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Abstract Sub-Saharan Africa is under-represented in global biodiversity datasets, particularly regarding the impact of land use on species’ population abundances. Drawing on recent advances in expert elicitation to ensure data consistency, 200 experts were convened using a modified-Delphi process to estimate ‘intactness scores’: the remaining proportion of an ‘intact’ reference population of a species group in a particular land use, on a scale from 0 (no remaining individuals) to 1 (same abundance as the reference) and, in rare cases, to 2 (populations that thrive in human-modified landscapes). The resulting bii4africa dataset contains intactness scores representing terrestrial vertebrates (tetrapods: ±5,400 amphibians, reptiles, birds, mammals) and vascular plants (±45,000 forbs, graminoids, trees, shrubs) in sub-Saharan Africa across the region’s major land uses (urban, cropland, rangeland, plantation, protected, etc.) and intensities (e.g., large-scale vs smallholder cropland). This dataset was co-produced as part of the Biodiversity Intactness Index for Africa Project. Additional uses include assessing ecosystem condition; rectifying geographic/taxonomic biases in global biodiversity indicators and maps; and informing the Red List of Ecosystems.

Wide Bandgap devices are becoming more popular because of their higher switching performance. However, this higher performance comes at the cost of increased susceptibility to parasitic effects and leads to problems such as voltage overshoot and ringing of the switching node. Many strategies have been described in the literature that suppress these undesirable effects and enable faster switching. Generally, the literature describes the effectiveness of a new suppression method by experimentally comparing the outcomes when the strategy is used versus when it is not used. However there is no study that compares experimental results of the many different reported strategies with each other. This work is a meta-analysis of previously reported experimental results of WBG devices that compare the different reported strategies against one another. This shows which class of strategy holds the most promise for future development. The data presented also enables future strategies to be benchmarked against the current state-of-the-art.

Recent advances in semiconductor technology have paved the way for ultra-fast switching capabilities. This increase in switching speed enhances efficiency, power density, and frequency but also increases overvoltage oscillations at the switching node. Existing methods that effectively suppress this overvoltage include slower switching and minimisation of inductance, but unfortunately, these methods become very difficult to implement as the switching speed increases. A new oscillation suppression method, Zero Overvoltage Switching (ZOS), has previously been developed in which the overvoltage is suppressed very effectively by increasing both the switching speed and inductance, contrary to mainstream expectation. This is the only oscillation suppression method that becomes more effective as the switching speed increases and is not constrained by the minimisation of inductance, yet this method has not gained widespread recognition. This is expected because Zero Overvoltage Switching is not explained within the context of existing knowledge, and the argument for implementing it is difficult in the very narrow window where the advantages outweigh the effort. This research develops a generalised fundamental model to better understand Zero Overvoltage Switching by describing the mechanics of fast and slow switching events. The model is also able to provide insights that lead to methods to apply Zero Overvoltage Switching over a broader range of voltages and currents.

