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While the COVID-19 pandemic disrupted education across the globe, special needs schools in middle- and low-income countries were particularly affected. Learners in these contexts often did not have access to assistive technologies and individualised adaptations of materials in their home environment. This study aimed to explore the experiences of special needs educators regarding how lockdown restrictions had impacted their educational practices. In-depth, semistructured interviews were conducted with 12 special needs educators across the Gauteng and Western Cape provinces of South Africa and were analysed through the lens of interpretive phenomenological analysis. Three themes emerged from the interviews. First, the teachers discussed the ways in which they ensured that the curriculum continued during the period of hard lockdown. Second, they discussed the challenges of remote teaching, and lastly, they addressed the challenges when the learners returned to face-to-face learning. These themes shed light on the teachers' flexibility, creativity and ability to improvise within uncertain, unpredictable and unfamiliar educational terrains. We draw the conclusion that it was largely due to positive teacher-learner relationships and the commitment by teachers that improvisation and creativity were possible and effective.

Could a transformative, inclusive and emancipatory educational framework like the Universal Design for Learning (UDL) advance academic success for all? Could racism and dis/ableism be dismantled through such an emerging educational trend that offers a redefinition of dis/ability abolishing oppressive pedagogical practices that perpetuate constructed views of special needs, often negatively correlated with racial and intellectual superiority? Could such a framework that foregrounds physical, cognitive and linguistic injustices advance achievement beyond merely meeting academic literacy standards within higher education settings like writing centres in a post-COVID 21st-century South Africa? These critical questions are some of the tensions raised in this paper proposing a compelling, yet controversial attempt at advancing student learning and achievement within an expanded definition of disability offered by the UDL framework developed by Rose and Meyer at the Center for Applied Special Technology at Harvard University. While COVID-19 centred around a pandemic, this global catastrophe accelerated the technological thrust into virtual and blended learning mediums of learning and engagement. Yet, given the technological explosion of the mid- and late 20th century, in many ways education have headed towards this direction. Now more than ever, the awareness of the Universal Design for Learning within the role of the writing centre and academic literacy is especially critical, given the drive for technologically driven approaches to address issues of social justice. This paper seeks to understand the obstacles and opportunities of the UDL framework within the role of writing centres in post-COVID 21st-century South African higher education. Through professional insights as a qualified practising writing consultant both locally in South Africa and in the United States, this reflective critique on the emerging vociferous dialogue around the adoption of the Universal Design for Learning framework at higher education institutions in South Africa, and its implications for the role of the writing centre, are based on this author's pragmatic, commonplace experiences as well as research studies conducted on UDL and the Harvard Review. It is hoped that this reflective paper may make visible some of the inherent juxtapositions Universal Design for Learning may hold for meeting individual students' learning needs principled on its universal approach to learning success for all, affording opportunities for further research and critique.

In rural contexts, schools experience many challenges such as lack of electricity, unstable WIFI, not enough classrooms and inadequate classroom technology. These challenges resulted in many teachers shying away from the use of technology in the classrooms. As with other subject fields, IsiNdebele language teachers want to prepare their learners for new careers and make their lessons interesting. However, they encounter challenges integrating e-learning tools in their lessons. A qualitative case study was conducted to understand the rural contextual perspective obtained through exploring the experiences of the researcher, four observers, and a class group of 20 learners. Data were collected using a document analysis protocol, learners' written questionnaire, observers' interview protocol, and a teacher's reflective journal. The Substitution, Augmentation, Modification, and Redefinition (SAMR) model was used as a frame of reference to integrate technology at various stages to enhance the quality of teaching and learning the IsiNdebele language in the rural context. In preparation for this study, six e-learning tools were found suitable for integration in teaching and learning, as well as enhancing classroom dynamics in the rural context. The data were analysed using content analysis. From this study, we suggest that rural IsiNdebele teachers should consider using e-learning tools daily, to ensure skills development and provide learners with real-world learning opportunities. Furthermore we recommend that similar research be conducted in different rural settings, using different official African languages to find more e-learning tools that can be used in rural contexts.

Abstract Background Children born to women with HIV but who do not become HIV infected experience increased morbidity and mortality compared with children born to women without HIV. The basis of this increased vulnerability is unknown. The microbiome, specifically the infant gut microbiome, likely plays an important role in infant immune development. The human milk microbiome is thought to have an important role in the development of the infant gut and therefore, if perturbed, may contribute to this increased vulnerability. We investigated the effects of HIV and its therapies on the milk microbiome and possible changes in the milk microbiome before or after infant HIV infection. Results Seven-hundred fifty-six human milk samples were selected from three separate studies conducted over a 15-year period to investigate the role of HIV and its therapies on the human milk microbiome. Our data reveal that the milk microbiome is modulated by parity (R 2 = 0.006, p = 0.041), region/country (R 2 = 0.014, p = 0.007), and duration of lactation (R 2 = 0.027–0.038, all p

