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Background: Hospitalized neonates are vulnerable to infection and have high rates of antibiotic utilization. Methods: Fourteen South African neonatal units (seven public, seven private sector) assembled multidisciplinary teams involving neonatologists, microbiologists, pharmacists, and nurses to implement prospective audit and feedback neonatal antimicrobial stewardship (NeoAMS) interventions. The teams attended seven online training sessions. Pharmacists conducted weekday antibiotic prescription reviews in the neonatal intensive care unit and/or neonatal wards providing feedback to the clinical teams. Anonymized demographic and NeoAMS interventions data were aggregated for descriptive purposes and statistical analysis. Findings: During the 20-week NeoAMS intervention in 2022, 565 neonates were enrolled. Pharmacists evaluated seven hundred antibiotic prescription episodes; rule-out sepsis (180; 26%) and culture-negative sepsis (138; 20%) were the most frequent indications for antibiotic prescription. For infection episodes with an identified pathogen, only 51% (116/229) of empiric treatments provided adequate antimicrobial coverage. Pharmacists recommended 437 NeoAMS interventions (0·6 per antibiotic prescription episode), with antibiotic discontinuation (42%), therapeutic drug monitoring (17%), and dosing (15%) recommendations most frequent. Neonatal clinicians’ acceptance rates for AMS recommendations were high (338; 77%). Mean antibiotic length of therapy decreased by 24% from 9·1 to 6·9 days (0·1 day decrease per intervention week; P = 0·001), with the greatest decline in length of therapy for culture-negative sepsis (8·2 days (95% CI 5·7-11·7) to 5·9 days (95% CI 4·6-7·5); P = 0·032). Interpretation: This neonatal AMS programme was successfully implemented in heterogenous and resource-limited settings. Pharmacist-recommended AMS interventions had high rates of clinician acceptance. The NeoAMS intervention significantly reduced neonatal antibiotic use, particularly for culture-negative sepsis. Funding: A grant from Merck provided partial support.

Post-rape research and support often focuses on external stigma, yet many rape survivors experience appreciable shame, self-blame and internalized-stigma. Despite a growing literature describing the impact of these feelings on survivors' emotional wellbeing, there has been little research on this in South Africa, where an average of 40,000 rape cases are reported annually. To strengthen our understanding of female rape survivors' experiences and perceptions of shame, self-blame and internalized-stigma, we undertook qualitative research with 16 survivors in eThekwini, South Africa. They participated in 2–3 in-depth and life history interviews, that sought to enable them to express how they made meaning of post-rape internalized-stigma, shame and self-blame, and how these may have influenced their psychological reactions to rape. The paper describes the women's experiences and reactions to the rape and reflects on how their descriptions contribute to theoretical perspectives on shame, self-blame and internalized-stigma. The women expressed feelings of shame, self-blame, and internalized-stigma, describing these as distinct, yet inter-connected. These feelings were a reaction to views expressed by family, community members and service providers, their relationship to the perpetrator, the extent of gossip about the incident and gender norms and rape myths. Furthermore, while the stigma was felt at an individual level, it was driven by external stigma enacted at interpersonal and structural/community levels. Women who had experienced more than one rape, explained this through the internally-stigmatizing notion of being ‘rape-able’. This study addresses a significant knowledge gap which could improve contextually appropriate post-rape care services and interventions in South Africa, particularly psychological support for survivors. Finally, while rape survivors should be supported to address their own shame, self-blame and internalized-stigma, external stigma needs to be addressed at interpersonal and structural levels.

Background: Diabetic monitoring and treatment guidelines are easily accessible, but compliance is poor in KwaZulu-Natal. The coronavirus disease 2019 (COVID-19) pandemic had a devastating impact on diabetic healthcare, both directly and through public health interventions. Objective: This study aimed to close the gaps in knowledge concerning glycated haemoglobin (HbA1c) test utilisation and how this was affected by the COVID-19 lockdown in KwaZulu-Natal. Methods: We reviewed HbA1c test volumes and results from public health facilities in the 11 health districts in KwaZulu-Natal, South Africa. We compared testing trends and glycaemic control between two 10-month study periods before (March 2019 – December 2019) and during (March 2020 – December 2020) the COVID-19 pandemic. Results: The number of HbA1c tests performed decreased 6.1% during the pandemic period, with 173 760 HbA1c tests performed in 2019 and 163 236 HbA1c tests performed in 2020. There was a statistically significant increase in the average HbA1c level during the pandemic (mean HbA1c level in the pre-pandemic period: 70.5 mmol/mol [8.6%] versus mean HbA1c level in the pandemic period: 72.7 mmol/mol [8.8%]; p-value 0.001). Of patients with suboptimal HbA1c results (83 421 in 2019, 83 259 in 2020), 11 656 (14.0%) in 2019 and 10 086 (12.1%) in 2020 had more than one HbA1c test performed during the study period. Conclusion: The COVID-19 pandemic impacted glycaemic monitoring in KwaZulu-Natal with lower HbA1c test volumes and worse glycaemic control seen during the pandemic. HbA1c testing practices are not in keeping with recommended guidelines. What this study adds: The study demonstrates that the COVID-19 pandemic impacted HbA1c utilisation in KwaZulu-Natal. Importantly, HbA1c testing practices in KwaZulu-Natal are not in keeping with Society for Endocrinology, Metabolism and Diabetes of South Africa guidelines regarding the monitoring of diabetic patients, and this requires more attention for future diabetic healthcare interventions.

