Search

Abstract South Africa faces both under- and over-nutrition, highlighting the need for prioritizing nutrition services. Registered dietitians are crucial for delivering appropriate and quality nutrition services. Consequently, this case study employs the World Health Organization evidence-based Workload Indicators of Staffing Need to ascertain the requisite dietetic workforce needed at central and tertiary public hospitals in South Africa. Head dietitians from 21 of 22 central and tertiary public hospitals participated in an online survey to provide data and consensus on workload components and activity standards via Delphi technique. Data were analyzed using the World Health Organisation Workload Indicators of Staffing Need software. Dietetic staffing needs were determined based on the difference between existing and required numbers of dietitians. WISN ratio was used as a metric to gauge dietitians’ workload pressure. Majority (95%) of hospitals experienced dietetic staff shortages and few (14%) had requisite staff to cover basic health services. Majority (76%) exhibited a WISN ratio below 0.5, indicating fullfilment of less than 50% of staff requirements. Based on the Workload Indicators of Staffing Need, dietitians in South African central and tertiary public hospitals experience high workload pressures due to extreme understaffing. The results can guide future profession workforce planning to facilitate enhanced nutrition outcomes in South Africa.

Coal continues to be one of the most important primary energy sources and is a major contributor to economic growth, especially in the developing world. Coal fines are an unavoidable by-product of coal extraction. Fine coal is classified as waste when it is too difficult or uneconomical to process and thus disposed of into waste ponds. This leads to environmental liability and loss of valuable high-quality product. There have been numerous studies regarding the efficient processing of fine coal particles, to realise the full economic potential whilst reducing the product's environmental risks. Fluidization is commonly used in the processing of powders or fine particles since it enables continuous powder handling and promotes good particulate mixing. However, the fluidization of fine particles is challenging due to the propensity for channelling, clustering and elutriation. Enhanced fluidization methods have been used to overcome these problems. Several methods that have been employed include electric or magnetic fields, mechanical vibrations, centrifugal forces, introduction of foreign particles, the use of microjets and the use of acoustic sound waves. This study considered the use of in-situ ultrasound as a new alternative enhanced fluidization technique. The overall aim of this research project was to quantitatively determine the improvement in the fluidization behaviour of fine coal particles, under the influence of ultrasound. This new technique helped prevent channel formation, and bed cracking, and improvement in fluidization regimes were observed. Decreasing minimum fluidization velocities were observed for increasing ultrasonic intensities, across various bed heights. The addition of the ultrasound correction factor was able to improve the prediction capability of the model that was developed for the minimum fluidization velocity. The reduction in minimum fluidization velocity shows promise for reduced energy consumption, and increased production throughput, of the fine coal particle processing industry. Overall the novel application of ultrasound improved the quality and operability of the fluidization of fine coal particles.

Abstract Objective To conduct a systematic review of the computer vision applications that detect, diagnose, or analyse tuberculosis (TB) pathology or bacilli using digitised human lung tissue images either through automatic or semi-automatic methods. We categorised the computer vision platform into four technologies: image processing, object/pattern recognition, computer graphics, and deep learning. In this paper, the focus is on image processing and deep learning (DL) applications for either 2D or 3D digitised human lung tissue images. This review is useful for establishing a common practice in TB analysis using human lung tissue as well as identifying opportunities for further research in this space. The review brings attention to the state-of-art techniques for detecting TB, with emphasis on the challenges and limitations of the current techniques. The ultimate goal is to promote the development of more efficient and accurate algorithms for the detection or analysis of TB, and raise awareness about the importance of early detection. Design We searched five databases and Google Scholar for articles published between January 2017 and December 2022 that focus on Mycobacterium tuberculosis detection, or tuberculosis pathology using digitised human lung tissue images. Details regarding design, image processing and computer-aided techniques, deep learning models, and datasets were collected and summarised. Discussions, analysis, and comparisons of state-of-the-art methods are provided to help guide future research. Further, a brief update on the relevant techniques and their performance is provided. Results Several studies have been conducted to develop automated and AI-assisted methods for diagnosing Mtb and TB pathology from digitised human lung tissue images. Some studies presented a completely automated method of diagnosis, while other studies developed AI-assisted diagnostic methods. Low-level focus areas included the development of a novel $$\upmu$$ μ CT scanner for soft tissue image contract, and use of multiresolution computed tomography to analyse the 3D structure of the human lung. High-level focus areas included the investigation the effects of aging on the number and size of small airways in the lungs using CT and whole lung high-resolution $$\upmu$$ μ CT, and the 3D microanatomy characterisation of human tuberculosis lung using $$\upmu$$ μ CT in conjunction with histology and immunohistochemistry. Additionally, a novel method for acquiring high-resolution 3D images of human lung structure and topology is also presented. Conclusion The literature indicates that post 1950s, TB was predominantly studied using animal models even though no animal model reflects the full spectrum of human pulmonary TB disease and does not reproducibly transmit Mtb infection to other animals (Hunter, 2011). This explains why there are very few studies that used human lung tissue for detection or analysis of Mtb. Nonetheless, we found 10 studies that used human tissues (predominately lung) of which five studies proposed machine learning (ML) models for the detection of bacilli and the other five used CT on human lung tissue scanned ex-vivo.

