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BACKGROUND: TB preventive treatment (TPT) prevents the development of TB disease in individuals at risk of progression from infection to disease. However, implementation of TPT for children is poor in most high-burden settings. The long duration and pill burden of the 6-month once-daily isoniazid regimen (6H) pose significant barriers to completion. We aimed to understand children’s, caregivers’, and healthcare providers’ experiences of the 12-week once-weekly rifapentine and isoniazid (3HP) regimen using a dispersible tablet formulation in South Africa. METHODS: Serial, in-depth qualitative interviews with 20 child-caregiver dyads, including 5 children living with HIV (CLWH) and 9 healthcare providers across two study sites implementing a pharmacokinetic and safety trial of 3HP, were analysed deductively. RESULTS: Of those with experience using both 3HP and 6H, caregivers and healthcare providers preferred 3HP, and study participants reported that the 3HP formulation was more palatable and easier to prepare and administer. Caregivers and healthcare providers were concerned about optimally integrating 3HP into routine care, primarily due to its once-weekly administration. Children with HIV preferred the once-daily 6H regimen for its ease of use with their daily antiretroviral therapy. CONCLUSIONS: 3HP reduced the administration burden for children and their caregivers. Once weekly, 3HP dosing will require education and adherence support to ensure completion.

Abstract The soilborne pathogen Fusarium oxysporum f. sp. cubense tropical race 4 (Foc TR4) is currently devastating banana production worldwide. Once introduced, it is not possible to eradicate the pathogen from soils where it can survive for decades. The only management option available then is to replace Foc TR4-susceptible with -resistant varieties. Timely detection of the pathogen, however, is an important strategy to prevent the introduction of Foc TR4 into new areas and prevent its spread from infested sites. In this study, a single-tube detection technique was developed by combining recombinase polymerase amplification (RPA) and clustered regularly interspaced short palindromic repeats (CRISPR)/Cas12a technology (RPA-Cas12a) for detection of Foc TR4. The RPA-Cas12a assay was conducted isothermally, had a sensitivity of up to 10 fg target DNA and did not cross react with any of the 76 non-target isolates included in the specificity testing. The RPA-Cas12a assay detected Foc TR4 from naturally infected banana samples collected in the field and visualization was possible with the naked eye under LED blue light transillumination. The method can be integrated with inexpensive fluorescent or electronic detection devices to accelerate Foc TR4 in-field detection and, thereby, fast-track disease containment strategies.

While climate change represents a universal threat to the sustainable growth efforts globally, its impacts are not experienced equally with marginalised population groups, especially informal settlement residents, being highly exposed to its negative effects. Despite being widely acknowledged that the built environment is a major driver of inhabitants’ exposure to climate change-related hazards, limited research has been undertaken on developing heat stress adaptation measures for informal settlements in Southern Africa. Furthermore, Africa’s projected rapid urbanisation and limited adequate housing provision point to a significant growth of informal settlements, particularly within the Southern African context. The dearth of available information on household level climate change adaptation in informal settlements prompted this study to investigate the efficacy of roof-based adaptation strategies to lower heat stress exposure in informal dwellings in Tshwane, South Africa. As an explorative study with a quantitative focus, the study uses a digital simulation research design to assess the efficacy of four climate change adaptation strategies to lower heat stress exposure in two typical informal dwellings as case studies. While informal settlements have diverse building typologies, informal dwellings – frame structures cladded with steel sheeting without any thermal insulation – are widely used and highly vulnerable. In contrast to typical adaptation measures proposed for informal dwellings, the main findings highlight the benefit of high thermal mass coupled with shading strategies to lower thermal amplitudes and lower excessive heat stress exposure. Consequently, the article contributes to the current climate change adaptation discourse, in particular its application in informal settlements.

Abstract Over the past five decades, a large number of wild animals have been individually identified by various observation systems and/or temporary tracking methods, providing unparalleled insights into their lives over both time and space. However, so far there is no comprehensive record of uniquely individually identified animals nor where their data and metadata are stored, for example photos, physiological and genetic samples, disease screens, information on social relationships. Databases currently do not offer unique identifiers for living, individual wild animals, similar to the permanent ID labelling for deceased museum specimens. To address this problem, we introduce two new concepts: (1) a globally unique animal ID (UAID) available to define uniquely and individually identified animals archived in any database, including metadata archived at the time of publication; and (2) the digital ‘home’ for UAIDs, the Movebank Life History Museum (MoMu), storing and linking metadata, media, communications and other files associated with animals individually identified in the wild. MoMu will ensure that metadata are available for future generations, allowing permanent linkages to information in other databases. MoMu allows researchers to collect and store photos, behavioural records, genome data and/or resightings of UAIDed animals, encompassing information not easily included in structured datasets supported by existing databases. Metadata is uploaded through the Animal Tracker app, the MoMu website, by email from registered users or through an Application Programming Interface (API) from any database. Initially, records can be stored in a temporary folder similar to a field drawer, as naturalists routinely do. Later, researchers and specialists can curate these materials for individual animals, manage the secure sharing of sensitive information and, where appropriate, publish individual life histories with DOIs. The storage of such synthesized lifetime stories of wild animals under a UAID (unique identifier or ‘animal passport’) will support basic science, conservation efforts and public participation.

Abstract Introduction To ensure that pre-final year medical students at Stellenbosch University were able to resume clinical training during the COVID-19 pandemic, a 12-week integrated rotation was introduced, during which students were distributed across a widespread training platform in two provinces of South Africa, utilizing a range of health care facilities in both rural and urban areas, rather than the central academic hospital (CAH) in which they would have been doing clerkships. Called the Integrated Distributed Engagement to Advance Learning (IDEAL) rotation, this clerkship was based on supervised engagement in healthcare services, focusing on patient-based clinical training, self-regulated learning and student participation as integral members of clinical teams. The success of this emergency intervention has led to its formal incorporation into the medical curriculum. This study aimed to understand the factors that influenced learning among students undertaking the IDEAL rotation at multiple sites on a distributed training platform. Methods Using an interpretive paradigm, we sought to conduct focus group interviews with students who completed the first iteration of the IDEAL rotation in the year after they had undertaken it to understand their experiences. All 252 students who were eligible were invited to participate by email on several occasions. Ultimately three focus group discussions and two individual interviews were undertaken, based on volunteers. Using a semi-structured interview guide, these explored student perceptions of their learning and growth through the rotation. Inductive and deductive analysis was carried out to identify themes. Findings Student descriptions of their learning experiences coalesced in 6 themes. The rotation was an enabling learning experience, which was more practically focused and assisted students in developing confidence in their clinical skills. It was seen to be a humanizing learning experience with greater opportunities for the development of relationships with patients and families, as well as with health professionals, who made them feel part of the team, so it was also a more collegial learning experience. At the same time, it was a variable learning experience with a lack of standardization on a number of levels and challenges being experienced at particular sites regarding both logistics and the nature of the exposure. Students perceived it to be a very different learning experience from what they had encountered in the CAH in terms of relationships, the kinds of patients and problems they saw, and their active participation. Through this, they also learned more about themselves and their roles, making it a personal learning journey. The findings confirm the importance of the dimensions of person, participation and place for being and becoming a doctor in a clinical environment. Conclusions Student learning experiences in the IDEAL rotation emphasize the importance of context, reinforcing the value of a distributed training platform in developing health professionals who are responsive to their environment. They emphasize the vital role of active participation in learning and the centrality of relationships in medical training, helping to develop graduates who are human beings and not only human doings.

Abstract Background This case study examines the application of Integrated Enhanced Cognitive Behavioural Therapy (I-CBTE) for a patient with severe, longstanding anorexia nervosa and multiple comorbidities, including organic hallucinosis, complex post-traumatic stress disorder (CPTSD), and severe self-harm. Such complex presentations often result in patients falling between services, which can lead to high chronicity and increased mortality risk. Commentaries from two additional patients who have recovered from severe and longstanding anorexia nervosa are included. Case study The patient developed severe anorexia nervosa and hallucinosis after a traumatic brain injury in 2000. Despite numerous hospitalisations and various psychotropic medications in the UK and France, standard treatments were ineffective for 17 years. However, Integrated Enhanced Cognitive Behaviour Therapy (I-CBTE) using a whole-team approach and intensive, personalised psychological treatment alongside nutritional rehabilitation proved effective. Methods In this paper, we describe the application of the I-CBTE model for individuals with severe, longstanding, and complex anorexia nervosa, using lived experience perspectives from three patients to inform clinicians. We also outline the methodology for adapting the model to different presentations of the disorder. Outcomes The patient achieved and maintained full remission from her eating disorder over the last 6 years, highlighting the benefit of the I-CBTE approach in patients with complex, longstanding eating disorder histories. Successful treatment also saved in excess of £360 k just by preventing further hospitalisations and not accounting for the improvement in her quality of life. This suggests that this method can improve outcomes and reduce healthcare costs. Conclusion This case study, with commentaries from two patients with histories of severe and longstanding anorexia nervosa, provides a detailed description of the practical application of I-CBTE for patients with severe and longstanding eating disorders with complex comorbidities, and extensive treatment histories. This offers hope for patients and a framework for clinicians to enhance existing treatment frameworks, potentially transforming the trajectory of those traditionally deemed treatment resistant. Recommendations We advocate the broader integration of CBT for EDs into specialist services across the care pathway to help improve outcomes for patients with complex eating disorders. Systematic training and supervision for multidisciplinary teams in this specialised therapeutic approach is recommended. Future research should investigate the long-term effectiveness of I-CBTE through longitudinal studies. Patient feedback on experiences of integrated models of care such as I-CBTE is also needed. In addition, systematic health economics studies should be conducted.

