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- ItemSTRATEGIC MANOEUVRING IN ZIMBABWEAN POLITICAL DELIBERATIONS:A PRAGMA-DIALECTICAL AND APPRAISAL THEORY APPROACH(Stellenbosch : Stellenbosch University, 2025-03) Mutsvairo, Jack; Dlali, Mawande; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of African Languages.Political argumentation by Zimbabwean government ministers and Members of Parliament, and political party representatives during Question Time sessions and radio political interviews, respectively, is not yet fully explored. This study analyses and evaluates the strategic manoeuvring of by ministers and Members of Parliament during Question Time question-and-answer deliberations, and party representatives on Studio 7 radio political interviews. The study aims to contribute new insights to the nascent literature on pragma-dialectical and appraisal research on Zimbabwean political discourse. Using data from the Hansard and Studio 7 radio political interviews, I analyse the political argumentation of Zimbabwean politicians within the two subgenres of parliamentary and media discourses. I use the pragma-dialectical argumentation theory as the main theoretical framework when analysing Hansard extracts and radio interview transcripts, and the appraisal theory as a complementary theoretical framework to evaluate language use in radio interviews. After carrying out reconstructive transformations of raw Hansard data which result in analytic overviews, I then apply and evaluate the typologies of differences of opinions, standpoints, argument schemes, argumentation structures, prototypical argumentative patterns, and argumentative styles. I also explore the use of ad hominems by the arguers. In the case of radio transcripts, I establish analytic overviews and then appraise language use by party representatives for attitudinal positioning, stance-taking and intertextual positioning using the appraisal analytical tools of the attitude and engagement semantics. My findings indicate that ministers use either complex pragmatic argumentation or complex problem-solving argumentation in defence of their prescriptive standpoints as they are expected to explain and justify government policies. MPs use mostly simple argumentation (enthymemic arguments) and at times complex pragmatic argumentation due to the limitations imposed by institutional preconditions. Argumentation by example and symptomatic argumentation are the favoured argument scheme and argumentation structure respectively for many politicians. Prototypical argumentative patterns revealed that ministers use direct dialectical routes since they have the burden of proof. They use largely detached argumentative styles except when they deliberate on divisive issues. Generally, politicians try to manoeuvre strategically but there are times when they aim for effectiveness at the expense of being reasonable, and when they are opposition MPs, they are called out by ZANU PF MPs and the Speaker hence their strategic manoeuvring derails. Politicians use ad hominems and erotema as emotional appeals and framing devices for their putative and/or primary audiences when deliberating hotly-contested issues, such as sanctions, human rights violations and currency policies. Shona proverbs and idiomatic expressions, emotive language and intertextuality/heteroglossic formulations are some of the presentational devices exploited by politicians during deliberations.
- ItemPatterns of on-scene and healthcare system trauma deaths in the Western Cape of South Africa. World(John Wiley & Sons Ltd, 2024-02-03) Finn, J; Dixon, J.M.; Moreira, F.; Herbst, C.; Bhaumik, S.; Fleischer, C.L.; Stassen, W.; Beaty, B.; Lourens, D.; Verster, J.; Fosdick, B.; Lategan, H.J.; De Vries, S.; Uren, G.; Wylie, C.; Steyn, E.; Geduld, H.; Mould-Millman, N.-K.Background Injuries account for 8% or 4.4 million deaths annually worldwide, with 90% of injury deaths occurring in low- and middle-income countries. Inter-personal violence and road traffic injuries account for most injury deaths in South Africa, with rates among the highest globally. Understanding the location, timing, and factors of trauma deaths can identify opportunities to strengthen care. Methods This is a retrospective cross-sectional secondary analysis of trauma deaths from 2021 to 2022 in the Western Cape of South Africa. Healthcare system trauma deaths were identified from a multicenter study paired with a dataset for on-scene (i.e., prior to ambulance or hospital) trauma deaths in the same jurisdictions. We describe locations, timing, injury factors, and cause of death. We assess associations between those factors. Results There were 2418 deaths, predominantly young men, with most (2274, 94.0%) occurring on-scene. The most frequent mechanism of injury for all deaths was firearms (32.6%), followed by road traffic collisions (17.8%). On-scene deaths (33.2%) were significantly more likely to be injured by firearms compared to healthcare system deaths (23.6%) (p-value <0.01). Most healthcare system deaths within 4–24 h of injury occurred in a hospital emergency center. Among healthcare system decedents, half died in the emergency unit. Conclusions We identified a large burden of deaths from interpersonal violence and road traffic collisions, mostly on-scene. In addition to primary prevention, shortening delays to care can improve mortality outcomes especially for deaths occurring within 4–24 h in emergency centers.