OBJECTIVES: The COVID-19 pandemic in South Africa introduced new societal adversities and mental health threats in a country where one in three individuals are expected to develop a psychiatric condition sometime in their life. Scientists have suggested that psychosocial stress and trauma during childhood may increase ones vulnerability to the mental health consequences of future stressors-a process known as stress sensitization. This prospective analysis assessed whether childhood adversity experienced among South African children across the first 18 years of life, coinciding with the post-apartheid transition, exacerbates the mental health impacts of psychosocial stress experienced during the 2019 coronavirus (COVID-19) pandemic (ca. 2020-2021). MATERIALS AND METHODS: Data came from 88 adults who participated in a follow-up study of a longitudinal birth cohort study in Soweto, South Africa. Childhood adversity and COVID-19 psychosocial stress were assessed as primary predictors of adult PTSD risk, and an interaction term between childhood adversity and COVID-19 stress was calculated to evaluate the potential effect of stress sensitization. RESULTS: Fifty-six percent of adults exhibited moderate-to-severe PTSD symptoms. Greater childhood adversity and higher COVID-19 psychosocial stress independently predicted worse post-traumatic stress disorder symptoms in adults. Adults who reported greater childhood adversity exhibited non-significantly worse PTSD symptoms from COVID-19 psychosocial stress. DISCUSSION: These results highlight the deleterious mental health effects of both childhood trauma and COVID-19 psychosocial stress in our sample and emphasize the need for greater and more accessible mental health support as the pandemic progresses in South Africa.

Abstract Background Successful deployment of clinical prediction models for clinical deterioration relates not only to predictive performance but to integration into the decision making process. Models may demonstrate good discrimination and calibration, but fail to match the needs of practising acute care clinicians who receive, interpret, and act upon model outputs or alerts. We sought to understand how prediction models for clinical deterioration, also known as early warning scores (EWS), influence the decision-making of clinicians who regularly use them and elicit their perspectives on model design to guide future deterioration model development and implementation. Methods Nurses and doctors who regularly receive or respond to EWS alerts in two digital metropolitan hospitals were interviewed for up to one hour between February 2022 and March 2023 using semi-structured formats. We grouped interview data into sub-themes and then into general themes using reflexive thematic analysis. Themes were then mapped to a model of clinical decision making using deductive framework mapping to develop a set of practical recommendations for future deterioration model development and deployment. Results Fifteen nurses (n = 8) and doctors (n = 7) were interviewed for a mean duration of 42 min. Participants emphasised the importance of using predictive tools for supporting rather than supplanting critical thinking, avoiding over-protocolising care, incorporating important contextual information and focusing on how clinicians generate, test, and select diagnostic hypotheses when managing deteriorating patients. These themes were incorporated into a conceptual model which informed recommendations that clinical deterioration prediction models demonstrate transparency and interactivity, generate outputs tailored to the tasks and responsibilities of end-users, avoid priming clinicians with potential diagnoses before patients were physically assessed, and support the process of deciding upon subsequent management. Conclusions Prediction models for deteriorating inpatients may be more impactful if they are designed in accordance with the decision-making processes of acute care clinicians. Models should produce actionable outputs that assist with, rather than supplant, critical thinking.

