Progress in transforming a health sciences postgraduate cohort in a south african research-intensive institution, 2008-2017.

BACKGROUND: Equity redress in the higher education and health sectors is a global discourse that seeks to address the inequalities caused by past discrimination practices. The apartheid regime in South Africa fragmented both the higher education and the health sectors, creating White and male dominated systems. Consequently, Black Africans and females were under-represented in these sectors. Furthermore, the provision of higher education including medical training was unequal between the different populations. As democracy was established in South Africa in 1994, it is necessary to assess whether transformation in population affinity and sex of postgraduate students in the higher education and health sector has occurred, as these individuals are crucial for providing the future academic workforce and also healthcare to the public. METHODS: The demographic profile of postgraduate students graduating in a health sciences facility in South Africa over the period 2008-2017 was retrospectively assessed. Survival analysis models were used to investigate the time taken to graduate. Log-rank tests were used to compare the completion rates. RESULTS: More females (53.3%) than males (41.9%) completed their postgraduate degree over the period 2008-2017 (p˂0.0001). In relation to population affinity, more White students (56.4%) than Black African students (40.8%) completed their degrees overall (p˂0.0001). CONCLUSION: While transformation occurred in the sex of graduating students over the ten year period, the same change has not occurred with regards to population affinity. The under-representation of Black African graduates is a major setback for efforts to diversify the South African higher education and health sectors. Transformation of the demographic profile of postgraduate students at South African institutions is vital for developing individuals who will contribute to equitable redress of academic staff in the higher education sector and also of the healthcare workforce. Diversified health personnel including highly skilled clinician scientists will aid in improving the provision of health care to communities particularly the underpriviledged rural areas, and also assist in training the next generation of healthcare staff. The challenges identified in this study may assist other countries where adequate transformation of the education and health sectors has not occurred.

Advances in Digital Technology in Teaching Human Anatomy: Ethical Predicaments.

The study of human anatomy has long been inseparable from illustration, as the portrayal of the dissected body alongside a descriptive text supports the understanding of this complex topic. With the advent of new technologies, applications for revealing the details of the human body have increased to include Computed Tomography and Magnetic Resonance Imaging scanning, digital photography and videography, and three-dimensional (3D) printing. In addition, the distribution of the captured image has become widespread in both online teaching and in hard copy textbooks. While these digital images and applications are invaluable for online teaching, particularly during pandemics, anatomists must consider whether the use of the images and data derived from human bodies (either donor or unclaimed) is ethical, as it is not always clear whether permission has been obtained for their creation.Questions regarding the ethical sourcing and use of images will become more urgent as the utilization of electronic data becomes routine. Particularly concerning is the distribution of images and videos in the public domain on social media, where the context and link with education may be severed. Other considerations include respect for the privacy of the deceased, ownership of images, and commercialization. An initial question that should be posed is "Who is responsible for the oversight of digital and 3D printed models of bodies?" The ethical use of such images needs to be considered by the global anatomy community in order to ensure that anatomists do not retreat into the ethical mire of their forefathers.

A morphometric analysis of the immature human infraorbital canal.

PURPOSE: The importance of the infraorbital canal in the growth of the maxilla and associated mid-facial region has significance for innervation of this region as well as the associated dentition, yet little is known about the development of the canal. An analysis of its dimensions and morphology during the late prenatal and early postnatal periods was thus undertaken. The aim of this study was to describe changes in the morphology, size and branching pattern of the infraorbital canal during the late prenatal and early postnatal stages of human growth. METHODS: Fifty human fetal and neonatal maxillae were analyzed. The sample included 27 late prenatal individuals (30 gestational weeks and birth) and 23 early postnatal individuals (birth and 1 year). Maxillae were scanned using a Nikon XTH 225 L micro-CT unit and analyzed using VG studiomax v3.2. Measurements included the maximum width, height and surface area of each foramen associated with the infraorbital canal and the total length of the canal, bilaterally. RESULTS: All the measurements of the canal were greater in the early postnatal group than in the late prenatal group, while the walls and branching pattern of the canal were better developed in the postnatal group. Bone development occurred within the walls as development proceeded. Variations in the branching pattern of the canal were found. CONCLUSION: The morphology of the infraorbital canal reflected the developmental stage of associated structures such as the dentition, maxillary sinus and orbit.

