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Recommender systems assist users in receiving preferred or relevant services and information. Using such technology could be instrumental in addressing the lack of relevance digital mental health apps have to the user, a leading cause of low engagement. However, the use of recommender systems for digital mental health apps, particularly those driven by personal data and artificial intelligence, presents a range of ethical considerations. This paper focuses on considerations particular to the juncture of recommender systems and digital mental health technologies. While separate bodies of work have focused on these two areas, to our knowledge, the intersection presented in this paper has not yet been examined. This paper identifies and discusses a set of advantages and ethical concerns related to incorporating recommender systems into the digital mental health (DMH) ecosystem. Advantages of incorporating recommender systems into DMH apps are identified as (1) a reduction in choice overload, (2) improvement to the digital therapeutic alliance, and (3) increased access to personal data & self-management. Ethical challenges identified are (1) lack of explainability, (2) complexities pertaining to the privacy/personalization trade-off and recommendation quality, and (3) the control of app usage history data. These novel considerations will provide a greater understanding of how DMH apps can effectively and ethically implement recommender systems.

The societal and ethical implications of artificial intelligence (AI) have sparked discussions among academics, policymakers and the public around the world. What has gone unnoticed so far are the likewise vibrant discussions in China. We analyzed a large sample of discussions about AI ethics on two Chinese social media platforms. Findings suggest that participants were diverse, and included scholars, IT industry actors, journalists, and members of the general public. They addressed a broad range of concerns associated with the application of AI in various fields. Some even gave recommendations on how to tackle these issues. We argue that these discussions are a valuable source for understanding the future trajectory of AI development in China as well as implications for global dialogue on AI governance.

Departing from popular imaginations around artificial intelligence (AI), this article engages in the I in the AI acronym but from perspectives outside of mathematics, computer science and machine learning. When intelligence is attended to here, it most often refers to narrow calculating tasks. This connotation to calculation provides AI an image of scientificity and objectivity, particularly attractive in societies with a pervasive desire for numbers. However, as is increasingly apparent today, when employed in more general areas of our messy socio-cultural realities, AI- powered automated systems often fail or have unintended consequences. This article will contribute to this critique of AI by attending to Nicholas of Cusa and his treatment of intelligence. According to him, intelligence is equally dependent on an ability to handle the unknown as it unfolds in the present moment. This suggests that intelligence is organic which ties Cusa to more contemporary discussions in tech philosophy, neurology, evolutionary biology, and cognitive sciences in which it is argued that intelligence is dependent on having—and acting through—an organic body. Understanding intelligence as organic thus suggests an oxymoronic relationship to artificial.

The informal sector in Zimbabwe employs more than 80 per cent of the population, whose livelihood strategies are under severe threat because of the COVID‐19 lockdown. This paper examines the effects of the lockdown on the informal sector in Gweru. Anchored within the legalist theory of informality, the paper analyses the response of government to the plight of the informal sector in Zimbabwe. A qualitative research design was applied and convenience sampling implemented to select 30 individuals whose livelihood depended on informal cross‐border trade, informal transport, forex trading, hairdressing, and street vending. Results reveal that despite many involved in the informal sector having lost their means of survival during the COVID‐19 lockdown, the government introduced additional restrictions on this sector, thus almost destroying it. In the absence of government assistance, many have adapted their operations, albeit through illegal activities. The study offers recommendations that may ensure the survival of the informal sector beyond the COVID‐19 pandemic. This is important, given that the informal sector is the largest contributor to household income and food security in Zimbabwe.

The COVID‐19 outbreak has not only affected the physical health of the public but also resulted in severe psychological outcomes. This study aims to investigate the psychological effects of the COVID‐19 outbreak on Pakistan's general public. In order to identify the main psychological factors that have emerged due to the current pandemic, extensive literature and opinion pieces of psychologists were reviewed. After a thorough study of the existing scholarship, four main psychological factors were investigated: stress and anxiety, obsessive compulsive disorder (OCD), delusions of getting infected from the disease, and religiosity. A research survey was circulated among the sample population online. A total 356 valid responses were received in the period of two to three weeks. Findings showed that the respondents reported a moderate level of anxiety, occasional symptoms of OCD, and delusions. However, respondents showed a high inclination toward religion during the current pandemic situation. Furthermore, respondents highlighted a few other psychological factors, such as financial strain and loneliness, in the survey. The primary sources of COVID‐19‐related information were social media and television among the general public of Pakistan. Finally, guidelines and tips from the reviewed psychologists and psychiatrists on overcoming the highlighted psychological problems that have arisen due to the COVID‐19 outbreak were summarised.