Purpose: Teachers at all levels of the education system are expected to model leadership qualities to students. Leadership qualities of level advisers (LAs) are regarded as charismatic, pragmatic, ideological and innovative (CPII) in this study. This study compared the leadership qualities of LAs in universities in Nigeria as perceived by students. The purpose of this paper is to compare the leadership qualities of LAs in universities in Nigeria as perceived by students. Design/methodology/approach: A survey-comparative design of a quantitative research approach was used. Two universities were purposively selected and the convenience sampling method was applied to select 207 participants. Findings: Findings revealed that LAs of the private university exhibit a slightly higher level of leadership qualities than those from the public university based on the students' assessment (t (207) = 2.19 and [rho] = 0.029 < 0.05). Research limitations/implications: The study concluded that universities should organise regular workshops for LAs on innovative leadership to stimulate 21st-century learners to achieve their educational objectives. Practical implications: It is therefore recommended that universities should organise a regular workshop for LAs on an innovative leadership model that promotes 21st century students to achieve their educational objectives. Originality/value: In practice, the study of this kind is timely, given that academic advisers or advisers are very influential on student achievement and success. Thus, the outcome will educate the academic advisers on the leadership qualities that will enhance their role in the 21st century. In addition, it will add to the literature on university LAs' leadership skills in Nigeria and other nations of Africa. Most literature available in the context is mainly from America.

The value of internationalization within the limits of mobility has become more pronounced during the COVID-19 pandemic. As reflection occurs on our own history, navigating a period of reset and renewal, this paper examines how to advance our thinking, and explore and transverse essential differences within the digital space. Hence, recalibrating the global north and south agenda to create inclusionary principles through virtual exchange. First, this ethnographic paper explores the sympoeitic relationship of creating opportunities and a sense of agency toward morphogenesis. Second, it focuses on the contextual rationale for Collaborative Online International Learning (COIL) within higher education. Third, it explores equity in the digital space through multiple engagements in COIL. The paper offers associated conclusions for critical virtual exchange to advance equity, inclusion, and social justice and suggests responsible pluralistic internationalization.

IntroductionScientific evidence shows that contemporary and emerging factors contribute to high blood lead concentrations in different populations. The study aimed to determine blood lead concentrations and risk factors associated with high blood lead concentrations among young males in conflict with the law.MethodsA cross-sectional analytical study was conducted among 192 conveniently selected participants from two youth secure (correctional) facilities in Gauteng Province, South Africa.ResultsThe study's overall blood lead concentration median was 3.30 μg/dl, ranging from 0.85 to 48.11 μg/dl. Young males born outside of South Africa (median = 8.78 μg/dl) and in villages (median = 4.95 μg/dl), working before coming to the facility (median = 5.23 μg/dl) and involvement in illegal mining (median = 9.00 μg/dl) had high blood lead concentrations in this study. Contemporary and emerging risk factors such as being born outside the country (AOR: 3.10, 95%CI: 1.01–1.88), involvement in illegal mining activities (AOR: 1.36, 95%CI: 1.14–1.91) and staying in a house with peeling paint on the outside (AOR: 2.26, 95%CI: 1.12–4.30) were found to influence blood lead concentration.DiscussionThe study findings show that contemporary (co-existing) and emerging factors influence blood lead concentrations. Therefore, there is a need to investigate these factors further in communities that may be affected. Lastly, there is a need for a holistic approach involving multiple sectors to introduce human lead concentration screening and preventive programmes.

Research has shown that school leaders must improve their knowledge and skills as the Fourth Industrial Revolution (4IR) dawns. Thus, the study validated a scale that could be adopted to assess school leaders’ development needs in the 4IR. Specifically, this study estimated the instrument’s validity, determined the number of factors underlining the scale, and established the reliability coefficient of the scale. A quantitative survey design was used. A systematic sampling was conducted to select 284 respondents from selected basic schools (public and private) in the Ibadan metropolis, Oyo State, Nigeria. A content validity ratio (CVR) and a content validity index (CVI) were calculated based on the judgments of the panelists. Using Ordinal, Omega, and Guttmann Alpha approaches, statistical computing was done using R software (R Core Team, 2020) to determine the underlying factors of the scale items using exploratory factor analysis (EFA). A parallel analysis identified eight factors: school leaders’ knowledge of 4IR attributes, leaders’ technology needs, easy usage of basic technology applications, agility, information management and evaluation, communication expressiveness and collaboration, critical thinking and problem-solving, and creativity. Based on the results, the scale is valid for measuring the construct, showing good content and construct validity. Also, there was high internal consistency in all the approaches used. The scale is reliable and valid. The study recommends that school leaders, administrators, researchers, and other stakeholders adopt this scale to assess their skills development needs in the 4IR era. Hence, scholars could use the scale to conduct reliable studies in Nigeria and other Sub-Saharan African nations.