Abstract Background Universal antiretroviral treatment (ART) for pregnant women has reduced mother-to-child transmission risk significantly. However, not all women on ART are virally suppressed during pregnancy and lactation. In addition to poor adherence to ART, co-infections particularly other sexually transmitted infections (STIs) are known to increase the risk of HIV acquisition and HIV transmission. While the prevalence of STIs during pregnancy has been well studied, the prevalence of STIs in the postpartum period and its association with HIV viral suppression are underreported. Methods In this cross-sectional study, we determined the prevalence of STIs among adolescent girls and young women (AGYW) living with HIV (WLHIV) and without HIV (WNLHIV) at their 6–14 week postnatal clinic visit in a high HIV prevalence district in South Africa. All women were examined for STI-related symptoms and had vaginal swabs collected and stored for later STI testing. Vaginal swabs were tested for Trichomonas vaginalis (T.vaginalis), Chlamydia trachomatis (C. trachomatis), Neisseria gonorrhoeae (N. gonorrhoea) and herpes simplex virus-2 (HSV-2) using PCR. All women were tested for bacterial vaginosis (BV) using the Nugent scoring criteria. WLHIV had a blood sample collected for HIV viral load, Hepatitis B and syphilis. Results Included in this analysis were 82 WLHIV and 102 WNLHIV. Between 6 and 14 weeks postpartum, 40 (21.7%) AGYW tested positive for any STI and among these 15 (37.5%) were symptomatic and received empirical treatment. C. trachomatis was most commonly detected (10.9%), followed by HSV-2 (7.7%), T. vaginalis (3.8%) and N. gonorrhoea (1.6%). WLHIV were more likely to test positive for an STI (OR 2.0; 0.96–3.96) and BV (OR 4.2; 95%CI 2.1–8.1) compared to WNLHIV. Among WLHIV on ART, 70.5% had an undetectable plasma viral load (PVL) and 20.5% had a PVL > 1000 copies/ml. Testing positive for any STI or BV at the postpartum visit was not associated with PVL > 1000 copies/ml (OR 1.33; 95%CI 0.38–4.64). Conclusion We report a high prevalence of largely asymptomatic STIs and BV in the early postpartum period and STIs in WLHIV were not associated with unsuppressed PVL.The high STI positivity rate among WNLHIV has implications for HIV risk during the postpartum period, and subsequently breastfeeding transmission.

In preparing undergraduates to become teachers, initial teacher education (ITE) institutions enter into partnerships with schools, a necessary but often ambiguous undertaking. Alignment or misalignment of the key roles and responsibilities of each stakeholder influences pre-service teachers' experience of teaching practice. The overarching research question that guided this study was: What can universities do to better prepare pre-service teachers for teaching practice? The study is underpinned by Cochran-Smith and Lytle's framework of knowledge for practice, knowledge in practice, and knowledge of practice. The article reports on findings from a case study of 79 purposively selected mentor teachers' views on how to prepare pre-service teachers for teaching practice. Data were collected using a qualitative open-ended questionnaire distributed by email, with responses received in writing. The findings indicate that most mentor teachers (73%) highly value student teachers' knowledge of the practice, and would like them to have a more detailed understanding of what teaching entails before they go on teaching practice. Based on the mentor teachers' input, we recommend that fewer student teachers be sent to each school at one time, more emphasis be given to students' professional behaviour, and that students be better prepared with content and lesson planning knowledge.

Abstract The Bellagio Group for Accelerating AMR Action met in April 2024 to develop the ambitious but achievable 1–10-100 unifying goals to galvanize global policy change and investments for antimicrobial resistance mitigation: 1 Health; 10 million lives saved; and 100% sustainable access to effective antimicrobials. High profile political goals such as the Paris Agreement’s objective to keep global warming well below 2° Celsius compared to pre-industrial levels, UNAIDS’ 90–90-90 goal, and the Sustainable Development Goals challenge global norms, direct attention towards relevant activities, and serve an energizing function to motivate action over an extended period of time. The 1–10-100 unifying goals propose to unite the world through a One Health approach to safeguard human health, animal welfare, agrifood systems, and the environment from the emergence and spread of drug-resistant microbes and infections; save over 10 million lives by 2040 through concerted efforts to prevent and appropriately treat infections while preserving the vital systems and services that depend on sustained antimicrobial effectiveness; and commit to ensuring that antimicrobials are available and affordable for all, used prudently, and secured for the future through innovation. Compared to existing technical targets, these unifying goals offer advantages of focusing on prevention, encouraging multisectoral action and collaboration, promoting health equity, recognizing the need for innovation, and integrating with Sustainable Development Goals. By committing to 1 Health, 10 million lives saved, and 100% sustainable access to effective antimicrobials, we can protect lives and livelihoods today and safeguard options for tomorrow.

Abstract Background Tuberculosis (TB), a major cause of disease and antimicrobial resistance, is spread via aerosols. Aerosols have diagnostic potential and airborne-microbes other than Mycobacterium tuberculosis complex (MTBC) may influence transmission. We evaluated whether PneumoniaCheck (PMC), a commercial aerosol collection device, captures MTBC and the aeromicrobiome of people with TB. Methods PMC was done in sputum culture-positive people (≥ 30 forced coughs each, n = 16) pre-treatment and PMC air reservoir (bag, corresponding to upper airways) and filter (lower airways) washes underwent Xpert MTB/RIF Ultra (Ultra) and 16S rRNA gene sequencing (sequencing also done on sputum). In a subset (n = 6), PMC microbiota (bag, filter) was compared to oral washes and bronchoalveolar lavage fluid (BALF). Findings 54% (7/13) bags and 46% (6/14) filters were Ultra-positive. Sequencing read counts and microbial diversity did not differ across bags, filters, and sputum. However, microbial composition in bags (Sphingobium-, Corynebacterium-, Novosphingobium-enriched) and filters (Mycobacterium-, Sphingobium-, Corynebacterium-enriched) each differed vs. sputum. Furthermore, sequencing only detected Mycobacterium in bags and filters but not sputum. In the subset, bag and filter microbial diversity did not differ vs. oral washes or BALF but microbial composition differed. Bags vs. BALF were Sphingobium-enriched and Mycobacterium-, Streptococcus-, and Anaerosinus-depleted (Anaerosinus also depleted in filters vs. BALF). Compared to BALF, none of the aerosol-enriched taxa were enriched in oral washes or sputum. Interpretation PMC captures aerosols with Ultra-detectable MTBC and MTBC is more detectable in aerosols than sputum by sequencing. The aeromicrobiome is distinct from sputum, oral washes and BALF and contains differentially-enriched lower respiratory tract microbes.

