M.Tech.

Implementation of combined anaerobic/aerobic processes for wastewater treatment has been shown feasible, especially for industrial wastewaters with high concentration of organics. However, the utilization of this type of technology for treating wastewaters with low content of organic matter, such as domestic sewage is quite recent, and very limited information is available regarding the topic. Recent investigations have demonstrated that it is feasible to utilize a combined technology composed of anaerobic pretreatment followed by an aerobic post-treatment to efficiently treat municipal wastewater. This research is a continuation of previous investigations about the feasibility of using an anaerobic fluidized bed reactor-aerated solids contact process to treat domestic wastewater. In the proposed system the excess sludge produced in the aerobic stage is recycled to the anaerobic unit. The proposed configuration is very attractive because the anaerobic fluidized bed reactor serves as pretreatment unit and a sludge digester at the same time. The main objective of this research is to quantify the SS removal and accumulation rates in the AFBR, and determine the degree of stabilization of solids in the unit. All this to demonstrate the feasibility of avoiding separate sludge stabilization units.

This research evaluated and demonstrated the disinfection efficiency of an electrochemical system for total coliform removal from wastewater effluents after secondary treatment. Four bench scale batch electrochemical cells were assembled and operated in the laboratory: the first electro-disinfection reactor was set with aluminum electrodes, the second with standard 316 stainless steel electrodes, the third one with titanium electrodes, and the fourth one with a standard 316 stainless steel cathode and a titanium anode. During the electro-disinfection process the water sample was placed on the reactor/disinfector to which direct current (DC) was charged. The results showed that total coliform counts in the treated water decreased significantly and that the characteristics of the effluent were highly improved, especially when stainless steel or titanium electrodes were employed. A bactericidal efficiency of 98.7 % or higher was achieved within a contact time of less than 15 min and a current density lower than 7.5 mA/cm2 when stainless steel electrodes were used, and a contact time of less than 5 min and a current density lower than 3.5 mA/cm2 when the stainless steel/titanium cell was utilized. Electrochlorination does not seem to be the predominant disinfective means of the process. Production of other short lived and more powerful killing substances such as H2O2, [O], •OH, and •HO2 provide the strong disinfecting action of the system within a short contact time. The bactericidal efficiency of the process generally increased with the current density and contact time, and the impact of these factors was much larger than that of salinity. The results obtained suggest that this electrochemical treatment is applicable to wastewater effluents. However, further investigation on the optimum operating conditions and a detailed comparative study of energy consumption by the electrochemical treatment system and the conventional methods are needed before constructing an industrial application system in the future. It is also indispensable to find out if halogenated hydrocarbons and other toxic compounds are produced during the process.

M.Tech.

Magister Public Health - MPH / Background: Over the past decade, South Africa has scaled-up its antiretroviral treatment (ART) programme in an effort to control the HIV epidemic. Interventions to support the rollout of ART include task shifting ART initiation to nurses at primary health care level and ensuring HIV adherence counselling at every visit by lay counsellors. Furthermore, community-based outreach teams work at the community level to follow up on patients and ensure that patients remain in care and are adhering to ART. Despite all these efforts, poor adherence to ART remains a pertinent problem. In 2016, the national adherence to ART rate among adult patients was estimated at 35% compared to 39% in Pule Sefatsa clinic in Mangaung district, Free-state Province. Aim: The aim of the study was to explore the factors that influence poor adherence to ART among patients receiving ART at Pule Sefatsa primary health care clinic in Mangaung district, South Africa. Methodology: A descriptive qualitative research approach was used. Two focus group discussions were conducted with health workers and community caregivers and 16 in-depth interviews were conducted with ART patients who are in care and those who had defaulted on their treatment. Audio recorded data obtained from these sources were transcribed verbatim and prepared for analysis. Thematic analysis was used for data analysis and the results were classified under various categories. Findings: Adherence to ART in Pule Sefatsa clinic was found to be influenced by medical related factors, socio-economic factors, health system factors and individual factors. The medical-related factor was the side effects of the medication. The socio-economic factors were stigma and discrimination, lack of family support, poverty and food insecurity. Health system factors that hindered adherence to ART were medication stock-outs, long waiting times and poor service delivery. The final group of barriers to ART adherence was related to the individuals using ART and these include patients forgetting to take treatment and feeling depressed.