A biostatistical support system in health sciences: is this sustainable in a resource-restricted environment?

BACKGROUND: Training in biostatistics is important for strengthening capacity in health research. This is particularly true for Africa, where research output in the health sciences has been low. Training initiatives for the continent are therefore essential. The aim of the present study was to analyse the quality and financial sustainability of the expanded biostatistical support system at a South African health sciences institution between 2013 and 2017. METHODS: A cross-sectional investigation of the initiatives created between the years 2013 and 2017 in the University of the Witwatersrand, Faculty of Health Sciences Research Office was undertaken. An assessment of the one-on-one consultations carried out by postgraduate students and staff, financial costs of the support system and the number of postgraduate student graduations were analysed. RESULTS: The number of statistical consultations increased over the period examined. The consultations were highly recommended by the postgraduate students and staff (consulters). A clear rise in the number of Masters and PhD student graduates and an increase in research units were observed from 2013 to 2017, although these cannot be solely associated with the biostatistical support system. The finances for maintaining the support system are cost effective as the number of graduates increases. The total cost to the Research Office is US$ 225 per graduate per annum. CONCLUSIONS: The expansion of the biostatistical support system has indirectly contributed to an increased number of graduates and research publication units in the institution. While the current finances support the system, any increases in enrolments or growth in diversification of biostatistical requirements may place a strain on the financial sustainability. This service is of value to developed and developing countries.

An osteological assessment of cyclopia by micro-CT scanning.

PURPOSE: Imaging modalities such as micro-CT scanning and three-dimensional reconstruction are providing a mechanism for detailed analysis of skeletal components not only of normal specimens but also through revisitation of the abnormal. The aim of this study was to analyse the craniofacial skeleton of five human fetuses with cyclopia by means of micro-CT scanning and three-dimensional reconstruction. MATERIALS AND METHODS: The study consisted of five cyclopean individuals from the paediatric collection of the School of Anatomical Sciences, University of the Witwatersrand. The specimens ranged in age from 22 to 42 weeks of gestation. The osteological features of each bone of the skull were analysed with the aid of micro-CT scanning and analysis using VG studiomax software. RESULTS: A detailed analysis of all the bones of the skull revealed that the upper two-thirds of the viscerocranium and the anterior region of the basicranium were the most affected regions of the cyclopean fetuses. The ethmoid, nasal, inferior concha and the lacrimal bones were absent in all the cases of cyclopia. Major abnormalities were found in the premaxillary region which affected the development of the anterior dentition. CONCLUSION: This study supports the suggestion that the malformations of the visceral bones are secondary to defective development of the presphenoid and mesethmoid cartilages. The ethmoidal bones are important midline struts during normal development and their absence in cyclopia leads to non-laterality of facial features.

Variations in bone density across the body of the immature human mandible.

During growth the mandible accommodates increases in biomechanical loading resulting from changes in the function of structures of the oral cavity. Biomechanical loads are thought to play an intricate and vital role in the modelling and remodelling of bone, with site-specific effects on bone mineral density. It is anticipated that the effects of this loading on bone mineral density are intensified during the functional transition from prenatal to postnatal stages. The aim of this study was thus to evaluate changes in bone mineral density across the body of the immature human mandible during the early stages of dental development. The study sample included 45 human mandibles, subdivided into three age groups: prenatal (30 gestational weeks to birth; n = 15); early postnatal (birth to 12 months; n = 18); and late postnatal (1-5 years; n = 12). Mandibles were scanned using X-ray micro-computed tomography. Eight landmarks were selected along the buccal/labial and lingual surfaces of each dental crypt for evaluation of the bone mineral density. Bone mineral density values were calculated using a reference standard and analysed using multivariate statistics. The bone mineral density of the lingual surface was found to be significantly higher (P ≤ 0.000) than that of the buccal/labial surface. Furthermore, bone mineral density in the alveolar region of the buccal/labial surface of the deciduous central incisor (P ≤ 0.001), the deciduous first molar (P ≤ 0.013) and lingual alveolar area of the deciduous second molar (P ≤ 0.032) were significantly greater in the early postnatal period than in the prenatal period. While changes in bone mineral density across the lingual surface were consistent with the progression of development and the biomechanical demand of the tongue as previously demonstrated, changes observed across the buccal/labial surface of the mandible appeared to accompany the advancing dental development. Thus, changes in bone mineral density across the mandible appear to be reflective of the stage of dental development and the level of biomechanical loading.