John Salmon,1 Daniel Bates,2 Neels Du Toit,2 Paul Verrills,2 James Yu,3 Murray G Taverner,4 Vahid Mohabbati,5 Matthew Green,6 Gary Heit7 ,† Robert Levy,8 Peter Staats,9 Shilpa Kottalgi,10 James Makous,11 Bruce Mitchell2 1Pain Management, Pain Care Perth, Perth Cottesloe, WA, Australia; 2Pain Management, Metro Pain Group, Melbourne, VIC, Australia; 3Pain Management, Sydney Spine and Pain, Sydney, NSW, Australia; 4Pain Management, Frankston Pain Management, Frankston, VIC, Australia; 5Pain Management, Sydney Pain Management Centre, Sydney, NSW, Australia; 6Pain Management, Pain Medicine of South Australia, Adelaide, SA, Australia; 7Department of Neurosurgery, Hue University of Medicine and Pharmacy, Hue, Vietnam; 8Neurosurgery, Institute for Neuromodulation, Boca Raton, FL, USA; 9Premier Pain Centers, Shrewsbury, NJ, USA; 10Clinical Department, Nalu Medical, Inc, Carlsbad, CA, USA; 11Makous Research, LLC, Carlsbad, CA, USA†Gary Heit passed away in February 2023Correspondence: John Salmon, Pain Management, Pain Care Perth, 2/89 Forrest Street, Perth Cottesloe, WA, 6011, Australia, Tel +61 428 246 846, Fax +61 8 92845759, Email Salmon8@bigpond.comPurpose: Spinal cord stimulation (SCS) is a highly effective treatment for chronic neuropathic pain. Despite recent advances in technology, treatment gaps remain. A small SCS system with a miniaturized implantable pulse generator (micro-IPG; < 1.5 cm3 in volume) and an externally worn power source may be preferred by patients who do not want a large, implanted battery. We report here the long-term outcomes from the first-in-human study evaluating the safety and performance of a new neurostimulation system.Patients and Methods: This was a prospective, multi-center, open-label, single-arm study to evaluate this SCS system, in the treatment of chronic, intractable leg and low-back pain. Consented subjects who passed screening continued on to the long-term phase of the study. One-year, patient-reported outcomes (PRO’s) such as pain (Numeric Rating Scale, NRS), functional disability, quality of life, and mood were captured.Results: Twenty-six (26) evaluable subjects with permanent implants were included in this analysis. The average leg pain NRS score decreased from 6.8 ± 1.2 at baseline to 1.1 ± 1.2 at the end of the study (p < 0.001), while the average low-back pain NRS score decreased from 6.8 ± 1.2 to 1.5 ± 1.2 (p < 0.001). The responder rate (proportion with ≥ 50% pain relief) was 91% in the leg(s) and 82% in the low back. There were significant improvements in functional disability (Oswestry Disability Index) and in mood (Beck Depression Inventory), demonstrating a 46% and 62% improvement, respectively (p < 0.001). Eleven-point Likert scales demonstrated the wearable to be very comfortable and very easy to use.Conclusion: There were considerable challenges conducting a clinical study during the COVID-19 pandemic, such as missed study programming visits. Nevertheless, subjects had significant PRO improvements through 1-year. The small size of the implanted device, along with a proprietary waveform, may allow for improved SCS outcomes and a drop in incidence of IPG-pocket pain.Plain Language Summary: Chronic neuropathic pain of the low back and legs is a common affliction. Unfortunately, many of these cases are medically intractable and require more invasive treatments. One such treatment is spinal cord stimulation, in which very small, cylindrical electrodes (leads) are percutaneously introduced into the epidural space where they deliver mild electrical pulses to the spinal cord thereby blocking the pain signals from reaching the brain. Among the shortcomings of this general approach is the bulkiness of the implanted battery and electronics that power the electrodes, which can be as large as 44 cm3 in volume. We report here the results of a study employing a very small spinal cord stimulator implant (< 1.5 cm3 in volume) that is externally powered by a wearable device. The results of this multi-center, prospective, open-label, single-arm study are reported here. Following 1 year of spinal cord stimulation therapy, the average pain reduction was 79% in the legs and 81% in the back, both of which were statistically significant at the p< 0.001 level. At the same study endpoint, patient-reported outcomes demonstrated significant improvements in functional disability (p < 0.001) and mood (p < 0.05). These outcomes are comparable to many of the other larger, fully implantable systems.Keywords: implantable pulse generator, IPG, battery free, neuropathic pain, pulsed stimulation pattern, micro-IPG, persistent spinal pain syndrome, failed back surgery syndrome, FBSS

Stemphylium leaf spot of spinach, caused by the seedborne fungi Stemphylium beticola and S. vesicarium, affects spinach grown for processing, fresh markets, and seed. Genomes of S. vesicarium, but not S. beticola, have been published. DNA was extracted from two isolates of S. beticola, St0030 and St1145, and used for Illumina sequencing to generate draft genome assemblies. This is the first reported genome sequence of S. beticola, which will provide a resource for population studies and development of molecular tools to differentiate S. beticola from other Stemphylium species infecting spinach leaves and seed. Additionally, these genomes will be useful for comparative genomic studies of other plant-pathogenic and non-pathogenic Stemphylium species. [Figure: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license.

