The challenge we face today is identification of the mechanisms through which dietary factors perturb fundamental fatty acid (FA) pathways in cancer cells. In principle, insight into a lipid model for the cancer entity under assessment is required. This prompted and investigation into FA role-players that drive cellular over-production and apoptotic pathways under circumstances where environmental factors impede essential fatty acid metabolism (EFAM) that contributes to colorectal cancer (CRC). Ultimately, better understanding of FA metabolic pathways followed under colorectal pathological conditions can contribute to improved therapies by which growth and recurrence of this disease may be obviated. PURPOSE OF STUDY: The primary goal of this study was to construct clinically relevant ex vivo FA profiles from a lipid model for colorectal adenocarcinoma, not previously reported in the literature. Aims were to identify prominent FA role-players and to debate their involvement in different signaling pathways. The final purpose of this study was to present a rationale for adjuvant FA therapies to improve the management of CRC. MATERIAL AND METHODS: The study group consisted of CRC biopsies (TNM staging, mostly T2/T3) and normal colorectal mucosal biopsies, (n8 of each group). Biopsy selection was hampered by difficult circumstances, since most patients received treatment prior to surgery. All the lipid analyses were personally conducted at the Biolipid Division of the Department Biochemistry at the University of the Free State (UFS) as follows: lipids were extracted; total lipids (TLs) were fractionated into neutral lipids (NLs) and phospholipids (PLs); phosholipid subclasses, i.e. phosphatidylcholine, (PC), phosphatidylserine (PS), phosphatidylethanolamine (PE) and phosphatidylinositol (PI), were separated; and fatty acid methyl esters of all the classes and subclasses were analyzed. Lipid analyses were done according to well established and internationally accepted gaschromatography (GLC) and thin layer chromatography (TLC) techniques. Statistical analyses were performed by a biostatistician attached to the UFS, and p-values and 95% confident intervals (95% CI) for median of differences, as well as specific ratios were calculated. MAIN RESULTS AND DISCUSSION: The ex vivo phospholipid FA profile for CRC cells revealed linoleic acid (LA), arachidonic acid (AA), palmitic acid (PA) and oleic acid (OA) as main role-players involved in CRC. An extensive literature study revealed that: prolonged inflammatory responses and oxidative events, marked by the up-regulation of cyclooxygenases (COXs) and inducible nitric oxide synthase (iNOS), contribute to colorectal carcinogenesis; and prolonged cytokine mediated responses, orchestrated by nuclear factor-kappa Beta (NF-κβ) with consequent immunodeficiency, are prevalent in CRC patients. Past research revealed without doubt that high dietary AA intake (meat) and COX-2 metabolism play a pivotal role during colorectal carcinogenesis. CRC is a stress-related cancer and it is plausible that high iron intake and lipids contribute to chronic inflammation and radical-mediated cell damage in this age-related disease. Current research directions in CRC concern LOX metabolism and peroxisome proliferator activator receptors (PPARs) are receiving much attention, especially PPARδ/β that was an enigma and elicited controversial debate in adenomas (polyps) and adenocarcinoma. Taken together at this point in time, the impact of environmental factors on essential fatty acid metabolism (EFAM) that impede LA conversion to AA via delta-6 and -5 desaturase (Î6d and Î5d) pathways with up-regulation of the fatty acid synthase (FAS) and Î9d pathways, and the down-regulation of LA oxidative metabolism via the 15 LOX-1 pathway with up-regulation of the COX-2 and 15- LOX-2 pathways of AA, is characteristic of colorectal carcinogenesis. Seen in context, the lipid findings of this study integrated with evidence-based information in the literature encompasses the following: excessive dietary linoleic acid (LA) intake that can contribute to cell proliferation, radical-mediated cell damage, and the production of conjugated linoleic acid (CLA) in the gut; high dietary AA intake and COX-2 over-expression that play a pivotal role during carcinogenesis and immune responses with consequent exhaustion of the AA source; enhanced FAS and Î9d activities that contribute to, respectively, enhanced palmitic acid (PA) and oleic acid (OA), is prevalent in CRC cells. The high PA content in CRC cells apparently activates PPARδ/β and thereby suppresses apoptosis, a crucial factor in the pathobiology of CRC. The link between OA and CRC still needs proper clarification. It is conceivable that the high saturated fatty acid (SFA) content observed in CRC cells, exogenous intake with red meat and endogenous production by enhanced FAS activity, contribute to colorectal carcinogenesis and immunodeficiency in CRC patients, since it can stimulate COX-2 expression (and PGE2 activity) and downregulate the Th1 immune pathway that make CRC a Th2 dominant disease. Taken in consideration that lipid rafts rich in SFAs down-regulate the Th1 cytokine subset, particularly interleukin-2 (IL-2) that stimulates lymphocyte production, it is plausible that management of the CRC patient is hampered by immunodeficiency. All the altered cell signaling pathways in CRC debated in this study served as sound foundation for clinical intervention with adjuvant FA therapeutic strategies to improve CRC management. CONCLUSION: The identification of prominent FA role-players in CRC cells that serve as ligands for specific PPAR family members contributed to the assessment of FA driven proliferation and apoptotic pathways characteristic of CRC. It is conceivable that enhanced PA (and LA) contributes to PPARδ/β over-expression that can suppress PPARγ (and PPARα) activity and then tilts the scale in favor of apoptotic resistance and survival of CRC cells. From an epidemiological viewpoint, excessive iron and SFAs seem to be important co-factors in the multifactorial etiology of CRC. The biohydroxygenation of LA to different CLA products in the gut and to what extent harmful CLA products may pose a danger need to be fully explored, especially since the uptake of beneficial products is apparently limited. Among current therapeutic options in the field of lipids, concurrent therapy with a COX-2 inhibitor (Celecoxib) and docosahexaenoic acid (DHA) to improve membrane fluidity and the impact of drug therapy entered clinical trials and although the outcome is still awaited, the impact of DHA on lymphocyte production may be a concern. Based on a mountain of evidence presented in this study, it is suffice to say that there is a rationale for additional adjuvant FA therapies that can be included in the existing therapeutic regime for CRC management. Firstly, CLA and EPA therapy for prevention of polyp recurrence and improvement of immunocompetence in CRC patients and secondly, GLA and EPA therapy in the management of patients with a history of polyp growths is proposed.

