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Background: Despite advances in surgery and pharmacotherapy, there remains significant residual ischemic risk after coronary artery bypass grafting surgery. Methods: In REDUCE-IT (Reduction of Cardiovascular Events With Icosapent Ethyl–Intervention Trial), a multicenter, placebo-controlled, double-blind trial, statin-treated patients with controlled low-density lipoprotein cholesterol and mild to moderate hypertriglyceridemia were randomized to 4 g daily of icosapent ethyl or placebo. They experienced a 25% reduction in risk of a primary efficacy end point (composite of cardiovascular death, myocardial infarction, stroke, coronary revascularization, or hospitalization for unstable angina) and a 26% reduction in risk of a key secondary efficacy end point (composite of cardiovascular death, myocardial infarction, or stroke) when compared with placebo. The current analysis reports on the subgroup of patients from the trial with a history of coronary artery bypass grafting. Results: Of the 8179 patients randomized in REDUCE-IT, a total of 1837 (22.5%) had a history of coronary artery bypass grafting, with 897 patients randomized to icosapent ethyl and 940 to placebo. Baseline characteristics were similar between treatment groups. Randomization to icosapent ethyl was associated with a significant reduction in the primary end point (hazard ratio [HR], 0.76 [95% CI, 0.63–0.92]; P =0.004), in the key secondary end point (HR, 0.69 [95% CI, 0.56–0.87]; P =0.001), and in total (first plus subsequent or recurrent) ischemic events (rate ratio, 0.64 [95% CI, 0.50–0.81]; P =0.0002) compared with placebo. This yielded an absolute risk reduction of 6.2% (95% CI, 2.3%–10.2%) in first events, with a number needed to treat of 16 (95% CI, 10–44) during a median follow-up time of 4.8 years. Safety findings were similar to the overall study: beyond an increased rate of atrial fibrillation/flutter requiring hospitalization for at least 24 hours (5.0% vs 3.1%; P =0.03) and a nonsignificant increase in bleeding, occurrences of adverse events were comparable between groups. Conclusions: In REDUCE-IT patients with a history of coronary artery bypass grafting, treatment with icosapent ethyl was associated with significant reductions in first and recurrent ischemic events. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01492361.

Dental professionals face many challenges due to a rapidly changing environment, and are acknowledging the need for essential leadership skills to perform optimally. We assessed key stakeholders’ views about the need for management and leadership training in dentistry in South Africa . The aim of this study, was to assess the need for leadership and management training in Dentistry in South Africa from an industry perspective. A qualitative study. Purposive sampling of 14 Senior Managers in the dental environment and 11 recently qualified dentists in South Africa. We conducted one-on-one and telephonic interviews guided by a semi-structured questionnaire with open-ended questions. Interviews were recorded, transcribed and data was thematically analysed. Participants expressed concerns about dentistry in South Africa. All participants mentioned financial constraints, including the high cost of setting up a practice, high cost of imported consumables and dwindling support from medical schemes. Participants stated that strong leadership and managerial skills were important for dealing with these challenges. Inculcating these skills will make a remarkable difference in enhancing services and providing purposive direction within the profession.

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.

BACKGROUND: To identify the best possible outcomes in liver transplantation from donation after circulatory death donors (DCD) and to propose outcome values, which serve as reference for individual liver recipients or patient groups.METHODS: Based on 2219 controlled DCD liver transplantations, collected from 17 centres in North America and Europe, we identified 1012 low-risk, primary, adult liver transplantations with a laboratory MELD of ≤20points, receiving a DCD liver with a total donor warm ischemia time of ≤30minutes and asystolic donor warm ischemia time of ≤15minutes. Clinically relevant outcomes were selected and complications were reported according to the Clavien-Dindo-Grading and the Comprehensive Complication Index (CCI). Corresponding benchmark cut-offs were based on median values of each centre, where the 75th-percentile was considered.RESULTS: Benchmark cases represented between 19.7% and 75% of DCD transplantations in participating centers. The one-year retransplant and mortality rate was 5.23% and 9.01%, respectively. Within the first year of follow-up, 51.1% of recipients developed at least one major complication (≥Clavien-Dindo-Grade-III). Benchmark cut-offs were ≤3days and ≤16days for ICU and hospital stay, ≤66% for severe recipient complications (≥Grade-III), ≤16.8% for ischemic cholangiopathy, and ≤38.9CCI points at one-year posttransplant. Comparisons with higher risk groups showed more complications and impaired graft survival, outside the benchmark cut-offs. Organ perfusion techniques reduced the complications to values below benchmark cut-offs, despite higher graft risk.CONCLUSIONS: Despite excellent 1-year survival, morbidity in benchmark cases remains high with more than half of recipients developing severe complications during 1-year follow-up. Benchmark cut-offs targeting morbidity parameters offer a valid tool to assess the protective value of new preservation technologies in higher risk groups, and provide a valid comparator cohort for future clinical trials.LAY SUMMARY: The best possible outcomes after liver transplantation of grafts donated after circulatory death (DCD) were defined using the concept of benchmarking. These were based on 2219 liver transplantations following controlled DCD donation in 17 centres worldwide. The following benchmark cut-offs for the most relevant outcome parameters were developed: ICU and hospital stay: ≤3 and ≤16 days; primary non function: ≤2.5%; renal replacement therapy: ≤9.6%; ischemic cholangiopathy: ≤16.8% and anastomotic strictures ≤28.4%. One-year graft loss and mortality were defined as ≤14.4% and 9.6%, respectively. Donor and recipient combinations with higher risk had significantly worse outcomes. The use of novel organ perfusion technology achieved similar, good results in this high-risk group with prolonged donor warm ischemia time, when compared to the benchmark cohort.

Combined oral contraceptive (COC) use has been associated with various adverse effects. Formulations containing drospirenone (DRSP) and ethinyl estradiol (EE) are generally regarded as milder COCs. Whether long term use of these pills indeed has a low health risk remains questionable. COC use may affect the biotransformation balance by increasing the toxic load or by interfering with the pharmacokinetics of other drugs. This may negatively impact overall health via the production of toxic biotransformation metabolites and induction of oxidative stress. Although individual enzymes involved in biotransformation are known to be regulated by COCs, the effect of COC use on the overall liver biotransformation efficiency has not been reported. Here, we evaluated the general subjective health status and overall liver biotransformation efficiency of healthy young women who were either long term chronic users of COCs containing DRSP/EE, or who were not using any hormonal products. COC users suffered from moderate to severe fatigue and reported more health-related symptoms. Furthermore, phase I (CYP1A2) activity was reduced whereas phase II conjugation reactions (glucuronide conjugation and glycine conjugation) were increased in COC users. Finally, serum peroxide levels were markedly elevated and antioxidant capacity of plasma was reduced in COC users. COCs containing DRSP/EE may, therefore, adversely affect health status and disturb the balance between phase I and II biotransformation reactions. These effects may be mediated by oxidative stress.