I researched my practice as a lecturer in a teacher education college in Zimbabwe as I was concerned that my teaching was not assisting students to realise their potential for independent thinking and knowledge creation and preparing them with appropriate skills and knowledge for life and work in the 21stcentury. I believe both aspects of education are essential in teacher preparation. There are injustices in the way the curriculum is enacted. I therefore focussed this research on improving learning to integrate social justice values into my practice and how to liberate my students and myself from traditional didactic pedagogy. I opted for Place-Based Learning as a teaching strategy since it has been shown to promote student engagement, critical thinking, innovation and reflexivity by embedding the learning in the social reality of the students. I collected and analysed data in the form of interviews, reflective diaries, and student assignments to enhance my learning to improve my practice and as evidence to support my knowledge claims that I had enabled students to become producers rather than just consumers of knowledge; fostered inclusion; and enabled transformative learning, all of which heightened student awareness of the need to make their future teaching more socially relevant and just. I conclude by proposing guidelines for professional practitioners in any educational context using Place-Based Learning to facilitate learning intended to promote students’ inclusion, democratic knowledge generation, and active participation.

Electroencephalography (EEG) data recordings can be contaminated by artefacts that reduce the quality and make analysis difficult, and therefore cleaning methods are essential for accurate analysis of EEG data. It is not yet well established how to measure performance based on measured contaminated data since there is no established benchmark for comparison. Here we use “clean” EEG data synthetically contaminated by electrocardiography (ECG), electrooculography (EOG) and electromyography (EMG). This introduces fewer assumptions to the comparison between various cleaning methods, providing a clear datum for comparison. Further contamination is controlled, adding artefacts individually and also as a combination of artefacts. The results show that signal to noise ratio (SNR) of the simulated artefacts was within the same ranges as found with measured artefacts from literature. Popular linear cleaning methods were evaluated on the dataset, showing similar results to those in the literature, further validating the usefulness and accuracy of the semi-synthetic dataset. The semi-synthetic dataset showed comparable characteristics to real measured EEG data and proved useful in the assessment of EEG cleaning methods. The cleaning methods showed varied results when performance was evaluated on individual artefacts.

In NT scholarship, the Paul Within Judaism approach has gained considerable momentum. In this approach to Paul’s discourse on identity, a distinction is drawn between “Jewish” and gentile followers of Christ. “Jewish” followers, including Paul, are considered those that remain fully Torah-observant, whereas gentile followers are regarded as not fully Torah-observant, especially with respect to circumcision. In this contribution, Paul’s identity in relation to first-century “Judaism” and/or historical Israel is reconsidered. The main question that is asked in this regard is whether the Paul Within Judaism approach is a viable position in light of the hermeneutical difficulties surrounding first-century “Judaism”, as well as Paul’s own rhetoric around the Ἰουδαῖοι (“Jews”/“Judaeans”). Another question that is asked is whether Ἰσραήλ (“Israel”) and the Ἰουδαῖοι point to the exact same entity. Would it be more accurate to see Paul as being within Israel as one of God’s covenant people than as remaining a Ἰουδαῖος (“Jew”/“Judaean”)? Or did Paul leave his identity as a Ἰουδαῖος or as part of Israel behind for a new identity to be defined around Israel’s Messiah only? Lastly, it is considered whether Paul’s discourse on identity leaves room for an identity in Christ that is inclusive of an identity as a Ἰουδαῖος or as being part of Israel, or whether the identity in Christ excludes the latter.

