Bridging skills demand and supply in South Africa: the role of public and private intermediaries

Demand-led skills development requires linkages and coordination between firms and education and training organisations, which are major challenges considering that each represents a ‘self-interested’ entity. The need for a ‘collaborative project’ involving government, firms, universities and colleges, and other bodies is thus increasingly recognised. However, the crucial role of intermediaries has been largely overlooked. The article addresses this gap by investigating the main roles of public and private intermediaries across three case studies: sugarcane growing and milling, automotive component manufacturing, and the Square Kilometre Array sectoral systems of innovation. The research highlights the need for a move towards systemic thinking, to bridge across public and private objectives. It shows that private intermediaries play a larger role than is recognised in policy; that public–private intermediaries play crucial roles in coordination; and the potential for public intermediaries to contribute more effectively to systemic functioning

Multidrug resistant tuberculosis co-existing with aspergilloma and invasive aspergillosis in a 50 year old diabetic woman: a case report

Aspergilloma and invasive aspergillosis coexisting with multidrug resistant Mycobacterium tuberculosis (MDR-TB) in the same patient is a rare entity. We report a 50 year old South Indian woman, a diabetic, who presented to us with complaints of productive cough and hemoptysis for the past 2 months. She was diagnosed to have pulmonary tuberculosis 2 years ago for which she took irregular treatment. Lung imaging showed features of a thick walled cavity in the right upper lobe with an indwelling aspergilloma. She underwent a right lung upper lobe resection. Biopsy and culture of the resected specimen showed the coexistence of Aspergillus fumigatus and multi-drug resistant Mycobacterium tuberculosis. 2 blood cultures grew Aspergillus fumigatus. She was successfully treated with Voriconazole and anti tuberculous therapy against MDR-TB

Nectar, humidity, honey bees (Apis mellifera) and varroa in summer: a theoretical thermofluid analysis of the fate of water vapour from honey ripening and its implications on the control of Varroa destructor

This theoretical thermofluid analysis investigates the relationships between honey production rate, nectar concentration and the parameters of entrance size, nest thermal conductance, brood nest humidity and the temperatures needed for nectar to honey conversion. It quantifies and shows that nest humidity is positively related to the amount, and water content of the nectar being desiccated into honey and negatively with respect to nest thermal conductance and entrance size. It is highly likely that honeybees, in temperate climates and in their natural home, with much smaller thermal conductance and entrance, can achieve higher humidities more easily and more frequently than in man-made hives. As a consequence, it is possible that Varroa destructor, a parasite implicated in the spread of pathogenic viruses and colony collapse, which loses fecundity at absolute humidities of 4.3 kPa (approx. 30 gm−3) and above, is impacted by the more frequent occurrence of higher humidities in these low conductance, small entrance nests. This study provides the theoretical basis for new avenues of research into the control of varroa, via the modification of beekeeping practices to help maintain higher hive humidities

Environmental benefits of improved water and nitrogen management in irrigated sugar cane : a combined crop modelling and life cycle assessment approach

