The ‘ins and outs’ of faecal microbiota transplant for recurrent Clostridium difficile diarrhoea at Wits Donald Gordon Medical Centre, Johannesburg, South Africa

Background. Clostridium difficile-associated diarrhoea (CDAD) is a potentially life-threatening condition that is becoming increasingly common. A persistent burden of this infectious illness has been demonstrated over the past 4 years at Wits Donald Gordon Medical Centre (WDGMC), Johannesburg, South Africa, through implementation of active surveillance of hospital-acquired infections as part of the infection prevention and control programme. Oral treatment with metronidazole or vancomycin is recommended, but there is a major problem with symptomatic recurrence after treatment. Replacement of normal flora by the administration of donor stool through colonoscopy or nasogastric/duodenal routes is becoming increasingly popular.Objectives. To identify risk factors for the development of CDAD in patients referred for faecal microbiota transplant (FMT) and evaluate the safety of administration of donor stool as an outpatient procedure, including via the nasogastric route.Methods. A retrospective record review of patients with recurrent CDAD referred for FMT at WDGMC between 1 January 2012 and 31 December 2016 was conducted.Results. Twenty-seven patients were identified, all of whom fulfilled the criteria for recurrent CDAD. One-third were aged >65 years, and the majority were female. The most common risk factors were prior exposure to antibiotics or proton-pump inhibitors and underlying inflammatory bowel disease. Three procedures were carried out as inpatients and 24 in the outpatient gastroenterology unit. At 4-week follow-up, all patients reported clinical resolution of their diarrhoea after a single treatment and there were no recurrences. The FMT procedure was associated with no morbidity (with particular reference to the risk of aspiration when administered via the nasogastric route) or mortality.Conclusions. This case series confirms that FMT is a safe and effective therapy for recurrent CDAD. In most cases it can be administered via the nasogastric route in the outpatient department. We propose that the recently published South African Gastroenterology Society guidelines be reviewed with regard to recommendations for the route of administration of FMT and hospital admission. Meticulous prescription practice by clinicians practising in hospitals and outpatient settings, with particular attention to antimicrobials and chronic medication, is urgently required to prevent this debilitating and potentially life-threatening condition

Statistical properties of 12.2 GHz methanol masers associated with a complete sample of 6.7 GHz methanol masers

We present definitive detection statistics for 12.2 GHz methanol masers towards a complete sample of 6.7 GHz methanol masers detected in the Methanol Multibeam survey south of declination -20 degrees. In total, we detect 250 12.2 GHz methanol masers towards 580 6.7 GHz methanol masers. This equates to a detection rate of 43.1%, which is lower than that of previous significant searches of comparable sensitivity. Both the velocity ranges and the flux densities of the target 6.7 GHz sources surpass that of their 12.2 GHz companion in almost all cases. 80 % of the detected 12.2 GHz methanol maser peaks are coincident in velocity with the 6.7 GHz maser peak. Our data support an evolutionary scenario whereby the 12.2 GHz sources are associated with a somewhat later evolutionary stage than the 6.7 GHz sources devoid of this transition. Furthermore, we find that the 6.7 GHz and 12.2 GHz methanol sources increase in luminosity as they evolve. In addition to this, evidence for an increase in velocity range with evolution is presented. This implies that it is not only the luminosity, but also the volume of gas conducive to the different maser transitions, that increases as the sources evolve. Comparison with GLIMPSE mid-infrared sources has revealed a coincidence rate between the locations of the 6.7 GHz methanol masers and GLIMPSE point sources similar to that achieved in previous studies. Overall, the properties of the GLIMPSE sources with and without 12.2 GHz counterparts are similar. There is a higher 12.2 GHz detection rate towards those 6.7 GHz methanol masers that are coincident with extended green objects.Comment: Accepted to ApJ March 2011. 28 pages, 9 figure

Quantifying water requirements of African ungulates through a combination of functional traits

Climate and land use change modify surface water availability in African savannas. Surface water is a key resource for both wildlife and livestock and its spatial and temporal distribution is important for understanding the composition of large herbivore assemblages in savannas. Yet, the extent to which ungulate species differ in their water requirements remains poorly quantified. Here, we infer the water requirements of 48 African ungulates by combining six different functional traits related to physiological adaptations to reduce water loss, namely minimum dung moisture, relative dung pellet size, relative surface area of the distal colon, urine osmolality, relative medullary thickness, and evaporation rate. In addition, we investigated how these differences in water requirements relate to differences in dietary water intake. We observed strong correlations between traits related to water loss through dung, urine and evaporation, suggesting that ungulates minimize water loss through multiple pathways simultaneously, which suggests that each trait can thus be used independently to predict water requirements. Furthermore, we found that browsers and grazers had similar water requirements, but browsers are expected to be less dependent on surface water because they acquire more water through their diet. We conclude that these key functional traits are a useful way to determine differences in water requirements and an important tool for predicting changes in herbivore community assembly resulting from changes in surface water availability

Methanol Masers as Tracers of Circumstellar Disks

We show that in many methanol maser sources the masers are located in lines, with a velocity gradient along them which suggests that the masers are situated in edge-on circumstellar, or protoplanetary, disks. We present VLBI observations of the methanol maser source G309.92+0.48, in the 12.2 GHz transition, which confirm previous observations that the masers in this source lie along a line. We show that such sources are not only linear in space but, in many cases, also have a linear velocity gradient. We then model these and other data in both the 6.7 GHz and the 12.2 GHz transition from a number of star formation regions, and show that the observed spatial and velocity distribution of methanol masers, and the derived Keplerian masses, are consistent with a circumstellar disk rotating around an OB star. We consider this and other hypotheses, and conclude that about half of these methanol masers are probably located in edge-on circumstellar disks around young stars. This is of particular significance for studies of circumstellar disks because of the detailed velocity information available from the masers.Comment: 38 pages, 13 figures accepted by Ap

