Classification and regression tree analysis to predict calving ease in Sussex heifers using pelvic area dimensions and morphological traits.

OBJECTIVES: The objective of this study was to assess the relationship between pelvic measurements, namely pelvic height (PH), pelvic area (PA), and pelvic width, and linear body measurement traits, such as hindquarters width, rump length (RL), hip height (HH), body weight (BW), shoulder height, chest depth (CD), body length, and also calve birth weight (CBW) under different calving ease scores, namely no assistance, gently pull, and hard pull. MATERIAL AND METHODS: A total of 51 first calf Sussex heifers at 24 months old, weighing approximately 440 ± 40.26 kg, were used for this study. Two-year-old bulls (n = 2), weighing approximately 800 kg, were used for mating the 51 heifers with a bull to cow ratio of 1:30 and 1:21. The fertility of bulls was assessed by a private veterinarian before the mating season. Calving ease was scored as follows: 1 = no assistance during parturition (normal), 2 = heifer assistance as gently pull, 3 = heifer assistance as hard pull, 4 = heifer cannot calf, 5 = heifer calved a dead calf, and 6 = heifer calf with the abnormal position. RESULTS: Descriptive statistics indicated that PH (p < 0.01) and RL (p < 0.05) were positively remarkable and different among calving ease scores. Correlation results of the no assistance Sussex heifers group revealed that CBW was positively correlated (p < 0.05) with PH. Classification and regression tree CART results demonstrated that PH, BW, CD, and HH play an important role in predicting calving ease in Sussex heifers. CONCLUSION: The findings suggest that there is an association among PAs and biometric traits. The present study might help farmers select animals with higher PH, BW, CD, and HH during breeding to lower dystocia incidents during parturition. However, further studies need to be carried out in CART modeling to reduce dystocia in a larger sample size of Sussex heifers or other cattle breeds.

Prevalence of gastrointestinal helminths and parasites in smallholder pigs reared in the central Free State Province.

Pigs are kept by farmers as a source of livelihood and food. Unfortunately, helminthiasis and other internal parasites are major setbacks to profitable pig production in Africa. There is a lack of information on the prevalence and intensity of gastrointestinal helminths and parasites plaguing resource-poor pig farmers in the Free State. Knowledge of these endemic parasites can be used as baseline data to help design future intervention plans. The aim of this study was to identify and quantify the types of gastrointestinal helminths and parasites prevalent in smallholder pigs reared in the central Free State Province. Faecal samples were randomly collected from 77 pigs and parasitologically analysed. Quantification was done using the McMaster counting technique. Farming system, age, gender and health status were the risk factors considered. The study was conducted between January and March 2016. Overall, results showed that 61 samples (79.2%) tested positive for one or more gastrointestinal parasites, which were observed as single or mixed infections. Amongst the positive samples, 44.5% were infected with Ascaris suum, 50.6% with Trichuris suis, 26.0% and 72.7% were infected with Oesophagostomum dentatum and coccidia, respectively. There were significant differences (p < 0.05) between the rate of infection in the intensive and semi-intensive systems and between the dewormed and non-dewormed pigs. Piglets and female pigs recorded a higher prevalence in their categories. Pigs excreted mostly low (eggs per gram [EPG] ≤ 100) to moderate (EPG > 100 < 500) levels of helminth eggs. It is concluded that different species of gastrointestinal parasites are present in most pigs reared by smallholder farmers in this study area.

PANDAS: Paediatric Attention-Deficit/Hyperactivity Disorder Application Software.

Attention-deficit/hyperactivity disorder (ADHD) is a common neuropsychiatric disorder that impairs social, academic, and occupational functioning in children, adolescents and adults. In South Africa, youth prevalence of ADHD is estimated as 10%. It is therefore necessary to further investigate methods that objectively diagnose, treat, and manage the disorder. The aim of the study was to develop a novel method that could be used as an aid to provide screening for ADHD. The study comprised of a beta-testing phase that included 30 children (19 non-ADHD and 11 ADHD) between the ages of 5 and 16 years old. The strategy was to use a tablet-based game that gathered real-time user data during game-play. This data was then used to train a linear binary support vector machine (SVM). The objective of the SVM was to differentiate between an ADHD individual versus a non-ADHD individual. A feature set was extracted from the gathered data and sequential forward selection (SFS) was performed to select the most significant features. The test set accuracy of 85.7% and leave-one-out cross-validation (LOOCV) accuracy of 83.5% were achieved. Overall, the classification accuracy of the trained SVM was 86.5%. Finally, the sensitivity of the model was 75% and this was seen as a moderate result. Since the sample size was fairly small, the results of the classifier were only seen as suggestive rather than conclusive. Therefore, the performance of the classifier was indicative that a quantitative tool could indeed be developed to perform screening for ADHD.