Abstract High‐density polyethylene (HDPE) polymer is one of the largest contributors to plastic wastes causing detrimental effects on various sectors of society, and is not biodegradable in nature. In the first stage, river sand and a recycled HDPE as a binder were used to manufacture eco‐friendly plastic sand bricks with various sand(s):plastic(p) ratios: 60s:40p; 65s:35p; 70s:30p; 75s:25p; 80s:20p; 85s:15p. In the second stage, 1%, 5%, and 10% of Kaolin Clay was added to each ratio of sand:plastic, respectively. Three mechanical tests were conducted: compressive strength, impact, and short beam strength. First, the addition of 5% Kaolin Clay to 75s:25p ratio increased compressive strength significantly from 21.4 to 52.76 MPa. Second, the addition of 10% Kaolin Clay in the ratio of 75s:25p mixture increased the impact strength from 4.8 to 5 J. Finally, the addition of 5% Kaolin Clay in the ratio of 60s:40p mixture increased the short beam strength significantly from 1.84 to 2.27 MPa. SEM analysis showed a well‐compacted interface indicating effective bonding between the HDPE and river sand particles in the 75s:25p ratio. Hence, the results of this study present a potential for the use of recycled HDPE plastic to manufacture plastic sand bricks. Highlights Addition of Kaolin Clay improved the mechanical properties of the composite material.

Abstract Uncertainty relations are core to both classical and quantum physics, and lend themselves to tests across many degrees of freedom, with structured light emerging as a vibrant tool to harness these degrees of freedom. Here, we test Popper’s conjecture by replacing the traditional spatial and momentum states with angular position and orbital angular momentum (OAM) states of photons, showing that the OAM spectrum for an entangled photon passing through a virtual slit differs from that of a photon passing through a physical slit. To achieve this, we produce two OAM entangled photons, one of which is sent to a slit encoded as a digital hologram, thereby localising its angular position, all the while measuring the OAM of the other. We show that the measured OAM spectrum is limited to that of the initial SPDC photons, independent of the OAM encoded into the slit, consistent with Popper’s viewpoint. Our approach allows us to overcome prior limitations imposed by physical slits and linear momentum, and offers a versatile toolbox for further probes of quantum systems.

Background Predicting severe Crohn's disease (SCD) can assist in planning risk reduction therapy for SCD, thereby improving disease outcomes. Objective To determine the prevalence and predictors of SCD in a sample of South African patients. Methods This was a retrospective chart review of patients with Crohn's disease (CD) attending the Gastroenterology Unit at a tertiary hospital in Durban, South Africa. Demographic and clinical variables at diagnosis of CD were collected and analysed for statistical association with development of SCD (defined as the presence of >/= 1 of the following over the course of CD: complex perianal disease, colonic resection >/= 2 small bowel resections, a single small bowel resection > 50cm, or construction of a definitive stoma). The prognostic utility of statistically significant variables was investigated by establishing their sensitivity, specificity, and predictive values for SCD. Results The study consisted of 93 patients. The rate of SCD was 64.5%, with 63.3 % of patients developing SCD within 1 year of CD diagnosis. Ileocolonic location (p = 0.046) and penetrating disease at initial diagnosis of CD (p = 0.021) were statistically associated with SCD. The sensitivity, specificity, positive predictive value, and negative predictive value of ileocolonic location for SCD was 72.7%, 47.4%, 66.7% and 54.6%. The sensitivity, specificity, positive predictive value, and negative predictive value of penetrating disease for SCD was 85.7%, 41.7%, 30.0% and 91.0%. Conclusion Most patients with CD developed SCD within 1 year of their CD diagnosis. CD with a penetrating phenotype at diagnosis is a good predictor for the devleopment of SCD and should be further investigated.