Background: There is a global concern regarding increasing colonization and/or infection of paediatric burns patients with multi-drug-resistant organisms, especially in Africa. Surveillance of antimicrobial resistant patterns enables clinicians to opt for the most appropriate empiric antimicrobial agent according to the unit’s susceptibility profile. Objective: This study sought to compile unit-specific antibiograms comparing the organism prevalence and their antimicrobial resistance trends in the paediatric burns unit, Chris Hani Baragwanath Academic Hospital (CHBAH) from January 2015 to December 2019. Methods: A retrospective, laboratory-based review was conducted of bacterial and fungal isolates including antimicrobial susceptibility testing (AST) data from blood cultures and tissue samples. Enterobacterales, non-fermenters, gram-positive organisms, and yeasts were analysed as a percentage of total positive blood cultures comparing 2015–2017 to 2018–2019 data. Analysis of antimicrobial resistance trends was performed for extended-spectrum beta-lactamases (ESBLs), carbapenem-resistant Enterobacterales (CRE), extensively-drug-resistant (XDR) Acinetobacter baumannii, and meticillin-resistant Staphylococcus aureus (MRSA) for the years 2015, 2017, and 2019. Results: A total of 1243 blood culture isolates were studied with A.baumannii (208/1243;17 %), coagulase negative staphylococci (141/1243; 11 %) and Candida auris (53/1243; 4 %) representing the predominant gram-negative bacteria, gram-positive bacteria, and yeast, respectively. A significant decrease in ESBLs (p = 0.00) was noted with a rise in CREs (p = 0.00) during the study period. Majority of the A. baumannii were XDR (≥77 %) despite an appreciable decrease. A notable decrease in MRSA (p = 0.00) isolates was observed. Pseudomonas aeruginosa (72/275; 26 %) was the leading organism recovered from a total of 275 tissue isolates. Conclusion: The results of this study encourage review of the current antimicrobial choices in the unit for empiric antibacterial cover. Due to the low numbers of yeasts, we cannot comment on the institution of early antifungal strategies. We support reinforced infection prevention and control practices as well as antimicrobial stewardship initiatives.

OBJECTIVE: To identify individual-level early warning indicators of virologic failure in HIV patients receiving antiretroviral therapy (ART) in South Africa. DESIGN: A matched case–control study of individuals with and without virologic failure (VF) (>5 months on ART and HIV-1 plasma viral load >1,000 copies/mL) was conducted between June 2014 and June 2018. Of the 1,000 participants enrolled in the parent cohort, 96 experienced VF, and 199 additional controls were identified from the parent cohort and matched 1:2 (some matched 1:3) for sex, age, ART duration, and site. Participants were interviewed while clinical, pharmacy refill, laboratory, and objective pharmacological data were obtained. Multivariate conditional logistic regression models were constructed using model selection to identify factors associated with VF. Significant determinants of VF were identified using an alpha level of 0.05. RESULTS: In a full conditional model, higher cumulative ART adherence, quantified using tenofovir-diphosphate concentrations in dried blood spots (OR 0.26) and medication possession ratio (OR 0.98) were protective against VF, whereas an increase in total depression score (OR 1.20) was predictive of VF. CONCLUSION: This analysis demonstrates the importance of depression as a key individual-level early warning indicator of VF. Efforts to address mental health concerns among patients with people living with HIV could improve virologic suppression.

Abstract Background Clinical associates are a health professional cadre that could be utilised in mental health task sharing in South Africa but this is training dependent. The objectives of the study were to identify the potential curricula content, training sites, and teaching modalities for undergraduate and potential postgraduate clinical associate mental health training and to identify the tasks that they should perform based on these curricula. Methods We utilised the Delphi method to reach consensus on items with the panel comprising psychiatrists and family physicians. The first round questionnaire of the Delphi survey was developed based on a literature review and the results from earlier phases of the overall study. The survey was administered electronically and consisted of three rounds. Following both the first and second rounds, an updated questionnaire was constructed omitting the items on which consensus was reached. The questionnaire consisted primarily of nine-point scales with consensus based on 70% of participants rating 1,2,3 or 7,8,9. Results There were 26 participants in the first round with this number falling to 23 in later rounds. There was strong consensus on a training attachment to a mental health clinic at a community health centre (CHC) at undergraduate (96.2%) and postgraduate level (100%). Consensus was reached on the importance of training on the management of six categories of disorders at the undergraduate level and nine categories of disorders at the postgraduate level. Clerking patients as a teaching modality reached 100% consensus at both undergraduate and postgraduate levels. PHC clinics, CHCs and district hospitals reached consensus as appropriate settings for clinical associates to provide mental health services. In addition, GP practices and secondary hospitals reached consensus for those with postgraduate training. Consensus was reached on ten of the 21 listed tasks that could be performed based on undergraduate training and 20 of the 21 tasks based on a postgraduate qualification in mental health. Conclusions The Delphi panel’s recommendations provide a clear roadmap for enhancing mental health curricula for clinical associates, enabling their utilisation in mental health service provision. A future postgraduate mental health qualification for clinical associates would allow for expanded task sharing.

Abstract Image‐based analyses from an online repository on rhino horns asserted that declines in size over time could be the consequence of poaching and hunting. We provide reflections on whether the sample was representative enough to make generalizations, the study adequately accounted for the main sources of horn‐size variation and the statistical methods were adequate to be confident in the results. The sample had a limited representation, most coming from zoo animals. We highlight several sources of variance in horn size that such a sample could not evaluate robustly using linear regressions, both for establishing a proxy for horn size corrected for size of a rhino and assessing trends over time. Nevertheless, horn poaching continues to be the key threat to rhinos. Addressing the underlying drivers of poaching and trafficking are key priorities for responsible public debate, policy making and interventions. Read the free Plain Language Summary for this article on the Journal blog.

The COVID-19 pandemic has affected teaching and learning globally. An increase in distance learning through online digital platforms and electronic devices has created a drastic change in education. The implication of online learning continuing post pandemic is prominent. An exploratory study of the educational experience of online learning through the lens of inquiry within social, cognitive and facilitator presence was conducted. The study focuses on the experiences of 18 adult students in an 8 week short course on "Instructional Design Tools for E-learning". All the participants within this course were in a role that involved online content development. Data gathered through weekly reflections and an online course evaluation survey reflects the importance, affordances and shortcomings in designing for online learning. The study reflects dynamic and authentic learning experiences and highlights the significance of design practices. An unexpected finding was the importance of learning presence as a contributing factor to the online learning experience.