- ItemOutcomes of surgical patients in a tertiary ICU with incidental COVID-19 in comparison with COVID-19 naïve patients(Association Of Surgeons Of South Africa, 2024-12) Parker M; Mia I; Ahmed N; Van der Westhuizen V; Diayar A; Buitendag JBACKGROUND: COVID-19 was first identified in Wuhan, China, in December 2019, where it spread over a wide geographic area until it reached the status of a pandemic in 2020. We postulated that patients who were diagnosed with incidental COVID-19, and underwent surgery, did not have a worse outcome due to the COVID-19 virus compared to their counterparts who did not have the virus. METHODS: This retrospective study included surgical patients (COVID-19 incidentals and COVID-19 negatives) who were admitted to the surgical intensive care unit (SICU) at Tygerberg Academic Hospital between 1 May 2020 and 31 December 2021. RESULTS: The sample consisted of 578 patients. Forty-one (41) patients had incidental COVID-19 infection, and 537 patients were COVID-19 naïve. The mean age was 43.9 years (SD = 16.7 years; range = 13.0-82.0 years) and 181 (31.3%) were female. The rates of complications in patients with COVID-19 infection (7.3%) and those without (5.0%) were similar (p = 0.64). Grades of complications, as measured using the Clavien-Dindo classification were also similar between patients with and without COVID-19 infection (p = 0.19). The mortality rates of patients with COVID-19 infection (17.1%) and those without (13.6%) were similar (p = 0.53). CONCLUSION: This study demonstrates that surgery among asymptomatic PCR-positive patients was not associated with increased mortality or morbidity in the SICU. This also adds a valuable contribution to the growing body of literature regarding COVID-19 infections. Further prospective and multicentred studies are required to provide more robust results.
- ItemObesity is South Africa’s new HIV epidemic(South African Medical Association, 2024-03) Chandiwana, Nomathemba; Venter, W D Francois; Manne-Goehler, Jennifer M; Wade, Alisha; le Roux, Carel W; Mbalati, Nzama Lawrence; Grimbeek, Angelika; Kruger, Petronell; Montsho, Eunice; Zimela, Zukiswa; Pillay Yogan; Dave, Joel A; Murphy, Angela; Goldstein, Sue; Hofman, Karen; Mahomedy, Sameera; Thomas, Elizabeth; Mrara, Busi; Wing, Jeff; Lubbe, Jeanne; Koto, Zack; Conradie-Smit, Marli; Wharton, Sean; May, Wayne; Marr, Ian; Kaplan, Hilton; Forgan, Mariam; Alexander, Graham; Turner, John S; Fourie, Gina; Hellig, Jocelyn Ann; Banks, Mandy; Ragsdale, Kim E; Noeth, Marisa; Mohamed, Farzahna; Myer, Landon; Lebina, Limakatso; Maswime, Salome; Moosa, Yunus; Thomas, Teressa Sumy; Mbelle, Mzamo; Sinxadi, Phumla; Bekker, Linda-Gail; Bhana, Sindeep; Fabian, June; Decloedt, Eric; Bayat, Zaheer; Daya, Reyna; Bobat, Bilal; Storie, Fiona; Goedecke, Julia H; Kahn, Kathleen; Tollman, Stephen; Mansfield, Brett; Siedner, Mark J; Marconi, Vincent C; Mody, Aaloke; Mtshali, Ntombifikile Nokwethemba; Geng, Elvin; Srinivasa, Suman; Ali, Mohammed K; Lalla-Edwards, Samanta; Bentley, Alison; Wolvaardt, Gustaaf; Hill, Andrew; Nel, JeremyWorld Obesity Day is on 4 March 2024, and our nation needs to pay attention. As with the HIV epidemic in the 1990s, we are facing a calamitous threat to the health of the population that has been ignored for too long. Weight-related diseases have eclipsed tuberculosis (TB) and HIV as leading causes of morbidity and mortality. Over two-thirds of South African (SA) women are overweight or are living with obesity.[1] For example, type 2 diabetes, stroke and heart disease, conditions all directly linked to the disease of obesity, account for three of the top four causes of death nationally and incur massive health system costs.[2,3] Moreover, excess weight gain has deleterious effects far beyond cardiovascular disease risk, with evidence strongly linking it to poor pregnancy outcomes, cancer, liver and kidney disease, mental illness, and sleep disorders.