No description available.

'Sangoma Boy' is the first book in an intended four-book series. The series is about three children who are brought together because of their parents' romantic involvement and who, by the end of the first book, come to identify themselves as 'The Bundu Bashers'. The idea for the Bundu Bashers series came to me when I was visiting at my parents' house in Cape Town, South Africa, in January, 2008. I had a newborn daughter who had to be breastfed every three hours as well as a ferociously jealous toddler son in tow, so my movements were pretty limited. It was a little difficult to go out to see childhood friends but lots of people dropped by to say hello and share a 'braai' (or barbecue) which is what you do just about every evening in the South African summer. One evening, one of these informal braai parties included Julia Raynham, my mother's goddaughter. I offered her some meat from the braai and she said yes, but not mutton because she was a sangoma now and there was a restriction on eating mutton. To say I was astonished is an understatement. A sangoma is a traditional African healer and diviner, versed in the arcana of plant medicine and spirit intercession. But Julia? My mother's goddaughter, no less? She was a whitey, just like me. We used to dive spoons together out of her parents' vast and twinkling swimming pool under the oak trees, in our walled-off privileged white childhood during apartheid. How could she possibly be a sangoma? Admittedly I'd been a bit busy in England with starting a career and squeezing out the babies, but the last time I saw Julia she was a keyboardist in a popular lounge band, The Honeymoon Suites, we used to go and bop to on Friday nights. I knew that she had been ill and I knew her long-term relationship had ended. But a sangoma? After a lengthy talk that night I understood a little better what Julia had been through since I saw her last. One doesn't chose to become a sangoma - one gets chosen. The first signs of being chosen are not pleasant, and usually include illness or affliction. With Julia, it was an onset of numbness in her legs, followed by a host of other complaints. Whilst in the grip of the illness, the sufferer sometimes has a vision, where they will be told to go to a certain house or place, or sometimes they just unexpectedly come into contact with a sangoma. Julia dreamt she needed to go to an art gallery in Johannesburg. At this stage she knew nothing about sangomas but the dream was so compelling that she did visit the gallery. At the gallery, a black cleaner put down her bucket and mop, walked over to Julia and asked her if she had been unwell recently, and experiencing peculiar dreams. This is the beginning of 'ukuthwasa' - the long period of training before the 'thwasa' (the initiate) emerges as a diviner. I mulled the whole thing over in the long night that followed while I was up feeding my daughter. So white people could be 'thwasana' now? That got me thinking. What if you were a person who was mixed-race, both white and black, with roots in Africa but living in England? And you experienced the calling? No wait, what if you were a child? In England? No, in Finchley specifically. Because we'd moved to leafy Finchley from gritty Hornsey, a year and a half before on account of my son. The children of Finchley were all over the place all the time. I could watch them and see what they did. And propped up there in the pillows of the bed with my little girl, I had a William Goyen moment. I'd never written a children's novel before. I didn't know if I could. But I knew I was due back at work in a few months. At that point I'd get the baby on a bottle, I'd hire a nanny, and I'd start stealing whatever bits of time I could to write. I had an adult novel to finish but as soon as that was off to the publishers, my whole attention for years to come was going to turn to this young boy in Finchley and exactly what happened to him.

In most African communities, the concept of disease goes beyond physical and mental pain. To many, societal imbalance, bad-luck, poverty and misery, misfortune, continuous unemployment and a host of others are treated as diseases. Despite biomedical attempts to explain and treat diseases, an ancient system of healing (traditional medicine) continues to thrive in Africa. The World Health Organization (WHO) has since recognized and encouraged governments to accept traditional medicine as an alternative healthcare; to adopt healthcare policies that will promote traditional medicine. Despite this call for recognition, most governments are still reluctant to officially incorporate traditional healing into healthcare policies. Countries which have recognized the relevance of traditional medicine face greater challenges on modalities to control and include traditional medicine into mainstream healthcare. This study is concerned with the role and contribution of African traditional medicine to healthcare, in an era of biomedicine. It provides a public and self assessment of traditional healers. The study also raises concerns on the need for healthcare policies that will enhance cooperation between traditional healing and biomedicine. Information was obtained through the use of questionnaires, in depth and face-to-face interviews with respondents. The actual field research was conducted in Qokolweni location in the King Sabatha Dalindyebo (KSD) district municipality of Eastern Cape Province, Republic of South Africa. Findings reveal that traditional healers handle and manage complex hospital diagnosed health conditions. It also reveals that perceptions on disease aetiology influence health seeking behaviour. It is therefore necessary to understand the efforts of traditional healers in order to formulate healthcare policies that would officially involve them in the mainstream healthcare in South Africa. It is noticeable that traditional healing is not only limited to Qokolweni. It occurs mutatis mutandis else wherein the Eastern Cape and in the whole of South Africa.

