Influenza- and respiratory syncytial virus-associated adult mortality in Soweto

Background. Influenza and respiratory syncytial virus (RSV)infections cause seasonal excess mortality and hospitalisationin adults (particularly the elderly) in high-income countries. Little information exists on the impact of these infections on adults in Africa.Objectives. To estimate influenza- and RSV-related adult mortality, stratified by age and hospitalisation in Soweto.Study design. A retrospective hospital-based study in Sowetofrom 1997 to 1999 to estimate influenza- and RSV-related excess all-cause deaths and hospitalisation using a ratedifferencemethod. The study was based on influenza seasons of varying severity, provided by surveillance data.Results. Influenza seasons were significantly associated with excess mortality in adults across all 3 years, except for 18 - 64-year-olds in 1998. Excess mortality was highest in those .65 years of age: 82.8/100 000 population in the mild 1997 season and 220.9/100 000 in the severe 1998 season. Influenza significantly increased adult medical hospitalisation in the severe 1998 season alone. RSV did not significantly affect mortality or hospitalisation.Conclusion. Influenza-related mortality was substantial and disproportionately affected the elderly. Influenza vaccination for the elderly warrants consideration. The RSV-related burden was not significantly increased but merits observation over a longer period

Speleothem evidence for C3 dominated vegetation during the Late Miocene (Messinian) of South Africa

During the Late Miocene, Africa experienced a number of ecological transitions including the spread of C4 grasslands, the expansion of the Sahara Desert, the Messinian Salinity Crisis and a number of mammalian migrations and expansions, including the origin of the hominin clade. A detailed understanding of the relationship between environmental change and hominin evolution is hampered by the paucity of data available from terrestrial localities, especially in southern Africa. Here, we present a stable isotope and trace element record from a speleothem from the South African cave site of Hoogland. Uranium-lead dating and magnetostratigraphy places the speleothem within the Messinian Age (7.25–5.33 Ma) of the Late Miocene, making it the oldest known cave deposit from the region near the UNESCO Fossil Hominids of South Africa World Heritage Site (locally known as the “Cradle of Humankind”). Low carbon isotope values indicate a predominantly C3 vegetation in the vicinity of the cave throughout the period of speleothem growth. It is not possible to determine if this represents a C3 grassland or a C3 woodland, but it is clear that an equivalent C3-rich environment has yet to be found during the Messinian of east Africa. We conclude that the C4 grass expansion occurred millions of years later in South Africa than it did in eastern Africa, and that this vegetation shift should be considered when comparing African vegetation change with the late Miocene hominin fossil record

The partial skeleton StW 431 from Sterkfontein – Is it time to rethink the Plio-Pleistocene hominin diversity in South Africa?

The discovery of the nearly complete Plio-Pleistocene skeleton StW 573 Australopithecus prometheus from Sterkfontein Member 2, South Africa, has intensified debates as to whether Sterkfontein Member 4 contains a hominin species other than Australopithecus africanus. For example, it has recently been suggested that the partial skeleton StW 431 should be removed from the A. africanus hypodigm and be placed into A. prometheus. Here we re-evaluate this latter proposition, using published information and new comparative data. Although both StW 573 and StW 431 are apparently comparable in their arboreal (i.e., climbing) and bipedal adaptations, they also show significant morphological differences. Surprisingly, StW 431 cannot be unequivocally aligned with either StW 573 or other hominins from Sterkfontein commonly attributed to A. africanus (nor with Paranthropus robustus and Australopithecus sediba). This finding, together with considerations about the recent dating of Plio-Pleistocene hominin-bearing sites in South Africa and palaeoecological/palaeoclimatic conditions, raises questions whether it is justified to subsume hominins from Taung, Makapansgat and Sterkfontein (and Gladysvale) within a single taxon. Given the wealth of fossil material and analytical techniques now available, we call for a re-evaluation of the taxonomy of South African Plio-Pleistocene hominins. Such an endeavour should however go beyond the current (narrow) focus on establishing an A. africanus-A. prometheus dichotomy. Macho, Gabriele A. Fornai, Cinzia Tardieu, Christine Hopley, Philip Haeusler, Martin Toussaint, Miche