Over the last decade, humans have produced each year as much data as were produced throughout the entire history of humankind. These data, in quantities that exceed current analytical capabilities, have been described as “the new oil,” an incomparable source of value. This is true for healthcare, as well. Conducting analyses of large, diverse, medical datasets promises the detection of previously unnoticed clinical correlations and new diagnostic or even therapeutic possibilities. However, using Big Data poses several problems, especially in terms of representing the uniqueness of each patient and expressing the differences between individuals, primarily gender and sex differences. The first two sections of the paper provide a definition of “Big Data” and illustrate the uses of Big Data in medicine. Subsequently, the paper explores the struggle to represent exhaustively the uniqueness of the patient through Big Data is highlighted prior to a deeper investigation of the digital representation of gender in personalized medicine. The final part of the paper put forward a series of recommendations for better approaching the complexity of gender in medical and clinical research involving Big Data for the creation or enhancement of personalized medicine services. Supplementary Information The online version contains supplementary material available at 10.1007/s00146-021-01234-9.

Working women face various challenges regarding work‐family balance due to societal, cultural, family, and gender norms These challenges have become more difficult since the emergence of COVID‐19 worldwide This qualitative research addresses work‐family issues of working women in the distinct Bangladeshi socio‐cultural context Guided by a thematic analysis, this study explores various driving forces and challenges faced by working women, and strategies adopted by women to manage work‐family obligations The findings reveal flexibility and homeworking, family and spousal support, and organisational support as key driving forces for women's work‐life balance during the COVID‐19 Lack of available time, socio‐cultural and family norms, and gender stereotypes are key challenges women face in a Muslim patriarchal societal context Effective time management, stress management, keeping husbands and family members happy, sustainable management of professional and personal lives, and listing out priorities are useful techniques women adopt to integrate work‐family commitments The findings provide potential solutions for women to effectively manage work‐family responsibilities in a patriarchal societal context [ABSTRACT FROM AUTHOR] Copyright of International Social Science Journal is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

This paper addresses three aspects of Bio Art: iconography, artificial life, and wetware. The development of models for innovation require hybrid practices which generate knowledge through epistemic experimental practices. The intersection of art and the biological sciences contain both scientific data as well as the visualization of its cultural imagination. In the Bio Art Lab at the School of Visual Arts, artists use the tools of science to make art.

When the city of Wuhan was severely locked down on January 23, 2020 for 76 days due to the coronavirus outbreak, many residents started writing "lockdown diaries." This article argues these diaries constitute a kind of performance art for their authors, specifically, an 'art of endurance' as described by Shalson (2018). Keeping a diary requires a plan, but the following through of the plan is a contingent process requiring efforts and endurance. The challenges become particularly daunting for authors of online diaries in pandemic times. The article analyzes multiple types of endurance associated with the Wuhan lockdown diarists, showing that in digitally-driven environments, where potential collective responses are a key context, the lockdown diaries of Wuhan, like works of endurance art, engage with meanings that reach far beyond their original experience and context. Their stories of endurance are an allegory of the endurance of the entire city of Wuhan.

We discuss the effectiveness of mediated communication (internet communication via a computer tablet) and tacit engagement in a Project on mental health. The project is aimed at improving the wellbeing of adult women living with chronic mental disorders in long-term psychiatric internment. The computer tablets act as "portals" to provide access and conatct with the outside world for patients who have poor (if any) external social support. This support includes a patient-centred psycho-social care, and accompanying clinical and pharmaceutical treatment. Both patients and their relatives accepted the benefits of internet mediation, for very different reasons. For the patient, this is a flash of contact with humanity, and for the relatives the internet communication this proved to be an alternative to the need for physical proximity. As some patients had no relatives or friends to communicate (even remotely) with the outside world, and because there is a school next door to the clinic, we visualized that the communication between these two communities could provide both a therapeutic and poetic act of learning and compassion. The electronic portal could serve as a virtual bridge between two forbidden domains. Although awareness of students of the nearby school was raised about mental health, the use of internet mediation devoid of physical proximity made the students suspicious of the goal of the mediation. From the patient's side, however, each contact was an instance of joy. Several issues were raised from this exercise.

