 corrects minor typos. v3 corrects an incorrect statement in footnote 8 and inserts a missing term in eq (3.9). v4 and v5 correct minor typos spotted by reader

Multiple roles of integrin-α3 in the development and maintenance of the neuromuscular junction

The neuromuscular junction (NMJ) is the synaptic contact between motoneurons and muscle, where neurotransmission results in the contraction of the muscle fibres. The basal lamina instructs NMJ development at virtually every stage. Largely, the functions of the basal lamina are mediated through interactions with cell surface adhesion receptors; however, less is known about the identities and roles of these at the NMJ. Integrin-α3 is an extracellular matrix receptor that has previously been identified at the NMJ active zones, the sites of neurotransmitter release in the presynaptic terminus. As integrin-α3 binds to laminin-α4 and other active zone components, my hypothesis is that it may be important for relaying signals provided by the basal lamina during NMJ development. In this study, the integrin-α3 knockout mouse was used to explore the functions of this protein at the NMJ. Mutants displayed defects in active zone assembly and developmental motoneuron patterning. NMJs frequently resembled those found in aged animals, and in some cases, nerve terminals were detached from the synaptic cleft. Finally, electrophysiological analysis revealed defects in neurotransmission at mutant NMJs, including reduced efficiency of synaptic vesicle release, and impaired sensitivity of nerve terminals to external Ca2+. Previous studies have implicated integrin-α3 in muscle development; however, I find no expression of integrin-α3 in the muscle, and no defects in myogenesis in integrin-α3 mutants. These results indicate multiple roles for integrin-α3 at the NMJ, for active zone assembly, adhesion of nerve terminal, morphological integrity and neurotransmission. To my knowledge, this study identifies for the first time a cell surface receptor for the anchorage of pre- and postsynaptic elements at the NMJ. These results suggest that alterations in integrin-α3 expression or function may underlie some of the changes associated with ageing at the NMJ, and that mutations in its encoding gene may cause myasthenic syndromes

Innovative techniques for local community engagement on climate change adaptation

Abstract: Climate change adaptation requires communities to prepare for both extreme weather events and the more gradual shifts that a changing climate may bring. Our project designed and evaluated several face-to-face activities to engage communities in North East Victoria on climate change adaptation. The objective was ultimately to help vulnerable people in the community become more resilient by connecting them with resources and supportive networks. The workshops tested several innovative community engagement activities, including storytelling, visioning and creative practice. These activities responded to a body of research on best-practice approaches for engaging community elders and leaders as spokespeople and peer educators, as well as research on deliberation and the use of story to locate sustainability experiences in an emotional landscape. The workshops used existing community networks to multiply their potential impact, and took place in communities that had experienced extreme climate events (drought, fire and flood) firsthand. We present a toolkit of ten community engagement activities drawing on the experience of these workshops. We contend that these activities are potentially replicable by local governments and other stakeholders in climate change adaptation. Further, they can bring to life the many and varied materials created by various agencies about preparation for climate change

Audit of failure rate of sulfadoxine/pyrimethamine combined with chloroquine to treat falciparum malaria at single fourteen-day follow-up

Objective. To assess the failure rate of the present first line treatment regime for uncomplicated falciparum malaria of sulfadoxine/pyrimethamine combined with chloroquine. Design. A before-after study1 Setting. Ndumo Clinic, Ingwavuma District, South Africa, October 2000 Study Group. 55 patients presenting to Ndumo clinic with uncomplicated malaria and malaria trophozoites visible on thin film. Main outcome measures:Trophozoite count on thick film at day 14. Results. 15 out of 37 patients who returned for follow-up still had trophozoites on thick film. Symptoms of most patients at day 0 and day 14 were mild, parasite counts before and after treatment were low, and trophozoites were atypical. Conclusions. There appears to be an unacceptably high day 14 failure rate with the combination of sulfadoxine/pyrimethamine and chloroquine.The mildness of symptoms, low parasite counts and atypical trophozoites suggest immunity to falciparum malaria amongst the local population. With few antimalarials to chose from, the difficult question as to future treatment of uncomplicated malaria arises. Keywords: Falciparum malaria, chloroquine, sulfadoxine, pyrimethamine SA Fam Prac Vol.25(3) 2002: 4-

A panel of kallikrein markers can predict outcome of prostate biopsy following clinical work-up: an independent validation study from the European Randomized Study of Prostate Cancer screening, France

