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The paper presents the method of forming TiO2 coatings on 100Cr6 steel using the ALD method and assessing the properties of the obtained coatings. The coatings were assessed in terms of surface morphology, chemical composition, contact angle and tribological properties. The performed tribological tests show that TiO2 coatings are characterized by lower resistance to motion. During measuring the geometric structure of surfaces on samples with TiO2 coating, smaller wear traces were recorded than for 100Cr6 steel. The obtained values of the contact angles prove that the 100Cr6 steel coated with TiO2 is more hydrophobic than the uncoated 100Cr6 steel. TiO2 coatings can be used in low-loaded tribological systems and as barrier coatings. [ABSTRACT FROM AUTHOR]

The need to find clarity concerning (1) the relationship between scientific and religious cosmological discourses and (2) the imagining of a space where various religions could meet in fruitful conciliation as far as (1) is concerned, formed the basis of the article. The aim of the article was to investigate the relevance of Buddhaghosa’s Visuddhimagga (5th CE, Pali compendium of Theravāda Buddhism) with regard to the above problems. The methodology employed involved clarifying the historical context of the Visuddhimagga; understanding the subjective intentions of Buddhaghosa and extrapolating non-emphasised but promising underlying tendencies in his magnum opus, conducive to a perspective of ultimate, universal peace as far as Cosmos, all of humanity and its various religious discourses are concerned. The reading of the Visuddhimagga revealed a mythology of many deities, tolerated but demoted to a status lower than that of enlightened humans; the denial of a Creator God; no notion of an analogia entis between humans and a living Cosmos, nor any tendency towards pantheism and a commitment to the ideal of universal happiness for all beings. The main conclusion was that Theravāda Buddhism (and, to a lesser extent, Christian theology) could be extended towards the notion of a living, evolving Cosmos, appearing from and disappearing into non-substantial silence. It is not claimed that Buddhaghosa succeeded in achieving a great cosmology. It remains an unrealised possibility, latently possible as an extension of Theravāda. Contribution: The contribution of the article is that it uncovers deeply hidden lines in Buddhism (and Christianity) that are emerging and converging. ‘Theo-logy’, re-interpreted as mystical ‘cosmo-sophy’, would not amount to a cynical debunking or irresponsible annexation of Buddhaghosa for utterly unthinkable ends, but as a topic worthy of investigation. The article is part of work in progress.

The article approaches the phenomenon of love from a theoretical perspective in which the interconnectedness of religions is constitutive of every religion, including Christianity, in its relative singularity. It explores a historical context in which Christianity with its unique message of love does not stand alone among the religions of the world, and a theoretical context that could account for that historical context, without abandoning or diluting the Christian vision, but enriching it, adding depth to the notion ‘Christianity’ in its most essential sense. The argument is developed by first introducing seven religious perspectives on love. This is followed by metaphysical-mystical reflections in which the concept ‘Infinitude’ features. The argument proceeds concentrically outwards, starting from Christianity as centre, seen as one magnificent dewdrop reflecting an infinite net of interdependence.

We use slow-light photonic crystals to enhance optical switching and modulation in silicon. By using dispersion-engineered designs, a switch as short as 5 ¿m was achieved, in which we have demonstrated rerouting of optical pulses on a 3-ps time scale through the absorption of a femtosecond pulse. We additionally demonstrate a modulator with a Mach-Zehnder interferometer (MZI) configuration with flat-band slow-light photonic crystal phase shifters that is designed to give a large group-index-bandwidth product. An extinction ratio in excess of 15 dB is obtained over the entire 11-nm bandwidth of the modulator.

The reaction of Jesus and his disciples to violence in the Gospel of John This article is the second of two articles in which violence in the Gospel of John is discussed. It is argued that Jesus' disciples used techniques of vilification in the Gospel, inter alia as way of dealing with the violence they experience at the hands of their opponents. Closer investigation reveals that they use vilification against their opponents as a pragmatic device for missionary purposes.

The role of ethics in preaching: New research in New Testament ethics and the implication for preaching To the Reformers, legalism was one of the greatest dangers that threatened the heart of preaching and Christian life in general. Luther argued that where preaching solidifies and degenerates into legalism, the essence of the gospel of grace is lost. Therefore, the dynamic relationship between identity, ethics and ethos in the New Testament has to be rediscovered. It is argued that the classical Bultmanian distinction between indicative and imperative does not do justice to the implicit ethical dimension of Biblical texts. New research into ethics, represented by Zimmermann�s heuristic categories, may help us in rediscovering the implicit ethical dimensions in the New Testament. Those who want to speak of the theology of ethical preaching should also take the new research in New Testament ethics into consideration.

