4. Electronic Theses and Dissertations (ETDs) - Faculties submissions

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Optimization of Prostate Plan in a Pelvic Prosthesis Phantom
(University of the Witwatersrand, Johannesburg, 2024-09) Dumela, Khombo Eunice; Oderinde, Oluwaseyi M.; Usman, IyaboT.
Background: An increasing number of elderly prostate cancer patients with high-density material hip prosthesis are referred for external beam Radiotherapy (EBRT). Radiation treatment of pelvis cancer patients with high-density hip prosthesis needs special attention because of the artifacts created in the computed tomography (CT) field of view and the radiotherapy dosimetry challenges. The accuracy of the treatment planning dose calculation algorithms determines the accuracy of the dose delivered to the patient during radiation therapy. However, the most available algorithms do not accurately model the absorption of high-density metals’ scattering properties and underestimate the resulting dose perturbations. Aim: This study aims to optimize the dose distribution of prostate 3D conformal treatment, intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) in an in-house metallic hip prosthesis phantom. Methods and materials: In this study, an ionization chamber and Gafchromic (EBT3) films were used to physically measure the prostate point dose in an in-house pelvic phantom. The pelvic phantom was irradiated on the Linac with four static fields, namely, (1) anterior field, (2) posterior field, (3) right lateral field passing through the bone of the normal hip and (4) left lateral passing through the hip prosthesis. IMRT and VMATs plans were also generated on the phantom. The phantom was also irradiated with IMRT and VMATs plan. The use of single arc versus two arcs with avoidance sector were also evaluated. The phantom consists of different materials; Nylon-12 (a solid water-equivalent material) to simulate the prostate with a central cavity to accommodate an ionization chamber and film, superflab gel bolus to simulate human soft tissue, dental wax to simulate human soft tissue, bone anatomy for the right hip and a titanium implant to replace the bony structure of the left hip. For the static fields, an in-house pelvic phantom was simulated using the EGSnrc Monte Carlo code, and 6 and 15 MV photon energies were employed as in an experimental setting. The prostate point doses computed by the Treatment Planning System (TPS), measured using ionisation chamber, and Gafchromic EBT3 film were compared with the prostate point doses simulated by Monte Carlo code. Results and discussion: The novel phantom was constructed using superflab gel bolus, Nylon-12, dental wax, pig bone insert and a titanium alloy hip replacement. The radiological equivalence of the superflab gel bolus and dental wax was determined employing linear attenuation coefficients and then compared to an RW3 Solid water phantom. EGSnrc Monte Carlo (MC) code was used in this study. Before using Monte Carlo codes, they need to be validated by comparing the Linear accelerator Monte Carlo simulated dose distribution with the experimental data measured in a Linear accelerator using water and ionization chamber for 6 MV and 15 MV photon beams of different field sizes. The EGSnrc dose distributions were compared with the experimental measurements using a gamma analysis, employing a 2 %/2 mm distance-to-agreement criterion. The EGSnrc Monte Carlo calculated dose distribution agreed well with experimental measurements within 2 %. The MC beam model was then used to compute the dose distribution in an in-house pelvic phantom. The comparison of the measurements between the TPS calculated prostate point dose and ionization chamber for the 6 MV and 15 MV photon beams was: anterior (gantry 0°) 1.8 % and -0.5 %; posterior (gantry 180°) 1.7 % and -0.2 %; left lateral (gantry 90°) 6.3% and 4.2 %; right lateral (gantry 270°) -2.2 % and -2.1 % respectively. Results obtained for Gafchromic EBT3 film measured doses were: anterior 2.3 % and 1.3 %; posterior -0.9 % and 0.2 %, left lateral 4.5 % and 3.5 %; right lateral -2.1 % and -2.5%, for the 6 MV and 15 MV photon beams, respectively. Consequently, results obtained for comparison of TPS, ion chamber and Film with MC simulated doses were: anterior 3.9 %, -2.1 and -1.6% %; posterior 1.8 %, -0.1% and -2.7 %; left lateral -0.2 %, 6.5 % and 4.7 %; right lateral 0.4 %, -2.6% and -2.5 %, for the 6 MV photon beam. And for 15 MV photon beam the results were: anterior 1.9 %, -3.8 and -0.6%; posterior 2.0 %, -2.3 % and -2.2 %; left lateral 0.5 %, 3.7 % and 2.9 %; right lateral 