Development of a web-based application to improve data collection for antimicrobial point prevalence surveys in the public health care system in South Africa; findings and implications

Background: Surveillance of antimicrobial use is one of the main recommended strategies in combating growing antimicrobial resistance (AMR) rates and a key part of developing pertinent policies and initiatives to reduce growing AMR rates in South Africa and wider. However, determining antimicrobial utilisation at a patient-level among public hospitals in South Africa can be a challenge given personnel and resource constraints. There are also currently no standardized data collection tools. Most countries in Africa currently undertake antimicrobial utilisation surveillance using paper-based data collection tools including point prevalence surveys (PPS). Unfortunately, paper-based systems have disadvantages including the time taken to complete the forms and analyse the findings, increasing costs and manpower hurdles. Electronic tools offer many advantages including mobile and real time data collection and also the opportunity for rapid analytics. Objectives: Develop and test a web-based application (APP) for future PPS studies to successfully address identified challenges. Methods: A web based application (APP) was developed based on previous PPS in Botswana and South Africa using a paper-based data collection tool and tested during July 2017 in a leading public hospital in South Africa. The developed APP was also evaluated for data quality by measuring the number of errors, work flow, and time taken for the survey versus the previous paper-based system. User acceptance was also measured via a questionnaire to the data collectors. Results: A total of 187 patients' files were surveyed in this leading hospital using the APP whilst also documenting the challenges and areas of improvement for the APP. The identified areas of improvement have now been incorporated into the revised APP for future studies. The data collectors agreed that surveying the patients' files took appreciably less time with the APP compared to the paper based tool, and should be used in the future. In addition, data analysis was hastened using the APP. Conclusions: The APP development process has been successful and the APP is a potential tool for future PPS in South Africa and wider. The APP methodology is now being tested in new studies across South Africa to help instigate pertinent educational and other interventions to improve the future use of antimicrobials among public hospitals in South Africa

Households’ Willingness to Pay for Improved Water Services: A Case of Semi-Urban Households in the Lubombo and Lowveld Regions of Swaziland

Management of water resources in an equitable manner by water managers has proved to be a demanding task. Therefore, evaluating domestic water demand behaviours produces an underlying basis for water managers to sustainably and efficiently meet the ever increasing demand for water. Using survey data collected from 314 households in the Lowveld and Lubombo regions of Swaziland, this paper uses the Contingent Valuation Method (CVM) to determine households’ willingness to pay (WTP) for improved water services. In estimating the parametric mean WTP and its determinants, the paper uses both the bivariate probit model and univariate probit model, respectively. The results show that 67% of the households were willing to pay the initial bid for improved water services. The mean WTP for a 20 litre of water was estimated at E0.47[1]. Probit model results show that household income, education, gender, distance and owning a backyard garden positively influence household WTP. However, age, water quality and the initial bid offered deter households WTP for improved water services. This suggests that socioeconomic factors should be considered when setting domestic water tariffs and designing strategies for improved water supply services. Keywords: Willingness to Pay (WTP), Contingent Valuation Method (CVM), Swaziland [1] 1 USD = E13.5 Emalangen

Effects of TiO2 and CS supports on hydrogen spillover in Co and Ru supported catalysts

School of Chemical and Metallurgical Engineering, Faculty of Engineering and the Built Environment, University of the Witwatersrand, Johannesburg, South Africa 22nd of February, 2018Hydrogen spillover is the surface migration of activated hydrogen atoms from a metal catalyst particle, on which they are generated, onto the catalyst support. A lot of research work has been done on hydrogen spillover since its discovery in 1964, and its incidence on reducible supports such as titanium oxide is established, yet questions remain about the role of the support in hydrogen spillover in heterogeneous catalysis. The aim of this research was to investigate the role of a support in hydrogen spillover, using cobalt and ruthenium supported on TiO2 and CS catalysts. These two catalysts were prepared by deposition precipitation-urea, incipient wetness impregnation and polyol methods and characterized using TGA, TEM, BET, XRD and Raman spectroscopic analysis. The Fischer-Tropsch evaluation of the catalysts was done in a fixed bed reactor and the products were analyzed on offline gas chromatographs. The results show a significant shift to lower reduction temperatures for the CoO to Co peak for the physical mixture of Co/TiO2 and Ru/TiO2. However, when Co/TiO2 and Ru/TiO2 catalysts were packed in a bed system separated by different amounts of TiO2, no significant change was observed compared to the “hybrid” catalyst. The separation distance between the two catalysts had no effect in the reduction temperature. The improved reducibility of CoO to Co was attributed to the dissociation of H2 on the Ru, which made the Ru/TiO2 catalyst the donor phase causing the hydrogen to spillover to the acceptor phase which is the Co/TiO2. The same finding was observed for the Ru and Co catalysts supported on the carbon spheres where the CoO to Co peak was shifted to lower reduction temperature compared to the monometallic Co/CS catalyst. The reducibility was attributed to the presence of Ru. For the Co and Ru catalysts supported on carbon spheres the physically mixed Co/CS and Ru/CS catalysts resulted in the increase of C5+ selectivities compared to the monometallic catalysts of Co catalysts. Microwave irradiation had a positive effect on the dispersion and surface area on the catalyst prepared using the polyol and incipient wetness methods.MT 201

