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The article explores the causal effect of local climate conditions on household consumption in South Africa. The climatic conditions are represented by monthly average temperature and precipitation. The study utilises the nationally representative 2017 National Income Dynamics Study (NIDS), wave 5 data and 2017 Climate Research Unit (CRU) climate data. The parsimonious quantile regression shows that climatic conditions (precipitation, temperature, wet days, and cloud cover) impact household per capita consumption. The quadratic quantile regression model analysis shows that household per capita consumption is convex in precipitation. Below the turning point, increased precipitation is associated with decreased household per capita consumption. Above the turning point, increased precipitation is related to increased household per capita consumption. Regions that receive very low precipitation or experience extreme temperatures (very cold or very hot) require tailor-made interventions to alleviate consumption. When we control for household characteristics, the impact of climatic conditions on household per capita consumption is weak. Providing inclusive development policies and programmes can mitigate the impact of climatic conditions on household per capita consumption. [ABSTRACT FROM AUTHOR]

Amphibians play an important role in the functioning of ecosystems and some of them inhabit human gardens where they can successfully reproduce. The decline of amphibian diversity worldwide suggests that people may play a crucial role in their survival. We conducted a cross-cultural study on high school students' tolerance of frogs in Chile, Slovakia, South Africa and Turkey (n = 655 high school students). We found that about 6% of students reported active killing of frogs and 30% reported moving frogs away from their home gardens. Pathogen disgust negatively correlated with frog tolerance suggesting that people who are more sensitive to pathogen connoting cues are less tolerant toward frogs. Tolerance of frogs in parents or other family members appears to significantly influence student tolerance of frogs. Females tended to show higher tolerance of frogs than males. This study highlights the importance of the emotion of disgust in human willingness to protect frogs from a cross-cultural perspective.

Transportation of incompatible items is a major problems for the logistic operators. Again today ceo-aware transportation is very much appreciated by the international bodies. In a transportation system, the realization of carbonemission can be incorporated as an important part of optimization. Now, the infrastructure of surface transportation is developed through the world including third world countries (like India, South-africa, Bangladesh, etc). In the present study, we incorporated the above problems and developed profit maximization of solid transportation problem with carbon emission under type-2 Fuzzy environment. So, a new concept to solve profit maximization transportation problem including sales revenue, purchase cost, transportation cost, procurement cost and carbon-emission cost has been proposed while transporting some goods from sources to destinations. In this model, two transportation schemes with carbon emission (WCE) and with out carbon-emission (WOCE) have been designed. We consider maximization of the total profit in these two models. In the model few parameters are treated as Gaussion fuzzy type-2 variable i.e. purchase cost, selling price, transportation and procurement cost. Critical Value (CV) based reduction help us to transform fuzzy type-2 to type-1 variable. To solve the problem in deterministic way we have to utilized Genetic Algorithm (GA). Finally, numerical results presented to establish the originality of the investigation. [ABSTRACT FROM AUTHOR]

Background: Multiple acyl-CoA dehydrogenase deficiency (MADD) is an autosomal recessive disorder resulting from pathogenic variants in three distinct genes, with most of the variants occurring in the electron transfer flavoprotein-ubiquinone oxidoreductase gene (ETFDH). Recent evidence of potential founder variants for MADD in the South African (SA) population, initiated this extensive investigation. As part of the International Centre for Genomic Medicine in Neuromuscular Diseases study, we recruited a cohort of patients diagnosed with MADD from academic medical centres across SA over a three-year period. The aim was to extensively profile the clinical, biochemical, and genomic characteristics of MADD in this understudied population. Methods: Clinical evaluations and whole exome sequencing were conducted on each patient. Metabolic profiling was performed before and after treatment, where possible. The recessive inheritance and phase of the variants were established via segregation analyses using Sanger sequencing. Lastly, the haplotype and allele frequencies were determined for the two main variants in the four largest SA populations. Results: Twelve unrelated families (ten of White SA and two of mixed ethnicity) with clinically heterogeneous presentations in 14 affected individuals were observed, and five pathogenic ETFDH variants were identified. Based on disease severity and treatment response, three distinct groups emerged. The most severe and fatal presentations were associated with the homozygous c.[1067G > A];c.[1067G > A] and compound heterozygous c.[976G > C];c.[1067G > A] genotypes, causing MADD types I and I/II, respectively. These, along with three less severe compound heterozygous genotypes (c.[1067G > A];c.[1448C > T], c.[740G > T];c.[1448C > T], and c.[287dupA*];c.[1448C > T]), resulting in MADD types II/III, presented before the age of five years, depending on the time and maintenance of intervention. By contrast, the homozygous c.[1448C > T];c.[1448C > T] genotype, which causes MADD type III, presented later in life. Except for the type I, I/II and II cases, urinary metabolic markers for MADD improved/normalised following treatment with riboflavin and L-carnitine. Furthermore, genetic analyses of the most frequent variants (c.[1067G > A] and c.[1448C > T]) revealed a shared haplotype in the region of ETFDH, with SA population-specific allele frequencies of < 0.00067–0.00084%. Conclusions: This study reveals the first extensive genotype–phenotype profile of a MADD patient cohort from the diverse and understudied SA population. The pathogenic variants and associated variable phenotypes were characterised, which will enable early screening, genetic counselling, and patient-specific treatment of MADD in this population. [ABSTRACT FROM AUTHOR]

This article reports on the introduction of a business communication course in the curriculum of postgraduate internal audit students at a higher education institution in South Africa. Internal auditors should have excellent verbal and written communication skills in performing value-adding assurance and consulting services to their engagement clients. A hands-on applied business communication course was developed in collaboration with a number of stakeholders to improve the communication skills of postgraduate internal audit students using the action research methodology. Data were gathered from these students to determine the benefits of an applied business communication course. The study found that a learning need had been addressed and that an applied business communication course has several benefits, such as promoting teamwork, building confidence, improving presentation skills and ultimately preparing postgraduate students for communicating effectively at work.

Introduction: Limited diagnostics are available for inherited neuromuscular diseases (NMD) in South Africa and (excluding muscle disease) are mainly aimed at the most frequent genes underlying genetic neuropathy (GN) and spastic ataxias in Europeans. In this study, we used next-generation sequencing to screen 61 probands with GN, hereditary spastic paraplegia (HSP), and spastic ataxias for a genetic diagnosis. Methods: After identifying four GN probands with PMP22 duplication and one spastic ataxia proband with SCA1, the remaining probands underwent whole exome (n = 26) or genome sequencing (n = 30). The curation of coding/splice region variants using gene panels was guided by allele frequencies from internal African-ancestry control genomes (n = 537) and the Clinical Genome Resource's Sequence Variant Interpretation guidelines. Results: Of 32 GN probands, 50% had African-genetic ancestry, and 44% were solved: PMP22 (n = 4); MFN2 (n = 3); one each of MORC2, ATP1A1, ADPRHL2, GJB1, GAN, MPZ, and ATM. Of 29 HSP probands (six with predominant ataxia), 66% had African-genetic ancestry, and 48% were solved: SPG11 (n = 3); KIF1A (n = 2); and one each of SPAST, ATL1, SPG7, PCYT2, PSEN1, ATXN1, ALDH18A1, CYP7B1, and RFT1. Structural variants in SPAST, SPG11, SPG7, MFN2, MPZ, KIF5A, and GJB1 were excluded by computational prediction and manual visualisation. Discussion: In this preliminary cohort screening panel of disease genes using WES/WGS data, we solved ~50% of cases, which is similar to diagnostic yields reported for global cohorts. However, the mutational profile among South Africans with GN and HSP differs substantially from that in the Global North. [ABSTRACT FROM AUTHOR]