No abstract available.

BackgroundWastewater surveillance has become an important public health tool with numerous research studies indicating its potential for monitoring coronavirus disease 2019 (COVID-19) outbreaks. The aim of this study was to apply wastewater surveillance as an indicator for COVID-19 to monitor the impact of a mass sporting event in the City of Cape Town. The study compared the same event over 2 years (2022 and 2023).MethodsWeekly grab wastewater samples were collected from wastewater treatment plants in the City of Cape Town, and quantitative reverse transcription-polymerase chain reaction used to quantify severe acute respiratory syndrome 2 (SARS-CoV-2) RNA in wastewater.ResultsOur findings show a statistically significant correlation (rho = 0.68, p = 0.01) between clinical cases and concentrations of SARS-CoV-2 RNA in wastewater in the 2022 study period. During this specific period, a rise in clinical cases was observed 2 weeks after the event and the peaks in clinical cases coincided with the peaks in SARS-CoV-2 RNA level in wastewater. The study also found a statistically significant positive correlation (R2 = 0.03, F (1,208) = 6.56, p = 0.01) between the SARS-CoV-2 RNA in wastewater and the 2022 event of the marathon hosted in the city.ConclusionDue to the decrease in clinical testing and the country being a popular destination for mass gatherings such as sporting events, the results from this study indicate the potential of wastewater surveillance providing supplementary information to form part of public health risk evaluations for mass gatherings.

The 21st century places significant demands on our educational system. It is an opportune time to re-imagine the mission, operations, and skills expected of school district offices. The focus of this study was on the school district’s role in strengthening principals’ instructional leadership capacity for improving educational outcomes. Using a case study design, interviews were conducted with 10 principals and 14 district officials in one school district. The findings showed that district officials placed instructional leadership at the core of their role in their interactions with principals. They continued to monitor curriculum delivery and provided reports but also assumed a mentoring approach in working with principals. The study further highlighted that principals did not always implement recommendations to improve instruction at schools as they felt overwhelmed by work demands. Principals expressed the need for professional development tailored to their instructional leadership roles and on-site workshops. The findings indicate that there is aneed for greater communication between principals and district officials where principals can openly deliberate issues related to instructional leadership confronting their schools with a view to problem solving. Moreover, district officials could enable the sharing of best instructional practices among schools.

AbstractThe Fourth Industrial Revolution (4IR) has brought about significant changes in organizational leadership. However, the accelerated transformation towards digitization was not without the influence of the COVID-19 pandemic. Hence, the COVID-19 pandemic aided the digital revolution in several organizations across the globe. This paper presents global evidence from a systematic literature review on the influence of digital leadership during the COVID-19 pandemic on organizational variables such as performance, relationship, satisfaction, collaboration, expertise, effectiveness, and efficiency. A PRISMA protocol was adopted for this review, while a thorough search of the Scopus bibliographic database was used to identify 416 academic papers. Eight papers met the inclusion criteria for in-depth analysis. The findings from the selected articles showed the role that technology played in enabling leaders to navigate the complexities of this global crisis. This review revealed that digital leadership has an influence on the organizational variables considered in this study. This paper, therefore, serves as reference material in guiding administrators and school leaders in leading a new organization’s digital culture. It will also aid in demonstrating digital technology-focused leadership required from school leaders.

