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The changes in climatic conditions and their associated impacts are contributing to a worsening of existing gender inequalities and a heightening of women’s socioeconomic vulnerabilities in South Africa. Using data collected by research methods inspired by the tradition of participatory appraisals, we systematically discuss the impacts of climate change on marginalized women and the ways in which they are actively responding to climate challenges and building their adaptive capacity and resilience in the urban areas of KwaZulu-Natal, South Africa. We argue that changes in climate have both direct and indirect negative impacts on women’s livelihoods and well-being. Less than one-half (37%) of the women reported implementing locally developed coping mechanisms to minimize the impacts of climate-related events, whereas 63% reported lacking any form of formal safety nets to deploy and reduce the impacts of climate-induced shocks and stresses. The lack of proactive and gender-sensitive local climate change policies and strategies creates socioeconomic and political barriers that limit the meaningful participation of women in issues that affect them and marginalize them in the climate change discourses and decision-making processes, thereby hampering their efforts to adapt and reduce existing vulnerabilities. Thus, we advocate for the creation of an enabling environment to develop and adopt progendered, cost-effective, transformative, and sustainable climate change policies and adaptation strategies that are responsive to the needs of vulnerable groups (women) of people in society. This will serve to build their adaptive capacity and resilience to climate variability and climate change–related risks and hazards.

Non-alcoholic fatty liver disease (NAFLD) represents a growing public health concern, with patients having higher risk of morbidity and mortality. It has a considerably high prevalence in the general population, estimated 20%-40% in Europe, and is asymptomatic until late in the disease course. It is therefore important to identify and validate tools that predict hard outcomes such as mortality for use in clinical practice in risk-stratifying NAFLD patients.To evaluate available evidence on the use of non-invasive test(s) as prognostic factors for mortality in NAFLD.We performed electronic searches of Medline and EMBASE (Ovid) until 7Database searches identified 2850 studies - 24 were included. 16 studies reported non-invasive scoring systems, 10 studies reported individual biomarkers, and 1 study reported imaging modalities. 4 studies on non-invasive scoring systems (6324 participants) had data available for inclusion in the meta-analysis. The non-invasive scoring system that performed best at predicting all-cause mortality was NAFLD fibrosis score (NFS) [pHR 3.07 (1.62-5.83)], followed by fibrosis-4 index [pHR 3.06 (1.54-6.07)], BARD [pHR 2.87 (1.27-6.46)], and AST to platelet ratio index [pHR 1.90 (1.32-2.73)]. NFS was also prognostic of cardiovascular-related mortality [pHR 3.09 (1.78-5.34)].This study reaffirms that non-invasive scoring systems, especially NFS, are reliable prognostic markers of all-cause mortality and cardiovascular mortality in NAFLD patients. These findings can inform clinical practice in risk stratifying NAFLD patients.

Palaeoecological evidence is compared with the existing archaeological record to understand how changing human activity, over the past two millennia, impacted fire regimes and vegetation dynamics in the Drakensberg Mountains, South Africa. Sediment cores from two wetland sites in the Cathedral Peak area of the northern Drakensberg, KwaZulu-Natal are dated using accelerator mass spectrometry to chronologically support biological proxy data. Fossil pollen analysis is used to detect changes in vegetation composition, and macroscopic charcoal to reconstruct changing fire regimes. Charcoal accumulation rates (CHAR) are used as a proxy for burned biomass, and charcoal width-to-length ratio (W/L) as a proxy for dominant fuel type, whether grassy or woody. Results indicate an increase in CHAR, coincident with the appearance of cereal-type grasses (>40 μm) c. 550 cal BP, suggesting a change in fire regimes associated with the arrival of early agropastoralists. A notable decline in charcoal W/L at this time indicates a shift towards a more grassy fuel type. This is consistent with a seasonal shift in the timing of ignitions from high intensity late season lightning fires to low intensity early season anthropogenic fires. The latter are less damaging to woody vegetation explaining an overall shift to a more grassy fuel type. Large scale ecosystem change is evident in the colonial period, including decreased forest pollen taxa such as Podocarpus, which may be linked to colonial period logging. The increased dominance of Pteridium spores documents the invasion trajectory of bracken fern into montane grasslands in the area, which is attributed to ecosystem disturbance in the form of colonial fire suppression. The subalpine wetland clearly documents woody encroachment of the surrounding open grassland landscape during the agropastoral and subsequent colonial periods. By contrast, at the montane wetland site, these trends appear to be overprinted by local forest dynamics and recent deforestation, likely an elevation effect. Palaeoecological evidence demonstrates how changes in fire regimes and vegetation composition in the northern Drakensberg are closely tied to human activity over the past two millennia.