Background: The dose of inhaled medication reaching a patient is dependent on drug formulation, method of delivery, output and correct use of the delivery device and frequency of use. The most commonly used aerosol drug delivery device in preschool children is the pressurised metered-dose inhaler (pMDI) -spacer. This study evaluated strategies for improving the delivery of inhalation therapy in preschool children by focusing on factors affecting the optimal use of pMDI-spacers and on the frequency of their use as determined by adherence to prescribed drug regimes. The study was divided into two parts. Part 1 examined the number and type of breaths needed for efficient drug delivery through a pMDI-spacer in preschool children. Part 2 was a randomised, controlled, prospective clinical trial in which a comparison was made between an incentive spacer device and a small volume spacer with respect to adherence, correct device use (spacer technique) and clinical outcome. Overall aims: ⢠To determine how many tidal breaths are required to effectively inhale medication from different types of spacer/ valved holding chamber devices, and to determine the efficacy of a single maximal inhalation for drug delivery in young children. ⢠To investigate the relationship between factors that determine dose delivery of inhaled asthma maintenance therapy and symptom control in preschool asthmatic children. ⢠To determine the influence of an incentive inhalation delivery device on drug delivery and clinical outcome in preschool asthmatic children. Part One (Chapters Two and Three): Background: The pMDI-spacer combination is currently the most commonly used method of drug delivery to preschool asthmatics. A patientâs competence in using a pMDI-spacer is an important part of drug delivery. Preschool children are instructed to breathe normally (tidally) through spacer devices. There is little evidence on the number of breaths required for optimal drug delivery. Whether the single maximal breath technique has a place in spacer use in preschool children also remains unclear. Due to a lack of data, authors of asthma guidelines have been unable to give evidence-based instruction on how a preschool child should breathe through a spacer. Aims: To determine the optimal method of breathing through a spacer for preschool asthmatic children to ensure effective drug delivery. Hypothesis: Based on technical data on in vitro spacer performance and knowledge of tidal flow patterns in young children the hypothesis is that a limited number of breaths would be sufficient for efficient drug inhalation via spacer in preschool children. Methods: A method for reliably recording and simulating breathing of patients using pMDI-spacer devices was designed, constructed and validated. Breathing flow patterns were recorded in preschool children inhaling placebo from spacers. The breathing patterns were reproduced by a breathing simulator which was connected to spacer devices. Breathing patterns previously recorded using each specific type of spacer, were simulated with the corresponding spacer type. To estimate delivery, the mass of salbutamol was measured on a filter interposed between the spacer and the simulator. Four different spacer devices, the Aerochamber Plus®, Funhaler®, Volumatic® and a modified 500ml plastic soft drink bottle were tested with a salbutamol pMDI. The effect of different numbers of tidal breaths and that of a single maximal breath on drug delivery were compared. Results: Drug delivery via the Funhaler® mean (95CI) was 39% (34-43) and 38% (35-42) of total dose recovered from filter, pMDI and spacer, for two and nine tidal breaths respectively. Drug delivery via the Aerochamber Plus mean (95CI) was 40% (34-46) and 41% (36-47) for two and nine tidal breaths respectively. There was no significant difference in drug delivery after three tidal breaths mean (95CI) 40% (36-44%) and nine tidal breaths nine tidal breaths; mean (95CI) 37% (33-41) for the Volumatic®. With the (unvalved) modified soft drink bottle, there was no significant difference in drug delivery between two, five or nine tidal breaths. Inhalation volumes were almost double the expected tidal volumes. The inhalation volume means (SD) of subjects using the Aerochamber Plus®, the Funhaler®, the Volumatic® and the modified soft drink bottle were respectively 393ml (247), 432ml (225), 384ml (185), 445ml (167) during tidal breathing and 515ml (164), 550ml (239), 503ml (213), 448ml (259) for the single maximal breath manoeuvre. 100% of seven year old children, 84% of six year olds, 76% of five year olds, 38% of four year olds and 20% of three year olds could perform a single maximal breath manoeuvre. Nine tidal breaths resulted in significantly greater drug delivery to filter than single maximal inhalation for both the Funhaler® (p=0.04) and the Volumatic® (p=0.01). There was no significant difference in drug delivery to filter between single maximal inhalation and nine tidal breaths with both the Aerochamber Plus® and the modified soft drink bottle. Conclusion: In preschool children, two tidal breaths were adequate for drug delivery through small volume valved spacers and a 500ml modified soft drink bottle. For a large volume spacer, three tidal breaths were adequate for drug delivery. Part Two (Chapters Four and Five): Background: Drug delivery