The aim of this study was to investigate whether the enactment of servant leadership could be a prospective strategy to raise teacher morale. First, the factors that cause poor teacher morale were sought. Second, the perspectives of teachers and principals regarding the notion of servant leadership in improving teacher morale were pursued. A generic qualitative approach was employed and data was collected from four principals and eight teachers by means of individual interviews. Insufficient support from principals, lack of involvement of teachers in decision-making, leadership styles of principals, and work-related factors were the main causes of poor teacher morale. Teachers and principals both agreed that servant leadership could contribute to raising teacher morale. The study was conducted when teaching and learning resumed after the Covid-19 lockdown. Therefore, the data collection was limited to one school district and the methodology limited to individual interviews, both online and face-to-face. The study led to the formulation of eight standards that leaders could use in their leadership practice.

BackgroundElectronic standard order sets automate the ordering of specific treatment, testing, and investigative protocols by physicians. These tools may help reduce unwarranted clinical variation and improve health care efficiency. Despite their routine implementation within electronic medical records (EMRs), little is understood about how they are used and what factors influence their adoption in practice. ObjectiveThis study aims to (1) describe the patterns of use of standard order sets implemented in a widely used EMR (PowerPlans and Cerner Millennium) within a multihospital digital health care system; (2) explore the experiences and perceptions of implementers and users regarding the factors contributing to the use of these standard order sets; and (3) map these findings to the Capability, Opportunity, and Motivation Behavior (COM-B) model of behavior change to assist those planning to develop, improve, implement, and iterate the use of standard order sets in hospital settings. MethodsQuantitative data on standard order set usage were captured from 5 hospitals over 5-month intervals for 3 years (2019, 2020, and 2021). Qualitative data, comprising unstructured and semistructured interviews (n=15), were collected and analyzed using a reflexive thematic approach. Interview themes were then mapped to a theory-informed model of behavior change (COM-B) to identify determinants of standard order set usage in routine clinical practice. The COM-B model is an evidence-based, multicomponent framework that posits that human actions result from multiple contextual influences, which can be categorized across 3 dimensions: capability, opportunity, and motivation, all of which intersect. ResultsThe total count of standard order set usage across the health system during the 2019 observation period was 267,253, increasing to 293,950 in 2020 and 335,066 in 2021. There was a notable shift toward using specialty order sets that received upgrades during the study period. Four emergent themes related to order set use were derived from clinician interviews: (1) Knowledge and Skills; (2) Perceptions; (3) Technical Dependencies; and (4) Unintended Consequences, all of which were mapped to the COM-B model. Findings indicate a user preference for customized order sets that respond to local context and user experience. ConclusionsThe study findings suggest that ongoing investment in the development and functionality of specialty order sets has the potential to enhance usage as these sets continue to be customized in response to local context and user experience. Sustained and continuous uptake of appropriate Computerized Provider Order Entry use may require implementation strategies that address the capability, opportunity, and motivational influencers of behavior.

HBeAg is a non-structural, secreted protein of hepatitis B virus (HBV). Its p25 precursor is post-translationally modified in the endoplasmic reticulum. The G1862T precore mutation leads to the accumulation of P25 in the endoplasmic reticulum and activation of unfolded protein response. Using mass spectrometry, comparative proteome profiling of Huh-7 cells transfected with wildtype (WT) or G1862T revealed significantly differentially expressed proteins resulting in 12 dysregulated pathways unique to WT-transfected cells and 7 shared between cells transfected with either WT or G1862T. Except for the p38 MAPK signalling pathway, WT showed a higher number of DEPs than G1862T-transfected cells in all remaining six shared pathways. Two signalling pathways: oxidative stress and cell cycle signalling were differentially expressed only in cells transfected with G1862T. Fifteen pathways were dysregulated in G1862T-transfected cells compared to WT. The 15 dysregulated pathways were involved in the following processes: MAPK signalling, DNA synthesis and methylation, and extracellular matrix organization. Moreover, proteins involved in DNA synthesis signalling (replication protein A (RPA) and DNA primase (PRIM2)) were significantly upregulated in G1862T compared to WT. This upregulation was confirmed by mRNA quantification of both genes and immunofluorescent confocal microscopy for RPA only. The dysregulation of the pathways involved in these processes may lead to immune evasion, persistence, and uncontrolled proliferation, which are hallmarks of cancer.