Writing for publication: institutional support provides an enabling environment.

BACKGROUND: Due to the excessive service delivery loads in public hospitals supported by academic institutions in developing environments, researchers at these institutions have little time to develop scientific writing skills or to write up their research. It is imperative to expand the writing skills of researchers and train the next generation of health sciences academics in order to disseminate research findings. This study reports on the implementation of approaches for writing and publication and the extent of support to staff suffering from the overload of service delivery and of heavy teaching duties. METHODS: Workshops in scientific writing and writing retreats were initiated and were offered to all staff. RESULTS: Feedback from participants of the writing skills workshops indicated that the workshops provided an injection of confidence and proficiency. Protected writing time resulted in 132 papers submitted to journals and 95 in preparation from 230 participants of the writing retreats over a two year period. Staff commended the off-site, collegial environment, which also supported future collaboration with new-found colleagues. CONCLUSION: This enabling environment facilitates not only the development of writing skills per se, but also the dissemination of the generated scientific knowledge. In addition, the training in writing skills of this generation will be of value in the training of future cohorts in countries with similar health care deliverables.

Acticoat™ stimulates inflammation, but does not delay healing, in acute full-thickness excisional wounds.

Acticoat™ has antimicrobial and anti-inflammatory effects which aid wound healing. However, in vitro studies indicate that Acticoat™ is cytotoxic and clinical and in vivo studies suggest that it may delay healing in acute wounds. Therefore, this study investigated the effects of Acticoat™ on healing in acute full-thickness excisional wounds. Using a porcine model, healing was assessed on days 3, 6, 9 and 15 post-wounding. Five wounds dressed with Acticoat™ and five wounds dressed with polyurethane film (control) were assessed per day (n = 40 wounds). The rate of healing, inflammatory response, restoration of the epithelium and blood vessel and collagen formation were evaluated. No difference was found in the rate of healing between wounds treated with Acticoat™ and the control wounds. Inflammation was increased in Acticoat™-treated wounds on day 3 post-wounding compared to the control wounds. However, by day 15 post-wounding, the epithelium of the Acticoat™-treated wounds closely resembled normal epithelium. Acticoat™-treated wounds also contained a higher proportion of mature blood vessels, and differences in collagen deposition were apparent. Despite inducing an inflammatory response, Acticoat™ did not delay healing in acute wounds. Conversely, the improved quality of the epithelium and blood vessels within Acticoat™-treated wounds indicates that Acticoat™ has a beneficial effect on healing.

Importance of teeth in maintaining the morphology of the adult mandible in humans.

Edentulism can negatively affect both masticatory performance and dietary intake by altering the patterns of biomechanical stress and strain, which in turn modifies the morphology of the different regions of the mandible. The morphological changes in the mandible caused by these stressors are unknown when comparing mandibles across varying dentition states. This study investigated differences in the morphology of human mandibles across various states of the dentition. In total, 498 mandibles of individuals between 20 and 80 yr of age at death were sourced from the Raymond A. Dart Collection of Human Skeletons. These included fully dentate (n = 95), partially edentulous (n = 333), and fully edentulous (n = 70) mandibles. Twelve linear anthropometric measurements of the mandible were derived from digitized landmarks located on its external surface. Data analysis included geometric morphometrics and multivariate analyses. Compared with dentate and partially edentulous mandibles, fully edentulous mandibles showed a shorter alveolar height (-0.4 mm), a shorter mandibular body length (-4 mm), a larger gonial angle (+4°), a more obtuse mental angle (+4.7°), a broader bicondylar width (+3.8 mm), and a taller ramus height (+1.6 mm). Thus, edentulous states are associated with an altered mandibular morphology, which may result from a reduction in jaw function.

Developing a biostatistical support system in a resource-restricted academic institution in Africa: making it happen.