Background. Over 30% of the world’s population is anaemic, with a significant proportion of these being iron deficient. As iron deficiency (ID) anaemia in men and post-menopausal women is mostly caused by gastrointestinal blood loss or malabsorption, the initial evaluation of a patient with ID anaemia involves referral to a gastroenterologist. The current drive towards patient blood management in sub-Saharan Africa (SSA)prescribes that we regulate not only the use of blood transfusion but also the management of patients in whom the cause of iron loss or inadequate iron absorption is sought. Recommendations have been developed to: (i) aid clinicians in the evaluation of suspected gastrointestinal iron loss and iron malabsorption, and often a combination of these; (ii) improve clinical outcomes for patients with gastrointestinal causes of ID; (iii) provide current, evidence-based, context-specific recommendations for use in the management of ID; and (iv) conserve resources by ensuring rational utilisation of blood and blood products. Method. Development of the guidance document was facilitated by the Gastroenterology Foundation of Sub-Saharan Africa and the South African Gastroenterology Society. The consensus recommendations are based on a rigorous process involving 21 experts in gastroenterology and haematology in SSA. Following discussion of the scope and purpose of the guidance document among the experts, an initial review of the literature and existing guidelines was undertaken. Thereafter, draft recommendation statements were produced to fulfil the outlined purpose of the guidance document. These were reviewed in a round-table discussion and were subjected to two rounds of anonymised consensus voting by the full committee in an electronic Delphi exercise during 2022 using the online platform, Research Electronic Data Capture. Recommendations were modified by considering feedback from the previous round, and those reaching a consensus of over 80% were incorporated into the final document. Finally, 44 statements in the document were read and approved by all members of the working group. Conclusion. The recommendations incorporate six areas, namely: general recommendations and practice, Helicobacter pylori, coeliac disease, suspected small bowel bleeding, inflammatory bowel disease, and preoperative care. Implementation of the recommendations is aimed at various levels from individual practitioners to healthcare institutions, departments and regional, district, provincial and national platforms. It is intended that the recommendations spur the development of centre-specific guidelines and that they are integrated with the relevant patient blood management protocols. Integration of the recommendations is intended to promote optimal evaluation and management of patients with ID, regardless of the presence of anaemia.

While previous research has suggested that prospective memory may be enhanced by providing a social motive (i.e., social importance) or by promising a monetary reward for successful performance, to the best of our knowledge, the underlying mechanisms responsible for these effects are still largely unexplored. In a sample of 96 younger adults, this study investigated how social importance and promising a monetary reward influence the prospective component and the retrospective component of event-based prospective memory separately, with the application of a multinomial modeling approach. Results revealed enhanced prospective memory performance for all importance conditions compared to a standard condition. This improvement was characterized by an increased allocation of resource-demanding attentional processes in performing the prospective memory task at the expense of the ongoing task without an increase in the perceived importance of the prospective memory task. The model-based analyses showed that the beneficial effects of importance arise from an increased engagement of the prospective component, leaving the estimates for the retrospective component unaffected.

Plastics are a precious, versatile set of materials. The accumulation of plastic waste threatens the environment. Recycling plastic waste can produce many new products. The many opportunities for using plastic waste create pressure for a strategy to develop or improve current waste management systems to reduce the negative impact on humans, fauna and flora. The objective of this review paper is to consider an opportunity to recycle plastic; to convert plastic waste into plastic sand bricks. This would reduce the impact of the four emerging crises (plastic pollution, unemployment, the shortage of affordable housing and climate change) identified in South Africa as a threat to sustainability. This paper reviews studies utilising plastic waste to manufacture materials for the construction industry. The feasibility of using plastic waste to manufacture bricks revealed high compressive strength, low water absorption and weighed considerably lower compared to traditional bricks. Plastic sand bricks, therefore, can provide a solution that can be used to curb the four emerging crises and contribute to sustainability.

Background: Inappropriate testing remains a high healthcare cost driver. Tumour marker tests are more expensive than routine chemistry testing. Implementing test demand management systems like electronic gatekeeping (EGK) has reportedly decreased test requests. Objective: This study aimed to describe the appropriateness of tumour marker tests, carcinoembryonic antigen, alpha foetal protein, prostate-specific antigen, carbohydrate antigen 19-9, cancer antigen 15-3, cancer antigen 125, and human chorionic gonadotropin, and determine the effectiveness of the EGK used in the public health sector in KwaZulu-Natal, South Africa. Methods: Tumour marker test data for the KwaZulu-Natal province were extracted from the National Health Laboratory Service Central Data Warehouse for 01 January 2017 – 30 June 2017 (pre-EGK) and 01 January 2018 – 30 June 2018 (post-EGK implementation). Questionnaires were sent to the clinicians in the regional hospitals ordering the most tumour marker tests to assess ordering practices. In addition, we assessed monthly rejection reports to determine the effect of the EGK. Results: The EGK minimally reduced tumour marker requests or associated costs (1.4% average EGK rejection rate). An overall 18% increase in the tumour marker tests occurred in 2018. The data suggest inappropriate tumour marker test utilisation, particularly for screening. Conclusion: The introduction of EGK as a test demand management had little impact on tumour marker test requests and costs. Continuous education and reiteration of indications for tumour marker test use are required. What this study adds: This study demonstrates the ineffectiveness of EGK in tumour marker orders, and provides some insight as to why these markers are being ordered, which is important in trying to decrease inappropriate ordering of these tests.

The care and rehabilitation of acute and chronic wounds have a significant social and economic impact on patients and global health. This burden is primarily due to the adverse effects of infections, prolonged recovery, and the associated treatment costs. Chronic wounds can be treated with a variety of approaches, which include surgery, negative pressure wound therapy, wound dressings, and hyperbaric oxygen therapy. However, each of these strategies has an array of limitations. The existing dry wound dressings lack functionality in promoting wound healing and exacerbating pain by adhering to the wound. Hydrogels, which are commonly polymer-based and swell in water, have been proposed as potential remedies due to their ability to provide a moist environment that facilitates wound healing. Their unique composition enables them to absorb wound exudates, exhibit shape adaptability, and be modified to incorporate active compounds such as growth factors and antibacterial compounds. This review provides an updated discussion of the leading natural and synthetic hydrogels utilized in wound healing, details the latest advancements in hydrogel technology, and explores alternate approaches in this field. Search engines Scopus, PubMed, Science Direct, and Web of Science were utilized to review the advances in hydrogel applications over the last fifteen years.