A single dose of cannabidiol modulates medial temporal and striatal function during fear processing in people at clinical high risk for psychosis

Emotional dysregulation and anxiety are common in people at clinical high risk for psychosis (CHR) and are associated with altered neural responses to emotional stimuli in the striatum and medial temporal lobe. Using a randomised, double-blind, parallel-group design, 33 CHR patients were randomised to a single oral dose of CBD (600 mg) or placebo. Healthy controls (n = 19) were studied under identical conditions but did not receive any drug. Participants were scanned with functional magnetic resonance imaging (fMRI) during a fearful face-processing paradigm. Activation related to the CHR state and to the effects of CBD was examined using a region-of-interest approach. During fear processing, CHR participants receiving placebo (n = 15) showed greater activation than controls (n = 19) in the parahippocampal gyrus but less activation in the striatum. Within these regions, activation in the CHR group that received CBD (n = 15) was intermediate between that of the CHR placebo and control groups. These findings suggest that in CHR patients, CBD modulates brain function in regions implicated in psychosis risk and emotion processing. These findings are similar to those previously evident using a memory paradigm, suggesting that the effects of CBD on medial temporal and striatal function may be task independent

Developing a sense of place toolkit: Identifying destination uniqueness

It has long been recognised that the tangible and intangible characteristics that make a location distinctive and memorable, contribute significantly to destination image. How this destination feel is communicated, has largely been the domain of place branding and destination marketing, which have the potential to miss stakeholder voices. Recently though, practitioners are starting to carefully consider ‘sense of place’; that is an emotional attachment to place, which is defined more carefully in the literature review of this article, and which corresponds with long-running academic discussions. This paper attempts to identify some of these and bridge the gap between academic theory on sense of place and practice. In the UK, many rural areas are now seeking to operationalise sense of place through toolkit documents that might inform landscape interpretation and destination branding. A scenario echoed internationally, where local distinctiveness features in both rural and urban planning. However, sense of place in a tourism context, and more specifically the development of these toolkits, has received limited academic attention. Hence, this paper presents the case of Morecambe Bay, and the development of a dedicated sense of place toolkit. The subsequent case emerges from a collaboration between academics and practitioners and draws on participant observation, semi-structured interviews and document analysis. Specifically, the paper outlines a series of workshop activities developed with destination stakeholders and identifies how these inform subsequent toolkit design. It offers a critical analysis of the benefits and potential pitfalls of employing this approach. This case is of value to academics and destination stakeholders interested in identifying and communicating the uniqueness and emotional tone of the destination. Key lessons and recommendations are identified for those engaging in similar toolkit development initiatives

Surgical preferences of patients at risk of hip fractures: hemiarthroplasty versus total hip arthroplasty

BACKGROUND: The optimal treatment of displaced femoral neck fractures in patients over 60 years is controversial. While much research has focused on the impact of total hip arthroplasty (THA) and hemiarthroplasty (HA) on surgical outcomes, little is known about patient preferences for either alternative. The purpose of this study was to elicit surgical preferences of patients at risk of sustaining hip fracture using a novel decision board. METHODS: We developed a decision board for the surgical management of displaced femoral neck fractures presenting risks and outcomes of HA and THA. The decision board was presented to 81 elderly patients at risk for developing femoral neck fractures identified from an osteoporosis clinic. The participants were faced with the scenario of sustaining a displaced femoral neck fracture and were asked to state their treatment option preference and rationale for operative procedure. RESULTS: Eighty-five percent (85%) of participants were between the age of 60 and 80 years; 89% were female; 88% were Caucasian; and 49% had some post-secondary education. Ninety-three percent (93%; 95% confidence interval [CI], 87-99%) of participants chose THA as their preferred operative choice. Participants identified several factors important to their decision, including the perception of greater walking distance (63%), less residual pain (29%), less reoperative risk (28%) and lower mortality risk (20%) with THA. Participants who preferred HA (7%; 95% CI, 1-13%) did so for perceived less invasiveness (50%), lower dislocation risk (33%), lower infection risk (33%), and shorter operative time (17%). CONCLUSION: The overwhelming majority of patients preferred THA to HA for the treatment of a displaced femoral neck fracture when confronted with risks and outcomes of both procedures on a decision board

