Patterns of care and outcomes for women with locally advanced cervical cancer, treated with curative intent, between 2013-2017 at a tertiary centre in South Africa

Objective Cervical cancer is the leading most common cause of cancer-related deaths in South Africa. The standard treatment guidelines of locally advanced cervical cancer (LACC) is external beam radiation followed by brachytherapy with concurrent platinum based chemotherapy. The aim of this study is to evaluate the patterns of care and outcomes for patients with LACC (Stage IB1 – IVA) treated with curative intent at a tertiary center in South Africa. Materials and Methods This is a retrospective study conducted at Groote Schuur Hospital (GSH) in Cape Town, South Africa between July 2013 – July 2017. Overall survival (OS) and disease free survival (DFS) were evaluated using the Kaplan–Meier method. Factors associated with outcomes were analyzed using Cox proportional hazards regression modeling. Logistic regression modeling was performed to assess factors associated with chemotherapy receipt and baseline hemoglobin ≥ 10 g/dL. Results A total of 278 women were eligible to participate in this study, of which 28.4% (n=79) were HIV infected and 71.6% (n=199) were HIV uninfected. Among the patients with HIV the median CD4 count was 441 cells/μL (IQR; 315-581 /μL) and all had been initiated ART before commencing treatment. The median age for all patients 51 years(IQR; 41-60). Most patients had stage II disease accounting for 48.6% (n=135) or stage III disease accounting for 45.3% (n=126). Majority of the patients had squamous cell carcinoma (SCC) 88.4% (n=246). Evaluation of baseline investigation showed median Hb for all patients was 11.3g/dL (IQR; 9.70-12.8). Patients who received concurrent chemotherapy were 64.8% (n=180) for a median of 5 cycles. Median EQD2 dose 74.5Gy (IQR;69-80.9). The 2-year OS and DFS in the entire population was 73.3% and 72.3% respectively. Factors associated with improved OS in our cohort were receipt of chemotherapy (HR 0.32, p=0.005) and higher baseline haemoglobin (HR 0.86; p=0.018). On multivariate logistic regression adjusting for age, stage, and HIV status, showed that patients with stage III/IV disease were less likely to receive chemotherapy (HR 48.17, p=10g/dL (HR 0.20, p<0.001). The 2- year OS was 87.4% for patients who received concurrent chemoradiotherapy (CCRT) vs. 52.8% for those who received radiotherapy (RT) alone (p<0.001). The 2-year DFS was 80.2% for those who received CCRT vs 58.3% for those who received radiotherapy alone(p=<0.001). Conclusion Concurrent chemotherapy is significantly associated with increased survival. In this study, patients with stage III and IV treated with curative intent did not receive chemotherapy, which was detrimental to their survival. Therefore, if performance status allows, it is essential for all to receive chemotherapy. However, patients with low Hb may require transfusion to necessitate they receive chemotherapy

Under the skin of a culture: perceptions of fake leopard skin alternatives in the Shembe Baptist Church

Since prehistoric times, big cats such as leopards have had symbolic importance in human culture. They are prized as symbols of power, nobility, ferocity and very often, masculinity. Religious groups have also been known to wear animal skin as part of their ceremonial regalia, typically for aesthetic, superstitious and spiritual reasons. However, throughout much of their historical distribution, leopards have been actively hunted, poached or killed in retaliation for livestock losses so extensively that many of their populations are now under direct threat. Despite attempts to control illegal harvesting and trade through international conservation organizations such as CITES the use of and trade in leopard products remains commonplace throughout their range. In Southern Africa one of the most widespread and obvious users of leopard skins are members of the Shembe Nazareth Baptist Church. The Shembe church, which has approximately 6 million followers, was founded by Prophet Isaiah Shembe on 1910 in Durban, South Africa. This modern take on Zionist beliefs integrates aspects of Christianity and traditional Zulu beliefs. Followers wear white, full length garments when praying and a diverse array of animal skins when engaging in traditional dance. The most popular and prestigious animal skin is that of a leopard. Given concerns around the increasing demand for leopard skins, Panthera (cat conservation NGO) initiated the Furs for Life project in 2013, introducing synthetic leopard skin alternatives to real skins. These ‘faux' skins were donated to the Shembe church for dissemination among their followers, with the hope that this would ultimately reduce demand for real skins. While approximately 24,000 faux furs have been distributed within the Shembe church to date, little is known about how well these have been received or how effective this conservation intervention has been. In this brief, exploratory study 100 randomly selected recipients of faux furs were surveyed to address concerns pertaining to: faux fur use, demand for real skins, consumer satisfaction, knowledge of conservation and policy perceptions, through a descriptive statistics and basic generalised linear model framework. We found that after a period of three years, at least 90% of the respondents still have their fake furs, have been using them approximately six times a year and were positive about the product they received from Panthera. More than 60% of respondents are aware of leopard population trends, and 66% of respondents believed that the government should intervene in leopard conservation. Faux leopard furs have been very successful, reporting a higher than 50% usage in Shembe gatherings, with most respondents indicating how aesthetic and durable faux furs are as well as how similar they are to real leopard fur. As this was a pilot study with only 100 respondents so statistical power was limited given the number of variables, we suggest a similar study done on a larger scale to understand the efficacy of the intervention