0.4 %, -2.4 % and -2.9 %. Monte Carlo simulations and film measurements have a statistically significant difference of p<0.001, with the film measurements having a higher value than MC simulations except on the left lateral field. Monte Carlo simulations and ionization chamber measurements also show a significant difference of p<0.001, with the ionization chamber having a higher value than the MC simulation, except for the left lateral field passing through the hip prosthesis. The comparison of the measurements between the TPS calculated prostate point dose with ionization chamber and Gafchromic EBT3 film for the 6 MV IMRT plan of the beam passing through the prosthesis was 2.2 % and 3.3%, respectively. While the IMRT plan with avoided beam was 1.9 % and 3.1% for ionization chamber and Gafchromic EBT3 film, respectively. The comparison of the measurements between the TPS calculated prostate point dose for the 6 MV VMAT plan without avoiding for the beam passing through the prosthesis was 1.1 % and 2.2 % for ionization chamber and Gafchromic EBT3 film, respectively. While for VMAT plan with avoided sector as 3.0 % and 4.0% for ionization chamber and Gafchromic EBT3 film, respectively. The test suggested a significant difference of p=0.0001 between the distribution of film measurements and TPS calculated dose. Meanwhile, for ionization chamber measurements and TPS calculated dose; the test indicated a significant difference between ion chamber measurements and TPS calculated dose with a significant level of less than 0.001. in addition, MC simulated dose and TPS calculated dose; the test shows a percentage difference of -0.2 % and 0.5 % for 6 MV and 15 MV photon beams in the lateral field that passes through the prosthesis. The test indicated the significant difference of p=0.001 which is slightly lower compared to the other comparisons. Conclusion: The dual dosimetric pelvic prosthesis phantom is easy to assembly and is more convenient for second dose check for patients with hip prostheses. Through the use of the pelvic phantom, it was possible to measure the prostate point dose using ionization chamber and films. The TPS overestimated the prostate point dose because the treatment planning algorithm could not accurately determine the CT number and the electron density of the prosthesis due to the limitation on the CT scanner. The maximum deviation calculated in this study for TPS, ionization chamber Gafchromic EBT3 films when compared to Monte Carlo simulated dose comes from the lateral fields passing through the prosthesis for both 6 MV and 15 MV photon beams.
Investigating the performance of South African children from an under-resourced background on selected verbal subtests of the WISC-V and SSAIS-R
(University of the Witwatersrand, Johannesburg, 2024) Rampai, Tsholofelo; Vorster, Adri
Given the South African context and the scarcity of valid and reliable individual intelligence measures to assess the intellectual functioning of a broad spectrum of children from different socioeconomic, cultural, and linguistic backgrounds, continued research must be done on the utility, validity, and reliability of available measures. Taking this into consideration, the present study aimed to investigate and compare the performance of a sample of South African children who predominantly speak English as a Second Language (ESL) and who come from an under-resourced background on selected verbal subtests of the Wechsler Intelligence Scale for Children – Fifth Edition (WISC-V) and the Senior South African Individual Scales – Revised (SSAIS-R). In addition, the study investigated the internal consistency reliability and concurrent validity of these subtests in the present sample. The children's biographical information was obtained from a demographic questionnaire. The sample consisted of 58 participants (N= 58) from grades 4 to 7 living and developing in under-resourced contexts. Based on the data spread, parametric statistics in the form of a paired t-test, Pearson’s correlation coefficient, and Spearman-Brown split-half formula were used to address the aims of the study and answer the research questions. The findings highlighted the different factors that might influence assessment results in South Africa, particularly for children from under-resourced contexts. The current study can be a stepping stone for further research into the appropriateness of commonly used individual intelligence measures in under-resourced contexts, given that not all South African contexts have been investigated regarding psychological assessments and individual intelligence measures.