Background Total shoulder arthroplasty (TSA) procedures performed for proximal humerus fractures are considered to have higher complications rates and longer operative time than TSA performed for osteoarthritis (OA). However, there exists only one current procedural terminology (CPT) code for TSA, which may not accurately capture the increased work and complexity required for fracture cases. The purpose of this study was to compare TSA work relative value unit (RVU) rates per operative time performed for osteoarthritis and fracture care. Methods Data were collected through the National Surgical Quality Improvement Program (NSQIP) database for the years 2006 to 2018 to identify all patients who underwent primary TSA for either OA or fractures. Work RVU, operation time (skin incision to closure), work RVU per minute, and payment per minute were compared between the osteoarthritis and fracture TSA cohorts. Bivariate and multivariate analyses controlling for patient demographics and comorbidity were utilized to determine whether there existed a reimbursement differential between the two groups. Results The mean operation times for primary TSA for osteoarthritis and fracture were 109 minutes and 122 minutes, respectively (P Conclusion On average, TSA performed for fracture care is associated with longer operative times and may require more work compared to elective TSA for OA. These results highlight the need for more precise procedural coding to accurately capture the added effort and operative time required for TSA in the setting of fracture care. Level of Evidence Level III

The paper examines relational capital in form of trust and connectedness as key attributes of social interactions among social actors involved in adaptive governance processes. The research is a lo...

BackgroundUnintentional home injuries are a leading cause of preventable death in young children. Safety education and equipment provision improve home safety practices, but their impact on injuries is less clear. Between 2009 and 2011, a national home safety equipment scheme was implemented in England (Safe At Home), targeting high-injury-rate areas and socioeconomically disadvantaged families with children under 5. This provided a ‘natural experiment’ for evaluating the scheme’s impact on hospital admissions for unintentional injuries.MethodsControlled interrupted time series analysis of unintentional injury hospital admission rates in small areas (Lower Layer Super Output Areas (LSOAs)) in England where the scheme was implemented (intervention areas, n=9466) and matched with LSOAs in England and Wales where it was not implemented (control areas, n=9466), with subgroup analyses by density of equipment provision.Results57 656 homes receiving safety equipment were included in the analysis. In the 2 years after the scheme ended, monthly admission rates declined in intervention areas (−0.33% (−0.47% to −0.18%)) but did not decline in control areas (0.04% (−0.11%–0.19%), p value for difference in trend=0.001). Greater reductions in admission rates were seen as equipment provision density increased. Effects were not maintained beyond 2 years after the scheme ended.ConclusionsA national home safety equipment scheme was associated with a reduction in injury-related hospital admissions in children under 5 in the 2 years after the scheme ended. Providing a higher number of items of safety equipment appears to be more effective in reducing injury rates than providing fewer items.

The coastal environment is one of the most utilised for human activities; providing a diverse range of goods and services such as fisheries, water purification and coastal erosion protection. This results in the need for effective, ongoing management and informed decision making, to ensure long-term sustainability of the coastal environment. However, Goble et al. (2017) highlight that institutional knowledge and capacity are currently limited to achieve the objectives of effective coastal management. This research considers the use of ArcGIS Portal as a component of a Decision Support System (or Info-portal) for coastal management in KwaZulu-Natal, through the development of an online, interactive mapping platform. This platform offers a portal to decision makers to access and interrogate data and information, thus informing decision making. The development of this tool followed a participatory approach, and engagement with end-users throughout the process to ensure that the tool meets users’ requirements. To date, the info-portal has been well utilised by both decision makers and members of the public that are interested in the coast. It offers an excellent example of the power of a spatial tool in improving decision making.