Background: Despite the development of new drugs and success of social programs, tuberculosis remains a leading cause of mortality. This burden falls disproportionately on developing countries where the high burden of HIV has a potentiating e↵ect, but may soon return to areas where it was previously brought under control as resistant strains continue to emerge. In the Western Cape, two closely related strains of the Beijing family have been isolated that provide an opportunity to study virulence in a system with relatively little noise. The aim of this project was to identify the cause of the altered virulence displayed between the two strains, and describe how the di↵erences between the two genomes contributed to the phenotypic di↵erences. Results: GenGraph allows for the creation of graph genomes, and facilitated the creation of a pan-transcriptome that allowed for the mapping of gene annotations between isolates. This allowed for the mapping of reads to a more suitable Beijing family reference while interpreting the results with annotations from the H37Rv reference. We generated expression and target profiles for the known sRNA, and identified a large number of novel sRNA. Transcriptomic data from 4 di↵erent growth conditions was integrated with this sRNA data as well as variant data using the Cell pipeline. From this data we identified multiple sets of genes linked to copper sensing in MTB, including the di↵erentially expressed MoCo operon. Increasing evidence that macrophages use copper to poison bacteria trapped in their phagosomes provides the link to virulence and pathogenicity. Conclusions: Through the integration of data from multiple data types we were able to elucidate the most probable cause of the altered virulence found between the two isolates in this study. We developed reusable tools and pipelines, and noted a large number of undescribed sRNA expressed in these isolates. The identification of the copper response as a chief contributor to the phenotype increases both our understanding of the isolates, and the role of the element in infection. These results will be key in guiding further investigation of the variant linked genes to identify those linked to copper homeostasis or response.

Over 2.5 million children are infected with HIV, the majority of whom reside in Sub-Saharan Africa. Treatment coverage is steadily gaining momentum, reducing mortality and morbidity. Yet little is known about brain development in HIV-infected (HIV+) children who are on highly-active antiretroviral therapy (ART), with viral load suppression from a young age. Here, we use resting state fMRI (rs-fMRI) to examine the impact of HIV and ART on the development of functional networks in 9-year-old vertically HIV-infected children compared to age-matched controls of similar socioeconomic status. We present analyses for a sample of 40 HIV+ (9.2 ± 0.20 years; 16 males) children from the Children with HIV Early Antiretroviral (CHER) clinical trial (Cotton et al. 2013; Violari et al. 2008) and 24 uninfected (12 exposed; 12 males; 9.6 ± 0.52 years) controls from an interlinking vaccine trial (Madhi et al. 2010). Scans were performed at the Cape Universities Body Imaging Centre (CUBIC) in Cape Town, South Africa. We investigated HIV-related differences in within- and between-network functional connectivity (FC) using independent component analysis(ICA) and seed-based correlation analysis (SCA). For SCA, seeds were placed in the structural core, in regions implicated in HIV-related between-group differences at age 7 years, and in regions associated with neuropsychological domains impaired in our cohort. In addition, we evaluated associations of past and present immune health measures with within-network connectivity using ICA. We found no HIV-related intra-network FC differences within any ICA-generated RSNs at age 9 years, perhaps as a result of within-network connectivity not being sufficiently robust at this age. We found a positive association of CD4%, both current and in infancy, with functional integration of left lobule 7 into the cerebellum network at age 9 years. Long-term impact of early immune health supports recently-revised policies of commencing ART immediately in HIV+ neonates. ii Compared to uninfected children, HIV+ children had increased FC to several seeds. Firstly, to seeds associated with the planning and visual perception neuropsychological domains. Secondly, to structural core seeds in the extrastriate visual cortex (of the medial visual network) and the right angular gyrus (of the temporoparietal network). Finally, to left paracentral (somatosensory network) and right precuneus (posterior DMN) seeds previously revealing between-group differences at age 7 years. The connections with greater FC in HIV+ children may variously indicate functional recruitment of additional brain capacity, immature excess of short-range connections, and/or immature excess of between-network connections. In conclusion, despite early ART and early virologic suppression, HIV+ children demonstrate instances of abnormal FC at age 9 years. Disruption to visual cortex is marked, consistent with indications from neuropsychological testing that visual perception is disrupted. The profile of HIV- and/or ART-related effects on FC differs considerably between the two ages of 7 and 9 years, but both show characteristics of immature functional organisation compared with age-matched controls.