Antiretroviral therapy (ART) has reduced the mortality and morbidity associated with HIV. However, irrespective of treatment, people living with HIV remain at a higher risk of developing non-AIDS-associated diseases. In 2019, the World Health Organization recommended the transition from efavirenz (EFV)- to dolutegravir (DTG)-based ART. Data on the impact of this transition are still limited. The current study therefore investigated the metabolic profiles, cytokine inflammatory responses, and platelet activation before and after the treatment transition. Plasma samples from nine virally suppressed adults living with HIV and sixteen healthy, HIV-uninfected individuals residing in Gauteng, South Africa were compared. Metabolite and cytokine profiles, and markers associated with platelet activation, were investigated with untargeted proton magnetic resonance metabolomics, multiplex suspension bead array immunoassays, and sandwich enzyme-linked immunosorbent assays, respectively. In those individuals with normal C-reactive protein levels, the transition to a DTG-based ART regimen resulted in decreased concentrations of acetoacetic acid, creatinine, adenosine monophosphate, 1,7-dimethylxanthine, glycolic acid, 3-hydroxybutyric acid, urea, and lysine. Moreover, increased levels of formic acid, glucose, lactic acid, myo-inositol, valine, glycolic acid, and 3-hydroxybutyric acid were observed. Notably, levels of interleukin-6, platelet-derived growth factor-BB, granulocyte-macrophage colony-stimulating factor, tumor necrosis factor–alpha, soluble cluster of differentiation 40 ligand, as well as regulated on activation, normal T-cell expressed and secreted (RANTES) reached levels close to those observed in the healthy control participants. The elevated concentration of macrophage inflammatory protein-1 alpha was the only marker indicative of elevated levels of inflammation associated with DTG-based treatment. The transition from EFV- to DTG-based regimens therefore appears to be of potential benefit with metabolic and inflammatory markers, as well as those associated with cardiovascular disease and other chronic non-AIDS-related diseases, reaching levels similar to those observed in individuals not living with HIV.

South Africa produces high-quality maize, yet food insecurity and malnutrition are prevalent. Maize is a staple for most South Africans and is often eaten as pap, gruel cooked from maize meal (corn flour) and water without diet diversification. Considering the reliance on maize in low-income communities, could nixtamalised maize products be developed that are nutritious, homemade and consumer-acceptable? Nixtamalisation could offer a solution. However, its acceptability and nutritional benefits remain in question. We aimed to develop a product using consumer-led methods. Consumer panels evaluated and selected products using overall acceptability (9-point hedonic scale), Just-About-Right (JAR) and penalty analysis. Consumer-acceptable nixtamalised chutney-flavoured maize chips were moderately liked (7.35) and reached acceptable JAR scores (74.2%). The nixtamalised products were liked and liked very much (56%), 61% of panel members agreed and strongly agreed to purchase and prepare, and 50% to consume nixtamalised products. Nutrient analysis of the chutney chips showed high energy (2302 kJ/100 g) and total fats (23.72), of which saturated fats were 11.47%. Total fibre (17.19 g/100 g), protein (6.64 g/100 g), calcium (163.3) and magnesium (53.67 g/100 g) were promising, while high phosphorous (566.00 mg/100 g) may indicate anti-nutrients present. Nixtamalisation can alleviate food insecurity and malnutrition in countries such as South Africa.

Early childhood development research typically focusses on populations that are either of upper or lower socioeconomic status. A population especially overlooked is the 'missing-middle', represented by middle-income, urban populations. Knowledge of children's development from middle-income populations to guide the implementation and customisation of early intervention policies, is needed. The Vineland-3 was used to describe the developmental outcomes of 55 young children, six to 24 months old, from an urban, middle-income setting in South Africa. The mHealth PEDS was used to identify caregivers' developmental concerns. Caregivers' concerns were positively associated with their children's developmental outcomes ([phi] = 0.355; p = 0.024), emphasising their valuable contribution in early identification of developmental delays. Fifteen percent (n = 8) of participants' children presented with developmental delays, with low birth weight identified as a significant risk ([phi] = 0.415; p = 0.011) and higher maternal education as a significant protective factor ([phi] = 0.365; p = 0.016). High gross motor proficiency appears to be a strength within this population, while receptive language and play skills require attention. Early childhood development should be prioritised across all socioeconomic classes to help ensure that children from the 'missing-middle' do not miss out on the opportunity to thrive.

Children in low-income communities are at risk for developmental delays and sensory losses. mHealth screening tools enable community health workers to detect developmental delays and sensory losses. This study aims to describe a combined (developmental and sensory -- hearing and vision) mHealth-supported screening programme conducted by community healthcare workers with children aged four-six years (n = 63) at early childhood development centres in a low-income community. Early childhood development practitioners (n = 5) assisted with developmental screening. Referral rates were 30% (n = 19) for development, 6% (n = 4) for hearing and 5% (n = 3) for vision. The average screening time for combined screenings was 11.72 min (SD 3.45 min). Post screening questionnaires probing participants' perspectives and experiences of the combined screening were positive. A combined mHealth-supported screening programme conducted by community health workers and early childhood development practitioners appears viable, supporting early detection of developmental delays and sensory losses in children from low-income communities.

