A list of my peer-reviewed publications

Orthopaedic devices comprise a significant portion of the medical devices that are imported into South Africa. Through case studies, we investigated the effect of contextual factors on knowledge development and exchange in the orthopaedic device innovation system, using the technological innovation systems framework. Our findings revealed that the drivers of knowledge development and exchange were inter-sectoral collaboration, availability of resources, affordability of available devices, creating legitimacy for devices, and the positive externalities of allied innovation systems. The main barriers identified were those that hindered inter-sectoral collaboration. The critical roles of the university and of healthcare actors were also highlighted. These findings may be used proactively to address problems in the innovation systems and to develop policy and institutional mechanisms that are aimed at building the domestic medical devices industry.

Link to publication: https://sajie.journals.ac.za/pub/article/view/2938

We assessed knowledge development and exchange among actors who patent orthopaedic devices in South Africa over the period 2000–2015. A social network analysis was performed on bibliometric data using co-inventorship on patents as an indicator of collaboration between different organisations, with a focus on the spatial and sectoral contexts. Network metrics and innovation system indices are used to describe knowledge development and exchange. The results show that university, healthcare and industry organisations have primarily been responsible for increased patenting over time. The key actors were a set of industry actors – a national actor and its US partner – who have patented many devices jointly. National universities were found to make a small contribution, and science councils were found to be absent, despite the efforts in the changing innovation landscape to encourage publicly financed research organisations to protect their intellectual property. The collaboration networks were found to be sparse and disjointed, with many actors – largely from the private healthcare sector – patenting in isolation.

Link to publication: https://www.ajol.info/index.php/sajsci/article/view/219774

We assess knowledge development and knowledge diffusion for orthopaedic device innovation in South Africa over the period 2000–2015. A structural network analysis is performed on bibliometric data using co-authorship on scientific publications as an indicator of collaboration between different organisations. We apply a technological innovation system (TIS) framework, quantitatively assessing the TIS functions ‘knowledge creation’ and ‘knowledge diffusion’ in their spatial and sectoral contexts. Network metrics (degree and betweenness centralities), and empirical TIS analyses are used to describe the knowledge functions of the TIS. Our results show that scientific knowledge development has increased as time has progressed, and that university and healthcare sectors have largely been responsible. Results further indicate that, for the national healthcare and national industry sector actors, ties to university and science council actors support scientific knowledge creation. The collaboration networks were found to be sparse, and disjointed, with many actors largely unreachable, indicating barriers to knowledge exchange between actors. Initially the network displayed spatial elements of an internationalised TIS, but over time, the spatial typology changed to that of a nationalised TIS. This shift may be a positive one, as South African research and development activity shifts towards being driven by local actors and towards medical devices which address the South African burden of disease.

Link to publication: https://link.springer.com/article/10.1007/s11192-019-03041-y

While the medical device value chain has been extensively studied, this article enhances understanding by offering a refined approach to analyze and explore its bottlenecks. Leveraging a design science research methodology, our article introduces a medical device value chain framework that advances beyond traditional mappings. Initially, two systematic literature reviews were employed to construct a preliminary map, pinpointing 74 value-adding activities across seven distinct categories: Idea generation, research and development, production/manufacturing, market, distribution and use, waste management, and systemic aspects. The framework was utilized with structured interviews with 17 subject matter experts from the Western Cape province in South Africa. These experts evaluated each value-adding activity on a 3-D scale—importance, effort required, and difficulty. After these evaluations were looked at more closely, the most important bottlenecks in the medical device value chain could be identified. The results were then visually combined using a linking grid. This matrix-based tool helps delineate the connections between medical device value chain components, pinpointing where bottlenecks align with undesirable effects. It forms a basis for formulating strategic interventions to achieve desirable outcomes.

Link to publication: https://ieeexplore.ieee.org/document/10557584

Low- and middle-income countries (LMICs) need better access to cost-effective and value-adding medical devices to minimise their reliance on imported and donated equipment. Most of this equipment, which makes up 80% of the existing equipment base, is unsuitable for local needs and cannot be maintained due to a lack of local infrastructure. Rather than completely overhauling the system, innovation systems (IS) should refocus already-existing tasks, resources, and activities on the localisation of the medical device industry, putting into place prioritisation strategies. The author conducted a Structured Review (SR) to understand the current state of knowledge and establish a future research direction on localisation frameworks supporting the medical device IS in LMICs. The SR aimed to synthesise and investigate the evidence from the literature regarding the existing artefacts used to facilitate medical device localisation in LMICs.

