Improved Cryptosporidium case findings using immunofluorescent microscopy on concentrated stool

Background: Diarrhoea is a major cause of morbidity in Cape Town, South Africa, and mortality is attributed to a failure to recognize the severity of the condition. Cryptosporidium and Giardia are increasingly recognized as important causes of diarrhoea in Africa however, suboptimal diagnostic techniques may lead to underappreciation of their significance. Our objectives are to compare the diagnostic yield of direct immunofluorescent antigen (DFA) microscopy on concentrated stool samples for Cryptosporidium and Giardia, with the current approach of wet mount microscopy for Giardia and auramine fluorescent stain for Cryptosporidium on unconcentrated stool.Methodology: Stool specimens (n=104) received at our hospital laboratory for routine microbiological investigations were used for the study. Direct wet-mount auramine-phenol fluorescent microscopy (auramine) detection of Cryptosporidium oocysts and wet mount iodine microscopy for Giardia detection, were performed on unconcentrated stool samples, while DFA stain for simultaneous detection of Cryptosporidium and Giardia was performed on sodium-acetate formalin concentrated stool samples. The diagnostic yields of the tests were compared using the MEDCALC® version 18.0Results: Of the 104 stool specimens received for microbiological analysis, only 66 (63.5%) had specific Cryptosporidium requests while 38 (36.5%) had no Cryptosporidium specific requests. Of the 66 specimens, 9 (13.6%) were positive for Cryptosporidium oocysts with DFA while only 1 (1.5%) was positive with auramine staining (p=0.013). The one auramine-positive specimen was also positive by DFA. Auramine stain microscopy gave a sensitivity of 11.1% (95%CI: 0.28-48.25%) and specificity of 100% (95%CI: 93.7%-100%) when compared to DFA. Of the 38 stool specimens without specific Cryptosporidium request, DFA yielded 5 (13.2%) additional positive results. Taken together, Cryptosporidium was detected in 14/104 (13.5%; 95%CI: 8.36–21.7%) specimens and only 1 of 14 (7.1%) specimens with the current routine laboratory testing approach. Giardia was detected by DFA in 3/104 (0.9%) specimens, while direct iodine wet mount microscopy did not yield any positive results (0%). All 3 Giardia-positive specimens had Cryptosporidium oocysts detected by DFA.Conclusion: These data suggest that a large proportion of Cryptosporidium cases remain undetected by the laboratory due to suboptimal testing methods, and failure by clinicians to specifically request for Cryptosporidium detection. There is need to periodically assess the effectiveness of diagnostic microbiology laboratory approaches to diarrhoea, and access to improved diagnostic laboratory techniques will contribute to more accurate differential diagnosis and a broadened understanding of local aetiology of diarrhoea diseases in Africa. Keywords: Cryptosporidium, Giardia, diarrhoea, stool concentration, DFA, microscopy French Title: Amélioration des découvertes de cas de Cryptosporidium à l'aide de la microscopie immunofluorescente sur des selles concentrées Contexte: La diarrhée est une cause majeure de morbidité au Cap, en Afrique du Sud, et la mortalité est attribuée à l'incapacité de reconnaître la gravité de la maladie. Cryptosporidium et Giardia sont de plus en plus reconnus comme des causes importantes de diarrhée en Afrique, cependant, des techniques de diagnostic sous-optimales peuvent conduire à une sous-estimation de leur importance. Nos objectifs sont de comparer le rendement diagnostique de la microscopie à antigène immunofluorescent direct (DFA) sur des échantillons de selles concentrées pour Cryptosporidium et Giardia, avec l'approche actuelle de la microscopie à montage humide pour Giardia et la coloration fluorescente auramine pour Cryptosporidium sur des selles non concentrées.Méthodologie: Des échantillons de selles (n=104) reçus au laboratoire de notre hôpital pour des examens microbiologiques de routine ont été utilisés pour l'étude. La détection directe par microscopie fluorescente auramine-phénol à montage humide (auramine) des oocystes de Cryptosporidium et la microscopie à l'iode à montage humide pour la détection de Giardia, ont été effectuées sur des échantillons de selles non concentrées, tandis que la coloration DFA pour la détection simultanée de Cryptosporidium et de Giardia a été réalisée sur de l'acétate de sodium formaline concentré échantillons de selles. Les rendements diagnostiques des tests ont étécomparés à l'aide de MEDCALC® version 18.0Résultats: Sur les 104 échantillons de selles reçus pour l'analyse microbiologique, seuls 66 (63,5%) avaient des demandes spécifiques de Cryptosporidium tandis que 38 (36,5%) n'avaient pas de demandes spécifiques de Cryptosporidium. Sur les 66 échantillons, 9 (13,6%) étaient positifs pour les oocystes de Cryptosporidium avec DFA tandis que seulement 1 (1,5%) était positif avec coloration à l'auramine (p=0,013). Le seul échantillon positif à l'auramine était également positif au DFA. La microscopie à l'auramine a donné une sensibilité de 11,1% (IC 95%: 0,28-48,25%) et une spécificité de 100% (IC 95%: 93,7% -100%) par rapport au DFA. Sur les 38 échantillons de selles sans demande spécifique de Cryptosporidium, le DFA a donné 5 (13,2%) résultats positifs supplémentaires. Pris ensemble, Cryptosporidium a été détecté dans 14/104 (13,5%; IC à 95%: 8,36–21,7%) et seulement 1 des 14 échantillons (7,1%) avec l'approche actuelle des tests de routine en laboratoire. Giardia a été détecté par DFA dans 3/104 (0,9%) échantillons, tandis que la microscopie directe à l'iode sur monture humide n'a donné aucun résultat positif (0%). Les 3 échantillons positifs à Giardia avaient des oocystes deCryptosporidium détectés par DFA.Conclusion: Ces données suggèrent qu'une grande proportion des cas de Cryptosporidium ne sont pas détectés par le laboratoire en raison de méthodes de test sous-optimales et de l'échec des cliniciens à demander spécifiquement la détection de Cryptosporidium. Il est nécessaire d'évaluer périodiquement l'efficacité des approches de laboratoire de microbiologie diagnostique pour la diarrhée, et l'accès à des techniques de laboratoire de diagnostic améliorées contribuera à un diagnostic différentiel plus précis et à une compréhension élargie de l'étiologie locale des maladies diarrhéiques en Afrique. Mots clés: Cryptosporidium, Giardia, diarrhée, concentration des selles, DFA, microscopi