Abstract Background Epidemiological and toxicological studies indicate that increased exposure to air pollutants can lead to neurodegenerative diseases. To further confirm this relationship, we evaluated the association between exposure to ambient air pollutants and corneal nerve measures as a surrogate for neurodegeneration, using corneal confocal microscopy. Methods We used population-based observational cross-sectional data from The Maastricht Study including N = 3635 participants (mean age 59.3 years, 51.6% were women, and 19.9% had type 2 diabetes) living in the Maastricht area. Using the Geoscience and hEalth Cohort COnsortium (GECCO) data we linked the yearly average exposure levels of ambient air pollutants at home address-level [particulate matter with diameters of ≤ 2.5 µm (PM2.5), and ≤ 10.0 µm (PM10), nitrogen dioxide (NO2), and elemental carbon (EC)]. We used linear regression analysis to study the associations between Z-score for ambient air pollutants concentrations (PM2.5, PM10, NO2, and EC) and Z-score for individual corneal nerve measures (corneal nerve bifurcation density, corneal nerve density, corneal nerve length, and fractal dimension). Results After adjustment for potential confounders (age, sex, level of education, glucose metabolism status, corneal confocal microscopy lag time, inclusion year of participants, smoking status, and alcohol consumption), higher Z-scores for PM2.5 and PM10 were associated with lower Z-scores for corneal nerve bifurcation density, nerve density, nerve length, and nerve fractal dimension [stβ (95% CI): PM2.5 -0.10 (-0.14; -0.05), -0.04 (-0.09; 0.01), -0.11 (-0.16; -0.06), -0.20 (-0.24; -0.15); and PM10 -0.08 (-0.13; -0.03), -0.04 (-0.09; 0.01), -0.08 (-0.13; -0.04), -0.17 (-0.21; -0.12)], respectively. No associations were found between NO2 and EC and corneal nerve measures. Conclusions Our population-based study demonstrated that exposure to higher levels of PM2.5 and PM10 are associated with higher levels of corneal neurodegeneration, estimated from lower corneal nerve measures. Our results suggest that air pollution may be a determinant for neurodegeneration assessed in the cornea and may impact the ocular surface health as well.

Abstract Background Population mail-out bowel cancer screening programs save lives through prevention and early detection; however, their effectiveness is constrained by low participation rates. Many non-participants are “intenders”; that is, they intend to screen but fail to do so, often forgetting or procrastinating. This study aimed to co-design interventions to increase screening participation among intenders in the Australian National Bowel Cancer Screening Program. Methods Three semi-structured interviews, and one online cross-sectional survey, were conducted between August 2021 and December 2022. Interviews with people who had completed and returned their latest screening kit (“completers”) were first conducted to identify the planning strategies they had used. Using survey data, logistic regressions were conducted to analyse strategies predictive of participants having returned their latest bowel cancer screening kit. Then, intenders were interviewed to explore their opinions of these strategies and worked with researchers to adapt these strategies into prototype interventions to facilitate screening participation. All interviews were analysed using the framework approach of codebook thematic analysis. Results Interview participants who returned their kit shared their effective planning strategies, such as putting the kit in a visible place or by the toilet, planning a time at home to complete the kit, and using reminders. Survey participants who reported using such strategies were more likely to have completed their screening kit compared to those who did not. Prototype interventions developed and endorsed by intenders included providing a prompt to place the kit or a sticker near the toilet as a reminder, a deadline for kit return, the option to sign up for reminders, and a bag to store the sample in the fridge. Conclusions These novel, consumer-led interventions that are built upon the needs and experience of screening invitees provide potential solutions to improve participation in population bowel cancer screening.

Phytoplankton occupy the oceans’ euphotic zone and are responsible for its primary production; thus, our ability to monitor their patterns of abundance and physiology is vital for tracking ocean health. Ocean colour sensors mounted on satellites can monitor the surface patterns of phytoplankton daily at global scales but cannot see into the subsurface. Autonomous robotic platforms, like Biogeochemical-Argo (BGC-Argo) profiling floats, do not have the coverage of satellites but can monitor the subsurface. Combining these methods can help track phytoplankton patterns throughout the euphotic zone. In this study, using a global array of BGC-Argo floats (76,043 profiles, spanning from 2010 to 2023), we revisit empirical relationships between the surface and column-integrated concentrations of chlorophyll-a (a proxy for phytoplankton abundance and physiology), originally developed using ship-based profiling data. We show that these relationships agree well with BGC-Argo float data. We then extend the relationships, removing the binary switch in parameters between mixed and stratified waters and trophic conditions such that the column-integrated chlorophyll-a concentration can be estimated as a continuous function of surface chlorophyll-a and a proxy for stratification (we use the optical mixed-layer depth, the mixed-layer depth multiplied by the diffuse attenuation coefficient, which is proportional to the ratio of the euphotic depth to the mixed layer depth when it approaches 1). The new model is shown to perform well in statistical tests (using separate training and independent validation data, with a correlation coefficient >0.73) and has fewer parameters than the earlier version. The model can be applied to satellite observations of surface chlorophyll-a and diffuse attenuation, together with fields of mixed-layer depth (e.g., from Argo), to track changes in column-integrated chlorophyll-a. Such fields may be useful for obtaining estimates of primary production, evaluating ecosystem models, and quantifying trophic energy transfer. The model may also be used to evaluate the influence of changing stratification patterns on phytoplankton abundance and physiology.

This article focuses on che raised. fourth or Lydian scale degree of the scale in Chopin's mazurkas from the viewpoint of the stylised mazurka's fusion of folkloric elements and nineteenth-century tonal language. A brief exposition of the functions of the raised fourth and its integradon into the tonal structures of the mazurkas is given. An investigation of the raised fourth in three selected mazurkas· reveals a significant expansion of its role musi~al meaning, function and effect, As an authentic, modal, structural, motivic and form-generating device, it is in terms of integral co tonal elaboration, development, unification, colouration and contrast.

Die affiniteit vie 'n meer sentimentele, ervaringsgerigte geestelike lied is binne die NG Kerk as histories-religieuse verskynsel gevestig. 'n Analise van polemiek in Die Kerkbode toon dat die meerderheid lidmate ook tans liedere vanuit die jeugsangbundels b6 die tradisionele reformatoriese kerklied verkies. Nuucgekomponeerde liedere in hierdie bundels gryp beide in eeks en musikale styl hoofsaaklik rerug op negenriende-eeuse revival cradisies. In teensrelling met die algemene opvacting dat daar binne die NG Kerk onlangs noemenswaardige vernuwings met betrekking tot die kerklied-idioom plaasgevind bet, coon laasgenoemde binne die breer raamwerk van die kontempor~re himnodie nie alleen 'n opvallende gebrek aan relevansie nie, maar ook as konrekstuele blik op die kerk se onlangse geskiedenis 'n skreiende onbetrokkenheid.

In hierdie artikel word 'n oorsig gebied oor die relevansiedebar in die sielkunde in Suid-Afrika. Die blyk dat die sielkundeprofessie as belangrike rolspeler in die sosiopolicieke konteks van die land gevestig moet word ten einde 'n bydrae tot 'n vreedsame en demokratiese samelewing re lewer. Om doelrreffende kruiskulturele dienste re kan !ewer, moec die universele beginsels van die sielkunde behou word. Dir is egcer ewe belangrik dat kulturele diversiteit erken en Afrosenrriese beginsels in die sielkunde geakkommodeer word. Aandag behoort geskenk re word aan die tekort aan sielkundiges uit nie-Westerse bevolkingsgroepe, terwyl samewerking met tradisionele genesers bevorder moet word. Daarby moet sielkundige dienste na die bree bevolking uitgebrei en sodanige dienste meer toeganklik gemaak en beter bemark word. Die voorafgaande het noodwendig implikasie vir die opleiding van sielkundiges.

