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Background & Aims: Autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC) can co-exist in AIH-PBC, requiring combined treatment with immunosuppression and ursodeoxycholic acid (UDCA). The Paris criteria are commonly used to identify these patients; however, the optimal diagnostic criteria are unknown. We aimed to evaluate the use and clinical relevance of both Paris and Zhang criteria. Methods: Eighty-three patients with a clinical suspicion of AIH-PBC who were treated with combination therapy were included. Histology was re-evaluated. Characteristics and long-term outcomes were retrospectively compared to patients with AIH and PBC. Results: Seventeen (24%) patients treated with combination therapy fulfilled the Paris criteria. Fifty-two patients (70%) fulfilled the Zhang criteria. Patients who met Paris and Zhang criteria more often had inflammation and fibrosis on histology compared to patients only meeting the Zhang criteria. Ten-year liver transplant (LT)-free survival was 87.3% (95% CI 78.9–95.7%) in patients with AIH-PBC. This did not differ in patients in or outside the Paris or Zhang criteria (p = 0.46 and p = 0.40, respectively) or from AIH (p = 0.086). LT-free survival was significantly lower in patients with PBC and severe hepatic inflammation – not receiving immunosuppression – compared to those with AIH-PBC (65%; 95% CI 52.2–77.8% vs. 87%; 95% CI 83.2–90.8%; hazard ratio 0.52; p = 0.043). Conclusions: In this study, patients with AIH-PBC outside Paris or Zhang criteria were frequently labeled as having AIH-PBC and were successfully treated with combination therapy with similar outcomes. LT-free survival was worse in patients with PBC and hepatic inflammation than in those treated as having AIH-PBC. More patients may benefit from combination therapy. Impact and implications: This study demonstrated that patients with AIH-PBC variant syndrome treated with combined therapy consisting of immunosuppressants and ursodeoxycholic acid often do not fulfill the Paris criteria. They do however have comparable response to therapy and long-term outcomes as patients who do fulfill the diagnostic criteria. Additionally, patients with PBC and additional signs of hepatic inflammation have poorer long-term outcomes compared to patients treated as having AIH-PBC. These results implicate that a larger group of patients with features of both AIH and PBC may benefit from combined treatment. With our results, we call for improved consensus among experts in the field on the diagnosis and management of AIH-PBC variant syndrome.

The global Covid-19 pandemic exposed the fragility of urban systems and underscored the need to recalibrate regulatory and institutional frameworks for an anticipated crisis-prone future. This article explores the notion of ‘adaptive law and governance’ as a lens through which city authorities can test and modify legal and governance responses to future urban crises. It compares the experiences of managing Covid-19 in the two biggest cities in the Netherlands (Amsterdam and Rotterdam) and in South Africa (Johannesburg and Cape Town). This comparison, between two sets of urban municipal governments functioning under different constitutional systems and in different socio-economic contexts, provides insights pertaining to how adaptive urban governance during the pandemic was constrained or enabled by the interaction between the regulatory and institutional frameworks for and political realities of urban autonomy and intergovernmental relations. The article demonstrates that cities that govern within a flexible and decentralised legal and governance system are better positioned to develop and implement responsive measures to address crises or uncertainty. To enhance resilience, legal systems should promote transparent, risk-responsive, and reflective local governance tools to enable agile, context- specific and decisive crisis responses that can be employed as a matter of course rather than exception.

Few developing countries participate in external educational evaluations. Information gaps on education quality make it imperative to expand such evaluations. Furthermore, international comparability across different evaluations should be improved. In addition, data from evaluations must be combined with data on access or coverage. Finally, educational evaluations reveal social inequalities; socioeconomic status has a systematic influence on educational outcomes, but social gradients vary over countries. Resources alone cannot explain massive performance gaps between developing and developed countries. Large efficiency improvements must occur in classrooms and schools. The need is not for "league tables," but for data that allow countries to judge the appropriateness of their policies and strategies in an international context. Efficient and targeted application of resources and policies to improve education in developing countries requires information on system performance, inequalities, progress and stagnation. International evaluations should be expanded to more countries, should be better anchored and comparable, and should be demystified. Too little international educational evaluation is the enemy of progress.

