Lost in transition: the barriers to educational access for school-age Zimbabwe migrant children in South Africa and the influences of institutional and social networks on overcoming them

This thesis aims to deepen our understanding of the barriers that migrant children face in accessing quality education in their host country. It has identified gaps in the research on education of cross-border migrant children in a setting which promotes integration into the host community, and which does not use camps. The research is based in a small border town in northern South Africa and focuses on the recent influx of Zimbabwean migrants into South Africa as a result of political crisis and economic collapse in their homeland. This community was chosen because it is believed to be illustrative of the broader problems faced by cross-border migrant children. The thesis is structured around three central questions, focusing on (i) understanding who these migrant children are and their reasons for migration, (ii) the barriers they face in accessing quality basic education and (iii) the social and institutional networks that influence these children and the role the networks play in overcoming these barriers. The research examines the role of the state and the international community in the provision of support for this marginalised group. It further assesses the influence of social and institutional networks on migrants and the tactics they employ to overcome the barriers to educational success. The study used both quantitative and qualitative research methods, with the majority of data collected through an in-depth survey of 100 migrant children, between the ages of 6 and 17, and 35 parent/guardians. In addition, focus group discussions with teachers and interviews with 12 school principals were conducted. The views of members of the local Municipality involved with migrant children were also sought. The literature review revealed that, while there has been some research on barriers to education in camp settings, there is very limited research on educational access for migrant children integrating into host communities. This study has been able to contribute to this thin body of knowledge by demonstrating that as well as facing the traditional educational access barriers (lack of infrastructure, educational costs, enrolment requirements and social exclusion), integrating migrant children are faced with additional access barriers largely linked to their legal status (civil status, residence, status of guardians). The research identified the difficulties of obtaining the necessary legal status and some important shortcomings of the current migrant classification system. Getting the right documentation to obtain legal status often placed unreasonable burdens on the children and forced them into a catch 22 situation where they needed to return to their homeland to procure documents required for admission to school but doing so automatically invalidated the claims to refugee status. This particular study also highlighted the difficulty in classifying migrants who have fled from a country (Zimbabwe) that is not officially recognised as a conflict zone despite the characteristics of the Zimbabwean migrant situation being largely indistinguishable from classical conflict driven migration. The thesis concludes by recommending steps to change the definition and typology of migrants and points to the policy changes, with regard to support of migrant children that are required. The definitions should be changed to cater for the individual needs of the children so that legal and bureaucratic requirements do not present such an impediment to education. The thesis identified the large role of both the social and institutional networks of the migrant children in overcoming access barriers. This points to an area of valuable further research, which could provide a foundation for better policy development and implementation strategies that recognise the social and institutional dynamics that influence the decisions and choices made by migrant children and their parents

Denial of long-term issues with agriculture on tropical peatlands will have devastating consequences

Non peer reviewe

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Denial of long-term issues with agriculture on tropical peatlands will have devastating consequences