The barriers to education associated with menstruation vary from country to country and within countries. We report on a cross-sectional survey conducted in diverse schools in 2 districts of the Eastern Cape, South Africa. Using multi-stage sampling (stratified random sampling of schools, and purposive sampling of Grade 11 female-identified learners), we accessed 1,035 respondents with an average age of 17.2 years. Respondents completed a questionnaire developed from previous questionnaires and our readings of the literature. We report here on results pertaining to the social and structural barriers related to menstruation. Just over one fifth of young women across the whole sample reported missing an average of 1.8 days of school per menstrual cycle, while a significant minority reported restrictions related to sporting and classroom activities. Results show, contrary to expectations, that young women attending under-resourced schools report missing fewer days than young women attending resourced schools, despite young women in under-resourced schools experiencing inadequate sanitation facilities and feeling unsafe using these facilities. This research indicates the importance of recognising social as well as structural features when considering the gendered barriers to education that menstruation may represent.

Purpose: This study aimed to critically appraise recent peer-reviewed scientific evidence on the effect of vocal hygiene education on voice quality and function directly and indirectly measured by auditory-perceptual, acoustic, and self-report measures in professional voice users. Method: A systematic review was conducted utilizing the Preferred Reporting Items for Systematic review and Meta-Analyses Protocols (PRISMA-P) guidelines. Five databases were searched using the keywords "vocal hygiene," "vocal hygiene education," "vocal health," "vocal quality," and "voice quality" with Boolean phrases "AND" and "OR." Twenty-three studies that met the eligibility criteria were included. Scoring was based on the American Speech-Language-Hearing Association's levels of evidence and quality indicators, as well as the Newcastle--Ottawa Scale for assessing the risk of bias. Results: Four studies (17%) linked low awareness of vocal hygiene or insufficient vocal hygiene education to self-reported acute and chronic voice symptoms, as well as a greater perception of voice handicap among professional voice users. Numerous studies (n = 10; 43%) showed that adequate voice training or vocal hygiene education was linked to positive voice outcomes. Six studies (6.26%), however, demonstrated that vocal hygiene education is more effective when combined with direct voice therapy. When vocal hygiene education is presented in isolation, the superiority of a direct voice therapy approach, with or without vocal hygiene education, is seen over a vocal hygiene education program alone (indirect treatment). Conclusions: Recent literature demonstrates mixed results obtained through auditory-perceptual, acoustic, and self-rating measures on the effects of vocal hygiene instruction on vocal quality and function in professional voice users. However, the compelling positive outcomes presented do warrant implementation of vocal hygiene education programs in combination with direct voice therapy for professional voice users.

Although irrigation scheduling has been studied for diverse vegetable crops, much less attention has been given to irrigation scheduling for the seed crops on which these production systems rely. In spinach, for which irrigation scheduling needs are likely to vary greatly between seed and leaf production, this leaves seed producers without adequate resources to make irrigation scheduling decisions. Our research sought to fill this gap by evaluating two alternative irrigation scheduling strategies (a publicly available decision-support tool and soil moisture sensors) and four soil moisture thresholds for irrigation for their impacts on vegetative growth, marketable seed yield, seed quality, and the severity of Stemphylium leaf spot (caused by Stemphylium vesicarium and Stemphylium beticola), a common foliar disease of spinach, under sprinkler irrigation. We found that in all 3 years of the study, earlier and more frequent irrigation increased vegetative growth. However, marketable seed yield only increased relative to the control treatment based on farmers’ standard irrigation practices in 1 of the 3 years—a year with an abnormally late planting date. This indicates that vegetative growth is more responsive than seed yield to earlier and more frequent irrigation, and that increases in vegetative growth do not translate directly to increased marketable seed yield. Contrary to the expected increase in Stemphylium leaf spot severity with increasing irrigation, the severity decreased in both years it was measured, likely as a result of the small stature of the spinach seed parent lines used in our study and opportunistic pathogenicity on moisture-stressed plants. These results provide a useful foundation from which spinach seed producers can make irrigation management decisions for their crops that underpin a valuable global industry.