This paper describes a process to develop and trial new metrics in South Africa to quantify school leadership and management practices or processes that are considered theoretically related to literacy outcomes. The predictive validity of these measures is assessed in challenging contexts, including 60 township and rural primary schools in South Africa. We observe a randomness to how better leadership and management practices are distributed across better and worse performing schools. Regression analyses confirm weak and inconsistent linkages between measured leadership and management dimensions and literacy outcomes across the sample. However, we find evidence of stronger linkages with intermediate outcomes, including monitoring curriculum coverage. This research contributes to a burgeoning, yet underdeveloped literature on educational management and leadership in Africa and the challenges of measurement in this context.

This study analyses information and feedback from matriculation-level continuous assessment in the South African education system in 2005. Continuous assessment (CASS) at the time carried a 25% weight in the final matriculation (Grade 12) mark, and it provided feedback that affected examination preparation and effort. Weak assessment in schools sends wrong signals to learners, which may have important consequences for the way in which they approach the final examination. Moreover, similarly wrong signals earlier in the learners' school careers may also have affected their subject choice and career planning. This study compares CASS data to the externally assessed matric exam marks for a number of subjects. There are two signalling dimensions to inaccurate assessments: (i) inflated CASS marks can give learners a false sense of security and lead to diminished exam effort; and (ii) a weak correlation between CASS and exam marks could mean poor signalling in another dimension: relatively good learners may get relatively low CASS marks. Such low correlations indicate poor assessment reliability, as the examination and continuous assessment should both be testing mastery of the same national curriculum. The paper analyses the prevalence and magnitude of each of these dimensions of weak signalling in South African schools and draws disturbing conclusions for a large part of the school system.

Much hope is placed on education systems to reduce socio-economic learning gaps. However, in South Africa, uneven functioning of the school system widens learning gaps. This paper analyses education performance using ANA data. Weak calibration and inter-temporal or inter-grade comparability of ANA test scores limit their usefulness for measuring learning gains. However, relative performance provides meaningful information on learning gaps and deficits. A reference group that is roughly on track to achieve the TIMSS average is used to estimate the performance required in each grade to perform at TIMSS' low international benchmark. By Grade 4, patterns across quintiles of on-track performance approximate matric exemption patterns. Viewed differently, academic and labour market prospects may be bleak for children who are no longer on track. Improvement in outcomes requires greater emphasis on the Foundation Phase or earlier, before learning deficits have grown to the extreme levels observed by the middle of primary school. This statement is true whether deficits arise from weak early instruction, or simply because a disadvantaged home environment requires early remedial action. The emphasis on the early grades that this analysis of the ANAs suggests is contrary to the conclusions drawn from the ANA results by policy makers that weak test scores in Mathematics in Grade 9 require major interventions in that grade.

The relationship between khôra and mysticism in M.M Walter’s poem ‘Die groot stilte’. In view of M.M. Walters’ recent death (28 Julie 2020), it is timeous to pay homage to him by focusing on a lesser-known aspect of his poetry, namely mysticism. This article aims to demonstrate the relationship between the mysterious and enigmatic Platonic concept khôra and mysticism, and to subsequently indicate how this is expressed in the poem ‘Die groot stilte’ (in the volume Sprekende van God). Walters (1929–2020) was mainly a satirist, but also a poet of religious verse. However, he differentiated himself as an unconventional religious poet and alternative seeker of God. He opposed church dogma and believed that Christ should be sought in ways that go beyond simply accepting the church’s teachings. The article opens with a brief survey of the mystical tradition in Afrikaans poetry, after which the poetry of Walters is briefly described. Subsequently, the reception of his anthology Sprekende van God is discussed. After an introductory discussion of the khôra concept, his poem Die groot stilte is analysed in detail, and the relationship between khôra and mysticism explained. Pieter G.R. de Villiers (2020) maintains that Walters created striking poems with mystical content, and that he was often misunderstood by the clergy and orthodox believers as an enemy of religion and the church. Countering this, De Villiers observes that Walters was driven to seek a genuine, credible spirituality. De Villiers finds it unfortunate that this aspect of Walters’ poetry is not sufficiently recognised. Contribution: Based on the analysis and interpretation of ‘Die groot stilte’, the conclusion is reached that Walters can indeed be described as a mystical poet and that his mystical poetry can be regarded as part of the relatively small yield in mystical Afrikaans literature. This article adds to the equally small corpus of academic literature on mysticism in Afrikaans.

