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Renewed interest is being shown in South Africa in the promotion of infrastructure for renewable energy (RE) to supplement the country's current energy-generation capacity and to break loose from its dependency on an unsustainable fossil-fuel-based energy-provision system. The latter system not only has unfavourable consequences for the environment, but is managed by a state-owned institution which since 2008 has been incapable of providing reliable electricity. RE infrastructure - especially for the generation of solar and wind energy - is a relatively new feature in the South African landscape. This paper examines the spatial distribution of the newly commissioned infrastructures for wind and solar energy (operational and under construction) and the role they can play in the diversification of the rural economies of parts of the country's Northern Cape, Western Cape and Eastern Cape provinces. First, literature on evolutionary economic geography, path dependence and new path creation is reviewed. Second, the role of a single energy provider - embedded in a monopolistic energy policy -in inhibiting the transition from a mainly fossil-fuel-based energy-provision system to a multisource (multi-owner) provision system is discussed. Third, the reasoning behind the siting of the infrastructures for solar and wind energy in three particular provinces is explained. Fourth, the possible roles these new infrastructures can play in the diversification of the rural economies where they occur are advanced. The paper concludes that solar- and wind-energy projects have the ability to transform the South African energy context and that these projects present some positive socio-economic impacts for rural economies in the three particular provinces. The paper also recommends that future research efforts should be aimed at the evolution of this socioeconomic transformation by taking into account the pre-development context of the areas under study.

Despite new Hepatitis C virus (HCV) therapeutic advances, challenges remain for HCV testing and linking patients to care. A point-of-care (POC) HCV antibody testing strategy was compared to traditional serological testing to determine patient preferences for type of testing and linkage to treatment in an innovative mobile medical clinic (MMC). From 2012 to 2013, all 1,345 MMC clients in New Haven, CT underwent a routine health assessment, including for HCV. Based on patient preferences, clients could select between standard phlebotomy or POC HCV testing, with results available in approximately 1 week versus 20 min, respectively. Outcomes included: (1) accepting HCV testing; (2) preference for rapid POC HCV testing; and (3) linkage to HCV care. All clients with reactive test results were referred to a HCV specialty clinic. Among the 438 (32.6 %) clients accepting HCV testing, HCV prevalence was 6.2 % (N = 27), and 209 (47.7 %) preferred POC testing. Significant correlates of accepting HCV testing was lower for the “baby boomer” generation (AOR 0.67; 95 % CI 0.46–0.97) and white race (AOR 0.55; 95 % CI 0.36–0.78) and higher for having had a prior STI diagnosis (AOR 5.03; 95 % CI 1.76–14.26), prior injection drug use (AOR 2.21; 95 % CI 1.12–4.46), and being US-born (AOR 1.76; 95 % CI 1.25–2.46). Those diagnosed with HCV and preferring POC testing (N = 16) were significantly more likely than those choosing standard testing (N = 11) to be linked to HCV care within 30 days (93.8 vs. 18.2 %; p < 0.0001). HCV testing is feasible in MMCs. While patients equally preferred POC and standard HCV testing strategies, HCV-infected patients choosing POC testing were significantly more likely to be linked to HCV treatment. Important differences in risk and background were associated with type of HCV testing strategy selected. HCV testing strategies should be balanced based on costs, convenience, and ability to link to HCV treatment.

Purpose – Inquiry-based approaches can potentially enrich sustainability learning in any educational context, more so in open and distance learning (ODL – perceived as theoretically inclined) and in regions of educational need (such as the Global South, of which Africa forms part). The purpose of this paper is to map the benefits and challenges of using inquiry-based learning (IBL), with reference to ODL and the value added by IBL in terms of education for sustainability (EfS) in Africa. Design/methodology/approach – Evidence-based reflection is used to provide a narrative assessment of the experience gained with IBL in two undergraduate sustainability-focussed modules in the Department of Geography at the University of South Africa (Unisa), an ODL provider in Africa and the Global South. Findings – Consideration of enabling and limiting factors indicates that although constraints are experienced, adoption of IBL approaches holds potential as pedagogic for EfS in Africa, due to grounding of learning in theory and applied to local places/contexts. This indicates a role for IBL to change perceptions regarding the lack of practical utility of ODL. Originality/value – Implementing place-based and contextual IBL is innovative in ODL. It adds value to learning experiences and supports transformative learning, both important components of EfS and addressing a need in the African context. Practitioners will find the experience gained with implementation of IBL, coupled with possibilities associated with information and communication technologies, of value.