This addendum expands upon the arguments made in the author's 2020 essay, "Legal Personhood for Artificial Intelligence: Citizenship as the Exception to the Rule", in an effort to display the significance human augmentation technologies will have on (feasibly) inadvertently providing legal protections to artificial intelligence systems (AIS)-a topic only briefly addressed in that work. It will also further discuss the impacts popular media have on imprinting notions of computerised behaviour and its subsequent consequences on the attribution of legal protections to AIS and on speculative technological advancement that would aid the sophistication of AIS.

Any first step in organisational adaptation starts with individuals' responses and willingness (or otherwise) to change an aspect of themselves given the transcontextual settings in which they are operating (Bateson in Small arcs of larger circles: framing through other patterns, Triarchy Press, Axminster, 2018). This research explores the implications for organisational adaptation strategies when Artificial Intelligence (AI) is being embedded into the ecology of the organisation, and when employees have a dominant fixed or growth mindset (Dweck in Mindset: changing the way you think to fulfil your potential. Robinson, London, 2017). Research participants were supplied with a single scenario based in 2030, where-as a result of Artificial Intelligence technology implementation-employees were going to be displaced. Using Torbert's (Organizational wisdom and executive courage, New Lexington Press, San Francisco, 1998) 'first, second and third person' research theory, participants were asked to independently review their thoughts, sense, and image of the future from a fixed mindset position (considered to be the worst case), then from a growth mindset perspective (best case), and then do the same collectively. Five key findings are outlined which support the principle that having a growth mindset is a key component of adaptive capacity and futures literacy. The five key findings conclude that AI adaptation processes need to include compassion and authenticity, embodiment, fundamental needs and motivations, mutual learning and considering what lies beyond the edges of the organisation (Bateson in Small arcs of larger circles: framing through other patterns, Triarchy Press, Axminster, 2018).

This paper investigates if and to what point it is possible to trade on news sentiment and if deep learning (DL), given the current hype on the topic, would be a good tool to do so. DL is built explicitly for dealing with significant amounts of data and performing complex tasks where automatic learning is a necessity. Thanks to its promise to detect complex patterns in a dataset, it may be appealing to those investors that are looking to improve their trading process. Moreover, DL and specifically LSTM seem a good pick from a linguistic perspective too, given its ability to “remember” previous words in a sentence. After having explained how DL models are built, we will use this tool for forecasting the market sentiment using news headlines. The prediction is based on the Dow Jones industrial average by analyzing 25 daily news headlines available between 2008 and 2016, which will then be extended up to 2020. The result will be the indicator used for developing an algorithmic trading strategy. The analysis will be performed on two specific cases that will be pursued over five time-steps and the testing will be developed in real-world scenarios.

This article conducts a literature review of current and future challenges in the use of artificial intelligence (AI) in cyber physical systems. The literature review is focused on identifying a conceptual framework for increasing resilience with AI through automation supporting both, a technical and human level. The methodology applied resembled a literature review and taxonomic analysis of complex internet of things (IoT) interconnected and coupled cyber physical systems. There is an increased attention on propositions on models, infrastructures and frameworks of IoT in both academic and technical papers. These reports and publications frequently represent a juxtaposition of other related systems and technologies (e.g. Industrial Internet of Things, Cyber Physical Systems, Industry 4.0 etc.). We review academic and industry papers published between 2010 and 2020. The results determine a new hierarchical cascading conceptual framework for analysing the evolution of AI decision-making in cyber physical systems. We argue that such evolution is inevitable and autonomous because of the increased integration of connected devices (IoT) in cyber physical systems. To support this argument, taxonomic methodology is adapted and applied for transparency and justifications of concepts selection decisions through building summary maps that are applied for designing the hierarchical cascading conceptual framework.