by pMDI-spacer is determined by many different factors, including spacer technique and adherence to prescribed medication. The effect of both spacer technique and adherence on clinical outcome has been demonstrated in older asthmatics. In this part of the thesis the influence of these factors on clinical outcome in preschool asthmatics was firstly investigated. Thereafter, the additional influence of an incentive spacer device on adherence, spacer technique and clinical outcome was also assessed. Aims: ⢠To investigate the effect of proficiency in spacer technique, as measured by deposition of drug inhaled onto a filter, on clinical outcome in preschool asthmatic children. ⢠To investigate the effect of adherence to prescribed inhaled asthma medication on clinical outcome in preschool asthmatic children. ⢠To investigate the influence of the use of an incentive spacer device on inhaled drug dose, adherence to prescribed treatment and clinical outcome in preschool asthmatic children. Hypothesis: ⢠Proficiency in spacer technique correlates positively with improved clinical outcome. ⢠Good adherence to prescribed medication regimens correlates positively with improved clinical outcome. ⢠Use of an incentive spacer device, the Funhaler® , improves both competency in spacer technique and adherence to prescribed medication and thereby improves clinical outcome in preschool children with asthma. Methods: A prospective randomised, controlled clinical trial was performed. Subjects were two to six year old children who had doctor-diagnosed asthma and were on daily maintenance therapy with inhaled corticosteroids. Maintenance therapy was delivered by Funhaler® in the study group and Aerochamber Plus® in the control group. Subjects were assessed for the following outcomes at three-monthly intervals for one year: (1) Proficiency in spacer technique was measured at each study visit by measuring the drug dose deposited on a filter interposed between the subject and the spacer. (2) Adherence was monitored using an electronic monitoring device (Smartinhaler) (3) Asthma symptoms were monitored using diary cards. (4) Quality of life (QoL) was measured using the PedsQL questionnaires. (5) Lung function was monitored using the forced oscillation technique. The Funhaler group was then compared with the Aerochamber Plus group in terms of determinants of drug delivery and markers of clinical outcome. Results: One hundred and thirty two subjects were included in the study. One hundred and eleven patients (84%) completed the study. By the six month follow-up, significantly more subjects in the Funhaler group had dropped out of the study (p=0.04). Throughout the clinical trial, there was large intra-subject variation in proficiency in spacer technique, as measured by drug dose deposited on filter. Individual patient drug doses recovered from the filters ranged from zero to 136μg (calculated as the mean of five 100μg pMDI actuations). There was no significant correlation between proficiency in using the delivery device and any measure of asthma control (p > 0.05). Correcting for age, gender, and adherence to prescribed medication did not influence the results. Inter subject variability in adherence to prescribed medication was extremely high throughout the study. Adherence to prescribed medication ranged from 1% to 99%. There was a significant correlation between adherence to prescribed medication and nights without wheeze, throughout the study period (r = 0.01; p = 0.01). The correlation between adherence to prescribed medication and nights without wheeze remained after correcting for age, gender, proficiency in spacer technique, and the number of nights without wheeze at the baseline visit (r = 0.01; p = <.01). There was also a significant correlation between adherence to prescribed treatment and (daytime) days without wheeze (r = 0.01; p = 0.01). The correlation ceased to be significant after correcting for age, gender, proficiency in spacer technique, and (daytime) days without wheeze at the time of the baseline visit. There was a significant correlation between adherence to prescribed medication and bronchodilator free days (r = 0.01; p = 0.02) throughout the study. After correcting for age, gender, proficiency in spacer technique, and bronchodilator free days at baseline, the correlation between adherence to prescribed medication and bronchodilator free days remained significant (r = 0.01; p = 0.01). There was no significant correlation between adherence and other markers of clinical outcome. After correcting for age and gender, the Funhaler group demonstrated significantly higher proficiency in spacer technique as determined by filter dose (p = 0.05). The improved proficiency in spacer technique in the Funhaler group was limited to subjects who were younger than 4 years of age at the baseline visit (p < 0.01). There was no significant difference in adherence to prescribed medication between the Funhaler group and the Aerochamber Plus group (p = 0.93). Correcting for age and gender did not influence the results. At the start of the clinical trial (baseline visit), the Funhaler group reported significantly less days without wheeze (p = 0.03), and significantly less bronchodilator free days (p = 0.02) than the Aerochamber Plus group in the seven days before the baseline visit. The Funhaler group also