Abstract Background Anticipated, internal, and enacted stigma are major barriers to tuberculosis (TB) care engagement and directly impact patient well-being. Unfortunately, targeted stigma interventions are lacking. We aimed to co-develop a person-centred stigma intervention with TB-affected community members and health workers in South Africa. Methods Using a community-based participatory research approach, we conducted ten group discussions with people diagnosed with TB (past or present), caregivers, and health workers (total n = 87) in Khayelitsha, Cape Town. Group discussions were facilitated by TB survivors. Discussion guides explored experiences and drivers of stigma and used human-centred design principles to co-develop solutions. Recordings were transcribed, coded, thematically analysed, and then further interpreted using the socio-ecological model and behaviour change wheel framework. Results Intervention components across socio-ecological levels shared common functions linked to effective behaviour change, namely education, training, enablement, persuasion, modelling, and environmental restructuring. At the individual level, participants recommended counselling to improve TB knowledge and provide ongoing support. TB survivors can guide messaging to nurture stigma resilience by highlighting that TB can affect anyone and is curable, and provide lived experiences of TB to decrease internal and anticipated stigma. At the interpersonal level, support clubs and family-centred counselling were suggested to dispel TB-related myths and foster support. At the institutional level, health worker stigma reduction training informed by TB survivor perspectives was recommended to decrease enacted stigma. Participants discussed how integration of TB/HIV care services may exacerbate TB/HIV intersectional stigma and ideas for restructured service delivery models were suggested. At the community level, participants recommended awareness-raising events led by TB survivors, including TB information in school curricula. At the policy level, solutions focused on reducing the visibility generated by a TB diagnosis and resultant stigma in health facilities and shifting tasks to community health workers. Conclusions Decreasing TB stigma requires a multi-level approach. Co-developing a person-centred intervention with affected communities is feasible and generates stigma intervention components that are directed and implementable. Such community-led multi-level intervention components should be prioritised by TB programs, including integrated TB/HIV care services.

Abstract Background Amyotrophic lateral sclerosis (ALS) is a rapidly progressing neurodegenerative disorder with minimally effective treatment options. An important hurdle in ALS drug development is the non-invasive therapeutic access to the motor cortex currently limited by the presence of the blood-brain barrier (BBB). Focused ultrasound and microbubble (FUS+ MB) treatment is an emerging technology that was successfully used in ALS patients to temporarily open the cortical BBB. However, FUS+ MB-mediated drug delivery across ALS patients’ BBB has not yet been reported. Similarly, the effects of FUS+ MB on human ALS BBB cells remain unexplored. Methods Here we established the first FUS+ MB-compatible, fully-human ALS patient-cell-derived BBB model based on induced brain endothelial-like cells (iBECs) to study anti-TDP-43 antibody delivery and FUS+ MB bioeffects in vitro. Results Generated ALS iBECs recapitulated disease-specific hallmarks of BBB pathology, including reduced BBB integrity and permeability, and TDP-43 proteinopathy. The results also identified differences between sporadic ALS and familial (C9orf72 expansion carrying) ALS iBECs reflecting patient heterogeneity associated with disease subgroups. Studies in these models revealed successful ALS iBEC monolayer opening in vitro with no adverse cellular effects of FUS+ MB as reflected by lactate dehydrogenase (LDH) release viability assay and the lack of visible monolayer damage or morphology change in FUS+ MB treated cells. This was accompanied by the molecular bioeffects of FUS+ MB in ALS iBECs including changes in expression of tight and adherens junction markers, and drug transporter and inflammatory mediators, with sporadic and C9orf72 ALS iBECs generating transient specific responses. Additionally, we demonstrated an effective increase in the delivery of anti-TDP-43 antibody with FUS+ MB in C9orf72 (2.7-fold) and sporadic (1.9-fold) ALS iBECs providing the first proof-of-concept evidence that FUS+ MB can be used to enhance the permeability of large molecule therapeutics across the BBB in a human ALS in vitro model. Conclusions Together, this study describes the first characterisation of cellular and molecular responses of ALS iBECs to FUS+ MB and provides a fully-human platform for FUS+ MB-mediated drug delivery screening on an ALS BBB in vitro model.

Aims/method This national pre-pandemic survey compared demand and capacity of adult community eating disorder services (ACEDS) with NHS England (NHSE) commissioning guidance. Results Thirteen services in England and Scotland responded (covering 10.7 million population). Between 2016–2017 and 2019–2020 mean referral rates increased by 18.8%, from 378 to 449/million population. Only 3.7% of referrals were from child and adolescent eating disorder services (CEDS-CYP), but 46% of patients were aged 18–25 and 54% were aged >25. Most ACEDS had waiting lists and rationed access. Many could not provide full medical monitoring, adapt treatment for comorbidities, offer assertive outreach or provide seamless transitions. For patient volume, the ACEDS workforce budget was 15%, compared with the NHSE workforce calculator recommendations for CEDS-CYP. Parity required £7 million investment/million population for the ACEDS. Clinical implications This study highlights the severe pressure in ACEDS, which has increased since the COVID-19 pandemic. Substantial investment is required to ensure NHS ACEDS meet national guidance, offer evidence-based treatment, reduce risk and preventable deaths, and achieve parity with CEDS-CYP.

Abstract Aims Peripartum cardiomyopathy (PPCM) is characterized by left ventricular (LV) dysfunction developing towards the end of pregnancy or in the first months postpartum. Although about 60% of women with PPCM (the majority of which are prescribed evidence based heart failure [HF] medications) show LV recovery within 6 to 12 months, others remain with persistently impaired LV function. Poor adherence to medical therapy represents a major cause of avoidable hospitalizations, disability, and death in other cardiovascular conditions. In this study, we aimed to determine drug adherence to HF therapy among women with PPCM and to identify possible associations between drug adherence and LV recovery, functional status and psychological well‐being. Methods and results In this single‐centre, prospective, observational study, we included 36 consecutive women with PPCM. Adherence to HF treatment was assessed by (i) verifying the collection of pharmacy refills and (ii) using liquid chromatography high‐resolution mass spectrometry (LC‐HRMS). Participants were thereby classified as ‘adherent’ (i.e. all prescribed HF drugs were detectable by LC‐HRMS), ‘partially adherent’ (i.e. at least one prescribed drug detectable) or ‘non‐adherent’ (i.e. none of the prescribed drugs detectable). Health state index scores were assessed by EQ‐5D‐5L and HADS‐A/D (for anxiety/depression). Patients' median age was 32.4 years (IQR 27.6–36.1). At the adherence visit (which occurred at a median of 16 months [IQR 5–45] after PPCM diagnosis), prescription included beta‐blockers (77.8%), angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers (75%), mineralocorticoid receptor antagonists (47.2%) and loop diuretics (95.2%). Less than two thirds of patients (63.9%) collected all their pharmacy refills in the 6 months prior to adherence visit. According to LC‐HRMS, 23.5% participants were classified as adherent, 53.0% as partially adherent, and 23.5% as non‐adherent. Adherence was associated with significantly lower LVEDD at follow‐up (47 mm [IQR 46–52), vs. 56 mm [IQR 49–64] with partial adherence, and 62 mm [IQR 55–64] with non‐adherence, P = 0.022), and higher LVEF at follow‐up (60% [IQR 41–65]), vs. partially adherence (46% [IQR 34–50]) and non‐adherence (41.0% [IQR 29–47], P = 014). Adherent patients had a lower overall EQ‐ 5D score (5.5 [IQR 5–7.5], vs. 6 [IQR 5–7] in partially adherent, and 10 [IQR 8–15] in non‐adherent patients, P = 0.032) suggestive of a better self‐rated health status. Conclusions Adherence to HF therapy was associated with favourable LV reverse remodelling in PPCM and better self‐rated health status. Our study highlights the importance of drug adherence for functional recovery. Drug adherence should be an important component of patient communication and specific interventions in PPCM.

