The Black River Cemetery, located in modern day Athlone (a suburb of Cape Town), was open for burials from 1867 – 1951, serving three Anglican Churches. The recent (2017) excavation of the historic site allowed for the analysis of the exhumed skeletal remains. The outcome of the skeletal analysis is valuable as the lives documented on the skeleton of a past group of people can write the story of individuals and communities that may have otherwise been omitted from the history books. The aim of this study is to describe demography, lifestyle and disease for a group of people living at the Cape between the 18th and early 20th centuries. The excavation of the cemetery yielded 1,305 graves of which 1,050 contained skeletal remains. Skeletal preservation was varied due to taphonomic influences, but overall it was poor with high fragmentation and taphonomic loss of skeletal material. The skeletal analysis performed utilised several well-established methodologies used in bioarchaeological and forensic anthropological disciplines and produced a body of information encompassing the demographics for this historic skeletal sample. Historical research on the Colonial Cape, coupled with the Black River Cemetery history and burial registers was employed to provide the context to the results of the skeletal analysis. The historic research suggests that the community and people buried there were most likely hardworking people of the poorer communities at the Cape in the 18th and 19th century with a division of labour between men and women. In the period of time that the cemetery was receiving burials, multiple social, political and economic changes occurred including; the bubonic (black) plague, Spanish influenza epidemic, the Boer War, the First World War and the Diamond Rush. It also saw the beginnings of racially segregated living and forced relocations. This backdrop provides an interesting landscape on which to view the skeletal analysis. The data analyses showed that the mortality profiles were skewed from the normal profiles determined by Weiss (1973). The sex ratio was skewed toward males indicating a greater mortality risk for men while the age mortality profiles showed a higher child and juvenile mortality and lower old adult mortality than is typically expected in a cemetery assemblage. This is an indicator of the effects of the epidemics and other factors reducing survivability of individuals. The low frequencies of periosteal reactions also may point to the poor survival capability as individuals may have succumbed to infections before the effect would be exhibited on the skeletal material. Pathological and stress indicators also show a sexually dimorphic trend with males exhibiting greater frequencies of degenerative joint disease, fractures, osteophytic growths and rates of dental attrition. Stature analysis showed a sexually homogenous group of people suggesting a lower health status and likely malnourishment or undernutrition. The social environment in which people lived likely contributed to a weakened immune system, and the generally poor health status of the people. The experience of the people living in Black River and the surrounding areas appears to be one of hard, repetitive labour and nutritional stress within an everchanging urban setting.

This study explores the modernist subjectivity in Africa by revisiting two major poets, Christopher Okigbo and Dambudzo Marechera. It argues that the modernist self is created in the form of melancholy and mourning. The main question is to see how the African modernist subjectivity is constructed through poetry. As subjects of colonialism, both Okigbo and Marechera sought to establish new links combining them with the mainstream Euromodernist movement along with their own spiritual roots. In the sense of the construction of a modernist self, the main predicament they have to challenge is the Western knowledge system which infiltrated into mindsets through colonial dominion. Thus, Okigbo and Marechera enact a certain type of positionality strategy to claim their own poetic utterance. By invoking natural and spiritual images the poets demonstrate their affiliation to their roots. The process of mourning, here, becomes a passage through which the poets claim their strong allegiances to their roots. The sense of absence leads the poets to mourn their remote past or culture. The poets’ relation with the past determines the dynamics of subjectivity. The idea of the past is so tempting and tantalising in many ways.

I call my mother by her first name because we look nothing alike. Sure, we could have lied and told everyone I was adopted, but things like that didn’t happen when Tasleem was growing up. A child with blue eyes and a nose pointed enough to puncture a balloon was only left with a brown woman if she worked for the parents. I couldn’t have called my mother ‘mom’ if I’d wanted to – she simply didn’t teach me that word. For everyone’s safety I called her ‘Tee’, and later, when I could get my mouth around the word, I referred to her as Tannie (Afrikaans, meaning ‘Aunty’). Much as Tasleem hates it, the name stuck. Twenty years later and she’s still my aunt sometimes.