Models of practice and training in psychotherapy: cross-national perspectives from Italy and Canada

Internationally, there is ongoing concern about accessibility to mental health care and training. The goal of this study was to explore commonalities and differences within models of clinical psychology and psychotherapy in Ontario, Canada, and Lombardia, Italy, respectively, to inform improvements to the accessibility of mental health care and training. Using key informant sampling, we recruited ten students and professionals in Italy and Canada who study or work in psychology for semi-structured interviews. We analyzed the interview content using an inductive approach for thematic analysis within countries and meta-theme analysis across countries. The findings indicated three cross-national meta-themes: the need to integrate evidence with practice, the limited accessibility of training for students and treatment for patients, and the importance of the quality of training programs. Despite some differences regarding the amount of scientific training, personal therapy for trainees, and the prominence of cultural diversity training, Canadian and Italian psychology professionals and students shared experiences of psychotherapy practice and clinical psychology training. The three cross-national meta-themes indicate which issues in training and practice may be relevant worldwide and where to focus resources. The findings can inform international collaborations regarding training model structures that may increase access to psychology training and may increase consensus on professional recognition standards to improve mobility for professionals. These changes could reduce barriers to mental healthcare services for patients

Orbital precession modulates interannual rainfall variability, as recorded in an Early Pleistocene speleothem

Interannual variability of African rainfall impacts local and global communities, but its past behavior and response in future climate projections are poorly understood. This is primarily due to short instrumental records and a lack of long high-resolution palaeoclimate proxy records. Here we present an annually resolved 91,000 year Early Pleistocene record of hydroclimate from the early homininbearing Makapansgat Valley, South Africa. Changes in speleothem annual band thickness are dominated by precession over four consecutive orbital cycles with strong millennial-scale periodicity. The frequency of interannual variability (2.0–6.5 yr oscillations) does not change systematically, yet its amplitude is modulated by the orbital forcing. These long-term characteristics of interannual variability are reproduced with transient climate model simulations of water balance for South Africa from the Late Pleistocene to Recent. Based on these results, we suggest that the frequency of interannual variations in southern African rainfall is likely to be stable under anthropogenic warming, but that the size of year-to-year variations may increase. We see an orbitally forced increase in the amplitude of interannual climate variability between 1.8 Ma and 1.7 Ma coincident with the first evidence for the Acheulean stone tool technology

Quaternary development of resilient reefs on the subsiding kimberley continental margin, Northwest Australia

The Kimberley region in remote northwest Australia has poorly known reef systems of two types; coastal fringing reefs and atoll-like shelf-edge reefs. As a major geomorphic feature (from 12ºS to 18ºS) situated along a subsiding continental margin, the shelf edge reefs are in a tropical realm with warm temperatures, relatively low salinity, clear low nutrient waters lacking sediment input, and Indo-West Pacific corals of moderate diversity. Seismic architecture of the Rowley Shoals reveals that differential pre-Holocene subsidence and relative elevation of the pre-Holocene substrate have controlled lagoon sediment infill and reef morphology, forming an evolutionary series reflecting differential accommodation in three otherwise similar reef systems.The Holocene core described for North Scott Reef confirms previous seismic interpretations, and provides a rare ocean-facing reef record. It demonstrates that the Indo-Pacific reef growth phase (RG111) developed during moderate rates of sea level rise of 10 mm/year from 11 to about 7-6.5 ka BP until sea level stabilization, filling the available 27 m of pre-Holocene accommodation. Despite the medium to high hydrodynamic energy imposed by the 4m tides, swell waves and cyclones the reef-building communities represent relatively low-wave energy settings due to their southeast facing and protection afforded by the proximity of the South Reef platform. This study demonstrates the resilience of reefs on the subsiding margin whilst linking Holocene reef morphology to the relative amount of pre-Holocene subsidence