Link to publication: https://www.proceedings.com/072261-0027.html

Abstract
Objectives: To investigate the network of stakeholders involved in rugby union research across the globe.
Methods: Using author affiliations listed on scientific publications, we identified the organisations that
contributed to rugby union research from 1977 to 2022 and examine collaboration through coauthorship
indicators. We determined the locations and sectors of identified organisations and constructed a collaboration network. Network metrics, including degree centrality and betweenness centrality, are computed to identify influential organisations and measure intersector collaboration.
Results: There is an increase in scientific knowledge creation and collaboration between organisations for
rugby union research over time. Among the sectors, the university, professional sports team and sports governing body sectors exhibit the highest intersectoral and intrasectoral density. Predominantly, influential actors are located in England, Australia, France, New Zealand, Ireland and South Africa. Australian Catholic University, Leeds Beckett University, Stellenbosch University, Swansea University, University College London and the University of Cape Town emerge as influential actors between 2016 and 2022.
Conclusions: Our study underscores the ongoing growth of scientific knowledge generation in rugby union, primarily led by organisations in tier 1 rugby-playing nations within the university sector. Intersectoral collaboration with sports governing bodies plays a crucial role, acting as a broker between sectors. However, the overall collaboration landscape between and within sectors is low. These results highlight an opportunity for improved collaboration opportunities, as the organisations driving knowledge
creation have been identified.

Link to publication: https://bmjopensem.bmj.com/content/bmjosem/10/1/e001559.full.pdf

Abstract

After nearly two decades of substantial investment in the field of nanomedicine within South Africa, this study undertakes an investigation into the specific diseases that have been targeted for research and development, as well as the key actors and collaborative networks involved in this burgeoning field. To accomplish this, the study adopts a mixed-method approach, combining bibliometric and scientometric techniques alongside a comprehensive review of existing literature. The study’s findings illuminate that the diseases selected for emphasis in nanomedicine research closely align with the prevalent health challenges faced by South Africa. Notably, these ailments encompass cancer, bacterial infections, and tuberculosis, all of which significantly contribute to the country’s disease burden. Furthermore, the investigation highlights that research-intensive South African universities play a pivotal role as the primary actors in advancing nanomedicine initiatives. Over time, collaborative endeavors among these key actors have seen a noteworthy upswing. These collaborations have fostered robust connections between South African institutions and counterparts in Asian nations and the Middle East. It is worth emphasizing that nanomedicine is a resource-intensive field, necessitating substantial capital investment. Collaborative initiatives have, in turn, granted access to critical infrastructure and materials that would have otherwise been beyond the reach of some participating entities. Remarkably, these collaborative partnerships have not only facilitated scientific progress but have also cultivated social capital and trust among involved stakeholders. These valuable intangible assets hold great potential as South Africa advances towards more exploitative phases of technology development within the domain of nanomedicine. Moreover, South Africa is strategically positioning itself to cultivate a critical mass of expertise in nanomedicine, recognising the significance of skilled human resources in harnessing the full potential of this technology in the future.

Link to publication: https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2023.1317137/full

The Total Cost of Ownership (TCO) is a calculation used to illustrate the actual cost of buying and owning products and services. In this paper, we perform a scoping review aimed at understanding the TCO of technologies introduced in the last mile of the cold chain. The search is performed in Scopus, where the literature explored lies at the intersection of TCO models and frameworks, products service systems (PSS), and supply chain, value chain, or logistics application. We deliberately scoped broadly and refine towards PSS applications. We present the results of 20 publications meeting our inclusion criteria. The literature is largely produced by developed country authors, with a complete absence of African authors. A broad range of PSS were investigated, including airlines, telecommunications, commercial vehicles, tinting, machine tooling, electric and fuel vehicles for logistics and last-mile delivery, washing machines, renewable energy alternatives, and smallholder farming. Most of the publications developed TCO models for supplier selection, based on cost and other factors such as risk and reliability. Some developments focused on developing their TCO model beyond a cost calculator, and make contributions as decision support tools, negotiation tools, organizational tool, and a way to measure social impact. The scoping reviewed allowed us to identify activity-based cost categories to consider over the value chain of technologies introduced in the last mile of the cold chain.

Link to publication: https://ieeexplore.ieee.org/document/10438125

Africa is challenged with impoverished and ineffective healthcare systems, and despite rampantly increasing healthcare costs, patient outcomes are often unsatisfactory. Outcome-based models (OBMs) improve healthcare spending and outcomes by ensuring that only products and services that perform well and achieve the desired outcomes are paid for with a focus on value rather than volume. However, the implementation of OBMs is complex, and without a comprehensive framework to guide the development of OBMs, the implementation of OBMs becomes constrained. This study builds on five key OBM concepts towards a conceptual framework that is meant to aid the development of OBMs.