Work-Family Conflict & Burnout in the face of a Pandemic as moderated by Sensory Processing Sensitivity and Social Support
(University of the Witwatersrand, Johannesburg, 2024) Ndlovu, Valerie; Pitman, Michael
Remote working has quickly become a norm in organisations in response to the COVID-19 global pandemic. This shift may have been a tough transition on some individuals as work and family spheres have been obscured by remote working where one environment is used for both leisure, domestic and professional reasons. A quantitative, non- experimental, correlational, cross- sectional study (N = 136) was conducted with employed South African participants using online self- report questionnaires. Correlation results showed a significant relationship between Work-Family Conflict (WFC) and burnout subscales, but not Family-Work Conflict (FWC) and burnout. Hierarchical Moderated regression was used to assess the data and showed that Sensory- Processing Sensitivity and Social Support did not moderate the relationship between WFC and burnout. The results show that females are more burnt out than males and as people get older, the less burnt out they are. Individuals experienced financial and fear of the unknown challenges due to the pandemic. This study offers a contribution to Human Resources on employee wellbeing and post- COVID-19 functioning.
Psychological Challenges facing Primary School Children in Windhoek, Namibia: Perspectives of Teachers
(University of the Witwatersrand, Johannesburg, 2024) Uupindi, Victoria N.; Kasese-Hara, Mambwe
The study aimed to explore the psychological challenges that primary school children were facing through the perspectives of teachers. The study also investigated the support system that was available to mitigate these challenges both at school and in the community. Urie Bronfenbrenner’s Bio-Ecological Theory of human development was used as a theoretical framework to comprehend and discuss the findings of the study. The study employed a Qualitative Research approach using a phenomenological perspective. The data was collected from three primary schools in Windhoek Namibia, from a total of eight participants using face-to-face recorded interviews. The participants were recruited using a snowball sampling technique that allowed the researcher to network for the next participant. The findings indicated that children are indeed influenced by their surroundings, experiencing many challenges such as those associated with Covid-19, those created by home circumstances, negative behavior, emotional distress and challenges associated with their schooling such as low school performance. The study revealed that various systems like the schools, churches and community members all collaborate to help primary school children navigate through their challenges.
The Enhancement of the SDLC Methodology utilised in the Delivery of Digital Healthcare Products
(University of the Witwatersrand, Johannesburg, 2024) Asamoah-Bekoe, Michael; Sunjka, Bernadette
The digital healthcare industry has experienced significant growth in recent years, resulting in increased competition among companies operating in this market. Company X, a competitor in this industry, utilises a mixed set of methodologies across their teams, where some methodologies may be outdated. With the emergence of new software development lifecycle methodologies (SDLC), it is crucial for Company X to adapt their current approach to remain competitive. As part of a research study, 24 participants from various teams in Company X were interviewed to gain insights into the industry, the current methodology being used, and how management could ensure a smooth transition to a new SDLC methodology. According to the study results, 21% of participants from Team A-D were unwilling to change their current methodology, while 37% were willing to make a switch. The remaining 42% were indifferent, with their decision depending on the reason for the transition. Based on the literature review and the findings from the study, a conceptual framework was developed to guide the process of transitioning to a new SDLC methodology.
Electrocatalytic detection of biomarkers of tuberculosis and cervical cancer
(University of the Witwatersrand, Johannesburg, 2024-07) Peteni, Siwaphiwe; Ozoemena, Kenneth Ikechukwu
The need for simpler, low cost and efficient diagnostic methods remains a matter of urgency. This has opened numerous streams of research. Electrochemistry is a simple, cost effective and efficient method that has been used for the detection of several diseases such as tuberculosis (TB) and human papilloma virus (HPV). TB has been ranked amongst the most problematic diseases in HIV/AIDS burdened communities, this alone calls for concern. Biomarkers of TB not only indicate mycobacterium infection but can also assist in the early detection of TB which is highly beneficial for the infected person and the health care system. HPV is the causative agent for cervical cancer. Cervical cancer is ranked as the fourth disease that causes mortality amongst women. With that in mind, HPV-16 L1 early detecting means possible early detection of cervical