Artificial intelligence plays an important role and has been used by several countries as a health strategy in an attempt to understand, control and find a cure for the disease caused by Coronavirus. These intelligent systems can assist in accelerating the process of developing antivirals for Coronavirus and in predicting new variants of this virus. For this reason, much research on COVID-19 has been developed with the aim of contributing to new discoveries about the Coronavirus. However, there are some epistemological aspects about the use of AI in this pandemic period of Covid-19 that deserve to be discussed and need reflections. In this scenario, this article presents a reflection on the two epistemological aspects faced by the COVID-19 pandemic: (1) The epistemological aspect resulting from the use of patient data to fill the knowledge base of intelligent systems; (2) the epistemological problem arising from the dependence of health professionals on the results/diagnoses issued by intelligent systems. In addition, we present some epistemological challenges to be implemented in a pandemic period.

Serological tests based on the enzyme immunoassay (EIA) are the primary tool for the diagnosis of human immunodeficiency virus (HIV) in adults and have rapidly evolved to quicker, affordable and more accurate test formats to detect early HIV infection. Second- and third-generation HIV rapid tests detect the immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies to the HIV and are used at the point of care and in HIV self-testing. The tests are affordable and accessible in state and private diagnostic laboratories. The present-day fourth- and fifth-generation EIAs can detect both p24 antigen and IgG and IgM HIV antibodies and thereby diagnose early HIV infection at approximately 2 weeks. The fourth- and fifth-generation EIAs also report sensitivity and specificity of more than 99%. The correct interpretation of HIV diagnosis of false-positive and false-negative EIA test results requires collaborative scrutiny of patient factors and laboratory test methodologies.

Leprosy (Hansen’s disease) can affect multiple organs and body structures. Skin signs are typically observed in the early phase of the disease, hence being the first identifiable signs to propel clinical suspicion. Leprosy predominantly affects the skin and peripheral nerves. The disease has been documented many centuries preceding the biblical era. Over many decades, the classification of Hansen’s disease has changed as modern medical science evolved. Patients with leprosy are usually subjected to discrimination, rejection from society and can suffer from social stigma, poor quality of life (QoL), low self-esteem and permanent disfigurements. Studies have shown that leprosy has a significant negative impact on the patients’ QoL. Leprosy is often not suspected by practicing clinicians because it is no longer emphasised in the medical curricula. In modern years, attention has gradually shifted from leprosy to tuberculosis (TB) and human immunodeficiency virus (HIV).

Historically, vaccine hesitancy (VH) has been a thorn in the side of public health efforts to contain and eradicate infectious diseases. This phenomenon is magnified in light of the current coronavirus disease 2019 (COVID-19) pandemic. Surveys conducted across South Africa since the outbreak of COVID-19 demonstrate the complexity of factors that contribute towards VH in this population. Amidst the negative press that the COVID-19 vaccine has received, especially across social media, understanding and combatting VH remains important to achieve herd immunity. This article aims to shed light on key factors fuelling COVID-19 VH in South Africa and provides a framework from which to address this problem.

People with disabilities, especially those living in low- and middle-income countries, experience significant challenges in accessing healthcare services and support. At times of disasters and emergencies, people with disabilities are further marginalised and excluded. During the coronavirus disease 2019 (COVID-19) pandemic, many people with disabilities are unable to access healthcare facilities, receive therapeutic interventions or rehabilitation, or gain access to medication. Of those who are able to access facilities, many experience challenges, and at times direct discrimination, accessing life-saving treatment such as intensive care unit admission and ventilator support. In addition, research has shown that people with disabilities are at higher risk of contracting the virus because of factors that include the need for interpersonal caregivers and living in residential facilities. We explore some of the challenges that people with disabilities residing in South Africa currently experience in relation to accessing healthcare facilities.

Most cases of hypertension are because of essential hypertension, however 5% - 15% of cases can be a result of a secondary cause. In this article, we focus on the endocrine causes of secondary hypertension with a particular focus on pheochromocytomas (PCCs) and paragangliomas (PGLs). Around 15 endocrine disorders can initially present with hypertension. Amongst those PCCs and PGLs are rare but potentially life-threatening causes. An early diagnosis and timely referral can be life-saving. Herein, we present an approach for screening and diagnosis of these patients and focus on the importance of genetic testing.