scored lower than the Aerochamber group in terms of QoL scores at the time of randomisation (p = 0.05). Where needed, various measures were used to correct for the significant differences at baseline, between the Funhaler group and the Aerochamber Plus group. There was no significant difference between the Funhaler group and the Aerochamber Plus group in terms any of clinical outcome measures used. Correcting for age, gender did not influence the results. Discussion: Use of the Funhaler® therefore appeared to specifically improve drug delivery in those subjects who, with a conventional spacer, would have inhaled very low doses of medication. The Funhaler® was therefore partially successful as an incentive device, as its use positively influenced drug delivery in a specific sub-group of preschool children. Proficiency in spacer technique did not translate to improved clinical outcomes. Various reasons for the lack of association between proficiency in spacer technique and clinical outcome, including the inevitable inherent limitations in design in a clinical study, are discussed. Results suggest that adherence to prescribed medication regimens correlates positively with improved clinical outcome in preschool children with asthma. Use of the Funhaler® did not improve adherence to prescribed medication, or clinical outcome, in preschool children with asthma. Funhaler® therefore failed as an incentive device to improve long term adherence, and clinical outcome, in preschool asthmatic children. Future design for an incentive device will need to consider providing feedback that is of more ongoing interest to the child. As the large variation, as observed in this study, in proficiency in spacer technique, and adherence to prescribed medication, is likely to influence results of clinical trials, an awareness of the variation in spacer technique and drug delivery may contribute towards the accurate interpretation of results in future studies. Finally, the wide variation in both proficiency in spacer technique, and adherence to prescribed medication, both factors that determine drug delivery to patients, highlight the importance of pursuing ways to improve inhalation drug delivery to preschool children in order to eliminate the variability in prescribed medication that eventually reaches patients. The delivery to the lungs of a constant, reliably repeatable inhaled drug dose should be a continuing aim for aerosol scientists and physicians.

The South African government introduced Affirmative Action in 1998 to redress historical workplace discrimination. The South African moral imperative considers Affirmative Action to be a necessary instrument of change influencing social and economic equality, which impacts on the development of Blacks. Affirmative Action is being researched in academic circles for reasons other than moral concern, which calls for a new breed of scientist to take equitable academic demographics into consideration. The exploratory study in question aimed to identify employees’ perceptions on Affirmative Action within the Faculty of Health Sciences at the University of Witwatersrand. The survey method was utilized in the study and opinions were elicited from 108 respondents in the Faculty. The results were analysed both qualitatively and quantitatively in order to gain a comprehensive insight into the perceptions. The focus of the study included: profile of the respondents, staffing and standards, employee development and mentorship, attitudes, training and culture. The findings of the investigation indicated that progress achieved by Affirmative Action within the Faculty was generally perceived to be slow. However, there appeared to be no problems related to holistic practices established in support of Affirmative Action. / Prof. W. Backer

Background: In 1998 the Wits Faculty of Health Science began to offer a master’s programme in public health, through the School of Public Health, called the Master of Public Health. (MPH). The aim of the degree is to prepare “professionals to play leadership roles in the management, improvement and evaluation of health and the health care system” and to respond “to the needs of the people of South Africa and the African continent in their various living and working conditions”. Eight objectives have been set for the degree and these will be gone into in detail. Admission requirements to the programme are a bachelor’s degree of a minimum of four years duration in dentistry, medicine, nursing, occupational therapy, physiotherapy, etc. The programme can be offered on a full- or part-time basis. The following core modules are offered: Primary Health Care & Social Context of Health; Health Measurement I & II; Environmental & Occupational Health; Public Health Law & Health Systems Integration; Health Policy &Policy Analysis; Health Systems & Decentralization; Health Management Theory & Practice; Epidemiology; Health Care Financing etc. The primary motivation for this study was to determine the level of satisfaction of MPH graduates with the degree that they studied. Methods: The study was a cross-sectional study design. It was a survey that entailed using a pretested interview schedule or questionnaire. The study population was all MPH graduates up until June 2007 (N = 80). The participants were contacted telephonically or by e-mail