Background: The spread of the coronavirus disease-2019 (COVID-19) has escalated the need for studying the home learning environment (HLE). With learners spending more time at home, understanding about learning at home, especially in disadvantaged communities, is paramount. Aim: The aim of this research study was to explore the HLE for foundation phase learners by analysing data from an intervention that aspired to support organised learning at home during the COVID-19 pandemic. Setting: This research study was conducted telephonically with families from 11 schools (10 in the Waterberg district, Limpopo and one in Soweto, Gauteng). Methods: Qualitative data (recorded phone interviews) were collected from caregivers and learners from 17 households. The interview recordings were transcribed and translated into English. The constant comparative method of data analysis was used to analyse interview transcripts. Results: Three themes emerged from the analysis: (1) challenges of learning at home, (2) perceived benefits of learning at home and (3) the desire to continue with the programme even after schools re-opened. The data showed that having access to learning material facilitated learning at home. Additionally, caregivers noted benefits to learners from engaging in learning activities. However, there were also challenges in facilitating learning at home. These include caregivers not following the learning guidelines provided. Conclusion: Caregivers appreciated having access to learning material and were willing to facilitate learning at home. However, the challenges they faced resulted in them not executing the programme effectively. Future studies and interventions should explore how to provide adequate and accessible support to caregivers.

There were a number of mergers and acquisition (M&A) and hostile take overs in South Africa over the past decade and half. Companies in a M&A are in most instances preoccupied in pursuit of increasing the shareholder value and securing the biggest market share through effective branding. The research objectives of the study were to evaluate the effectiveness of mergers and acquisitions in relation to its image as a brand and to provide recommendations in respect of future merger and acquisition deals for an organisation. The study adopted the quantitative method of research by means of a survey questionnaire and the target population for this study was 310 managers (in the financial services sector) in Kwazulu-Natal. Relevant descriptive and inferential statistics were used to analyse the data collected. The research findings uncovered that from a turnaround perspective in mergers and acquisition deals, brand image should be skilfully and appealingly crafted to generate the desired return on investment. This study contributes to the body of knowledge by revealing that institutions who merge in the financial services sector consolidate their position in the market if brand image is aligned to the institution’s strategy. A fortified brand image results in greater market share.

Quinoline-urea-benzothiazole hybrids exhibited low to sub-micromolar in vitro activities against the Plasmodium falciparum (P. falciparum) 3D7 chloroquine (CQ)-sensitive strain, with compounds 5a, 5b and 5f showing activities ranging from 0.33 to 0.97 μM. Against the formation of β-haematin, the majority of the tested compounds were comparable to the reference drug, chloroquine (CQ), with compounds 5c (IC50 = 9.55 ± 0.62 μM) and 5h (IC50 = 9.73 ± 1.38 μM), exhibiting slightly better in vitro efficacy than CQ. The hybrids also exhibited low micromolar to submicromolar activities against Trypanosoma brucei brucei, with 5j-5k being comparable to the reference drug, pentamidine. Compound 5b displayed higher in silico binding energy than CQ when docked against P. falciparum dihydroorotate dehydrogenase enzyme. Compounds 5j and 5k showed higher binding energies than pentamidine within the trypanothione reductase enzyme binding pocket. The root means square deviations of the hit compounds 5b, 5j and 5k were stable throughout the 100 ns simulation period. Post-molecular dynamics MMGBSA binding free energies showed that the selected hybrids bind spontaneously to the respective enzymes. The DFT investigation revealed that the compounds have regions that can bind to the electropositive and electronegative sites of the proteins.

Background: Timely detection of oesophageal injuries post-penetrating neck trauma is imperative because of the associated high morbidity and mortality. Patients commonly undergo both CT angiography (CTA) and contrast swallow studies (fluoroscopic oesophagography) when oesophageal injury is suspected. Objectives: To determine the radiological findings of oesophageal injury after penetrating neck trauma comparing CTA and fluoroscopic oesophagography at a single tertiary centre. Method: The study retrospectively reviewed the data from CTA and fluoroscopic oesophagography reports of patients suspected of oesophageal injuries secondary to penetrating neck trauma at a tertiary hospital in South Africa from January 2018 to December 2022. Results: A total of 76 records were reviewed. The mean age for the participants was 31.5 years, ranging from 0.75–66 years. In this study 6/76 (8%) patients had confirmed oesophageal injury on fluoroscopy, which is considered the gold standard. The majority of penetrating neck injuries were in the 20–29 year age group, with 33/76 (43%) injuries. Stab wounds as the mechanism of injury accounted for 57/76 (75%). Dysphagia was experienced by 10/76 (13%) of those who had injuries. Zone I injuries accounted for 33/76 (43%) of the injuries. Conclusion: The incidence of oesophageal injuries secondary to penetrating neck injuries is comparable to previous studies. This study determined that CTA has a high sensitivity but low specificity. Contribution: Fluoroscopic oesophagography should, therefore, be performed in patients who have an abnormal CTA coupled with clinical signs and symptoms of oesophageal injury.

Education in the 21st century must have a vision that will support and empower teachers to face the demands of the digital age. The use of information communication technology (ICT) in education can serve this end but ensuring access to digital resources will not address the digital disparity. Culture and language play an equally important role in exacerbating and maintaining the digital disparity as the traditional factor of access. In the study reported on here we investigated the experiences and attitudes of Setswana-speaking teachers in 3 primary schools in the North West province, South Africa, as they were exposed to online software in Setswana, an indigenous African language. Purposive sampling was used to select 7 teachers for the study. Two research questions were answered using systematic self-observation (SSO) instruments, the participant observation (PO) instrument and the in-depth interview (IDI) instrument to determine the experiences and attitudes of the teachers. Thematic analysis was used to analyse the interview data. It was found that accuracy of translation was key for adopting and using software in an African language. The teachers felt that English was the language of ICT and that African languages were not intellectual languages and did not have the capacity to be used in ICT. It is, therefore, recommended that more must be done to translate software into African languages and an effort must be made to raise the status of African languages in academic and technical fields.