At the coalface of collaborative mental health care: A qualitative study of governance and power in district-level service provision in South Africa.

Globally, there is an urgency to address fragmented mental health systems, especially in low-to-middle income countries. State and non-state mental health service collaboration is a central strategy to strengthen care. The study was undertaken to analyse the power in governance processes of public mental health service provision. Semi-structured interviews were conducted with state and non-state actors in mental health care in a South African district. Transcriptions were thematically analysed using the Framework for Assessing Power in Collaborative Processes. Findings suggested that collaborative processes were significantly state-owned, in terms of funding models, administrative and legislative jurisdiction, and state hierarchical referral structure. No formal agreements were in place, elevating the importance of key network actors to bring less-endowed NGOs into the service network. Fragmentation between the Departments of Health and Social Development was telling in district forums. Resistance to power structures unfolded, some participants sidestepping traditional hierarchies to leverage funding and support. The paper highlights the complexities and different facets of power in integrated mental health care in a South African district, adding to growing literature on the social mechanisms that influence collaboration.

State and non-state mental health service collaboration in a South African district: a mixed methods study.

The Life Esidimeni tragedy in South Africa showed that, despite significant global gains in recognizing the salience of integrated public mental health care during the past decade, crucial gaps remain. State and non-state mental health service collaboration is a recognized strategy to increase access to care and optimal use of community resources, but little evidence exist about how it unfolds in low- to middle-income countries. South Africa's Mental Health Policy Framework and Strategic Plan 2013-20 (MHPF) underlines the importance of collaborative public mental health care, though it is unclear how and to what extent this happens. The aim of the study was to explore the extent and nature of state and non-state mental health service collaboration in the Mangaung Metropolitan District, Free State, South Africa. The research involved an equal status, sequential mixed methods design, comprised of social network analysis (SNA) and semi-structured interviews. SNA-structured interviews were conducted with collaborating state and non-state mental health service providers. Semi-structured interviews were conducted with collaborating partners and key stake holders. Descriptive network analyses of the SNA data were performed with Gephi, and thematic analysis of the semi-structured interview data were performed in NVivo. SNA results suggested a fragmented, hospital centric network, with low average density and clustering, and high authority and influence of a specialist psychiatric hospital. Several different types of collaborative interactions emerged, of which housing and treatment adherence a key point of collaboration. Proportional interactions between state and non-state services were low. Qualitative data expanded on these findings, highlighting the range of available mental health services, and pointed to power dynamics as an important consideration in the mental health service network. The fostering of a well-integrated system of care as proposed in the MHPF requires inter-institutional arrangements that include both clinical and social facets of care, and improvements in local governance.

Health policy and integrated mental health care in the SADC region: strategic clarification using the Rainbow Model.

BACKGROUND: Mental illness is a well-known challenge to global development, particularly in low-to-middle income countries. A key health systems response to mental illness is different models of integrated health care, especially popular in the South African Development Community (SADC) region. This complex construct is often not well-defined in health policy, hampering implementation efforts. A key development in this vein has been the Rainbow Model of integrated care, a comprehensive framework and taxonomy of integrated care based on the integrative functions of primary care. The purpose of this study was to explore the nature and strategic forms of integrated mental health care in selected SADC countries, specifically how integrated care is outlined in state-driven policies. METHODS: Health policies from five SADC countries were analysed using the Rainbow Model as framework. Electronic copies of policy documents were transferred into NVivo 10, which aided in the framework analysis on the different types of integrated mental health care promoted in the countries assessed. RESULTS: Several Rainbow Model components were emphasised. Clinical integration strategies (coordination of person-focused care) such as centrality of client needs, case management and continuity were central considerations, while others such as patient education and client satisfaction were largely lacking. Professional integration (inter-professional partnerships) was mentioned in terms of agreements on interdisciplinary collaboration and performance management, while organisational integration (inter-organisational relationships) emerged under the guise of inter-organisational governance, population needs and interest management. Among others, available resources, population management and stakeholder management fed into system integration strategies (horizontally and vertically integrated systems), while functional integration strategies (financial, management and information system functions) included human resource, information and resource management. Normative integration (a common frame of reference) included collective attitude, sense of urgency, and linking cultures, though aspects such as conflict management, quality features of the informal collaboration, and trust were largely lacking. CONCLUSIONS: Most countries stressed the importance of integrating mental health on primary healthcare level, though an absence of supporting strategies could prove to bar implementation. Inter-service collaboration emerged as a significant goal, though a lack of (especially) normative integration dimensions could prove to be a key omission. Despite the usefulness of the Rainbow Model, it failed to adequately frame regional governance aspects of integration, as the SADC Secretariat could play an important role in coordinating and supporting the development and strengthening of better mental health systems.