Abstract Background Concussions in Rugby Union are common with an increased risk to adolescent players. Coaches are key to injury prevention and a greater understanding of their knowledge and sentiments may guide future initiatives. There is a lack of data on rugby coaches, especially in South Africa. This study aimed to investigate the knowledge and opinions of high school rugby coaches regarding concussion management. Methods This cross-sectional study of 37 high school rugby coaches in South Africa, was conducted via a self-reported questionnaire. Concussion knowledge was scored for correct answers only with closed-question scaling methods to measure the importance of items of concussion management using a graphical rating scale. An attitude scale (Likert) was used to assess self-reported opinions and behaviours. Associations were calculated for participant characteristics and overall concussion injury knowledge. Results More participants showed good overall knowledge of ≥ 75% (n = 22, 59% vs. n = 15, 40%), especially those with greater coaching experience (p = 0.021). Player welfare was perceived more important than player performance (185 vs. 164), with concussion prevention most important (184 of 185). Appealing characteristics of an injury prevention programme were the improvement of player skill (173, SD ± 0.75, mean 4.68), being adaptable (171, ± 0.86, 4.62), and being completed in the warm-up (167, ± 0.93, 4.51). The biggest perceived barriers were duration (138, ± 1.59, mean 3.73), effort (130, ± 1.56, 3.51), compliance and lack of knowledge (both 127, ± 1.68, 3.43). Conclusion These results support the implementation of ongoing concussion education for rugby coaches and identify areas for promoting awareness and knowledge of concussion injury prevention, identification, and specific management of younger athletes. Appealing characteristics and barriers are highlighted and may allow for improved implementation and adherence to concussion prevention programmes.

Background: Leukaemias are haematological malignancies resulting from the abnormal clonal proliferation of haematopoietic precursors. Their incidence is influenced by various environmental and genetic factors. Aim: With this retrospective descriptive study, the authors aimed to explore the possible influence of seasonality on the type and number of acute leukaemia (AL) diagnoses made at the Universitas Academic Hospital (UAH) National Health Laboratory Service (NHLS) from 01 January 2018 to 31 December 2021. Setting: Universitas Academic Hospital, Bloemfontein, South Africa. Methods: Archived laboratory reports of all patients diagnosed with lymphoid and myeloid during the study period were included. Patients’ age, sex, ethnicity, final diagnosis and date of diagnosis were recorded. Information was pseudonymised to maintain confidentiality. A descriptive statistical analysis was performed to explore the possible influence of seasonality on the number of cases and type of leukaemia diagnosed. Results: In all, 249 patients were included. Acute myeloid leukaemia (AML) was the most common AL subtype (n = 117; 47.0%). Over the 4-year study period, all AL subtypes were more frequently diagnosed in summer (n = 131; 52.6%). However, the monthly number of AL diagnoses was relatively consistent over the 4 years for all subtypes (p = 0.7603), with consistent peaks of AML cases during January and February (summer) and May (autumn). Conclusion: No statistically significant association between the different seasons and AL diagnosis was noted. Contribution: Further studies using a larger study population and a wider geographical area, conducted over a more extended period, might affect the observations made in this study

Abstract Healthcare professionals (HCPs) have vital roles in providing evidence‐based care to promote healthy micronutrient nutrition in early life. Providing such care requires scalable training to strengthen knowledge and confident application of effective behaviour change skills. Among 33 public and private HCPs (primarily dietitians) in South Africa, we evaluated the behaviour change aspects of a technology‐enabled National Qualification Sub‐Framework level 6 programme, Improving Early Nutrition and Health in South Africa (‘ImpENSA’). This programme comprises two self‐directed micronutrient and behaviour change knowledge‐based eLearning and one facilitated online practical skills modules to improve maternal and infant micronutrient nutrition. Using assessments, questionnaires and interviews, we collected data at baseline, after module completion and at 3‐month follow‐up after programme completion. Questionnaire and interview data showed major improvements in understanding of and attitudes towards person‐centred behaviour change support immediately following the eLearning module on behaviour change. The assessment pass rate increased from 38% at baseline to 88% postmodule, demonstrating significant knowledge gain in behaviour change support. Intention to change practice towards a person‐centred approach was high and many had already started implementing changes. Three months postprogramme, support was centred around patients' needs. Open relationships with patients, improved patient outcomes and increased job satisfaction were among reported outcomes. Many reported becoming better change facilitators and reflective practitioners. Additional improvements in understanding and attitudes to behaviour change support were evident, reinforced by making changes and experiencing positive outcomes. The findings suggest that technology‐enabled learning can equip HCPs with knowledge and skills to effectively support behaviour change for healthy micronutrient nutrition during pregnancy and infancy.

The article presents and validates an extensive multivariate dataset that offers insights into water–energy–food (WEF) nexus governance for social justice at the intrahousehold, household, and community levels. The lack of insights in the WEF nexus debate that take social justice and governance into account is what spurred the data collection. The initial process involved scoping the originally selected investigated sites and their suitability. Once the research areas were identified, the data were collected from 1184 households in the Matatiele, Magareng, and Greater Taung Local Municipalities in South Africa, using a semi-structured questionnaire and KoboCollect software. The freely available software was installed on Android Tablets which were used by the enumerators. The questionnaires were initially piloted in Matatiele Local Municipality, testing for internal validity and skip patterns, as well as time to complete the questionnaire. The reliability of the Likert responses from the questionnaire was evaluated using Cronbachʼs alpha. The questionnaire was then refined for data collection and utilized a total of twenty-two (22) locally trained enumerators who were employed at the investigated sites. These enumerators were trained in administering the questionnaire and the use of the KoboCollect software used in data collection. The enumerators also received training on how to conduct the survey ethically, including informed permission, confidentiality, and the option to withdraw from the interview. The design of the data collection process was a cross-sectional survey that was conducted between 6 June and 4 August 2022, using purposive sampling. At the end of each data collection day, the enumerators uploaded their collected data into the KoboTool cloud, which allowed the lead in the survey to assess the data and effect any correctional measures on the questionnaire if the need arose. The enumerators also used a WhatsApp chat group to communicate real time opportunities and challenges in the questionnaire, which allowed the lead in the survey to constantly update the questionnaire. The multivariate questionnaire was divided into sections of socioeconomic and demographic characteristics, community-level governance, decision-making, food, energy, and water security, social justice, legal knowledge, and rights to utilize these resources. The dataset will be of significance to multi-disciplinary researchers focusing on WEF security, governance, and social justice in Southern Africa. Furthermore, environmental and sustainability practitioners can find valuable insights from the provided data. The employed methodology is replicable and adaptable, enabling real-time monitoring of social justice and governance in the context of food, energy, and water security. The real time monitoring of governance and social justice in water, energy and food allows for the possibility of continual data collection and updating, and if a longitudinal design is adopted, it can be used for impact inquiry of any interventions or policies.

Measures of physical growth, such as weight and height have long been the predominant outcomes for monitoring child health and evaluating interventional outcomes in public health studies, including those that may impact neurodevelopment. While physical growth generally reflects overall health and nutritional status, it lacks sensitivity and specificity to brain growth and developing cognitive skills and abilities. Psychometric tools, e.g., the Bayley Scales of Infant and Toddler Development, may afford more direct assessment of cognitive development but they require language translation, cultural adaptation, and population norming. Further, they are not always reliable predictors of future outcomes when assessed within the first 12–18 months of a child’s life. Neuroimaging may provide more objective, sensitive, and predictive measures of neurodevelopment but tools such as magnetic resonance (MR) imaging are not readily available in many low and middle-income countries (LMICs). MRI systems that operate at lower magnetic fields (< 100mT) may offer increased accessibility, but their use for global health studies remains nascent. The UNITY project is envisaged as a global partnership to advance neuroimaging in global health studies. Here we describe the UNITY project, its goals, methods, operating procedures, and expected outcomes in characterizing neurodevelopment in sub-Saharan Africa and South Asia.

No abstract available.

Background: The radiology report is the primary means of conveying imaging findings between radiologists and clinicians. As a result, clinician satisfaction with the radiology report is an indicator of its quality and clinical relevance. It is crucial to identify factors that can enhance the radiology report in order to improve service delivery. Objectives: This study evaluates clinician and radiologist opinions, preferences and clinician utilisation of the radiology report. Method: Mixed quantitative and qualitative survey questionnaires were distributed in-person and online from December 2022 to February 2023 to a total of 287 clinicians and 43 independent medical practitioners specialising in radiology. Results: A total of 73.0% of radiologists and 56.5% of clinicians expressed satisfaction with the radiology reports. Additionally, 72.0% of radiologists expressed dissatisfaction with the history provided on the referral forms. It was found that 87.6% of clinicians read the radiology report, while 26.2% reviewed the radiological imaging without referring to it. Interestingly, 77.8% of clinicians preferred itemised listed reports, whereas 53.8% of radiologists preferred reports in paragraph format. It was discovered that 69.6% of radiologists and 65.4% of clinicians preferred a standardised reporting format. Conclusion: More than half of the clinicians and most of the radiologists expressed satisfaction with the radiology report. Both clinicians and radiologists showed a preference for a structured reporting format. A crucial element in constructing a good radiology report was having a relevant clinical history. The radiologist continued to be the preferred professional for interpreting radiological imaging. Contribution: This survey was a good starting point for improving communication between clinicians and radiologists. This will ultimately result in reports that are more useful to clinicians and radiologists who have a better understanding of what should be included in reports and how they should be structured.