Describes the outcomes of a pilot project which was designed to predate an expanded Concentrated Language Encounter (CLE) literacy development program in the Western Cape region of South Africa. Discusses lessons learned from this pilot program. Highlights the value of pilot programs in general. (PM)

Clivia miniata (Amaryllidaceae) is an herbaceous evergreen flowering plant that is endemic to South Africa and Swaziland and belongs to one of the top-10 traded medicinal plants in informal medicine markets in South Africa. The species has been reported as the most important component of a traditional healer's pallet of healing plants. Eighteen known Amaryllidaceae alkaloids (AAs) of various structural types, and one undescribed alkaloid of homolycorine-type, named clivimine B (3), were isolated from Clivia miniata. The chemical structures of the isolated alkaloids were elucidated by a combination of MS, HRMS, 1D and 2D NMR techniques and by comparison with literature data. Compounds isolated in a sufficient quantity, and not tested previously, were evaluated for their in vitro acetylcholinesterase (AChE; E.C. 3.1.1.7) and butyrylcholinesterase (BuChE; E.C. 3.1.1.8) inhibition activities. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic and associated restrictions could adversely affect long-term HIV care. We evaluated the experiences of people receiving antiretroviral therapy (ART) through a decentralized delivery program in South Africa during the COVID-19 pandemic. We telephoned a random subsample of participants enrolled in a prospective cohort study in KwaZulu-Natal in April and May 2020 and administered a semi-structured telephone interview to consenting participants. We completed interviews with 303 of 638 contacted participants (47%); 66% were female, with median age 36y. The most common concerns regarding the COVID-19 pandemic were food running out (121, 40%), fear of becoming infected with COVID-19 (103, 34%), and being unable to work/losing employment or income (102, 34%). Twenty-five (8%) participants had delayed ART pick-up due to the pandemic, while 212 (70%) had new concerns about ART access going forward. Mental health scores were worse during the pandemic compared to baseline (median score 65.0 vs 80.0, p < 0.001). Decentralized ART distribution systems have the potential to support patients outside of health facilities during the COVID-19 pandemic, but economic concerns and mental health impacts related to the pandemic must also be recognized and addressed. [ABSTRACT FROM AUTHOR]

Over the last decades, concern has arisen worldwide about the negative impacts of pesticides on the environment and human health. Exposure via dust ingestion is important for many chemicals but poorly characterized for pesticides, particularly in Africa. We investigated the spatial and temporal variations of 30 pesticides in dust and estimated the human exposure via dust ingestion, which was compared to inhalation and soil ingestion. Indoor dust samples were collected from thirty-eight households and two schools located in two agricultural regions in South Africa and were analyzed using high-performance liquid chromatography coupled to tandem mass spectrometry. We found 10 pesticides in dust, with chlorpyrifos, terbuthylazine, carbaryl, diazinon, carbendazim, and tebuconazole quantified in >50% of the samples. Over seven days, no significant temporal variations in the dust levels of individual pesticides were found. Significant spatial variations were observed for some pesticides, highlighting the importance of proximity to agricultural fields or of indoor pesticide use. For five out of the nineteen pesticides quantified in dust, air, or soil (i.e., carbendazim, chlorpyrifos, diazinon, diuron and propiconazole), human intake via dust ingestion was important (>10%) compared to inhalation or soil ingestion. Dust ingestion should therefore be considered in future human exposure assessment to pesticides. [ABSTRACT FROM AUTHOR]

Background In 2010, the World Health Organization (WHO) revised dosing guidelines for treatment of childhood tuberculosis. Our aim was to investigate first-line antituberculosis drug exposures under these guidelines, explore dose optimization using the current dispersible fixed-dose combination (FDC) tablet of rifampicin/isoniazid/pyrazinamide; 75/50/150 mg, and suggest a new FDC with revised weight bands. Methods Children with drug-susceptible tuberculosis in Malawi and South Africa underwent pharmacokinetic sampling while receiving first-line tuberculosis drugs as single formulations according the 2010 WHO recommended doses. Nonlinear mixed-effects modeling and simulation was used to design the optimal FDC and weight-band dosing strategy for achieving the pharmacokinetic targets based on literature-derived adult AUC0-24h for rifampicin (38.7–72.9), isoniazid (11.6–26.3), and pyrazinamide (233–429 mg ∙ h/L). Results In total, 180 children (42% female; 13.9% living with human immunodeficiency virus [HIV]; median [range] age 1.9 [0.22–12] years; weight 10.7 [3.20–28.8] kg) were administered 1, 2, 3, or 4 FDC tablets (rifampicin/isoniazid/pyrazinamide 75/50/150 mg) daily for 4–8, 8–12, 12–16, and 16–25 kg weight bands, respectively. Rifampicin exposure (for weight and age) was up to 50% lower than in adults. Increasing the tablet number resulted in adequate rifampicin but relatively high isoniazid and pyrazinamide exposures. Administering 1, 2, 3, or 4 optimized FDC tablets (rifampicin/isoniazid/pyrazinamide 120/35/130 mg) to children < 6, 6–13, 13–20. and 20–25 kg, and 0.5 tablet in < 3-month-olds with immature metabolism, improved exposures to all 3 drugs. Conclusions Current pediatric FDC doses resulted in low rifampicin exposures. Optimal dosing of all drugs cannot be achieved with the current FDCs. We propose a new FDC formulation and revised weight bands. [ABSTRACT FROM AUTHOR]

Organisations within the banking industry are increasingly confronted with attraction and retention challenges within their Information Technology (IT) divisions, driven by an increase in demand for skilled resources within the market. Therefore, the primary objective of the study was to explore the impact of job resources and job demands on work engagement and employee turnover intentions within the IT division of a South African bank. The Job Demands-Resources (JD-R) model was applied as theoretical framework to identify the unique job resources and job demands driving work engagement and turnover intentions of employees within this highly specialised section of the South African banking industry. Quantitative data was collected from 239 IT professionals via a self-administered, web-based survey measuring work engagement, job demands and resources, and turnover intentions. After confirmation of the factor structures of each of the variables, the direct and indirect relationships between the variables were analysed. The results indicate statistically significant relationships between job resources, work engagement and turnover intentions. Job demands moderated the relationship between job resources and work engagement, whilst work engagement mediated the relationship between job resources and turnover intention. By applying the JD-R model as a theoretical framework for the study, the unique job resources and job demands as drivers of work engagement and turnover intentions of IT employees could be highlighted to direct the development of focused work engagement and retention strategies. [ABSTRACT FROM AUTHOR]

Background: Distributed training has been cited as an opportunity that offers transformative learning experiences in preparing a future workforce to address local needs. For this reason, rural and longitudinal placements are increasingly being adopted by medical schools across the world. Place, participation and person are considered integral in the process of transformation of medical students into responsive graduates on the distributed platform. This article aims to explore the experiences and perceptions of student learning on a rural training platform in South Africa while considering the interrelation between person, place and participation as a process of transformation to becoming a health care professional. The research forms part of a 5-year longitudinal case study, initiated in 2019 to explore a university-rural hospital collaboration on students, staff and the local health care system. Methods: Data was collected using interviews and surveys from 63 purposively selected and consenting participants between January and November of 2019. All qualitative data were inductively analysed using an interpretivist approach to thematic analysis for the purposes of this article. All quantitative data was analysed descriptively using Microsoft Excel. Ethics and permission for this research was granted by the Stellenbosch University Human Research Ethics Committee, the Undergraduate Students Programme Committee and the Northern Cape Department of Health, South Africa. Findings: Four themes, namely: authenticity of context; participation in a community of practice and social activities; supervision and reflection; and distance support were extracted from the data. These findings contribute to the theory of transformative learning on the distributed platform by expanding on the interrelationship of person, place and participation, specifically as it relates to participation within various communities and practices. The value of active participation in reflection and supervision, distance academic support and social support systems are explored. Conclusions: The three dimensions and interrelationship of person, place and participation in the process of transformative learning on the rural training platform can be further unpacked by exploring the types of participation that have facilitated student learning in this research context. Participation in interprofessional teams; supervision, reflection and distance support appear to be the most crucial elements during this transformative learning process. [ABSTRACT FROM AUTHOR]