Scabies is a parasitic infestation of the skin caused by the mite Sarcoptes scabiei var. hominis . It is common in tropical areas, including the sub-tropical areas of Southern Africa. Predisposing factors are overcrowding, poor personal hygiene, low socio-economic standards and impaired host immunity. Although it can occur at any age, scabies is commonly seen in children and young adults. It is not a fatal disease; however, it can cause severe morbidity and poor quality of life. Scabies can complicate with pyoderma which may result in post-streptococcal glomerulonephritis. There are two clinical variants, classic scabies and the much rarer crusted scabies (Norwegian scabies).

The use of hand sanitisers is common practice to prevent the spread of coronavirus disease 2019 (COVID-19). However, the safety thereof requires consideration as this may be hazardous in children. Recent studies have shown that the misuse and increased unsupervised availability of alcohol-based hand sanitisers may result in adverse events in children such as skin irritation, dryness, cracking and peeling. Unintentional or intentional ingestion of hand sanitisers in children under the age of 12 years may occur because of the colour, smell and flavour added to it. Consumption of alcohol in children may result in hypoglycaemia, apnoea and acidosis. This allows the invasion of other bacterial and viral infections. Children may also rub their eyes with sanitised hands and cause ocular injury. Therefore, the use of hand sanitisers in general needs to be revised in both children and adults. Other interventions on lowering the risk of adverse events because of misuse of hand sanitiser should be practised more often. These include promoting washing of hands over sanitisers where possible, training children on how to use hand sanitisers and creating awareness of the dangers if ingested or in contact with the eyes.

In the wake of the coronavirus disease 2019 (COVID-19) pandemic, the links between poor hygiene, unclean environments and human health cannot be overemphasised, particularly in South Africa with its high incidence of infectious diseases and overburdened health system. One very controllable factor that is often overlooked is the poor disposal of litter and waste management and its adverse effects on public health. By wearing masks, regular handwashing and sanitising, as well as making sure that neighbourhoods and public spaces are clean and safe, the spread of COVID-19 and other diseases can be prevented.

Clinicians notify positive results of the severe acute respiratory syndrome coronavirus-2 polymerase chain reaction to patients and/or relatives, whilst short message service (SMS) has been adopted as a means of disseminating negative results. Therefore, clinicians should be adequately equipped to provide telephonic consultation whilst delivering a positive test result to patients. The news of the coronavirus disease 2019 (COVID-19) test result often invokes fear of impending death in patients, especially the elderlies and those with comorbidities. In addition, several survivors have reported persistent symptoms and COVID-19-related stigma, which precludes them from immediate re-integration into their workplaces. Consequently, COVID-19 results are perceived as bad news by the members of the public. This article justifies why COVID-19 test results are bad news and also discusses the notification steps to follow when delivering COVID-19 results, whilst also addressing patients' immediate concerns. The article concludes by highlighting an important safety net for COVID-19 patients and the attending clinician.

The article examines the problem of ensuring the political stability of a democratic social system with a shortage of a vital commodity (like vaccine against COVID-19). In such a system, members of society citizens assess the authorities. Thus, actions by the authorities to increase the supply of this commodity can contribute to citizens' approval and hence political stability. However, this supply is influenced by random factors, the actions of competitors, etc. Therefore, citizens do not have sufficient information about all the possibilities of supplying, and it is difficult for them to make the right decisions. Such citizen unawareness can be exploited by unscrupulous politicians to achieve personal targets. Therefore, it is necessary to organize public control to motivate politicians to use all available opportunities in supplying. The goal of the paper is to build such a digital mechanism of public control of the politicians by citizens, which would best assess and stimulate the activities of the authorities to improve the supply of a vital commodity. In the age of artificial intelligence, such digital public control in the face of uncertainty can be based on digital machine learning. In addition, it is necessary to take into account and model the activities of politicians associated with the presence of their own targets that do not coincide with public ones. Such politicians can use the learning of citizens for their own targets. The objective of the article is to build an optimal digital mechanism of public control in a two-level model of a democratic social system-a digital society. At its top level, there is the Citizen, who gives an assessment for the Politico located at the lower level. In turn, the Politico can influence the supplying of a vital commodity. Political stability is guaranteed if the Citizen regularly approves of the Politico's actions to increase this supply. However, the Politico may not use the opportunities available to him to offer a commodity to achieve a personal target. To avoid this, the Politico's control mechanism is proposed. It includes the procedure for digital learning of the Citizen, as well as a procedure for assessing the Politico activity. Sufficient conditions have been found for the synthesis of such the Politico's control mechanism, at which stochastic possibilities of increasing the supply of a vital commodity are used. The example of such the Politico's control mechanism is considered on the case of supply of the COVID-19 vaccine in England.