Although chronic hepatitis B and chronic hepatitis C are diseases of public health importance, only a few health departments nationally have chronic viral hepatitis under surveillance; these programs rely primarily on direct reporting by medical laboratories. We conducted an evaluation to determine if lessons from these programs can guide other health departments. Between December 2002 and February 2003, we visited the Connecticut Department of Public Health, the Multnomah County Health Department in Portland, Oregon, and the Minnesota Department of Health to determine the capacity of their chronic hepatitis registries to monitor trends and provide case management. We found that the registries facilitated investigations of potentially acute cases by identifying previously known infections, and aided prevention planning by pinpointing areas where viral hepatitis was being diagnosed. For chronic cases, case management (defined as the process of ensuring that infected individuals and their partners receive medical evaluation, counseling, vaccination, and referral to specialists for treatment when indicated) was provided for hepatitis B in Multnomah County, but was limited in other programs; barriers included resource constraints, difficulties confirming chronic infection, and privacy concerns. Finding innovative ways to overcome these barriers and improve case management is important if chronic hepatitis surveillance is to realize its full potential.

Now that very clear thinking is needed, the American voter isn't even able to discern for himself that someone who lied to get a first term is likely to lie to get a second term. As [Bill Clinton] positions himself closer and closer to the right to get votes, he knowsthat our educational system has taught people the lie of socialism, the lie of no moral absolutes and the lie that our country was not founded in Christian beliefs.

In my opinion, [Bill Clinton] has sent a clear signal to the American people. It doesn't matter what you do in your personal or public life to achieve and maintain power.

[Ralph Adam Fine] referred to the quality of life he felt as a child growing up in Harlem in New York City, and the quality of life that is there now. Can this happen in Wisconsin? You bet it can! Most of us feel a great deal less safe than we did even 10 years ago.

HIV-associated tuberculosis is difficult to diagnose and results in high mortality. Frequent extra-pulmonary presentation, inability to obtain sputum, and paucibacillary samples limits the usefulness of nucleic-acid amplification tests and smear microscopy. We therefore assessed a urine-based, lateral flow, point-of-care, lipoarabinomannan assay (LAM) and the effect of a LAM-guided anti-tuberculosis treatment initiation strategy on mortality. We did a pragmatic, randomised, parallel-group, multicentre trial in ten hospitals in Africa—four in South Africa, two in Tanzania, two in Zambia, and two in Zimbabwe. Eligible patients were HIV-positive adults aged at least 18 years with at least one of the following symptoms of tuberculosis (fever, cough, night sweats, or self-reported weightloss) and illness severity necessitating admission to hospital. Exclusion criteria included receipt of any anti-tuberculosis medicine in the 60 days before enrolment. We randomly assigned patients (1:1) to either LAM plus routine diagnostic tests for tuberculosis (smear microscopy, Xpert-MTB/RIF, and culture; LAM group) or routine diagnostic tests alone (no LAM group) using computer-generated allocation lists in blocks of ten. All patients were asked to provide a urine sample of at least 30 mL at enrolment, and trained research nurses did the LAM test in patients allocated to this group using the Alere Determine tuberculosis LAM Ag lateral flow strip test (Alere, USA) at the bedside on enrolment. On the basis of a positive test result, the nurses made a recommendation for initiating anti-tuberculosis treatment. The attending physician made an independent decision about whether to start treatment or not. Neither patients nor health-care workers were masked to group allocation and test results. The primary endpoint was 8-week all-cause mortality assessed in the modified intention-to-treat population (those who received their allocated intervention). This trial is registered with ClinicalTrials.gov, number NCT01770730. Between Jan 1, 2013, and Oct 2, 2014, we screened 8728 patients and randomly assigned 2659 to treatment (1336 to LAM, 1323 to no LAM). 108 patients did not receive their allocated treatment, mainly because they did not meet the inclusion criteria, and 23 were excluded from analysis, leaving 2528 in the final modified intention-to-treat analysis (1257 in the LAM group, 1271 in the no LAM group). Overall all-cause 8-week mortality occurred in 578 (23%) patients, 261 (21%) in LAM and 317 (25%) in no LAM, an absolute reduction of 4% (95% CI 1–7). The risk ratio adjusted for country was 0·83 (95% CI 0·73–0·96), p=0·012, with a relative risk reduction of 17% (95% CI 4–28). With the time-to-event analysis, there were 159 deaths per 100 person-years in LAM and 196 per 100 person-years in no LAM (hazard ratio adjusted for country 0·82 [95% CI 0·70–0·96], p=0·015). No adverse events were associated with LAM testing. Bedside LAM-guided initiation of anti-tuberculosis treatment in HIV-positive hospital inpatients with suspected tuberculosis was associated with reduced 8-week mortality. The implementation of LAM testing is likely to offer the greatest benefit in hospitals where diagnostic resources are most scarce and where patients present with severe illness, advanced immunosuppression, and an inability to self-expectorate sputum. The European & Developing Countries Clinical Trials Partnership, the South African Medical Research Council, and the South African National Research Foundation.