Abstract Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is commonly associated with cognitive complaints. To bring out the neuropsychological symptomatology inherent to ME/CFS, we conducted a systematic review according to PRISMA and MOOSE guidelines of the literature through the analysis of 764 studies published between 1988 and 2019 by using PubMed Central website and Clarivate analytics platform. We performed a meta-analysis to delineate an idea of the neuropsychological profile inherent in ME/CFS. The clinical picture typically affects visuo-spatial immediate memory (g = − 0.55, p = 0.007), reading speed (g = − 0.82, p = 0.0001) and graphics gesture (g = − 0.59, p = 0.0001). Analysis also revealed difficulties in several processes inherent in episodic verbal memory (storage, retrieval, recognition) and visual memory (recovery) and a low efficiency in attentional abilities. Executive functions seemed to be little or not affected and instrumental functions appeared constantly preserved. With regard to the complexity and heterogeneity of the cognitive phenotype, it turns out that determining a sound clinical picture of ME/CFS cognitive profile must go through a neuropsychological examination allowing a complete evaluation integrating the notion of agreement between the choice and the number of tests and the complexity intrinsic to the pathology.

Post-colonoscopy consults empower patients to make informed decisions around their subsequent treatment, and non-compliance with these consults ("no-shows") hinders disease management. There is a paucity in the literature regarding self-adherence to post-colonoscopy consults in resource-limited settings such as South Africa. An understanding of self-adherence to post-colonoscopy consults in this setting is required to establish whether improved interventions are needed, and what specific elements of self-adherence should be addressed with these interventions. The objective of this hypothesis-generating, cross-sectional, quantitative survey was to conduct a baseline assessment of cognitive, motivational, social, and behavioural variables related to self-adherence to post-colonoscopy consults in patients who underwent diagnostic colonoscopy at a South African quaternary hospital. The Adherence Determinants Questionnaire (ADQ) was administered in 47 patients to establish a baseline assessment of elements related to self-adherence to post-colonoscopy consults, including interpersonal aspects of care, perceived utility, severity, susceptibility, subjective norms, intentions, and supports/barriers. ADQ scores were transformed to a percentage of the maximum score for each element (100.0%). The overall mean transformed ADQ score was 57.8%. The mean transformed scores for specific ADQ components were as follows: subjective norms (40.8%), perceived severity (55.4%), perceived utility (56.6%), intentions (59.4%), supports/barriers (59.9%), interpersonal aspects (62.2%), and perceived susceptibility (65.9%). There were no statistically significant differences in overall mean transformed ADQ scores and individual ADQ elements across categories of participant age (p-values ranging between 0.180 and 0.949 when compared between participants ≤40 years and >40 years old), gender (p-values ranging between 0.071 and 0.946 when compared between males and females), and race (p-values ranging between 0.119 and 0.774 when compared between Black Africans and non-Black Africans). Our findings suggest a general need for appropriate interventions to improve self-adherence to post-colonoscopy consults in our setting.

Current research on Coastal and Marine Tourism (CTM) in South Africa focuses on two main coastal tourism provinces (KwaZulu-Natal and Western Cape) as well as specific CMT activities such as whale watching and shark cage diving. This study, therefore, contributes to the body of knowledge on CMT by focusing on the Eastern Cape and undertaking a provincial level analysis. Coastal and Marine Tourism location visitor profiles in terms of socio-economic profile, types of CMT visitors, types of CMT activities participated and future interest in the Eastern Cape, South Africa. CMT encompasses activities and resources in and near coastal and marine areas that attract visitors who participate in a range of active and passive business, adventure, leisure and recreational activities that generate socio-economic and environmental benefits. A quantitative approach is adopted, drawing on 700 visitor surveys that were conducted at purposively selected CMT locations in the Eastern Cape. Visitors were from a range of socio-economic backgrounds. There were high levels of participation in CMT activities, especially coastal leisure and recreational activities. Results indicate increased CMT location visitation demand. From a sustainability and responsible tourism perspective, understanding who visits CMT sites assists in ensuring effective planning to manage demand and protect/ conserve coastal and marine resources.

Cape Town, one of South Africa’s key coastal tourism destinations, provides a useful case study to examine visitor profiles in Coastal and Marine Tourism (CMT) sites. Nine hundred and seven visitor surveys were completed in purposively selected CMT locations in Cape Town. The main findings reveal that there is diversity among visitors frequenting CMT sites in Cape Town in terms of type of visitor, gender, population group, age, educational level and economic status. Visitors participated in a range of CMT activities and indicated an interest to participate in future activities. Furthermore, high levels of satisfaction with the CMT activities and locations were evident which suggests that a growing demand for CMT activities in Cape Town which needs to be managed. Examining visitor profiles, perceptions, preferences and experiences is important to improve planning and management of these destinations to ensure long-term sustainability.