Urban and agricultural land uses have the potential to severely compromise the quality of impoundments, if ineffectively managed and operated. A case in point is the upper uMngeni Catchment, including Midmar Dam, which is integral to the freshwater supply infrastructure in KwaZulu-Natal, South Africa. Monitoring sites were established in varying land use types in three subcatchments of the upper uMngeni Catchment to assess water quality and ecosystem health impacts of current land uses. Conclusions about water quality were drawn using pairing of SASS5 and spot water quality data. Water quality and ecological condition were highest in commercial plantations and upstream of a high-density settlement where natural land cover and sparse settlement occurred. Although marked declines in water quality and ecological condition were observed under commercial agriculture. The most notable declines in water quality and ecological condition were observed downstream of the settlement with elevated nutrient loads. Shifts in aquatic biota were highly correlated with seasonal shifts in water quality, influenced markedly by land use. The cumulative effects of current land use activities, urban development and agriculture on Midmar Dam’s water quality should be viewed with concern. Additional development in the form of additional social housing projects may exacerbate impacts.&nbsp

BackgroundInjuries in children aged under 5 years most commonly occur in the home and disproportionately affect those living in the most disadvantaged communities. The ‘Safe at Home’ (SAH) national home safety equipment scheme, which ran in England between 2009 and 2011, has been shown to reduce injury-related hospital admissions, but there is little evidence of cost-effectiveness.Materials and methodsCost-effectiveness analysis from a health and local government perspective. Measures were the incremental cost-effectiveness ratio per hospital admission averted (ICER) and cost-offset ratio (COR), comparing SAH expenditure to savings in admission expenditure. The study period was split into three periods: T1 (years 0–2, implementation); T2 (years 3–4) and T3 (years 5–6). Analyses were conducted for T2 versus T1 and T3 versus T1.ResultsTotal cost of SAH was £9 518 066. 202 223 hospital admissions in the children occurred during T1-3, costing £3 320 000. Comparing T3 to T1 SAH reduced admission expenditure by £924 per month per local authority and monthly admission rates by 0.5 per local authority per month compared with control areas. ICER per admission averted was £4209 for T3 versus T1, with a COR of £0.29, suggesting that 29p was returned in savings on admission expenditure for every pound spent on SAH.ConclusionSAH was effective at reducing hospital admissions due to injury and did result in some cost recovery when taking into admissions only. Further analysis of its cost-effectiveness, including emergency healthcare, primary care attendances and wider societal costs, is likely to improve the return on investment further.

The coastal environment is one of the most utilised for human activities; providing a diverse range of goods and services such as fisheries, water purification and coastal erosion protection. This results in the need for effective, ongoing management and informed decision making, to ensure long-term sustainability of the coastal environment. However, Goble et al. (2017) highlight that institutional knowledge and capacity are currently limited to achieve the objectives of effective coastal management. This research considers the use of ArcGIS Portal as a component of a Decision Support System (or Info-portal) for coastal management in KwaZulu-Natal, through the development of an online, interactive mapping platform. This platform offers a portal to decision makers to access and interrogate data and information, thus informing decision making. The development of this tool followed a participatory approach, and engagement with end-users throughout the process to ensure that the tool meets users’ requirements. To date, the info-portal has been well utilised by both decision makers and members of the public that are interested in the coast. It offers an excellent example of the power of a spatial tool in improving decision making.

Hydrological modelling is an appropriate approach to investigate the effect of interactions of climate, landuse and soil on the water-use of natural or managed ecosystems, in particular where spatial heterogeneity exists. The Soil and Water Assessment Tool (SWAT) model has evolved into one of the most widely used catchment-scale hydrological models, which has been extensively used to better understand hydrological processes. In this paper, the SWAT model was adopted to simulate a wattle plantation in KwaZulu-Natal, South Africa. User-defined vegetation growth, soil and management input parameters were constructed for the study area based on site measurements. These parameters were subsequently modified using the Sequential Uncertainty Fitting (SUFI-2) analysis routine to calibrate the model. The calibrated model captured seasonal trends in the observed sediment and streamflow data. The compilation of spatially explicit sediment output provides a useful approach to manage catchments by identifying high erosion-risk areas. The SWAT model, using site-specific input parameters, provides a platform for subsequent hydrological and sediment modelling in South Africa. Keywords: commercial plantations modelling sediment yield surface run-off SWAT

In common with arid and semi-arid areas worldwide, South Africa’s Karoo has experienced significant population shifts over the last 100 years. These have been caused by a range of considerations re...