Factors associated with health information systems that influence continuity of TB care between a District hospital and Primary Healthcare facilities

Background: South Africa is well known to have a high burden of Tuberculosis (TB) disease. The Western Cape has been identified as having one of the highest numbers of new infections of TB per year in South Africa. TB is the cause of significant mortality and morbidity and has substantial financial implications for patients and the health system. As a result of high levels of HIV, poverty and overcrowding TB has been difficult to eradicate. The significant burden of disease, the caseloads and staff shortages also contribute to challenges to successfully continuing care of TB patients. It has been noted that as much as 24% of TB patients may be lost to follow up (LTFU) in certain districts of the Western Cape. While previous studies have looked at factors that influence LTFU and continuity of care (COC), no studies have examined how the design and use of Health Information Systems (HIS) may influence these outcomes. This study aims to describe the current use of HIS in the discharge process of a TB patient at a district hospital in Western Cape and further aims to identify how HIS may facilitate or create barriers to successfully continuing a patient's TB treatment at primary healthcare level after discharge from a district hospital. Methods: The study was conducted through two phases. Phase 1, secondary data analysis of process maps previously created to understand the TB care pathways and the associated gaps in care within a district hospital and phase 2, a semi-structured interview process. Analysis of both phases involved qualitative thematic analysis attempting to identify and unpack Health Information Systems (HIS) challenges associated with TB care. Results: Barriers were identified which prevented seamless use of HIS and which did not promote COC. These included poor understanding of TB administrative and referral processes, and what is required to successfully link to TB care and continue care at primary healthcare (PHC) facilities. Further barriers were resources and usability of the HIS, as well as data integrity and fragmented HISs. The only facilitators identified was the availability of clinical information where access was possible and data was complete, as well as an electronic referral platform to TB hospitals. Conclusion: Obstacles exist to the effective utilization of HISs in ensuring continuity of TB care between district hospitals and community clinics. To mitigate some of these limitations, we propose that training on SOPs, HISs, and administrative procedures for TB management be intensified. Clarifying ambiguities regarding data, workflows, and HIS prerequisites that support COC could help HCWs better facilitate COC through HIS usage. Additionally, organizations should strive to minimize resource deficiencies hindering HIS utilization. Insights from the TB hospital referral system can be leveraged to enhance care linkage

“Foreign migrant women's perceptions of obstetric care in the Cape Town metro pole.”