The escalating global demand for dairy products due to population growth has led to increased production in the dairy industry, resulting in a significant rise in wastewater generation. This wastewater, laden with contaminants such as fats, oils, and greases (FOGs), biological oxygen demand (BOD), chemical oxygen demand (COD), nitrogen, and phosphorus, poses a threat to freshwater sources. Anaerobic digestion (AD) is considered the optimal treatment method for dairy wastewater, but the high-fat content poses challenges like reactor clogging. To overcome this, various authors propose and implement an enzymatic pre-treatment strategy that improves FOG and organic content removal, increases biogas production, and addresses economic and environmental concerns. Despite the proven efficacy of enzymatic pre-treatment, a significant drawback is the associated cost. However, it remains a promising strategy for enhancing the biodegradability of complex organic compounds in dairy effluents. This review delves into the crucial role of enzyme-producing microorganisms in enhancing AD efficiency for dairy wastewater treatment, emphasizing their potential benefits and addressing the economic and environmental considerations associated with this approach. HIGHLIGHTS Enzymatic pre-treatment coupled with an AD produces a high-quality effluent.; Enzymatic pre-treatment is effective in the reduction of SS, FOGs in DWW but the cost implication makes it less appealing.; Recommendations have been offered for promising research areas in enzymatic pre-treatment with the use of new enzymes.;

Religion and Marital Status amongst Colorectal Cancer Patients in Kwazulu-Natal, South Africa: Potential Tools for Cancer Control

It is desired to improve the efficiency of liquid-liquid extraction processes in the fuel industry by reducing energy consumption and operational costs as well as reducing risk to health, safety and the environment. Co-solvent mixtures for extraction consisting of butane-1,4-diol, propane-1,2,3-triol (glycerol), and 2-methylpentane-2,4-diol (hexylene glycol) were assessed in terms of capital costs, operating costs and total annual costs relative to a baseline process that is employed for the liquid-liquid extraction of toluene from n-heptane. Commercial solvents such as sulfolane, morpholine-4-carbaldehyde (NFM), and dimethyl sulfoxide (DMSO) were used for the baseline processes that were simulated in ASPEN Plus V10. The capital costs ranged between 5.8–6.2 million US dollars, while the energy intensity ranged between 1000 - 1400 kJ/kg. The total annual costs for all solvents studied varied between 2.4 - 2.6 million dollars. The results highlighted that these co-solvent mixtures may offer some benefits in terms of total annual cost when the impact of solvent choice is holistically considered.

Rare earth metals are considered to be some of the most critical raw materials on the planet due to their use in many products and technologies, the difficulty in isolating the individual elements from ores and each other, and the market restrictions that threaten their supply. However, despite this, the recycling rates for rare earth metals remain low. Hydrometallurgy has been proposed to hold the greatest potential for the recovery of rare earth metals from waste materials. However, the design of hydrometallurgical processes for the recovery of rare earth elements from waste requires a good understanding of the behaviour of the rare earth metals between different phases.In this study, the distribution coefficients of two rare earth metals, yttrium, and neodymium, between an organic solvent; bis(2-ethylhexyl) phosphate, diluted in n-dodecane at between 0.25 M and 1 M; and an aqueous nitric acid solution at concentrations of between 0.1 M and 2.8 M were measured. Distribution measurements were performed using a series of liquid–liquid extraction cells at a constant temperature of 298.2 K. The concentration of the rare earth metals was measured using ICP-OES analysis. The distribution coefficients and the acid concentration were found to be inversely related to each other. Conversely, the distribution coefficients were directly proportional to the concentration of the solvent in the organic phase.The data reported in this paper will be used to design a counter-current liquid–liquid extraction column for the recovery of neodymium from waste permanent magnet powder.

Abstract Background As the population of people with HIV ages, concerns over managing age-related comorbidities, polypharmacy, immune recovery, and drug-drug interactions while maintaining viral suppression have arisen. We present pooled TANGO and SALSA efficacy and safety results dichotomized by age (

This study provides evidence and proof of dynamic return connectedness alongside the revelation that certain macroeconomic factors determine the return connectedness of size-based industries of the Johannesburg Stock Exchange (JSE). The objective of this study is to examine the effect of COVID-19 on the connectedness of JSE size-based indices and to investigate the effect of macroeconomic variables on JSE size-based index connectedness under changing market conditions. By employing the time varying parameter vector autoregressive (TVP-VAR) model alongside the Diebold and Yilmaz Connectedness framework to examine the time-varying connectedness and using the Markov regime-switching model to determine the drivers of the return connectedness for the period from 4 January 2017, to 30 June 2023. The findings of this study demonstrated that the return connectedness of the JSE-size-based indices vary over time, especially in extreme market conditions such as the pre, during and post-Covid-19 periods. Moreover, the Covid-19 pandemic period reveals a season of high correlation; hence, a heightened co-movement in the returns of all JSE sized-based indices. Moreover, macroeconomic variables have an alternating effect on the connectedness of JSE sized-based indices during bull and bear market conditions. That is, the effect is regime-dependent and time varying. These findings have serious implications for portfolio diversification, in which portfolio rebalancing is needed during alternating market conditions.