[4,5]. As with HIV in the early 2000s, tools to prevent and treat obesity are available, but too often are being ignored or obfuscated through government inaction, industry interests, and societal inertia. Also, as with HIV, SA has waited too long to convert effective interventions into effective public health strategy. Instead, we remain trapped in a cycle of apathy while blaming and stigmatising those affected. The medical establishment has not always been an ally in combating the obesity health emergency.[6] A poor understanding of the physiology of the disease, the endocrinological complexity of fat tissue, and the contribution of diet and exercise to weight gain has led healthcare providers to preach the common refrain of 'eat less and move more'. This serves to further perpetuate shame and stigma for those with the disease, even as it is now well understood to be ineffective alone for most of those affected.[7] Unsuitable weight loss advice contributes to confusion and anxiety for individuals with obesity, and in turn allows a diet, exercise and supplement industrial complex to thrive with minimal regulation.[8] But it is not too late for SA to implement an effective response to this established disease crisis. There are two important next steps. First, to apply the lessons from the HIV epidemic to reduce obesity-related stigma and facilitate widespread access to novel anti-obesity therapies using a public health approach; and second, to establish robust advocacy efforts that ensure that structural determinants of the disease, including food supply and the built environment, promote, rather than undermine, health. Much as combination therapy was a game changer for the HIV response, modern obesity medicine has demonstrated that novel medications and/or surgery are critical elements to achieve sustained weight loss and improved health outcomes.[9] For example, new classes of medications, such as the glucagon-like peptide (GLP)-1 receptor agonists, effectively control the disease, improve glycaemic control and reduce cardiovascular events, but are currently prohibitively expensive, prone to massive repeated supply shortages, and unavailable from state clinics and most medical aids.[9,10] SA is uniquely positioned to build upon the success of HIV and TB programmes to change this situation, by including simplification of access alongside generic manufacture at scale to facilitate price reduction. Notably, these interventions do not conflict with lifestyle recommendations, with recent evidence suggesting greater efficacy when these drugs are used in combination with lifestyle changes. The Standard Treatment Guidelines and Essential Medicines List currently contains no approach to the disease of obesity, and medication and surgical approaches were removed from the 2023 National Obesity Strategy, which barely mentions treatment, apparently owing to cost.[12] Obesity science is also teaching us how biomedical interventions are unlikely to be sufficient to tackle this epidemic alone. The obesogenic environment - structural societal conditions including both our food system and our built environment - is an important driver of the rise in obesity levels in the past 40 years in SA and elsewhere.[13-15] For example, the introduction of ubiquitous, cheap, highly and ultra-processed food and sugar-sweetened beverages, offered in slick venues and spaza shops accompanied by marketing campaigns often aimed at children, alongside a built environment that hinders sufficient physical activity, are major driving forces.[13,14,16] Focusing on our food supply, facilitating access to a diversity of affordable fresh, healthy, unprocessed food and the means to prepare it, and ensuring that the public is aware of the dangers of highly processed and ultra-processed food, is a necessary step.[17] It is highly unlikely that these systematic changes will be possible without firm government and regulatory intervention. Profit margins on heavily processed goods are far higher than on their less packaged counterparts, and powerfully resourced industries oppose such action, including opposition to even the most tentative steps around regulating sugary drinks and, more recently, promotion of food labelling.