Analysis of the factors affecting the sustainability of ICT4D initiatives.

Abstract The sustainability of ICT for Development (ICT4D) initiatives remains an enduring concern, and projects typically have a high rate of failure. ICT4D is in flux and the trends are analysed to show how sustainability issues have changed from requirements for external support via governments or funding agencies to self-sufficiency (mainly) based on economic viability. Sustainability is typically defined in terms of financial, social, institutional, technological, and environmental aspects. The major factors influencing the sustainability of ICT4D projects in poor rural areas are summarised via a systems analysis. The questions posed by this analysis may be partially addressed by strategies based upon the concept of human scale development. Two ICT4D initiatives that are concerned with enterprise development are used to illustrate the practical realisation of aspects of such a strategy

The use of information concepts in the dialogue between science and theology

We are living in the information age and this has had an effect on both science and theology. Our understanding of the fundamental role of information has increased significantly. One can even say that information has become an overarching metaphor in the world of science. This dissertation gives an overview of the impact of the information-based scientific world-view on the dialogue between science and theology. The study investigates the metaphorical use of information concepts to secure a better understanding of God's action in the world and the role that information plays in the processes of life. The focus is on the role of biological information, and its relation to divine action is investigated. The scientific importance of information and the possible impact of information concepts on the science and theology dialogue of the future are discussed.Philosophy, Practical and Systematic TheologyM. Th.(Systematic Theology

E-tourism : a survey of e-business among South African tour operators

This contribution presents the results of a pilot project on ICT usage by South African SMMEs in the tourism industry. The Electronic Business Survey (EBS) methodology which was tested for applicability in a developing country, in this case South Africa, uses qualitative indicators and quantitative estimations to measure the impacts of e-business practices. The results, based on 40 face-to-face interviews, were substantive and showed that the adapted OECD methodology could be used successfully. In the South African tourism industry, ICT significantly improves the performance of these businesses. Although ICT adoption represents a significant operational cost for the interviewed firms, it also substantially contributes to increased revenue and improved labour productivity. On balance the results are extremely positive: 44.7% of firms report increased profitability, whereas for 50% it remained the same as three years ago. Of the firms that reported increased profitability, 75% indicated ICT as a contributing factor, and 31% considered ICT as the main contributing factor. The most positive effects are attributed to the usage of the Internet to improve customer relations in conjunction with creative product offerings (customisation, product-service bundling). Findings are consistent with research applying the same methodology in Western and Eastern Europe. This includes the finding that positive effects of ICT tend to be bigger for industries in transition, supporting businesses to become internationally competitive

Teachers’ ICT Adoption in South African Rural Schools: A Study of Technology Readiness and Implications for the South Africa Connect Broadband Policy

The South Africa Connect national broadband policy of 2013 aims to ensure that the country achieves universal internet access by 2030, thereby fostering digital skills development. This study investigates one dimension of the South Africa Connect policy objectives, by considering rural teachers’ adoption of information and communication technologies (ICTs) for teaching and learning at 24 schools. This research used baseline data from the Information and Communication Technology for Education (ICT4E) project undertaken in rural schools in seven South African provinces. The technology readiness index (TRI) was used as the theoretical lens. We found that the vast majority of the teachers surveyed were optimistic about the use of ICTs for teaching and learning, which suggests teachers’ readiness to use ICTs despite the existing financial, technical and digital skills challenges at their schools. We also found that the majority of the schools had policies prohibiting student use of personal digital devices, apart from calculators, on school premises. In our analysis, these policies potentially conflict with the objectives of South Africa Connect. This study contributes to theory and practice by offering empirical evidence of the usefulness of the TRI for presenting teachers’ readiness to adopt ICTs in situations of conflicting forces. The study also has the potential to contribute to policy deliberations by highlighting the possible disconnect between the schools’ bans on student personal digital devices and the objectives and targets set by the South Africa Connect policy.School of Computin

Drug-Resistant Tuberculosis--Current Dilemmas, Unanswered Questions, Challenges and Priority Needs