by the researcher. The initial idea was to interview the participants telephonically, but most preferred to have the prepared interview schedule e-mailed to them. A Pilot Study (using 8 students) was conducted before commencement of the actual study. The pilot study revealed that the study questionnaire, although long and cumbersome, was do-able. A sample of 70 graduates was used and of these, 60 responded i.e. response rate of 86%. The researcher e-mailed the interview schedule and the information sheet which explained what the study was about and also made it clear that even if they had initially agreed to participate, they could still opt out if they later changed their minds. The information sheet further explained that their participation would be kept strictly anonymous, only codes would be used. The data gathering sheet (questionnaire) is in two parts: Part One is the “Course Evaluation” and Part Two is the “Value of the Masters in Public Health to Your Career”. Under Part One the candidates gave their views on the following: the content of various courses or modules offered; the teaching methods applied by the School; academic quality; administrative support; and research report support. Questions in each of these subsections were such that a rating on a scale of 1 to 5 (5 being excellent and 1 poor) had to be given and next to the score (rating) the candidate could also give a comment to explain the rating or how they felt about what was asked. At the end of each of the subsections are a number of open-ended questions that gave the candidate more scope for further written or verbal input. Similarly, Part Two has a rating on a scale of 1 to 5 (5 being extremely valuable and 1 less valuable) in terms of the value the particular course or module mentioned in the career of the graduate. There is also a “comment” portion accompanying every question. And at the end of this part are six open-ended questions aimed at eliciting more qualitative information based on the experiences of graduates post graduation and specifically focusing on the working environment. One very important question in this section is: “Would you or have you recommended this masters programme to others”. There are only two possible answers to this question: “Yes” – which signifies satisfaction with the programme, and “No” – which signifies unhappiness with the programme. It is a very important question in gauging client satisfaction. Results: On a rating of 1 to 5 (1 being poor whilst 5 is excellent the top rated modules were rated as follows under course evaluation: (i) Primary Health Care & Social Context of Health: All respondents (60 i.e. 100%) rated this module and gave it a rating of 4.13 (83%) (ii) Health Policy and Policy Analysis: Although 40 (67%) out of 60 people responded to this question, they gave it a rating of 4.25 (85%) (iii) Project Management for Public Health Practitioners: It was given a 4.27 (85%) rating by 44 (73%) out of 60 participants. (iv) Management in Health and Health Services: This module was given a rating of 3.83 (77%) by 58 (97%) out of 60 participants and (v) Introduction to Management in Theory and Practice: It was rated at 3.82 (76%) by 32 (53%) of the 60 participants. The same top-rated above modules were rated as follows under “Value of the Masters in Public Health (MPH) to your career” i.e. Part II of the questionnaire. (i)Primary Health Care & Social Context of Health: 3.26 (65%) as rated by 46 (77%) out 60 participants. (ii) Health Policy and Policy Analysis: 3.96 (79%) by 46 (77%) respondents out of 60. (iii) Project Management for Public Health Practitioners: 3.26 (65%) as rated by 46 (77%) out 60 participants. (iv) Management in Health and Health Services: 3.96 (79%) by 54 (90%) out of 60 participants. Discussion: Various laudable written comments made by participants about each module have been captured and recorded. These will be seen later. (i) Primary Health Care & Social Context of Health: This module received a very high from all the participants of the research study. The concepts of Primary Health Care and Social Context of Health have clearly been taught and grasped. (ii) Health Policy and Policy Analysis: This was the track that most graduates followed. It helped graduates understand and be able to analyse various policy issues in their respective organizations. Emphasis has not only been laid on policy formulation but also on policy implementation. (iii) Project Management for Public Health Practitioners: This module scored a very high rating under course evaluation. There is a perception that some public health services could be run as projects in an endeavour to increase efficiency. (iv) Management in Health and Health Services: A number of the students who come from the public health sector to do MPH are in management positions already, although they may not have a formal management qualification. Those who are not in management positions are preparing themselves to go into management positions in future. This module is of great assistance in preparing them for careers in management. The study has revealed that 98% of participants have stated that they would or have recommended the Wits MPH to others. And 80% of the participants have also stated that there has been a positive change in their careers since acquiring the MPH qualification.