cancer. In this thesis, methyl nicotinate (MN), which is one of TB’s biomarkers was detected in phosphate buffer solution (PBS, pH 6.0) and commercial human serum using cobalt nanoparticles supported on carbon derived from trimesic acid (TMA) (abbreviated as Co-NPs@CTMA) and biphenyldicarboxylic acid (BPDC) abbreviated as Co-NPs@CBPDC) as electrocatalysts. These electrocatalysts were obtained using microwave-assisted metal-organic framework process with TMA and BPDC as ligands. XRD data showed that these electrocatalysts are cobalt nanoparticles with dominant {111} and {200} phase with traces of cobalt oxide (CoO). XPS and Raman data showed that Co-NPs@CBPDC is defect-rich compared to the Co-NPs@CTMA counterpart. BET showed that CoPs@CBPDC has higher surface area and pore size and volume than the Co-NPs@CTMA catalyst. Both electrocatalysts showed reversible cobalt nanoparticle oxidation and reduction reactions, in the absence and in the presence of the MN, thereby allowing for a facile indirect electrochemical detection of this biomarker. The calibration curves showed low limit of detection (LoD) of 0.47 and 0.147 µM for Co-NPs@CTMA and Co-NPs@CBPDC, respectively. The higher performance of the latter is attributed to its enhanced physico-chemical properties compared to the former. Next, HPV-16 L1, which is the conventional high-risk antigen that is present in cervical cancer, was detected using onion-like carbon (OLC) and polyacrylonitrile fibre integrated with OLC (OLC-PAN) as electrode platforms. Two electrode platforms were used; onion-like carbon (OLC) and its polyacrylonitrile (OLC-PAN) composites. Both platforms led to the detection in a wide linear concentration range (1.95 fg/ml to 50 µg/ml), excellent sensitivity (>5.2 µA/log([HPV-16 L1, fg/mL]) and ultra-low detection of ca. 1.0 and 1.4 fg/ml for OLC-PAN and OLC-based immunosensors, respectively. The high specificity of detection was proven by experimenting with an anti-Ovalbumin antibody (anti-Ova) and native Ovalbumin protein (Ova). An immobilized antigenic HPV-16-L1 peptide showed insignificant interaction with anti-OVA in contrast with the excellent interaction with anti-HPV-16 LI antibody. The immunosensors showed satisfactory stability of ~ 3 days of re-usability. The application of the immunosensor as a potential point-of-care diagnostic (PoC) device was investigated with the screen printed carbon electrode which showed the ability to detect ultra-low (~ 0.7 fg/ml) and high (~ 12 µg/ml) concentrations. This study opens the door of opportunity for further investigation with other electrode platforms and realization of PoC diagnostic devicesfor screening and testing of HPV biomarker for cervical cancer.
Using a hybrid adsorption-membrane filtration system to produce biologically stable drinking water
(University of the Witwatersrand, Johannesburg, 2024) Omalanga, Landry Sendango; Biyela , Precious; Simate, Geoffrey S.
The purpose of water treatment is to produce clean and safe drinking water, for consumers. Water quality, both during treatment and distribution, is greatly affected by the presence of natural organic matter (NOM). The presence of NOM affects the effectiveness of water treatment processes and sometimes increases the cost of water treatment and leads to operational problems. Furthermore, the presence of biodegradable organic matter (BOM), which is a fraction of NOM, can degrade water quality during distribution resulting in the loss of biological stability. The excessive presence of BOM can be addressed using advanced water treatment processes or by relying on systems which combine multiple water treatment processes to increase treatment efficiency. The main aim of this study was to evaluate the effectiveness of a hybrid adsorption- membrane filtration system in lowering the bacterial regrowth potential in water. Ready-made multi-walled carbon nanotubes (MWCNTs) were used as adsorbents in this study. MWCNTs were chosen because they exhibit high adsorption properties mainly because of their fibrous shape and external surface accessibility. MWCNTs have hydrophobic characteristics and a propensity to aggregate due to the presence of electrostatic interactions among them, therefore, functionalization of MWCNTs was required to improve their dispersion in the organic and inorganic solvents. A non-covalent functionalization process was employed using cetyltrimethylammonium bromide (CTAB) as a cationic surfactant to ameliorate the stability and dispersibility of MWCNTs in aqueous solution. The non-covalent functionalization was preferred to sustain the functionalities needed for BOM capture enhancement and environmental safety. Polysulfone (PSF) membranes were produced by phase inversion method using N, N- dimethylformamide as solvent for the removal of BOM from water. The phase inversion method was chosen in this study due to its simple processing, flexible production scales, and low cost. The MWCNTs and PSF membranes were characterized using microscopy techniques such as transmission electron microscopy (TEM), scanning electron microscopy (SEM), X ray diffraction (XRD), Raman spectroscopy, tensile strength test, and the