Objective: This pilot study explores the feasibility and acceptability of using telephonic verbal autopsies (teleVAs) in South Africa to collect information on causes of death., Design: Quantitative and qualitative data collection methods were used to evaluate the feasibility and acceptability of these telephonic interviews., Setting: The teleVA pilot was conducted in South Africa's Western Cape province. The qualitative component also included two rural South African Population Research Infrastructure Network nodes (Africa Health Research Institute in KwaZulu-Natal and Agincourt in Mpumalanga), which had transitioned to teleVAs during COVID-19, allowing exploration of teleVA's feasibility in both urban and rural settings., Participants: We recruited 229 respondents to participate in a pilot teleVA. After each VA, VA interviewers filled in a survey to assess their perceptions and discern if they experienced any technical challenges. We also conducted 18 in-depth interviews with both interviewers (n=6) and respondents (n=12) to explore their views on the acceptability of the teleVA. We conducted a thematic analysis of these interviews., Interventions: VA was piloted over the phone, instead of face-to-face., Primary and Secondary Outcome Measures: Primary outcomes focused on the feasibility and acceptability of phone VAs among both interviewers and respondents. Secondary outcomes evaluated the quality of teleVAs., Results: Participants expressed willingness to participate in teleVAs, considering them valuable for public health planning and decision-making. The feasibility of collecting next-of-kin information proved challenging, with incomplete or incorrect contact details posing future logistic issues. Only one question out of 76, showed a statistically significant difference in the proportions of non-informative teleVA compared with face-to-face VA., Conclusions: The study offers valuable insights into using teleVAs to gather cause of death information in resource-limited settings. It highlights the feasibility and acceptability of teleVAs while emphasising the need for comprehensive planning, integration with the civil registration and vital statistics system and community participation enhancement., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.)

Objectives: To investigate the short- and long-term dynamics of intact and defective proviral HIV DNA during ART., Design: We evaluated viral reservoir dynamics in a cohort of nine individuals with chronic HIV-1 subtype B infection who initiated first-line ART and were followed for 20 years while continuing ART., Methods: PBMCs were obtained before ART (n = 5), during the first year, and after 8.5 and 20 years of treatment. T cell subsets (naive, central-memory, transitional-memory and effector-memory) were sorted at 8.5 and 20 years. DNA was isolated and analyzed using the intact proviral DNA assay (IPDA). Deep-sequencing of the viral env region enabled analysis of viral evolution and cellular mechanisms underlying HIV persistence., Results: Initially, defective and intact proviral DNA in PBMCs declined with half-lives of 3.6 and 5.4 weeks, respectively. Over the following 8.5 years, the intact reservoir continued to decrease, with a half-life of 18.8 months in PBMCs, while defective proviral DNA levels stabilized. After 8.5 and 20 years of ART, the intact reservoir showed no further decline, with most intact proviral DNA residing in memory T cell subsets. Phylogenetic analysis revealed no signs of viral evolution over time, both within and between T cell subsets., Conclusions: PBMCs containing intact proviral DNA are selectively lost during the first decade of suppressive ART, followed by a decade of stabilization of this reservoir in the memory T cell subsets. In the absence of clear signs of viral evolution and massive clonal expansion, homeostatic proliferation might be an important driver of HIV persistence during long-term ART., (Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Cannabidiol (CBD) has numerous therapeutic properties, and is used to treat neurological conditions, such as neuroinflammation. However, the optimal dose of CBD to penetrate the brain requires further investigation. The primary aim of this study was to use a mouse model and the intrabuccal route for CBD administration to determine the optimal dose at which CBD can penetrate the brain. The secondary aim was to determine whether sex is a confounding factor., Methods: Thirty adult Kramnik mice, divided equally into three groups, were administered CBD oil intrabuccally at three doses-10, 20, and 30 mg/kg, euthanized 6 h later, and whole brain, urine, and blood samples were collected. Liquid chromatography with tandem mass spectrometry was used to analyze the collected samples., Results: CBD and its three metabolites-7-carboxy cannabidiol (7-COOH-CBD), 7-hydroxy cannabidiol (7-OH-CBD) and 6-hydroxy cannabidiol (6-OH-CBD), were identified and quantified in all samples. The 10 and 20 mg/kg doses of CBD produced similar results in the brain, but the group given the 10 mg/kg dose had the least variation. The 30 mg/kg dose yielded the highest abundance of CBD and its metabolites in all samples, but also the greatest variation. Sex only became a confounding factor at 30 mg/kg., Conclusions: This study shows that the intrabuccal route of CBD administration is reliable and the 10 mg/kg dose of CBD is recommended in mice because there were good CBD metabolite concentrations in all samples, with the least variation among the doses, and sex was not a confounder at 10 mg/kg., (© 2025 The Author(s). Animal Models and Experimental Medicine published by John Wiley & Sons Australia, Ltd on behalf of The Chinese Association for Laboratory Animal Sciences.)