Background Due to its potential nephrotoxicity, screening for pre-existing renal function disorders has become a routine clinical assessment for initiating Tenofovir diphosphate fumarate (TDF)-containing antiretroviral treatment (ART) or pre-exposure prophylaxis (PrEP) in pregnant and non-pregnant adults. We aimed to establish reference values for commonly used markers of renal function in healthy pregnant women of African origin.Methods Pregnant women ≥18 years, not living with HIV, and at 14–28 weeks gestation were enrolled in a PrEP clinical trial in Durban, South Africa between September 2017 and December 2019. Women were monitored 4-weekly during pregnancy until six months postpartum. We measured maternal weight and serum creatinine (sCr) at each visit and calculated creatinine clearance (CrCl) rates using the Cockcroft–Gault (CG) and Modification of Diet in Renal Disease (MDRD) formulae. Reference ranges for sCr and CrCl by CG and MDRD calculations were derived from the mean ± 2SD of values for pregnancy and postdelivery.Results Between 14-–and 40 weeks gestation, 249 African women not exposed to TDF-PrEP contributed a total of 1193 renal function values. Postdelivery, 207 of these women contributed to 800 renal function values. The normal reference range for sCr was 30–57 and 32–60 umol/l in the 2nd and 3rd trimesters of pregnancy. Normal reference ranges for CrCl using the MDRD calculation were 129–282 and 119–267 ml/min/1.73m2 for the 2nd and 3rd trimesters, respectively. Using the CG method of calculation, normal reference ranges for CrCl were 120—304 and 123–309 ml/min/1.73m2 for the 2nd and 3rd trimesters respectively. In comparison, the normal reference range for sCr, CrCl by MDRD and CG calculations postpartum was 40–77 umol/l, 92–201, and 90–238 ml/min/1.73m2, respectively.Conclusions In African women, the Upper Limit of Normal (ULN) for sCr in pregnancy is approximately 20% lower than 6 months postnatally. Inversely, the Lower Limit of Normal (LLN) for CrCl using either MDRD or CG equation is approximately 35% higher than 6 months postnatally. We provide normal reference ranges for sCr and CrCl for both methods of calculation and appropriate for the 2nd and 3rd trimesters of pregnancy in African women.

ABSTRACTSouth Africa has been rated as having the most severe HIV epidemic in the world since it has one of the largest populations of people living with HIV (PLHIV). KwaZulu-Natal (KZN) is the epicentre of the HIV epidemic. The HIV test and treat services in the public health sector are critical to managing the epidemic and responding to the increase in HIV infections. The KwaZulu-Natal Department of Health (DOH) commissioned a review of the provision of HIV testing services in the province and aimed to investigate its impact on the HIV positivity rate over a ten-year period. The study was an ecological study design using data extracted from the Department’s District Health Information System (DHIS). Descriptive analysis was conducted in addition to ANOVA and multiple regression analysis. The results of this study have shown that the total number of HIV tests conducted over the ten-year period in the province has increased with the highest number of HIV tests being conducted in the 2018/2019 MTEF year. ANOVA analysis indicates that there was a statistically significant difference in the total number of HIV tests conducted and the number of HIV tests per 100 000 population across the province’s 11 districts (p

Background: Technological advancements have heightened the importance of safeguarding individual privacy and data. In response to these challenges, South Africa introduced the Protection of Personal Information (POPI) Act. This legislation established robust legal frameworks aimed at protecting confidential information and upholding individuals’ right to anonymity. However, there is a significant research gap regarding the POPI Act’s direct implications and effectiveness in the context of artificial intelligence (AI) adoption and utilisation. Understanding the interplay between the POPI Act and AI technologies is crucial for ensuring regulatory compliance, safeguarding personal data and fostering responsible AI deployment in South Africa. Objectives: This study investigates the POPI Act’s applicability in addressing privacy issues related to AI adoption in various sectors. Method: The research uses a document review methodology to analyse the documents and synthesise the results. This approach offers efficiency, accessibility, cost-effectiveness and non-intrusiveness benefits, making it a valuable tool for qualitative research across various disciplines. Results: Despite the POPI Act’s guiding principles aligning with key concepts of personal information protection, there are several gaps in its applicability to AI advancements across various sectors. Conclusion: The study emphasises the need for a dynamic legal framework that evolves with AI advancements, advocating for the incorporation of more stringent measures to address emerging privacy concerns. Contribution: The research contributes to the ongoing discourse on data protection and AI by highlighting the need for a forward-thinking legal framework that balances innovation and privacy, ensuring that the POPI Act remains effective in the face of evolving technologies.

Effective management of Distributed Energy Resources (DERs) and optimization of grid operations are crucial responsibilities of Distribution System Operators (DSOs). Hence, this comprehensive critical review aims to analyze the current state of DER forecasting practices for DSOs and their implications for achieving the SDG goals. These goals underscore the significance of clean and accessible energy, advancements in infrastructure, sustainable urban development, climate change mitigation, and collaborative partnerships. The review's core focuses on the DER forecasting techniques employed by DSOs. It explores various aspects, including data collection methods, load forecasting models, DER generation forecasting, aggregation and integration techniques, and the role of advanced technologies like machine learning and artificial intelligence. The review highlights the critical role of accurate DER forecasts in optimizing grid operations, managing energy flows, and facilitating the integration of renewable energy sources. Furthermore, the review examines the implications of DER forecasting for DSOs in achieving the SDGs. It discusses how DER forecasting facilitates the transition to affordable and clean energy, enhances industry innovation and infrastructure, builds sustainable cities and communities, drives climate action efforts, and fosters stakeholder partnerships. However, the review also identifies challenges and limitations in DER forecasting, including data availability, forecasting accuracy, uncertainty management, and regulatory barriers. It emphasizes further research and development in improved forecasting algorithms, advanced data analytics, and enhanced communication and coordination mechanisms. Finally, this comprehensive critical review highlights the importance of DER forecasting for DSOs in achieving the SDGs. Accurate forecasting can promote sustainable and clean energy practices, drive innovation, build resilient communities, mitigate climate change, and foster collaborative partnerships. The review emphasizes the necessity of advancing DER forecasting techniques and addressing associated challenges to fully realize the potential of DERs in contributing to a sustainable and inclusive future.This comprehensive critical review aims to analyze the current state of DER forecasting practices for DSOs and their implications for achieving the SDG goals. As Distributed Energy Resources (DERs) play an increasingly significant role in the transition to sustainable energy systems, accurate forecasting techniques are essential for optimizing grid operations and facilitating the integration of renewable energy sources. By effectively managing DERs, Distribution System Operators (DSOs) contribute to the advancement of several SDGs, including affordable and clean energy (SDG 7), sustainable infrastructure (SDG 9), climate action (SDG 13), and partnerships for the goals (SDG 17). This review explores the intersection of DER forecasting with the SDGs, highlighting how forecasting initiatives can support national and global efforts toward sustainable development by providing insights into energy demand, grid stability, and renewable energy integration. The goals and targets are derived from an analysis of current trends and the identification of potential development scenarios by 2030. Both optimistic and pessimistic projections are utilized for communicating with the general public and national governments concerning DSM network planning. Utilizing data from various nations enables the identification of effective strategies and the prediction of similar trends in other areas. Simultaneously, the magnitude of activities related to Sustainable Development Goals (SDGs) enables the improvement and efficient organization of data gathering on a global basis. This, in turn, provides a foundation for future forecasting endeavours.