This psychoanalytically informed research project combines three theoretical trajectories together with illustrative clinical material to present an exploration of anorexia through a particular conceptual lens. The three theoretical areas are synthesised in an original way through the ideas and arguments presented in the thesis. The theory included: contemporary understandings of eating disorders; contemporary Kleinian literature on pathological organisations and psychic retreats (Steiner, 1982; 1987; 1992; 1993; 2011); and literature on autistic-like (autistoid) defences in non-autistic adults (S. Klein, 1980; Tustin, 1972; 1973; 1978; 1981; 1986; 1991). The research aimed to interrogate and explicate the relationship between pathological organisations of personality structure in anorexia, using case studies and vignettes to illustrate and elaborate the arguments. There was also some consideration of other types of eating disorder, similarly conceptualised. Case material from clinical work as a psychoanalytically informed psychotherapist was used as data in all but one case, in the latter instance interview material being used. The body of the thesis was structured in the form of four journal articles.

背景：腕管綜合征，又名腕管狹窄征，俗稱“滑鼠手＂，是最常見的周圍神經卡壓性疾患，有研究顯示，腕管綜合征的發病率正在逐年的上升，在壽命為70歲以下的人群中發生腕管綜合征的概率女性為l1%、男性為3.5%。是一種因為正中神經在腕管內因為腕管內的容積減少或壓力增大而受到壓迫，引起的手指麻木無力的戚覺，運動和自主功能紊亂症候群。 目的：通過查閱有關中醫治療腕管綜合征文獻，歸納和總結正確的合理的治療思維，尋找出理想的治療腕管綜合征的方法。 方法：1.檢索近20年的相關文獻，輸入關鍵字“腕管綜合征 針灸 推拿 中藥 Carpal Tunnel Syndrome＂，在CNKI資料庫和EBSCOhost資料庫和維普資料庫中，根據納入標準：(1）診斷為腕管綜合征（2）以中醫為主治療之文獻。排除標準：非中醫治療文獻，選出共57篇符合納入標準的文獻，並用Excel軟體對其記錄和總結。 2. 臨床隨診塗封老師從2015年1月到2015年4月期間在相關浸會大學診所收集診斷為腕管綜合征的患者，觀察針灸、中藥和推拿治療此病的效果。 結果：針灸治療腕管綜合征的最常用的幾個穴位，分別為內關、大陵、外關、合谷、陽池、陽溪。中藥最常用的幾味藥為桂枝、威靈仙、透骨草、川穹、伸筋草、紅花、當歸。在中藥熏洗方面，最常用的是透骨草、伸筋草、威靈仙、桂枝。在中藥外敷方面，最常用的是桂枝、威靈仙、防風、透骨草。在中藥內服方面，最常用的是當歸、乳香、桂枝、雞血藤。在手法治療治療腕管綜合征，主要是以放鬆肌肉和松解組織粘連的手法為主。中醫方法治療腕管綜合征的效果，要優於現代醫學治療此病的效果。

After 25 years of existence, the Human Immuno-deficiency Virus (HIV) has become a global challenge. Yearly, about 3 million people in the sub Saharan region become infected with the disease each year, while 2 million die of the disease. The young, sexually active and those in the economically active group are mostly affected although other categories are also affected. Over the years efforts have been made to turn HIV infection from a death sentence to a manageable chronic disease through the use of antiretro viral treatment (ART). Despite the fact that this treatment is a life-long commitment with adherence being crucial to its effectiveness, some patients still default. This research study sought to identify the characteristics of HIV positive patients who are lost to follow up after the initiation of antiretroviral treatment over a 2-year period (2007-2008). A tick sheet was used to collect data from all the files of patients lost to follow up and 20 variables were tested. The conclusion reached is that age, sex, distance of residence to the ART site and economic capability contribute to ‘lost to follow-up’.