Abstract Non-syndromic orofacial clefts (NSOFCs) are common birth defects with a complex etiology. While over 60 common risk loci have been identified, they explain only a small proportion of the heritability for NSOFCs. Rare variants have been implicated in the missing heritability. Thus, our study aimed to identify genes enriched with nonsynonymous rare coding variants associated with NSOFCs. Our sample included 814 non-syndromic cleft lip with or without palate (NSCL/P), 205 non-syndromic cleft palate only (NSCPO), and 2150 unrelated control children from Nigeria, Ghana, and Ethiopia. We conducted a gene-based analysis separately for each phenotype using three rare-variants collapsing models: (1) protein-altering (PA), (2) missense variants only (MO); and (3) loss of function variants only (LOFO). Subsequently, we utilized relevant transcriptomics data to evaluate associated gene expression and examined their mutation constraint using the gnomeAD database. In total, 13 genes showed suggestive associations (p = E−04). Among them, eight genes (ABCB1, ALKBH8, CENPF, CSAD, EXPH5, PDZD8, SLC16A9, and TTC28) were consistently expressed in relevant mouse and human craniofacial tissues during the formation of the face, and three genes (ABCB1, TTC28, and PDZD8) showed statistically significant mutation constraint. These findings underscore the role of rare variants in identifying candidate genes for NSOFCs.

Background: The Modified Stoppa approach is a minimally invasive method of accessing the pelvis when treating pelvic ring and acetabular fractures. Although this approach is reported to be effective in exposing pelvic fractures, there are iatrogenic risks associated with the procedure. These risks arise from the inadvertent severing of vessels along the pelvic brim, resulting in bleeding, prolonged recovery, or even death. The specific vessels of concern include the corona mortis (CM) anastomosis and aberrant vasculature, which course over the superior pubic ramus. Methods: The current study aimed to create and validate clinically significant safe zones to avoid injury to these anomalous vessels during the Modified Stoppa approach. Measurements were taken between the CM and crossing vessels (CV), as well as various bony landmarks encountered during the anterior approach, using 63 cadavers. Measurements were statistically analyzed for any significant differences between sides and sex using t-tests, and safe zones were formulated. The safe zones were then assessed for precision using a stepwise cadaver simulation of the Modified Stoppa approach. Results: Safe zones from the pubic tubercle were calculated as 57.96 mm (SD ± 21.40) for the CM, while safe zones for the CV were reported as 48.07 mm (SD ± 25.52). These safe zones proved to be accurate when implemented during the cadaver simulation of the Modified Stoppa approach, as all cases of CM and aberrant vessels were positioned outside the prescribed zones. Conclusion: The results reiterate the clinical significance of the CM and its impact on orthopedic surgery and patient care.

We report a 23% asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) Omicron carriage rate in participants being enrolled into a clinical trial in South Africa, 15-fold higher than in trials before Omicron. We also found lower CD4 + T-cell counts in persons with human immunodeficiency virus (HIV) strongly correlated with increased odds of being SARS-CoV-2 polymerase chain reaction (PCR) positive.

BackgroundOccupational injuries are a growing public health problem. Approximately 1,000 workers die daily from occupational injuries globally. Artisans working in the informal sector of the construction industry in many low/middle income countries like Nigeria have a higher injury predisposition. This study will assess the determinants of occupational injuries and design a safety intervention for informal sector artisans in the Nigerian construction industry.MethodsA sequential mixed-methods design will be employed to study 840 bricklayers and carpenters (420 per artisan group) in Osun State, Nigeria. Quantitative data will be collected first while qualitative data will be collected thereafter. Thirdly, a modified Delphi-technique will be employed to co-design a safety education intervention. For the quantitative study, artisans will be recruited via multi-stage sampling and a semi-structured questionnaire will be administered to obtain information on artisans’ socio-demographics, work-patterns and occupational injuries. A multivariable regression model will be used to determine the association between injury occurrence and independent variables. Twelve to sixteen focus group discussion (FGD) sessions will be conducted for artisans to obtain group perspectives about injuries and preferred safety training topics. From the FGD and quantitative study findings, a list of items for the safety training module will be compiled for the modified-Delphi process. Thereafter, the content validation index (CVI) will be derived and items with CVI of ≥0.80 will be included in the final safety training module.ConclusionThis paper describes the process required to assess the determinants of occupational injuries among artisans in the informal sector of the construction industry in Nigeria and further proposes the design of a context-relevant safety training intervention. The information from this study will be essential in promoting safe working environments for construction artisans.