This study explores the maternal healthcare experiences of nine foreign migrant women who received obstetric care in the Cape Town metropole. The Republic of South Africa's legislation enshrines the right to health for all who live within the country's borders, regardless of residency status. In practice however, foreign migrants can experience significant challenges and, in the Cape Town metropole how these women experience obstetric care has not been a focus of scholarly interrogation. With this study I hope to establish the factors that influence migrant women's experiences positively or negatively and to utilise the knowledge gained from their experiences to enhance pregnancy care of migrant women in the longer term. A literature review was performed covering the areas of migration to South Africa, migrant women's health, migrant's health challenges and official South African health care policies. Data was collected by doing one on one, open-ended and semi-structured interviews with nine foreign migrant women from seven different countries and with two key stakeholders employed at two of Cape Town's largest refugee centres. The interviews were recorded, professionally transcribed and then data inductively coded using thematic analysis. Thematic analysis was used since it is a way to extract descriptive information concerning the experiences of migrant women in Cape Town and to construct meaning, in order to understand their perceptions about the obstetric care. The findings indicate that the attitudes &amp; behaviours of staff, language, prior traumatic experiences, degree of assimilation and healthcare systemic issues are some of the chief factors that influence perception of care. Xenophobia and dismissive behaviour were the main issue with staff but that was juxtaposed against some excellent and compassionate care received. Some of the women struggled to communicate the nature of their problems and being understood but also found understanding local staff a significant barrier. Having had to endure staff attitudes and behaviours can reasonably be agreed to have delayed monitoring or intervention. Language barriers resulted in adherence issues with medications, potential missed appointments, issues around informed consent and missed opportunities at health promotion. The women had a poor understanding of the local healthcare system's design and had expecta tions in relation to their own experience of the system in origin countries. When these expectations were not met, it was perceived as poor. A key challenge was the failure of the facilities to recognise the asylum documentation and the rights afforded to those who had them. The reasons for fleeing their countries included warfare, geno cide, political turmoil and economic deprivation. The journeys to Cape Town were fraught with further trauma and this made the women vulnerable to mental health is sues which also impacted their perceptions of care. Further, a traumatic birth in Cape Town carried significant sway over how further births in Cape Town were viewed. It is clear from this study that multiple, complex factors influence the way foreign mi grant women perceive their care. These factors are personal and unique to each indi vidual but there were commonalities. Trained interpreters, cultural sensitivity training, education surrounding documentation, allowing birth partners to be present during visits and births, extra safety checks on perinatal mental health for first time births in Cape Town and a more robust, confidential and accountable complaints system were recommendations by this cohort

A design-based research perspective for multiple immersive digital conversations in academic research writing literacies

In the South African higher education context, academic writing support at the postgraduate level presents significant challenges for institutions. The conventional dyadic models of writing support, typically offered by writing centres, are increasingly viewed as inadequate in addressing the multifaceted nature of academic writing and literacy challenges. This study advocates for a shift towards a more inclusive and holistic approach, promoting trialogic and multi-lateral conversations within writing centres to address these challenges. The study's methodology is deeply rooted in literature and adopts Reeves' (2006) four-phase model to guide the Design-Based Research (DBR) approach. Through two iterative intervention cycles, the study integrates efforts from writing centres and subject lecturers to facilitate immersive conversations aimed at academic research literacy development. The third phase of DBR intensively focuses on testing and refining the interventions to address directly identified obstacles. The effectiveness of these interventions is measured through qualitative data collection methods, including surveys, interviews, observations, and document analysis. The study aims to answer the question: What are the design principles for facilitating multiple immersive digital conversations in academic research writing literacies? To answer this question, the study creates a dynamic and interactive environment where students can engage in meaningful dialogues and collaborative activities by integrating digital tools like Google Drive into the learning process. The study develops an integrated theoretical framework for multiple immersive digital conversations for academic research writing that interlinks linguistic, cognitive, and social elements. The study's participants include Bachelor Honours students and Advanced Diploma students, writing centre practitioners, and academic supervisors at a university in South Africa. The theoretical contribution of the study is a model of refined design principles for developing a robust intervention for multiple immersive digital conversations in academic research writing literacies. These principles advocate for pedagogies that respect and incorporate students' identities, aligning with adaptive and culturally inclusive teaching practices. In the realm of academic writing instruction, these principles have the potential to improve support systems significantly, enhancing students' academic achievements and advancing their research literacy skills

Functional divergence of the RNA polymerase II transcription machinery in Plasmodium falciparum