Major incidents account for a vast number of consequences, whether it be individual morbidity and mortality or economic disruption and expense. Because of the infrequent nature, it poses a variety of unique risks and challenges for individual emergency medical services systems. Air ambulances are usually dispatched based on the clinical presentation of an individual patient who needs emergent critical care intervention. The response to a major incident is unusual and infrequent, but the benefit of tasking air ambulances to such incidents has been described by various authors. Here, such a response is described in a low- to middle-income country that saw the immediate tasking of 2 separate air ambulances to a single, multivehicle collision with multiple injured patients that occurred near a small, rural hospital not capable of treating critically ill patients. The benefits of tasking of the air ambulance in the sense of additional expertise as well as potential other nonclinical benefits are discussed and described here.

Purpose The purpose of this paper is to evaluate the effect of the Albertina Sisulu Executive Leadership Programme in Health (ASELPH) in improving the competencies and performance of public healthcare managers in South Africa (SA). Design/methodology/approach This study used a quasi-experimental study design, with pre-post assessments to assess the performance and competencies of students participating in a public health leadership programme. Students were assessed using a 360° assessment of 14 competencies and 56 performance indicators. Findings Students improved significantly in 11 competencies and 44 performance indicators; they perceived improvements in their own performance. The assessors observed the same improvements, which confirmed performance change at the students’ workplaces. The study showed the positive effect of the ASELPH Fellowship in improving the competencies and performance of public healthcare managers in SA. Originality/value The ASELPH Fellowship enhanced the leadership competencies and the performance of South African public healthcare managers. South African public healthcare managers face significant challenges and concerns have been raised regarding the competencies of healthcare managers to deal with these challenges. This study shows that leadership programmes can improve competencies and performance of managers to have an impact on the South African healthcare system

GSK3389404 is a liver‐targeted antisense oligonucleotide that inhibits synthesis of hepatitis B surface antigen and all other hepatitis B virus proteins. This first‐in‐human, randomized, double‐blind, phase 1 study assessed the safety and pharmacokinetics of GSK3389404 administered subcutaneously (SC) in healthy subjects. Four single ascending‐dose cohorts (10 mg, 30 mg, 60 mg, and 120 mg) and 3 multiple ascending‐dose cohorts (30 mg, 60 mg, and 120 mg once weekly for 4 weeks) each comprised 6 subjects randomized to GSK3389404 and 2 subjects randomized to placebo. There were no serious adverse events (AEs) or withdrawals due to AEs. The safety profile did not worsen with repeated dosing. The most frequent treatment‐related AEs were injection site reactions (19.0% [n = 8/42], frequency unrelated to dose levels); all were mild (Grade 1) and resolved without dose modification or discontinuation. GSK3389404 administered subcutaneously was readily absorbed with a time to maximum plasma concentration (Tmax) of 1–4 hours and an elimination half‐life of 3–6 hours in plasma. Plasma area under the concentration‐time curve (AUC) and maximum observed concentration (Cmax) were dose‐proportional. Dose‐normalized plasma AUC from time 0 to infinity averaged 69.9 ng·h/(mL·mg dose) across cohorts, and Cmax 9.5 ng/(mL·mg dose). Pharmacokinetic profiles and parameters were comparable between single and multiple dosing. No accumulation was observed with once‐weekly dosing. The metabolite was undetectable in urine and plasma. In the pooled urine, GSK3389404 was estimated to account for

Multi-threaded unit tests for high-performance thread-safe data structures typically do not test all behaviour, because only a single scheduling of threads is witnessed per invocation of the unit tests. Model checking such unit tests allows to verify all interleavings of threads. These tests could be written in or compiled to LLVM IR. Existing LLVM IR model checkers like divine and Nidhugg, use an LLVM IR interpreter to determine the next state. This paper introduces llmc, a multi-core explicit-state model checker of multi-threaded LLVM IR that translates LLVM IR to LLVM IR that is executed instead of interpreted. A test suite of 24 tests, stressing data structures, shows that on average llmc clearly outperforms the state-of-the-art tools divine and Nidhugg.

Background Arterial stiffness is an independent risk factor for cardiovascular disease and can be beneficially influenced by physical activity. However, it is not clear how an individual’s physical activity pattern over a week is associated with arterial stiffness. Therefore, we examined the associations of the amount and pattern of higher intensity physical activity with arterial stiffness. Methods and Results Data from the Maastricht Study (n=1699; mean age: 60±8 years, 49.4% women, 26.9% type 2 diabetes mellitus) were used. Arterial stiffness was assessed by carotid‐to‐femoral pulse wave velocity and carotid distensibility. The amount (continuous variable as h/wk) and pattern (categorical variable) of higher intensity physical activity were assessed with the activPAL3. Activity groups were: inactive (150 min/wk in ≤2 sessions), and regularly active (>150 min/wk in ≥3 sessions). In the fully adjusted model (adjusted for demographic, lifestyle, and cardiovascular risk factors), higher intensity physical activity was associated with lower carotid‐to‐femoral pulse wave velocity (amount: β = −0.05, 95% CI, −0.09 to −0.01; insufficiently active: β = −0.33, 95% CI, −0.55 to −0.11; weekend warrior: β = −0.38, 95% CI, −0.64 to −0.12; and regularly active: β = −0.46, 95% CI, −0.71 to −0.21 [reference: inactive]). These associations were stronger in those with type 2 diabetes mellitus. There was no statistically significant association between higher intensity physical activity with carotid distensibility. Conclusions Participating in higher intensity physical activity was associated with lower carotid‐to‐femoral pulse wave velocity, but there was no difference between the regularly actives and the weekend warriors. From the perspective of arterial stiffness, engaging higher intensity physical activity, regardless of the weekly pattern, may be an important strategy to reduce the risk of cardiovascular disease, particularly in individuals with type 2 diabetes mellitus.

Objective Physical activity may provide a means for the prevention of cardiovascular disease via improving microvascular function. Therefore, this study investigated whether physical activity is associated with skin and retinal microvascular function.Methods In The Maastricht Study, a population-based cohort study enriched with type 2 diabetes (n = 1298, 47.3% women, aged 60.2 +/- 8.1 years, 29.5% type 2 diabetes), we studied whether accelerometer-assessed physical activity and sedentary time associate with skin and retinal microvascular function. Associations were studied by linear regression and adjusted for major cardiovascular risk factors. In addition, we investigated whether associations were stronger in type 2 diabetes.Results In individuals with type 2 diabetes, total physical activity and higher-intensity physical activity were independently associated with greater heat-induced skin hyperemia (regression coefficients per hour), respectively, 10 (95% CI: 1; 18) and 36 perfusion units (14; 58). In individuals without type 2 diabetes, total physical activity and higher-intensity physical activity were not associated with heat-induced skin hyperemia. No associations with retinal arteriolar %-dilation were identified.Conclusion Higher levels of total and higher-intensity physical activity were associated with greater skin microvascular vasodilation in individuals with, but not in those without, type 2 diabetes.