Thesis (MScMedSc)--Stellenbosch University, 2012. / Bibliography / ENGLISH ABSTRACT: The communicable disease tuberculosis (TB) is responsible for millions of deaths each year, on a global scale. At present the contribution of host genetics in TB is generally accepted and, together with environmental aspects (e.g. nutrition and crowding) and the causative bacterium, Mycobacterium tuberculosis (M. tuberculosis); it will possibly have a hand in the outcome of disease. Clearly, TB is a multifaceted disease and the repercussions for studying genetic susceptibility are that many genes will potentially be implicated. To date a variety of genes such as NRAMP1 and HLA have been implicated in influencing the host response to TB, albeit with varying effects in different populations. Some of the more recently implicated genes are the pattern recognition receptors, the Toll-like receptors (TLRs). Genetic variation in theses genes has been associated with a myriad of different diseases, including those of an infectious nature, such as TB. In the case of TB, TLR2 is the most prominent candidate with TLR8 and 9 more recently implicated. One of the more well known genes implicated with TB is the vitamin D receptor (VDR), as the antimicrobial gene cathelicidin (CAMP), one of the most important agents of mycobacterial killing, has a VDR response element in its promoter. TLR2, VDR and CAMP are all connected in a complex pathway essential for the host defence against M. tuberculosis. Nine single nucleotide polymorphisms (SNPs) in three TLR genes (TLR2,8 & 9) were investigated via a case-control approach to determine their potential role in human genetic susceptiblity to TB in the Coloured population of South Africa. The effect of the VDR polymorphism Cdx2 on the expression of cathelicidin mRNA and protein expression was also investigated. Three genes were found to contribute significantly to genetic host susceptibility in the Coloured population of South Africa. An allelic association (p = 0.031) was observed for the TLR8 (located on the X-chromosome) SNP rs3761624, with the A-allele being more prominent in females. Four haplotypes of TLR8 were found to be significantly linked to TB susceptibility with the three SNP haplotype rs3761624-rs3764879-rs3764880, specifically the allelic combination of G/C/A [p = 0.004, OR = 2.67(95% CI: 1.90-3.74)], showing a marked association (p = 0.001). The TLR9 introexon2 boundary SNP rs352139 was significantly associated with TB susceptiblity on a genotypic (P = 0.02) and allelic scale [p = 0.05, OR=0.70; (95% CI: 0.55–0.90)], with the T allele more frequent in controls. The TLR9 two SNP haplotype consisting of rs5743836 and rs352139 was linked (p = 0.037) to TB susceptibility, specifically the combination of the alleles A/T [p = 0.013, OR=0.71; (95% CI: 0.55–0.92)]. No gene-gene interaction between TLR2, TLR8 and TLR9 was observed. No significant conclusions could be drawn from the analysis of the mRNA and protein expression of CAMP in samples harbouring the different genotypes of the VDR polymorphism Cdx2. Genetic variations in the TLR8 and 9 genes were identified as potential factors that influence genetic host susceptibility to tuberculosis in the Coloured population of South Africa. / AFRIKAANSE OPSOMMING: Die oordragbare siekte tuberkulose (TB) is elke jaar verantwoordelik vir miljoene sterftes wêreldwyd. Die invloed van die gasheer genoom op TB vatbaarheid word huidiglik aanvaar, tesame met die invloed van omgewingsfaktore (dieet, oorbevolking ens.) en die bakterium Mycobacterium tuberculosis (M. tuberculosis). Dit is duidelik dat TB ‘n veelvlakkigesiekte is wat beïnvloed sal word deur ‘n menigte verskillende gene. ‘n Verskeidenheid gene is al betrek by TB genetiese vatbaarheid, onder andere NRAMP1 en HLA, hoewel hul effekte in uiteenlopende bevolkings verskil. Sommige van die onlangse gene wat betrek is in TB genetiese vatbaarheid is die Toll-like reseptore (TLRs). Genetiese variasie in hierdie gene is geassosieer met ‘n wye verskeidenheid van siektes, insluitend aansteeklik van aard, onder andere TB. In die geval van TB speel TLR2 ‘n prominente rol, terwyl TLR8 en TLR9 meer onlangs geïmpliseer is. Een van die meer bestudeerde TB vatbaarheidsgene is die vitamiene D reseptor geen (VDR). VDR is direk betrokke in die uitdrukking van die anti-mikrobiale geen cathelicidin (CAMP),’n integrale komponent in die vernietiging van mikobakterieë. Die CAMP geen het ‘n VDR respons-element in sy promotor. Die TLR2, VDR en CAMP gene word verbind deur ‘n komplekse netwerk wat integraal is tot die liggaam se vermoë om TB af te weer. Nege enkel nukleotied polimorfismes (ENPs) in drie gene (TLR2,8 & 9) is vir hierdie studie ondersoek, deur gebruik te maak van ‘n pasiënt-kontrole assosiasiestudies, om te bepaal watter rol hul speel in genetiese vatbaarheid vir TB in die Kleurling bevoling van Suid-Afrika, al dan nie. Die invloed van die VDR polimorfisme Cdx2 op die uitdrukking van die mRNS (boodskapper ribonukleïensuur) en proteïen van die geen CAMP is ook ondersoek. Ons het gevind dat drie gene beduidend bygedra het tot genetiese vatbaarheid vir TB in die Kleurling populasie. ‘n Alleel verwante assosiasie (p = 0.031) was gevind vir die TLR8 SNP rs3761624, waar die A-alleel meer algemeen was in vroue. Vier haplotipes vir TLR8 het beduidende assosiasies met TB vatbaarheid getoon. Die drie SNP haplotipe rs3761624-rs3764879- rs3764880, spesifiek die alleel kombinasie C/G/A [p = 0.004, OR = 2.67(95% CI: 1.90-3.74)] het sterk assosiasie (p = 0.001) met TB getoon. Die TLR9 intron-ekson2 grens SNP, rs352139 het beduidende assosiasie met TB getoon op ‘n genotipiese (p = 0.02) sowel as alleliese skaal [p = 0.05, OR=0.70; (95% CI: 0.55–0.90)], met die T alleel meer algemeen in kontroles. Die twee SNP haplotipe bestaande uit rs5743836 en rs352139 het TB vatbaarheid beïnvloed (p = 0.037), spesifiek die alleliese kombinasie van A/T [p = 0.013, OR=0.71; (95% CI: 0.55–0.92)]. Geen noemenswaardige interaksies tussen TLR2, 8 en 9 is gevind nie. So ook is geen beduidende resultate gevind vir die effek van die VDR SNP Cdx2 op die uitdrukking van CAMP mRNS en proteïen nie. Genetiese variasie in die TLR8 en 9 gene is geïdentifiseer as moontlike faktore wat gasheer genetiese vatbaarheid vir TB in die Kleurlingbevolking van Suid-Afrika beïnvloed. / WW Roome Trust