In this paper, we discuss several problems with current Big data practices which, we claim, seriously erode the role of informed consent as it pertains to the use of personal information. To illustrate these problems, we consider how the notion of informed consent has been understood and operationalised in the ethical regulation of biomedical research (and medical practices, more broadly) and compare this with current Big data practices. We do so by first discussing three types of problems that can impede informed consent with respect to Big data use. First, we discuss the transparency (or explanation) problem. Second, we discuss the re-repurposed data problem. Third, we discuss the meaningful alternatives problem. In the final section of the paper, we suggest some solutions to these problems. In particular, we propose that the use of personal data for commercial and administrative objectives could be subject to a ‘soft governance’ ethical regulation, akin to the way that all projects involving human participants (e.g., social science projects, human medical data and tissue use) are regulated in Australia through the Human Research Ethics Committees (HRECs). We also consider alternatives to the standard consent forms, and privacy policies, that could make use of some of the latest research focussed on the usability of pictorial legal contracts.

The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on elderly patients, and thus, adequate treatment plans are essential. This qualitative report provides recommendations for the supportive care and treatment of residents in long-term care facilities (LTCF) with COVID-19. A treatment protocol was developed in response to an outbreak of COVID-19 in an LTCF based in Johannesburg and was implemented over a 3-month period.

In this article, we analyse the role that artificial intelligence (AI) could play, and is playing, to combat global climate change. We identify two crucial opportunities that AI offers in this domain: it can help improve and expand current understanding of climate change, and it can contribute to combatting the climate crisis effectively. However, the development of AI also raises two sets of problems when considering climate change: the possible exacerbation of social and ethical challenges already associated with AI, and the contribution to climate change of the greenhouse gases emitted by training data and computation-intensive AI systems. We assess the carbon footprint of AI research, and the factors that influence AI’s greenhouse gas (GHG) emissions in this domain. We find that the carbon footprint of AI research may be significant and highlight the need for more evidence concerning the trade-off between the GHG emissions generated by AI research and the energy and resource efficiency gains that AI can offer. In light of our analysis, we argue that leveraging the opportunities offered by AI for global climate change whilst limiting its risks is a gambit which requires responsive, evidence-based, and effective governance to become a winning strategy. We conclude by identifying the European Union as being especially well-placed to play a leading role in this policy response and provide 13 recommendations that are designed to identify and harness the opportunities of AI for combatting climate change, while reducing its impact on the environment.

The essential medicines concept is recognised as an instrument to improve medicines access and to promote cost-effective use of health resources. outh Africa adopted the concept and implemented the Standard Treatment Guidelines and Essential Medicines List (STGs/EML) in 996 when the National Drug Policy for South Africa was launched. The STGs/EML was meant to address the inequities in medicines access and use and to ensure a standard of care to all citizens, yet these inequities still exist. The implementation of the new National Health Insurance (NHI) scheme is envisaged to relieve this healthcare inequity. The STGs/EML still forms the basis of care in the public sector, but a critique of implementing this tool and lessons that can be applied from this implementation for NHI are lacking. This piece addresses these shortfalls and highlights questions surrounding the implementation of the STGs/EML.

The coronavirus disease 2019 (COVID-19) pandemic has changed the world as we knew it, and medical education is not an exception. Walter Sisulu University (WSU) has a distributed model of clinical training for the Bachelor of Medicine and Bachelor of Surgery (MBChB) programme. To address the challenges occasioned by the pandemic, the Department of Family Medicine and Rural Health undertook a modification of its MBChB VI programme. The changes aim to ensure the protection of all stakeholders and maintain the integrity of the programme, including the assessment. Changes were made in the delivery of the programme and in the way people interact with one another. Continuous assessment was modified, and the oral portfolio examination was introduced as the summative assessment tool. Although COVID-19 threatened the traditional way of teaching and learning, it however provided us with the opportunity to refocus and reposition our undergraduate medical programme.