If the world stays on its current development path, the state of biodiversity will continue to decline. This is due to projected further increases in pressures, most prominently habitat loss and climate change. In order to reduce these pressures, biodiversity conservation and restoration, as well as sustainable resource use, needs to be an integral part of sustainable development strategies of primary production sectors, such as agriculture, forestry, fisheries and energy. This paper presents a model-based analysis of three alternative pathways described as Global Technology, Decentralized Solutions and Consumption Change to conserve biodiversity. Each of these pathways pursues international biodiversity goals together with a broader set of environmental sustainability objectives, including feeding the world, universal access to modern energy, limiting climate change and controlling air pollution. We show that different combinations of bio-physical measures, ecosystem management changes and behavioural changes can globally substantially reduce biodiversity loss in the coming decades (avoided Mean Species Abundance (MSA) loss is 4.4–4.8% MSA, compared to 9.5% MSA loss in the Trend), although the types of biodiversity conserved in the pathways will be different. The agricultural and forestry sectors together have until 2010 globally caused almost 60% of the total reduction in terrestrial biodiversity in MSA terms and 55% of the expected loss up to 2050. We show that increased productivity by technological improvements, increased use of ecological methods in agriculture and forestry, and consumption changes help to avoid biodiversity loss by 3.1–3.5% MSA. In addition, combinations of pathways, taking into account specific regional contexts, might result in even larger reduction of biodiversity loss. The changes needed in the agricultural and forestry sector to achieve this go well beyond current efforts to reduce their impact on biodiversity.

Homelessness is a global phenomenon that is escalating for economic, social, structural and political reasons. Many organisations render services to the homeless in the inner city of Tshwane (Region Three), but these services have not been explored. This article discusses a qualitative research study focusing on the social services rendered to the homeless in Tshwane Region Three. Beneficiaries of the services include men, women and children. Individual, family, group and community services are rendered. Services focus on basic needs, skills training and socio-emotional needs and are rendered from a strengths perspective. Research results indicate that the homeless are often involved in planning, assessing and implementing services. Service-rendering may be hindered by poor funding opportunities and ignorance of service providers regarding the content of policies and guiding documents. The lack of coordinated efforts can be ascribed to unawareness about the services rendered by other organisations. Recommendations include fostering collaboration between the government, Non-Governmental Organisations (NGOs) and Faith-Based Organisations (FBOs). Specific policy related to the homeless must be formulated to guide service providers to provide a legislative framework for funding, service delivery and the development of training and financing for staff and volunteers of NGOs.Keywords: homelessness; social services; strengths perspective; developmental welfare approach

Potchefstroom and the neighbouring cities rely mostly on the Mooi River and Vaal River for their water needs. These rivers flow through the gold mining areas and farms, and are therefore likely to be contaminated with substantial amounts of inorganic pollutants. Water was collected along the rivers network, streams, canals and dams in Potchefstroom and the vicinity. The samples were characterized for geochemical parameters, metals and anions concentrations. The results showed high concentrations of potentially toxic elements such as As (4.53 mg/L – 5.74 mg/L), Cd (0.25 mg/L – 0.7 mg/L), Pb (1.14 mg/L – 5.13 mg/L) and U (0.04 mg/L – 0.11 mg/L) which were predominantly found around the mining areas. Elevated concentrations of anions such SO 4 2- and CN − were detected around mining areas while NO 3 − was dominant near farms. The relatively high levels of anions and metals in the surface water made it unfit for domestic or agricultural use. The study showed that contaminants in mining and agricultural facilities were potentially mobilised, thus impacting the nearby water systems.

Corruption impacts egregiously on any and all of the fundamental rights enshrined in the Bill of Rights. However, a more positive relationship exists between corruption and human rights, in that th...

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.

The present paper proposes the application of the safe-by-design concept to crop breeding innovation with the aim to accommodate safety considerations for new agricultural food and feed products. Safe-by-design can be implemented in all stages of the innovation cycle of agricultural products, from the early stages of research and development towards the post-market stage. Our proposed application of safe-by-design can be part of “responsible research and innovation” concepts, because they share features such as risk prevention strategies and a participatory approach. Early awareness of potential safety issues can guide the development of agricultural products towards safe options, both at the process and product level, and thus may help to reduce extensive pre-market assessment studies that might otherwise be needed further downstream for regulatory product approval. Here, it is discussed how the proposed safe-by-design approach can be introduced into the development of safe food crops using emerging technologies, such as gene editing and synthetic biology, and how this may help to safeguard the safety of our food and feed supply in the light of the ongoing global innovations in agricultural crop breeding.

INTRODUCTION: From the perspective of patients, quality of care can be defined as the ability of healthcare products and services to satisfy their stated or implied needs. Dental professionals have a moral obligation to deliver the best quality care in today's increasingly informed, consumer-driven society AIM: To jumpstart the discussion on assessing quality of dental care, using patient perceptions DESIGN: A cross-sectional study of South African dental patients METHODS: Questionnaires were distributed to all non-emergency, adult patients at a teaching dental hospital in South Africa The outcome variables were: a) Access to Care; b) Technical Quality; c) Structure and Facilities; d) Communication; e) Global Rating of Safety. RESULTS: Overall, 58.6% of the participants had a positive view about the quality of dental care in South Africa. Age, race, marital status, child status, employment status, household income and educational status were associated with higher quality ratings THE QUESTION: "The instrument used in treating me appeared clean" (97.6%) was rated highly, while the question "Whenever I was sent to a new dentist, I had to repeat the tests that I did at the previous dentist" rated very low (36.9% CONCLUSIONS: The findings suggest that the dental profession still has challenges in meeting the expectations of patients

Article in press, Dynamic sitting, such as fidgeting and desk work, might be associated with health, but remains difficult toidentify out of accelerometry data. We examined, in a laboratory study, whether dynamic sitting can beidentified out of triaxial activity counts. Among 18 participants (56% men, 27.3 ± 6.5 years), up to 236 countsper minute were recorded in the anteroposterior and mediolateral axes during dynamic sitting using a hip-worn accelerometer. Subsequently, we examined in 621 participants (38% men, 80.0 ± 4.7 years) from theAGES-Reykjavik Study whether dynamic sitting was associated with cardio-metabolic health. Compared toparticipants who recorded the fewest dynamic sitting minutes (Q1), those with more dynamic sittingminutes had a lower BMI (Q2=−1.39 (95%CI =−2.33;–0.46); Q3=−1.87 (−2.82;–0.92); Q4=−3.38 (−4.32;–2.45)), a smaller waist circumference (Q2=−2.95 (−5.44;–0.46); Q3=−3.47 (−6.01;–0.93); Q4=−8.21 (−10.72;–5.71)), and a lower odds for the metabolic syndrome (Q2= 0.74 [0.45;1.20] Q3= 0.58 [0.36;0.95]; Q4=0.36[0.22;0.59]). Our findings suggest that dynamic sitting might be identified using accelerometry and that thisbehaviour was associated with health. This might be important given the large amounts of time peoplespend sitting. Future studies with a focus on validation, causation and physiological pathways are needed tofurther examine the possible relevance of dynamic sitting., This work was supported by the National Institute on Aging;National Institutes of Health [N01-AG-12100];FP7 People: Marie-Curie Actions (FP7- PEOPLE-2011-CIG) [PCIG09-GA-2011-293621];Icelandic Heart Association; Icelandic Parliament.