BACKGROUND: In order to address and support biostatistics for health research, the Health Sciences Research Office of the University of the Witwatersrand sought to introduce training in biomedical statistics to sustain research and postgraduate education. The experiences encountered in setting up such statistical support in a limited resource, developing country are discussed here. METHODS: Two cross-sectional surveys (a) statistical needs assessment (2009) and (b) feedback (2010-11) on the statistical support through biostatistics courses and consultations were conducted. These surveys were supplemented with information such as graduations, research publication output and costs of setting up the support. RESULTS: Seventy-three percent of respondents favoured short courses with "hands-on" practice. Eighty-nine percent agreed that these courses should be run and coordinated by the Health Sciences Research Office instead of the departments. There was use of varied statistical packages requiring one package for standardised support. The numbers of postgraduate students attending short courses in statistics increased from 2010 to 2012 as did the numbers attending statistical consultations. Graduations and publication outputs increased over this period of time although this may not be directly linked solely to the biostatistical support system introduced. CONCLUSIONS: There is a distinct need for biostatistics training in developing countries and the process described in this study could be replicated in any health sciences institution, especially in a resource-restricted environment.

Morphometric growth relationships of the immature human mandible and tongue.

The masticatory apparatus is a highly adaptive musculoskeletal complex comprising several relatively independent structural components, which assist in functions including feeding and breathing. We hypothesized that the tongue is elemental in the maintenance of normal ontogeny of the mandible and in its post-natal growth and development, and tested this using a morphometric approach. We assessed tongue and mandibular measurements in 174 (97 male) human cadavers. Landmark lingual and mandibular data were gathered individuals aged between 20 gestational weeks and 3 yr postnatal. In this analysis, geometric morphometrics assisted in visualizing the morphometrical growth changes in the mandible and tongue. A linear correlation in conjunction with principal component analysis further visualized the growth relationship between these structures. We found that the growth of the tongue and mandible were intrinsically linked in size and shape between 20 gestational weeks and 24 months postnatal. However, the mandible continued to change in shape and size into the 3rd yr of life, whereas the tongue only increased in size over this same period of time. These findings provide valuable insights into the allometric growth relationship between these structures, potentially assisting the clinician in predicting the behaviour of these structures in the assessment of malocclusions.

Challenges to sourcing human bodies for teaching and research in Africa: Are the challenges insurmountable?

The teaching and learning of human anatomy by dissection has existed for thousands of years. Over the centuries, evolving ethical considerations for the sourcing of human bodies for dissection have resulted in a transition from the use of unconsented individuals to that of body donors and the institution of body donation programmes around the world. However, major challenges on the African continent have resulted in the continued use of unconsented or unclaimed bodies and the ethical dilemma for African anatomy departments regarding their use. Some of the key difficulties in sourcing donor bodies which exist on the African continent emanate from religious, cultural, societal trust and other confounding factors. This manuscript explores the challenges and suggests ways in which some of these constraints may be overcome.

Perceptions of journal editors on the use of eponyms in anatomical publishing: the need for compromise.

While arguments have been made both for and against the value of anatomical eponyms, limited research exists regarding their use by anatomists. As the editors of the principal international anatomy journals have purview and control of terminology in anatomical journals, their perceptions regarding the relevance, ethics and inclusivity of eponym use in anatomy and in publishing in anatomical journals were investigated. A validated, confidential and anonymized self-administered questionnaire which included open-ended questions was distributed to the 22 Editor-in-Chiefs/Senior Editors of anatomical journals. Of the 16 (73%) editors who responded to the survey, only 56% were aware that eponyms had been censured since the time of the 1895 Nomina Anatomica. The majority of responding editors found the use of Latin- and Greek-derived terms more valuable when communicating with students and peers, but also thought eponyms were acceptable in manuscripts submitted to their journals. Thirteen (81%) of the responding editors agreed that eponyms play a vital role in the history of anatomy, and some thought they were important for discussing bioethics concepts. However, 62.5% felt that there were valid reasons for their discontinuation. Half of the respondents did not consider the continued use of eponyms an ethical concern. Responding editors of anatomical journals prefer the use of Latin- and Greek- derived terms when interacting with other anatomists and students. However, the continued use of eponyms was seen as an important opportunity for discussion on the history and ethics of anatomy.

Leading the transition to ethical human body sourcing in Africa: The South African experience.