Theory of mind development : comparing autism spectrum disorder subgroups in light of changing diagnostic criteria

Includes bibliographical references (leaves 88-106).It has been proposed that autism is fundamentally a disorder of social relatedness. Severe deficits in theory of mind (ToM) - or the ability to understand that other people can have mental states different from our own and that these mental states influence behaviour - are commonly thought to explain the social-communicative deficits seen in autism spectrum disorders (ASDs). If deficits in ToM are responsible for the impairments found in ASD, these deficits should be found amongst all individuals with ASD (universality) and must be present throughout the course of the disorder (stability)

SME Corporate Philanthropy (CP): Exploring how CP is managed and appraised for its impact on communities

Purpose The ability to appraise the impact of any project allows for the opportunity to improve the project over time. The purpose of this study is to develop a bespoke Appraisal Tool, for SMEs, for Strategic Corporate Philanthropy (SCP), which allows organisations to appraise the impact of their SCP projects for themselves and the community. Exploring approaches to appraise SCP has been severely neglected by academics. Most appraisal tools focus on Corporate Social Responsibility (CSR). This study will research how organisations practise and appraise their SCP activities. It is believed that a strategic approach to corporate philanthropy will increase the impact it has on the community, and the bespoke SCP Appraisal Tool for SMEs developed by the researcher will complement this approach. The central focus of this study is the way key decision makers of SMEs manage SCP. The impact of utilising a separate Appraisal Tool from that used to measure CSR will be observed by focusing on the impact the relevant projects have on the community and the SMEs’ corporate objectives. The study commenced in 2019. In 2020, the World Health Organization (WHO) declared COVID-19 as a worldwide pandemic, which had a great impact on businesses and their philanthropic activities. It is for this reason that the researcher also included a research objective to address this phenomenon. The study aimed to gain an understanding of the influence that the COVID-19 worldwide pandemic had on company decision making with regards to philanthropic activities. Research Design A phenomenological approach was undertaken, given the unique pandemic situation and the need to gain a deep understanding of the experience and decision making of SME entrepreneurs and managers. Data collection was undertaken via in-depth, semi-structured interviews and observations within eight small and medium companies and one large corporate (key informant). The study identified the definitions of SCP that set it apart from CSR. The study also investigated how entrepreneurs and SME decision makers appraised and managed CSR projects and identified if this was undertaken separately from philanthropic activities. Qualitative data analysis was undertaken via cognitive mapping and template analysis. Findings This research echoed Kubíčková’s (2018) review of the current literature relating to SCP. Kubíčková stated that turning corporate philanthropy into measurable projects will benefit both society and corporations alike, and this seems to have been confirmed by this research. The respondents in this study felt that their philanthropic activities were driven by a deep-seated desire to “do good” and a desire to “support their local community.” They felt that their local community was an important stakeholder and as important as their customers. The data indicated that SMEs that publicised their CSR and SCP activities seemed to have a positive effect on the SME’s company and on the organisations they supported. Respondents involved their staff with all their CSR and SCP activities, from inception through to completion. The research indicated that the pandemic had a great effect on the day-to-day business of all participants, affecting staff numbers, staff morale and income, which in turn influenced their philanthropic activities. Companies adapted by adjusting their resource allocation and by focusing on local causes. Companies that held fundraising events in the past reverted to hosting online events and sponsoring local projects and clubs. The data indicated that COVID-19 had urged people to take a closer look at their own neighbours and communities and that the focus moved away from supporting international causes in favour of local community causes. This could have a knock-on effect for the income streams of international charities. Recommendations Key recommendations of this study (Chapter 7) are as follows: • Charities should build relationships with SMEs and not just larger corporates. • National and international charities are advised to establish community projects and team up with local businesses and organisations. • Government should consider reinstating the mandatory reporting of corporate giving (as part of the Companies Act), as was the case in 2013. • The United Nations’ Sustainable Development Goals (SDGs) could be simplified for use by SMEs. • Corporate Social Responsibility (CSR) and Strategic Corporate Philanthropy (SCP) could be defined and managed separately for better results and impact. This study found that most literature (both academic and practice) relating to CSR and SCP mostly focused on larger corporates and not on SMEs. The study found a gap in the literature with regards to defining, managing, and appraising SCP from the perspective of an SME. Originality The originality and distinctiveness of this research project is found in the development of a bespoke SCP Appraisal Tool for SMEs and the research done relating to corporate giving by SMEs during the COVID-19 pandemic, as this has never been done before