Genome editing is an emerging, new breeding technology with numerous potential applications in plant breeding. In Europe, genome editing is regarded, in legal terms, as a genetic modification technique, hence plants obtained using these methods fall under the legislation for genetically modified organisms (GMOs). Despite the opportunities that genome editing brings to the plant sector, it also poses challenges to the regulatory system. For example, the enforcement of labelling and traceability requirements for GM foods and feeds may be impossible for small genome edits that are indistinguishable from natural mutations. In order to discuss potential adaptations of EU legislation with stakeholders from the Dutch plant breeding sector, five different scenarios of future regulation of plants obtained by means of genome editing were elaborated. These scenarios were discussed in depth, along with the potential applications of genome editing in plant breeding, as well as challenges and opportunities. Stakeholders particularly indicated their preference for new, future-proof legislation in the long term, which will also include products of novel technologies. Finally, we discuss potential short-term amendments to current legislation, including the exemption of certain small mutations, that would make it align with regulation of genome edited plants in non-EU countries.

Introduction A 20 year review of health and health care presents the multiple challenges faced by South Africans. Health and poverty is highlighted with 45% of population living on approximately US$ 2 per day and 10 million living on less than US$ 1 per day. Widening disparities in health care provision between public and private sector hospital services exist. The South African population includes the largest number of people living with HIV infection/AIDS of any country in the world, with a 70% estimate of 7.5 million people living with HIV on antiretroviral therapy. The South African National Blood Service provides a mixed model therapeutic apheresis service including mobile service and fixed-site therapeutic apheresis and an apheresis collection of hematopoietic stem cell (HPC-A) service. Therapeutic apheresis modalities offered by SANBS include plasmapheresis, red cell exchange, leukocyte and platelet reduction. In addition, collection of plasma, thrombocytes, mononuclear cells including CD34+ cells (HPCs) and granulocytes by apheresis for plasma and cellular therapies, and customised apheresis products for research purposes is offered. An operational database for the period 2013 to 2020 was reviewed to characterise the SANBS’s mixed therapeutic apheresis service and HPC-A service from 2013 to 2020 in terms of patient numbers, patient demographics, patient procedures, therapeutic apheresis indication or diagnosis, therapeutic apheresis modality, hospital service type, and the American Society for Apheresis (ASFA) category of diagnosis. Methods A retrospective review of therapeutic apheresis patients referred to SANBS characterising patient numbers, patient demographics, patient procedures, therapeutic apheresis indication or diagnosis, therapeutic apheresis modality (Linz, 2017), hospital service type, and the ASFA category of diagnosis (Padmanabhan et al., 2019) for the period 01 January 2013 to 31 December 2020 was completed. Data is obtained from a SANBS operational routinely utilised to record patient procedure data. Patient procedure data is manually recorded by apheresis nurses and indexed on to the operational database, with both processes audited. The review period is a convenience sample. Storage of the database and access of the operational database is in compliance with the Protection of Personal Information Act (Government Gazette, 2013). Therapeutic apheresis modalities analysed include Plasmapheresis, Red Cell Exchange, Leukopheresis, Thrombocytapheresis, Lymphocyte collection, Granulocyte collection, Haematopoietic stem cell collection by apheresis and customised apheresis products for research purposes. Customised apheresis products for research purposes is excluded from this review. Descriptive statistics is used. Results For the review period, 2,485 unique patients with 120 unique indications as recorded by referring clinicians received 13,518 procedures involving 7 therapeutic apheresis modalities at 78 hospitals (21 public sector and 57 private sector) and at 3 SANBS blood donor centres in 7 provinces of South Africa. The age range of patients serviced is 4 months to 90 years (median = 39.5 years) (figure 1), 91% by procedure count was for patients 21 years of age or older, 62% were female, with 10,783 (79.6%) procedures performed in public sector hospitals. In all patients, the most common indications was plasmapheresis for thrombotic thromobocytopaenic purpura (52.5% of cumulative procedures), HPC-A for multiple myeloma (7.86%) and Antibody-mediated kidney transplant rejection (4.90%). Plasmapheresis was the most common therapeutic apheresis modality used (82.5% of cumulative procedures) followed by HPC-A (13.7%) and leukoreduction (3.39%). A range of indications for plasmapheresis (n = 65) and HPC-A (n = 41) were observed. Red cell exchange procedures was performed for patients with severe malaria and sickle cell disease indications. For leukoreduction indications, all patients were adults managed in public sector facilities and all were symptomatic. The most common indications were Chronic Myelogenous Leukemia, Chronic Lymphocytic Leukaemia and Multiple Myeloma. A pooled, total white cell count average of 457 × 109/L (range 141–689 × 109/L) prior to first procedure. Despite complex challenges for a national mixed model service, successful patient outcomes in emergent indications such as TTP (Louw et al., 2018; Swart et al., 2019) and engraftment post HPC-A in HSCT in multiple centres (Glatt, personal communication) are reported. Conclusion The review confirms that apheresis medicine is increasingly used in South Africa in patients in both public and private sector, with the most common modalities being plasmapheresis, HPC-A and leukoreduction. Patients with HIV-associated TTP is the most commonly referred patient in both paediatric and adult patients and this is anticipated to continue. A growing HSCT transplant network capacity in South Africa is augmented through the mixed model mobile and fixed-site therapeutic apheresis services, including a mobile HPC-A service. The increasing number of HPC-A is a trend towards increasing numbers of patients support to HSCT for both adults and paediatric patients in private and public sector hospitals.

Die Digitalisierung hat zu einem tiefgreifenden Wandel der Kultur- und Wissensproduktion geführt und neue Formen der Kulturvermittlung durch vielfältige kulturelle Öffentlichkeiten hervorgebracht. Vor diesem Hintergrund entwickeln sich die Kreativindustrien, erodiert der klassische und expandiert der neue Mediensektor, entstehen vielfältige Formen der Mitbestimmung und der Vernetzung. Damit sind die Erwartungen an die Mitgestaltung und -entwicklung von Kultur-, Medien- und Kreativformaten gestiegen. Dieser Umbruch von Praktiken, Wissensformen, Arbeitsweisen und – in der Folge – auch der Ökonomien im Kultur- und Medienbereich verlangt Pioniere, Gestalter, und Gründer eines neuen Typs. Die Neuordnung gesellschaftlicher Beteiligungsstrukturen und zivilgesellschaftlichen Engagements braucht ein spezifisches Management. Alternative Projekte suchen nach alternativen Finanzierungsstrategien, passgenauen Betreibermodellen und unabhängigen Kommunikationskanälen.