Caesarean section (CS) is one of the most frequently performed major abdominal surgeries in the world. There has been a global increasing trend in CS rates over the past three decades, particularly in women who have had one previous CS. Vaginal birth after caesarean section (VBAC) is a safe option and is still strongly recommended by all international authorities with success rates ranging from 60% to 80%. However, women’s preference for VBAC vs elective repeat caesarean section (ERCS) remains very poorly understood in South Africa (SA) as very few studies have addressed women’s preference for mode of delivery. Repeat caesarean delivery (CD) is reported as the single largest contributor to the escalating CS rate worldwide. So why do women choose repeat CD? Evidence suggests that fear, health care worker influence, social stigma, cultural practise and religious beliefs can significantly influence the attitude toward CS. South African data remains limited and we are yet to ascertain how women make their choice and what drives their specific preferences. The rationale behind this study therefore was to gain better insight into why the women in Cape Town choose VBAC or ERCS and to ascertain to what extent their knowledge, attitude and preferences influence their choice. In so doing, we were able to highlight key findings in order to attempt to reduce the increasing CS rate in our country. AIMS AND OBJECTIVES The primary objective was to explore women’s knowledge, attitudes and preferences for VBAC or ERCS after one previous CS, from 36 weeks gestation, attending antenatal care at Mowbray Maternity Hospital (MMH) and New Somerset Hospital (NSH). The secondary outcome was to describe the major reasons for their preferred mode of delivery. METHODOLOGY A prospective descriptive study was conducted over four months, of pregnant participants with one previous lower uterine segment caesarean section (LUSCS), attending antenatal care at MMH and NSH. Participants were recruited from 36-41weeks gestation. Participants over the age of 18 years with one previous LUSCS were eligible for inclusion. Participants with a medical indication for CS were excluded. An interview-based questionnaire, previously adapted for use in a Cape Town antenatal population regarding women’s knowledge, attitudes and preferences for mode of delivery was conducted at a routine antenatal visit. In addition, basic obstetric and socio-demographic data was abstracted from their folders. A descriptive analysis of participants’ preferences for mode of delivery was completed, with subgroup comparisons. The Fisher’s Exact test was used in all the statistical analyses that involved categorical variables whilst continuous variables were analysed using t-tests. RESULTS The study included 100 participants who were eligible for VBAC. Of the participants, 51% preferred ERCS whilst 49% preferred VBAC. Married couples and those in co-habiting relationships, more frequently chose VBAC compared to single participants, who more frequently chose ERCS. Participants were greatly influenced by the opinion of the HCW, particularly if ERCS was suggested, they were likely to choose a CS (p=0.001). If a previous history of long or obstructed labour was reported, participants were inclined to choose ERCS. Fear was identified as a major determinant as 78.4% cited fear of vaginal birth as their reason for preferring a CS. History of previous CS (88.2%) and fear of the risks associated with VBAC were the main reasons cited for their preference. In the group who preferred VBAC, 89.8% were of the perception that VBAC would allow them to recover faster and 87.7% desired to be home sooner therefore, favouring their choice. Whether or not the participants had a previous vaginal delivery or VBAC, it did not affect their preference for mode of delivery in a statistically significant manner. CONCLUSION This study which explored knowledge, attitudes and preferences of women who had had one previous CS, concerning their preference for mode of delivery, is one of the first to be done in South Africa. Despite all participants being medically eligible for VBAC, only 49% preferred this option, the remaining 51% preferring ERCS. Significant determinants of their choice were unstable relationships, influence of the doctor, concern about uterine rupture and fear of labour and unpredictability. Knowledge of the complications of ERCS and VBAC was very limited. This information is useful to design further research to improve understanding of these issues and to design services in a way to overcome the identified problems. In particular, women must be provided non-biased evidence-based information in order to foster a relationship of trust with the health care worker, in assisting her to make an informed decision. Similarly improving respectful competent care of women in labour with better attention to alleviating labour pain, will assist in reducing fear.