Interpretation of a microbe: Historicizing anthrax in Bangladesh

This discursive essay considers the role of interpretation in the modern public health laboratory through the lens of biopolitics, and analyses with a case study of anthrax in Bangladesh, the consequent social effects incurred by the global health in-security dispositif. The laboratory blazes a trail between the unknown chaotic world of disease with a sensorially perceptible, structured and ordered world. The findings of the laboratory became part of a narrative structure where healers interpret a coherent set of symbols through emplotment that involves the roles of performance and social action in healing enactments. The laboratory is shown to be an inscription device that transform bodily specimens into text that are symbolically represented and imbued with contextual interpretation. Public health laboratories have traditionally been seen as spaces where disinterested scientific inquiry yield objective facts for the protection of the population against infectious diseases. As such, the laboratory has continued to occupy a sacred position, its knowledge generating work – the social effects of science - escaping analysis. The historical development of the public health laboratory is traced from its inception, making visible it’s efficiency as a tool for the political administration and policing of life that has culminated in the post 9/11 phantasm of global health in-security. I show how discourses and the in-security dispositif shape the things of which they speak, reflecting a Northern fear and anxiety projected onto everyday life of the South, resulting in what can be described as an epidemiology of affect. A case study of anthrax in Bangladesh is used to illustrate the influence of particular power/knowledge relationships effected through the globalized health security agenda and how Northern fears and anxieties contaminate local conceptions and beliefs. Could the emerging infectious disease and health in-security dispositif reveal the affective spectrum of the North’s attraction to the exotic South and simultaneous repulsion by it, reminiscent of the eroticized narrative of New World imperialism? Has the biology of everyday life in the South become interpreted in the North in the symbol of the black woman

Challenges of a simplified opt-out consent process in a neonatal randomised controlled trial: a qualitative study of parents’ and health professionals’ views and experiences

Background: More effective recruitment strategies like alternative approaches to consent are needed to facilitate adequately powered trials. WithHolding Enteral feeds Around Transfusion (WHEAT) was a multicentre, randomised, pilot trial that compared withholding and continuing feeds around transfusion. The primary clinical outcome was necrotising enterocolitis (NEC). The trial used simplified opt-out consent with concise parent information and no consent form. Objective: To explore the views and experiences of parents and health professionals on the acceptability and feasibility of opt-out consent in randomised comparative effectiveness trials. Methods: A qualitative, descriptive interview-based study nested within a randomised trial. Semi-structured interview transcripts were analysed using inductive thematic analysis. Setting: Eleven neonatal units in England. Participants: Eleven parents and ten health professionals with experience of simplified consent. Results: Five themes emerged: ‘Opt-out consent operationalised as verbal opt-in consent’, ‘Opt-out consent normalises participation while preserving parental choice’, ‘Opt-out consent as an ongoing process of informed choice’, ‘Consent without a consent form’ and ‘Choosing to opt out of a comparative effectiveness trial’, with two subthemes: ‘Wanting “normal care”’ and ‘A belief that feeding is better’. Conclusions: Introducing a novel form of consent proved challenging in practice. The principle of simplified, opt-out approach to consent was generally considered feasible and acceptable by health professionals for a neonatal comparative effectiveness trial. The priority for parents was having the right to decide about trial participation, and they did not see opt-out consent as undermining this. Describing a study as ‘opt-out’ can help to normalise participation and emphasise that parents can withdraw consent