Introduction: About 5% of all strokes are subarachnoid hemorrhages (SAHs). Accurate segmentation and detection of SAH in CT scans is important because the SAH volume is linked to delayed cerebral ischemia and poor patient outcome. SAH segmentation is a difficult task with high interobserver variability. Previous studies reported a limited average Dice of 0.66 between expert radiologists. We studied the use of deep learning for fast and accurate detection and segmentation of SAH in CT scans. Methodology: A convolutional neural network (CNN) was designed for segmentation and detection of SAH in CT scans. This CNN was trained to classify each voxel as “SAH” or “no SAH”. The input of this CNN was the local information around the voxel and its output was the probability that this voxel is “SAH” or “no SAH”. We used active learning for optimal selection of training samples. By doing so, we boosted the learning performance while keeping a balanced representation of both classes of voxels. Results: The CNN segmented 469 scans from SAH patients and achieved an average Dice of 0.62 ± 0.16 [0.19, 0.92] (avg. ± std. [min., max.]). The CNN also segmented 383 scans from patients with repeated bleeding after an initial SAH. Because most of these patients were treated with endovascular coiling, strong metal artefacts were present in these 383 scans. Regardless of these metal artefacts, an average Dice of 0.66 ± 0.19 [0.05, 0.92] was achieved. Finally, the CNN was used for detection of SAH in 35 scans from SAH patients and 35 images from ischemic stroke patients. The proposed CNN achieved an accuracy of 96% for detection of SAH in these 70 images. The CNN took less than 40 seconds to analyze a CT scan. Conclusion: The proposed CNN can produce SAH segmentations with a similar accuracy as expert radiologists. This CNN was able to reach state-of-the-art SAH segmentation results and SAH detection accuracy.

ObjectiveCombined paediatric and forensic medical expertise to interpret physical findings is not available in Dutch healthcare facilities. The Dutch Expertise Centre for Child Abuse (DECCA) was founded in the conviction that this combination is essential in assessing potential physical child abuse. DECCA is a collaboration between the three paediatric hospitals and the Netherlands Forensic Institute. DECCA works with Bayes’ theorem and uses likelihood ratios in their conclusions.DesignWe present the implementation process of DECCA and cross-sectional data of the first 4 years.ParticipantsBetween 14 December 2014 and 31 December 2018, a total of 761 advisory requests were referred, all of which were included in this study. An advisee evaluation over the year 2015 was performed using a self-constructed survey to gain insight in the first experiences with DECCA.Results761 cases were included, 381 (50.1%) boys and 361 (47.4%) girls (19 cases (2.5%) sex undisclosed). Median age was 1.5 years (range 1 day to 20 years). Paediatricians (53.1%) and child safeguarding doctors (21.9%) most frequently contacted DECCA. The two most common reasons for referral were presence of injury/skin lesions (n=592) and clinical history inconsistent with findings (n=145). The most common injuries were bruises (264) and non-skull fractures (166). Outcome of DECCA evaluation was almost certainly no or improbable child abuse in 35.7%; child abuse likely or almost certain in 24.3%, and unclear in 12%. The advisee evaluations (response rate 50%) showed that 93% experienced added value and that 100% were (very) satisfied with the advice.ConclusionData show growing interest in the expertise of DECCA through the years. DECCA seems to be a valuable addition to Dutch child protection, since advisee value the service and outcome of DECCA evaluations. In almost half of the cases, DECCA concluded that child abuse could not be substantiated.

OBJECTIVE Posttransplantation diabetes mellitus (PTDM) contributes to risk for cardiovascular morbidity and mortality in renal transplant recipients (RTRs). In the general population, consumption of a diet containing few fruits and vegetables predisposes to type 2 diabetes. The role of diet as a potential modifiable risk factor for PTDM has not been explored. Our focus was to investigate the prospective associations of fruit and vegetable intake with risk of PTDM in stable RTRs. RESEARCH DESIGN AND METHODS We included 472 adult RTRs who had a functioning graft ≥1 year. Fruit and vegetable intake was assessed by using a 177-item food frequency questionnaire. PTDM was defined according the American Diabetes Association’s diagnostic criteria for diabetes. RESULTS During 5.2 years of follow-up, 52 RTRs (11%) developed PTDM. Fruit intake was not associated with PTDM (hazard ratio [HR] 0.90 [95% CI 0.79–1.03] per 2log g/day; P = 0.13), whereas vegetable intake was inversely associated with PTDM (HR 0.77 [95% CI 0.63–0.94] per 2log g/day; P = 0.009). Mediation analyses revealed that ±50% of the association between vegetable intake and PTDM was mediated by variations in key components of the metabolic syndrome (i.e., HDL cholesterol, triglycerides, and waist circumference) as determined by the National Cholesterol Education Program’s Adult Treatment Panel III Expert Panel. CONCLUSIONS In this study vegetable intake, but not fruit intake, was associated with lower risk of PTDM in RTRs, likely largely through beneficial effects on key components of the metabolic syndrome. These findings further support accumulating evidence that supports a recommendation of higher vegetable intake by RTRs.

This document discusses recent developments in cloning of husbandry animals through somatic cell nuclear transfer, particularly with a view on improvements in their efficacy. Commercial developments in North and South America, Australia-New Zealand, and China are noted. The regulations and safety aspects surrounding the use of clones and their offspring for the purpose of food production are discussed. It is generally considered that foods from offspring of clones are no different than similar foods from conventional animals, yet besides safety, also ethical and animal welfare considerations come into play at the policy level. The related topic of detection and traceability of clones is discussed, which covers both molecular and documentary methods.

An almost unnoticed problem in the South African education system is the high rate of grade repetition. In this report, a combination of household and administrative datasets is used to identify patterns in learner repetition and dropout in South African schooling and the costs associated with these issues. According to the most conservative estimate, the number of learners in public schools repeating in grades 1 to 12 could have been 1 180 000. In monetary terms, this implies that the cost of having repeaters in the public education system was at least R20 billion (in 2018 prices), absorbing 8% of the total national budget allocated to basic education in 2018/2019. At least a half of these repetition costs is attributed to the high prevalence of repetition in the secondary school phase, with the largest number of repeaters located in grade 10 (at least 1 in every 5 grade 10 learners repeat). Despite the promulgation of repetition policy that limits the number of times learners can repeat a school phase, repetition trends in the past decade display a strong inertia, especially in higher grades. To monitor these trends better, and to track the implementation of these policies, significant improvements will need to be made to the quality of reporting on repeaters and dropout in EMIS data. While repetition is a problem, it is merely a symptom of a weakly functioning education system. The repetition debate is thus secondary to the need to address the quality of the education provided in our schools, and particularly in the foundation phase. Quality improvements will also make it easier to implement sensible policies on repetition and to provide remediation and support where these are needed. Moreover, by freeing resources currently needed to deal with repetition, improved education quality would also make remediation more feasible.