Introduction. The high cost and concern of adverse events, particularly infections, limit the use of biologic disease-modifying anti-rheumatic (bDMARD) therapies. We undertook this retrospective study to document their use for immune-mediated diseases (IMDs) and explore the efficacy, safety, adherence and screening practices prior to initiating bDMARDs in a tertiary referral hospital. Methods. A folder review of all adult and paediatric patients treated for IMDs with bDMARDs at Groote Schuur and Red Cross Hospitals between January 2013 and December 2019. Clinico-demographic particulars, details of bDMARD therapy, and adverse events were collated. Changes in disease activity were measured by diseasespecific tools at 6, 12, 24-months and at the last available visit, and patient adherence to bDMARDs was explored by folder and pharmacy record review. Results. We studied 151 folders, with 182 bDMARDs uses (29 patients used more than 1 bDMARD). Patients were from rheumatology (n= 38: 13 rheumatoid arthritis; 10 spondyloarthritis, 5 Systemic Lupus Erythematosus (SLE) , 5 inflammatory myositis and 5 other conditions); gastroenterology (n=31; 26 Crohn`s and 5 Ulcerative Colitis), dermatology (n=9; psoriasis), neurology (n=4, ophthalmology (n= 25; 6 scleritis, 18 uveitis, 1 optic neuritis), and paediatrics (n= 45, 26 juvenile idiopathic arthritis , 12 SLE, 7 other conditions). The bDMARDs used were TNF inhibitors (112), rituximab (55), tocilizumab (10), anakinra (3), abatacept (1), and tofacitinib (1). The vast majority of patients had an excellent response and were in low disease activity or remission at their last available visit. Adverse events included severe infection (4), tuberculosis (TB) (2), mild infection (4), severe allergic reaction (3), mild skin reaction (14), elevated liver enzymes (2), and worsening interstitial lung disease ILD (1). bDMARD Therapy was discontinued in 18 patients, most commonly due to adverse reaction (9), lack of response (3), poor adherence (2), or remission (1). bDMARD Therapy was changed to alternative therapy in 29 patients, most commonly because of poor response (14), or adverse effects (9) or poor adherence (3). Poor adherence or patients lost to follow-up was noted in 18/182 (9.9%). Complete latent TB infection screening with chest x-ray and TB skin test was performed in only 55 (36.4 %) but INH prophylaxis was given to 51/88 (57.9%) of patients prescribed TNFi therapy. Hepatitis B screening performed in 93 (61.6 %) patients, but most patients (72.2 %) were not tested for Hepatitis B core ab. Hepatitis C screening was performed in 81 (53.6 %) patients. Only 88 (58.3%) patients had a recent HIV test. The majority (17.2%) received the influenza vaccine, but only 24 (15.8 %) received pneumococcal vaccination. Discussion and Conclusion. bDMARD therapy was an effective treatment, and the most common adverse effect was infection (7.2%), with 2 TB infections. Vaccination and screening for TB, viral hepatitis and HIV was suboptimal. Of concern, poor adherence to bDMARDs was frequently encountered.

Background: Sexual violence policy frameworks and service delivery models are well defined in Kenya. However, little is known about the extent to which different sectors effectively work together to ensure survivors receive comprehensive care. The need for a multi-sectoral response framework has been cited in the literature. Nonetheless, it is not clearly defined what this entails in the Kenyan context. Aim: This thesis aimed at reviewing and documenting the processes involved in the delivery of services by the different sectors with a focus on patient flow, data systems, community perceptions and referral mechanisms The study also aimed to develop an in-depth understanding of the factors that influence reporting of cases of sexual violence, provision of services and uptake of available services. Also explored were the requisites for a coordinated and multi-sectoral approach to sexual violence. Methods: This is a cross-sectional study that applied a mixed-methods approach. Qualitative interviews were conducted with 23 service providers, survivors and caregivers. The quantitative component entailed abstraction of service statistics from records maintained for survivors. A total of 1259 records were obtained from two hospitals, two police stations and two courts in two counties in Kenya. Key informant guides were used for the qualitative interviews, while an Excel data abstraction tool was implemented to capture data obtained from service statistics. Thematic analysis of qualitative data was undertaken using NVivo 12. The records were analysed using SPSS Version 20.0 The Anderson model (1973) informed the interpretation of the qualitative data. Data were triangulated during the analysis across the interviews and service records. Defilement constitute the largest proportion of cases of sexual violence reported across different sectors. Poor quality of sexual violence data maintained for survivors across different service delivery points presents a difficulty in tracking survivors to examine completeness in service uptake. Existent difficulties persist in determining the extent to which the different sectors are responsive to the survivor’s need for quality and comprehensive services. Survivors--more so female and children--do not have autonomy in decision making regarding whether to report a sexual violation meted on them or not. Lack of a standardized multi-sectoral referral framework contributes to survivor frustration in accessing services due to the multiple referral pathways, costs and time delays involved. There is continued reliance on informal community level arbitration of cases despite the existing legal provisions in the Sexual Offences Act. Conclusion: The Anderson (1973) framework provides a basis for an in-depth understanding of survivors’ service utilization related behaviours and decisions. The findings reveal the interconnectedness of predisposing enabling and need factors in the context of the available services and decision making on what service to take up. While the health sector and police continue to play a key role in response to sexual violence, there still exist gaps that impede the comprehensiveness in response. Communities still prefer reaching out to informal sources of support. However, there is a disconnect between formal and informal sources of support. The need for a multi-sectoral and coordinated approach to sexual violence is critical, and its design should be informed by the needs of survivors. Measures should be put in place to address enabling factors to service access through training of providers on the management of survivors. This study provides anecdotal evidence to be utilized in informing development and implementation of multi-sectoral models of post-sexual violence service delivery models in Kenya and in Sub-Saharan Africa.