One way of undertaking experiential learning is through the mini-SASS method used as an event of a larger social learning process. The mini-SASS method is used to indicate the ecological condition, at a point in a stream by identifying the macro-invertebrates found at that location. The macro-invertebrates are assigned a sensitivity score which indicates the taxonomic group’s tolerance to pollution. The averaged sensitivity scores of the macro-invertebrates identified are used to determine the ecological condition of the river. This method is said to be user friendly and can be carried out by civil society and scholars. The aim of the project was to determine the perceptions, outcomes and attitude experienced by 12-year-old learners when conducting mini-SASS. The research was guided by the Mintzberg model of learning, which involves a cyclic process including theoretical knowledge, practical implementation followed by reflection. The mini-SASS method was perceived in a positive light by the learners and teacher whose attitude was enthusiastic and the outcome was considered by the learners, teacher and researcher to be a success.

Objective: To quantify psychological morbidity and identify baseline factors associated with depression, anxiety and post-traumatic distress symptoms up to 12 months post-injury. Methods: Multicentre cohort study of 668 adults, aged 16 to 70, admitted to 4 UK NHS hospital trusts. Data on injury, socio-demographic characteristics and health status was collected at recruitment. Depression, anxiety and post-traumatic distress were measured at 1, 2, 4 and 12 months post-injury. Multilevel linear regression assessed associations between patient and injury characteristics and psychological outcomes over 12 months follow-up. Results: Depression, anxiety and post-traumatic distress scores were highest 1 month post-injury, and remained above baseline at 2, 4 and 12 months post-injury. Moderate or severe injuries, previous psychiatric diagnoses, higher pre-injury depression and anxiety scores, middle age (45-64 years), greater deprivation and lower pre-injury quality of life (QoL) were associated with higher depression scores post-injury. Previous psychiatric diagnoses, higher pre-injury depression and anxiety scores, middle age, greater deprivation and lower pre-injury QoL were associated with higher anxiety scores post-injury. Traffic injuries or injuries from being struck by objects, multiple injures (≥ 3), being female, previous psychiatric diagnoses, higher pre-injury anxiety scores and greater deprivation were associated with higher post-traumatic distress scores post-injury. Conclusion: A range of risk factors, identifiable shortly after injury, are associated with psychological morbidity occurring up to 12 months post-injury in a general trauma population. Further research is required to explore the utility of these, and other risk factors in predicting psychological morbidity on an individual patient basis.

The 2011 Durban Adaptation Charter for Local Governments calls on local governments, worldwide, to institutionalise climate response, with the aim of minimising the impacts of climate change on loc...

Punch and Judy is a traditional form of puppet theatre widely known in the United Kingdom and certain other English-speaking countries. As part of the national culture for over 350 years it has featured in numerous works of art, particularly in literature of the nineteenth and twentieth centuries. Being generally less well-known beyond Britain, it may be problematic for readers encountering references to the show in English literature, such as the works of Dickens and Conrad. This paper provides an overview of the show, a short history and a description of certain aspects of historical and social change within the tradition.

(2021). A Scientific Bibliography of the Drakensberg, Maloti & Adjacent Lowlands. African Journal of Range & Forage Science: Vol. 38, Montane Rangelands in a Changing World, pp. 137-138.

Modern foraminiferal assemblage zones can be used to reconstruct palaeo sea levels when applied to fossil foraminifera down a sediment core. Previous intertidal foraminiferal studies have predomina...

This paper seeks to complement ongoing discussions around water allocation by offering an analytic framework for examining the evolution of paradigms for water allocation in river basins. It traces this evolution from the hydraulic paradigm through to Integrated Water Resources Management (IWRM) and the current water security paradigm. Using a society-science-practice interaction perspective, the paper draws attention to the governance processes of water allocation that underlie these paradigms using examples from river basins in southern Africa. It is argued that the process of allocating water resources is often influenced by societal priorities and values that do not necessarily result in maintaining ecosystem health and integrity. The efficacy of water allocation depends on the extent to which implementation takes into account the socio-political dynamics associated with collective action involving multiple water users. While paradigm shifts provide windows of opportunity for strengthening legislation, the mere adoption of paradigms should not be taken as a panacea for addressing challenges associated with water allocation in river basins. This is especially relevant for several countries in southern Africa that are undertaking water reforms with the view of strengthening allocation of water resources at basin scale.