AIMS/HYPOTHESIS: The study investigated cross-sectional associations of total amount and patterns of sedentary behaviour with glucose metabolism status and the metabolic syndrome. METHODS: We included 2,497 participants (mean age 60.0 +/- 8.1 years, 52% men) from The Maastricht Study who were asked to wear an activPAL accelerometer 24 h/day for 8 consecutive days. We calculated the daily amount of sedentary time, daily number of sedentary breaks and prolonged sedentary bouts (>/=30 min), and the average duration of the sedentary bouts. To determine glucose metabolism status, participants underwent an oral glucose tolerance test. Associations of sedentary behaviour variables with glucose metabolism status and the metabolic syndrome were examined using multinomial logistic regression analyses. RESULTS: Overall, 1,395 (55.9%) participants had normal glucose metabolism, 388 (15.5%) had impaired glucose metabolism and 714 (28.6%) had type 2 diabetes. The odds ratio per additional hour of sedentary time was 1.22 (95% CI 1.13, 1.32) for type 2 diabetes and 1.39 (1.27, 1.53) for the metabolic syndrome. No significant or only weak associations were seen for the number of sedentary breaks, number of prolonged sedentary bouts or average bout duration with either glucose metabolism status or the metabolic syndrome. CONCLUSIONS/INTERPRETATION: An extra hour of sedentary time was associated with a 22% increased odds for type 2 diabetes and a 39% increased odds for the metabolic syndrome. The pattern in which sedentary time was accumulated was weakly associated with the presence of the metabolic syndrome. These results suggest that sedentary behaviour may play a significant role in the development and prevention of type 2 diabetes, although longitudinal studies are needed to confirm our findings.

Introduction: Sedentary time has been associated with detrimental health effects, so in some countries, guidelines to reduce sedentary time have been developed. As reducing sedentary time inevitably results in more nonsedentary time, effects of this reduction may depend on the activity with which it is replaced. Purpose: This study aimed to examine associations of theoretical reallocations of sedentary time to standing or stepping with cardiometabolic outcomes and type 2 diabetes. Methods: We included 2213 participants (51% men, mean +/- SD age = 60.0 +/- 8.1 yr) of the Maastricht Study who were asked to wear an accelerometer 24 h.d(-1) for a week. We calculated daily sedentary, standing, and stepping time. An isotemporal substitution modeling approach was applied to examine effects on waist circumference; body mass index; cholesterol, triacylglycerol, glucose, and insulin levels; metabolic syndrome; and type 2 diabetes. Results: Replacement of sedentary time (30 min.d(-1)) with stepping was associated with lower odds for metabolic syndrome (odds ratio [OR] = 0.72, 95% confidence interval [CI] = 0.66-0.78) and type 2 diabetes (OR = 0.79, 95% CI = 0.72-0.87), more favorable waist circumference (B = -1.42, 95% CI = -1.78 to -1.06), and body mass index (B = -0.48, 95% CI = -0.62 to -0.35) and improved cholesterol, triacylglycerol, glucose, and insulin levels. Replacing sedentary time with standing was associated with lower odds for metabolic syndrome and type 2 diabetes and favorable outcomes in waist circumference, cholesterol, triacylglycerol, and insulin levels. Conclusion: Theoretical replacements of sedentary time with nonsedentary time (both standing and stepping) were associated with lower odds for metabolic syndrome, type 2 diabetes, and beneficial metabolic outcomes. These results could be important for the general population, including those who cannot meet physical activity guidelines. Consideration should be given to developing recommendations for daily reallocating sedentary time. This study was supported by the European Regional Development Fund via OP-Zuid, the Province of Limburg, the Dutch Ministry of Economic Affairs (grant no. 31O.041), Stichting De Weijerhorst (Maastricht, the Netherlands), the Pearl String Initiative Diabetes (Amsterdam, the Netherlands), the Cardiovascular Center (CVC, Maastricht, the Netherlands), CARIM School for Cardiovascular Diseases (Maastricht, the Netherlands), CAPHRI School for Public Health and Primary Care (Maastricht, the Netherlands), NUTRIM School for Nutrition and Translational Research in Metabolism (Maastricht, the Netherlands), Stichting Annadal (Maastricht, the Netherlands), and Health Foundation Limburg (Maastricht, the Netherlands) and by unrestricted grants from Janssen-Cilag B.V. (Tilburg, the Netherlands), Novo Nordisk Farma B.V. (Alphen aan den Rijn, the Netherlands), and Sanofi-Aventis Netherlands B.V. (Gouda, the Netherlands). A Koster has received funding from the European Union Seventh Framework Programme (FP7-PEOPLE-2011-CIG) under grant agreement PCIG09-GA-2011-293621.

In recent years, there has been an increase in research studies highlighting patients' experiences of adverse events (AEs) as well as the role of patients in promoting safety. The primary goal of the study was to assess the prevalence of dental AEs (DAEs) among dental patients in South Africa and its associated factors. The integration of the patient perspective into dental patient safety research will enhance our collective understanding of DAEs.We conducted a cross-sectional study of adult patients at a large dental academic institution in South Africa from May to June 2015, evaluating their previous experiences of DAEs at any dental clinic in South Africa. Descriptive statistics and bivariate and multivariate analyses were performed to identify the factors associated with an increased likelihood of experiencing a DAE.A total of 440 questionnaires were returned during the 6-week study period (response rate = 97.8%). Overall, 45.5% of participants reported experiencing one or more DAEs. Two hundred participants reported a total of 717 DAEs giving us a lifetime prevalence of 1.6 DAEs per respondent. Our results suggest that respondents who were younger (18-24 y), from high-income families (R150,000 or US $9200), dissatisfied with their last dental visit and oral health had an increased likelihood of reporting a previous experience of a DAE.This study provides an insight into the nature of information that can be gleaned from dental patients regarding safety and helps lay the foundation for patient involvement in patient safety reporting.

Background Chronic kidney disease, which is defined as having a reduced kidney function (estimated glomerular filtration rate (eGFR)) and/or signs of kidney damage (albuminuria), is highly prevalent in Western society and is associated with adverse health outcomes, such as cardiovascular disease. This warrants a search for risk factors of lower eGFR and higher albuminuria. Physical activity and sedentary behavior may be such risk factors. Objective To examine associations of physical activity (total, high, low), sedentary time and sedentary behavior patterns (breaks, prolonged bouts, average bout duration) with eGFR and albuminuria. Methods We examined these associations in 2,258 participants of the Maastricht Study (average age 60.1±8.1 years; 51.3% men), who wore an accelerometer 24h/day on 7 consecutive days. Associations with continuous eGFR and categories of urinary albumin excretion (UAE

The realisation of socio-economic rights constitutes a critical prerequisite in the struggle to eradicate poverty and inequality in South Africa. State resource allocation lies at the heart of the realisation of socio-economic rights. Courts will often be called upon to adjudicate complex, polycentric prioritisation decisions taken by the state. An appropriate review paradigm can aid courts in performing this onerous task. Capabilities, as the substantive freedom to choose the lives we have reason to value, resonate strongly with the socio-economic rights enshrined in the Constitution of the Republic of South Africa, 1996. The capabilities approach can therefore be developed to constitute a capabilities-based standard of review for the adjudication of state resource allocation decisions. The need for such a theoretically justified standard of review becomes apparent from the Constitutional Court's insufficient focus on the content of socio-economic rights, and from the maintenance of a rigid distinction between the positive and negative duties imposed upon the state by socio-economic rights

We examined the associations of sedentary behavior and high intensity physical activity (HPA) with physical fitness in 1,897 men and women aged 40–75 years from The Maastricht Study. Sedentary behavior and HPA (time/day) were measured continuously with the activPAL3 during 7 days. Physical fitness was expressed as 1) maximum power output (Wmax kg-1) estimated from a sub-maximal cycle ergometer test and 2) covered distance (m) from fast-paced 6 minute walk test (6MWD). Mean (±SD) sedentary time was 9.3 ± 1.6 hours and median [25%-75%] time in HPA was 19.8[10.1–31.1] minutes. One hour less sedentary behavior was associated with a higher Wmax kg-1 (B= 0.022) and longer 6MWD (B= 2.455) independent of HPA (p