Author(s): Constantinos Kurt Wibmer [sup.1] , Frances Ayres [sup.1] , Tandile Hermanus [sup.1] , Mashudu Madzivhandila [sup.1] , Prudence Kgagudi [sup.1] , Brent Oosthuysen [sup.1] , Bronwen E. Lambson [sup.1] [...], SARS-CoV-2 501Y.V2 (B.1.351), a novel lineage of coronavirus causing COVID-19, contains substitutions in two immunodominant domains of the spike protein. Here, we show that pseudovirus expressing 501Y.V2 spike protein completely escapes three classes of therapeutically relevant antibodies. This pseudovirus also exhibits substantial to complete escape from neutralization, but not binding, by convalescent plasma. These data highlight the prospect of reinfection with antigenically distinct variants and foreshadows reduced efficacy of spike-based vaccines. Substitutions in SARS-CoV-2 spike protein present in the B.1.351 variant first detected in South Africa, when expressed in pseudoviruses, mediate escape from neutralization by monoclonal antibodies under clinical development and by plasma from individuals previously infected with SARS-CoV-2, but do not prevent binding of convalescent plasma to recombinant spike protein containing B.1.351 lineage substitutions.

In this paper we describe the historical background and contents of the DUMIRA vegetation plot database (GIVD-code EU-NL-003). It contains 13,046 relevés, collected between 1995 and 2018 at military ranges in the Netherlands, and it is updated regularly with new data. Historical circumstances led to the placement of military ranges at the most nutrient poor, dry, sandy soils, and as a result, the database is built up mainly by plots of Calluno-Ulicetea and Nardetea heathlands, Koelerio-Corynephoretea grasslands, and Quercetea robori-petraeae woodlands. These classes account for more than 50% of the database. Coastal communities (e.g. from the Juncetea maritimae and the Therosalicornietea) and scrubs (e.g. the Lonicero-Rubetea plicati and Salicetea arenariae) are other important sources. Notably, throughout the database, Rubus species are identified to species level. Although the DUMIRA database was initially used for management related vegetation mapping projects, the data gave rise to several more scientific studies and papers. Taxonomic reference: Van der Meijden (2005) for vascular plants; Van de Beek et al. (2014) for Rubus; Kleukers et al. (2004) for Orthoptera. Syntaxonomic reference: Mucina et al. (2016). Abbreviations: DUMIRA = Vegetation plot database of Dutch Military Ranges; GIVD = Global Index of Vegetation-plot Databases; MoD = Ministry of Defence.

Genetic modification techniques, in particular novel gene editing technologies, hold the yet unfulfilled promise of altering genetic traits in farm animals more efficiently than by crossbreeding, allowing for a more rapid development of new cattle breeds with distinct traits. Gene editing technologies allow for the directed alteration of specific traits and thereby have the potential to enhance, for instance, disease resilience, production yield and the production of desired substances in milk. The potential implications of these technological advancements, which are often combined with animal cloning methods, are discussed both for animal health and for consumer safety, also with consideration of available methods for the detection and identification of the related products in the food supply chain. Finally, an overview is provided of current regulatory approaches in the European Union (EU) and major countries exporting beef to the EU, for products from animals bred through established practices as well as modern biotechnologies.