We examined how mushroom experts organize and process their knowledge, compared with novices, and which types of arguments they use to process information. Mushroom experts and novices carried out an identification/memorization task, a free recall task, and a matching task. Results showed that experts performed better than novices on all three tasks. In the identification task, they named items at the subordinate level, whereas novices named them at the basic level. In the free recall task, experts recalled more items than novices, by grouping them into categories, while in the matching task, they used both similarity and dissimilarity criteria and provided conceptual and perceptual arguments. In conclusion, experts seem capable of carrying out two types of processing: relational processing, reflecting the ability to form categories at the basic level by considering the similarities of items belonging to the same category, and more analytical processing at the subordinate level, reflecting the ability to process difference in a context of similarity, indicating that experts are also able to use specific (distinctive) attributes, relying simultaneously on perceptual and conceptual information.

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While some studies have examined aspects of tourism in Lesotho, there is limited research examining domestic tourist profiles and travel patterns, crucial to unlocking Lesotho’s domestic tourism potential. There is a need for such research to enable the development of appropriate tourism products and strategies. This study then critically examines results from a household survey that was undertaken in Lesotho to assess domestic tourists’ profiles, travel patterns, main motivations, and tourism products or services. Face-to-face interviews were conducted in 1 210 households across all administrative districts of Lesotho using a proportionate sampling approach. Within each District, a systematic sampling approach was adopted to minimise bias. Lesotho has several tourism products such as cultural and heritage sites, nature-based destinations and unique leisure experiences. Pre COVID-19 levels of domestic tourism and travel were relatively high. The study found that several socio-economic factors influence the willingness and ability of households to consume domestic tourism products. It is concluded that domestic tourism in Lesotho can be improved with better, more appropriate communication and marketing strategies, as well as an upgraded transport infrastructure and tourism services.

Background: Traumatic brain injury (TBI) is a common cause of paediatric morbidity and mortality, with higher TBI rates in low- and middle-income countries. Non-contrast brain CT is the gold standard for diagnosing intracranial injuries; however, it exposes patients to ionising radiation. The Paediatric Emergency Care Applied Research Network (PECARN) clinical decision rule (CDR) aids clinicians in their decision-making processes whilst deciding whether a patient at very low risk of a clinically important TBI (ciTBI) requires a CT scan. Objectives: To establish whether the introduction of the PECARN CDR would affect CT utilisation rates for paediatric patients presenting with minor blunt head injuries to an academic hospital in Gauteng, South Africa. Method: This was an audit of paediatric patients who presented with minor blunt head injuries and were referred for CT imaging at an academic hospital in Gauteng, compared with PECARN CDR recommendations, over a 1-year period. Results: A total of 100 patients were referred for CT imaging. Twenty patients were classified as very low risk, none of whom had any CT findings of a TBI or ciTBI (p 0.01). A total of 61 patients were classified as intermediate risk and 19 as high risk. In all, 23% of the intermediate and 47% of the high-risk patients had CT features of a TBI, whilst 8% and 37% had a ciTBI, respectively. Conclusion: Computed tomography brain imaging may be omitted in patients classified as very low risk without missing a clinically important TBI. Implementing the PECARN CDR in appropriate patients would reduce CT utilisation rates.

The Mzansi Golden Economy (MGE) programme in South Africa is intended to unlock the arts, culture and heritage sector to create sustainable jobs and economic development as well as address social cohesion. This research focuses on one of the main sub-categories, the Festivals and Events Grant Programme of the MGE and investigates the programme for a three year funding cycle period. The methodological approach included an examination of 30 organiser reports submitted to DAC and indepth interviews to examine the spatial distribution, amount and number of years of funding received, types supported, job creation and socio-environmental impacts of the Festivals and Events. A spatial spread across South Africa’s nine provinces, different types and sizes of Festivals and Events, job creation, and variation in funding (with reliance on public funding) were noted. The Programme meets the broader objectives of the MGE to contribute to increased diversity of cultural offerings.

Background: The International Myeloma Working Group and College of American Pathologists recommend a 24-h urine collection to determine the Bence Jones protein (BJP) excretion level for monitoring treatment response in patients with multiple myeloma (MM). There are several issues related to sample collection and the method is prone to inaccuracy. Objective: This study compared measured 24-h to random urine collections for the quantitation of BJP in a South African population. Methods: Sixty-six patients with MM submitted random urine samples with their routine 24-h urine collection from April 2016 – March 2018. Measured 24-h urine BJP was compared to two estimated 24-h BJP excretions calculated as follows: Estimation 1 (E1): Estimated 24-h BJP (mg/24 h) = Urine BJP/Creatinine ratio (mg/mmol) × 10. Estimation 2 (E2): Estimated 24-h BJP (mg/24 h) = Urine BJP/Creatinine ratio (mg/mmol) × 15 mg/kg for women or × 20 mg/kg for men. Results: Correlation of estimation equations E1 and E2 to the measured 24-h urine BJP was 0.893. Patients showed no difference in classification of treatment response using either the E1 or E2 estimation equations when compared to the measured 24-h urine BJP results. Conclusion: This study demonstrates that the estimated 24-h BJP shows a high degree of correlation with the measured 24-h BJP and can likely be used to monitor treatment response in South African patients with MM.