A bimodal impact strength distribution was found in notched impact specimens of HDPE composites with calcium carbonate, carbon black, SEBS and stabilisers. The bimodal distribution was only found at moderate-to-high calcium carbonate loadings, with the likelihood of low impact strength increasing with increasing stabiliser loading and decreasing with increasing SEBS/CB masterbatch loading. Bayesian methods were used first to confirm bimodality and then to investigate the effects of formulation on the performance of the system, based on a hierarchical model with quadratic and interactive terms and switching based on the sampling of a Bernoulli distribution with a logistic regression informing the probability of high or low impact strength. The results are contextualised through micrograph fractography and, briefly, differential scanning calorimetry. Results are also reported for unnotched impact tests, with negative correlations for impact strength with calcium carbonate and stabilisers, a positive correlation with SEBS/CB and interactive effects.

Abortion is one of the major causes of economic losses in livestock production worldwide. Because several factors can lead to abortion in cattle, sheep and goats, laboratory diagnosis, including the molecular detection of pathogens causing abortion, is often necessary. Bacterial zoonotic diseases such as brucellosis, coxiellosis, leptospirosis, and listeriosis have been implicated in livestock abortion, but they are under diagnosed and under-reported in most developing countries, including Botswana. This study applied a recently developed multiplex high-resolution melting analysis technique, coupled with singleplex qPCR assays, to investigate abortions in livestock in Botswana, using 152 samples from cattle, sheep, and goat abortion cases. Brucella spp. were the most frequent pathogen detected, with an overall frequency of 21.1%, followed by Coxiella burnetii with 19.1%. Listeria monocytogenes and Leptospira spp. were not detected in any of specimens samples investigated. Mixed infections with Brucella spp. and C. burnetii were observed in 35% specimes examined. There was a good agreement between the multiplex qPCR-HRM and singleplex qPCR for detecting Brucella spp. and C. burnetii. This study is the first report on the syndromic testing of abortion-causing pathogens in Botswana. It shows the importance of molecular methods in the differential diagnosis of abortion-causing diseases in domestic ruminants.

Background: Even though adults with foetal alcohol spectrum disorder (FASD) are at risk of negative life outcomes, there is no published evidence of this in South Africa, which has the highest estimated FASD prevalence rate globally. Objectives: The purpose of the study was to describe and compare the life outcomes of adults with FASD and adults without FASD in a South African rural community, 16 years after diagnosis. Method: Participants were examined and interviewed regarding their biographical information, knowledge of FASD, information on their family, relationships, home circumstances, education, work and medical history. Results: Adults with FASD were less likely to be in a relationship and more likely to have poor educational outcomes and to be exposed to violence as victim or perpetrator than their peers who did not have FASD. None of the participants with FASD completed secondary school successfully. No differences were found for independent living, employment, health, substance use and legal outcomes, between the foetal alcohol syndrome (FAS) or partial foetal alcohol syndrome (PFAS) and control group. Conclusion: While significant differences existed in certain aspects, differences are not as stark as one would expect between individuals with FASD and controls. Contribution: This study highlights the importance of considering the social context in which a FASD diagnosis is made. The comparative negative impact of an FASD diagnosis and the associated challenges on life outcomes may be less pronounced in rural communities where everyone has fewer opportunities and resources. This can also make the unique needs of persons with disabilities less visible.

The community structure and ecological function of marine ecosystems are critically dependent on phytoplankton. However, our understanding of phytoplankton is limited due to the lack of detailed information on their morphology. To address this gap, we developed a framework that combines scanning electron microscopy (SEM) with photogrammetry to create realistic 3D (three-dimensional) models of phytoplankton. The workflow of this framework is demonstrated using two marine algal species, one dinoflagellate Prorocentrum micans and one diatom Halamphora sp. The resulting 3D models are made openly available and allow users to interact with phytoplankton and their complex structures virtually (digitally) and tangibly (3D printing). They also allow for surface area and biovolume calculations of phytoplankton, as well as the exploration of their light scattering properties, which are both important for ecosystem modeling. Additionally, by presenting these models to the public, it bridges the gap between scientific inquiry and education, promoting broader awareness on the importance of phytoplankton.

The primary healthcare (PHC) rotation places medical students in rural district hospitals for 4 weeks during their 4th or 5th year. This rotation is a collaboration among three academic units at Stellenbosch University’s Faculty of Medicine and Health Sciences. Learning activities during this rotation include participation in a longitudinal community-oriented primary care project, conducting rehabilitation-oriented home visits to persons with disabilities, and assessing and treating patients presenting with undifferentiated problems on an in- and outpatient basis. Working in rural contexts for a month affords students opportunities to foster meaningful relationships with the healthcare team, patients and the community, while learning about collaborative teamwork and communities. Critical reflections about the interprofessional care of patients and a community evaluation are key components of the students’ learning and assessment. Demonstrating the importance of interprofessional collaboration in PHC, this integrated training model has received, and continues to receive, positive feedback from students and the clinicians involved. Attention to logistics and academic support plays a crucial role in ensuring optimal learning for students. An integrated approach that involves multiple academic units, various healthcare professions and communities is strongly recommended for those who are considering training students in rural PHC environments.

Cells can be cultured to very high densities in hollow alginate tubes (5−10×108cells/mL), with the provisothat their nutrient and oxygen needs are met. After the tubes have been extruded, they are suspended in growth medium. Nutrients and metabolic products pass readily through the alginate tube walls and the cells grow from small aggregates until they fill the hollow space in the tube. A mathematical model is presented of nutrient and oxygen transport between the bulk phase and the tubes. Our main result is a necessary condition for growing cells to confluency. It sets an upper limit on the inner tube diameter. This limit depends on the alginate wall thickness, transport properties and consumption rates. Experimental results are reported for l-Wnt-3a cells, which have been expanded in tubes with inner diameters of 400,500,600and 700μm. For our experimental set-up, glucose was the limiting nutrient. Cells reached confluency in 400and500μm tubes at bulk glucose concentrations of 20mM. When the bulk glucose concentration was increased to 25, 30 and 35 mM, confluency was reached in 600μm tubes for all three cases. Confluency was not achieved in tubes with inner diameters of 700 um, even at the elevated glucose concentrations, suggesting that the dissolved oxygen concentration has become the limiting factor. These results match the model predictions well and confirms that the model can be used to select tube dimensions.

The precious Malagasy rosewood species of the genus Dalbergia have been listed in Appendix II of CITES due to illegal logging and timber trade. Accurate identification and proper delimitation are of paramount importance for endangered species regulated by CITES. One of the most accurate methods of identifying precious woods is DNA barcoding which is a technique for rapid and accurate species identification based on a short DNA sequence or a few DNA regions. Recent studies have shown that the ITS barcode can identify Malagasy Dalbergia species, but the number of species has been limited. In this research study, a total of 136 nuclear ribosomal internal transcribed spacer (nrITS) DNA sequences representing 41 species of Malagasy Dalbergia were used to assess the effectiveness of the ITS barcode in species identification. Each sequence was evaluated by genetic distance and tree-based methods. Using clustering analyses, estimating genetic distances, and comparing sequences of 136 samples, we were able to distinguish species. The interspecific distance was greater than the intraspecific distance, but no barcoding gap was observed. It was found that ITS has a very high discriminatory power for Malagasy Dalbergia species using both NJ and TaxonDNA methods. Considering the ''Best Match'' and ''Best Close Match'' analyses, the discrimination powers of ITS were 98.54% and 93.40%, respectively. Our research indicates that the use of ITS as a barcode enables the identification of Malagasy Dalbergia species and contributes to completing the reference library for controlling the trade in precious woods. These results are essential to ensure effective enforcement of regulations and promote the long-term conservation of these species.