International collaboration in genomic research is gaining momentum in African countries and is often supported by external funding. Over the last decade, there has been an increased interest in African genomic data. The contribution of this rich data resource in understanding diseases predominant in both African and global populations has been limited to date. There has been some non-governmental funding dedicated to the advancement of genomic research and innovation by African-based and African-led research groups, but the impact of these initiatives is hard to quantify. However, there is now an opportunity for the global research community to leverage decades of genomic data and biospecimens originating from African populations. The experience we describe in this paper is of an access governance framework established under the Human, Heredity, and Health in Africa (H3A) consortium, given the task of managing wider access to the data and biospecimen resources collected via its various projects. The function of the Data and Biospecimen Access Committee (DBAC) is to facilitate the advancement of medicine and health while fostering the development of bioinformatics capabilities at Africa-based institutions or regional hubs. Our collective experiences and lessons learnt as a committee provide examples of nuanced considerations when evaluating access to African data. The committee was semi-autonomous in its establishment and had independence in decision-making. The DBAC continually advocates for the responsible use of genomic data and biospecimens that were obtained from African research participants, under broad consent, by primary researchers who no longer have oversight over the future use of these resources., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: The measurement of cause-specific mortality is critical for health system planning but remains a challenge in many low-resource settings due to societal, legal, and logistical barriers. We present a co-development process with community members for the design and implementation of an autopsy program to improve cause of death data in a historically underserved population., Methods: We sought to develop an autopsy program at the Africa Health Research Institute (AHRI) Health and Demographic Surveillance Site (HDSS). The project proposes to obtain consent from families of deceased adults, to perform diagnostic autopsies by a trained pathologist, and to process samples to determine causes of death. Prior to launching the program, we engaged key partners in learning their perspectives about such a program and understanding the landscape of challenges needed for successful implementation. Herein, we describe lessons from interactions with these partners, including 1) the AHRI community advisory board (CAB), 2) the South Africa Department of Health (SA DoH), 3) local traditional authorities, 4) funeral home personnel, 5) traditional healers, and 6) healthcare providers. We also detail the development of community outreach efforts used to inform the public about the program., Results: The partners provided valuable feedback on the study design and informed us of issues that needed to be addressed: community concerns about organ retention and sale (CAB), implications of how autopsy findings could spur litigation and erode trust in healthcare providers who determined alternate causes of death (SA DoH), a cultural practice that conflicts with the autopsy procedure (traditional healers), the need to educate families before they engage with funeral businesses (funeral homes), and enhancing our death referral network through healthcare providers. This led to protocol changes and an adapted community engagement strategy, which included educating healthcare providers, hosting community dialogs, broadcasting radio advertisements, and developing a film to describe autopsy procedures to families considering participation., Conclusions: We present a comprehensive model of partner engagement for a community-based autopsy program in South Africa, leading to the co-development of a program that incorporates local customs around death while promoting buy-in and support from the government, civil society, and medical partners., Competing Interests: CI received grant funding from Gilead Sciences paid to his Institution for investigator-sponsored research. CI received support from the International Vaccine Institute to attend the Indo-Pacific Climate Resilience Forum. All other authors declare that they have no competing interests.