Tuberculosis was declared a global emergency by the World Health Organization (WHO) in 1993. Following the declaration and the promotion in 1995 of directly observed treatment short course (DOTS), a cost-effective strategy to contain the tuberculosis epidemic, nearly 7 million lives have been saved compared with the pre-DOTS era, high cure rates have been achieved in most countries worldwide, and the global incidence of tuberculosis has been in a slow decline since the early 2000s. However, the emergence and spread of multidrug-resistant (MDR) tuberculosis, extensively drug-resistant (XDR) tuberculosis, and more recently, totally drug-resistant tuberculosis pose a threat to global tuberculosis control. Multidrug-resistant tuberculosis is a man-made problem. Laboratory facilities for drug susceptibility testing are inadequate in most tuberculosis-endemic countries, especially in Africa; thus diagnosis is missed, routine surveillance is not implemented, and the actual numbers of global drug-resistant tuberculosis cases have yet to be estimated. This exposes an ominous situation and reveals an urgent need for commitment by national programs to health system improvement because the response to MDR tuberculosis requires strong health services in general. Multidrug-resistant tuberculosis and XDR tuberculosis greatly complicate patient management within resource-poor national tuberculosis programs, reducing treatment efficacy and increasing the cost of treatment to the extent that it could bankrupt healthcare financing in tuberculosis-endemic areas. Why, despite nearly 20 years of WHO-promoted activity and >12 years of MDR tuberculosis–specific activity, has the country response to the drug-resistant tuberculosis epidemic been so ineffectual? The current dilemmas, unanswered questions, operational issues, challenges, and priority needs for global drug resistance screening and surveillance, improved treatment regimens, and management of outcomes and prevention of DR tuberculosis are discussed

What Research Is Needed to Stop TB? Introducing the TB Research Movement

Christian Lienhardt and colleagues describe the development of the TB Research Movement, which aims to create a framework for concrete actions to harmonize and synergize TB research efforts globally

Essentiality Is a Strong Determinant of Protein Rates of Evolution during Mutation Accumulation Experiments in Escherichia coli

[EN] The Neutral Theory of Molecular Evolution is considered the most powerful theory to understand the evolutionary behavior of proteins. One of the main predictions of this theory is that essential proteins should evolve slower than dispensable ones owing to increased selective constraints. Comparison of genomes of different species, however, has revealed only small differences between the rates of evolution ofessential and nonessential proteins. In some analyses, these differences vanish once confounding factors are controlled for, whereas in other cases essentiality seems to have an independent, albeit small, effect. It has been argued that comparing relatively distant genomes may entail a number of limitations. For instance, many of the genes that are dispensable in controlled lab conditions may be essential in some of the conditions faced in nature. Moreover, essentiality can change during evolution, and rates of protein evolution are simultaneously shaped by a variety of factors, whose individual effects are difficult to isolate. Here, we conducted two parallel mutation accumulation experiments in Escherichia coli, during 5,500–5,750 generations, and compared the genomes at different points of the experiments. Our approach (a short-term experiment, under highly controlled conditions) enabled us to overcome many of the limitations of previous studies. We observed that essential proteins evolved substantially slower than nonessential ones during our experiments. Strikingly, rates of protein evolution were only moderately affected by expression level and protein length.We are grateful to Kais Fares, Maria Prats-Escriche and Victor Berlanga-Laparra for technical assistance with the evolution experiments. We are also grateful to the Editor and two anonymous referees for helpful comments. This work was supported by grants from the Spanish Ministerio de Economia y Competitividad (BFU2009-12022, BFU2012-36346, and BFU2015-66073-P) and Science Foundation Ireland (12/IP/1673) to M.A.F. D.A.-P. was partially supported by funds from the University of Nevada, Reno. C.T. was supported by a European Molecular Biology Organization long-term fellowship (EMBO ALTF 730-2011) and a Juan de la Cierva fellowship from the Ministerio de Economia y Competitividad (JCA-2012-14056). M.X.R.-G. was partially supported by a JAE DOC fellowship from the Ministerio de Economia y Competitividad, Spain.Alvarez-Ponce, D.; Sabater-Munoz, B.; Toft, C.; Ruíz-González, MJ.; Fares Riaño, MA. (2016). Essentiality Is a Strong Determinant of Protein Rates of Evolution during Mutation Accumulation Experiments in Escherichia coli. Genome Biology and Evolution. 8(9):2914-2927. https://doi.org/10.1093/gbe/evw205S291429278