Power and Integrated Health Care: Shifting from Governance to Governmentality.

Integrated care occurs within micro, meso and macro levels of governance structures, which are shaped by complex power dynamics. Yet theoretically-led notions of power, and scrutiny of its meanings and its functioning, are neglected in the literature on integrated care. We explore an alternative approach. Following a discussion on governance, two streams of theorising power are presented: mainstream and second-stream. Mainstream concepts are based on the notion of power-as-capacity, of one agent having the capacity to influence another-so the overall idea is 'power over?'. Studies on integrated care typically employ mainstream ideas, which yield rather limited analyses. Second-stream concepts focus on strategies and relations of power-how it is channelled, negotiated and (re)produced. These notions align well with the contemporary shift away from the idea that power is centralised, towards more fluid ideas of power as dispersed and (re)negotiated throughout a range of societal structures, networks and actors. Accompanying this shift, the notion of governance is slowly being eclipsed by that of governmentality. We propose governmentality as a valuable perspective for analysing and understanding power in integrated care. Our contribution aims to address the need for more finely tuned theoretical frameworks that can be used to guide empirical work.

Regional health governance: A suggested agenda for Southern African health diplomacy.

Regional organisations can effectively promote regional health diplomacy and governance through engagement with regional social policy. Regional bodies make decisions about health challenges in the region, for example, the Union of South American Nations (UNASUR) and the World Health Organisation South East Asia Regional Office (WHO-SEARO). The Southern African Development Community (SADC) has a limited health presence as a regional organisation and diplomatic partner in health governance. This article identifies how SADC facilitates and coordinates health policy, arguing that SADC has the potential to promote regional health diplomacy and governance through engagement with regional social policy. The article identifies the role of global health diplomacy and niche diplomacy in health governance. The role of SADC as a regional organisation and the way it functions is then explained, focusing on how SADC engages with health issues in the region. Recommendations are made as to how SADC can play a more decisive role as a regional organisation to implement South-South management of the regional social policy, health governance and health diplomacy agenda.

The epistemology of AIDS in South Africa: lessons from three scenario projects.

This article reviews the methodology of future scenario-building in the context of HIV and AIDS in Africa. It considers three scenario studies conducted in the past decade: UNAIDS (2005), Metropolitan Holdings (2006) and the AIDS Governance scenarios (2015). The article is a critical reflection of Future Studies epistemology which claims to contribute a unique heuristic niche in the study of AIDS. The article offers several methodological insights: (1) despite claims to the contrary, scenario methodology remains profoundly influenced by existing political and research agenda; instead of denying these, scenarists should acknowledge this; (2) the utility of scenario studies is strongly influenced by their unit of analysis and their time frame, which determine their applicability and therefore their policy relevance; and (3) scenario planners should guard against perpetuating the myth that this methodology is a crystal ball into the future because they are powerful tools for strategic planning about the present, rather than the distant future. In addition to these methodological insights, the article finds that future scenario studies are useful in identifying significant discursive and policy shifts in the AIDS response.

Turning dread into capital: South Africa's AIDS diplomacy.