ObjectiveWe evaluated growth metrics in HIV unexposed African breastfed infants in the first 18 months of life in association with in-utero exposure to Tenofovir Diphosphate Fumarate (TDF) containing pre-exposure prophylaxis (PrEP).DesignWe conducted a secondary data analysis of a TDF-PrEP randomized control trial (CAP016 RCT). Pregnant women without HIV were randomized to initiating TDF-PrEP in pregnancy (Immediate-PrEP-IP) or deferred initiation of TDF-PrEP at cessation of breastfeeding (Deferred-PrEP-DP).MethodsInfant weight (W), length (L), and head circumference (HC) were measured at birth and 6, 26, 50, and 74 weeks of age. Stored dried blood spot samples from pregnant women randomized to the IP arm were used to measure tenofovir-diphosphate (TFV-DP) levels. Age-stratified mean weight-for-age (WAZ), length-for-age (LAZ), weight-for-length (WLZ), and head circumference-for-age (HCAZ) Z-scores were compared between infants exposed to varying TFV-DP concentrations and infants in the DP arm.ResultsA total of 455 mother-infant pairs were included in the secondary analysis, 228 in the IP arm and 227 in the DP arm. WAZ, LAZ, WLZ, and HCAZ scores were comparable between infants in the Deferred-PrEP arm and Immediate-PrEP arm. In a mixed-effects linear regression model adjusting for maternal age, body mass index, socioeconomic and newborn characteristics, in-utero exposure to varying TFV-DP levels was not associated with WAZ (β = −0.52), LAZ (β = −0.46), WLZ (β = −0.43) and HCAZ (β = −0.11) scores over time.ConclusionThere was no evidence of an association between growth metrics in the first 18 months of life and in-utero exposure to TFV-DP among breastfed HIV unexposed infants.

Background: Provision of comprehensive eye care remains a challenge in low to medium income countries including South Africa. The recent surge of keratoconus (KC) is exacerbating this challenge especially in terms of the need for specialised equipment, optical devices, and quality knowledgeable eyecare workforce necessary for KC management. Aim: This study aimed to analyse the capacity of the public sector facilities in the provision of eyecare service to KC patients in view of developing strategies for strengthening systems for efficiency and effectiveness of KC patient care. Setting: Public sector hospitals of Capricorn District, Limpopo Province, South Africa. Methods: Concurrent mixed methods triangulation which included document review of clinical reports on patient headcount, cross-sectional survey of available equipment, working space and eyecare workforce, and key stakeholder and focus group interviews for exploring the perspectives of optometrists on eyecare service provision was conducted. Results: A significant patient headcount of consulting patients and well-established outreach programmes were reported. Limited knowledge of KC and severe shortages of basic equipment, consumables, and optical devices associated with financial constraints were commonly reported barriers to service provision to KC patients. Conclusion: The district has made progress in setting up systems for eyecare provision though gaps were identified in the service offered to KC patients. More efforts are required to strengthen the systems in this district for improvement of this service. Contribution: This article seeks to highlight the capacity of the public sector as the main contributor to eyecare and to strengthen systems for KC patient care.

Emergency medical services (EMS) are a vital component of the health system and provide pre-hospital emergency care and specialised transport for patients requiring access to health facilities, thereby contributing to universal health coverage and improving health outcomes. Evidence regarding the current state of EMS within South Africa to fulfil this role is lacking and was the motivation for this review. Our objective was to describe the current state of EMS in South Africa. A literature search was conducted using keywords, BOOLEAN operating terms, and eligibility criteria on Sabinet, EBSCOhost, Google Scholar, ProQuest, Medline, PubMed, and ScienceDirect databases to find articles related to the components of the EMS system in South Africa. The articles were critically assessed, and six themes emerged: leadership and governance; resources; preparedness (knowledge, attitude, and practices) of the emergency care provider; health and safety; training; and communications. Challenges were found in all themes at a provincial EMS level despite improvements in legislation, leadership, and governance from the National Department of Health. These themes demonstrate that all components in the EMS system are not functioning optimally and may be affecting its contribution to improving universal health coverage and health outcomes. The current state of EMS appears to be constrained and requires greater leadership and governance from the Provincial Departments of Health to improve poorly functioning components of the EMS system. Significance: The current state of EMS in South Africa lacks efficiency in its role to provide emergency care and transportation for patients wanting to access health facilities. Poorly functioning components of the EMS system have been identified and provide an opportunity for health authorities to make improvements so that the goal of universal health coverage and improved health outcomes can be realised.