Background: The global mining industry has an opportunity to mobilize resources to advance progress against the Sustainable Development Goals (SDGs). In 2018, the Anglo-American Group outlined aspirations for mining host communities to meet the SDG3 health targets. To progress from aspiration to action we designed and implemented a mixed-methods approach to attain a deeper understanding of the health and wellbeing priorities within the local context of host communities of fifteen mines in South Africa.Methods: To identify local needs and priorities relating to SDG3 targets in host communities, stakeholder workshops and key informant interviews were conducted between June and August 2019. A baseline assessment of health data, related to each of the SDG3 targets and indicators and to each host community location, was also conducted. Findings emerging from the qualitative and quantitative baseline assessments were compared to identify the extent to which health issues aligned and health and wellbeing priority areas for action.Results: A total of 407 people participated in the workshops, and 85 key informants were interviewed. Quantitative data were available at sub-national level for seven of the nine SDG3 targets and eleven of the 21 indicators. Key priority areas for action identified through alignment of the qualitative and quantitative data were maternal mortality (SDG3.1), HIV (SDG3.3.1), tuberculosis (SDG3.3.2), substance abuse (SDG3.5), and road traffic accidents (SDG3.6) We found consistency in the individual, interpersonal, community, societal, and structural factors underlying these priority areas. At a structural level, poor access to quality healthcare was raised at every workshop as a key factor underlying the achievement of all SDG3 targets. Of the five priority areas identified, HIV, TB and substance abuse were found to overlap in the study communities in terms of risk, burden, and underlying factors.Conclusions: We demonstrate a mixed method approach for identifying local health needs and prioritised SDG3 targets in mining host communities. Consistency in reporting suggests the need for effective, efficient and feasible interventions to address five priority areas. Given the prominent economic role of the mining sector in South Africa, it can play a critical role in implementing programmatic activities that further progress towards achieving the SDG3 targets. [ABSTRACT FROM AUTHOR]

Background: HIV education targeting children and adolescents is a key component of HIV prevention. This is especially important in the context of increasing HIV prevalence rates among adolescents and young people. The authors sought to examine the role and effectiveness of an extra-curricular school based programme, Soul Buddyz Clubs (SBC) on HIV knowledge, attitudes, behaviours and biomedical outcomes.Methods: This paper employs a mixed methods approach drawing on data from independent qualitative and quantitative sources. Secondary data analysis was performed using survey data from a nationally representative sample that was restricted to 10-14 year-old males and females living in South Africa. Ten focus group discussions and ten in-depth interviews conducted with SBC members and facilitators from 5 provinces, as part of a process evaluation are used to triangulate the effectiveness of SBC intervention.Results: The analysis of survey data from 2 198 children indicated that 12% of respondents were exposed to SBC with 4% reporting that they had ever belonged to a club. Children exposed to SBC were more likely to be medically circumcised (AOR 2.38; 95%CI 1.29 -4.40, p=0.006), had correct HIV knowledge (AOR 2.21; 95%CI 1.36 - 3.57, p<0.001) and had less HIV stigmatising attitudes (AOR 0.54; 95%CI 0.31-0.93, p=0.025), adjusting for age, sex, province and exposure to other media - in comparison to those not exposed. Propensity Score Matching findings were consistent with the regression findings. Qualitative findings also supported some of the quantitative results. SBC members reported having learnt about HIV prevention life skills, including condom use, positive attitudes towards people living with HIV, and alcohol abuse.Conclusions: Participation in SBC is associated with accessing biomedical HIV prevention services, specifically MMC, correct HIV prevention knowledge and less HIV stigmatizing attitudes. This paper demonstrates the effectiveness of a school-based extracurricular intervention using a club approach targeting boys and girls ages 10-14 years on some of the key HIV prevention biomarkers as well as knowledge and attitudes. The article suggests that extra-curricular interventions can form an effective component of school-based comprehensive sexuality education in preventing HIV and promoting medical male circumcision. [ABSTRACT FROM AUTHOR]

We evaluated COVID-19 stigma and medical mistrust among people living with HIV in South Africa. We conducted telephone interviews with participants in a prospective study of a decentralized antiretroviral therapy program. Scales assessing medical mistrust, conspiracy beliefs, anticipated and internalized stigma, and stereotypes specific to COVID-19 were adapted primarily from the HIV literature, with higher scores indicating more stigma or mistrust. Among 303 participants, the median stigma summary score was 4 [interquartile range (IQR) 0–8; possible range 0–24] and 6 (IQR 2–9) for mistrust (possible range 0–28). A substantial proportion of participants agreed or strongly agreed with at least one item assessing stigma (54%) or mistrust (43%). Higher COVID-19 stigma was associated with female gender and antecedent HIV stigma, and lower stigma with reporting television as a source of information on COVID-19. Further efforts should focus on effects of stigma and mistrust on protective health behaviors and vaccine hesitancy. [ABSTRACT FROM AUTHOR]

The presence of micropollutants, such as pharmaceuticals and personal care products, in surface and ground water has escalated globally, leading to adverse effects on aquatic organisms in receiving waters. Untreated or inadequately treated wastewater is the main source of micropollutants entering the environment. In South Africa, the consumption of antibiotics and antiretroviral drugs is relatively higher than other nations; however, little data exists on the identification and remediation of micropollutants in domestic wastewater. In this study, a novel method to detect and measure 71 micropollutants using online solid phase extraction liquid chromatography coupled to tandem mass spectrometry was developed. To test the method in the South African context, grab samples of the influent and anaerobically treated effluent (AF effluent) from a demonstration-scale decentralised wastewater treatment system in eThekwini (Durban) were taken over 3 consecutive days at 2 time points. The presence of 24 micropollutants was detected in the raw wastewater, with analgesics/anti-inflammatory drugs, antiretrovirals, and antibiotics showing the highest concentrations and with the majority of compounds still present in the AF effluent. One antibiotic, ciprofloxacin, exceeded its predicted no-effect concentration in all influent and AF effluent samples. This suggests that the anaerobic treatment of the raw wastewater was not effective in removing micropollutants. Preliminary data from lab-scale adsorption experiments using biochar produced from a set of 4 feedstocks - olive residues, tomato residues, rice husks, and the African palm tree Raphia farinifera - showed average removal rates for 4 compounds of up to 62%. The application of biochar is thus recommended as a secondary treatment step in decentralised wastewater treatment for the removal of micropollutants in South Africa. [ABSTRACT FROM AUTHOR]