Problem and Motivation: Posterior rotator cuff injuries are common (Yamaguchi et al., 2006), (Neri et al., 2009) and often debilitating and irreparable (Sim et al., 2001). Latissimus dorsi (LD) tendon transfers have been shown to be an effective treatment for these massive or irreparable tears (Habermeyer, 2006), (De Casas et al., 2014). This procedure can have unpredictable outcomes (Ling et al., 2009). This is partially caused by discrepancies in the suggested insertion site for the LD tendon during transfers. The current literature is composed of in-silico studies which ignore the practicalities of the human body (Magermans et al., 2004), in-vivo studies which use subjective pain scores, and small scale cadaver trials. For these reasons, a study is needed that uses the power of in-silico modeling in a way that is verified using in-vitro testing on cadavers. Aims and Objectives: The aim of this study is to determine the effects of varying the insertion point of the LD tendon on the humeral head to treat posterior rotator cuff tears in terms of the effects on strength, primarily in rotation and in flexion over a range of motion. The objectives are to use an in-silico model to define the effects of various insertion points and validate this model using a cadaver trial before presenting the final findings. Methods: In-silico Model The Upper Extremity Model (Holzbaur et al., 2005) was used to simulate tendon transfers. The moment arms in flexion and rotation were measured and recorded at angles of 0° and 90° of forward ix elevation. The moment arms at each point were then projected onto humeral maps to display the results. Cadaver Trial Four fresh frozen cadaver torsos (eight shoulders) were mounted into a specifically designed rig. The LD was transferred to 7 points illustrative of the humeral head. The strain generated by the humerus in rotation on the clamps was measured at 0° and 90° of forward flexion for each point. These were then compared. Results In-silico Model The in-silico moment arm maps were generated and analysed. The optimal point for external rotation at 0° of flexion was the lesser tuberosity. Moment arms to produce external rotation were found over the entire greater tuberosity. Flexion was only generated on the posterior edge of the greater tuberosity. At 90° of flexion, little to no rotation generating moment arms were found in the lesser tuberosity and the anterior ridge of the greater tuberosity. Rotation generating moment arms were not significantly different between the posterior edge and the face of the greater tuberosity. No areas generated flexion moment arms. Cadaver Trial At 0° of flexion, the lesser tuberosity (point 1) generated the most flexion, with the greater tuberosity (points 2-7) also generating external rotation, but at reduced levels. At 90° of flexion, the lesser tuberosity and the anterior ridges of the greater tuberosty (points 1-3) generated no significant rotation. The posterior ridge and face of the greater tuberosity generated similar amounts of flexion, greater than points 1-3 Conclusions: The in-silico model was validated in rotation by the cadaver trials and this validation was extended to flexion. For maximum rotation strength at 0° of flexion and no flexion strength, the x lesser tuberosity is the optimal point. For maximum rotation strength and no flexion throughout the motion of flexion, the middle of the face of the greater tuberosity is the optimal area. For maximum rotation throughout the motion of flexion, points 4 and 5 (the posterior edge of the greater tuberosity) represent the optimal area for insertion. This area represents the optimal compromise in terms of range of motion and strength.