Link to publication: https://ieeexplore.ieee.org/document/10438122

Outcome-based models (OBMs) guarantee quality outcomes through pay-for-performance mechanisms. This article considers OBMs to reduce healthcare spending and improve healthcare outputs by conducting a scoping review (SR) of literature surrounding this topic. The set of articles considered was visualised and analysed through Bibliometrix and full-text reading. Key findings from the review include the growth of the topic in the last five years and the need for further research on contract agreements, cost/risk-sharing, measurement of outcomes, types of OBMs, and guiding conceptual frameworks.

Link to publication: https://ieeexplore.ieee.org/abstract/document/9989779

The response to the challenges arising during the COVID-19 pandemic has seen the rapid implementation of innovative technological solutions which have been built on established knowledge and resources. This has been reflected in infection, prevention and control practices (IPC) to minimise the transmission of the disease. In this article, we review ultraviolet germicidal irradiation (UVGI) as such a technology. We illustrate the way it has traditionally been used in airborne and surface disinfection strategies, and how it has, more recently, been adapted. UVGI has been widely used as an environmental IPC measure against tuberculosis in South Africa, though challenges have been experienced in the implementation of the technology in public healthcare facilities. This has resulted in the development of a knowledge and infrastructure base. We posit that, given the established UVGI resources in South Africa, the technology may be a viable environmental IPC solution for the COVID-19 period and beyond.

Link to publication: https://journals.uct.ac.za/index.php/GHI/article/view/1009

Abstract

Background: Explaining policy change is one of the central tasks of contemporary policy analysis. In this article,

we examine the changes in infection control policies for multi-drug resistant tuberculosis (MDR-TB) in South Africa

from the time the country made the transition to democracy in 1994, until 2015. We focus on MDR-TB infection

control and refer to decentralised management as a form of infection control. Using Kingdon’s theoretical framework of

policy streams, we explore the temporal ordering of policy framework changes. We also consider the role of research in

motivating policy changes.

Methods: Policy documents addressing MDR-TB in South Africa over the period 1994 to 2014 were extracted. Literature on

MDR-TB infection control in South Africa was extracted from PubMed using key search terms. The documents were analysed

to identify the changes that occurred and the factors driving them.

Results: During the period under study, five different policy frameworks were implemented. The policies were meant

to address the overwhelming challenge of MDR-TB in South Africa, contextualised by high prevalence of HIV

infection, that threatened to undermine public health programmes and the success of antiretroviral therapy rollouts.

Policy changes in MDR-TB infection control were supported by research evidence and driven by the high incidence

and complexity of the disease, increasing levels of dissatisfaction among patients, challenges of physical, human and

financial resources in public hospitals, and the ideologies of the political leadership. Activists and people living with HIV

played an important role in highlighting the importance of MDR-TB as well as exerting pressure on policymakers, while

the mass media drew public attention to infection control as both a cause of and a solution to MDR-TB.

Conclusion: The critical factors for policy change for infection control of MDR-TB in South Africa were rooted in the

socioeconomic and political environment, were supported by extensive research, and can be framed using Kingdon’s

policy streams approach as an interplay of the problem of the disease, political forces that prevailed and alternative

proposals.

Link to publication: https://link.springer.com/epdf/10.1186/s12961-017-0203-y?author_access_token=4CvuWiJewjWmvSHqL3EpZm_BpE1tBhCbnbw3BuzI2RNGoSB4zzo5wBW0Lf99gIEKUnJAbwubCMBpkA8FSrl9T5LDjggySWRmpVILwG2CucQ3X_8HI831cXzbIYXmZlwPRbiB0ijSvhHvLMmUOeUcMQ==

In upper-room ultraviolet germicidal irradiance (UVGI) design, irradiance is an important characteristic, with two opposing dominant dynamics: high-level irradiation on the microorganism and minimum levels of irradiance on human skin and eyes. The use of high-level ray-tracing procedures is followed in establishing radiance and irradiance levels. The main constants in a room influencing these calculations are the spectral and spatial characteristics of the radiation sources in the inter-reflecting surfaces inside the luminaire, as well as the surfaces in the room. The most important characteristic to be determined for the radiation source prior to calculations is its spatial radiant intensity distribution. This characterization is performed using a gonioradiometer. The complexity of the physical construction of the luminaire will determine the extent to which measurements have to be taken. Accurate gonioradiometer readings provide the required radiant intensities in all directions for computer-aided design (CAD), and can also be used to determine the total radiant flux leaving the luminaire, as well as calculating isoirradiance surfaces around the UVGI luminaire. This study will present a laboratory experimental approach to deriving the radiant intensity distribution of a UVGI luminaire. The UVGI luminaire is then characterized in situ, and compared with the gonioradiometric output.

Link to publication: https://pubmed.ncbi.nlm.nih.gov/23437974/