Summary: Background: The HVTN 705 Imbokodo trial of 2636 people without HIV and assigned female sex at birth, conducted in southern Africa, evaluated a heterologous HIV-1 vaccine regimen: mosaic adenovirus 26-based vaccine (Ad26.Mos4.HIV) at Months 0, 3, 6, 12 and alum-adjuvanted clade C gp140 at Months 6, 12. Per-protocol vaccine efficacy (VE) against HIV-1 diagnosis from seven to 24 months was 14.1% (95% CI: −22.0% to 39.5%). Immune correlates analysis was performed for markers selected based on prior evidence in efficacy trials and/or nonhuman primate models. Methods: Humoral and cellular immune response markers at Month 7 were evaluated as immune correlates of risk and of protection in a breakthrough case–control cohort (n = 52 cases, 246 non-cases). Primary markers were IgG binding to vaccine-strain gp140, IgG3 binding to diverse Env antigens (IgG3 Env breadth), IgG3 binding to diverse V1V2 antigens (IgG3 V1V2 breadth), antibody-dependent phagocytosis against the vaccine-strain gp140, Env-specific CD4+ and CD8+ T-cell responses, and multi-epitope functions. Findings: No immune markers were statistically significant correlates of risk. IgG3 V1V2 breadth trended toward an inverse association: hazard ratio 0.70 (95% CI: 0.36 to 1.35; p = 0.29) per 10-fold increase and 0.51 (95% CI: 0.21 to 1.24; p = 0.14) in a Cox model with all primary markers. The VE estimate was 11.8% (95% CI: −17.9% to 34.0%) at all IgG3 V1V2 breadth values below 667 weighted geometric mean net MFI; just above this value, the VE estimate sharply increased to 62.6% (95% CI: −17.9% to 89.6%), and further increased to 80.9% (95% CI: −17.9% to 99.5%) at 1471 MFI, the 95th percentile of the marker distribution. Mediation analysis yielded a VE of 35.7% (95% CI: 15.0% to 51.3%) attributable to the vaccine's impact on this marker. Interpretation: The trend in association of greater IgG3 V1V2 antibody breadth with lower likelihood of HIV acquisition is consistent with the identification of antibodies against V1V2 as immune correlates in three other HIV vaccine efficacy trials and suggests that a greater emphasis should be placed on studying this region in the HIV-1 envelope as a vaccine immunogen. Funding: National Institute of Allergy and Infectious Diseases and Janssen Vaccines & Prevention BV.

BackgroundComputerized clinical decision support systems (CDSSs) enhance patient care through real-time, evidence-based guidance for health care professionals. Despite this, the effective implementation of these systems for health services presents multifaceted challenges, leading to inappropriate use and abandonment over the course of time. Using the Non-Adoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework, this qualitative study examined CDSS adoption in a metropolitan health service, identifying determinants across implementation stages to optimize CDSS integration into health care practice. ObjectiveThis study aims to identify the theory-informed (NASSS) determinants, which included multiple CDSS interventions across a 2-year period, both at the health-service level and at the individual hospital setting, that either facilitate or hinder the application of CDSSs within a metropolitan health service. In addition, this study aimed to map these determinants onto specific stages of the implementation process, thereby developing a system-level understanding of CDSS application across implementation stages. MethodsParticipants involved in various stages of the implementation process were recruited (N=30). Participants took part in interviews and focus groups. We used a hybrid inductive-deductive qualitative content analysis and a framework mapping approach to categorize findings into barriers, enablers, or neutral determinants aligned to NASSS framework domains. These determinants were also mapped to implementation stages using the Active Implementation Framework stages approach. ResultsParticipants comprised clinical adopters (14/30, 47%), organizational champions (5/30, 16%), and those with roles in organizational clinical informatics (5/30, 16%). Most determinants were mapped to the organization level, technology, and adopter subdomains. However, the study findings also demonstrated a relative lack of long-term implementation planning. Consequently, determinants were not uniformly distributed across the stages of implementation, with 61.1% (77/126) identified in the exploration stage, 30.9% (39/126) in the full implementation stage, and 4.7% (6/126) in the installation stages. Stakeholders engaged in more preimplementation and full-scale implementation activities, with fewer cycles of monitoring and iteration activities identified. ConclusionsThese findings addressed a substantial knowledge gap in the literature using systems thinking principles to identify the interdependent dynamics of CDSS implementation. A lack of sustained implementation strategies (ie, training and longer-term, adopter-level championing) weakened the sociotechnical network between developers and adopters, leading to communication barriers. More rigorous implementation planning, encompassing all 4 implementation stages, may, in a way, help in addressing the barriers identified and enhancing enablers.