International and national guidelines on chronic obstructive pulmonary disease (COPD) emphasise bronchodilators as first-line therapy. However, in considering them the ‘foundation’ of treatment, attention has shifted from the fact that COPD is fundamentally an inflammatory disease. The mainstay ought to be anti-inflammatory medication, and inhaled corticosteroids (ICS) are the best agents we have presently. There was initial scepticism about their role, but ICS were subsequently shown to have numerous anti-inflammatory effects. They are synergistic with bronchodilators at a molecular and clinical level and unequivocally improve dyspnoea, quality of life, exacerbation frequency and, more recently, mortality. These benefits are most apparent in the COPD eosinophilic phenotype. These beneficial effects have been met with some reservations because of the predisposition to pneumonia of ICS. This must be seen in context: over 90% of COPD patients in all clinical trials do not get pneumonia. The fact that patients with COPD are predisposed to pneumonia because of the disease itself is disregarded; this is a crucial omission as this constitutes the baseline incidence of about 3%. When one allows for this, then in the clinical reports, the excess risk of pneumonia ranges from zero to a maximum of 3%. Equally, some of the systemic effects attributed to ICS fail to appreciate that the disease, smoking and older age are risk factors in themselves, and ICS do not aggravate these. Chronic obstructive pulmonary disease has considerable impact on respiratory reserve and is associated with increasing morbidity; optimal outcomes are best achieved with long-acting bronchodilators and ICS co-prescription.

The book – Connected Lives : Families, households, health and care in South Africa (edited by Nolwazi Mkhwanazi and Lenore Manderson) 1 – is about some of the core business of family medicine. In primary healthcare, and family medicine in particular, the context of the person being treated is central. The evolving understanding of social determinants of health and disease, the linkages between biological illness with social, nutritional, environmental and political context are increasingly important. These shifts require health practitioners to practice differently to how many have been trained traditionally, being challenged to be much more explicit in linking clinical care to the context of the person (‘patient’). Yet, it is this context that clinicians often struggle to understand how the family and households are constituted, how it ‘works’ and what the dynamics are.

Practice-based research networks have been an important strategy in many parts of the world to enable primary care research and involve clinicians. The Stellenbosch University Family Physician Research Network (SUFPREN) was established in 2017 to enable family physicians in clinical practice to engage with practical research that addressed key challenges and enhanced clinical governance. It is a collaboration between academic family physicians at the university and clinical family physicians in the district health services. In this article, the establishment of SUFPREN is described – membership of the network, selection of research questions, roles in the research process, communication and coordination, involvement of the Department of Health, types of questions and methods, data management, dissemination of findings and funding. The initial work of SUFPREN is described and a vision for future family physician research networks in South Africa is defined.

Allergic rhinitis is a common and troubling condition. Basic management of this condition has been well described. However, acute exacerbations of the chronic condition allergic rhinitis are a seldom discussed or described problem despite the fact that even well-controlled patients frequently have exacerbations. This consideration means that a new approach is necessary to define the management of these patients. There are three important events that illustrate the need for a new therapeutic approach:A person who gets a new diagnosis of allergic rhinitis, but has symptoms for many months or yearsA sufferer of allergic rhinitis who is exposed to an environment that triggers an exacerbationA person who has an exacerbation related to another trigger.Recognition of triggers and management strategies to correctly use ‘relief’ therapies such as topical nasal decongestants is the key to successful management. In addition, the use of an ‘action plan’, as for asthma, is useful.

[This is a post-peer-review, pre-copy edit version of an article in AI & Society. The final authenticated version is available online at: http://dx.doi.org/10.1007/s00146-020-01033-8 or https://rdcu.be/b6avX.] Like previous educational technologies, artificial intelligence in education (AIEd) threatens to disrupt the status quo, with proponents highlighting the potential for efficiency and democratization, and skeptics warning of industrialization and alienation. However, unlike frequently discussed applications of AI in autonomous vehicles, military and cybersecurity concerns, and healthcare, AI’s impacts on education policy and practice have not yet captured the public attention. This paper therefore evaluates the status of AIEd, with special attention to intelligent tutoring systems and anthropomorphized artificial educational agents. I discuss AIEd’s purported capacities, including the abilities to simulate teachers, provide robust student differentiation, and even foster socioemotional engagement. Next, in order to situate developmental pathways for AIEd going forward, I contrast sociotechnical possibilities and risks through two idealized futures. Finally, I consider a recent proposal to use peer review as a gatekeeping strategy to prevent harmful research. This proposal serves as a jumping off point for recommendations to AIEd stakeholders towards improving their engagement with socially responsible research and implementation of AI in educational systems.