<p>Abstract</p> <p>Background</p> <p>We have previously shown that a panel of kallikrein markers - total prostate-specific antigen (PSA), free PSA, intact PSA and human kallikrein-related peptidase 2 (hK2) - can predict the outcome of prostate biopsy in men with elevated PSA. Here we investigate the properties of our panel in men subject to clinical work-up before biopsy.</p> <p>Methods</p> <p>We applied a previously published predictive model based on the kallikrein panel to 262 men undergoing prostate biopsy following an elevated PSA (≥ 3 ng/ml) and further clinical work-up during the European Randomized Study of Prostate Cancer screening, France. The predictive accuracy of the model was compared to a "base" model of PSA, age and digital rectal exam (DRE).</p> <p>Results</p> <p>83 (32%) men had prostate cancer on biopsy of whom 45 (54%) had high grade disease (Gleason score 7 or higher). Our model had significantly higher accuracy than the base model in predicting cancer (area-under-the-curve [AUC] improved from 0.63 to 0.78) or high-grade cancer (AUC increased from 0.77 to 0.87). Using a decision rule to biopsy those with a 20% or higher risk of cancer from the model would reduce the number of biopsies by nearly half. For every 1000 men with elevated PSA and clinical indication for biopsy, the model would recommend against biopsy in 61 men with cancer, the majority (≈80%) of whom would have low stage <it>and </it>low grade disease at diagnosis.</p> <p>Conclusions</p> <p>In this independent validation study, the model was highly predictive of prostate cancer in men for whom the decision to biopsy is based on both elevated PSA and clinical work-up. Use of this model would reduce a large number of biopsies while missing few cancers.</p

Sea anemones may thrive in a high CO2 world

Increased seawater pCO 2, and in turn 'ocean acidification' (OA), is predicted to profoundly impact marine ecosystem diversity and function this century. Much research has already focussed on calcifying reef-forming corals (Class: Anthozoa) that appear particularly susceptible to OA via reduced net calcification. However, here we show that OA-like conditions can simultaneously enhance the ecological success of non-calcifying anthozoans, which not only play key ecological and biogeochemical roles in present day benthic ecosystems but also represent a model organism should calcifying anthozoans exist as less calcified (soft-bodied) forms in future oceans. Increased growth (abundance and size) of the sea anemone (Anemonia viridis) population was observed along a natural CO 2 gradient at Vulcano, Italy. Both gross photosynthesis (P G) and respiration (R) increased with pCO 2 indicating that the increased growth was, at least in part, fuelled by bottom up (CO 2 stimulation) of metabolism. The increase of P G outweighed that of R and the genetic identity of the symbiotic microalgae (Symbiodinium spp.) remained unchanged (type A19) suggesting proximity to the vent site relieved CO 2 limitation of the anemones' symbiotic microalgal population. Our observations of enhanced productivity with pCO 2, which are consistent with previous reports for some calcifying corals, convey an increase in fitness that may enable non-calcifying anthozoans to thrive in future environments, i.e. higher seawater pCO 2. Understanding how CO 2-enhanced productivity of non- (and less-) calcifying anthozoans applies more widely to tropical ecosystems is a priority where such organisms can dominate benthic ecosystems, in particular following localized anthropogenic stress. © 2012 Blackwell Publishing Ltd

Measuring Invisible Particle Masses Using a Single Short Decay Chain

We consider the mass measurement at hadron colliders for a decay chain of two steps, which ends with a missing particle. Such a topology appears as a subprocess of signal events of many new physics models which contain a dark matter candidate. From the two visible particles coming from the decay chain, only one invariant mass combination can be formed and hence it is na\"ively expected that the masses of the three invisible particles in the decay chain cannot be determined from a single end point of the invariant mass distribution. We show that the event distribution in the $\log(E_{1T}/E_{2T})$ vs. invariant mass-squared plane, where $E_{1T}$, $E_{2T}$ are the transverse energies of the two visible particles, contains the information of all three invisible particle masses and allows them to be extracted individually. The experimental smearing and combinatorial issues pose challenges to the mass measurements. However, in many cases the three invisible particle masses in the decay chain can be determined with reasonable accuracies.Comment: 45 pages, 32 figure

Ising-like antiferromagnetism on the octahedral sublattice of a cobalt-containing garnet and the potential for quantum criticality

In this contribution, we report that CaY2Co2Ge3O12 exhibits an unusual anisotropic and chainlike antiferromagnetic arrangement of spins despite crystallizing in the highly symmetric garnet structure. Using low-temperature powder neutron diffraction and symmetry analysis, we identify a magnetic structure consisting of chainlike motifs oriented along the body diagonals of the cubic unit cell with moments pointing parallel to the chain direction due to the strong Ising character of the Co ions. Antiferromagnetic order sets in below 6 K and exhibits both temperature- and field-induced magnetic transitions at high fields. Combining the results, we present a magnetic phase diagram that suggests CaY2Co2Ge3O12 undergoes a quantum phase transition at low temperatures and moderate fields