Coastal areas are under increasing pressure driven by demands for coastal space, primarily though population growth, in migration and the need for space for socioeconomic activities. The pressures and associated changes to the coastal environment need to be managed to ensure long-term sustainability. South Africa has enacted an Integrated Coastal Management Act (ICM Act) to facilitate dedicated management of its coastal environment. The implementation has been met with a number of challenges, primarily relating to financial and human capacity constraints, particularly at the local government level. Given that the ICM Act devolves powers to local government, it is imperative that implementation challenges be addressed. This paper focuses on KwaZulu-Natal, one of four South African coastal regions, which is a renowned tourist destination and home to 11.1 million people (Statistics South Africa 2015). This paper considers the state of coastal management, as well as implementation challenges being exp...

Importance Anticholinergic medicines have short-term cognitive adverse effects, but it is uncertain whether long-term use of these drugs is associated with an increased risk of dementia. Objective To assess associations between anticholinergic drug treatments and risk of dementia in persons 55 years or older. Design, Setting, and Participants This nested case-control study took place in general practices in England that contributed to the QResearch primary care database. The study evaluated whether exposure to anticholinergic drugs was associated with dementia risk in 58 769 patients with a diagnosis of dementia and 225 574 controls 55 years or older matched by age, sex, general practice, and calendar time. Information on prescriptions for 56 drugs with strong anticholinergic properties was used to calculate measures of cumulative anticholinergic drug exposure. Data were analyzed from May 2016 to June 2018. Exposures The primary exposure was the total standardized daily doses (TSDDs) of anticholinergic drugs prescribed in the 1 to 11 years prior to the date of diagnosis of dementia or equivalent date in matched controls (index date). Main Outcomes and Measures Odds ratios (ORs) for dementia associated with cumulative exposure to anticholinergic drugs, adjusted for confounding variables. Results Of the entire study population (284 343 case patients and matched controls), 179 365 (63.1%) were women, and the mean (SD) age of the entire population was 82.2 (6.8) years. The adjusted OR for dementia increased from 1.06 (95% CI, 1.03-1.09) in the lowest overall anticholinergic exposure category (total exposure of 1-90 TSDDs) to 1.49 (95% CI, 1.44-1.54) in the highest category (>1095 TSDDs), compared with no anticholinergic drug prescriptions in the 1 to 11 years before the index date. There were significant increases in dementia risk for the anticholinergic antidepressants (adjusted OR [AOR], 1.29; 95% CI, 1.24-1.34), antiparkinson drugs (AOR, 1.52; 95% CI, 1.16-2.00), antipsychotics (AOR, 1.70; 95% CI, 1.53-1.90), bladder antimuscarinic drugs (AOR, 1.65; 95% CI, 1.56-1.75), and antiepileptic drugs (AOR, 1.39; 95% CI, 1.22-1.57) all for more than 1095 TSDDs. Results were similar when exposures were restricted to exposure windows of 3 to 13 years (AOR, 1.46; 95% CI, 1.41-1.52) and 5 to 20 years (AOR, 1.44; 95% CI, 1.32-1.57) before the index date for more than 1095 TSDDs. Associations were stronger in cases diagnosed before the age of 80 years. The population-attributable fraction associated with total anticholinergic drug exposure during the 1 to 11 years before diagnosis was 10.3%. Conclusions and Relevance Exposure to several types of strong anticholinergic drugs is associated with an increased risk of dementia. These findings highlight the importance of reducing exposure to anticholinergic drugs in middle-aged and older people.