BackgroundFinding individuals with drug-resistant tuberculosis (DR-TB) is important to control the pandemic and improve patient clinical outcomes. To our knowledge, systematic reviews assessing the effectiveness, cost-effectiveness, acceptability, and feasibility of different DR-TB case-finding strategies to inform research, policy, and practice, have not been conducted and the scope of primary research is unknown. ObjectiveWe therefore assessed the available literature on DR-TB case-finding strategies. MethodsWe looked at systematic reviews, trials, qualitative studies, diagnostic test accuracy studies, and other primary research that sought to improve DR-TB case detection specifically. We excluded studies that included patients seeking care for tuberculosis (TB) symptoms, patients already diagnosed with TB, or were laboratory-based. We searched the academic databases of MEDLINE, Embase, The Cochrane Library, Africa-Wide Information, CINAHL (Cumulated Index to Nursing and Allied Health Literature), Epistemonikos, and PROSPERO (The International Prospective Register of Systematic Reviews) using no language or date restrictions. We screened titles, abstracts, and full-text articles in duplicate. Data extraction and analyses were carried out in Excel (Microsoft Corp). ResultsWe screened 3646 titles and abstracts and 236 full-text articles. We identified 6 systematic reviews and 61 primary studies. Five reviews described the yield of contact investigation and focused on household contacts, airline contacts, comparison between drug-susceptible tuberculosis and DR-TB contacts, and concordance of DR-TB profiles between index cases and contacts. One review compared universal versus selective drug resistance testing. Primary studies described (1) 34 contact investigations, (2) 17 outbreak investigations, (3) 3 airline contact investigations, (4) 5 epidemiological analyses, (5) 1 public-private partnership program, and (6) an e-registry program. Primary studies were all descriptive and included cross-sectional and retrospective reviews of program data. No trials were identified. Data extraction from contact investigations was difficult due to incomplete reporting of relevant information. ConclusionsExisting descriptive reviews can be updated, but there is a dearth of knowledge on the effectiveness, cost-effectiveness, acceptability, and feasibility of DR-TB case-finding strategies to inform policy and practice. There is also a need for standardization of terminology, design, and reporting of DR-TB case-finding studies.

Obesity is the fifth leading risk factor for global deaths with numbers continuing to increase worldwide. In the last 20 years, the emergence of pharmacological treatments for obesity based on gastrointestinal hormones has transformed the therapeutic landscape. The successful development of glucagon-like peptide-1 (GLP-1) receptor agonists, followed by the synergistic combined effect of glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonists achieved remarkable weight loss and glycemic control in those with the diseases of obesity and type 2 diabetes. The multiple cardiometabolic benefits include improving glycemic control, lipid profiles, blood pressure, inflammation, and hepatic steatosis. The 2023 phase 2 double-blind, randomized controlled trial evaluating a GLP-1/GIP/glucagon receptor triagonist (retatrutide) in patients with the disease of obesity reported 24.2% weight loss at 48 weeks with 12 mg retatrutide. This review evaluates the current available evidence for GLP-1 receptor agonists, dual GLP-1/GIP receptor co-agonists with a focus on GLP-1/GIP/glucagon receptor triagonists and discusses the potential future benefits and research directions.

Abstract Background Babesia canis is a clinically relevant vector-borne pathogen in dogs, and its presence is expanding. The efficacy of Simparica Trio® (Zoetis) in the prevention of B. canis transmission was evaluated at the minimum recommended label dose of 1.2 mg/kg sarolaner, 24 µg/kg moxidectin and 5 mg/kg pyrantel per kg bodyweight. Methods Twenty-four (24) dogs were randomly allocated to either a placebo-treated group or one of two treatment groups with Simparica Trio. Dogs were infested with B. canis-infected Dermacentor reticulatus ticks 21 or 28 days after treatment administration. Blood samples for antibody and DNA detection were collected from each dog prior to tick infestation until 28 days after infestation. A dog was defined as being B. canis positive if it tested positive by both an indirect immunofluorescence assay (IFA) and PCR at any time during the study. Results No treatment-related adverse reactions were recorded during the study. All placebo-treated animals displayed clinical signs due to babesiosis and tested positive on both IFA and PCR. None of the Simparica Trio-treated animals displayed any clinical symptoms or tested positive, resulting in a 100% efficacy in the prevention of canine babesiosis (P

South Africa has been experiencing an energy crisis since 2007. Utility loadshedding became the main control for under-frequency events due to a mismatch in generation and consumption. Rolling blackouts are further supported by failing electrical infrastructure and illegal (non-metered) connections to the distribution network. A common remedy to mandatory South African loadshedding, from the perspective of university campuses, is to deploy hybrid photovoltaic-diesel (PV-diesel) microgrids that allow for an uninterrupted power supply for a few hours. Campus microgrids are typically smaller compared to national utilities (less inertia) and require sensitive control schemes to remain stable. In this paper, frequency recordings associated with the operating microgrid of the University of the Free State QwaQwa campus are analysed. A simplistic stochastic mathematical model is presented as a model describing the observed frequency dynamics, describing the transition between the utility grid and the microgrid state, the microgrid frequency controller response, and the influence of the PV generators. Moreover, inter-campus synchronous frequency measurements are showcased and the future implications thereof are discussed. The main contributions of this paper focus on the recording and modelling of the frequency dynamics of fully functioning campus microgrids, and the showcasing of continuous synchronous measurements of frequency at two different campuses.

Aims Ward rounds are key to treatment-related decision-making, but are often stressful. This project aimed to explore and improve patients’ experiences of the clinical team meeting (CTM; historically known as ward round) in an adult in-patient eating disorders unit. A mixed-method approach was adopted with in vivo observations, two focus groups and an interview. Six patients participated. Two former patients contributed to data analysis, co-production of service improvement initiatives and write-up. Results The mean CTM duration was 14.3 min. Patients spoke half of the time, followed by psychiatry colleagues. ‘Request’ was the most discussed category. Three themes were identified: CTMs are important but impersonal, a sense of palpable anxiety was generated and staff and patients had divergent views regarding CTM goals. Clinical implications The co-produced changes to CTMs were implemented and improved patient's experiences despite COVID-19 challenges. Factors beyond CTMs, including the ward's power hierarchy, culture and language, need addressing to facilitate shared decision-making.

Study Design Prospective study. Purpose To propose a scoring system for predicting the need for surgery in patients with lumbar disc herniation (LDH). Overview of Literature The indications for surgery in patients with LDH are well established. However, the exact timing of surgery is not. According to surgeons, patients with failed conservative treatment who underwent delayed surgery, often after 6 months post-symptom initiation, have poor functional recovery and outcome. Methods The current study included patients with symptomatic LDH. Patients with an indication for emergent surgery such as profound or progressive motor deficit, cauda equina syndrome, and diagnoses other than single-level LDH were excluded from the analysis. All patients followed a conservative treatment regimen (a combination of physical therapy, pain medications, and/or spinal epidural steroid injections). Surgery was indicated for patients who continuously experienced pain despite maximal conservative therapy. Results In total, 134 patients met the inclusion and exclusion criteria. Among them, 108 (80.6%) responded to conservative management, and 26 (19.4%) underwent unilateral laminotomy and microdiscectomy. The symptom duration, disc degeneration grade on magnetic resonance imaging (Pfirrmann disc grade), herniated disc location and type, fragment size, and thecal sac diameter significantly differed between patients who responded to conservative treatment and those requiring surgery. The area under the receiver operating characteristic curve of the scoring system based on the anteroposterior size of the herniated disc fragment and herniated disc location and type was 0.81. Conclusions A scoring system based on herniated disc/fragment size, location, and type can be applied to predict the need for surgery in patients with LDH. In the future, this tool can be used to prevent unnecessarily prolonged conservative management (>4–8 weeks).

Background: Pain is often a significant symptom in patients with head and neck cancer (HNC). The objective of this study was to determine the prevalence of pain, factors limiting effective pain management, and whether differences in pain management exist between the public and private health sectors in South Africa in HNC patients after they have completed treatment. Methods: A cross-sectional survey using the Brief Pain Inventory was performed on adults over the age of 18 years treated for HNC of any subsite in both a public and private hospital in Cape Town, South Africa. Results: Overall pain scores indicated mild levels of pain and impact on daily activities. The domains of life most affected by pain were general activity, sleep and mood. There was no difference in pain scores between public hospital patients versus those with private insurance. Less than half of the patients reported receiving all their necessary medications. Most of the postoperative pain was managed with paracetamol, tramadol and ibuprofen, with only 12.8% of patients using morphine. Conclusion: This study provides a survey of pain experiences in HNC patients in a middle-income country. Insurance status did not significantly impact pain experiences, indicating equitable access to pain management resources. However, the overall utilisation of morphine and medications used to treat neuropathic pain is low. Further research is needed into the complex factors associated with pain in HNC patients. Contribution: This article is an example of a standard clinical study on patient-reported outcome measures.