12.2-GHz methanol maser MMB follow-up catalogue - I. Longitude range 330 to 10 degrees

We present a catalogue of 12.2-GHz methanol masers detected towards 6.7-GHz methanol masers observed in the unbiased Methanol Multibeam (MMB) survey in the longitude range 330\circ (through 360\circ) to 10\circ. This is the first portion of the catalogue which, when complete, will encompass all of the MMB detections. We report the detection of 184 12.2-GHz sources towards 400 6.7-GHz methanol maser targets, equating to a detection rate of 46 per cent. Of the 184 12.2-GHz detections, 117 are reported here for the first time. We draw attention to a number of 'special' sources, particularly those with emission at 12.2-GHz stronger than their 6.7-GHz counterpart and conclude that these unusual sources are not associated with a specific evolutionary stage.Comment: accepted to MNRAS 21 Dec 201

12.2-GHz methanol maser MMB follow-up catalogue - II. Longitude range 186 to 330 degrees

We present the second portion of a catalogue of 12.2-GHz methanol masers detected towards 6.7-GHz methanol masers observed in the unbiased Methanol Multibeam (MMB) Survey. Using the Parkes radio telescope we have targeted all 207 6.7-GHz methanol masers in the longitude range 186 to 330 degrees for 12.2-GHz counterparts. We report the detection of 83 12.2-GHz methanol masers, and one additional source which we suspect is thermal emission, equating to a detection rate of 40 per cent. Of the 83 maser detections, 39 are reported here for the first time. We discuss source properties, including variability and highlight a number of unusual sources. We present a list of 45 candidates that are likely to harbor methanol masers in the 107.0-GHz transition.Comment: Accepted MNRAS 19 July 201

The quiet editor: Ivan Vladislavić and South African cultural production

This article examines the literary and sociological significance of Ivan Vladislavić’s "double life” (Lahire, 2010: n.p.) as both editor and writer. With reference to a number of his editorial roles as well as the joint projects he has worked on with writers and visual artists, the article considers how Vladislavić’s work with others spreads symbolic value. Described by one of his clients as the “quiet editor”, Vladislavić can be read as a new kind of author; what he terms “creative editing” (Steyn, 2012: n.p.) as a new kind of writing, through which more traditional models of authorship and literary production are thrown into question — less Bourdieu’s (1984) “field of literary production” or Casanova’s (2004: 82) “world literary space”, red in tooth and claw, amd more Howard Becker’s “art world”: a convivial “network of cooperating people, all of whose work is essential to the final outcome” (1982: 25)

The ‘ins and outs’ of colonoscopy at Wits Donald Gordon Medical Centre, South Africa: A practice audit of the outpatient endoscopy unit

Background. In South Africa, there are no national guidelines for the conduct or quality assessment of colonoscopy, the gold standard for investigation and diagnosis of bowel pathology.Objectives. To describe the clinical profile of patients and evaluate the practice of colonoscopy using procedural quality indicators at the Wits Donald Gordon Medical Centre (WDGMC) outpatient endoscopy unit (OEU).Methods. We conducted a prospective, clinical practice audit of colonoscopies performed on adults (≥18 years of age). A total of 1 643 patients were included in the study and variables that were collected enabled the assessment of adequacy of bowel preparation, length of withdrawal time and calculation of caecal intubation rate (CIR), polyp detection rate (PDR) and adenoma detection rate (ADR). We stratified PDR and ADR by sex, age, population group, withdrawal time and bowel preparation. CIR, PDR and ADR estimates were compared between patient groups by the χ2 test; Fisher’s exact test was used for 2 × 2 tables. A p-value <0.05 was used. Benchmark recommendations by the American Society for Gastrointestinal Endoscopy (ASGE)/American College of Gastroenterology (ACG) Task Force on Colorectal Cancer (CRC) were used in this audit to assess individual endoscopist performance and that of the endoscopy unit as a whole.Results. The mean age of patients was 55.7 (standard deviation (SD) 14.4; range 18 - 91) years, ~60% were female, and the majority (75.5%) were white. Of the outpatients, 77.6% had adequate bowel preparation (ASGE/ACG benchmark ≥85%). The CIR was 97.0% overall, and screening colonoscopy was 96.3% (ASGE/ACG benchmark ≥90% overall and ≥95% for screening colonoscopies). The median withdrawal time for negative-result screening colonoscopies was 5.7 minutes (interquartile range (IQR) 4.2 - 9.3; range 1.1 - 20.6) (ASGE/ACG benchmark ≥ 6minutes), and PDR and ADR were 27.6% and 15.6%, respectively (ASGE/ACG benchmark ADR ≥25%). We demonstrated a 23.7% increase in PDR and 14.1% increase in ADR between scopes that had mean withdrawal times of ≥6 minutes and <6 minutes, respectively. Although the number of black Africans in the study was relatively small, our results showed that they have similar ADRs and PDRs to the white population group, contradicting popular belief.Conclusions. The WDGMC OEU performed reasonably well against the international guidelines, despite some inadequacy in bowel preparation and lower than recommended median withdrawal times on negative-result colonoscopy. Annual auditing of clinical practice and availability of these data in the public domain will become standard of care, making this audit a baseline for longitudinal observation, assessing the impact of interventions, and contributing to the development of local guidelines