Background: We sought to improve the current understanding of how climate change impacts women’s reproductive health in sub-Saharan Africa. Objectives: We investigated the relationship between maternal heat exposure and miscarriage (pregnancy ending before 20 weeks gestation) in a South African setting. Design: Population-based cohort study. Methods: Our study involved data for pregnancies collected via a health and demographic surveillance system in rural KwaZulu-Natal, South Africa between 2012 and 2016. Data from the South African Weather Service were used to compute maternal exposure to heat during the following time windows for each pregnancy: during the month preceding conception (T1) and during the week preceding the study outcome (either a miscarriage or no miscarriage, T2). Heat exposure was operationalized as a continuous variable and defined as the number of days that a mother was exposed to a mean daily temperature of > 26.6°C (A “hot day,” equivalent to a mean daily temperature of > 80°F) during T1 or T2. Binary logistic regression was used to investigate the relationship between maternal heat exposure and miscarriage. Results: A total of 105/3477 pregnancies included in our analysis ended in miscarriage (3.0%). Each additional hot day during T1 was associated with a 26% higher odds of miscarriage (odds ratio: 1.26; 95% confidence interval: 1.15–1.38). No significant associations were observed between maternal heat exposure during T2 and the odds of miscarriage (odds ratio: 0.94, 95% confidence interval: 0.73–1.20). The relationship between maternal heat exposure during T1 and the odds of miscarriage was J-shaped. Conclusion: There is a clear relationship between maternal heat exposure during the month preceding conception and miscarriage in our sub-Saharan African setting. Given the lack of feasible strategies to reduce pregnancy loss associated with prevailing high temperatures in sub-Saharan Africa, progressive climate change will likely exacerbate existing challenges for women’s reproductive health in this region.

Background: There is concern regarding the increasing resistance of Group A streptococcus (GAS) to routinely used antibiotics. GAS is a common cause of bacterial pharyngitis and more severe invasive infections such as septicaemia. Furthermore, GAS pharyngitis is the antecedent for serious conditions such as rheumatic fever and rheumatic heart disease. The study aimed to determine the antimicrobial susceptibility patterns of GAS cultured from patients with invasive and non-invasive infections from Cape Town, as part of the AFROStrep Registry. Methods: Samples were provided by the AFROStrep Registry, a continental endeavour aiming to document Streptococcus pyogenes infection in Africa and create the first biorepository of its kind. Ninety-five GAS isolates (invasive, n = 40; non-invasive, n = 55) were evaluated for resistance to a panel of 20 antibiotics using the Sensititre® STP6F system with MICs interpreted by CLSI break points. Results: Amongst all isolates, highest levels of resistance were observed with respect to tetracycline (8.33 %), followed by azithromycin (1.04 %) and erythromycin (1.04 %). No resistance to the remaining antibiotics was detected amongst all isolates. No differences with regard to MIC values were observed between isolates from invasive and non-invasive infections (p-value >0.05 for all antibiotics). Conclusion: GAS remains susceptible to routine-antimicrobial agents used in our low-resourced setting. Eight percent of the GAS isolates were resistant to tetracycline, and we did not observe macrolide resistance as reported in high income countries. This is the first study to report on the antimicrobial patterns of GAS in South Africa. These results address a critical gap in the available data on GAS in Africa and specifically South Africa and, thus, aid in avoiding therapeutic failures.

Key Clinical Message This case report explores the clinical journey of a patient initially diagnosed with botryomycosis, only to later reveal the underlying and rare condition of actinomycosis. The report highlights the challenges in getting to an accurate diagnosis, emphasizing the importance of considering uncommon pathologies, the utility of multi‐disciplinary teams and clinico‐pathologic correlation in clinical practice.

IntroductionApproximately 70% of diarrheal cases in Kenya are attributed to ingestion of contaminated food and water and costs an estimated $ 1 billion USD due to morbidity and cost of treatment. This study aimed to assess the levels of microbiological contamination of meat sold in selected butcheries in Nairobi and the handling practices of butcher shop attendants.MethodsA cross-sectional study design was used during which 200 meat samples were collected, and meat handling practices were observed. Total coliforms and Escherichia coli were enumerated using 3M™ Petrifilm® count plates. Additionally, quantification of tetracycline- and cefotaxime-resistant Enterobacteriaceae was done on agar plates containing the respective antibiotics. Bacterial species were confirmed by Matrix-Assisted Laser Desorption/Ionization-Time of Flight mass spectrometry.Results and discussionSeventy two percent and 84% of the samples had E. coli and total coliforms respectively above the acceptable regulatory limits (i.e. E. coli >100 CFU/g, Total coliforms >361 CFU/g,) respectively as per the Kenya Bureau of Standards South African microbiological standards the European Union. Enterobacteriaceae resistant to tetracycline and cefotaxime were detected in 35% and 9.5% of the samples respectively. Eighty-five percent of the butcher shop attendants neither washed their hands before nor after handling the meat, 91% handled money while selling meat concurrently, and 99% did not wear gloves while handling meat. These poor meat handling practices coupled with the presence of microbial loads above the regulatory acceptable limits imply an increased risk of foodborne illness to consumers. Therefore, there is an urgent need for education of butcher shop attendants on appropriate handling of meat, highlighting the importance of good hygienic practices and their relationship to food safety, and provision of incentives for behavior change. This study is important and serves to inform policymakers in the identification of key control points for designing meat safety intervention(s).

Livestock associated antimicrobial resistance (AMR) can reduce productivity and cause economic losses, threatening the livelihoods of poor farming communities in low-income settings. We investigated the practices and risk factors for increased antibiotic use, and AMR in Escherichia coli including resistance to human critically important antibiotics like cefotaxime and colistin in semi-intensive and free-range poultry farms in Uganda. Samples and farm management data were collected from 402 poultry farms in two districts between October 2021 to March 2022. Samples were processed to isolate E. coli and to quantify cefotaxime (CTX) and colistin (COL) resistant coliforms. The identification of presumptive E. coli isolated on MacConkey agar without antibiotics, was confirmed by matrix-assisted laser desorption/ionization-time of flight mass spectrometry and subjected to antimicrobial susceptibility testing by disk diffusion using EUCAST guidelines. Our models indicated that antibiotic use was associated with production intensity, and type of feed used. Moreover, semi-intensive farmers had better knowledge on antibiotic use compared to farmers in the free-range system. In semi-intensive farms, 52% harbored COLR and 57% CTXR coliforms. In free-range farms, 54% had COLR and 67% CTXR coliforms. Resistance to tetracycline, ampicillin and enrofloxacin were more frequent in semi-intensive farms compared to the free-range farms. Multi-drug resistant E. coli were identified in both poultry production systems despite different management and antibiotic use practices. There was no significant relationship between antibiotic use and resistance for the six antibiotics tested.