Background: South Africa faces a high burden of unmet contraceptive need, particularly among adolescent girls and young women. Providing contraception in community-based venues may overcome barriers to contraceptive access. Our objective was to explore the potential impact of the social environment and stylist–client interactions on perceived accessibility of contraceptives within hair salons. Methods: We conducted 42 semi-structured, in-depth interviews with salon clients (100% identified as female, 100% identified as Black, median age 27.1 years) and 6 focus groups with 43 stylists (95% identified as female, 98% identified as Black, median age 29.6 years) in and around Umlazi Township, Durban, KwaZulu-Natal to explore perspectives on offering contraceptive services in hair salons. We used an inductive and deductive approach to generate the codebook, identified themes in the data, and then organized findings according to Rogers' Individual Adoption Model as applied to community-based health prevention programs. Twenty-five percent of transcripts were coded by two independent coders to ensure reliability. Results: We identified elements of the salon environment and stylist–client relationships as facilitators of and barriers to acceptability of salon-based contraceptive care. Factors that may facilitate perceived contraceptive accessibility in salons include: the anonymous, young, female-centered nature of salons; high trust and kinship within stylist–client interactions; and mutual investment of time. Stylists may further help clients build comprehension about contraceptives through training. Stylists and clients believe salon-based contraceptive delivery may be more accessible due to contraceptive need facilitating client buy-in for the program, as well as a salon environment in which clients may encourage other clients by voluntarily sharing their own contraceptive decisions. The non-judgmental nature of stylist–client relationships can empower clients to make contraceptive decisions, and stylists seek to support clients' continued use of contraceptives through various adherence and support strategies. Some stylists and clients identified existing social barriers (e.g. confidentiality concerns) and made recommendations to strengthen potential contraceptive delivery in salons. Conclusion: Stylists and clients were highly receptive to contraceptive delivery in salons and identified several social facilitators as well as barriers within this setting. Hair salons are community venues with a social environment that may uniquely mitigate barriers to contraceptive access in South Africa. Plain language summary: Women in South Africa experience high rates of unintended pregnancies. Because of high HIV prevalence within the country, women who experience unplanned pregnancies may also be vulnerable to HIV. Studies have detailed the barriers women in South Africa face in accessing contraceptives, including poverty, cultural norms around contraceptive use, lack of confidential spaces, and negative experiences with healthcare workers. In response, we propose the provision of contraceptive and preventive HIV care in salons—places that may be more convenient, accessible, and comfortable for women to acquire contraceptives. In this analysis, we aimed to understand how the salon social environment and client–stylist relationships may lower barriers women face when accessing contraceptives, using a framework for how individuals adopt new interventions. We conducted in-depth interviews with 42 salon clients and six focus group discussions with 43 stylists and used content analysis to explore themes within the data. Overall, participants identified components of the salon environment and stylist–client relationships that may facilitate how clients learn and make decisions about contraceptive use. These included perceptions of: salons being anonymous and centered around young, female clients; and stylists and clients recognizing contraceptive need within the community, being invested in salon services, and building trusted relationships. Although overall buy-in was high, some stylists and clients also identified barriers such as confidentiality concerns, negative views on stylists, and discomfort with discussing contraceptives. Overall, our study identifies hair salons as promising spaces for women in South Africa to seek contraceptive care. [ABSTRACT FROM AUTHOR]

Background: The Fourth Industrial Revolution (4IR) and the Coronavirus Disease 2019 (COVID-19) have disrupted the higher education environment in unprecedented ways. Aim: This article identifies the impact of increasing disruption driven by the 4IR and COVID-19 on the content and curriculum design of degree programmes in economic and management sciences offered by South African universities. Setting: Six South African and five top-tier US and UK universities. Methods: The study used a non-positivist qualitative research design and specifically the casestudy approach. A document analysis of the information in university yearbooks and prospectuses was conducted, using a purposive sampling design. Results: An online presence will become more important due to increased disruption, and will not only ensure an additional revenue stream, but also promote continuity in operations and mitigate threats from competitors. COVID-19 has accelerated the extent of this disruption and expedited the migration to online teaching and learning platforms. Conclusion: Since science, technology, engineering and mathematics are integral to the majority of 4IR-related modules, South African universities must not shy away from degree programmes that ignore inter- and multi-disciplinary curriculum designs. Coupled with the challenges facing the majority of South African students to access electronic devices, data and the internet, COVID-19 has thrust this challenge to the forefront in the South African higher education landscape. By comparing the developments in South African universities with those in trendsetting, top-tier, global universities, management can assess the extent to which they are internationally competitive and adapting to the demands of the 4IR. [ABSTRACT FROM AUTHOR]

Nasionale Pers established a mail-order book club based on the Bertelsmann model called Leserskring in 1980. The club became incredibly successful and by 1985 it had a membership of 250,000. However, technology and a changing South African landscape brought challenges to the club. In 2016, Naspers announced that the iconic book club's doors would be shut for good. Some believe that the club experienced its success due to the culture of reading and publishing that had developed among mostly white South Africans during the apartheid period, and that with democratisation the niche it once held slowly started to disappear. [ABSTRACT FROM AUTHOR]

Previous research has demonstrated a virtual absence of vitamin A deficiency and adequacy of vitamin A intake through consumption of liver in preschool children of a community in the Northern Cape province of South Africa where sheep farming is common, and liver, an exceptionally rich source of vitamin A, is frequently eaten. Only 60–75 g of liver per month is needed to meet the vitamin A requirement of preschool children. Because this may have implications for routine vitamin A supplementation, and because liver consumption for the rest of the province is unknown, the study aim was to establish the prevalence and frequency of liver intake in a provincial‐wide survey. An unquantified liver‐specific food frequency questionnaire, covering a period of 1 month, complemented by a 1‐year recall, was administered to mothers of 2‐ to 5‐year‐old children (n = 2,864) attending primary health care facilities in all five districts and 26 subdistricts. A total of 86% of children were reported to eat liver, which was eaten in all districts by at least 80% of children. The overall median frequency of liver intake was 1.0 [25th, 75th percentiles: 0.5, 3.0] times per month and ranged from 1.0 [0.3, 2.0] to 2.0 [1.0, 4.0] for the various districts. Based on a previously reported portion size of 66 g, these results suggest vitamin A dietary adequacy in all districts and possibly also vitamin A intake exceeding the Tolerable Upper Intake Level in some children. Routine vitamin A supplementation in this province may not be necessary and should be reconsidered. [ABSTRACT FROM AUTHOR]

Background: People with disabilities often participate in income-generating activities (IGAs) in sheltered workshop in South Africa. However, they face many barriers that limit their ability to participate effectively in economic activities hosted by the workshops. Objectives: To illustrate the barriers that limit the participation of people with disabilities in IGAs in a sheltered workshop. Method: A qualitative exploratory single case study was conducted in a sheltered workshop. Eighteen participants, age 22 to 52 years with various disabilities were purposively sampled. Observations and semi-structured interview guides were used to generate data. Verbatim transcription was used after which content analysis was applied to identify ideas and concepts relating to barriers experienced by people with disabilities participating in IGAs. Results: Some of the barriers participants experienced included institutional barriers (ability to use working tools, inability to concentrate for long periods, lack of funds, language barriers, lack of motivation, activities that are not stimulating and lack of artistry skills) and attitudinal barriers (exclusion from decision making) These barriers had an adverse influence on their performance in IGAs. Conclusion: The study found eight different barriers that existed in a sheltered workshop which limited the participation of the people with disabilities that attended the workshop. This information can be used to develop strategies to address each barrier and promote increased participation of the individual thereby improving their quality of life. [ABSTRACT FROM AUTHOR]

A major area of inequality may be seen in the healthcare sector where systematic exclusion from access to services exists due to poverty, lack of employment, and poor infrastructure, transport systems and other social factors. In this article, we draw on two complementary frameworks: (i) Technological Innovation Systems (TIS) and (ii) Platform-based Innovation Ecosystems (PIE) to explore the need for the orchestration between macro-level policies and micro-level connections among platform actors as crucial for large-scale e-health/m-health programmes to succeed. We explore this empirically by using the MomConnect programme as a successful case of orchestration between the macro- and micro-level. Here the utilisation of systemic policy instruments are uncovered through which the design of large scale mHealth programmes may be supported with the aim of developing more inclusive innovation systems. [ABSTRACT FROM AUTHOR]