hydrophilicity (contact angle) test. These techniques were selected because they enable the evaluation of the morphology, composition, physical characteristics, and dynamic behavior of nanostructured materials. iv Batch adsorption experiments were employed to investigate the adsorption properties of functionalized MWCNTs for BOM removal. Four different concentrations of functionalized MWCNTs were tested to determine the ideal conditions for the adsorption of two forms of BOM; assimilable organic carbon (AOC) and biodegradable dissolved organic carbon (BDOC), from water. The concentrations of functionalized MWCNTs used were 4, 8, 12, and 16 mg in 100 mL of BOM solution. Furthermore, the cross-flow filtration mode, also known as tangential flow filtration, was used to separate the remaining BOM in water by passing water along the surface of the NF membrane using pressure difference. Cross-flow filtration was chosen because it removes the buildup from the surface of the membrane and provides the benefit of an improved membrane lifespan by helping to prevent irreversible fouling. A mathematical model of membrane filtration process in continuous system was also developed to better understand the correlations between the different variables of the membrane filtration process such as the inlet (feed) concentration (Cin) and flow rate (Qin), and the outlet (retentate) concentration (Cout) and flow rate (Qout), and the permeate concentration Cp. Results obtained after the functionalization process of MWCNTs showed an improvement in their stability and dispersibility in aqueous solution. The characterization of both MWCNTs and PSF membranes showed some interesting features. For example, morphological and structural studies show that MWCNTs possess fibrous shapes with a high aspect ratio, and a hollow structure with an inner diameter. The finger-like structures found on the surfaces of PSF membranes play a crucial role in their adsorption capabilities. These structures, which vary in pore size, contribute to the overall capacity of the membranes to absorb BOM from water. During adsorption experiments, it was observed that the removal of BOM from water increased with an increase in the adsorbent (functionalized MWCNTs) concentration. This is likely due to high concentration gradient which acts as a driving force to overcome resistances to mass transfer of dye ions between the aqueous phase and the solid phase. However, the maximum removal of both AOC and BDOC was recorded at a concentration of functionalized MWCNTs of 12 mg, at a contact time of 4 hours and at an agitation speed of 180 rpm. The PSF membrane produced by phase inversion method demonstrated the highest flux of 0.0091 ml/cm2.min at room temperature (25°C) and after a filtration time of 90 minutes. The selectivity and permeate flux were increased with forward flushing and backwashing processes of the PSF membranes because it flushes out accumulated debris and particles on the surface and inside the pores of the membranes. After using the hybrid adsorption-membrane v filtration system, BDOC concentrations dropped to an average of 65% of the initial raw water BDOC and the AOC concentrations dropped to approximately 80% of the initial raw water AOC. Outputs from the mathematical model demonstrated that the change in initial conditions (Cin and Qin) is responsible for the transient response (changes from one steady state to another) in these membranes. The adsorption and membrane nanofiltration hybrid system adopted in this study, effectively removed both AOC and BDOC from water, and can therefore be used to produce biologically stable drinking water. The outcome of this study could be the application of the combination of BOM targeting strategies and residual disinfection to better control bacterial regrowth in drinking water distribution systems (DWDSs). This in turn could help water utilities with meeting distribution systems, water quality guidelines, and protect public health
Spirit of place: demystifying the significance of sangoma practices in our communities, education, and well-being, while looking at how they can exist in modern spaces
(University of the Witwatersrand, Johannesburg, 2024) Pitse, Dikeledi
With the evolution of technology and the modern man, sacred spiritual practice and African tradition has become lost amongst our people. Ancient communities took pride in preserving ancestral teachings and rituals that kept us connected and grounded before the rise of modern medicine as we know it. The role of the sangoma/traditional healer in these communities was seem as extremely significant, in that they can communicate with our forefathers. These modes of communication provide clarity on where we come from, as well as where we should go. Therefore, I will be looking at ways in which this sacred practice can be preserved and have a legacy in the modern environment. Additionally, I will show that indigenous knowledge can form part of higher education. Lastly, through research and interviews, I will show the types of spaces that are required in urban the environment for traditional spiritual practices to remain part of everyday life.