No description available.

This thesis seeks to address two distinct sets of criticisms that have been offered at medical practice. The first criticism suggests that medicine today is too exclusive in its application of the term 'disease.' As a consequence, important biological phenomena are marginalized by physicians and scientists. The second criticism suggests that medicine has been too inclusive in its understanding of disease. As a result, many biological phenomena that were once considered 'natural' or 'normal' aspects of human life are now given a medical dimension that they previously did not have. The goal of this thesis is to understand why two seemingly contradictory criticisms have been applied to the same practice. To answer this question, I invoke Edmund Husserl's important analysis of modern science to argue that medicine suffers from a problem of 'naive objectivism.' This problem is present under the dominant paradigm of medical diagnosis, the biomedical model. Having identified the source of these two criticisms, my goal is to then develop new models of medical practice that can address these criticisms. First, I turn to John Dewey's philosophical naturalism to develop a medical model that can address the problem of exclusion in biomedicine. Then, I turn to Martin Heidegger?s existential analytic to develop a medical model that can address the problem of inclusion in biomedicine. I supplement both of these analyses with research generated in the medical humanities fields, attempting to show how the biomedical model of medicine fails to meet the goals of medical care. The end result of such analysis is the development of two new medical models that can serve to replace the biomedical model. I offer no attempt to adjudicate between these two models, instead leaving such issues to be handled by the patient and the physician throughout the course of his or her treatment.

1998 Dozier Award Winner / It is widely recognized that the role of the physician has undergone dramatic changes in the last century changes which have serous implications for the patient-physician relationship. This is an ethnographic study examining how certain changes in the role and abilities of biomedical physicians have affected patient attitudes and expectations about end-of-life care. In-home interviews were conducted with eighteen persons age fifty-five and older, including a sample of Hemlock Society members. Results indicate a broad spectrum of end-of-life concerns including capacity, autonomy, pain, and burden to loved ones. Most participants reported a reluctance to begin a discussion of death or future deteriorating capacity with their physicians. Instead, when conversations about death were reported, they had been largely limited to the scenarios of catastrophic illness (e.g., hospitalization, ventilator, etc.) and the Living Will. While this discussion does not overlook the utility of the Living Will, it proposes that reliance on this document for preparing patients for end-of-life care is inadequate.

Ph.D., Faculty of Science, University of the Witwatersrand, 2011 / This study investigated the effect of exogenous melatonin administration on transient global cerebral ischemia and adult neurogenesis in adult male Sprague- Dawley rats. It also determined serum melatonin concentrations in all the experimental groups and established any effect of melatonin on estimated total granule cell numbers. Adult male Sprague-Dawley rats were divided into eight groups with each group consisting of 6 rats (n = 6). Post-induction time durations of 72 hours and 7 days was used. Single dose of 5 mg/kg exogenous melatonin was administered at each phases of 30 minutes before and after a 10 minutes transient bilateral occlusion of the common carotid arteries in the different groups, followed by reperfusion. Rats were anesthetized with 20 mg/kg of ketamine and 2.5 mls of blood was collected via cardiac puncture for estimation of serum melatonin concentration using commercially prepared radioimmunoassay ELISA kit. Free floating brain sections cut at 50 μm were immunostained for Ki-67, marker for proliferating cells. The total granule cell number in the dentate gyrus was estimated using the optical fractionator method on plastic embedded brain sections. Mean melatonin concentration (pg/mol) was 268.54 ± 28.73 (72 hours) and 277.83 ± 28.73 (7 days) compared to the sham control; 266.94 ± 37.6 and non surgical 262.96 ± 23.85 respectively. Differences in the concentration were not statistically significant (P<0.05). Histological finding indicated neuropil disruption with potentiation of restoration as the post ischemia days progressed in the melatonin administered groups. The estimated total granule cell number in the dentate gyrus of the hippocampus was not affected by exogenous melatonin administration. However, there was potentiation in proliferations of the neurogenic niche in the dentate gyrus of the hippocampus demonstrating a very strong indications that melatonin enhanced the generations of proliferating cells in adult male Sprague-Dawley rats.