The first International Peat Congress (IPC) held in the tropics - in Kuching (Malaysia) - brought together over 1000 international peatland scientists and industrial partners from across the world (“International Peat Congress with over 1000 participants!,” 2016). The congress covered all aspects of peatland ecosystems and their management, with a strong focus on the environmental, societal and economic challenges associated with contemporary large-scale agricultural conversion of tropical peat. However, recent encouraging developments towards better management of tropical peatlands have been undermined by misleading newspaper headlines and statements first published during the conference. Articles in leading regional newspapers (“Oil palm planting on peat soil handled well, says Uggah,” 2016; Cheng & Sibon, 2016; Nurbianto, 2016a, 2016b; Wong, 2016) widely read across the region, portrayed a general consensus, in summary of the conference, that current agricultural practices in peatland areas, such as oil palm plantations, do not have a negative impact on the environment. This view is not shared by many scientists, or supported by the weight of evidence that business-as-usual management is not sustainable for tropical peatland agriculture. Peer-reviewed scientific studies published over the last 19 years, as reflected in the Intergovernmental Panel on Climate Change (IPCC) Wetland Supplement on greenhouse gas inventories, affirms that drained tropical peatlands lose considerable amounts of carbon at high rates (Drösler et al., 2014). Tropical peat swamp forests have sequestered carbon for millennia, storing a globally significant reservoir below ground in the peat (Page et al., 2011; Dommain et al., 2014). However, contemporary agriculture techniques on peatlands heavily impact this system through land clearance, drainage and fertilization, a process that too often involves fire. Along with biodiversity losses driven by deforestation (Koh et al., 2011; Posa et al., 2011; Giam et al., 2012), the carbon stored in drained peatlands is rapidly lost through oxidation, dissolution and fire (Couwenberg et al., 2009; Hirano et al., 2012; Ramdani & Hino, 2013; Schrier-Uijl et al., 2013; Carlson et al., 2015; Warren et al., 2016). Tropical peat fires are a major contributor to global greenhouse gas emissions and produce transboundary haze causing significant impacts on human health, regional economies and ecosystems (Page et al., 2002; Marlier et al., 2012; Jaafar & Loh, 2014; Chisholm et al., 2016; Huijnen et al., 2016; Stockwell et al., 2016). With future El-Niño events predicted to increase in frequency and severity (Cai et al., 2014) and with fire prevalence now decoupled from drought years (Gaveau et al., 2014), future large scale fire and haze events are imminent given the extensive areas of now drained fire prone drained peatlands (Kettridge et al., 2015; Turetsky et al., 2015; Page & Hooijer, 2016). In reality, just how much of the estimated 69 gigatonnes of carbon (Page et al., 2011) stored in Southeast Asian tropical peatlands is being lost due to agricultural operations under the current management regime is still uncertain. Of great concern is that none of the agricultural management methods applied to date have been shown to prevent the loss of peat and the associated subsidence of the peatland surface following drainage (Wösten et al., 1997; Melling et al., 2008; Hooijer et al., 2012; Evers et al., 2016). Recent projections suggest that large areas of currently drained coastal peatlands will become un-drainable, and progressively be subjected to longer periods of inundation by river and ultimately sea water (Hooijer et al., 2015a, 2015b; Sumarga et al., 2016). With growing risk of saltwater intrusion, agriculture in these coastal lands will become increasingly untenable, calling into question the very notion of “long-term sustainability of tropical peatland agriculture”. A more accurate view of drained peatland agriculture is that of an extractive industry, in which a finite resource (the peat) is ‘mined’ to produce food, fibre and fuel, driven by global demand. In developing countries with growing populations, there are strong socio-economic arguments for exploiting this resource to support local livelihoods and broader economic development (Mizuno et al., 2016). However, an acceptance that on-going peat loss is inevitable under this scenario. Science-based measures towards improved management, including limitations on the extent of plantation development, can be used to minimise the rate of this peat loss (President of Indonesia, 2011). Such an evidence-based position, supported with data and necessary legal instruments are needed for sustainable futures. The scientifically unfounded belief that drained peatland agriculture can be made ‘sustainable’, and peat loss can be halted, via unproven methods such as peat compaction debilitates the effort to find sustainable possibilities. To a large extent, the issues surrounding unsustainable peatland management have now been recognized by sections of industry (Wilmar, 2013; APP, 2014; Cargill Inc., 2014; Mondelēz International, 2014; Sime Darby Plantation, 2014; APRIL, 2015; Olam International, 2015), government (President of Indonesia, 2014, 2016; Mongabay, 2015; Mongabay Haze Beat, 2015; Hermansyah, 2016) and consumers (Wijedasa et al., 2015). In recognition of the constraints and risks of peatland development, many large and experienced oil palm and pulpwood companies have halted further development on peat and introduced rigorous management requirements for existing peatland plantations(Lim et al., 2012). However, the denial of the empirical basis calling for improved peatland management remains persistent in influential policy spaces, as illustrated by the articles reporting on the conference (“Oil palm planting on peat soil handled well, says Uggah,” 2016; Cheng & Sibon, 2016; Nurbianto, 2016a, 2016b). The search for more responsible tropical peatland agriculture techniques includes promising recent initiatives to develop methods to cultivate crops on peat under wet conditions (Giesen, 2015; Dommain et al., 2016; Mizuno et al., 2016). While a truly sustainable peatland agriculture method does not yet exist, the scientific community and industry are collaborating in the search for solutions(International Peat Society, 2016), and for interim measures to mitigate ongoing rates of peat loss under existing plantations. Failing to recognize the devastating consequences of the current land use practices on peat soils and failing to work together to address them could mean that the next generation will have to deal with an irreversibly altered, dysfunctional landscape where neither environment nor society, globally or locally, will be winners.JRC.D.1-Bio-econom