The purpose of this research is to document the design and optimisation of a full suite of guidance, navigation and control (GNC) algorithms for a small unmanned aerial vehicle (UAV), the Skywalker X8. This was performed so as to ll a void in the available literature on the selected airframe, which currently only focuses on aspects such as aerodynamic modelling, advanced controller design, or uses of the airframe to perform higher level tasks. All of these research areas make use of o-the-shelf ight controllers, but these are not always the most appropriate foundations for more advanced work as they are inherently sluggish so as to be broadly applicable to a variety of airframes. Subsequently, the Skywalker X8 airframe was modelled, using existing literature, and then characterised so as to establish what the goals might be for an optimal set of controllers. An autopilot was then designed which was optimised so as to be as close to the identied optimal performance characteristics as possible, with eort being put into ensuring that all non-linearities and disturbances were taken into account. This included advanced modelling of sensors, actuators, the environment, and the system itself. The autopilot design was then extended with a set of guidance and navigation algorithms, also developed as part of this research. This consisted of both path planning and path following algorithms which allowed for the synthesis of general classes of paths useful to the application. With both the autopilot and guidance laws developed, the system could be tested under several atmospheric ight conditions. These took the form of various wind directions and intensity levels being applied to the airframe whilst transitioning between a range of dierent waypoint congurations. The system was subsequently shown to be able to follow a set of waypoints very accurately, even with winds and turbulence with magnitudes of in excess of 60% of the aircraft's nominal airspeed. With a strong autopilot designed and illustrated in a high delity simulation environment, this work can now easily be extended into many elds. All of the tools used for this research are available and well documented, and the processes followed repeatable with all justication available in the text. As such, should a project which aims to extend this work wish to adjust the autopilot design or guidance laws, based on dierent requirements, this is easily accomplished and recommendations of starting points are provided. The system model and autopilot are also made available and are usable exactly as they are should one wish to undertake additional research which does not aim to modify, but to extend this work.

Trabecular bone is made up of an irregular, interconnecting framework of rod- and plate-like struts [1], therefore the mechanical properties of the bone may only be determined through experimental testing or detailed Finite Element modelling. Experimental testing requires a sample to be removed from the body, which is not possible in living patients. As such, there is a drive to move away from experimental testing and focus instead on creating accurate patient-specic Finite Element models from CT scans of the bone. The computational \gold-standard" Finite Element model used for trabecular bone, namely the voxel-based method, uses solid tetrahedral elements, which are extremely resource intensive. Vanderoost, et al [2] developed an alternative Finite Element code which discretises the structure into a series of beams and shells. This beam-shell approach vastly reduces the size of the mesh and, consequently, the processing time required for the simulation. In this work, an analysis cycle was developed to determine the apparent modulus of a structure using the beam-shell Finite Element model [2]. The cycle imports micro-CT scans of a structure, discretises the structure into a beam-shell mesh, performs a Finite Element simulation and outputs the apparent modulus of the structure along with a reconstructed image. The analysis cycle was validated by analysing over 3000 articially generated images, comprising various congurations of cubic lattices, Kelvin cell lattices and octet truss lattices, and comparing the modulus output by the analysis cycle to baseline results obtained through the simulation of known node and element data. The analysis cycle provided predictions within 10% of the baseline value for most lattices, however there were issues associated with the rasterisation of the input images and postprocessing which caused variation in the results. Overall, it was determined that the analysis cycle is capable of capturing the apparent modulus of a variety of dierent structures. Micro-CT scans of 127 bone specimens were run through the analysis cycle. The results from the beam-shell analysis were compared to results from experimental testing [3] and an equivalent voxel-based analysis. There was a clear trend in both the beam-shell and voxel-based data, however the voxel-based method produced stier results than the beam-shell method overall. The beam-shell method showed more scatter than the voxel-based method, but contained less signicant outliers. The eective modulus, i.e. the modulus of an inner core region, was determined for 17 of the bone specimens and compared to equivalent experimental results. The beam-shell method captured the increase in stiness between the apparent modulus and the eective modulus as regularly as the voxel-based method, given appropriate boundary conditions were applied. The results produced by both methods can be improved by the removal of machining artifacts and improved segmentation of the micro-CT scans. This work conrms that the beam-shell method is capable of capturing the apparent modulus of a trabecular bone sample, however the scatter in the data must be reduced for it to be considered a viable alternative to the voxel-based method. It was found that the beamshell method is equally capable of predicting the relationship between apparent modulus and eective modulus as the voxel-based method. In both the beam-shell results and voxel-based results, the accuracy of a particular data point could only be determined by considering the results in reference to additional simulation and experimental data points. In light of these results, researchers should be cautious in reporting simulation results for trabecular bone without additional verification.