Background: We have developed and validated methods for the determination of three major tryptophan metabolites metabolized by the kynurenine pathway, namely kynurenine (KYN), 3-hydroxykynurenine (3-HK), and 3-hydroxyanthranilic acid (3-HAA). KYN and 3-HK were determined using RP-HPLC-UV, and 3-HAA using RP-HPLC-FL. We then developed a comparative method based on CE-UV. The developed methods were validated and 36 samples of human brain glioma tissue homogenates were assayed in all 4 grades of malignancy, and the concentration levels of assayed metabolites were compared with available clinical data., Results: Each of the methods is characterized by high precision, accuracy and repeatability, and the determined LOQ values indicate the possibility of performing quantitative analysis on the available samples of human glioma tumors (36 samples in grades G1-G4). The concentration values of selected metabolites obtained using HPLC methods were subjected to statistical analysis and preliminary clinical data processing. We found statistically significant differences in the concentrations of KYN, 3-HK and 3-HAA between the various grades of the disease, and characterized these differences more precisely by means of the Dunn-Bonferroni post hoc test. We did not find that the patient's environment or habits significantly affected the metabolites concentration of the study samples population. In addition, we showed a high positive correlation between KYN, 3-HK and 3-HAA, which appears to be a characteristic that describes metabolic changes of Trp in relation to KYN, 3-HK and 3-HAA, and indicates potential diagnostic value., Significance: The preliminary studies carried out contribute new knowledge on the molecular basis of human brain glioma. They also provide valuable information useful for the development of glioma diagnostics, differentiation of disease grades and assessment of the patient's condition. The obtained relationships between metabolite concentrations and the grade of malignancy of the disease and correlations between metabolite concentrations constitute the basis for further broader biochemical and clinical analysis., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: To ensure that pre-final year medical students at Stellenbosch University were able to resume clinical training during the COVID-19 pandemic, a 12-week integrated rotation was introduced, during which students were distributed across a widespread training platform in two provinces of South Africa, utilizing a range of health care facilities in both rural and urban areas, rather than the central academic hospital (CAH) in which they would have been doing clerkships. Called the Integrated Distributed Engagement to Advance Learning (IDEAL) rotation, this clerkship was based on supervised engagement in healthcare services, focusing on patient-based clinical training, self-regulated learning and student participation as integral members of clinical teams. The success of this emergency intervention has led to its formal incorporation into the medical curriculum. This study aimed to understand the factors that influenced learning among students undertaking the IDEAL rotation at multiple sites on a distributed training platform., Methods: Using an interpretive paradigm, we sought to conduct focus group interviews with students who completed the first iteration of the IDEAL rotation in the year after they had undertaken it to understand their experiences. All 252 students who were eligible were invited to participate by email on several occasions. Ultimately three focus group discussions and two individual interviews were undertaken, based on volunteers. Using a semi-structured interview guide, these explored student perceptions of their learning and growth through the rotation. Inductive and deductive analysis was carried out to identify themes., Findings: Student descriptions of their learning experiences coalesced in 6 themes. The rotation was an enabling learning experience, which was more practically focused and assisted students in developing confidence in their clinical skills. It was seen to be a humanizing learning experience with greater opportunities for the development of relationships with patients and families, as well as with health professionals, who made them feel part of the team, so it was also a more collegial learning experience. At the same time, it was a variable learning experience with a lack of standardization on a number of levels and challenges being experienced at particular sites regarding both logistics and the nature of the exposure. Students perceived it to be a very different learning experience from what they had encountered in the CAH in terms of relationships, the kinds of patients and problems they saw, and their active participation. Through this, they also learned more about themselves and their roles, making it a personal learning journey. The findings confirm the importance of the dimensions of person, participation and place for being and becoming a doctor in a clinical environment., Conclusions: Student learning experiences in the IDEAL rotation emphasize the importance of context, reinforcing the value of a distributed training platform in developing health professionals who are responsive to their environment. They emphasize the vital role of active participation in learning and the centrality of relationships in medical training, helping to develop graduates who are human beings and not only human doings., (© 2024. The Author(s).)