Thesis (MPhil)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: Background: The theoretical / cognitive component of ethics and professionalism teaching to undergraduate medical students at Stellenbosch University (SU) is well developed, but a concern exists about the need for teaching and assessment of clinical ethics and professionalism on ward rounds. Some teaching does take place during clinical rotations in the form of role modelling as part of the hidden curriculum. Opportunities should be created for explicit teaching of ethics and professionalism beyond the hidden curriculum. Assessment of the cognitive component of ethical and professionalism occurs, but assessment of clinical ethics and professionalism during clinical rotations remains a challenge. Methods: This was a non-experimental study and included three subgroups of undergraduate medical students in their clinical years as well as a random sample of educators involved in clinical training. Questionnaires were distributed to the students and educators. This was followed by focus group interviews among the students. Results: A majority of the students (88%) had indicated that they had experienced ethical and professional dilemmas while working in the wards or during ward rounds. The main dilemmas revolved around inadequate consent processes, lack of confidentiality and privacy, disrespect for patients, poor communication and students being expected to perform tasks they were not trained for. An average of 64% of students indicated that ethical and professional issues were not discussed during the clinical rotations in hospitals. Seventy-eight percent of students indicated that they did not feel free to discuss their own feelings or beliefs on ward rounds. All of the educators felt that there was a need for increased teaching and assessment of the medical students during their clinical rotations. Conclusions: Deliberate opportunities need to be created for teaching ethics and professionalism on clinical ward rounds. This could be a shared responsibility between the clinical departments with continuous input throughout the clinical years of study. Strong institutional support and commitment are necessary to make the teaching sustainable and successful. Structured opportunities need to be developed where students can discuss ethical and professional issues in a safe environment. Further research is needed for the development of an appropriate curriculum and assessment tools. / AFRIKAANSE OPSOMMING: Geen opsomming

The diploma work deals with the proffesional development of the first graduates of bachelor studies The General Nurse at The Faculty of Health and Social Studies of the University of South Bohemia since their graduation till the present. The goal of this work was to ascertain the opinions about the bachelor studies of the discipline General Nurse at the The Faculty of Health and Social Studies of the University of South Bohemia, namely of the first graduates of this discipline. The goal was to find out, how the studies and their succesfull graduation affected their proffesional career and social credit. Moreover to ascertain the attitude of the first graduates of the discipline The General Nurse at the The Faculty of Health and Social Studies of the University of South Bohemia to follow-up master's degree study Nursing care by selected clinical branches at The University of South Bohemia. The diploma work is divided into two parts ? the theoretic and empiric. The theoretic part deals with nursing and the conclusive part is educational. It includes the history and equipment of the nursing and the education of nurses in the Czech Republic, afterwards the problems of the profession of nurses and the related legislation . The educational part deals with the attitude as a social problem and the evaluation of the university education of the students themselves. In the empiric part of the diploma work were chosen both the quantitive and qualitative methods of an investigation research. The quantitive research had the form of a anonymous questionnaire for the first graduates of bachelor studies The General Nurse at The Faculty of Health and Social Studies of the University of South Bohemia. There were determined four assumptions. The results of the investigation have been processed into charts and tables. For the qualitative part of the survey research has been used in-depth unstructured interview, which was realised with the selected graduates. The results of the qualitative investigation have been adapted in the form of transcription of the interview. The results of this work can be used as an informational materiál for students and tutors of The Department of Nursing at The Faculty of Health and Social Studies of the University of South Bohemia. The results can help to be well informed in the education of nurses and to realise, which field of study needs to be strengthened.

In my thesis, I am finding out about the attitudes of students of the health and social faculty towards their own future occupation prospects. Although the unemployment situation in the Czech Republic as well as the situation in the South Region is favorable, graduates and young people are among the most vulnerable groups in the labor market. The first chapter describes the theoretical background of this issue. This part defines the overall unemployment problems of the Czech Republic, unemployment in the South Region. It describes the labor market and students situation is described based on the educational attainment and then their situation in the Czech Republic is compared to the similar situation abroad. Then it also describes the faculty and defines the issues of helping professions covered by the fields of the faculty. The aim of my thesis was to find out what the students of the faculty imagine when asked of their future occupation. They would like to stay in the field which they graduated from and then why they would want to stay in it or why not. The results show that students of the faculty want to stay in the field they graduated from on the labor market in the future. The research was conducted via questionnaire. In the practical part of the thesis I compared the attitudes of students of health and social fields. I also compared the attitudes of students who are studying in bachelor's program and students who continue their studies in the follow-up study. When it comes to comparison between the social and health studies, it is possible to see the differences in the attitudes of students, as well as the comparison of bachelor and master programs. Thesis may be beneficial for the employment deparment of Czech Republic and for the health and social faculty. Furthermore it may also be beneficial for representatives of state administration who monitor and control the whole system of tertiary education.