[12,18-20] One chilling difference from HIV is that the viral vector did not have a massive unregulated marketing machine behind it. Distressingly, there has been little sign of urgency on the part of government to take up the issue of food advertising, quality and affordability, and some of these industries clearly have the ear of senior officials, as in other countries.[18]. Debates on where to focus resources, programming, and attention on the prevention or treatment of clinical obesity are also reminiscent of the early HIV epidemic. Then, many prevention advocates regarded people with HIV as sad casualties of failed prevention programmes, too expensive and complex to treat. The language 'medicalising a social problem' has similarly started to creep into the discourse about obesity and its management, occasionally with a moral touch of 'they brought it on themselves'.[7] Allowing this language to persist would be a dreadful mistake. To destigmatise obesity, and effectively combat the obesity epidemic, it will be important to maximise the use of all prevention and treatment strategies simultaneously. The activist and medical communities were critical in advocating for the introduction of antiretroviral drugs and provision of healthcare that allowed individuals with HIV to live healthy, productive lives. We think that we have a moral imperative to advocate just as vigorously for individuals with obesity (Table 1). It is past time for our government and medical community to develop a laser-like focus on responding to the disease of obesity. Doing this will require policy, legislation, programming, and funding actions that will both facilitate access to innovative medical tools for obesity and deliver these in an environment that promotes healthy food choices and active lifestyles accessible to all. SA's HIV programme is often held up as the global model, thanks to decades of health activism, community engagement and science-based policy, along with government resources and commitment. Our established obesity epidemic now demands the same energy, commitment and focus from all of us.
- ItemInternational registry on aortic balloon occlusion in major trauma: Partial inflation does not improve outcomes in abdominal trauma(Elsevier, 2023-08-30) Paran Maya; McGreevy, David; Horer. Tal M; Khan, Mansoor; Dudkiewicz, Mickey; Kessel, Boris; the ABO Trauma Registry research groupBackground Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a method for temporary hemorrhage control used in haemodynamically unwell patients with severe bleeding. In haemodynamically unwell abdominal trauma patients, laparotomy remains the initial procedure of choice. Using REBOA in patients as a bridge to laparotomy is a novel option whose feasibility and efficacy remain unclear. We aimed to assess the clinical outcome in patients with abdominal injury who underwent both REBOA placement and laparotomy. Methods This is a retrospective study, including trauma patients with an isolated abdominal injury who underwent both REBOA placement and laparotomy, during the period 2011–2019. All data were collected via the Aortic Balloon Occlusion Trauma Registry database. Results One hundred and three patients were included in this study. The main mechanism of trauma was blunt injury (62.1%) and the median injury severity score (ISS) was 33 (14–74). Renal failure and multi-organ dysfunction syndrome (MODS) occurred in 15.5% and 35% of patients, respectively. Overall, 30-day mortality was 50.5%. Post balloon inflation systolic blood pressure (SBP) >80 mmHg was associated with lower 24-h mortality (p = 0.007). No differences in mortality were found among patients who underwent partial occlusion vs. total occlusion of the aorta. Conclusions Our results support the feasibility of REBOA use in patients with isolated abdominal injury, with survival rates similar to previous reports for haemodynamically unstable abdominal trauma patients. Post-balloon inflation SBP >80 mmHg was associated with a significant reduction in 24-h mortality rates, but not 30-day mortality. Total aortic occlusion was not associated with increased mortality, MODS, and complication rates compared with partial occlusion.