The prevalence of cardiovascular disease (CVD) has increased in South Africa, emphasizing the importance of prevention strategies. This study used echocardiography to investigate the impact of Rooibos on cardiovascular function in those at risk of CVD. This research aims to contribute to understanding its effects on reducing cardiovascular risk factors. The study design involved a 12-week randomized, parallel, double-blinded, placebo-controlled dietary intervention trial using capsules containing standardized water-soluble extracts of green and traditional fermented Rooibos alongside a placebo control. Echocardiography was incorporated as a diagnostic imaging tool to assess cardiac function in the participant cohort. Aorta (AO) dimensions showed no significant change in any intervention group. Left atrium (LA) reduced in size from 3.832 ± 0.071 cm to 3.675 ± 0.067 cm ( P = 0.01 ). There was no significant change in LA/AO ratio in any intervention group. Interventricular septum diameter in the placebo group decreased from 1.334 ± 0.030 cm to 1.250 ± 0.025 cm ( P = 0.002 ), with no significance in fermented Rooibos, while green Rooibos resulted in a decrease from 1.282 ± 0.036 cm to 1.186 ± 0.029 cm ( P = 0.002 ). Left ventricle posterior wall (LVPW) showed no significant changes in any of the intervention group. The left ventricle mass in the placebo and green Rooibos groups demonstrated no significance changes, while fermented Rooibos caused a decrease from 204.102 ± 7.102 g to 191.394 ± 6.707 g ( P = 0.015 ). The phytochemical bioactive components, such as the polyphenolic antioxidants present in green and fermented Rooibos, improved cardiovascular function. This study confirms the effectiveness of echocardiography as imaging tool for assessing cardiac function in this particular population. Regular Rooibos consumption may offer promising therapeutic benefits for preventing and managing CVD risk.

Background: Attention Deficit Hyperactivity Disorder (ADHD) frequently persists into adulthood. There are practice guidelines that outline the requirements for the assessment and treatment of adults. Nevertheless, guidelines specifying what constitutes a good quality diagnostic assessment and report and the competencies required to be a specialist assessor are lacking. This can lead to variation in the quality and reliability of adult ADHD assessments. Poor quality assessments may not be accepted as valid indicators of the presence of ADHD by other clinicians or services, resulting in wasteful re-assessments and delays in providing treatment. To address this issue the UK Adult ADHD Network (UKAAN) proposes a quality framework for adult ADHD assessments - the Adult ADHD Assessment Quality Assurance Standard (AQAS)., Methods: The co-authors agreed on five questions or themes that then guided the development of a set of consensus statements. An initial draft was reviewed and amended in an iterative process to reach a final consensus., Results: What constitutes a high-quality diagnostic assessment and report was agreed by consensus of the co-authors. The resulting guideline emphasises the need to evaluate impairment, describes core competencies required by the assessor and highlights the importance of linking the diagnosis to an appropriate post-diagnostic discussion. Assessments should be completed in the context of a full psychiatric and neurodevelopmental review, and need good interview skills, using a semi-structured interview with open questioning and probing to elicit real life examples of symptoms and impairments. It is recommended that 2 hours or more is required for an adequate assessment including both the diagnostic assessment and initial post-assessment discussions., Conclusion: The AQAS has been developed as a practical resource to support reliable and valid diagnostic assessments of adult ADHD. It is intended to complement formal training. A secondary objective is to empower patients by providing them with evidence-based information on what to expect from an assessment and assessment report., Competing Interests: PA received honoraria for consultancy and educational talks from Janssen, Lily, Takeda/Shire, Medice and Flynn-pharma. MA received sponsorships to educational/scientific meetings and honoraria for consultancy and educational talks from Janssen, Lily, Takeda/Shire, and Flynn-pharma. KvR was a speaker at conferences sponsored by the Takeda, Flynn Pharma, Medice, Eli Lilly and Janssen, and was an advisor for Takeda, Flynn Pharma and Eli Lilly. JK works partly in private practice. He received honoraria for consultancy and educational talks from Janssen, Lily, Takeda and Flynn-pharma. SC works in private practice. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Adamou, Arif, Asherson, Cubbin, Leaver, Sedgwick-Müller, Müller-Sedgwick, van Rensburg and Kustow.)

Building longitudinal population cohorts in Africa for coordinated research and surveillance can influence the setting of national health priorities, lead to the introduction of appropriate interventions, and provide evidence for targeted treatment, leading to better health across the continent. However, compared to cohorts from the global north, longitudinal continental African population cohorts remain scarce, are relatively small in size, and lack data complexity. As infections and noncommunicable diseases disproportionately affect Africa's approximately 1.4 billion inhabitants, African cohorts present a unique opportunity for research and surveillance. High genetic diversity in African populations and multiomic research studies, together with detailed phenotyping and clinical profiling, will be a treasure trove for discovery. The outcomes, including novel drug targets, biological pathways for disease, and gene-environment interactions, will boost precision medicine approaches, not only in Africa but across the globe.