Thesis submitted in fulfillment of the requirements for the degree Magister of Technology: Dental Technology In the Faculty of Health & Wellness Sciences At the Cape Peninsula University of Technology 2013 / Orthodontic archwires are made from different alloys. It is now possible to match phases of treatment with orthodontic archwires according to its mechanical properties. On this basis, the titanium molybdenum alloys (TMA) in its beta phase have an excellent combination of strength and flexibility when used as archwires to apply biomechanical forces that affect tooth movement. It has recently gained increased popularity in orthodontic treatment. There are, however, disadvantages associated with the use of orthodontic archwires, such as high surface roughness, which increases friction at the archwire-brackets interface during the sliding process. The surface roughness of dental materials is of utmost importance. Properties such as desirable tensile strengths, load deflection, hardness and low modulus of elasticity and resistance against corrosion & wear determine the area of the contact surface, thereby influencing the friction. The main object of this study was to improve the strength and surface roughness of the beta-titanium orthodontic archwires (β-Ti III) and timolium archwires (TIM), taking into account of retention of the archwires strength. The following tasks were performed. Layers of Zr were deposited on the β-Ti archwires and compared with the archwire strength before and after Zr deposition. The structure of selected archwires and its composition and surface roughness was investigated before and after Zr deposition, using scanning electron microscopy (SEM) and atomic force microscopy (AFM). The force of selected archwires before and after deposition with layers of Zr by Hounsfield deflection testing was studied. Two commercially available orthodontic archwires were used in this study, namely, β-Ti III and TIM orthodontic archwires. The archwires were cut into 25 mm long specimens. In this study, the electron beam-physical vapour deposition (EB-PVD) technique was applied to deposit pure Zr (thicknesses of 5, 10, 25 and 50 nm) on selected archwires and the effects thereof were investigated using AFM, SEM and the Hounsfield deflection test. Results of SEM and AFM analysis and deflection tests showed significant differences between Zr-coated archwires compared with uncoated archwires. Zr-coated archwires (5, 10, 25 and 50 nm depositions) had reduced surface roughness compared with uncoated archwires. A high load deflection rate was exhibited by the coated β-Ti III archwires and a low load deflection rate was exhibited by the coated TIM archwires. There was a difference in load deflection rate between the coated and uncoated archwires. Deposition of 5, 10, 25 and 50 nm Zr on both types of β-Ti orthodontic archwires is recommended for even sliding mechanics due to resulting reduced surface roughness with a good load deflection rate compared with uncoated β-Ti orthodontic archwires. KEYWORDS Surface roughness Zirconium Titanium Deflection test Beta titanium orthodontic archwires Orthodontic archwires alloys Coated materials Electron beam-physical vapour deposition Scanning electron microscopy Atomic force microscopy

The diploma thesis deals with the less known type of advertising - the social advertising. The social advertising uses mostly emotional appeals to raise awareness about societal problems, bad habits of people and strives for the behavioural change aiming to make the contemporary world better. The diploma thesis consists of a theoretical and a practical part, whilst the theoretical part offers a comprehensive view not only on the social advertising but partly on the advertising in general as well. It explains the term of social advertising, compares it to the commercial advertising, describes its historical development and defines the subjects of the social advertising. The theoretical part further explains how the social advertising influences the society, which is mostly done by the emotional expression of the given problem and by advertising appeals. Approached are also the specific advertising campaigns - by the most common typologisation of social advertising themes. The research was conducted using surveys aiming to find out whether there are any differences in the awareness of social advertising by students of the HSS SBU and the FE SBU all together with finding out whether it is possible to talk about a higher social advertising influence on students of the HSS SBU. The results were in accordance with these hypothesises which can prove the existence of knowledge differences of students about the social advertising based on their field of study and the fact that the social advertising has bigger influence on students of the health and social fields of study. Answers of respondents from both faculties were often different. On the other hand, students from both HSS SBU and FE SBU have shown the same answers regarding the attitude towards the social advertising. It is possible to make a statement that the social advertising seems beneficial to both HSS SBU and FE SBU students as well and they would like to be in contact with it more often. The students of HSS SBU have chosen to perform the helping professions for their carrier which demands also personal traits that can be e.g. the social feeling and the desire to help. The research brought the finding, that the students care about the social problems and that the social advertising fulfils its purpose which is raising awareness about the societal problems that should get known by people this way.