Universities trailing behind: Unquestioned epistemological foundations constraining the transition to online instructional delivery and learning

Universities across South Africa have positioned learning management systems (LMS) as central to remote teaching and learning in response to COVID-19. This fundamentally challenges traditional teaching and learning practices where lecturers typically have close personal contact with students. Our argument is underpinned by critical discourse analysis and social constructivist pedagogy to gain deeper insights into the dimensions of LMS pedagogical affordances and the notion of equitable access to tertiary education in the midst of COVID-19 and the subsequent education and economic depression. Conducting a social constructivist pedagogy inspired analytical argumentative evaluation, we interrogate how digital technologies and platforms challenge the status quo and then argue on the systemic deficits of placing LMS at the centre of the transition in the hope of automatically cultivating an equitable learning environment to enable ubiquitous learning. Our analysis highlights potential contradictions in universities’ reliance on lecturers’ ingenuity without developing enabling structures supporting digital pedagogies at grassroots. This is to ensure inclusivity and avoid creating systemic inequalities that affect individual students’ experiences

Experiences of Cooperating Teachers on Teaching Practice Supervision in Eswatini, Swaziland

Cooperating teachers (CTs) are key participants in ensuring a valuable experience for the student teacher (ST) during teaching practice. Surprisingly, their voices largely remain absent in the extant literature. Thus, the purpose of the study was to investigate the experiences of CTs during teaching practice supervision in Eswatini. A descriptive research design using a census of 46 CTs for student teachers (STs) who did teaching practice in the 2015/16 academic year of the University of Eswatini in the Department of Agricultural Education was used. A selfadministered questionnaire was used for collecting data. A five-point numerical scale and sixpoint Likert-type rating scale were used to measure the variables. Three lecturers from the Department of Agricultural Education and Extension and two agriculture teachers established content and face validity for the questionnaire. Inter-item reliability from a pilot study was .78. Findings of the study revealed that CTs were supported by the University through the supervisors and Teaching Practice Handbook. The CTs noted that establishing rapport with the STs was essential and head teachers needed to visit the STs in the respective classes they teach. STs were good in developing, organizing and using instructional materials but had challenges in disciplining learners. The study recommended that CTs should be provided with trainings and incentives so that they can effectively discharge their duties during teaching practice

Review: Use of EEG on Measuring Stress Levels When Painting and Programming

For years, brain activity, stress level during programming and painting have been analyzed separately. As the world gets more digital and human life gets more dependent on technology, it has become more important to analyse the relationship between programming, software developers’ brain activity, creative practices (i.e painting) and stress level. In this paper, we present the results of a systematic literature review whereby the research questions are centred around analysing the relationship between stress levels and brain activity when a person is painting or writing a piece of software. The search for relevant studies was done on google scholar and IEEE Xplore. The results of our review show that: (1) EEG can be used to accurately measure stress levels, (2) there is limited research in the analysis of stress level pattern of the stress level when people paint depending on different situations and styles of painting. In light of the systematic literature review result, using EEG we plan to conduct experiments to measure the stress level when a person is painting a picture or programming

Prevalence of sexually transmitted infections among young people in South Africa: A nested survey in a health and demographic surveillance site