This thesis describes the functional characterisation of three Plasmodium falciparum general transcription factors - two TBP family proteins designated the TATA-binding protein (TBP) and TBP like protein (TLP), and the P. falciparum orthologue of general transcription factor IIB (TFIIB). Through the biochemical characterisation of protein-DNA interactions, protein-protein interactions and the biomolecular condensation properties of these transcription factors, this study aimed to provide insight into the molecular mechanisms governing promoter recognition and the regulated assembly of the RNA polymerase II transcription initiation complex in P. falciparum, which are hitherto not understood. The work shows that P. falciparum expresses two highly divergent TBP family proteins that do not possess sequence-specific TATA box-binding activity. Both PfTBP and PfTLP bind DNA with a general preference for A/T-rich sequences, mediated through interactions with the DNA minor groove, without detectable preference for specific sequence motifs. PfTBP and PfTLP are thus unlikely to contribute to the recognition of specific promoter regions within the A/T-rich context of the P. falciparum genome. The study further characterises TBP-independent DNA-binding of PfTFIIB, a Plasmodium-specific feature not seen with TFIIB in well-studied eukaryotes. The data presented here show that PfTFIIB binds to DNA in an unspecific manner. Interestingly, PfTFIIB stimulates the DNA binding activity of PfTBP and PfTLP and forms stable PfTBP-PfTFIIB-DNA and PfTLP-PfTFIIB-DNA nucleoprotein complexes. However, these PfTFIIB interactions do not detectably enhance the sequence-selectivity of PfTBP- or PfTLP-DNA interactions. Thus, recognition of genomic regions at which transcription is preferentially initiated must involve additional factors or may depend to a lesser extent on the recognition of specific core promoter elements by the general transcription machinery. Transcription condensates play an important role in eukaryotic transcription regulation. In this study, the potential role of PfTFIIB in the formation and regulation of P. falciparum transcription condensates is investigated by fluorescence microscopy using a panel of fluorescent protein-tagged PfTFIIB fusion proteins. The work demonstrates that PfTFIIB undergoes condensation at nanomolar concentrations, and partitions with PfTBP and PfTLP into mixed phase separated condensates. Furthermore, assembly and properties of PfTFIIB condensates are shown to be strongly influenced by the presence of DNA and RNA. Interestingly, PfTBP and PfTLP are found to localise in discrete foci in cultured P. falciparum blood-stage parasites. Together, these results provide first evidence for the existence of transcription condensates, mediated by transient multivalent interactions between general transcription factors, in the P. falciparum malaria parasite

Religion and politics: the legal regulation of religious organisations in Uganda — 2016 - present

With increased visibility and social activism of religious actors and organisations in many post colonial African states, the legal governance of religious organisations has come into tension with citizenship rights and freedoms. This is the case in Uganda in recent years, where the state government at the federal level has proposed the National Religion and Faith Organizations (RFO) Policy. This policy was first proposed in 2016 and the policy document was revised in 2019. It purports to maintain the authority of the State over religious organisations while ensuring to observe the constitutionally guaranteed freedoms pertaining to religious beliefs, associations, practices, and belongings. This research aimed to understand the literature around the relationship between religion and politics in Uganda, between 1986 and present as well as the reactions for and against the RFO policy. Using data generated through telephone interviews, government documents, public forums, social media posts and comments, newspaper articles, periodicals, and news network interviews, from 2016 till the present, this study argued for a more nuanced and in-depth understanding of the complex and complicated process of the public governance of religious organisations in post-colonial African states such as Uganda. The reactions and arguments for and against the RFO policy indicate the need for the regulation of religious organisations in Uganda is based on socio-political dynamics and pressures which shape the way religious and political leaders and organizations interact in the society, how policies are implemented and the overall direction of the society concerning national development

An exploration of the determinants of sexual risk behaviour among adolescent girls and young women aged 15-24 years in South Africa: a sub-study of the 2019-2022 HERStory2 study

Objective: The study aims to understand why South African adolescent girls and young women (AGYW) engage in sexual risk behaviours, such as unsafe sex and transactional and inter-generational sexual relationships. These behaviours lead to adverse sexual and reproductive health (SRH) outcomes, including HIV, STIs, unplanned pregnancies, and forced sex. By exploring the perspectives of AGYW and community stakeholders, the study seeks to enhance future interventions aimed at reducing the risk of STIs, including HIV, and unintended pregnancies among AGYW. Methods The study is based on the qualitative component of the HERStory2 study, a mixed-methods evaluation of an SRH intervention for AGYW in six South African districts. Data from in-depth interviews with twenty-seven participants were thematically analysed using the social-ecological model as a theoretical framework. Results The findings showed that the reasons for AGYW's engagement in sexual risk behaviour are nested within individual, interpersonal, community, and structural levels. At the individual level, participants reported that AGYW may engage in sexual risk behaviours due to their age, low perception of risk, problematic alcohol consumption, and the need for high grades at school. At the interpersonal level, social media-induced peer pressure was cited as a reason for AGYW's engagement in sexual risk behaviours. Community-level factors included lack of safety and economic activities such as mining. At the structural level, poverty, negative attitudes from public healthcare providers at clinics, and social and gender norms were perceived to influence AGYW's sexual risk behavior. Conclusion The results suggest that AGYW's sexual risk behaviour is influenced by many complex factors beyond the individual. The results call for targeted holistic interventions to reduce sexual risk behaviour and improve the SRH outcomes for AGYW in this high HIV burden context