In animals and plants, the H3K9me3 and H3K27me3 chromatin silencing marks are deposited by different protein machineries. H3K9me3 is catalyzed by the SET-domain SU(VAR)3–9 enzymes, while H3K27me3 is catalyzed by the SET-domain Enhancer-of-zeste enzymes, which are the catalytic subunits of Polycomb Repressive Complex 2 (PRC2). Here, we show that the Enhancer-of-zeste-like protein Ezl1 from the unicellular eukaryote Paramecium tetraurelia , which exhibits significant sequence and structural similarities with human EZH2, catalyzes methylation of histone H3 in vitro and in vivo with an apparent specificity toward K9 and K27. We find that H3K9me3 and H3K27me3 co-occur at multiple families of transposable elements in an Ezl1-dependent manner. We demonstrate that loss of these histone marks results in global transcriptional hyperactivation of transposable elements with modest effects on protein-coding gene expression. Our study suggests that although often considered functionally distinct, H3K9me3 and H3K27me3 may share a common evolutionary history as well as a common ancestral role in silencing transposable elements. H3K9me3 and H3K27me3 chromatin silencing marks are usually deposited by different SET-domain proteins. Here the authors show that the Enhancer-of-zeste-like protein Ezl1, from the unicellular eukaryote Paramecium tetraurelia , catalyzes methylation of histone H3 in vitro and in vivo with an apparent specificity toward K9 and K27, and controls the repression of transposable elements.

People experiencing homelessness (PEH) face complex health and social care needs, contributing to poor health outcomes and premature mortality. The Pharmacy Homeless Outreach Engagement Non-medical Independent prescribing Rx (PHOENIx) intervention was developed to address these challenges through assertive outreach by NHS pharmacist independent prescribers working with third sector homelessness charity workers for PEH presenting to community pharmacy. This qualitative study aims to explore participant, healthcare professional, and stakeholder perceptions of the PHOENIx intervention and acceptability of trial procedures. Semi-structured interviews were conducted with trial participants, internal stakeholders (healthcare professionals/researchers), and external stakeholders (national and local) across two intervention sites (Glasgow and Birmingham) between March 2023 and February 2024. Data was analysed thematically using Normalisation Process Theory (NPT) as a conceptual framework. Participants (n = 26; usual care n = 7; intervention n = 19) viewed PHOENIx as distinctively comprehensive, consistent, and caring, valuing its holistic approach and the trusting relationships developed with the team. Stakeholders (n = 16; internal n = 5; external n = 11) recognised PHOENIx's potential to fill gaps in current service provision for PEH, appreciating its flexible, outreach-based model. Challenges identified included resource constraints, integration with existing services, and concerns about long-term sustainability. The PHOENIx intervention shows promise in providing accessible, comprehensive healthcare which was acceptable to PEH. Its success in engaging this underserved population offers valuable lessons for service development. However, addressing challenges around resources, scalability, and sustainability will be important considerations for a future trial and wider implementation and expansion.