Background Postmortem minimally invasive tissue sampling (MITS) is a potential alternative to the gold standard complete diagnostic autopsy for identifying specific causes of childhood deaths. We investigated the utility of MITS, interpreted with available clinical data, for attributing underlying and immediate causes of neonatal deaths. Methods This prospective, observational pilot study enrolled neonatal deaths at Chris Hani Baragwanath Academic Hospital in Soweto, South Africa. The MITS included needle core-biopsy sampling for histopathology of brain, lung, and liver tissue. Microbiological culture and/or molecular tests were performed on lung, liver, blood, cerebrospinal fluid, and stool samples. The "underlying" and "immediate" causes of death (CoD) were determined for each case by an international panel of 12–15 medical specialists. Results We enrolled 153 neonatal deaths, 106 aged 3–28 days. Leading underlying CoD included "complications of prematurity" (52.9%), "complications of intrapartum events" (15.0%), "congenital malformations" (13.1%), and "infection related" (9.8%). Overall, infections were the immediate or underlying CoD in 57.5% (n = 88) of all neonatal deaths, including the immediate CoD in 70.4% (58/81) of neonates with "complications of prematurity" as the underlying cause. Overall, 74.4% of 90 infection-related deaths were hospital acquired, mainly due to multidrug-resistant Acinetobacter baumannii (52.2%), Klebsiella pneumoniae (22.4%), and Staphylococcus aureus (20.9%). Streptococcus agalactiae was the most common pathogen (5/15 [33.3%]) among deaths with "infections" as the underlying cause. Conclusions MITS has potential to address the knowledge gap on specific causes of neonatal mortality. In our setting, this included the hitherto underrecognized dominant role of hospital-acquired multidrug-resistant bacterial infections as the leading immediate cause of neonatal deaths. [ABSTRACT FROM AUTHOR]

Background Current estimates for causes of childhood deaths are mainly premised on modeling of vital registration and limited verbal autopsy data and generally only characterize the underlying cause of death (CoD). We investigated the potential of minimally invasive tissue sampling (MITS) for ascertaining the underlying and immediate CoD in children 1 month to 14 years of age. Methods MITS included postmortem tissue biopsies of brain, liver, and lung for histopathology examination; microbial culture of blood, cerebrospinal fluid (CSF), liver, and lung samples; and molecular microbial testing on blood, CSF, lung, and rectal swabs. Each case was individually adjudicated for underlying, antecedent, and immediate CoD by an international multidisciplinary team of medical experts and coded using the International Classification of Diseases , Tenth Revision (ICD-10). Results An underlying CoD was determined for 99% of 127 cases, leading causes being congenital malformations (18.9%), complications of prematurity (14.2%), human immunodeficiency virus/AIDS (12.6%), diarrheal disease (8.7%), acute respiratory infections (7.9%), injuries (7.9%), and malignancies (7.1%). The main immediate CoD was pneumonia, sepsis, and diarrhea in 33.9%, 19.7%, and 10.2% of cases, respectively. Infection-related deaths were either an underlying or immediate CoD in 78.0% of cases. Community-acquired pneumonia deaths (n = 32) were attributed to respiratory syncytial virus (21.9%), Pneumocystis jirovecii (18.8%), cytomegalovirus (15.6%), Klebsiella pneumoniae (15.6%), and Streptococcus pneumoniae (12.5%). Seventy-one percent of 24 sepsis deaths were hospital-acquired, mainly due to Acinetobacter baumannii (47.1%) and K. pneumoniae (35.3%). Sixty-two percent of cases were malnourished. Conclusions MITS, coupled with antemortem clinical information, provides detailed insight into causes of childhood deaths that could be informative for prioritization of strategies aimed at reducing under-5 mortality. [ABSTRACT FROM AUTHOR]

Background Despite approximately 2.6 million stillbirths occurring annually, there is a paucity of systematic biological investigation and consequently knowledge on the causes of these deaths in low- and middle-income countries (LMICs). We investigated the utility of minimally invasive tissue sampling (MITS), placental examination, and clinical history, in attributing the causes of stillbirth in a South African LMIC setting. Methods This prospective, observational pilot study undertook sampling of brain, lung, and liver tissue using core biopsy needles, blood and cerebrospinal fluid collection, and placental examination. Testing included microbial culture and/or molecular testing and tissue histological examination. The cause of death was determined for each case by an international panel of medical specialists and categorized using the World Health Organization's International Classification of Diseases, Tenth Revision application to perinatal deaths. Results A cause of stillbirth was identifiable for 117 of 129 (90.7%) stillbirths, including an underlying maternal cause in 63.4% (n = 83) and an immediate fetal cause in 79.1% (n = 102) of cases. The leading underlying causes of stillbirth were maternal hypertensive disorders (16.3%), placental separation and hemorrhage (14.0%), and chorioamnionitis (10.9%). The leading immediate causes of fetal death were antepartum hypoxia (35.7%) and fetal infection (37.2%), including due to Escherichia coli (16.3%), Enterococcus species (3.9%), and group B Streptococcus (3.1%). Conclusions In this pilot, proof-of-concept study, focused investigation of stillbirth provided granular detail on the causes thereof in an LMIC setting, including provisionally highlighting the largely underrecognized role of fetal sepsis as a dominant cause. [ABSTRACT FROM AUTHOR]

Flame retardants (FRs), such as brominated flame retardants (BFRs) and organophosphorus flame retardants (OPFRs), are diverse groups of compounds used in various products related to the indoor environment. In this study concentrations of eight polybrominated diphenyl ethers (PBDEs), two alternative BFRs and ten OPFRs were determined in indoor dust (n = 20) and pet cat hair (n = 11) from South Africa. The OPFRs were the major FRs, contributing to more than 97% of the total FR concentration. The median Ʃ 10 OPFRs concentrations were 44,800 ng/g in freshly collected dust (F-dust), 19,800 ng/g in the dust collected from vacuum cleaner bags (V-dust), and 865 ng/g in cat hair (C-hair). Tris(1-chloro-2-propyl) phosphate (TCIPP) was the dominant OPFR in the dust samples with median concentrations of 7,010 ng/g in F-dust and 3,590 ng/g in V-dust. Tris(2-butoxyethyl) phosphate (TBOEP) was the dominant OPFR in C-hair, with a median concentration of 387 ng/g. The concentrations of Ʃ 8 PBDEs were higher in F-dust than in V-dust. BDE209 was the dominant BFR in all three matrices. Bis(2-ethylhexyl)-3,4,5,6-tetrabromo-phthalate (BEH-TEBP) and 2-ethylhexyl-2,3,4,5- tetrabromobenzoate (EH-TBB) showed notable contributions to the BFR profile in cat hair. A worst-case dust exposure estimation was performed for all analytes. The estimated TCIPP daily intake through dust ingestion was up to 1,240 ng/kg bw for toddlers. The results indicate that OPFRs are ubiquitous in South African indoor environment. Indoor dust is a major source of human exposure to environmental contaminants. This can for example occur through hand-to-mouth contact of toddlers, and is an important route of exposure to currently used FRs accumulated on dust particles. The presence of FRs, in particular high concentrations of OPFRs, suggests that children and indoor pet cats may have greater exposure to FRs than adults. Image 1 • First report on chloroalkyl, aryl and alkyl OPFRs in the South African indoor environment. • First results of OPFRs in cat hair as a non-invasive sampler for human exposure, aimed at toddlers. • OPFRs are the major FRs and contribute for more than 97% to the total FR load. • TCIPP is the major OPFR in indoor dust and TBOEP the major OPFR in cat hair. • BEH-TEBP and EH-TBB showed notable contributions to the BFR profile in cat hair. The quantitative analysis of brominated and organophosphorus flame retardants in indoor dust and cat hair shows higher concentrations of organophosphorus flame retardants; chloroalkyl phosphates were prominent in dust and alkyl phosphates in cat hair. [ABSTRACT FROM AUTHOR]