A chaotic cipher is presented in this paper using 1-Dimensional and 2- Dimensional chaotic maps like logistic, Chebyshev and Arnold cat map. Permutation phase utilizes logistic map followed by Arnold cat map whereas in diffusion phase, Chebyshev’s map is used. Subsequently, another complex diffusion matrix is generated from the original image. This matrix is employed to enhance the diffusion effect further. Eventually, strong input image sensitivity is explored due to this diffusion. Simulation results exhibit that the recommended cipher ensures not only high key and entropy value but also less correspondence between nearby pixels along all directions. The key point of this cipher is the high Number of Pixels Change Rate (NPCR) and Unified Average Changing Intensity (UACI) values. Due to this impact, the proposed cipher produces completely random encrypted images.

Abstract Background The thrombotic microangiopathies (TMAs) is a heterogeneous group of relatively uncommon but serious disorders presenting with thrombocytopenia and microangiopathic haemolysis. Thrombotic thrombocytopenic purpura (TTP) is one of these microangiopathic processes. HIV infection is an acquired cause of TTP but the pathogenesis is poorly understood. HIV-associated TTP was previously described to be associated with advanced immunosuppression. The incidence of HIV-related TTP was expected to decline with access to anti-retroviral therapy (ART). Methods We undertook an observational study of patients with a diagnosis of TTP admitted to our hospital (CMJAH). The patient demographics, laboratory test results and treatment outcomes were recorded. Results Twenty-one patients were admitted with a diagnosis of TTP during the study period. All patients had schistocytes and severe thrombocytopaenia. The presenting symptoms were non-specific and renal dysfunction and neurological compromise were uncommon. 77% of the patients were HIV-infected and, in 7 patients, TTP was the index presentation. The remainder of the HIV infected patients were on ART and the majority were virologically suppressed. A significant female preponderance was present. Only 4 of the 21 patients tested HIV negative with a positive Coombs test in 2. All patients in this cohort received treatment with plasma exchange therapy for a median period of 12 days with a 96.5% survival rate. Neither the baseline laboratory features nor the degree of immunosuppression was predictive of the duration of therapy needed for remission. Conclusion HIV-related TTP is still a cause of morbidity and the clinical presentation is heterogeneous which may present a diagnostic challenge in the absence of sensitive biomarkers. Early treatment with plasma exchange is effective but expensive and invasive.

A lucid dream is a dream in which one is conscious of dreaming and can possibly control the dream or passively observe its unfolding. Frequencies of lucid dreaming (LD), dream with awareness, and dream with actual control were previously investigated in a French student population. As a student population usually differs on oneiric and sleep characteristics (such as sleep quality) from the general population, more investigations were needed. Additionally, it is yet unresolved if LD is related to one’s overall sleep quality. This study aims at describing and comparing dream experience frequencies (dream, lucid dreams, awareness, and control) and sleep quality assessed with the Pittsburgh Sleep Quality Index (PSQI) among students (n = 274) and in a general population sample (n = 681). It also aims at evaluating if dream experience frequencies can predict sleep quality across these two samples. Predictive models of PSQI score controlling for age and gender were not significant in the student group while they were all marginally predictive for the general population. However, none of these models showed that the frequency of dream experiences could actually help predict the quality of sleep as the significance of the model was carried over only by the gender variable. These results are discussed in line with previous studies on LD frequencies. Several methodological adjustments for future study are proposed.

Background: South Africa has the highest burden of tuberculosis/human immunodeficiency virus (TB/HIV) co-infection in the world, with the province of KwaZulu-Natal representing the global epicentre of TB/HIV. While significant progress has been made to improve the diagnosis of pulmonary tuberculosis, the diagnosis of extrapulmonary TB (EPTB) remains a significant challenge in resource-constrained settings. Methods: A retrospective chart review was conducted, and included all adult patients diagnosed with EPTB at a tertiary hospital in Durban, South Africa, between January 1, 2016 and March 31, 2016. Results: There were 188 new cases of TB during the study period, with 80 patients diagnosed with EPTB. The mean age of patients was 34.73 (SD ± 9.44) years. Forty-two (52.5%) patients were female, while 76 (96%) were black. The most common risk factor for EPTB was HIV co-infection (88.8%). The median CD4 cell count was 68 (IQR 32–165) cells/mm3. Pleural (36.3%), lymph node (28.7%) and abdominal (27.5%) involvement were the most common sites of disease Weight loss, fever, night sweats and cough were amongst the most common symptoms reported. A microbiologically confirmed diagnosis was made in only 65% of cases. In the majority of cases, more than one diagnostic method was used to confirm the presence of TB in distant organs. Conclusion: Immunosuppression, most commonly by HIV, remains the most significant risk factor for the development of EPTB. Advancements in Xpert MTB/Rif and computed tomography have assisted in increasing the diagnostic armamentarium of EPTB. Despite improved access to antiretroviral therapy over the past years, advanced HIV disease remains a significant challenge to TB control.