We examined associations of theoretical reallocations of sedentary time to standing or stepping with cardio-metabolic risk factors and type 2 diabetes (T2D) in The Maastricht Study. Participants (n=2,213, 52% men, mean±SD age 60.0 ± 0.8 years), who were asked to wear an activPAL accelerometer for 8 days were included. Daily amounts sedentary, standing, and stepping time were calculated. An isotemporal substitution modelling approach was applied to examine replacement effects on waist circumference, body mass index (BMI), blood pressure, levels of cholesterol, triglycerides, glucose, and insulin, HbA1c, and T2D. Replacement of sedentary time (30 min/day) with stepping was associated with a 1.42 cm (B=-1.42, (95%CI=-1.78,-1.06)) smaller waist circumference, a 0.48 kg/m2 (B=-0.48 (-0.62,-0.35)) lower BMI, a lower odds for and T2D (0.79 (0.72,0.87), and improved cholesterol, triglyceride and glucose levels. Replacing sedentary time with standing was associated with favourable outcomes in waist circumference, and cholesterol, triglyceride and insulin levels.

OBJECTIVES: The study investigated whether dentists in South Africa are actively planning for retirement and if they are confident about being able to retire as financially independent. METHODS: An anonymous online questionnaire was used to collect data from private dental practitioners who were members of the South African Dental Association. Stata release 11 was used for descriptive statistical analysis. RESULTS: The majority of the respondents (71%) were male and 42% of respondents were older than 50 years of age. It was mostly the older respondents, namely 71% of 41-50 year old respondents, 94% of 51-60 year old respondents and 72 % of respondents older than 60 years, who were actively planning for financial independence at retirement. More than half of the respondents (54.35%) were not confident that they would be able to retire as financially independent and think they will have to postpone their retirements. CONCLUSION: Retirement planning is much more complex than simply contributing to a pension, provident or retirement annuity fund. Dental schools can play an important role in equipping dentists with the necessary knowledge and skills to enable proper retirement planning, and to encourage early retirement saving and investment to ultimately ensure financially independent retirement.

Contains fulltext : 174660.pdf (Publisher’s version ) (Open Access) Background: In an aging population, regular physical activity (PA) and exercise have been recognized as important factors in maintaining physical function and thereby preventing loss of independence and disability. However, (older) adults spent the majority of their day sedentary and therefore insight into the consequences of sedentary behavior on physical function, independent of PA, is warranted. Objective: To examine the associations of objectively measured sedentary time (ST), patterns of sedentary behavior, overall PA, and higher intensity PA (HPA) with objective measures of physical function. Methods: This is a cross-sectional study in 1,932 men and women (aged 40-75 years) participating in The Maastricht Study. The activPAL3 was used to assess daily sedentary behavior: ST (h), sedentary breaks (n), prolonged (>/=30 min) sedentary bouts (n), and to assess time spent in (H)PA (h). Measures of physical function included: covered distance during a 6 min walk test [6MWD (meters)], timed chair rise stand test performance [TCSTtime (seconds)], grip strength (kg kg-1), and elbow flexion and knee extension strength (Nm kg-1). Linear regression analyses were used to examine associations between daily sedentary behavior and PA with physical function. Results: Every additional hour ST was associated with shorter 6MWD [B = -2.69 m (95% CI = -4.69; -0.69)] and lower relative elbow extension strength (B = -0.01 Nm kg-1 (-0.02; 0.00). More sedentary breaks were associated with faster TCSTtime: B = -0.55 s (-0.85; -0.26). Longer average sedentary bout duration was associated with slower TCSTtime [B = 0.17 s (0.09; 0.25)] and lower knee extension strength [B = -0.01 Nm kg-1 (-0.02; 0.00)]. Every hour of PA and HPA were associated with greater 6MWD [BPA = 15.88 m (9.87; 21.89), BHPA = 40.72 m (30.18; 51.25)], faster TCSTtime [BPA = -0.55 s (-1.03; -0.07), BHPA = -2.25 s (-3.09; -1.41)], greater elbow flexion strength [BPA = 0.03 Nm kg-1 (0.01; 0.07)], [BHPA = 0.05 Nm kg-1 (0.01; 0.08)], and greater knee extension strength [BPA = 0.04 Nm kg-1 (0.01; 0.07)], [BHPA = 0.13 Nm kg-1 (0.06; 0.20)]. Conclusion: In adults aged 40-75 years, sedentary behavior appeared to be marginally associated with lower physical function, independent of HPA. This suggests that merely reducing sedentary behavior is insufficient to improve/maintain physical function. In contrast, engaging regularly in PA, in particular HPA, is important for physical function.

VAN DER BERG, J. D., H. BOSMA, P. CASEROTTI, G. EIRIKSDOTTIR, N. Y. ARNARDOTTIR, K. R. MARTIN, R. J. BRYCHTA, K. Y. CHEN, T. SVEINSSON, E. JOHANNSSON, L. J. LAUNER, V. GUDNASON, P. V. JONSSON, C. D. STEHOUWER, T. B. HARRIS, and A. KOSTER. Midlife Determinants Associated with Sedentary Behavior in Old Age. Med. Sci. Sports Exerc., Vol. 46, No. 7, pp. 1359–1365, 2014. Background: Sedentary behavior is associated with adverse health effects. Insights into associated determinants are essential to prevent sedentary behavior and limit health risks. Sedentary behavior should be viewed as a distinct health behavior; therefore, its determinants should be independently identified. Purpose: This study examines the prospective associations between a wide range of midlife determinants and objectively measured sedentary time in old age. Methods: Data from 565 participants (age 73–92 yr) of the AGESII-Reykjavik Study were used. Participants wore an accelerometer (ActiGraph GT3X) on the right hip for seven consecutive days. On average, 31 yr earlier (during midlife), demographic, socioeconomic, lifestyle, and biomedical factors were collected. Linear regression models were used to examine prospective associations between midlife determinants and sedentary time (G100 counts per minute) in old age. Results: After adjustment for sex, age, follow-up time, minutes of moderate to vigorous physical activity, body mass index, health status, mobility limitation, and joint pain in old age, the midlife determinants not being married, primary education, living in a duplex or living in an apartment (vs villa), being obese, and having a heart disease were associated with, on average, 15.3, 12.4, 13.5, 13.3, 21.8, and 38.9 sedentary minutes more per day in old age, respectively. Conclusions: This study shows that demographic, socioeconomic, and biomedical determinants in midlife were associated with considerably more sedentary time per day in old age. These results can indicate the possibility of predicting sedentariness in old age, which could be used to

Multinational corporations are being pressed to improve the social justice and environmental stewardship of their global value chains (i.e., organizational groups involved in the production, transp...