Background. HIV‐infected kidney transplant recipients with COVID‐19 are at increased risk of acute illness and death owing to their underlying comorbidities and chronic immunosuppression. Objectives. To describe the incidence, clinical presentation and course of COVID‐19, vaccination status, and SARS‐CoV‐2 antibody positivity rate among HIV‐infected‐to‐HIV‐infected kidney transplant recipients in South Africa (SA). Methods. This retrospective study reports on rates of SARS‐CoV‐2 infection, COVID‐19 and mortality among SA HIV‐infected kidney transplant recipients who received organs from HIV‐infected donors (HIV positive to HIV positive), before and after vaccination. Patient demographics, clinical presentation, course, management and disease outcomes were analysed. Antibody serology tests were performed between May and September 2022. Results. Among 39 HIV‐positive‐to‐HIV‐positive transplant recipients, 11 cases of COVID‐19 were diagnosed from March 2020 to September 2022. Six patients (55%) required hospitalisation, of whom 3 were admitted to a high‐care unit or intensive care unit. Two patients required mechanical ventilation, and 2 received acute dialysis. One patient was declined access to intensive care. Four patients (10%) died of COVID‐19 pneumonia. All the COVID‐19‐positive patients had at least one comorbidity. Vaccination data were available for 24 patients, of whom 5 had refused SARS‐CoV‐2 vaccination. SARS‐CoV‐2 antibody data were available for 20 patients; 4 vaccinated patients had a negative nucleocapsid protein antibody test and a positive spike protein antibody test, suggesting vaccination‐acquired immunity. The remaining 16 patients demonstrated immunity that was probably due to COVID infection, and of these, 14 were also vaccinated. Of the 11 COVID‐19 cases, only 1 was observed after vaccination. Conclusion. In our case series, ~10% of the HIV‐positive‐to‐HIV‐positive transplant recipients died of COVID‐19 pneumonia. This mortality rate appears higher than figures reported in other transplant cohorts. However, it is likely that the actual number of cases of SARS‐CoV‐2 infection was much higher, as the study only included polymerase chain reaction‐confirmed cases. It remains unclear whether HIV infection, transplant or the combination of the two drives poorer outcomes, and larger studies adjusting for important demographic and biological factors may isolate these effects.

Background. At Groote Schuur Hospital in Cape Town, South Africa, the number of deceased organ donors has declined over the past 2 decades, necessitating a more liberal approach to donor selection. In 2007, measures to expand the deceased kidney donor pool were implemented, including an HIV positive-to-positive transplant programme and the utilisation of extended-criteria donors as well as donors after circulatory death (DCDs). Objectives. To report on our institutional experience with DCD kidney transplants and to encourage this approach among other African centres to improve access to transplantation. Methods. An observational cohort study of consecutive DCD kidney transplants at Groote Schuur Hospital over a 17-year period was performed. Primary endpoints were 1-, 2- and 5-year graft and patient survival. Secondary endpoints included the incidence of delayed graft function (DGF), 30-day morbidity, length of stay, and donor and recipient clinical characteristics. Results. Fifteen DCD procurements were performed, with no kidneys discarded. Thirty kidney transplants were performed, with a median (interquartile range) cold ischaemic time of 11.5 (8 - 14) hours. The incidence of DGF was 60.0%, and 30-day morbidity (other than DGF) was 20.0%. Graft survival at 1, 2 and 5 years was 100%, 96.0% and 73.7%, respectively. Patient survival at 1, 2 and 5 years was 93.3%, 93.3% and 88.4%, respectively. Conclusion. Long-term graft and patient survival was comparable with the international literature. DCD may present a unique opportunity to expand deceased donation throughout Africa, particularly in areas affected by a lack of brain death legislation and religious or cultural objections to donation after brain death.