Many life-saving drugs are still inaccessible and unaffordable in low- and middle-income countries, particularly in Sub-Saharan Africa. This contributes to poor health outcomes, wider health and socioeconomic inequities, and higher patient spending on healthcare. While resource limitations facing national regulatory authorities (NRAs) contribute to the problem, we believe that (1) fragmented and complex drug regulations, (2) suboptimal enforcement of existing regulations, and (3) poorly designed disincentives for non-compliance play a larger role. These “unintended consequences” that are a direct result of our current regulatory regimes limit competition, keep drug costs high, and lead to shortages and the proliferation of illegitimate and unregistered drugs. While NRAs can gain a lot from increased investment in their work, regulatory harmonization and innovation can arrest and reverse the regulatory failures we still see today and improve medicine access in Africa. Unfortunately, harmonization initiatives in Sub-Saharan Africa have made modest impact and have done so slowly. We encourage greater attention and investment in harmonization and other downstream functions of NRAs. We also urge increased participation of national governments–particularly executive agencies in health and the treasury—and patient advocacy groups in advancing harmonization across the subcontinent.

This paper proposes a Capacitor Excited Induction Generator (CEIG)-Matrix Converter (MC) system for feeding stand-alone AC loads. The variable output voltage magnitude and frequency from CEIG is converted into a constant voltage magnitude and frequency at the load terminals by controlling MC using Space Vector Modulation (SVM) technique. This single-stage MC is turned up as a good alternative for the proposed system against commonly used AC/DC/AC two stage power converters. The configuration and implementation of the closed-loop control scheme employing dSPACE 1103 real time controller have been fully described in the paper. The proposed closed-loop controller regulates the AC load voltage irrespective of changes in the prime mover speed and load. A method for predetermining the steady-state performance of the proposed system has been developed and described with relevant analytical expressions. The effectiveness of the proposed system is exemplified through simulation results for various operating conditions. The proposed control technique is further validated using an experimental setup developed in the laboratory.

We examined how mushroom experts organize and process their knowledge, compared with novices, and which types of arguments they use to process information. Mushroom experts and novices carried out an identification/memorization task, a free recall task, and a matching task. Results showed that experts performed better than novices on all three tasks. In the identification task, they named items at the subordinate level, whereas novices named them at the basic level. In the free recall task, experts recalled more items than novices, by grouping them into categories, while in the matching task, they used both similarity and dissimilarity criteria and provided conceptual and perceptual arguments. In conclusion, experts seem capable of carrying out two types of processing: relational processing, reflecting the ability to form categories at the basic level by considering the similarities of items belonging to the same category, and more analytical processing at the subordinate level, reflecting the ability to process difference in a context of similarity, indicating that experts are also able to use specific (distinctive) attributes, relying simultaneously on perceptual and conceptual information.

BackgroundPeritoneal dialysis (PD) is an easily implementable dialysis modality in end-stage renal disease (ESRD). PD may improve access to renal replacement therapy in low- and middle-income countries; however, these countries have a higher prevalence of protein-energy wasting in patients and poorer socioeconomic conditions. We evaluated the effects of HIV infection on serum albumin levels in ESRD patients starting continuous ambulatory PD (CAPD) and mortality outcomes.MethodsWe conducted a single-center prospective cohort study of consecutive incident CAPD patients recruited from two hospitals in Durban, South Africa, from September 2012 to February 2015. Seventy HIV-negative and 70 HIV-positive ESRD patients were followed monthly for serum albumin levels and mortality events during the first 18 months of CAPD therapy.ResultsThe HIV-positive cohort recorded 28 deaths (40%) among patients with a functional CAPD catheter at 18 months and 13 deaths (18.6%) in the HIV-negative cohort (p = 0.005). The mean serum albumin levels were lower in the HIV-positive cohort than in the HIV-negative cohort during the 18-month follow-up. The mean difference in serum albumin levels between the two cohorts was 4.24 g/L (95% confidence interval [CI] 2.02-6.46, pConclusionsHIV infection can adversely affect serum albumin levels in ESRD patients managed with CAPD, while low baseline serum albumin levels and impaired immunity reliably predict mortality.

This study proposes a chaos‐based image encryption scheme using Henon map and Lorenz equation with multiple levels of diffusion. The Henon map is used for confusion and the Lorenz equation for diffusion. Apart from the Lorenz equation, another matrix with the same size as the original image is generated which is a complex function of the original image. This matrix which is configured as a diffusion matrix permits two stages of diffusion. Due to this step, there is a strong sensitivity to input image. This encryption algorithm has high key space, entropy very close to eight (for grey images) and very less correlation among adjacent pixels. The highlight of this method is the ideal number of pixels change rate and unified average changing intensity it offers. These ideal values indicate that the encrypted images produced by this proposed scheme are random‐like. Further, a cryptanalysis study has been carried out to prove that the proposed algorithm is resistant to known attacks.

