Medicine & Health

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  • (2022) Skliros, Christodoulos
    There are few detailed studies on the pathways through the human brainstem and even fewer on those through the pons. This thesis aims to address this lack of fine detail, and used ultra-high-field magnetic resonance imaging (MRI) of human and macaque brains to identify and characterise fibre tracts connecting cortical and spinal areas as they traverse through brainstem and thalamic structures. The material in this thesis is based on a unique dataset of ultra-high-field (7 Tesla – Duke and 11, 7 Tesla – Johns Hopkins) MRI scans on postmortem specimens, on which deterministic tractography has been applied based on high-angular-resolution diffusion imaging (HARDI) and subsequently higher order tensor glyph models. The first results section of the thesis (Chapter 3) maps the descending fibre bundles associated with movement. From the motor cortical areas, the fibres of the internal capsule are traced through the crus cerebri, basilar pons and pyramids in three dimensions to reveal their organisation into functional and topographic subdivisions. While human cortico-pontine, -bulbar and -spinal tracts were traditionally considered to be dispersed, or a “melange”, I show here a much more discrete and defined organisation of these descending fibre bundles. Nine descending fibre bundles are identified and their anatomical location and terminations are described. A hitherto unknown pathway at the midline of the pons has been discovered and named herein as the Stria Pontis which connects the neocortex to the pontine tegmentum. Ten transverse fibre bundles connecting the pontine nuclei to the cerebellum are also identified. The second results section (Chapter 4) analyses the sensory pathways; the dorsal column - medial lemniscus pathway, the spinothalamic tract, the spinal trigeminal tract and the trigeminothalamic tracts. The third results section (Chapter 5) analyses the dentato-rubro-thalamic tract. The mapping identifies the superior cerebellar peduncle, the patterning of the fibres within the superior cerebellar decussation, the patterning of the fibres within the red nucleus and finally the projection of the dentato-rubro-thalamic tract from the red nucleus to the ventral lateral nucleus of the thalamus. Finally, I characterised 117 already known anatomical parts, areas and structures of the brainstem and thalamus in 3D.

  • (2024) Mabunda, Sikhumbuzo
    Introduction Return-of-service (RoS) initiatives are government-funded strategies used to educate health professionals by contracting beneficiaries to undertake government work following their qualifications. It is envisaged that once they have served their contracts, they will be attracted to serve in the same area or government institution beyond the duration of their obligatory period. Little is known about the processes that have led to the development and implementation of RoS policies. This research aimed to evaluate RoS initiatives, explore their effectiveness and sustainability across four Southern African countries to determine their value as a sustainable solution and propose areas for improvement. Methods and Analysis This study was conducted in South Africa, Eswatini, Lesotho and Botswana in a phased approach through a multi-methods approach of policy reviews, literature reviews, and quantitative and qualitative research. Data were sourced from multiple provincial or national information systems and/or databases. The fourth and final phase included data analyses and triangulation of the findings, enabling recommendations on restructuring and enhancing, maintaining or even eliminating RoS schemes as a viable mechanism for expanding healthcare coverage. Findings The precise origins of South African RoS schemes could not be established. The origins of RoS schemes in Botswana, Eswatini and Lesotho could be established. RoS schemes aim to address critical skills shortages, contribute to citizens’ education, comply with legislation and boost the economy. The schemes are poorly planned, poorly implemented and poorly monitored, and they have not been evaluated. This study also revealed that the schemes lack effectiveness, incur significant costs, experience high defaulter rates and suffer from inadequate information management. Conclusion RoS schemes do not currently offer sustainable health workforce solutions in the four countries studied and will not unless governance, planning and implementation (including coordination and monitoring) are improved. Better monitoring and placement of beneficiaries in suitable health facilities could lead to quick improvements. Over the longer term, improved identification of the service need and appropriate incentivisation of needed skills could lead to a worthwhile investment through improved beneficiary retention.