Assessment design as supporter or enabler of student learning at an open distance learning higher education institution

Assessment design has always been a topic of interest to researchers in higher education and often focuses on assessment as a tool to measure student achievement. Little research exists on assessment design itself, the role of the educator in designing and implementing assessments, judging the outcomes, and the impact of assessment design on student learning (Bearman, Dawson, Noud, Bennett, Hall &amp; Molloy, 2016:545). While the literature suggests that assessment is an essential construct in shaping student learning, the alignment between what assessment literature calls for and the assessment design practices in place is falling short (Medland, 2016:87). Therefore, this study aims to investigate the relations and tensions that shape assessment practices to support or enable student learning at an open distance learning, private higher education institution. The aim is supported by four research questions: What does assessment practice mean for the institution? What types of assessments are set and why? What is the learning intention and learning outcome? What aspects lead to relations or tensions for assessment design? The study is conducted at a private open distance learning institution and focuses on a single programme accredited by an external regulating body from the Faculty of Accounting. A qualitative, approach is employed through personal interviews, focusing on formative assessment, or assessment for learning, with three educators within the programme. The critical data analysis is conducted with the help of Activity Theory to illuminate assessment design as an activity system, along with the tensions and contestations. Findings suggest that the institution regulates assessment design through its stance on assessment practice, the regulating body, and students as co-producers of knowledge. Educators use tools, such as textbooks, videos, and additional activities, to guide the design process but ultimately look to course demands, the regulating body, and student queries to determine learning intentions. Outcomes are judged based on specific key indicators educators deem necessary for student learning, and external, contextual, and personal factors enable or constrain the design process. The study contributes to the literature on assessment design and student learning by providing insights into how assessment design can support or enable student learning and highlights areas where improvement can be made to enhance the student learning experience further

Growth of mixed cultures of moderate thermophiles for commercial heap bioleaching of low-grade copper-sulphide ores