Drug-Resistant Tuberculosis—Current Dilemmas, Unanswered Questions, Challenges, and Priority Needs

Tuberculosis was declared a global emergency by the World Health Organization (WHO) in 1993. Following the declaration and the promotion in 1995 of directly observed treatment short course (DOTS), a cost-effective strategy to contain the tuberculosis epidemic, nearly 7 million lives have been saved compared with the pre-DOTS era, high cure rates have been achieved in most countries worldwide, and the global incidence of tuberculosis has been in a slow decline since the early 2000s. However, the emergence and spread of multidrug-resistant (MDR) tuberculosis, extensively drug-resistant (XDR) tuberculosis, and more recently, totally drug-resistant tuberculosis pose a threat to global tuberculosis control. Multidrug-resistant tuberculosis is a man-made problem. Laboratory facilities for drug susceptibility testing are inadequate in most tuberculosis-endemic countries, especially in Africa; thus diagnosis is missed, routine surveillance is not implemented, and the actual numbers of global drug-resistant tuberculosis cases have yet to be estimated. This exposes an ominous situation and reveals an urgent need for commitment by national programs to health system improvement because the response to MDR tuberculosis requires strong health services in general. Multidrug-resistant tuberculosis and XDR tuberculosis greatly complicate patient management within resource-poor national tuberculosis programs, reducing treatment efficacy and increasing the cost of treatment to the extent that it could bankrupt healthcare financing in tuberculosis-endemic areas. Why, despite nearly 20 years of WHO-promoted activity and >12 years of MDR tuberculosis-specific activity, has the country response to the drug-resistant tuberculosis epidemic been so ineffectual? The current dilemmas, unanswered questions, operational issues, challenges, and priority needs for global drug resistance screening and surveillance, improved treatment regimens, and management of outcomes and prevention of DR tuberculosis are discusse

Epidemiology of Tuberculosis in a High HIV Prevalence Population Provided with Enhanced Diagnosis of Symptomatic Disease

BACKGROUND: Directly observed treatment short course (DOTS), the global control strategy aimed at controlling tuberculosis (TB) transmission through prompt diagnosis of symptomatic smear-positive disease, has failed to prevent rising tuberculosis incidence rates in Africa brought about by the HIV epidemic. However, rising incidence does not necessarily imply failure to control tuberculosis transmission, which is primarily driven by prevalent infectious disease. We investigated the epidemiology of prevalent and incident TB in a high HIV prevalence population provided with enhanced primary health care. METHODS AND FINDINGS: Twenty-two businesses in Harare, Zimbabwe, were provided with free smear- and culture-based investigation of TB symptoms through occupational clinics. Anonymised HIV tests were requested from all employees. After 2 y of follow-up for incident TB, a culture-based survey for undiagnosed prevalent TB was conducted. A total of 6,440 of 7,478 eligible employees participated. HIV prevalence was 19%. For HIV-positive and -negative participants, the incidence of culture-positive tuberculosis was 25.3 and 1.3 per 1,000 person-years, respectively (adjusted incidence rate ratio = 18.8; 95% confidence interval [CI] = 10.3 to 34.5: population attributable fraction = 78%), and point prevalence after 2 y was 5.7 and 2.6 per 1,000 population (adjusted odds ratio = 1.7; 95% CI = 0.5 to 6.8: population attributable fraction = 14%). Most patients with prevalent culture-positive TB had subclinical disease when first detected. CONCLUSIONS: Strategies based on prompt investigation of TB symptoms, such as DOTS, may be an effective way of controlling prevalent TB in high HIV prevalence populations. This may translate into effective control of TB transmission despite high TB incidence rates and a period of subclinical infectiousness in some patients

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life