Background. Solid-organ transplantation (SOT) has been proven to be a highly effective and life-saving treatment modality for adults and children suffering from end-stage organ failure. However, high paediatric waiting-list mortality has been reported, and children may suffer irreversible physical and deleterious psychological effects if not transplanted timeously. Objectives. To identify in-hospital barriers to organ donation and gain a better understanding of the paediatric donor landscape. Methods. A retrospective descriptive study of consecutive deceased-donor referrals at Red Cross War Memorial Children’s Hospital over a 14-year period, from 1 January 2007 to 31 December 2020. Results. During the study period, 156 in-hospital deaths were recorded in the trauma unit and 1 425 in the paediatric intensive care unit. Ninety-three of the 1 581 patients (5.9%) were referred to the on-call transplant co-ordinator as potential organ donors, of whom 69% had been involved in a traumatic accident, including 52% in road traffic collisions. The mean age of the potential donors was 7 years with 60.2% being boys. On initial assessment, 67 of the 93 potential donors (72%) were assessed as eligible for donation of at least one solid organ. The transplant co-ordinator attempted to approach all families for consent; however, five families/next of kin could not be located despite multiple attempts. Among the remaining 62 eligible donors, 44 families/next-of-kin declined consent for solid-organ donation, resulting in a consent rate of 29% (n=18). Several families refused consent for religious reasons. One of the consented donors did not proceed to procurement as there were no suitable recipients. Seventeen donors proceeded to theatre, the intention being solid-organ procurement, but in 2 donors the organs were assessed as being unsuitable for transplant. From the remaining 15 donors, a total of 46 organs were procured and successfully transplanted: 14 livers, 30 kidneys and 2 hearts. Conclusion. During the 14-year study period, only 15 deceased donors could be utilised for SOT, as a result of low in-hospital referral (5.9%) and consent rates (29%). The reasons for low referral and consent rates are complex and often multifactorial, which the current study was not designed to investigate in sufficient detail. Future studies should be designed to further interrogate our findings, while accommodating for nuances specific to the paediatric deceased-donor population and their families.

Extended-criteria donors (ECDs) are seen as a means of addressing the shortfall in solid-organ availability for transplant. However, the use of ECD kidneys is associated with a greater risk of primary non-function compared with standard-criteria donor kidneys, and a higher discard rate has been described internationally. There seems to be a lack of consensus in the consideration of ECD kidneys for transplant, with reliance often placed on the subjective assessment of individual clinicians. The following case examines the difference in the institutional decision-making process applied to two kidneys from a single donor, and provides an argument for the use of hypothermic machine perfusion in low- to middle-income countries as an efficacious and objective means of assessing ECD kidney suitability.

Background: Globally professional accounting bodies expect of higher education institutions to develop integrated thinking skills in prospective chartered accountants. There are, however, many barriers in the way of both lecturers and students to achieve the development of integrated thinking skills. Aim: This article sought to identify the most significant barriers lecturers and students face when developing integrated thinking skills in prospective chartered accountants during higher education. Setting: Interviews were conducted and an online questionnaire ministered. Method: The mixed-method approach and a pragmatist paradigm are utilised. Both questionnaires and interviews were used to collect primary data. A triangulation between the quantitative data, qualitative data, and literature had been performed. Results: The three most significant barriers that lecturers face in developing integrated thinking skills are the volume of technical content, lack of expertise, and large classroom sizes. The three most significant barriers that students face in developing integrated thinking skills are students being overburdened with the technical content of the syllabus, not having been exposed to integrated thinking prior to higher education, and having to study in a second language. Conclusion: The most significant barriers for both lecturers and students in the development of integrated thinking skills during the higher education of prospective chartered accountants are identified in this study. Contribution: While much has been published on the barriers to developing integrated thinking skills, a limited amount of literature addresses the specific barriers that exist in the accounting education field.

BackgroundHIV can invade the central nervous system (CNS) early during infection, invading perivascular macrophages and microglia, which, in turn, release viral particles and immune mediators that dysregulate all brain cell types. Consequently, children living with HIV often present with neurodevelopmental delays.MethodsIn this study, we used proton nuclear magnetic resonance (1H-NMR) spectroscopy to analyze the neurometabolic profile of HIV infection using cerebrospinal fluid samples obtained from 17 HIV+ and 50 HIV− South African children.ResultsNine metabolites, including glucose, lactate, glutamine, 1,2-propanediol, acetone, 3-hydroxybutyrate, acetoacetate, 2-hydroxybutyrate, and myo-inositol, showed significant differences when comparing children infected with HIV and those uninfected. These metabolites may be associated with activation of the innate immune response and disruption of neuroenergetics pathways.ConclusionThese results elucidate the neurometabolic state of children infected with HIV, including upregulation of glycolysis, dysregulation of ketone body metabolism, and elevated reactive oxygen species production. Furthermore, we hypothesize that neuroinflammation alters astrocyte–neuron communication, lowering neuronal activity in children infected with HIV, which may contribute to the neurodevelopmental delay often observed in this population.