Minerals play a vital role in societal and economic growth. As finite and non-renewable resources, minerals inevitably diminish upon extraction. Consequently, there is an expectation that the extraction process should involve and benefit the local communities hosting these resources. Despite expectations of benefitting local communities, mineral extraction often results in more economic, social, and environmental burdens than advantages for them. This contribution is centred on a theoretical inquiry, employing the concept of social justice to explore and mitigate the disparities in the distribution of costs and benefits experienced by mine-host communities. It aims to balance the inequities, emphasising the principles of distributive, procedural and remedial justice to reconcile the losses and gains in a fair and equitable manner

This article investigates the attribute of God’s wisdom in Matthew’s Gospel as personified in the ministry of his Son, Jesus. This Gospel identifies Jesus as ‘Immanuel’. He is ‘God with us’. The focus falls on several statements exhibiting wisdom motifs that are either uttered by or ascribed to Jesus. These statements are quite puzzling and continue to evoke scholarly discussion. The central theoretical argument of this article is that these statements cannot be fully understood without considering the echoes of the Jewish context exhibited in them. The objective of his investigation is to demonstrate how the recognition of similarities between the statements in Matthew and in Jewish literature contribute towards the understanding of wisdom statements in the Matthean Gospel. This article therefore begins by identifying key wisdom motifs within Jewish tradition, followed by an investigation of wisdom sayings in Matthew. Parallels in Luke are considered to sharpen peculiarities of Matthew’s narration. From this investigation it became clear that the ministry of Jesus in Matthew is met with similar reactions as that of Wisdom in Jewish literature. The article accentuates a significant dimension of Matthew’s Christology. Matthew vindicates Jesus against his opponents and justifies Jesus’ acceptance within the Matthean community. For this community, he is not only recognised as wise teacher, but even the one who reveals and personifies wisdom. As ‘Immanuel’, he presents the attribute of God’s wisdom. Contribution: This article contributes to the ongoing scholarly discussion of several puzzling and seemingly obscure statements echoing wisdom motifs, either attributed to or uttered by Jesus.

Abstract Background South Africa is reported to have the highest burden of HIV with an estimated 8.2 million people living with HIV (PLHIV) in 2021- despite adopting the World Health Organisation (WHO) universal HIV test and treat (UTT) recommendations in 2016. As of 2021, only an estimated 67% (5.5 million) of all PLHIV were accessing antiretroviral therapy (ART), as per recorded clinic appointments attendance. Studies in sub-Saharan Africa show that people living in low-income households experience multiple livelihood-related barriers to either accessing or adhering to HIV treatment including lack of resources to attend to facilities and food insecurity. We describe the interactions between managing household income and ART adherence for PLHIV in low-income urban and semi-urban settings in the Western Cape, South Africa. Methods We draw on qualitative data collected as part of the HPTN 071 (PopART) HIV prevention trial (2016 – 2018) to provide a detailed description of the interactions between household income and self-reported ART adherence (including accessing ART and the ability to consistently take ART as prescribed) for PLHIV in the Western Cape, South Africa. We included data from 21 PLHIV (10 men and 11 women aged between 18 and 70 years old) from 13 households. As part of the qualitative component, we submitted an amendment to the ethics to recruit and interview community members across age ranges. We purposefully sampled for diversity in terms of age, gender, and household composition. Results We found that the management of household income interacted with people’s experiences of accessing and adhering to ART in diverse ways. Participants reported that ART adherence was not a linear process as it was influenced by income stability, changing household composition, and other financial considerations. Participants reported that they did not have a fixed way of managing income and that subsequently caused inconsistency in their ART adherence. Participants reported that they experienced disruptions in ART access and adherence due to competing household priorities. These included difficulties balancing between accessing care and/or going to work, as well as struggling to cover HIV care-related costs above other basic needs. Conclusion Our analysis explored links between managing household income and ART adherence practices. We showed that these are complex and change over the course of treatment duration. We argued that mitigating negative impacts of income fluctuation and managing complex trade-offs in households be included in ART adherence support programmes.

The study applied the systems theory to investigate causes of food waste generation in the University food service operation. A qualitative, case study design was adopted. One-on-one interviews with food service managers and supervisors, focus group discussions with back-of-house and front-of-house food service personnel, participant observation and document analysis were used to explore causes of food waste at different points of the University food service. The data collected were analysed with a qualitative data analysis software; ATLAS.ti. Thematic analysis was conducted to generate common themes. The findings illustrated that different activities in the functional subsystem of the food service system had an influence on food waste. The study contributes to the literature as causes of food waste were investigated from the systems theoretical perspective. This represents an important first step towards an improved understanding of the causes of food waste within the university food service setting. Unlike previous studies, a holistic view of the causes of food waste in different parts of the functional subsystem of the University food service were explored. An understanding of food waste from this perspective is useful in proposing strategies that adequately address food waste in the entire functional subsystem.

Abstract Abortifacient pathogens induce substantial economic losses in the livestock industry worldwide, and many of these pathogens are zoonotic, impacting human health. As Brucella spp., Coxiella burnetii, Leptospira spp., and Listeria monocytogenes cause abortion, rapid differential molecular diagnostic tests are needed to facilitate early and accurate detection of abortion to establish effective control measures. However, the available molecular methods are laborious, time-consuming, or costly. Therefore, we developed and validated a novel multiplex real-time polymerase chain reaction (qPCR) method based on high-resolution melting (HRM) curve analysis to simultaneously detect and differentiate four zoonotic abortifacient agents in cattle, goats, and sheep. Our HRM assay generated four well-separated melting peaks allowing the differentiation between the four zoonotic abortifacients. Out of 216 DNA samples tested, Brucella spp. was detected in 45 samples, Coxiella burnetii in 57 samples, Leptospira spp. in 12 samples, and Listeria monocytogenes in 19 samples, co-infection with Brucella spp. and Coxiella burnetii in 41 samples, and 42 samples were negative. This assay demonstrated good analytical sensitivity, specificity, and reproducibility. This is a valuable rapid, cost-saving, and reliable diagnostic tool for detecting individual and co-infections for zoonotic abortifacient agents in ruminants.

Background: Despite attempts to control malaria, poor drug bioavailability means malaria still places enormous pressure on health globally. It has been found that the solubility of highly lipophilic compounds can be enhanced through lipid formulations, e.g., self-emulsifying drug delivery systems (SEDDSs). Thus, quality-by-design and characterization were used to justify the development and determine the feasibility of oral oil-in-water SEDDSs comprising a fixed-dose combination (FDC) of artemether–lumefantrine to treat malaria more effectively without the aid of a fatty meal. These formulations were compared to a commercial product containing the same active compounds. Methods: Excipient compatibility and spontaneous emulsification capacity of different FDC–excipient combinations were identified by employing isothermal microcalorimetry, solubility, and water titration tests. Pseudoternary phase diagrams were constructed, and checkpoint formulations were selected within the self-emulsification region by reviewing formulation properties essential for optimized drug delivery. SEDDSs capable of enduring phase separation within 24 h were subjected to characterization experiments, i.e., drug concentration determination, cloud point, droplet size, size distribution, self-emulsification time, self-emulsification efficacy, viscosity, zeta potential, and thermodynamic stability analysis. SEDDSs with favorable characteristics were identified in the micro or nano range (SNEDDSs) before being subjected to drug release studies. Results: All final formulations depicted enhanced artemether and lumefantrine release compared to the commercial product, which could not release lumefantrine at a quantifiable concentration in this study. The avocado oil (AVO)4:6 and olive oil (OLV)3:7 SNEDDSs overall portrayed the ideal characteristics and depicted the highest percentage of drug release. Conclusions: This study offers evidence that SNEDDSs from selected natural oils comprising an artemether–lumefantrine FDC can potentially enhance the bioavailability of these lipophilic drugs.

Commercial crocodilian farms face significant economic and livestock losses attributed to stress, which may be linked to their adopted husbandry practices. The development of appropriate and modernized husbandry guidelines, particularly those focused on stress mitigation, is impeded by the limited understanding of the crocodilian stress response. Fifteen grower Nile crocodiles were subjected to simulated acute transport stress, with blood samples collected at various intervals post-stress. Plasma levels of corticosterone (CORT), dehydroepiandrosterone (DHEA), adrenaline, and noradrenaline were determined using high-performance liquid chromatography. Glucose and lactate were measured using portable meters and the heterophil-to-lymphocyte ratio (HLR) was determined via differential leucocyte counts. Significant differences were elicited after the stressor, with acute fluctuations observed in the fast-acting catecholamines (adrenaline and noradrenaline) when compared to the baseline. Downstream effects of these catecholamines and CORT appear to be associated with a persistent increase in plasma glucose and HLR. Lactate also showed acute fluctuations over time but returned to the baseline by the final measurement. DHEA, which is used in a ratio with CORT, showed fluctuations over time with an inverted release pattern to the catecholamines. The study highlights the temporal dynamics of physiological markers under acute stress, contributing to our understanding of crocodilian stress and potentially informing improved farming practices for conservation and sustainable management.