Background: The absence of high-quality comprehensive civil registration and vital statistics systems across many settings in Africa has led to little empirical data on causes of death in the region. We aimed to use verbal autopsy data to provide comparative, population-based estimates of cause-specific mortality among adolescents and adults in eastern and southern Africa., Methods: In this surveillance study, we harmonised verbal autopsy and residency data from nine health and demographic surveillance system (HDSS) sites in Kenya, Malawi, Tanzania, South Africa, Uganda, and Zimbabwe, each with variable coverage from Jan 1, 1995, to Dec 31, 2019. We included all deaths to adolescents and adults aged 12 or over that were residents of the study sites and had a verbal autopsy conducted. InSilicoVA, a probabilistic model, was used to assign cause of death on the basis of the signs and symptoms reported in the verbal autopsy. Levels and trends in all-cause and cause-specific mortality rates and cause-specific mortality fractions were calculated, stratified by HDSS site, sex, age, and calendar periods., Findings: 52 484 deaths and 5 157 802 person-years were reported among 1 071 913 individuals across the nine sites during the study period. 47 961 (91·4%) deaths had a verbal autopsy, of which 46 570 (97·1%) were assigned a cause of death. All-cause mortality generally decreased across the HDSS sites during this period, particularly for adults aged 20-59 years. In many of the HDSS sites, these decreases were driven by reductions in HIV and tuberculosis-related deaths. In 2010-14, the top causes of death were: road traffic accidents, HIV or tuberculosis, and meningitis or sepsis in adolescents (12-19 years); HIV or tuberculosis in adults aged 20-59 years; and neoplasms and cardiovascular disease in adults aged 60 years and older. There was greater between-HDSS and between-sex variation in causes of death for adolescents compared with adults., Interpretation: This study shows progress in reducing mortality across eastern and southern Africa but also highlights age, sex, within-HDSS, and between-HDSS differences in causes of adolescent and adult deaths. These findings highlight the importance of detailed local data to inform health needs to ensure continued improvements in survival., Funding: National Institute of Child Health and Human Development of the US National Institutes of Health., Competing Interests: Declaration of interests LM reports research grants from Wellcome Trust, the US National Institutes of Health (NIH), and Medical Research Council Centre for Global Infectious Disease Analysis funding from the UK Medical Research Council (MRC) and the UK Department for International Development. SG reports research grants from Wellcome Trust, NIH, Bill & Melinda Gates Foundation, and WHO; financial support for attending meetings and travel from Imperial College London; and participation on a Data Safety Monitoring Board at Kings College London and as a board member at Biomedical Research Training Institute, Harare, Zimbabwe. CC reports research grants from NIH. SJC reports research grants from NIH; and acting as a paid consultant on verbal autopsy implementation methods and software for two non-governmental organisations (Vital Strategies and CDC Foundation). All other authors declare no competing interests. LM, CN, and SG have received funding from the MRC Centre for Global Infectious Disease Analysis (reference MR/R015600/1), jointly funded by the UK MRC and the UK Foreign, Commonwealth & Development Office (FCDO), under the MRC and FCDO Concordat agreement and this centre is also part of the European and Developing Countries Clinical Trials Partnership programme supported by the EU; and LM, CN, and SG have received funding by Community Jameel., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

The primary healthcare (PHC) rotation places medical students in rural district hospitals for 4 weeks during their 4th or 5th year. This rotation is a collaboration among three academic units at Stellenbosch University's Faculty of Medicine and Health Sciences. Learning activities during this rotation include participation in a longitudinal community-oriented primary care project, conducting rehabilitation-oriented home visits to persons with disabilities, and assessing and treating patients presenting with undifferentiated problems on an in- and outpatient basis. Working in rural contexts for a month affords students opportunities to foster meaningful relationships with the healthcare team, patients and the community, while learning about collaborative teamwork and communities. Critical reflections about the interprofessional care of patients and a community evaluation are key components of the students' learning and assessment. Demonstrating the importance of interprofessional collaboration in PHC, this integrated training model has received, and continues to receive, positive feedback from students and the clinicians involved. Attention to logistics and academic support plays a crucial role in ensuring optimal learning for students. An integrated approach that involves multiple academic units, various healthcare professions and communities is strongly recommended for those who are considering training students in rural PHC environments.