The 37kDa/67kDa laminin receptor (LRP/LR) is thought to play a major role in the adhesion to laminin and consequently invasion resulting in the metastasis of tumor cells. This receptor is reported to be over-expressed in several neoplastic cell lines and is believed to increase tumor aggressiveness. This research aims at determining whether the application of anti-LRP/LR specific antibody (IgG1-iS18) on neoplastic cell lines would result in a decrease in invasion and adhesion. All neoplastic cell lines had significantly increased cell surface LRP/LR levels compared to NIH/3T3 cells, with the most notable increase seen in SW480 cells (10.98%). Due to a positive correlation between the cell surface LRP/LR levels and invasion potential we propose that an increased LRP/LR level correlates to an increased ability to invade. A significantly decreased adhesion potential was noted in all neoplastic cell lines except the non-invasive MCF-7 cell line, upon application of IgG1-iS18, 21% decrease in HT-1080 cells, 14% in HeLa, 20% in LNCaP, 48% and 74% in A549 and SW480 cells, respectively. Incubation with the anti-LRP/LR antibody IgG1-iS18 resulted in a significant reduction of the invasive potential of HT-1080 (44%), A549 (33%), HeLa (69%), SW480 (91%) and LNCaP cells (38%). Furthermore, a high Pearson’s correlation coefficient between adhesion potential and invasive potential was seen, confirming that adhesion is indeed a pre-requisite for invasion. The significant reduction in invasion and adhesion of HT-1080, A549, HeLa, SW480 and LNCaP cells upon application of the IgG1-iS18 antibody suggests that this macromolecule might act as a promising therapeutic tool for the treatment of various metastatic cancer types.

A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand , in fulfillment of the requirements for the degree of Master of Science in Medicine, 2013 / Sequence analysis from HIV-1 (human immunodeficiency virus type 1) subtype B and more recently subtype C infected patients has revealed that mutations in the HIV-1 protease region that confer drug resistance to boosted protease inhibitor (PIs) are rarely detected at the time of virological failure. Mutations in the HIV-1 subtype B gag-pol cleavage sites are thought to be compensatory mutations which arise as a result of PI use. This study investigated the presence of compensatory mutations in the HIV-1 subtype C gag-pol cleavage sites and matched pol genotypes from South African patients failing a boosted PI-based regimen, as compared to antiretroviral drug naïve patients. A new amplification protocol encompassing the near full-length gag, PR and partial RT was established and used to sequence the HIV-1 gag-pol cleavage sites from 23 proviral DNA samples (p24 antigen cultured peripheral blood mononuclear cells; PBMCs), and 51 patient samples (23 antiretroviral drug-naïve, 26 failing second-line lopinavir/ritonavir containing regimens), all attending the Charlotte Maxeke Johannesburg Hospital. Nucleotide sequences were aligned and codon positions S373Q, A431V, I437T/V, L449P or P453L associated with known gag-pol cleavage site mutations were analysed and compared. The pol genotypes were established using an in house assay. Antiretroviral drug resistant primary virus isolates were grown from samples from patients enrolled on the CIPRA-SA study, and propagated in coculture with PHA-activated, IL-2 stimulated PBMCs. HIV-1 gag-pol cleavage sites and pol genotypes for all primary virus isolates were established as described above. Fifty one of 74 patient samples, used to establish the in-house gag-pol cleavage site assay, were successfully amplified and sequenced. Detailed analysis of the five known gag-pol cleavage sites revealed that 5 patient samples (4 PI-exposed, 1 unknown regimen) encoded for the previously described mutations that impact on gag-pol cleavage in the absence of any major PR mutations. A further five samples from patients on the failing PI-based regimen had major PR mutations. No known mutations in the gag-pol region were identified in patients failing a first line regimen. The pol mutations described in this study were similar to the findings reported for treatment failures in South African HIV-1 subtype C infected patients. Primary virus was grown from only 25 of the 91 PBMC CIPRA samples. None of the 25 CIPRA-SA primary virus isolates had gag-pol cleavage site mutations, and only 9 harboured known RT antiretroviral drug resistant mutations. Overall, the presence of HIV-1 gag-pol cleavage site mutations may account for virological treatment failure in 5 of the South African patient samples analysed. Although the gag-pol cleavage site mutations detected in the current study are only present in a small proportion of treatment-experienced South African patients, this may increase due to more patients accessing second line PI-containing regimens. Thus, future genotyping work incorporating the analysis of the gag-pol cleavage sites in addition to the PR and RT regions is warranted. The antiretroviral drug resistant primary viruses obtained provide valuable reagents for future phenotyping studies.