BACKGROUND: Sexually transmitted infections (STIs) and bacterial vaginosis (BV) are associated with increased transmission of HIV, and poor reproductive and sexual health. The burden of STIs/BV among young people is unknown in many high HIV prevalence settings. We conducted an acceptability, feasibility, and prevalence study of home-based sampling for STIs/BV among young men and women aged 15-24 years old in a health and demographic surveillance site (HDSS) in rural KwaZulu-Natal, South Africa. METHODS AND FINDINGS: A total of 1,342 young people, stratified by age (15-19 and 20-24 years) and sex were selected from the HDSS sampling frame; 1,171/1,342 (87%) individuals had ≥1 attempted home visit between 4 October 2016 and 31 January 2017, of whom 790 (67%) were successfully contacted. Among the 645 who were contacted and eligible, 447 (69%) enrolled. Consenting/assenting participants were interviewed, and blood, self-collected urine (men), and vaginal swabs (women) were tested for herpes simplex virus type 2 (HSV-2), chlamydia, gonorrhoea, syphilis, trichomoniasis, and BV. Both men and women reported that sample collection was easy. Participants disagreed that sampling was painful; more than half of the participants disagreed that they felt anxious or embarrassed. The weighted prevalence of STIs/BV among men and women, respectively, was 5.3% and 11.2% for chlamydia, 1.5% and 1.8% for gonorrhoea, 0% and 0.4% for active syphilis, 0.6% and 4.6% for trichomoniasis, 16.8% and 28.7% for HSV-2, and 42.1% for BV (women only). Of the women with ≥1 curable STI, 75% reported no symptoms. Factors associated with STIs/BV included having older age, being female, and not being in school or working. Among those who participated in the 2016 HIV serosurvey, the prevalence of HIV was 5.6% among men and 19% among women. Feasibility was impacted by the short study duration and the difficulty finding men at home. CONCLUSIONS: A high prevalence of STIs/BV was found in this rural setting with high HIV prevalence in South Africa. Most STIs and HIV infections were asymptomatic and would not have been identified or treated under national syndromic management guidelines. A nested STI/BV survey within a HDSS proved acceptable and feasible. This is a proof of concept for population-based STI surveillance in low- and middle-income countries that could be utilised in the evaluation of STI/HIV prevention and control programmes

The use of hypercapnic challenge blood oxygen level dependent (BOLD) MRI for the investigation of childhood steno-occlusive arteriopathy

BACKGROUND: In childhood, cerebral arteriopathy causes cerebral ischaemia and infarction via two related mechanisms. The first, thrombotic vaso-occlusive stroke is the more typical mechanism of stroke in childhood. The second mechanism of infarction related to arteriopathy and not seen in other forms of ischaemic stroke is that of chronic hypoperfusion of the brain. The infarcts in this case are typically located in watershed zones and can accumulate gradually over time. Moyamoya is the prototypic arteriopathy representing the hypoperfusion injury. It is characterized by chronic progressive narrowing of the distal internal carotid, proximal middle cerebral and anterior cerebral arteries; chronic low flow infarction with accumulating ‘string of pearls’ in the white matter (Fig 1). It is this chronic hypoperfusion of the brain that is the subject of my PhD thesis. Cerebrovascular reactivity is a marker of cerebrovascular reserve and has been shown to be a biomarker of ischaemic risk in adults. OBJECTIVES: The primary objectives were to, in a group of children with moyamoya: 1) Validate the use of a qualitative measure of cerebrovascular reactivity as a biomarker of ischaemic risk, namely, hypercapnic challenge BOLD MRI CVR (hBOLD CVR) via two methods: a) breath-holding and b) induced hypercapnia during general anaesthesia as reliable and repeatable for use in the paediatric population 2) Assess the utility of qualitative assessment of cerebrovascular reactivity using hBOLD CVR as a tool for the identification of the risk of ischaemia in children with arteriopathy Method Hypercapnic challenge hBOLD CVR studies were obtained in children with steno-occlusive arteriopathy prospectively enrolled in The Hospital for Sick Children Stroke Registry. Semi-quantitative methods of measuring CVR were devised and used for the purpose of analysis. hBOLD CVR studies were analysed for reliability and reproducibility of the method of analysis. Clinical and radiologic data were collected and hBOLD CVR findings described for all children enrolled. Exploratory analysis of hBOLD CVR as a potential biomarker of ischaemic risk in the paediatric population were conducted. In particular association of hBOLD CVR with clinical symptomatology; parenchymal and vascular indicators of arteriopathy; neuropsychological outcome and cortical thickness were examined. Results Forty seven children (37 Bilateral or unilateral Moyamoya arteriopathy, 6 Unilateral Non-moyamoya arteriopathy [Transient Cerebral Arteriopathy] and 4 Bilateral Non-moyamoya arteriopathy [2 PHACE(S), 1 Takayasu arteritis, 1 Sickle Cell Disease]) were enrolled and had hBOLD CVR studies. The mean age of diagnosis of arteriopathy across all groups was 8.1 years (SD 4.2) (range 7 months - 18 years). Clinical and radiographic features differed across arteriopathy groups. Most presented with acute stroke, however, among children with NF1-MM most (almost 50%) were asymptomatic and diagnosed on screening MRIs. Infarction patterns differed, with deep watershed infarction being the typical pattern in the moyamoya group in contrast to thrombotic vaso-occlusive infarction pattern in the Non-moyamoya groups. Qualitative hBOLD CVR abnormalities were concordant with moyamoya laterality, and in unilateral moyamoya demonstrated tissue level microvascular dysfunction in the contralateral unaffected hemisphere. Qualitative hBOLD CVR abnormalities demonstrated concordance with clinically important manifestations of ischaemia including stroke, transient ischaemic attacks, cortical thinning and IQ. There was a lack of concordance with indices of executive function. In addition the moderate to severe steno-occlusive arteriopathy seen in the children with Transient Cerebral Arteriopathy was not associated with abnormality of hBOLD CVR. Conclusion The thesis studies demonstrated that qualitative assessment of hBOLD CVR using breath-hold or general anaesthetic is feasible, reproducible and reliable in paediatric population. The utility of hBOLD CVR as a measure of tissue level microvascular dysfunction and thus a biomarker of ischaemic risk was demonstrated. However, larger longitudinal studies are required to characterize this further