Severe asthma in South Africa (SA) is underappreciated, especially in the primary care setting. This study highlights the epidemiological context of severe asthma as a phenotypic variant. Primary care practitioners, as first-contact medical providers, need grounding in the management of severe asthma based on the precision of diagnosis and negotiated along the 10-point strategy. The underdiagnosis and undertreatment of asthma ought to inform educational programmes and research in this country.

Road traffic injuries (RTIs) constitute one of the five major disease burdens in South Africa with high mortality and morbidity. Thus far, the scientific enquiry into this burden has not been accompanied by successful government efforts to meet the challenge. Currently, more than 1.2 million people die and 20–50 million are with disabilities annually country-wide from RTIs. While there is a progressive reduction in mortality related to human immunodeficiency virus (HIV) conditions as a result of interventions, the mortality from RTI is seen to be progressively worsening as a result of increasing motorisation. There are disparities in the burden of RTI across different countries, with low- and middle-income countries bearing the highest burden. In Africa, 24.1 per 100 000 people die annually from RTI compared to 10.3 per 100 000 people in European countries. This opinion article investigates the magnitude, trends and prevention of RTI in South Africa.

“My first long haul flight that didn’t fill up and an empty row for me. I have been blessed by the algorithm ”.The phrase ‘blessed by the algorithm’ expresses the feeling of having been fortunate in what appears on your feed on various social media platforms, or in the success or virality of your content as a creator, or in what gig economy jobs you are offered. However, we can also place it within wider public discourse employing theistic conceptions of AI. Building on anthropological fieldwork into the ‘entanglements of AI and Religion’ (Singler 2017a), this article will explore how ‘blessed by the algorithm’ tweets are indicative of the impact of theistic AI narratives: modes of thinking about AI in an implicitly religious way. This thinking also represents continuities that push back against the secularisation thesis and other grand narratives of disenchantment that claim secularity occurs because of technological and intellectual progress. This article will also explore new religious movements, where theistic conceptions of AI entangle technological aspirations with religious ones.

Recognising that mild asthmatics are at risk of exacerbations and mortality, the Global Initiative for Asthma (GINA) issued an updated strategy in 2019. This was premised on two studies culminating in their recommendation that mild asthma should be treated by using a combination of a rapid and long-acting beta 2 agonist and an inhaled corticosteroid (ICS) administered as required. Their rationale is, however, debatable, as the studies actually showed that regular daily ICS administration was more effective for a number of asthma control endpoints. A patient-driven treatment strategy is also questionable, as there are a number of concerns about behaviour of patients suffering from asthma and perception of airway narrowing that should trigger medication intake but in fact does not do so. These deficiencies also influence a similar maintenance and reliever treatment (MART) approach that would be suboptimal. Intermittent ICS regimens are also inferior when compared to regular treatment. Not all asthmatics respond to the same dose of ICS. The best way to manage asthma is by adopting a step-up ICS approach, to encompass varying disease severity, with a long-acting beta agonist taken on a daily basis, ideally in a single combination inhaler.

In South Africa, the national policy on re-engineering primary health care (PHC) supports the implementation of ward-based outreach teams with community health workers. In the Western Cape, a community-orientated primary care (COPC) approach has been adopted in provincial goals for 2030 and the key strategies for the improvement of district health services. This approach is expected to improve health and also save costs. A task team was established in the Metropolitan Health Services to develop an implementation framework for COPC. The framework was developed in an iterative process with four learning sites in the metropole over a period of 18 months. The framework consists of 10 inter-related elements: geographic delineation of PHC teams, composition of PHC teams, facility-based and community-based teamwork, partnership of government and non-government organisations, scope of practice, information system, community engagement, stakeholder engagement, training and development of PHC teams, system preparation and change management. This framework was implemented at the four learning sites and is now being taken to scale and further assessed in the metropole.