Heap bioleaching has been demonstrated as an economic technology for processing low grade and recalcitrant copper-sulphide ores which would otherwise be uneconomic to process using conventional methods of mineral extraction such as concentration followed by smelting or autoclaving. Heap bioleaching has lower operating costs compared to other metallurgical methods. Naturally, a bioleach heap can be colonised by the indigenous micro organisms but the need to shorten process times and to increase efficiency has resulted in a need to inoculate the heaps. The aim of inoculation is to deliver micro-organisms best suited for the conditions expected in a heap as leaching progresses and as the heap ages. Successful leaching of primary copper-sulphide ores such as chalcopyrite has been shown to require thermophilic temperatures. Therefore, an inoculum with micro-organisms that facilitate the increase of temperature in the bioleach heap is required. Successful inoculation of a thermophilic bioleach heap requires a fundamental understanding of microbial growth on the ore at different temperature ranges. Furthermore, successful preparation and maintenance of suitable inocula also requires an understanding of culture conditions that could affect the micro-organisms in the stock cultures. This study focused on investigating the growth of bioleaching micro-organisms at 50°C, a moderate thermophilic temperature. This temperature is of particular interest as a ramping temperature from ambient to thermophilic temperatures. It is well known that efficient progression through the moderately thermophilic region can be a challenge. In the first part of the study, the aim was to characterise microbial growth in a bioleach heap environment. This was carried out in a controlled environment to allow for an independent study to determine growth rates of the component species in the community on low-grade ore as well as studying the effect of different microbial compositions of the inocula and the copper concentrations on the growth rates of a consortium of selected bioleaching micro-organisms. A simulated heap environment was created by packing a series of identical laboratory glass columns with low grade chalcopyrite ore and inoculating the columns with consortia of moderate thermophiles implicated in bioleaching. Physicochemical parameters such as Eh, pH, soluble copper and iron were monitored every second day in the pregnant liquid solution from the columns for a maximum of 50 days in each experiment. Assuming uniformity across all the columns in a series, columns were sacrificed at regular intervals to determine the microbial composition on the ore. Microbial assays included cell counts and quantification of microbial species using quantitative real-time polymerase chain reaction (qPCR) analysis with universal and species-specific primers. The microbial community from a single column was taken to be representative of all the columns in the series at a particular instance. Microbial community analyses using qPCR showed that all the four major microbial species detected in the inocula i.e. Acidithiobacillus caldus, Acidiplasma cupricumulans, Acidithiomicrobium species and Metallosphaera species colonised the ore, albeit at different rates. The growth rates of individual microbial species were observed to vary in response to the changing physicochemical and biological environment in the ore. The maximum specific growth rates in the whole ore bioleach heap environment were reported. Regardless of the starting composition of the inoculum, At. caldus, a sulphur-oxidiser was shown to be the first species to dominate the columns and was succeeded by Acidithiomicrobium spp. or Metallosphaera spp., the iron- and sulphur-oxidisers over time. Copper concentration was observed to affect microbial growth. Substantial growth and attachment of micro-organisms to the ore took place up to 5.0 g/L Cu in the irrigation solution but beyond this concentration the growth was minimal. At 10.0 and 15.0 g/L Cu, no detectable microbial growth occurred on the ore and the micro-organisms were only detected in the PLS, indicating that the micro-organisms could not attach strongly to the ore at higher Cu concentration. The second part of the study assayed microbial growth in a liquid culture environment used to prepare inocula for the heaps, paying particular attention to Acidithiomicrobium species, a key iron- and sulphur-oxidising moderate thermophile. The effect of carbon dioxide concentration and agitation speed on the microbial composition of a mixed moderate thermophilic culture was investigated. Three stirred tank reactors (STRs) and a shake flask were inoculated with the culture and maintained at 50 °C. Two STRs were sparged with air enriched to 1 % CO2 content while the third STR was sparged with normal air. One CO2 enriched STR was agitated at 550 rpm whilst the other two STRs were agitated at 250 rpm. The shake flask was not sparged and was agitated at 180 rpm. The cultures were monitored for 98 days and their microbial composition assayed weekly using cell counts and qPCR analysis. Eh, pH, iron and copper were also monitored. Similar physicochemical conditions occurred across all the reactors. Microbial community analysis using qPCR showed that the CO2 concentration in normal air did not limit the growth of Acidithiomicrobium spp. at an agitation speed of 250 rpm i.e. sparging with air enriched to 1 % CO2 was not beneficial at low agitation speed. A higher agitation speed of 550 rpm was detrimental to Acidithiomicrobium spp. Furthermore, the effect of Cu concentration on the microbial composition of the mixed culture was investigated. Growth of Acidithiomicrobium spp. was inhibited by an additional 2.5 g/L Cu in solution and the inhibition increased with increasing Cu concentration. On day 20 of the experiment, the presence of Acidithiomicrobium spp. in the reactors with the initial Cu concentration of 2.5, 5.0 and 7.5 g/L was reduced by 17 %, 50% and 88 %, respectively with respect to the Control. The amount of Acidithiomicrobium spp. present was observed to recover over the duration of the experiment, up to 5 g/L Cu suggesting the potential for acclimatisation to Cu. At higher Cu concentration, this species did not recover for the entire 127 days of the experiment. This work describes both microbial growth and colonisation of a bioleach heap, and inocula preparation. The work contributes a fundamental understanding of microbial growth on the ore and in liquid culture at species level. This is important for a successful design of suitable inocula and for optimisation of microbial succession during thermophilic heap bioleaching particularly to get to high temperatures through the moderate thermophile zone. The process management of a heap is particularly important at 50 to 55 °C owing to less biodiversity and activity of acidophiles in this temperature range. This work shows microbial succession at 50 °C. Sulphur-oxidisers dominate first as sulphur oxidation produces more energy for biomass growth than iron oxidation. Sulphur oxidation produces the heat required to raise the temperature to levels conducive for the growth of moderate thermophiles; subsequently the sulphur-oxidisers are succeeded by the combined iron- and sulphur-oxidisers over time. Finally, the importance of culture conditions was also shown. It was indicated that microbial species respond differently to copper and agitation speed, affecting the ecology of the inoculum, whilst the CO2 was shown to have no effect across the conditions studied. Through understanding microbial growth and colonisation of low-grade ore, and inocula preparation, minimisation of the time required to raise the temperature in thermophilic bioleach heap, and therefore allow value to be derived from the heap, can be achieve