Using a game-based learning environment to develop the 4Cs

It is becoming increasingly difficult to ignore the disparity between learning environments, the needs of students, and the expectations of the ever-evolving workplace in South Africa. This study investigated the influence of a gamebased learning environment on the development of the 4Cs (communication, collaboration, creativity and critical thinking) that students need to be successful in their studies and subsequently in industry. The data for the study was collected by means of reflective essays that were written by 145 first-year engineering students only one month after the completion of the game-based activity. A focus group interview was conducted with six participants and it shed further light on the students' experiences. Their comments, harnessed by analysing their essays qualitatively, confirmed that a game-based learning environment provided opportunities to develop the 4Cs. Thus, the implementation of game-based learning environments in higher education should be further investigated.https://unisapressjournals.co.za/index.php/Progressiohj2023Science, Mathematics and Technology Educatio

Design principles for introducing 21st century skills by means of game-based learning

Educators are drawn into a battle for student attention and engagement in any learning environment. This article describes how a learning environment can be changed into a game-based activity to ensure student engagement. Modules aimed at the professional development of students present numerous challenges in the structuring of learning environments that develop communication, collaboration, creativity and critical thinking skills, the 4Cs of 21st century skills. This article is based on an activity designed for 145 engineering students and intended to habituate them to the university while simultaneously exposing them to opportunities for the development of the 4Cs. During the design, execution and refinement of the learning environment in five consecutive years, 15 design principles that could be employed to facilitate the implementation of a game-based learning activity emerged. Student reflection essays, lecturer observations, field notes and a focus group interview conducted with tutors and colleagues were analysed qualitatively to inform the investigation into students’ experiences of a game-based learning environment aimed at their professional development. The voices of the students were used to confirm the value of this environment. The design principles can be employed in other learning environments to support practitioners’ game-based learning efforts.http:/journals.sagepub.com/home/ihehj2023Science, Mathematics and Technology Educatio

Modeling the behavior of steel-fiber reinforced concrete ground slabs. I : development of material model

Steel-fiber reinforced concrete (SFRC) brings favorable properties to concrete ground slabs. The use of the material is limited by the lack of an appropriate analysis method. This paper is the first in a series of two regarding research aimed at providing a modeling approach that can be used to model the behavior of SFRC concrete and SFRC ground slabs. Here, an improved generalized analytical method is presented to determine the tensile stress-strain (σ-ε) response using an inverse analysis. The tensile σ-ε response is determined by using either the experimental moment-curvature (M-ϕ) or load-deflection (P-δ) responses. The validity of the inverse analysis is evaluated by comparing calculated and measured tensile σ-ε responses. The tensile σ-ε response is subsequently utilized in nonlinear finite-element analysis of an SFRC beam with the purpose of examining the tensile σ-ε relationship. The calculated results compare well with the experimental observations.http://pubs.asce.org/journals/transportation/default.ht

Modeling the behavior of steel-fiber reinforced concrete ground slabs. II : development of slab model

Steel Fibre Reinforced Concrete (SFRC) brings favourable properties to concrete pavements. The use of the material is limited by the lack of an appropriate analysis method. This paper is the second in a series of two aimed at providing a modelling approach, which can be used to model the behaviour of SFRC concrete and SFRC ground slabs. In this paper, a finite element model, capable of simulating the non-linear behaviour of the SFRC slab is proposed and compared to the slab’s experimental response. An approximate model describing the behaviour of the support layers is developed using results from a plate-bearing test. The same support model is adopted for the analysis of the combined structure of the slab and the support. The material model developed and tested in the first paper, for the SFRC containing 15 kg/m3 of steel fibres, is adopted for the analysis of the SFRC slabs. In addition, a parameter study is conducted to investigate the influence of concrete strength, steel fibre content and the support stiffness on the P-Δ response of SFRC ground slabs.http://ascelibrary.org/journal/jtpedihb2016Civil Engineerin