Healing from the Past, into the Future: Socio-Cultural & Health Remediation for a Holistic Wellness Facility in Riverlea Township (Extension)
(University of the Witwatersrand, Johannesburg, 2024) McCulloch, Claude Martin; Jivan, Sundeep
The Witwatersrand Mining Basin has been in existence since 1852, which is astonishingly more than a century old. It is the world’s largest gold and uranium basin and has created extraction from over 120 mines stretching from the East to the West of Johannesburg. It is an integral part and the backbone of Johannesburg’s economy. However, regardless of how much mining has boosted the economy, it has not played a sustainable role with the health of the citizens of Johannesburg. This is largely because of radioactive chemicals within the pyrite basin, holding 600 000 tons of uranium, amongst other chemicals as well (Liefferink, 2022). These radioactive chemicals are spread from the mining basin into the surrounding environment via windblown dust (Coetzee et al., 2008). Monitoring of these occurrences have shown that this dust is inhalable due to its structure and particle size, that being either PM 2,5 or PM 10. These happen at residential settings and have exceeded the levels of occupational health standards. A link is suggested from (Nkosi et al., 2015) between the respiratory issues amongst residents that live in communities next to mine tailings & waste facilities. These communities are exposed and have an increased prevalence of ‘chronic respiratory symptoms’ compared to other communities (Van Wyk, 2013). There are currently 585600 people living in communities next to mine tailings according to the 2011 census. (Kneen et al., 2015). The community I will be conducting my research will be in the Township of Riverlea, located in the South-West of Johannesburg. Riverlea is in close proximity to industrial areas and mine dumps. Research has shown that harmful pollutants can from these areas can have negative effects such on the respiratory system, as the particles are airbourne (Makene, 2007). Built in 1963 during Apartheid, ‘coloured’ residents were forcibly removed from other parts of the city and given new homes by the government. The township is conveniently located 500m away from the mine dumps, thus making it a high exposure zone to airborne dust pollution (Kneen et al., 2015). The respiratory diseases in Riverlea are caused from environmental problems. To relate this Architecturally, I research that social and cultural problems may be a symptom towards the residents being unhappy about their environment. This unhappiness and deals with the ‘Sense of Place’ for the resident’s and I believe, alters their social and cultural behaviour, hence many of these communities suffer from poverty, drugs, and crime (Najafi et al., 2011). This can be done using the design methods of Salutogenic design, which promotes healthy living and creates better places that can reduce stress, encourage physical activity, and afford opportunities for socializing, enhancing the general daily health and wellbeing of people (Cushing et al., 2020). I aim to design a holistic wellness facility that remediates the social, cultural and environmental problems which contests the current narrative of the context - that being poverty and respiratory disease.
Factors influencing innovation in public healthcare in South Africa: A critical analysis
(University of the Witwatersrand, Johannesburg, 2024) Nkosi, Mbali Rosemary; Siriram, Rajenlall
Healthcare innovation has proven to reduce morbidity and mortality rates by enhancing healthcare delivery. Most of the South African population depends on the public healthcare system for health needs. The morbidity and mortality rates in South Africa are much higher compared to other middle-income countries in the world. To enhance healthcare delivery in South Africa, understanding the factors that influence innovation in public healthcare is important. Therefore, this research aims to provide a comprehensive understanding of the factors influencing innovation in public healthcare in South Africa and the potential impact of innovation on the country's healthcare system. The main objectives of this study are to determine the level of successfully implemented innovation in public healthcare and the factors influencing it. Existing literature identifies several factors that influence innovation in public healthcare, including design empathy, technological infrastructure, decision-makers, human capital, and organisational culture. This study also investigates the readiness of the public health sector to embrace innovation and the strategies in place for implementing innovation in public healthcare. A gap was identified in the existing literature. There is evidence in literature is that healthcare innovation centres in South Africa and their impact on the adoption of innovation in public healthcare were only covered marginally by existing literature. To bridge this gap, this study provides results on the status of suitable research and development hubs for testing healthcare innovation prototypes in South Africa and their impact on the adoption of innovation in public healthcare. Currently, there are limited health innovation centres in South Africa. This study posits that an increase in the number of healthcare innovation centres would increase evidence-based innovation which would increase the uptake of innovation in public healthcare. A qualitative research approach was used to acquire descriptive information on the factors that influence innovation in healthcare through interviewing participants. Semi-structured interviews were used as the primary instruments of data collection. The interviews were then subjected to a thematic analysis. One of the significant findings of this research is that the lack of funding in public healthcare hinders innovation in the public healthcare system. Also, the rigorous regulatory requirements pertaining to healthcare innovation tend to cause uncertainty and delays, which in turn reduces the funding available for innovative proje

4. Electronic Theses and Dissertations (ETDs) - Faculties submissions

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