Internet Protocol network architectures are gradually evolving from legacy flat networks to new modern software defined networking approaches. This evolution is crucial as it provides the ideal supporting network structure, architecture and framework that supports the technologies that are also evolving in software-based systems like Network Functions Virtualization (NFV). The connectivity requirements resulting from this paradigm shift in technology is being driven by new bandwidth requirements emanating from the huge number of new use cases from 5G networks and Internet of things (IoT) future technologies. Network security remains a key critical requirement of these new modern network architectures to deliver a highly available, reliable service and guaranteed quality of service. Unprotected networks will usually experience service interruptions and cases of system non-availability due to network attacks such as denial-of services and virus attacks which can render key network components unusable or totally unavailable. With the centralized approach of the Software Defined Networking architecture, the SDN controller becomes a key network point that is susceptible to internal and external attacks from hackers and many forms of network breaches. It being the heart of the SDN network makes it a single point of failure and it is crucial that the security of the controller is guaranteed to avoid unnecessary irrecoverable loss of valuable production time, data and money. The SDN controller design should be guided by a robust security policy framework with a very sound remedy and business continuity plan in the event of any form of a security attack. Security designs and research work in SDN controllers have been done with focus on achieving the most reliable and scalable platforms through self-healing and replication processes. In this dissertation the research that was done proposed a security solution for the SDN controller and evaluated the impact of the security solution on the overall SDN controller performance. As part of the research work literature review of the SDN controller and related technology carried out. The SDN controller interfaces were analyzed and the security threats that attack interfaces were explored. With link to a robust security framework a security solution was used in the experiments that analyzed the attacks from the external network sources which focused on securing the southbound interface by use of a netfilter with iptables firewall on the SDN controller. The SDN controller was subjected to denial service attack packets and the impact of the mitigation action observed on the SDN controller resources. Given that the network security layer introduced an additional overhead on the SDN controller’s processors the security feature negatively affected the controller performance. The impact of the security overhead will inform on the future designs and possibly achieve a trade-off point between the level of security of the network and overall system performance due to security policies. The research analyzed and determined the performance impact of this crucial design aspect and how the additional loading due to network security affected the SDN controller normal operation.

Over the last few decades, water stress has been imminent in most municipalities around the world. The problem of water losses from pipelines is a major concern due to the increasing demands. Leakage is normally responsible for a large percentage of water losses in distribution systems and results in enormous wastage of valuable resources and energy. Leaks may be developed in many forms and locations in the system and active leak detections are required to find and repair damaged pipes. Few studies have been done on the soil-leak interaction in real pipeline systems. Recent research have shown that the high velocity water jets entering the surrounding soil causes a fluidisation zone outside leaks. The fluidised zone of soil and water is responsible for dissipating most of the energy of the water jet from the pipe leak and thus, limiting the leak’s ability to reach soil surface. In municipalities where active leak detections are not implemented, it is easier for municipalities to detect leaks if they appear on the surface and thus, it is crucial to understand the routes of water leaks and the factors causing them to appear above the ground. This study investigated the soil-leak interaction focusing mainly on factors affecting leakage flow paths in water distribution systems. An experimental set up was designed and built to study the different factors in a controlled environment. A series of experiments were performed where water jets from manufactured circular leaks were released in different trench set ups. Three main variables were investigated namely flow rate, leak orientation and in-situ soil to start understanding the movement of the leak flow as a preliminary study. The volumetric moisture content were measured using EC-5 moisture sensors at different locations in the tank to analyse the movement of leakage water and iPERLS smart water meters were used to measure the flow of water through the walls of the trench. The results of the experiments showed how much leakage water is actually lost through the side and bottom walls. The volumetric moisture content readings indicated the movement of the leak in the tank. The results of the study indicated that leak orientation has the greatest influence on the paths of the leaks. Also, the flow rate had to be increased to a very high value so that the leak appears above the sand surface. The permeability of the in-situ soil was found to have the least effect on the leakage flow paths.