BACKGROUND: In much of the world, President George W. Bush was not admired for his foreign policy and diplomacy. It is therefore ironic that Bush's single most uncontested foreign policy triumph was an instance of what has now become known as "health diplomacy". In 2003 Bush launched the President's Emergency Plan for AIDS Relief, a five-year $15 billion initiative to fight HIV/AIDS, mostly in Africa. The president's pragmatic health diplomacy may well save his foreign policy legacy. This article argues that a middle power such as South Africa should consider a similar instrumental AIDS diplomatic strategy, to rehabilitate its public health as well as foreign policy images. DISCUSSION: This article reflects on the emergence and contemporary practice of health diplomacy. In particular, it explores the potential of niche areas within health diplomacy to become constructive focal points of emerging middle powers' foreign policies. Middle powers often apply niche diplomacy to maximise their foreign policy impact, particularly by pursuing a multilateral agenda. The literature on middle powers indicates that such foreign policy ambitions and concomitant diplomacy mostly act to affirm the global status quo. Instead, this paper argues that there may well be niches within health diplomacy in particular that can be used to actually challenge the existing global order. Emerging middle powers in particular can use niche areas within health diplomacy in a critical theoretical manner, so that foreign policy and diplomacy become a project of emancipation and transformation, rather than an affirmation of the world as it is. SUMMARY: The article first describes the emergence and contemporary practice of health diplomacy; this is followed by a discussion of niche diplomacy, in particular as it applies to the foreign policy agendas of emerging middle powers. It then reviews South African foreign policy and diplomacy, before situating these policies within the context of emerging mechanisms of south-south multilateralism. The article concludes by synthesizing these elements and advocating for a South African AIDS diplomacy, emphasizing its potential to galvanize a global project of emancipation.

Missile embolism--pulmonary vein to systemic bullet embolism: a case report and review of the literature.

Missile embolism occurs very rarely. It was first reported by Thomas Davis in 1834, and only 153 cases had been reported up to 1988. Rich et al. reported a 0.3% incidence in 7 500 cases of vascular injury in the Vietnam conflict. To our knowledge, this is the first reported case of pulmonary vein entry and internal carotid artery embolisation.

The future of AIDS in Africa: lessons from two scenario projects.

Scenario planning or futures studies have their origin in military planning, but have also been used with great success in the private sector, most notably in the energy industry. UNAIDS and the South African financial services group Metropolitan each recently published a set of scenarios regarding the future impact of HIV/AIDS in Africa and South Africa, respectively. This article reviews the methodologies and outcomes of those two studies, and highlights the many lessons to be gleaned for HIV-related health planning and policy-making in general. This is the first time that a comparative study has been done on scenario planning that refers to HIV in particular, and the findings may inspire the conceptualisation of futures studies elsewhere.

Direct percutaneous intratumoral bleomycin injection for palliative treatment of impending quadriplegia.

We describe a case of midcervical angiosarcoma causing compression of the cervical spinal cord, producing rapidly progressive neurologic deficits. The tumor had recurred despite previous resection and was refractory to radiation and chemotherapy. Shrinkage of the tumor by percutaneous embolization was not considered feasible. A single direct percutaneous intratumoral injection of 15 U of bleomycin produced sufficient tumor shrinkage to relieve the pressure on the spinal cord and thereby reverse some of the neurologic deficits and give adequate palliation against recurrence of this problem for the remainder of the patient's life. Direct percutaneous intratumoral injection of bleomycin may thus be considered for palliation when other treatment methods have failed to elicit a suitable clinical response.

Percutaneous management of concomitant post-traumatic high vertebrovertebral and caroticojugular fistulas using balloons, coils, and a covered stent.

PURPOSE: To describe the endovascular management of vertebrovertebral and caroticojugular fistulas in the same patient using a combination of endovascular techniques including covered stent placement in the high extracranial internal carotid artery. CASE REPORT: A 22-year-old man presented with ipsilateral vertebrovertebral and caroticojugular fistulas at the C1 level several weeks after sustaining a solitary penetrating knife injury below the right ear. The right vertebral artery was sacrificed after a failed endovascular attempt to close the vertebrovertebral fistula. The caroticojugular fistula was treated with a self-expanding covered stent (Wallgraft) with exclusion of the fistula and preservation of flow through the carotid artery. CONCLUSIONS: Preservation of the extracranial arteries should be the preferred goal of treatment in traumatic extracranial arteriovenous fistulas. The use of covered stents in the extracranial vessels can accomplish this goal.

Circumferential flow reduction during percutaneous embolotherapy of extracranial vascular malformations: the "cookie-cutter" technique.

We describe a simple, inexpensive, and very effective method of achieving circumferential flow reduction during direct percutaneous cyanoacrylate embolization of a high-flow vascular malformation of the scalp. By using a plastic "cookie cutter" placed over the lesion and applying various degrees of pressure, both venous outflow from and arterial inflow into the lesion were limited. This flow reduction technique improved both the efficacy and safety of the procedure.