Many countries rely on community health workers (CHWs) at a primary health care (PHC) level to connect individuals with needs to health professionals at health-care facilities, especially in resource-limited environments. The majority of health professionals are centrally based in facilities with little to no interaction with communities or CHWs. Stellenbosch University (South Africa), included interprofessional home visits in collaboration with CHWs as part of students' contextual PHC exposure in a rural community to identify factors impacting on the health of patients and their families. The aim of this study was to determine the impact of this interprofessional student service-learning initiative on identifying and addressing health-care challenges of households known to CHWs. Active physical, social and attitudinal factors were identified and recorded using a standardized paper case report form. Data were anonymized, captured and categorized for analysis. The frequency and proportion of each type of active problem and referral were calculated. The collaborative team identified many unaddressed health and social issues during their visits. Their exposure to communities at a PHC level offered benefits of experiential learning and provided insight into community needs, as well as offering services to enhance the current health-care system. [ABSTRACT FROM AUTHOR]

Background In some regions, multiple vitamin A (VA) interventions occur in the same target groups, which may lead to excessive stores. Retinol isotope dilution (RID) is a more sensitive technique than serum retinol to measure VA status. Objective We evaluated VA status before and after a high-dose supplement in preschool children living in a region in South Africa with habitual liver consumption and exposed to VA supplementation and fortification. Methods After baseline blood samples, subjects (46.7 ± 8.4 mo; n  = 94) were administered 1.0 μmol [14,15]-13C2-retinyl acetate to estimate total liver retinol reserves by RID with a follow-up 14-d blood sample. Liver intake was assessed with a frequency questionnaire. In line with current practice, a routine 200,000 IU VA capsule was administered after the RID test. RID was repeated 1 mo later. Serum retinyl esters were evaluated using ultra-performance liquid chromatography. Results At baseline, 63.6% of these children had hypervitaminosis A defined as total liver retinol reserves ≥1.0 μmol/g liver, which increased to 71.6% after supplementation (1.13 ± 0.43 to 1.29 ± 0.46 μmol/g; P  < 0.001). Total serum VA as retinyl esters was elevated in 4.8% and 6.1% of children before and after supplementation. The odds of having hypervitaminosis A at baseline were higher in children consuming liver ≥1/mo (ratio 3.70 [95% CI: 1.08, 12.6]) and in children receiving 2 (4.28 [1.03, 17.9]) or 3 (6.45 [0.64, 65.41]) supplements in the past 12 mo. Total body stores decreased after the supplement in children in the highest quartile at baseline compared with children with lower stores, who showed an increase (P  = 0.007). Conclusions In children, such as this cohort in South Africa, with adequate VA intake through diet, and overlapping VA fortification and supplementation, preschool VA capsule distribution should be re-evaluated. This trial was registered at https://clinicaltrials.gov/ct2/show/NCT02915731 as NCT02915731. [ABSTRACT FROM AUTHOR]

Background: Linezolid is increasingly important for multidrug-resistant tuberculosis (MDR-TB) treatment. However, among children with MDR-TB, there are no linezolid pharmacokinetic data, and its adverse effects have not yet been prospectively described. We characterised the pharmacokinetics, safety, and optimal dose of linezolid in children treated for MDR-TB.Methods and Findings: Children routinely treated for MDR-TB in 2 observational studies (2011-2015, 2016-2018) conducted at a single site in Cape Town, South Africa, underwent intensive pharmacokinetic sampling after either a single dose or multiple doses of linezolid (at steady state). Linezolid pharmacokinetic parameters, and their relationships with covariates of interest, were described using nonlinear mixed-effects modelling. Children receiving long-term linezolid as a component of their routine treatment had regular clinical and laboratory monitoring. Adverse events were assessed for severity and attribution to linezolid. The final population pharmacokinetic model was used to derive optimal weight-banded doses resulting in exposures in children approximating those in adults receiving once-daily linezolid 600 mg. Forty-eight children were included (mean age 5.9 years; range 0.6 to 15.3); 31 received a single dose of linezolid, and 17 received multiple doses. The final pharmacokinetic model consisted of a one-compartment model characterised by clearance (CL) and volume (V) parameters that included allometric scaling to account for weight; no other evaluated covariates contributed to the model. Linezolid exposures in this population were higher compared to exposures in adults who had received a 600 mg once-daily dose. Consequently simulated, weight-banded once-daily optimal doses for children were lower than those currently used for most weight bands. Ten of 17 children who were followed long term had a linezolid-related adverse event, including 5 with a grade 3 or 4 event, all anaemia. Adverse events resulted in linezolid dose reductions in 4, temporary interruptions in 5, and permanent discontinuation in 4 children. Limitations of the study include the lack of very young children (none below 6 months of age), the limited number who were HIV infected, and the modest number of children contributing to long-term safety data.Conclusions: Linezolid-related adverse effects were frequent and occasionally severe. Careful linezolid safety monitoring is required. Compared to doses currently used in children in many settings for MDR-TB treatment, lower doses may approximate current adult target exposures, might result in fewer adverse events, and should therefore be evaluated. [ABSTRACT FROM AUTHOR]

This paper investigates the history of the De Burger-Leeskring and the impact it had on Afrikaans literature and cultural development. It places the development of Nasionale Pers and the Afrikaans language within the context of South Africa's history and the development of language, politics and culture, as well as considering book clubs or readers' circles and their purpose within this context. This paper uses Bourdieu's classification of different kinds of capital—specifically cultural capital and financial capital—to evaluate the success of this Leeskring [Reader's Circle]. It was found that although not financially successful, the Leeskring' s influence on Afrikaans literature was vast. [ABSTRACT FROM AUTHOR]

A study of the distribution of polycyclic aromatic hydrocarbons (PAHs) and polychlorinated biphenyls (PCBs) utilising 16 priority PAHs, benzo(e)pyrene, perylene, 19 alkylated PAHs and 31 ortho substituted PCBs in South Africa is presented. It was aimed to (a) deduce characteristic contamination patterns for both PCBs and PAHs and (b) provide the first comprehensive dataset for establishment of source characterisation of PCBs and PAHs. This is in line with new South African legislation on mandatory monitoring of PCB and PAH emissions. Bar charts, principal component analysis (PCA) and biplots were utilised to identify signature contamination patterns and distribution of PCBs and PAHs within the Jukskei and Klip Rivers. Sediments from the Jukskei and Klip River catchments both showed distinct contamination signatures for hexa to nonachlorinated PCBs, characteristic of contamination by Aroclor 1254 and 1260 technical mixtures. PCB signature patterns in order of abundance were 138 > 180 > 206 > 153 > 187 > 149 and 138 > 153 > 180 > 149 > 187 > 110 > 170 for the Jukskei and Klip River sediments, respectively. The upstream Alberton point had the highest Σ31 PCB and Σ (parent+alkyl) PAH concentrations in the Klip River of 61 and 6000 μg kg dry weight (dw), respectively. In the Jukskei River, the upstream Marlboro point had the highest Σ31 PCB concentration of 19 μg kg dw and the N14 site recorded the highest Σ (parent+alkyl) PAH concentration of 2750 μg kg dw. PAH concentrations in both the Jukskei and Klip Rivers were significantly higher than the PCB concentrations. Fluoranthene, phenanthrene and pyrene were found in the highest concentrations in both the Jukskei and Klip River sediments. Both the Jukskei and Klip River sediments showed trends of a mixed pyrogenic-petrogenic PAH source contamination. [ABSTRACT FROM AUTHOR]