The application of irrigation water and nitrogen (N) fertilizer in excess of crop demand reduces profitability and has multiple detrimental impacts on the environment. N dynamics in agroecosystems are extremely complex, and mechanistic crop models are most often required to quantify the impact of improved management practices on reducing fertilizer N losses. In this study, Life Cycle Assessment (LCA) methodology and mechanistic modelling was used to quantify the environmental benefits of improved management of water and fertilizer N by sugarcane farmers in a case study in Pongola, South Africa. A baseline scenario, representing farmer intuition-based irrigation scheduling management, and two additional scenarios in which water, and water and N were more rationally managed, were compared. Results show that improved water and N management can lead to a 20% reduction in non-renewable energy consumption per functional unit (FU), with sustained or even increased yields. Total GHG emissions can potentially be reduced by 25% through more efficient water and N management. Limiting the rates of fertilizer N applied, made possible by decreasing N leaching through improved irrigation scheduling, resulted in the highest reductions for both impact categories. While total water consumption was very similar between the scenarios, more efficient use of rainfall was achieved through accurate scheduling, reducing blue water requirements. Through the simultaneous consideration of multiple environmental impacts, combining mechanistic crop modelling and LCA shows potential to identify improved management practices as well as to establish environmental stewardship incentives.L'application d'eau d'irrigation et d'engrais azotés (N) en excès par rapport à la demande des cultures réduit la profitabilité et a de multiples impacts négatifs sur l'environnement. La dynamique de l'azote dans les agrosystèmes est extrèmement complexe, et des modèles de culture mécanistes sont souvent nécessaires pour quantifier l'impact de pratiques de gestion améliorées sur la réduction des pertes en azote. Cette étude utilise la méthodologie de l'Analyse du Cycle de Vie (ACV) combinée à la modélisation mécaniste pour quantifier les bénéfices environnementaux d'une gestion améliorée de l'eau et des fertilisants azotés par des producteurs de canne à sucre, dans une étude de cas à Pongola, Afrique du Sud. Un scénario de base représente les pratiques courantes et intuitives des producteurs en termes d'irrigation, et deux scénarios supplémentaires représentent des pratiques de gestion plus rationnelles de l'eau, et de l'eau et des engrais, respectivement. Les résultats montrent qu'une meilleure gestion de l'eau et de l'azote peut générer une réduction de 20% de la consommation en énergie non-renouvelable, avec des rendements maintenus voire améliorés. Les émissions totales de GES peuvent potentiellement être réduites de 25%. La réduction des applications d'engrais, rendue possible par le moindre lessivage de l'azote sous irrigation raisonnée, résulte en de fortes réductions de ces deux catégories d'impacts. La consommation totale en eau est similaire entre scénario de base et scénarios de meilleure gestion de l'eau; cependant l'utilisation de l'eau de pluie est plus efficiente avec les irrigations raisonnées, réduisant ainsi les besoins d'extraction de la ressource. Par la prise en compte simultanée d'impacts environnementaux multiples, la combinaison de l'ACV et de la modélisation mécaniste de culture montre un potentiel pour identifier les pratiques améliorées et pour développer un accompagnement en éco-conception de systèmes.http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1531-03612016-04-30hb201

Genetic assessment of additional endophenotypes from the Consortium on the Genetics of Schizophrenia Family Study

The Consortium on the Genetics of Schizophrenia Family Study (COGS-1) has previously reported our efforts to characterize the genetic architecture of 12 primary endophenotypes for schizophrenia. We now report the characterization of 13 additional measures derived from the same endophenotype test paradigms in the COGS-1 families. Nine of the measures were found to discriminate between schizophrenia patients and controls, were significantly heritable (31 to 62%), and were sufficiently independent of previously assessed endophenotypes, demonstrating utility as additional endophenotypes. Genotyping via a custom array of 1536 SNPs from 94 candidate genes identified associations for CTNNA2, ERBB4, GRID1, GRID2, GRIK3, GRIK4, GRIN2B, NOS1AP, NRG1, and RELN across multiple endophenotypes. An experiment-wide p value of 0.003 suggested that the associations across all SNPs and endophenotypes collectively exceeded chance. Linkage analyses performed using a genome-wide SNP array further identified significant or suggestive linkage for six of the candidate endophenotypes, with several genes of interest located beneath the linkage peaks (e.g., CSMD1, DISC1, DLGAP2, GRIK2, GRIN3A, and SLC6A3). While the partial convergence of the association and linkage likely reflects differences in density of gene coverage provided by the distinct genotyping platforms, it is also likely an indication of the differential contribution of rare and common variants for some genes and methodological differences in detection ability. Still, many of the genes implicated by COGS through endophenotypes have been identified by independent studies of common, rare, and de novo variation in schizophrenia, all converging on a functional genetic network related to glutamatergic neurotransmission that warrants further investigation

Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012

OBJECTIVE: To provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," last published in 2008. DESIGN: A consensus committee of 68 international experts representing 30 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict of interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independent of any industry funding. A stand-alone meeting was held for all subgroup heads, co- and vice-chairs, and selected individuals. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. METHODS: The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations as strong (1) or weak (2). The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. Recommendations were classified into three groups: (1) those directly targeting severe sepsis; (2) those targeting general care of the critically ill patient and considered high priority in severe sepsis; and (3) pediatric considerations. RESULTS: Key recommendations and suggestions, listed by category, include: early quantitative resuscitation of the septic patient during the first 6 h after recognition (1C); blood cultures before antibiotic therapy (1C); imaging studies performed promptly to confirm a potential source of infection (UG); administration of broad-spectrum antimicrobials therapy within 1 h of the recognition of septic shock (1B) and severe sepsis without septic shock (1C) as the goal of therapy; reassessment of antimicrobial therapy daily for de-escalation, when appropriate (1B); infection source control with attention to the balance of risks and benefits of the chosen method within 12 h of diagnosis (1C); initial fluid resuscitation with crystalloid (1B) and consideration of the addition of albumin in patients who continue to require substantial amounts of crystalloid to maintain adequate mean arterial pressure (2C) and the avoidance of hetastarch formulations (1B); initial fluid challenge in patients with sepsis-induced tissue hypoperfusion and suspicion of hypovolemia to achieve a minimum of 30 mL/kg of crystalloids (more rapid administration and greater amounts of fluid may be needed in some patients (1C); fluid challenge technique continued as long as hemodynamic improvement is based on either dynamic or static variables (UG); norepinephrine as the first-choice vasopressor to maintain mean arterial pressure ≥65 mmHg (1B); epinephrine when an additional agent is needed to maintain adequate blood pressure (2B); vasopressin (0.03 U/min) can be added to norepinephrine to either raise mean arterial pressure to target or to decrease norepinephrine dose but should not be used as the initial vasopressor (UG); dopamine is not recommended except in highly selected circumstances (2C); dobutamine infusion administered or added to vasopressor in the presence of (a) myocardial dysfunction as suggested by elevated cardiac filling pressures and low cardiac output, or (b) ongoing signs of hypoperfusion despite achieving adequate intravascular volume and adequate mean arterial pressure (1C); avoiding use of intravenous hydrocortisone in adult septic shock patients if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability (2C); hemoglobin target of 7-9 g/dL in the absence of tissue hypoperfusion, ischemic coronary artery disease, or acute hemorrhage (1B); low tidal volume (1A) and limitation of inspiratory plateau pressure (1B) for acute respiratory distress syndrome (ARDS); application of at least a minimal amount of positive end-expiratory pressure (PEEP) in ARDS (1B); higher rather than lower level of PEEP for patients with sepsis-induced moderate or severe ARDS (2C); recruitment maneuvers in sepsis patients with severe refractory hypoxemia due to ARDS (2C); prone positioning in sepsis-induced ARDS patients with a PaO (2)/FiO (2) ratio of ≤100 mm Hg in facilities that have experience with such practices (2C); head-of-bed elevation in mechanically ventilated patients unless contraindicated (1B); a conservative fluid strategy for patients with established ARDS who do not have evidence of tissue hypoperfusion (1C); protocols for weaning and sedation (1A); minimizing use of either intermittent bolus sedation or continuous infusion sedation targeting specific titration endpoints (1B); avoidance of neuromuscular blockers if possible in the septic patient without ARDS (1C); a short course of neuromuscular blocker (no longer than 48 h) for patients with early ARDS and a PaO (2)/FI O (2) 180 mg/dL, targeting an upper blood glucose ≤180 mg/dL (1A); equivalency of continuous veno-venous hemofiltration or intermittent hemodialysis (2B); prophylaxis for deep vein thrombosis (1B); use of stress ulcer prophylaxis to prevent upper gastrointestinal bleeding in patients with bleeding risk factors (1B); oral or enteral (if necessary) feedings, as tolerated, rather than either complete fasting or provision of only intravenous glucose within the first 48 h after a diagnosis of severe sepsis/septic shock (2C); and addressing goals of care, including treatment plans and end-of-life planning (as appropriate) (1B), as early as feasible, but within 72 h of intensive care unit admission (2C). Recommendations specific to pediatric severe sepsis include: therapy with face mask oxygen, high flow nasal cannula oxygen, or nasopharyngeal continuous PEEP in the presence of respiratory distress and hypoxemia (2C), use of physical examination therapeutic endpoints such as capillary refill (2C); for septic shock associated with hypovolemia, the use of crystalloids or albumin to deliver a bolus of 20 mL/kg of crystalloids (or albumin equivalent) over 5-10 min (2C); more common use of inotropes and vasodilators for low cardiac output septic shock associated with elevated systemic vascular resistance (2C); and use of hydrocortisone only in children with suspected or proven "absolute"' adrenal insufficiency (2C). CONCLUSIONS: Strong agreement existed among a large cohort of international experts regarding many level 1 recommendations for the best care of patients with severe sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for this important group of critically ill patients