IntroductionResolution of a child’s diagnosis, the process of accepting and adjusting to the reality of a child’s significant diagnosis, has been often associated with decreased parental stress. Hope, a potential buffer against psychological distress, has been suggested as a potential explanation for this relationship. However, the mediating role of hope in the relationship between resolution of diagnosis and parental stress has not been explored.MethodsThis study aimed to examine whether four types of hope (child, parental, societal, denial of diagnosis) mediated the relationship between resolution to an autism diagnosis and reduced parental stress. Participants included 73 parents (Mage = 43.22, SD = 7.69, female 97.3%) of autistic children (Mage = 11.15, SD = 4.56, male = 67.1%).ResultsResolution to diagnosis was negatively and significantly correlated with resolution to diagnosis, as well as child, parental and societal hope. These three hopes were also significantly and negatively correlated with parental stress. Importantly, when controlling for level of support and autism awareness, parental hope mediated the relationship between resolution to diagnosis and parental stress. Denial of diagnosis was not correlated with resolution or parental stress but did have significant but weak associate with the other hopes.DiscussionThese findings suggest that hope based on parent’s abilities to support their child and be supported themselves play an important role in parental stress once parents are more resolved to their child’s diagnosis. Supporting parents to manage factors associated with supporting their child’s needs, may benefit parents of autistic children.

School leadership development (SLP) in the context of the Fourth Industrial Revolution (4.0) is a crucial aspect of preparing basic school leaders to navigate the challenges and opportunities presented by the rapid technological advancements and changes in the modern world. The 4.0 is characterized by the fusion of digital, physical, and biological technologies, which profoundly impact various aspects of society, including education. Thus, this study examined basic school leaders’ development needs in 4.0 in Nigeria and South Africa. A comparative research approach of survey design was adopted with the aid of a questionnaire. Descriptive statistics (mean score) and an independent t-test were used to analyze the collected data. Results indicated that basic school leaders in South Africa fared better than their counterparts from Nigeria regarding their 4.0 knowledge. However, no significant difference was found in 4.0 leadership skills. Leaders from both nations indicated the need for development programs in technological applications to enhance competency to perform their administrative tasks. In theory, the study addresses African schools’ 4.0 leadership needs. To lead education into the future, each nation must also understand the specific 4.0 leadership skills its school leaders will need. In light of the study’s findings, policymakers should consider what gaps need to be filled to equip their basic school leaders with Education 4.0 skills.

Background: Sexual orientation discrimination impacts teachers’ well-being in school environments. The Prevention of Discrimination and Promotion of Equality Act of 2002 prohibits discrimination based on gender and sexual orientation, granting lesbian, gay, bisexual, transgender and queer (LGBTQ) individuals many of the same rights as their cis-gender, heterosexual peers. Despite this, many LGBTQ teachers still face problematic, uncomfortable, and tension-filled experiences in schools. Traditionally, the Foundation Phase (FP) of education was gendered, but this is changing. However, there is a perception that male FP teachers are primarily queer with a “gay agenda.” The authors used the Class Psychological Stressor Strain theory to explore the negative experiences of queer-identifying teachers. Objectives: This article examines the effects of Foundation Phase teachers’ sexual orientation on their work environment experiences. Methods: This qualitative study, grounded in an interpretivist paradigm, explored the lived experiences of three queer-identifying teachers in the Gauteng Province through individual face-to-face interviews. Results: The findings reveal that schools are not adequately addressing discrimination. Teachers often face marginalisation and discrimination. Conclusion: This article explored a sensitive issue faced by teachers whose sexual orientation differs from society’s norms. It highlighted the discrimination and harassment LGBTQ teachers face in the Foundation Phase in public schools in South Africa. Contribution: By unveiling these issues, the article aims to reduce the stigma, bias, and prejudice commonly faced by LGBTQ Foundation Phase teachers in the teaching profession.