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Purpose: Co-prevalence of abdominal aortic aneurysm (AAA) and cancer poses a unique challenge in medical care since both diseases and their respective therapies might interact. Recently, reduced AAA growth rates were observed in cancer patients that received radiation therapy (RT). The purpose of this study was to perform a fine-grained analysis of the effects of RT on AAA growth with respect to direct (infield) and out-of-field (outfield) radiation exposure, and radiation dose-dependency., Methods: A retrospective single-center analysis identified patients with AAA, cancer, and RT. Clinical data, radiation plans, and aneurysm diameters were analyzed. The total dose of radiation to each aneurysm was computed. AAA growth under infield and outfield exposure was compared to patients with AAA and cancer that did not receive RT (no-RT control) and to an external noncancer AAA reference cohort., Results: Between 2003 and 2020, a total of 38 AAA patients who had received well-documented RT for their malignancy were identified. AAA growth was considerably reduced for infield patients (n = 18) compared to outfield patients (n = 20), albeit not significantly (0.8 ± 1.0 vs. 1.3 ± 1.6 mm/year, p = 0.28). Overall, annual AAA growth in RT patients was lower compared to no-RT control patients (1.1 ± 1.5 vs. 1.8 ± 2.2 mm/year, p = 0.06) and significantly reduced compared to the reference cohort (1.1 ± 1.5 vs. 2.7 ± 2.1 mm/year, p < 0.001). The pattern of AAA growth reduction due to RT was corroborated in linear regression analyses correcting for initial AAA diameter. A further investigation with respect to dose-dependency of radiation effects on AAA growth, however, revealed no apparent association., Conclusion: In this study, both infield and outfield radiation exposure were associated with reduced AAA growth. This finding warrants further investigation, both in a larger scale clinical cohort and on a molecular level., (© 2023. The Author(s).)

Coastal seas are under increasing pressure from extreme weather events and sea level rise, resulting in impacts such as changing hydrodynamic conditions, coastal erosion, and marine heat waves. To monitor changes in coastal marine habitats, such as reefs and macrophytes meadows, which add to the resilience of our coasts, consistent, medium- to long-term seafloor observations are needed. This project aims to deliver repeated, high-frequency sonar surveys on a stationary seabed mooring of a specific target area over a period of up to several months. A new stand-alone subsea system, the Sonarlogger, based on a battery pack, low-power logger and a high-resolution scanning sonar, was developed. It allows for long-term deployments with a customisable battery pack, WI-FI download and configurable sleep state. The system has been tested for over 130 days in dynamic coastal environments off the Belgian coast. Combined with auxiliary sensors, such as for measuring currents, waves and turbidity, this system enables comprehensive studies of morphologic changes and changing benthic ecosystems. Moreover, this system has the capacity to provide measurements of coastal environments during storms, where conventional systems may fall short, providing insights into event-based changes of the seafloor., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Introduction: Understanding mortality variability by age and cause is critical to identifying intervention and prevention actions to support disadvantaged populations. We assessed mortality changes in two rural South African populations over 25 years covering pre-AIDS and peak AIDS epidemic and subsequent antiretroviral therapy (ART) availability., Methods: Using population surveillance data from the Agincourt Health and Socio-Demographic Surveillance System (AHDSS; 1994-2018) and Africa Health Research Institute (AHRI; 2000-2018) for 5-year periods, we calculated life expectancy from birth to age 85, mortality age distributions and variation, and life-years lost (LYL) decomposed into four cause-of-death groups., Results: The AIDS epidemic shifted the age-at-death distribution to younger ages and increased LYL. For AHDSS, between 1994-1998 and 1999-2003 LYL increased for females from 13.6 years (95% CI 12.7 to 14.4) to 22.1 (95% CI 21.2 to 23.0) and for males from 19.9 (95% CI 18.8 to 20.8) to 27.1 (95% CI 26.2 to 28.0). AHRI LYL in 2000-2003 was extremely high (females=40.7 years (95% CI 39.8 to 41.5), males=44.8 years (95% CI 44.1 to 45.5)). Subsequent widespread ART availability reduced LYL (2014-2018) for women (AHDSS=15.7 (95% CI 15.0 to 16.3); AHRI=22.4 (95% CI 21.7 to 23.1)) and men (AHDSS=21.2 (95% CI 20.5 to 22.0); AHRI=27.4 (95% CI 26.7 to 28.2)), primarily due to reduced HIV/AIDS/TB deaths in mid-life and other communicable disease deaths in children. External causes increased as a proportion of LYL for men (2014-2018: AHRI=25%, AHDSS=17%). The share of AHDSS LYL 2014-2018 due to non-communicable diseases exceeded pre-HIV levels: females=43%; males=40%., Conclusions: Our findings highlight shifting burdens in cause-specific LYL and persistent mortality differentials in two populations experiencing complex epidemiological transitions. Results show high contributions of child deaths to LYL at the height of the AIDS epidemic. Reductions in LYL were primarily driven by lowered HIV/AIDS/TB and other communicable disease mortality during the ART periods. LYL differentials persist despite widespread ART availability, highlighting the contributions of other communicable diseases in children, HIV/AIDS/TB and external causes in mid-life and non-communicable diseases in older ages., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Nature-based solutions, such as shellfish reefs, can support natural coastal defence and be a potential solution for climate-resilient shorelines in the future. In the Belgian Part of the North Sea, the "Coastbusters" projects aim to develop nature-based coastal protection by favouring subtidal mussel bed establishment on the seafloor through typical longline aquaculture techniques. Mussel beds are dependent on environmental conditions, and both influence the physical and biogeochemical features in a soft-sediment environment. Therefore, a comprehensive ecological monitoring program is essential to assess the success of future mussel bed development and its influence on the surrounding ecosystem. For establishing a monitoring baseline of the two experimental areas, a combination of conventional benthic assessment methods (grab sampling and granulometry) and non-invasive techniques (sediment profile imaging and transect diving video surveys) were utilised. Although mussel reefs did not yet develop by the time of this study, clear differences in ecological and sedimentological characteristics were found between two experimental areas (sheltered and exposed), subjected to slightly different hydrodynamic conditions. The one sheltered by coastal sandbanks was dominated by fine-muddy sand, higher species richness, biomass, and higher biological activity (burrows, fauna, and biological beds) as observed by all methods in one or another way. Moreover, functional diversity indices revealed a higher partitioning of the total available resources, suggesting more complex ecological processes in the sheltered area. Conversely, the area more exposed to the open sea was dominated by more sandy sediments, and fewer organisms were found. The combination of those different monitoring tools provides an integrated, complementary view, from different perspectives, on the biological, physical and functional characteristics of the study areas., (© 2024. The Author(s).)