Background: Nurses are often required to perform dysphagia screening prior to oral intake by people following stroke. Previous studies report limited knowledge of nurses in identifying symptoms of post-stroke dysphagia. Objective: To explore existing literature regarding nurses’ practices and knowledge in the identification and management of post-stroke oropharyngeal dysphagia (OPD) in low- and middle income countries (LMICs). Method: A scoping review was conducted according to the PRISMA-ScR guidelines. Studies were retrieved from PubMed, Scopus, EBSCOhost (CINAHL and Health source: Nursing and Academic edition), Web of Science Core collection, and Cochrane libraries. No time frame was applied, and all included studies were screened according to predefined eligibility criteria. Results: Eight studies were included from 1 792 initial hits. Studies described nursing practices in acute care pertaining to identification and management of stroke-related dysphagia in LMICs. Increased knowledge was reported in nurses who had greater clinical experience in managing patients with dysphagia. Needs for training relating to dysphagia management and opportunities for interprofessional collaboration with speech-language therapists (SLTs) were identified. Contextual barriers specific to LMICs impacting on optimal nursing management of dysphagia included heavy workloads, staff-shortages and time constraints. Conclusion and contribution: Eight studies described nurses’ practices and identified needs for the improvement of nurses’ dysphagia care in LMICs. This scoping review highlighted the urgency for further research in dysphagia management that provides creative, contextually relevant solutions for improved protocols and training of health care professionals. Findings may be valuable for the multidisciplinary team involved in post-stroke dysphagia care.

Background: Many accounting professional bodies, of which the South African Institute of Chartered Accountants (SAICA) is one, expect academics to develop integrated thinking skills in their students during higher education. Integrated thinking is, however, often confused with critical thinking, systems thinking and design thinking. Aim: This article aims to delineate the concept of integrated thinking by analysing the similarities and differences between integrated thinking, integrative thinking, critical thinking, systems thinking and design thinking. Conclusion: Integrated thinking is a higher-order thinking skill with a strong emphasis on the ability to think in a creative manner. Although there are differences between integrated thinking and other higher-order thinking skills, there are also similarities. This article sets integrated thinking apart from other higher-order thinking skills. Contribution: Limited research has been conducted to distinguish integrated thinking from integrative thinking, critical thinking, systems thinking and design thinking. This article endeavours to identify the true nature of integrated thinking by comparing it with other higher-order thinking skills. If lecturers at higher education institutions are to develop integrated thinking skills, it is important for them to have a clear understanding of what integrated thinking is, and how it differs from other thinking models. Without a grounded understanding of what integrated thinking is, it is nearly impossible to develop it in students.

Tuberculous meningitis (TBM) is a severe form of tuberculosis with high neuro-morbidity and mortality, especially among the paediatric population (aged ≤12 years). Little is known of the associated metabolic changes. This study aimed to identify characteristic metabolic markers that differentiate severe cases of paediatric TBM from controls, through non-invasive urine collection. Urine samples selected for this study were from two paediatric groups. Group 1: controls (n = 44): children without meningitis, no neurological symptoms and from the same geographical region as group 2. Group 2: TBM cases (n = 13): collected from paediatric patients that were admitted to Tygerberg Hospital in South Africa on the suspicion of TBM, mostly severely ill; with a later confirmation of TBM. Untargeted 1H NMR-based metabolomics data of urine were generated, followed by statistical analyses via MetaboAnalyst (v5.0), and the identification of important metabolites. Twenty nine urinary metabolites were identified as characteristic of advanced TBM and categorized in terms of six dysregulated metabolic pathways: 1) upregulated tryptophan catabolism linked to an altered vitamin B metabolism; 2) perturbation of amino acid metabolism; 3) increased energy production–metabolic burst; 4) disrupted gut microbiota metabolism; 5) ketoacidosis; 6) increased nitrogen excretion. We also provide original biological insights into this biosignature of urinary metabolites that can be used to characterize paediatric TBM patients in a South African cohort.