Objective: To investigate the associations between direct oral anticoagulants (DOACs) and risks of bleeding, ischaemic stroke, venous thromboembolism, and all cause mortality compared with warfarin. Design: Prospective open cohort study. Setting: UK general practices contributing to QResearch or Clinical Practice Research Datalink. Participants: 132 231 warfarin, 7744 dabigatran, 37 863 rivaroxaban, and 18 223 apixaban users without anticoagulant prescriptions for 12 months before study entry, subgrouped into 103 270 patients with atrial fibrillation and 92 791 without atrial fibrillation between 2011 and 2016. Main outcome measures: Major bleeding leading to hospital admission or death. Specific sites of bleeding and all cause mortality were also studied. Results: In patients with atrial fibrillation, compared with warfarin, apixaban was associated with a decreased risk of major bleeding (adjusted hazard ratio 0.66, 95% confidence interval 0.54 to 0.79) and intracranial bleeding (0.40, 0.25 to 0.64); dabigatran was associated with a decreased risk of intracranial bleeding (0.45, 0.26 to 0.77). An increased risk of all cause mortality was observed in patients taking rivaroxaban (1.19, 1.09 to 1.29) or on lower doses of apixaban (1.27, 1.12 to 1.45). In patients without atrial fibrillation, compared with warfarin, apixaban was associated with a decreased risk of major bleeding (0.60, 0.46 to 0.79), any gastrointestinal bleeding (0.55, 0.37 to 0.83), and upper gastrointestinal bleeding (0.55, 0.36 to 0.83); rivaroxaban was associated with a decreased risk of intracranial bleeding (0.54, 0.35 to 0.82). Increased risk of all cause mortality was observed in patients taking rivaroxaban (1.51, 1.38 to 1.66) and those on lower doses of apixaban (1.34, 1.13 to 1.58). Conclusions: Overall, apixaban was found to be the safest drug, with reduced risks of major, intracranial, and gastrointestinal bleeding compared with warfarin. Rivaroxaban and low dose apixaban were, however, associated with increased risks of all cause mortality compared with warfarin.

Goble, B.J.; Hill, T.R., and Phillips, M.R., 2020. Building institutional knowledge for effective Integrated Coastal Management decision making: KwaZulu-Natal, South Africa. In: Malvarez, G. and Navas, F. (eds.), Global Coastal Issues of 2020. Journal of Coastal Research, Special Issue No. 95, pp. 808-813. Coconut Creek (Florida), ISSN 0749-0208.Coastal zones are highly utilised making the management thereof complex. To support this many coastal nations have developed coast specific legislation; South Africa being no exception. However, implementation remains the biggest hurdle; some of the best environmental legislation is offered but the skills, capacity and financial resources to achieve this are lacking. National governments have made efforts to ensure knowledge transfer and capacity building for ICM, but is this enough? Is there is a real improvement in the capacity of managers and decision makers and are we seeing resultant effective ICM? This paper considers the success of traditional training for knowledge transfer and capacity building within KwaZulu-Natal (KZN) (South Africa). It further reviews a KZN specific information support tool to aid in on-going knowledge building and storing of institutional information and evaluates if this is complementary to traditional approaches. While participants of traditional training sessions gain value from these, the link to implementation is largely lacking. This coupled with high staff turnover rates creates a barrier to objectives of the ICM Act. In comparison the use of an information support tool potentially adds value by storing information and data in a readily available format and serves as an ‘institutional information bank’, contributing to improved, informed coastal decision making.

The scarcity of continuous, terrestrial, palaeoenvironmental records in eastern South Africa leaves the evolution of late Quaternary climate and its driving mechanisms uncertain. Here we use a ~ 7-m long core from Mfabeni peatland (KwaZulu-Natal, South Africa) to reconstruct climate variability for the last 32 thousand years (ka BP). We infer past vegetation and hydrological variability using stable carbon (𝛿13Cwax) and hydrogen isotopes (𝛿Dwax) of plant-wax n-alkanes and use Paq to reconstruct water table changes. Our results indicate that late Quaternary climate in eastern South Africa did not respond directly to orbital forcing nor to changes in sea surface temperatures (SSTs) in the western Indian Ocean. The arid conditions evidenced at Mfabeni during the Last Glacial Maximum (LGM) are a consequence of both low SSTs and an equatorward displacement of the southern hemisphere westerlies due to increased Antarctic sea ice extent. The increased humidity at Mfabeni between 19–14 ka BP likely resulted from decreased Antarctic sea ice which led to a southward retreat of the westerlies and increased the influence of the moisture-bearing tropical easterlies. Between 14–5 ka BP, when the westerlies were in their southernmost position, local insolation became the dominant control, leading to stronger atmospheric convection and an enhanced tropical easterly monsoon. Generally drier conditions persisted during the past c. 5 kyrs, but were overlain by high amplitude, millennial-scale environmental variability, probably resulting from an equatorward return of the southern hemisphere westerlies and heightened ENSO activity. Our findings stress the influence of the southern hemisphere westerlies in driving climatological and environmental changes in eastern South Africa.