It is anticipated that the occurrence and intensity of disasters will increase globally and in South Africa where typical disasters include droughts, floods, extreme hailstorms, gales, fires and earthquakes, as well as sinkholes arising from mining activity in dolomitic areas. Disasters such as these result in human suffering and damage to the resources and infrastructure on which South Africans rely for their survival and the maintenance of their quality of life. Section 24 of the Constitution of the Republic of South Africa, 1996 affords to everyone the right to an environment that is not harmful to his or her health and well-being. It may be argued that a person's sense of environmental security in relation to the potential risks and dangers of disaster falls within the scope of the protection provided by section 24. The responsibility to intervene for the protection of the interests inherent in the constitutional environmental right lies with the government of South Africa. Disaster management specifically is a functional area of competence of national and provincial government, but practice has shown that the actual implementation of and planning for disaster management happens in the local government sphere. Against the backdrop of these introductory discussions and, given the fact that several municipalities in South Africa are under-resourced, this article very specifically aims to critically discuss and describe from a legal perspective the potential and function of public-private partnerships (PPPs) between local government (municipalities) and the private sector (such as industries) in fulfilling the legally entrenched disaster management mandate of municipalities. Through a critical evaluation of some existing PPPs, this article illustrates that the private sector has a key role to play in assisting municipalities to fulfil their legally entrenched disaster management mandate.KEYWORDS: local government; local disaster management; disaster management;public-private partnerships.

Purpose: This cross-sectional study examined the mutual independent associations of sedentary behavior, lower intensity physical activity (LPA) and higher intensity physical activity (HPA) (an approximation of moderate to vigorous physical activity with cardiorespiratory fitness (CRF). Methods: Two thousand twenty-four participants were included from The Maastricht Study (mean +/- SD age, 59.7 +/- 8.1 yr; 49.6% men). With the activPAL3 activity monitor, we assessed sedentary time (ST), sedentary pattern variables (number of sedentary breaks, average sedentary bout duration, and number of prolonged sedentary bouts [>= 30 min]), LPA, and HPA. CRF was calculated as maximum power output per kilogram body mass (W-max.kg(-1)) estimated from a submaximal cycle ergometer test. Linear regression analyses and isotemporal substitution analyses were used to examine associations of ST, sedentary pattern variables, and HPA with CRF. Analyses were stratified by sex. Results: One hour of ST per day was associated with a lower W-max.kg(-1) : B-men = -0.03 (95% confidence interval [CI], -0.05 to -0.01) and B-women = -0.02 (95% CI, -0.04 to 0.00), independent of HPA. No statistically significant associations between sedentary patterns variables and CRF were observed. LPA was associated with a higher W-max.kg(-1): B-men = 0.12 (95% CI, 0.07-0.17) and B-women = -0.12 (95% CI, 0.07-0.18). HPA was associated with a higher W-max.kg(-1) : B-men = 0.48 (95% CI, 0.38-0.58) and B-women = 0.27 (95% CI, 0.18-0.36). Replacing ST with LPA (B-men, 0.08; 95% CI, 0.03-0.14; B-women, 0.10; 95% CI, 0.05-0.16) or with HPA (B-men, 0.49; 95% CI, 0.39-0.59; B-women = 0.28; 95% CI, 0.19-0.36), but not with standing was associated with higher CRF. Conclusions: Modest associations between sedentary behavior and CRF were observed. Replacing ST with LPA was associated with higher CRF, which could be of particular importance for individuals who cannot engage in HPA. Nonetheless, replacing ST with HPA was associated with greatest estimated change in CRF.

Recent developmental frameworks suggest that dental curricula should focus on developing nonclinical skills in dental students. The aim of this study was to qualitatively map students’ perceptions of the most important nonclinical skills against the Medical Leadership Competency Framework (MLCF). A representative sample of second- to fifth-year students (n=594; overall response rate 69%) from all four dental schools in South Africa participated in a cross-sectional survey in 2014–15 enquiring about nonclinical skills and dental practice management. One of the questions required students to list the four most important nonclinical skills required for a dentist. Students (n=541) most frequently noted competencies related to working with others (97.9%), personal qualities (72.3%), and managing services (42.9%) as the most important nonclinical skills. Very few students mentioned competencies related to the improvement of services (14.1%) and the provision of strategic direction (10.9%). The students’ attention appeared to be on nonclinical skills generally required for clinical care with some realization of the importance of managing services, indicating a need for a stronger focus on leadership and management training in dental schools in South Africa. The results also helped to unravel some of the conceptual ambiguity of the MLCF and highlight opportunities for leadership research using the MLCF as a conceptual framework.

Please cite this paper as: Tajik P, van der Tuuk K, Koopmans C, Groen H, van Pampus M, van der Berg P, van der Post J, van Loon A, de Groot C, Kwee A, Huisjes A, van Beek E, Papatsonis D, Bloemenkamp K, van Unnik G, Porath M, Rijnders R, Stigter R, de Boer K, Scheepers H, Zwinderman A, Bossuyt P, Mol B. Should cervical favourability play a role in the decision for labour induction in gestational hypertension or mild pre-eclampsia at term? An exploratory analysis of the HYPITAT trial. BJOG 2012;119:11231130. Objective To examine whether cervical favourability (measured by cervical length and the Bishop score) should inform obstetricians decision regarding labour induction for women with gestational hypertension or mild pre-eclampsia at term. Design A post hoc analysis of the Hypertension and Pre-eclampsia Intervention Trial At Term (HYPITAT). Setting Obstetric departments of six university and 32 teaching and district hospitals in the Netherlands. Population A total of 756 women diagnosed with gestational hypertension or pre-eclampsia between 36 + 0 and 41 + 0 weeks of gestation randomly allocated to induction of labour or expectant management. Methods Data were analysed using logistic regression modelling. Main outcome measures The occurrence of a high-risk maternal situation defined as either maternal complications or progression to severe disease. Secondary outcomes were caesarean delivery and adverse neonatal outcomes. Results The superiority of labour induction in preventing high-risk situations in women with gestational hypertension or mild pre-eclampsia at term varied significantly according to cervical favourability. In women who were managed expectantly, the longer the cervix the higher the risk of developing maternal high-risk situations, whereas in women in whom labour was induced, cervical length was not associated with a higher probability of maternal high-risk situations (test of interaction P = 0.03). Similarly, the beneficial effect of labour induction on reducing the caesarean section rate was stronger in women with an unfavourable cervix. Conclusion Against widely held opinion, our exploratory analysis showed that women with gestational hypertension or mild pre-eclampsia at term who have an unfavourable cervix benefited more from labour induction than other women. Trial registration The trial has been registered in the clinical trial register as ISRCTN08132825.

Social spending has become a major tool of targeting resources to South Africa's poor. The poor now get considerably more than their population share of social spending, but the underlying distribution of income is so skewed that overall post-fiscal inequality has not improved much. Concentration ratios and curves show considerable shifts in social spending incidence in the period 1995 to 2006. However, the efficiency of that spending is low, resulting in limited social outcomes and consequently also limited gains to the poor from better targeting. This paper therefore calls for the South African policy discussion to shift to why the ever-increasing fiscal inputs and improved targeting of those inputs have not produced the desired social outcomes.