Visible spectral radiometry of seawater, often referred to as ocean colour, from space, provides a synoptic view of surface phytoplankton, and other optically-active constituents, at high temporal resolution, that is unsurpassed by any other technology. Yet, in-situ observations of ocean colour are critical to the success of the satellite, tracking the calibration of the radiometers and validating atmospheric correction algorithms. Owing to the high cost of commercial field radiometers, as well as the high costs associated with ocean-based field work, ocean colour scientists are plagued by a sparsity of high quality in-situ radiometric observations, particularly in remote regions. In this perspective article, we highlight potential to increase the number of in-situ observations of ocean colour by harnessing superyachts. Using openly-available data processing software, we show that automated ocean colour data collected using a superyacht can be used for the validation of an ocean colour satellite, with comparable results to traditional validation studies. Reaching out to wealthy citizen scientists may help fill gaps in our ability to monitor the colour of the ocean.

Ethnopharmacological relevance: In recent times the decriminalisation of cannabis globally has increased its use as an alternative medication. Where it has been used in modern medicinal practises since the 1800s, there is limited scientific investigation to understand the biological activities of this plant. Aim of the study: Dipeptidyl peptidase IV (DPP-IV) plays a key role in regulating glucose homeostasis, and inhibition of this enzyme has been used as a therapeutic approach to treat type 2 diabetes. However, some of the synthetic inhibitors for this enzyme available on the market may cause undesirable side effects. Therefore, it is important to identify new inhibitors of DPP-IV and to understand their interaction with this enzyme. Methods: In this study, four cannabinoids (cannabidiol, cannabigerol, cannabinol and Δ9-tetrahydrocannabinol) were evaluated for their inhibitory effects against recombinant human DPP-IV and their potential inhibition mechanism was explored using both in vitro and in silico approaches. Results: All four cannabinoids resulted in a dose-dependent response with IC50 values of between 4.0 and 6.9 μg/mL. Kinetic analysis revealed a mixed mode of inhibition. CD spectra indicated that binding of cannabinoids results in structural and conformational changes in the secondary structure of the enzyme. These findings were supported by molecular docking studies which revealed best docking scores at both active and allosteric sites for all tested inhibitors. Furthermore, molecular dynamics simulations showed that cannabinoids formed a stable complex with DPP-IV protein via hydrogen bonds at an allosteric site, suggesting that cannabinoids act by either inducing conformational changes or blocking the active site of the enzyme. Conclusion: These results demonstrated that cannabinoids may modulate DPP-IV activity and thereby potentially assist in improving glycaemic regulation in type 2 diabetes.

Petrological and major-trace element mineral chemistry studies have been carried out on pyroxenites from the Pakkanadu alkaline-ultramafic complex from the southern India to understand their origin and nature of magma responsible for ultramafic magmatism in the area. Pyroxenites display cumulus texture and consist of clinopyroxenes (cpx) and amphiboles (amp) as dominant phases with a subordinate amount of apatite, biotite, ilmenite, magnetite, pyrite, sphene, and calcite. Mineral chemistry classifies cpx as augite and diopside, whereas amp falls under tremolite-actinolite and hornblende-actinolite fields. Cpx are alkaline to sub-alkaline in composition and Mg# - Al2O3 compositions suggest their crystallization under high-pressure conditions. A negative correlation between Mg# and TiO2 in cpx suggests early crystallization of magnetite and pyrite; high Mg# (76–92) suggests its link with the Alaskan-type intrusions, which may be crystallized through fractionation-accumulation Processes. Tectonic discrimination diagrams for cpx argue for the magmatic emplacements under an arc-tholeiitic environment in a subduction zone setting. Amp mineral chemistry (high SiO2 and low TiO2) indicate as the products of hydrothermal alteration of clinopyroxenes. A Low Al/Si ratio in the cpx suggests their derivation from silica-oversaturated magma, whereas low-Ti contents reflect slow cooling rate of the magma. Positive Rb, Ba and U anomalies in the multi-element patterns of the cpx probably signifying varying degrees of hydrothermal alteration in the studied samples. However, consistent Nb-Ta depletion can also be attributed to an enriched mantle source of the magma from which pyroxenites were crystallized. Moreover, single-cpx geothermobarometry yielded a crystallization temperature of 905 to 911°C under moderate to high pressure of 3–9 kbar.

BackgroundWhile early autism intervention can significantly improve outcomes, gaps in implementation exist globally. These gaps are clearest in Africa, where forty percent of the world's children will live by 2050. Task-sharing early intervention to non-specialists is a key implementation strategy, given the lack of specialists in Africa. Naturalistic Developmental Behavioral Interventions (NDBI) are a class of early autism intervention that can be delivered by caregivers. As a foundational step to address the early autism intervention gap, we adapted a non-specialist delivered caregiver coaching NDBI for the South African context, and pre-piloted this cascaded task-sharing approach in an existing system of care.ObjectivesFirst, we will test the effectiveness of the caregiver coaching NDBI compared to usual care. Second, we will describe coaching implementation factors within the Western Cape Department of Education in South Africa.MethodsThis is a type 1 effectiveness-implementation hybrid design; assessor-blinded, group randomized controlled trial. Participants include 150 autistic children (18-72 months) and their caregivers who live in Cape Town, South Africa, and those involved in intervention implementation. Early Childhood Development practitioners, employed by the Department of Education, will deliver 12, one hour, coaching sessions to the intervention group. The control group will receive usual care. Distal co-primary outcomes include the Communication Domain Standard Score (Vineland Adaptive Behavior Scales, Third Edition) and the Language and Communication Developmental Quotient (Griffiths Scales of Child Development, Third Edition). Proximal secondary outcome include caregiver strategies measured by the sum of five items from the Joint Engagement Rating Inventory. We will describe key implementation determinants.ResultsParticipant enrolment started in April 2023. Estimated primary completion date is March 2027.ConclusionThe ACACIA trial will determine whether a cascaded task-sharing intervention delivered in an educational setting leads to meaningful improvements in communication abilities of autistic children, and identify implementation barriers and facilitators.Trial registrationNCT05551728 in Clinical Trial Registry (https://clinicaltrials.gov).

Abstract Objective: This study aimed to describe and compare the nutrient intake of young adults in the African Prospective Study on the Early Detection and Identification of Cardiovascular Disease and Hypertension (African-PREDICT) study according to ethnicity and socio-economic status (SES). Design: Cross-sectional analysis of baseline nutrient intakes in the African-PREDICT study. Setting: North West Province, South Africa Participants: Black and white adults (n 1153), aged 20–30 years, were classified into three SES groups. Dietary data were collected using three multiple-pass 24-h dietary recalls. Results: Among all participants, over 70 % failed to meet the estimated energy requirements and the estimated average requirements (EAR) for seventeen of the nineteen reported micronutrients. Across SES groups, more than 50 % of participants consistently did not meet the EAR for Ca, Mg, folate, pantothenic acid and biotin, as well as vitamins A, C, D and E. Participants’ distribution by nutrient pattern tertiles showed high adherence to two patterns: one rich in animal protein and saturated fat, and the other in Mg, potassium, Ca, phosphorus and fibre. This was seen only in white participants and high SES. Black participants and low SES showed higher adherence to a plant protein, B-vitamins, Zn and Fe nutrient pattern. Conclusions: The dietary intake of young adults in this study was restricted, with none of the groups meeting nutrient requirements for essential nutrients. Further research is needed to establish a direct link between nutrient patterns and the early detection and identification of CVD and hypertension.

This study reported the synthesis of a low-cost, and efficient adsorbent through surfactant modified macadamia nutshells (SMS) by a facile sodium dodecyl sulfonate (SDS) treatment approach. The SDS treatment resulted in increased functionalities, and ion exchangeable sites of macadamia nutshells leading to enhanced the removal of methylene blue (MB) dye from water. Factors such as pH (2-11), contact time (1-360 min), initial MB dye concentration (30-385 mg/L), and adsorbent mass (0.02 – 0.18 g/L), were tested in this study. The enhanced removal of MB removal (≥ 90%) was synergistically influenced by pH, with optimum adsorption removal around pH 7 to 11 for the SMS adsorbent. The results showed that MB removal was fast with SMS, and that the equilibrium was reached in 80 min. The batch adsorption results showed a good fit with pseudo-first-order kinetics, and the Langmuir isotherm model, in agreement with the experimental values, with a maximum adsorption capacity of 195.97 mg/g for MB. Surfactant modified macadamia nutshells (SMS) composed of surface functional groups: –OH, –C = O, -C-O, and multiple carbon-carbon bond, all contributed to synergistic mechanism interaction between the adsorbent and MB dye in this study. This study thus suggested that the SMS could be highly beneficial for eliminating anionic dye from polluted water-based solutions, thus highlighting its potential for practical usage in large pollutants removal.