Health-related quality of life (HRQoL) assesses the perceived impact of health status across life domains. Although research has explored the relationship between specific conditions, including HIV, and HRQoL in low-resource settings, less attention has been paid to the association between multimorbidity and HRQoL. In a secondary analysis of cross-sectional data from the Vukuzazi ("Wake up and know ourselves" in isiZulu) study, which identified the prevalence and overlap of non-communicable and infectious diseases in the uMkhanyakunde district of KwaZulu-Natal, we (1) evaluated the impact of multimorbidity on HRQoL; (2) determined the relative associations among infectious diseases, non-communicable diseases (NCDs), and HRQoL; and (3) examined the effects of controlled versus non-controlled disease on HRQoL. HRQoL was measured using the EQ-5D-3L, which assesses overall perceived health, five specific domains (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), and three levels of problems (no problems, some problems, and extreme problems). Six diseases and disease states were included in this analysis: HIV, diabetes, stroke, heart attack, high blood pressure, and TB. After examining the degree to which number of conditions affects HRQoL, we estimated the effect of joint associations among combinations of diseases, each HRQoL domain, and overall health. Then, in one set of ridge regression models, we assessed the relative impact of HIV, diabetes, stroke, heart attack, high blood pressure, and tuberculosis on the HRQoL domains; in a second set of models, the contribution of treatment (controlled vs. uncontrolled disease) was added. A total of 14,008 individuals were included in this analysis. Having more conditions adversely affected perceived health (r = -0.060, p<0.001, 95% CI: -0.073 to -0.046) and all HRQoL domains. Infectious conditions were related to better perceived health (r = 0.051, p<0.001, 95% CI: 0.037 to 0.064) and better HRQoL, whereas non-communicable diseases (NCDs) were associated with worse perceived health (r = -0.124, p<0.001, -95% CI: 0.137 to -0.110) and lower HRQoL. Particular combinations of NCDs were detrimental to perceived health, whereas HIV, which was characterized by access to care and suppressed viral load in the large majority of those affected, was counterintuitively associated with better perceived health. With respect to disease control, unique combinations of uncontrolled NCDs were significantly related to worse perceived health, and controlled HIV was associated with better perceived health. The presence of controlled and uncontrolled NCDs was associated with poor perceived health and worse HRQoL, whereas the presence of controlled HIV was associated with improved HRQoL. HIV disease control may be critical for HRQoL among people with HIV, and incorporating NCD prevention and attention to multimorbidity into healthcare strategies may improve HRQoL., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Stanton et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)