Genetic determinants of risk in pulmonary arterial hypertension: international genome-wide association studies and meta-analysis.

BACKGROUND: Rare genetic variants cause pulmonary arterial hypertension, but the contribution of common genetic variation to disease risk and natural history is poorly characterised. We tested for genome-wide association for pulmonary arterial hypertension in large international cohorts and assessed the contribution of associated regions to outcomes. METHODS: We did two separate genome-wide association studies (GWAS) and a meta-analysis of pulmonary arterial hypertension. These GWAS used data from four international case-control studies across 11 744 individuals with European ancestry (including 2085 patients). One GWAS used genotypes from 5895 whole-genome sequences and the other GWAS used genotyping array data from an additional 5849 individuals. Cross-validation of loci reaching genome-wide significance was sought by meta-analysis. Conditional analysis corrected for the most significant variants at each locus was used to resolve signals for multiple associations. We functionally annotated associated variants and tested associations with duration of survival. All-cause mortality was the primary endpoint in survival analyses. FINDINGS: A locus near SOX17 (rs10103692, odds ratio 1·80 [95% CI 1·55-2·08], p=5·13 × 10-15) and a second locus in HLA-DPA1 and HLA-DPB1 (collectively referred to as HLA-DPA1/DPB1 here; rs2856830, 1·56 [1·42-1·71], p=7·65 × 10-20) within the class II MHC region were associated with pulmonary arterial hypertension. The SOX17 locus had two independent signals associated with pulmonary arterial hypertension (rs13266183, 1·36 [1·25-1·48], p=1·69 × 10-12; and rs10103692). Functional and epigenomic data indicate that the risk variants near SOX17 alter gene regulation via an enhancer active in endothelial cells. Pulmonary arterial hypertension risk variants determined haplotype-specific enhancer activity, and CRISPR-mediated inhibition of the enhancer reduced SOX17 expression. The HLA-DPA1/DPB1 rs2856830 genotype was strongly associated with survival. Median survival from diagnosis in patients with pulmonary arterial hypertension with the C/C homozygous genotype was double (13·50 years [95% CI 12·07 to >13·50]) that of those with the T/T genotype (6·97 years [6·02-8·05]), despite similar baseline disease severity. INTERPRETATION: This is the first study to report that common genetic variation at loci in an enhancer near SOX17 and in HLA-DPA1/DPB1 is associated with pulmonary arterial hypertension. Impairment of SOX17 function might be more common in pulmonary arterial hypertension than suggested by rare mutations in SOX17. Further studies are needed to confirm the association between HLA typing or rs2856830 genotyping and survival, and to determine whether HLA typing or rs2856830 genotyping improves risk stratification in clinical practice or trials. FUNDING: UK NIHR, BHF, UK MRC, Dinosaur Trust, NIH/NHLBI, ERS, EMBO, Wellcome Trust, EU, AHA, ACClinPharm, Netherlands CVRI, Dutch Heart Foundation, Dutch Federation of UMC, Netherlands OHRD and RNAS, German DFG, German BMBF, APH Paris, INSERM, Université Paris-Sud, and French ANR