Nowadays, there is an increased emphasis on utilizing the renewable energy sources and selection of suitable power converters for supplying dc microgrid. Among the various renewable energy sources, wind energy stands first in terms of installed capacity. So, an attempt is made in this paper for supplying dc microgrid utilizing wind energy. A self-excited induction generator has been used in the proposed wind energy conversion system (WECS). A single-stage power converter, namely, semi-converter is connected between the SEIG and dc grid terminals for closed-loop control of the proposed system. A perturb and observe (P&O) based maximum power point tracking (MPPT) algorithm has been developed and implemented using a dsPIC30F4011 digital controller. In this MPPT algorithm, the firing angle of the converter is adjusted by continuously monitoring the dc grid current for a given wind velocity. For analyzing the proposed system, a MATLAB/Simulink model has been developed by selecting the various components starting from wind-turbine model to the power converter supplying dc microgrid. Successful working of the proposed WECS has also been shown through experimental results obtained on a prototype model developed in the laboratory.

Hypertension in childhood leads to hypertension in adult life, the strongest risk factor being obesity. This study determined the prevalence of primary hypertension and its risk factors in Grade XII learners in KwaZulu-Natal, South Africa, from March 2016 to June 2017. Weight, height, body mass index (BMI), random finger prick cholesterol and glucose, and spot urine for an albumin : creatinine ratio were measured. An average of three separate blood pressure readings taken was at least 5 minutes apart. Five hundred and sixty-four learners had weight, height, and BMI; 536 had random blood glucose; and 545 had cholesterol and random spot urine albumin : creatinine ratios measured. Prehypertension was detected in 168 (29.7%) and hypertension in 77 (13.7%) of learners. Ninety (15.9%) were overweight and 75 (13,3%) were obese. Hypercholesterolaemia was present in 58 (10.8%) and a high spot random urine albumin : creatinine ratio in 5 (1.0%). None had a high blood glucose level. Both prehypertension and hypertension in all learners showed a significant increase with increasing BMI. Six (1.0%) learners had metabolic syndrome. Female learners in other racial groups (defined as Indian, mixed race, and White learners), overweight, and obese learners showed significantly higher rates of hypercholesterolaemia. We showed overweight and obesity as risk factors for prehypertension and hypertension. This presages the need for an appropriate diet and adequate exercise in a child’s school career.

The way how cognition is conceived and represented in brain functioning will directly impact clinical investigations of people with cognitive difficulties. This is particularly evident in the field of clinical neuropsychology where methodologies and tools are justified on a fundamental level by the theoretical foundations adopted. The present article outlined how the dominant influences of structural and anatomo-clinical theories of memory have led to a particular conception of clinical investigations. We propose to reconsider these dominant methods in favor of a more dynamic and functional representation of memory that would be clinically more appropriate. More precisely, we argued that relying exclusively on a particular memory conception (i.e., structural) may not be sufficient considering the range of real-life variables affecting a patient’s memory. By extracting clinically meaningful information in more functional and dynamic memory conceptions, we also aim at underlining the potentials advantages of such theories in facilitating personalized assessments and follow up of patients in clinical neuropsychology. We suggest that a dynamic, functional, and integrative conception of memory would be more coherent with the trend in clinical neuropsychology to promote a more collaborative interaction between the clinician and the patient. Finally, considering the absence of empirical studies on the possible benefits of implementing such recent memory concepts in clinical practice, we encourage researchers and clinicians to test in the field of clinical neuropsychology, the usefulness and explanatory power of more dynamic and functional representation of memory in order to objectively demonstrate its validity outside the research loop.

Background: It is common practice in most chemical pathology laboratories for reflective immunofixation electrophoresis (IFE) to occur following the detection or suspicion of a paraprotein on serum protein electrophoresis (SPEP). The chemical pathology laboratory at Inkosi Albert Luthuli Central Hospital (IALCH) in Durban, South Africa, is currently the only non-private laboratory in the KwaZulu Natal province that performs SPEP analysis, with current practice requiring that the clinician request IFE following suggestion by the laboratory after a suspicious SPEP result. Objectives: To review the current process for IFE at IALCH in the context of reflective testing and to examine the use of the alpha-2-globulin/alpha-1-globulin ratio as a predictor of a positive IFE result. Methods: Data for 1260 consecutive SPEP tests performed at the IALCH National Health Laboratory Service were collected between February and July 2011. SPEP and IFE were performed with a Sebia Hydrasys automated electrophoresis system. The alpha-2-globulin/alpha-1-globulin ratio was calculated using density of corresponding fractions on SPEP. Results: Analysis revealed that of the 1260 SPEPs performed during the analysis period, 304 IFEs were suggested by the reviewing pathologist. A total of 45 (15%) of the suggested IFEs were subsequently requested by the attending clinicians. Almost half (46.5%) (n = 20) of the suggested IFEs that were performed revealed the presence of a paraprotein. There was no statistically-significant difference between the alpha-2-globulin/alpha-1-globulin ratio for patients with positive or negative IFEs (p-value = 0.2). Conclusions: This study reveals the need for reflective addition of IFE testing by the laboratory following suspicious findings on SPEP.