Serum retinol was assessed in mothers and newborns from an impoverished South African community where liver is frequently eaten and vitamin A deficiency known to be absent. Paired cord and maternal blood (n = 201) were collected after delivery and analysed for serum retinol and C‐reactive protein (CRP). Liver intake during pregnancy and intention to breastfeed were also assessed. Mean serum retinol was 1.03 µmol/L ± 0.40 in mothers and 0.73 ± 0.24 µmol/L in newborns, with 21.4% and 49.3% having serum retinol <0.70 µmol/L (<20 µg/dL), respectively. Raised CRP was found in 59.9% of mothers, with a significant negative correlation between serum retinol and CRP (r = −0.273; p < 0.0001). Liver was eaten by 87.6% of mothers, and 99% indicated their intention to breastfeed. Despite consumption of liver, serum retinol was low in both the mother and the newborn. The conventional cut‐off for serum retinol, i.e. <0.70 µmol/L may therefore not apply for the mother and newborn in the period immediately after delivery. Serum retinol may be influenced by factors other than vitamin A status, e.g. the haemodilution of pregnancy, as well as the acute phase response induced by the birth process, as suggested by raised CRP in 60% of mothers. In the newborns, the low serum retinol is likely to increase rapidly, as liver is frequently eaten by mothers and practically all of them intended to breastfeed. Our results confirm the need for better indicators of vitamin A status or alternative cut‐off values during this period. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to assess practice patterns and rationale with regard to debulking surgery for advanced epithelial ovarian carcinoma among South African Gynaecological oncologists. Methods: A survey was distributed to all practicing gynecological oncologists in South Africa. It was structured to assess definitions of optimal debulking, procedures used to achieve optimal debulking, and reasons for not performing specific procedures. Respondents were also asked to report on experience and additional surgical training to improve skill in performing ultra-radical debulking surgery. Results: Eighty percent of gynecological oncologists completed the survey. Sixty percent of respondents reported that they view optimal debulking as no visible disease, and this was achieved in 63% of surgical cases. The most common barriers to optimal debulking were medical comorbidities (85%), followed by lack of expertise in ultra-radical debulking surgery (55%) and advanced patient age (40%). At operation, the most common disease findings precluding optimal debulking were large volume confluent peritoneal disease and confluent diaphragmatic disease. All of the surgeons perform excision of bulky pelvic and lower paraaortic nodes themselves. Bowel resections are often performed with the help of a colleague, but more than half of the respondents never perform diaphragmatic stripping, resection of liver metastases, distal pancreatic resection, or ablation of peritoneal metastases. Overall, most participants seem to regularly perform debulking procedures in the pelvis but are less comfortable with resection of upper abdominal or peritoneal disease. Most common reasons for not performing procedures were concerns about patient morbidity and concerns regarding benefit. Fifty percent of respondents also reported a lack of personal expertise in performing ultra-radical debulking procedures. Conclusions: The progression of South African Gynaecological Oncologist towards more aggressive debulking surgery is following international trends, but many of the surgeons report a lack of experience in ultra-radical debulking surgery, especially in the upper abdomen. [ABSTRACT FROM AUTHOR]

Directly observed treatment short course (DOTS) has been the recommended strategy for Tuberculosis (TB) control since 1995. Developed as an alternative to inpatient treatment, it involves observation of patients' medication intake to promote adherence. However, the burden of daily clinic visits may affect access to care. Using a mixed methods approach, we consider whether (1) non-adherence differs systematically between patients required to make daily clinic visits and patients cared for under less frequent clinic visits and (2) the association between frequency of required clinic visits and adherence depends on affordability and acceptability of care. Data were collected in facility exit interviews with 1200 TB patients in two rural and two urban sub-districts in South Africa. Additionally, 17 in-depth interviews were completed with TB patients. After controlling for socioeconomic and demographic factors, patient type (new or retreatment) and treatment duration, regression analyses showed that daily attending patients were over twice as likely to report a missed clinic visit (P < 0.001) or a missed dose of treatment (P = 0.002) compared with patients required to attend clinics for treatment collection less frequently. Missed visits increased with treatment duration (P = 0.01). The significant interaction between clinic visit frequency and treatment duration indicated that sustaining daily visits over time may become increasingly difficult over the course of treatment. The qualitative analysis identified treatment cost and duration, patients' physical condition and varying social contexts (family, community and work) as important influences on adherence. These findings suggest that strategies involving daily clinic visits may require reconsideration if resources for TB care are to be used efficiently. The adoption of approaches that place patient interests at the centre of TB treatment delivery would appear to be of high priority, particularly in countries where TB prevalence is high and resources for TB care are highly constrained. [ABSTRACT FROM AUTHOR]

Background: In the field of spinal cord injury (SCI) research there is an emphasis on the ability to ambulate. Purpose: To determine the ambulation energy expenditure (EE) and factors that affect ambulation EE in SCI participants compared to able-bodied participants. Methods: This was a cross-sectional study. Participants were recruited from seven SCI rehabilitation units within the Johannesburg area. The following were used: demographic questionnaire to capture participants’ characteristics, modified Ashworth scale for spasticity; goniometer for range of movement (ROM); American Spinal Injury Association (ASIA) scale for patient classification; accelerometer for EE and the six-minute walk test (6MWT) for endurance. Characteristics of the study participants were summarised using descriptive statistics. Data were analysed as follows: two-sample t-test for comparison between the able-bodied and SCI sample and Pearson product moment correlations for relationship between identified factors and EE. Results: Participants comprised 45 in the SCI group and 21 in the able-bodied group. The mean energy expenditure per metre (EE/m) for the SCI participants was 0.33 (± 0.29) calories compared to 0.08 (± 0.02) calories for the able-bodied participants. A decrease in walking velocity resulted in an increase in EE. For SCI participants, every decrease in degree of hip flexion ROM resulted in a 0.003 increase in EE/m walked. A unit decrease in velocity resulted in an increase of 0.41 in EE/m walked. Energy expenditure per metre decreased from ASIA A to ASIA D. Crutch walking utilised 0.34 calories per metre less energy than walking frames (p = 0.03). Conclusion: Based on this study’s findings, factors to consider in order to maximise energy efficiency whilst walking are maintaining hip flexion ROM and optimising velocity of walking. [ABSTRACT FROM AUTHOR]

Background: South Africa is at present undertaking a series of reforms to transform public health services to make them more effective and responsive to patient and provider needs. A key focus of these reforms is primary care and its overburdened, somewhat dysfunctional and hierarchical nature. This comparative case study examines how patients and providers respond in this system and cope with its systemic demands through mechanisms of endurance, resistance and resilience, using coping and agency literatures as the theoretical lenses.Methods: As part of a larger research project carried out between 2009 and 2010, this study conducted semi-structured interviews and observations at health facilities in three South African provinces. This study explored patient experiences of access to health care, in particular, ways of coping and how health care providers cope with the health care system's realities. From this interpretive base, four cases (two patients, two providers) were selected as they best informed on endurance, resistance and resilience. Some commentary from other respondents is added to underline the more ubiquitous nature of these coping mechanisms.Results: The cases of four individuals highlight the complexity of different forms of endurance and passivity, emotion- and problem-based coping with health care interactions in an overburdened, under-resourced and, in some instances, poorly managed system. Patients' narratives show the micro-practices they use to cope with their treatment, by not recognizing victimhood and sometimes practising unhealthy behaviours. Providers indicate how they cope in their work situations by using peer support and becoming knowledgeable in providing good service.Conclusions: Resistance and resilience narratives show the adaptive power of individuals in dealing with difficult illness, circumstances or treatment settings. They permit individuals to do more than endure (itself a coping mechanism) their circumstances, though resistance and resilience may be limited. These are individual responses to systemic forces. To transform health care, mutually supportive interactions are required among and between both patients and providers but their nature, as micro-practices, may show a way forward for system change. [ABSTRACT FROM AUTHOR]