BACKGROUND: The use of human bodies for anatomy education and research forms an integral part of the training of health professionals around the world. However, the ethical acquisition of human remains for this purpose has been a challenge in many countries, particularly for those on the African continent. South African institutions have however, been able to progressively transition to a more ethical approach to human body acquisition. The aim of the current study was to investigate the provenance of human bodies and the number used in South African health sciences institutions during the period 2017-2021. METHODS: an online self-administered anonymised questionnaire was circulated to all health sciences institutions in South Africa. Questions were focused on establishing the provenance and the associated number of bodies and body donor programmes. RESULTS: responses were received from thirteen of the fourteen South African institutions. All thirteen institutions use human bodies for teaching and research, with the majority of the institutions being reliant on bequests (77%) and family donations (62%), and less on unclaimed remains (46%). Most institutions have established body donor programmes. Four institutions were negatively affected by the effects of the pandemic. Memorial services, which continued during the pandemic, were conducted by eight of the thirteen institutions. CONCLUSION: South Africa is leading the transition to the ethical acquisition of human remains on the African continent. It is hoped that South African institutions will soon transform to the exclusive sourcing of bodies through willed donation and provide guidance and support for the other countries on the continent.

Profiting from public dissection: A new era of unethical practices.

Historically, adverse events have reflected poorly on both the practice of dissection and the perception of the discipline of anatomy. The recent public dissection of a body donor is a regression to an unethical historical practice and was strongly denounced by anatomists around the world. The individual whose donated body was sourced from a 'for-profit" company in the United States had not given consent for a public dissection. This violates the ethics surrounding consent and body donation and potentially places the future of body donor programs in jeopardy as it compromises community frameworks around epistemic trust. Recent guiding frameworks by international anatomical associations on the ethical use of bodies have cemented the way in which body donor programs should operate. This viewpoint reflects on past and current events pertaining to public dissections and questions how these indignities may influence the public's interaction with human bodies. The authors argue that public dissection should be prohibited as it is against social mores. Social pressure should be applied to individuals or companies who wish to profit from unethical anatomical practice and legislation prohibiting public dissection should be introduced in those countries where it does not yet exist.

Pathobiology of cancer metastasis: a short account.

Cancer-initiating cells display aberrant functional and phenotypic characteristics of normal stem cells from which they evolved by accumulation of multiple cytogenetic and/or epigenetic alterations. Signal transduction pathways which are essential for normal stem cell function are abnormally expressed by cancer cells, with a cancer cell phenotype playing an essential role in cancerization and metastasis.Local tumour progression, metastasis and metastatic tumour growth are mediated by direct cell-to-cell and paracrine reciprocal interactions between cancer cells and various stromal cells including fibroblasts, macrophages, bone marrow derived stem cells and progenitor cells. These interactions mediate breakdown of basement membrane barriers and angiogenesis both locally at the invasive front of the primary tumour and at the distant metastatic site; attract primary tumour cells to the candidate metastatic site; and promote proliferation, survival and growth of primary tumour cells and of metastatic cells at their distant site.It is the purpose of this article to highlight the analogies between some of the genetic programs of normal stem cells, and of cancer cells participating in the process of metastasis.

A reappraisal of the hypophysial region of the floor of the sella turcica.

While studying the detailed anatomy of the cranial sella turcica, an additional fossa in its floor, which has not previously been described, was noted. A survey for this fossa, therefore, was conducted on 205 adult crania from the Raymond A. Dart Collection of Human Skeletons, University of the Witwatersrand. To confirm the survey observations, the sella turcica region of 10 adult cadavers was also dissected. A larger anterior depression and a smaller posterior concave fossa, often extending on to the anterior surface of the dorsum sellae, were evident in the hypophysial region and occurred in 21.5% of crania and in six of the 10 dissected specimens. An anterior depression alone or a posterior fossa alone occurred in 2.4% and in 72% of the crania, respectively, indicating that the posterior fossa occurs most commonly in this series. The more commonly occurring presence of a posterior fossa abutting on to the anterior surface of the dorsum sellae is described for the first time.

The ethical use of digital technology in teaching anatomy: A southern African perspective.