Calcium Homeostasis in Myogenic Differentiation Factor 1 (MyoD)-Transformed, Virally-Transduced, Skin-Derived Equine Myotubes

Dysfunctional skeletal muscle calcium homeostasis plays a central role in the pathophysiology of several human and animal skeletal muscle disorders, in particular, genetic disorders associated with ryanodine receptor 1 (RYR1) mutations, such as malignant hyperthermia, central core disease, multiminicore disease and certain centronuclear myopathies. In addition, aberrant skeletal muscle calcium handling is believed to play a pivotal role in the highly prevalent disorder of Thoroughbred racehorses, known as Recurrent Exertional Rhabdomyolysis. Traditionally, such defects were studied in human and equine subjects by examining the contractile responses of biopsied muscle strips exposed to caffeine, a potent RYR1 agonist. However, this test is not widely available and, due to its invasive nature, is potentially less suitable for valuable animals in training or in the human paediatric setting. Furthermore, increasingly, RYR1 gene polymorphisms (of unknown pathogenicity and significance) are being identified through next generation sequencing projects. Consequently, we have investigated a less invasive test that can be used to study calcium homeostasis in cultured, skin-derived fibroblasts that are converted to the muscle lineage by viral transduction with a MyoD (myogenic differentiation 1) transgene. Similar models have been utilised to examine calcium homeostasis in human patient cells, however, to date, there has been no detailed assessment of the cells’ calcium homeostasis, and in particular, the responses to agonists and antagonists of RYR1. Here we describe experiments conducted to assess calcium handling of the cells and examine responses to treatment with dantrolene, a drug commonly used for prophylaxis of recurrent exertional rhabdomyolysis in horses and malignant hyperthermia in humans

Increased prevalence of potential right-to-left shunting in children with sickle cell anaemia and stroke

'Paradoxical' embolization via intracardiac or intrapulmonary right-to-left shunts (RLS) is an established cause of stroke. Hypercoagulable states and increased right heart pressure, which both occur in sickle cell anaemia (SCA), predispose to paradoxical embolization. We hypothesized that children with SCA and overt stroke (SCA + stroke) have an increased prevalence of potential RLS. We performed contrasted transthoracic echocardiograms on 147 children (aged 2-19 years) with SCA + stroke) mean age 12·7 ± 4·8 years, 54·4% male) and a control group without SCA or stroke (n = 123; mean age 12·1 ± 4·9 years, 53·3% male). RLS was defined as any potential RLS detected by any method, including intrapulmonary shunting. Echocardiograms were masked and adjudicated centrally. The prevalence of potential RLS was significantly higher in the SCA+stroke group than controls (45·6% vs. 23·6%, P < 0·001). The odds ratio for potential RLS in the SCA + stroke group was 2·7 (95% confidence interval: 1·6-4·6) vs controls. In post hoc analyses, the SCA + stroke group had a higher prevalence of intrapulmonary (23·8% vs. 5·7%, P < 0·001) but not intracardiac shunting (21·8% vs. 18·7%, P = 0·533). SCA patients with potential RLS were more likely to report headache at stroke onset than those without. Intrapulmonary and intracardiac shunting may be an overlooked, independent and potentially modifiable risk factor for stroke in SCA