Objectives: This cross-sectional study examined the nutritional factors associated with the high levels of stunting in 2- to 5-y-old children in an impoverished South African setting where liver is frequently eaten and vitamin A deficiency known to be absent. Methods: Children's dietary intake was assessed by a single 24-h recall. Heights and weights were measured and information was obtained on breast-feeding history, the child's habitual milk intake, as well as substance use by the mother during pregnancy (n = 150). Results: The overall prevalence of stunting was 36.9% (CI 29.2, 44.6) and increased with age, being 49% in the 4- to 5-y-old age category. Birth weight correlated significantly with height-for-age z-scores (HAZ; r = 0.250, P = 0.003), and was lower in children whose mothers smoked and used alcohol during pregnancy than in children whose mothers abstained (P < 0.0001). Median intake of energy, carbohydrate and protein was adequate. Median intake for all micronutrients was at least 90% of the estimated average requirement, except for calcium, vitamin D and vitamin E, which was 21%, 15%, and 32%, respectively. Intake of fat, calcium, phosphorous, vitamin D, riboflavin, and vitamin B12 (nutrients that typically occur in milk) was significantly lower in stunted than in non-stunted children (P < 0.05). When excluding children with low birth weight, intake of calcium, vitamin D, and riboflavin were still significantly lower (P < 0.05). HAZ was higher in children who habitually drank milk compared to those who did not (P = 0.003). Conclusions: Inadequate calcium and vitamin D intake, presumably because of low intake of milk after weaning, may have contributed to stunting in this population. [ABSTRACT FROM AUTHOR]

This article investigates the publication of titles in english and afrikaans (one title published in two languages) by looking specifically at three publishers: LAPA Uitgewers, jacana media and NB Publishers. Furthermore, the article examines why some books are more likely to be published bilingually than others in the sector of trade non-fiction for adults specifically; this excludes children's literature as well as titles in the religious trade sector. Bilingual publications from the period 2010–2014 are investigated for the article in order to examine this phenomenon over a relatively recent period of time. the research determines what the reasons are for publishers to publish in both languages, how the decision-making process takes place, and whether the timing of publishing bilingual titles plays a significant role in their publishing strategy. By investigating the reasons publishers use to make their decisions, the possible future of this trend is predicted. this information was collected through an investigation of available literature and also through interviews with key role players at the publishing houses. [ABSTRACT FROM PUBLISHER]

This article investigates author profiles and writing in South Africa's history, with a special focus on changes that have occurred from the apartheid period to the present day. South Africa has gone through significant change in the past few decades, including major political upheaval. This has had a notable effect on South African writers and the works they produced then, and still produce. These changes have also had an effect on the languages, readers, publishers and book market in South Africa. This author has concluded that South African authors have adapted to their environment and that their writing is representative of this. While English-language books have always had a strong readership market, Afrikaans has surged in popularity, while African languages continue to be poorly represented. Authors from different races and both genders are being published in this country, but the themes of their writings have changed from resistance to reconciliation literature. Today, a greater number of publications on political disaster and crime are appearing, while books detailing South Africa's history remain popular with readers. Authors are also attempting to write ‘lighter’ material, such as romance, adventure and crime fiction. While there are more women writers on the scene than before, there is a paucity of black women writers. In general, though, women writers still lag behind their male counterparts in the popularity stakes. [ABSTRACT FROM AUTHOR]

This article considers attempts by multinational corporations to provide services in areas of limited statehood. Under which conditions are such attempts effective? We make two arguments: First, they must be legitimate to be effective. Second, the institutional design of the firms' service provision programs is an important factor for their effectiveness. We assess these arguments by analyzing multinationals in the South African car industry fighting HIV/ AIDS, and international mining firms in South Africa and the Democratic Republic of Congo trying to improve public security. The analysis demonstrates that under conditions of legitimacy and high degrees of institutionalization firm programs effectively contribute to service provision in areas of limited statehood. [ABSTRACT FROM AUTHOR]

Beverages derived from wild plant species play an important role in local and traditional food systems in rural communities such as in the Vhembe District, South Africa. Conducting research on such foodstuffs may help to prevent loss of indigenous knowledge on potential dietary sources for needy households. Through surveys and focussed group discussions, 41 different beverage-making plant species were identified. Traditional beverage making processes are of three types. Preparing teas involve a boiling process while juices are manually extracted following overnight soaking of the fruit pulp mixture. Brewing traditional beer usually requires a spontaneous fermentation process lasting 2–3 days. [ABSTRACT FROM AUTHOR]

Background: Athrixia phylicoides DC. (Asteraceae) is used medicinally in South Africa to treat a plethora of ailments, including heart problems, diabetes, diarrhoea, sores and infected wounds. It is also prepared in the form of a tea (hot decoction) taken as a refreshing, pleasant-tasting beverage with commercialization potential. Methods: Extracts of the dried ground aerial parts were prepared using organic solvents (diethyl ether, dichloromethane/methanol, ethyl acetate and ethanol) and water. These extracts were subjected to HPLC, TLC and bioautography analysis with the aim of linking a range of peaks visualized in HPLC chromatography profiles to antibacterial and antifungal activity of the same extracts. Results: HPLC revealed a group of compounds extracted by more than one solvent. Compounds identified include inositol, caffeic acid, quercetin, kaempferol, apigenin, hymenoxin and oleanolic acid. The organic extracts displayed similar TLC profiles, and bioautography indicated approximately five antibacterial compounds, but only two antifungal compounds in these extracts. Bioautography indicated that cold water extracted the least antimicrobial compounds. Conclusions: Several previously unknown compounds were identified in Athrixia phylicoides extracts, and bioautography indicated a number of antibacterial and antifungal compounds. There were notable differences in chemical composition and bioactivity between the organic and aqueous extracts. Further research is necessary to fully characterize the active components of the extracts. [ABSTRACT FROM AUTHOR]

Sirex noctilio F. (Siricidae: Hymenoptera) is one of the most serious invasive pests of pine. In South Africa, there has been a national effort to control S. noctilio, including a campaign to increase awareness of the pest amongst the local forestry community., We considered the impacts that the arrival of the pest and the awareness campaign have had on perceptions and knowledge of S. noctilio, as well as other forestry pests, amongst members of the forestry community., For data collection, a survey questionnaire was developed and used in telephone interviews., The results obtained in the present study showed that the Sirex awareness campaign had increased knowledge of forestry pests in general but basic knowledge regarding the identification and symptoms of specific pests, such as S. noctilio, was poor. This will negatively influence monitoring efficacy., Traditional paper-based media and personal contact contributed most to enhanced awareness. Electronic media were less effective and improvement would require a more focused effort. It was of concern that private farmers and contractors, as well as non-European first language speakers, were less well informed about forestry pests., Clearly, a fragmented landscape in terms of ownership and language, presents challenges for effective communication of forestry pest threats. [ABSTRACT FROM AUTHOR]