Ecological Reserve determination for rivers in South Africa presently does not include a water temperature component, in spite of its importance in determining species distribution patterns. To achieve this requires an understanding of how lotic thermographs from South African rivers differ from northern hemisphere rivers, to avoid mismanaging rivers based on incorrect regional assumptions. Hourly water temperatures from 20 sites in four river systems, representing a range of latitudes, altitudes and stream orders, were assessed using a range of metrics. These data were analysed using principal component analyses and multiple linear regressions to understand what variables a water temperature model for use in ecoregions within South Africa should include. While temperature data are generally lacking in low- and higher-order South African rivers, data suggest that South African rivers are warmer than northern hemisphere rivers. Water temperatures could be grouped into cool, warm and intermediate types. Based on temperature time series analyses, this paper argues that a suitable water-temperature model for use in ecological Reserve determinations should be dynamic, include flow and air temperature variables, and be adaptive through a heat exchange coefficient term. The inclusion of water temperature in the determination and management of river ecological Reserves would allow for more holistic application of the National Water Act’s ecological management provisions. Water temperature guidelines added to the ecological Reserve could be integrated into heuristic aquatic monitoring programmes within priority areas identified in regional conservation plans.Keywords: water temperatures, conservation planning, water temperature modelling, management

South Africa’s rising urbanization has exacerbated the levels of urban poverty and inequality. The urban poor are increasingly vulnerable to the impacts of climate variability and have weak household risk response capacities. The study, through the use of a questionnaire survey, investigated how climate stressors such as the change of seasons, drought, heat waves, cold spells, hailstorms, floods, disease outbreaks, and veld fires are affecting four socioeconomically marginalized urban communities in Pietermaritzburg, KwaZulu-Natal. The respondents identified eight stressors that affect lifestyles and livelihoods; however, the majority do not have the means to cope adequately. Moreover, the coping strategies that were adopted were stop-gap reactive-type measures and provide limited capacity to build resilience and response capacity. With the projections that climate stressors will increase in frequency and duration in the region, the local government must increase investment in urban pro-poor climate change projects, which have been successful in some rural and urban areas, and educate the communities on climate-related risks so as to increase their knowledge and response capacities.

Background Antidepressants are one of the most commonly prescribed medications in young and middle-aged adults, but there is relatively little information on their safety across a range of adverse outcomes in this age group. This study aimed to assess associations between antidepressant treatment and several adverse outcomes in people aged 20–64 years diagnosed with depression. Methods We conducted a cohort study in 238,963 patients aged 20–64 years registered with practices across the UK contributing to the QResearch primary care database. Only patients with a first diagnosis of depression were included. Outcomes were falls, fractures, upper gastrointestinal bleed, road traffic accidents, adverse drug reactions and all-cause mortality recorded during follow-up. Cox proportional hazards models were used to estimate hazard ratios associated with antidepressant exposure adjusting for potential confounding variables. Results During 5 years of follow-up, 4651 patients had experienced a fall, 4796 had fractures, 1066 had upper gastrointestinal bleeds, 3690 had road traffic accidents, 1058 had experienced adverse drug reactions, and 3181 patients died. Fracture rates were significantly increased for selective serotonin reuptake inhibitors (adjusted hazard ratio 1.30, 95% CI 1.21–1.39) and other antidepressants (1.28, 1.11–1.48) compared with periods when antidepressants were not used. All antidepressant drug classes were associated with significantly increased rates of falls. Rates of adverse drug reactions were significantly higher for tricyclic and related antidepressants (1.54, 1.25–1.88) and other antidepressants (1.61, 1.22–2.12) compared with selective serotonin reuptake inhibitors. Trazodone was associated with a significantly increased risk of upper gastrointestinal bleed. All-cause mortality rates were significantly higher for tricyclic and related antidepressants (1.39, 1.22–1.59) and other antidepressants (1.26, 1.08–1.47) than for selective serotonin reuptake inhibitors over 5 years but not 1 year, and were significantly reduced after 85 or more days of treatment with selective serotonin reuptake inhibitors. Mirtazapine was associated with significantly increased mortality rates over 1 and 5 years of follow-up. Conclusions Selective serotonin reuptake inhibitors had higher rates of fracture than tricyclic and related antidepressants but lower mortality and adverse drug reaction rates than the other antidepressant drug classes. The association between mirtazapine and increased mortality merits further investigation. These risks should be carefully considered and balanced against potential benefits for individual patients when the decision to prescribe an antidepressant is made. Electronic supplementary material The online version of this article (10.1186/s12916-018-1022-x) contains supplementary material, which is available to authorized users.