BACKGROUND: The use of 21st Century technology in anatomy teaching and the recent crisis caused by the Coronavirus pandemic has stimulated anatomists to ponder the ethics surrounding the utilisation of digital images from human bodies of known and unknown provenance in teaching. AIM: This novel study explores the awareness of southern African anatomy educators regarding the provenance and ethical use of human material in digital resources for E-learning purposes. MATERIALS AND METHOD: Anatomy educators (both members and non-members of the Anatomical Society of Southern Africa including postgraduate students in anatomy) located in 15 health sciences facilities in southern Africa were asked to participate in the survey which consisted of an anonymous, cross-sectional, questionnaire conducted on an online research data system, REDCap. RESULTS: While 52% of respondents used E-learning resources sourced from their own departments for teaching, only 58% of these had knowledge of the provenance of the human material used. Of the 72% of respondents using images from external E-learning resources, 64% did not know the provenance of the human material in these resources. Some southern African anatomists considered anonymity as equivalent to informed consent. Regarding the acceptability of unclaimed bodies for online images, 37% of respondents were against the use of these bodies, while 20% indicated that it was acceptable. Personal internal moral conflict was acknowledged regarding the use of material from unclaimed bodies, particularly during crises such as the Coronavirus pandemic when digital resources were limited. DISCUSSION AND CONCLUSIONS: Factors such as lack of awareness of provenance, the law in South Africa and using anonymity for consent, influence the ethical behaviour of southern African anatomists. Clear guiding principles would be of value for anatomists globally with respect to consent to the taking and distribution of images, and transparency on the source of the digital images provided in digital texts and online platforms. The establishment of both an oversight and ethics committee at institutions where digital imaging will be used is recommended.

Electronic Data Capture System (REDCap) for Health Care Research and Training in a Resource-Constrained Environment: Technology Adoption Case Study.

BACKGROUND: Electronic data capture (EDC) in academic health care organizations provides an opportunity for the management, aggregation, and secondary use of research and clinical data. It is especially important in resource-constrained environments such as the South African public health care sector, where paper records are still the main form of clinical record keeping. OBJECTIVE: The aim of this study was to describe the strategies followed by the University of the Witwatersrand Faculty of Health Sciences (Wits FHS) during the period from 2013 to 2021 to overcome resistance to, and encourage the adoption of, the REDCap (Research Electronic Data Capture; Vanderbilt University) system by academic and clinical staff. REDCap has found wide use in varying domains, including clinical studies and research projects as well as administrative, financial, and human resource applications. Given REDCap's global footprint in >5000 institutions worldwide and potential for future growth, the strategies followed by the Wits FHS to support users and encourage adoption may be of importance to others using the system, particularly in resource-constrained settings. METHODS: The strategies to support users and encourage adoption included top-down organizational support; secure and reliable application, hosting infrastructure, and systems administration; an enabling and accessible REDCap support team; regular hands-on training workshops covering REDCap project setup and data collection instrument design techniques; annual local symposia to promote networking and awareness of all the latest software features and best practices for using them; participation in REDCap Consortium activities; and regular and ongoing mentorship from members of the Vanderbilt University Medical Center. RESULTS: During the period from 2013 to 2021, the use of the REDCap EDC system by individuals at the Wits FHS increased, respectively, from 129 active user accounts to 3447 active user accounts. The number of REDCap projects increased from 149 in 2013 to 12,865 in 2021. REDCap at Wits also supported various publications and research outputs, including journal articles and postgraduate monographs. As of 2020, a total of 233 journal articles and 87 postgraduate monographs acknowledged the use of the Wits REDCap system. CONCLUSIONS: By providing reliable infrastructure and accessible support resources, we were able to successfully implement and grow the REDCap EDC system at the Wits FHS and its associated academic medical centers. We believe that the increase in the use of REDCap was driven by offering a dependable, secure service with a strong end-user training and support model. This model may be applied by other academic and health care organizations in resource-constrained environments planning to implement EDC technology.

A short account of metastatic bone disease.

In adults, bone is the preferential target site for metastases from primary cancers of prostate, breast, lungs and thyroid. The tendency of these cancers to metastasize to bone is determined by the anatomical distribution of the blood vessels, by the genetic profile of the cancer cells and by the biological characteristics of the bone microenvironment that favour the growth of metastatic cells of certain cancers.Metastases to bone may have either an osteolytic or an ostoblastic phenotype. The interaction in the bone microenvironment between biological factors secreted by metastatic cells, and by osteoblasts and osteoclasts, and the osteolytic and osteoblastic factors released from the organic matrix mediate a vicious cycle characterized by metastatic growth and by ongoing progressive bone destruction. This interaction determines the phenotype of the metastatic bone disease.