There is a need for science and community knowledge and resources to be combined in the mitigation and rehabilitation of land degradation, as a large portion of degraded land in South Africa is communal land. Rainfall simulation was used at Okhombe valley, KwaZulu-Natal, South Africa as a tool to collect scientific data regarding the erosion rates on cattle access paths and to demonstrate erosion driving forces to the community members. The community members were able to experience erosion taking place through rainfall simulation and observe the impact of slope and basal cover change on erosion rates. Cattle access paths and rehabilitated access paths showed similar runoff rates (Figure 1), however the sediment concentration varied between the severely degraded cattle access paths and the rehabilitated land. Through the rainfall demonstration a better understanding of the driving factors in the erosion process, an understanding of why particular mitigation techniques work and where such mitigation measures would be effective were identified. With the combination of scientific techniques and community knowledge and resources a step can be taken towards sustainable land degradation mitigation and rehabilitation in the communal areas of South Africa.

Aim Salt-marsh foraminifera are widely used as robust sea-level indicators. High-resolution Holocene sea-level reconstructions depend on the accurate characterization of modern foraminifera-environment relationships representative of a study site. We investigate the relationship between modern foraminiferal assemblage distribution and key environmental variables, viz. elevation above land levelling datum (LLD), sediment grain size, organic content, pH and salinity. We hypothesize that the distribution of modern salt-marsh foraminifera is primarily controlled by elevation above LLD. Location Knysna and Keiskamma estuaries along the southern coastline of South Africa. Methods Salt-marsh surface sediment samples (n = 97) were collected along eight intertidal transects with corresponding environmental data (pH, salinity, organic content, sand, silt, clay and elevation). Multivariate ordination analysis (partial redundancy analysis; pRDA) was used to investigate the relationship between living foraminiferal assemblages and environmental controls, after accounting for spatial variability in community composition. Results The pRDA suggests that species composition varied spatially within estuaries, but was strongly influenced by elevation at Keiskamma (r = 0.63) and Knysna (r = −0.75). At Keiskamma, the main gradient in composition was also influenced by salinity (r = −0.63), in an equal and opposite manner to elevation. Composition at Keiskamma was influenced to a much lesser extent by sediment organic content (r = 0.20) and the clay fraction (r = −0.13). At Knysna, pH (r = 0.455) was a secondary determinant of composition, and sediment characteristics covaried with elevation. Main conclusion Elevation was found to be a key environmental variable controlling the distribution of salt-marsh foraminifera at both estuaries, thereby validating the use of foraminifera as sea-level indicators. Certain species were particularly sensitive to elevation changes and could thus serve as useful indicators of past sea-level change. This is an important first step towards the development of high-resolution sea-level reconstructions for the South African coastline.

Black wattle (Acacia mearnsii, De Wild.) is a fast growing tree species introduced into South Africa in the nineteenth century for commercial purposes. While being an important source of timber and firewood for local communities, black wattle is an aggressive invasive species and has pervasive adverse environmental impacts in South Africa. Little is known about the effects of black wattle encroachment on soil carbon, therefore the aim of this study was to investigate the impact of black wattle encroachment of natural grassland on soil carbon stocks and dynamics. Focussing on two sites in the Eastern Cape, South Africa, the study analysed carbon stocks in soil and litter on a chronosequence of black wattle stands of varying ages (up to >50 years) and compared these with adjacent native grassland. The study found that woody encroachment of grassland at one site had an insignificant effect on soil and litter carbon stocks. The second site showed a clear decline in combined soil and litter carbon stocks following wattle encroachment. The lowest stock was in the oldest wattle stand, meaning that carbon stocks are still declining after 50 years of encroachment. The results from the two sites demonstrate the importance of considering changes in soil carbon when evaluating ecosystem effects of invasive species.