A retrospective study assessing the clinical outcomes and costs of acute hepatitis A in Cape Town, South Africa

Background While some evidence has been demonstrated the cost-effectiveness of routine hepatitis A vaccination in middle-income countries, the evidence is still limited in other settings including in South Africa. Given this, the evidence base around the cost of care for hepatitis A needs to be developed towards considerations of introducing hepatitis A vaccines in the national immunisation schedule and guidelines. Objectives To describe the severity, clinical outcomes, and cost of hepatitis A cases presenting to two tertiary healthcare centers in Cape Town, South Africa. Methods We conducted a retrospective folder review of patients presenting with hepatitis A at two tertiary level hospitals providing care for urban communities of metropolitan Cape Town, South Africa. Patients included in this folder review tested positive for hepatitis A immunoglobulin M between 1 January 2008 and 1 March 2018. Results In total, 239 folders of hepatitis A paediatric patients < 15 years old and 212 folders of hepatitis A adult patients $$\ge$$ ≥ 15 years old were included in the study. Before presenting for tertiary level care, more than half of patients presented for an initial consultation at either a community clinic or general physician. The mean length of hospital stay was 7.45 days for adult patients and 3.11 days for paediatric patients. Three adult patients in the study population died as a result of hepatitis A infection and 29 developed complicated hepatitis A. One paediatric patient in the study population died as a result of hepatitis A infection and 27 developed complicated hepatitis A, including 4 paediatric patients diagnosed with acute liver failure. The total cost per hepatitis A hospitalisation was $1935.41 for adult patients and $563.06 for paediatric patients, with overhead costs dictated by the length of stay being the largest cost driver. Conclusion More than 1 in every 10 hepatitis A cases (13.3%) included in this study developed complicated hepatitis A or resulted in death. Given the severity of clinical outcomes and high costs associated with hepatitis A hospitalisation, it is important to consider the introduction of hepatitis A immunisation in the public sector in South Africa to potentially avert future morbidity, mortality, and healthcare spending.

INVESTIGATING LEARNER AUTONOMY OF EFL AND ESP STUDENTS AT THE TERTIARY LEVEL: CROSS-SECTIONAL STUDY

Learner autonomy is a concept developed to reiterate the need for life-long learning that goes beyond the prescribed curriculum and institutional settings. In addition, learner-centered approach shifts the burden of responsibility from teachers to learners, as learners are now obliged to take charge of their learning. In that respect, students at the tertiary level of education are expected to know how to learn, inclusive of what to learn and where to learn. In other words, they should be trained to organize their own learning, control and monitor their progress, and evaluate the results, whereas the current educational settings should be given the task to contribute to the development of learner autonomy that paves the way for life-long education. The participants in the research are EFL students from the department of English Language and Literature at Faculty of Philosophy, University of Priština in Kosovska Mitrovica, and ESP students from the Academy of Technical and Pre-School Vocational Studies Niš, Department Vranje. A Learner Autonomy Questionnaire developed by Zhang and Li (2004) was administered to measure students’ learner autonomy level. The aim of the paper is not only to outline the significance of taking control of one’s learning, but also to use certain tools in the EFL classroom that contribute to the process of building learner autonomy, as its pedagogical implication, including language learning strategies, project-based tasks, reflective journals, etc.

Environmental spreading of clinically relevant carbapenem-resistant gram-negative bacilli: the occurrence of blaKPC-or-NDM strains relates to local hospital activities

Background Aquatic matrices impacted by sewage may shelter carbapenem-resistant (CR) Gram-negative bacilli (GNB) harboring resistance genes of public health concern. In this study, sewage treatment plants (STPs) servicing well-defined catchment areas were surveyed for the presence of CR-GNB bearing carbapenemase genes (blaKPC or blaNDM). Results A total of 325 CR-GNB were recovered from raw (RS) and treated (TS) sewage samples as well as from water body spots upstream (UW) and downstream (DW) from STPs. Klebsiella-Enterobacter (KE) group amounted to 116 isolates (35.7%). CR-KE isolates were recovered from TS, DW (35.7%) and RS samples (44.2%) (p = 0.001); but not from UW samples. KE isolates represented 65.8% of all blaKPC or blaNDM positive strains. The frequency of blaKPC-or-NDM strains was positively associated with the occurrence of district hospitals located near STPs, as well as with the number of hospitalizations and of sewer connections serviced by the STPs. blaKPC-or-NDM strains were recovered from ST samples in 7 out of 14 STPs, including four tertiary-level STPs; and from 6 out of 13 DW spots whose RS samples also had blaKPC-or-NDM strains. Conclusions Clinically relevant GNB bearing blaKPC-or-NDM resist sewage treatments and spread into environmental aquatic matrices mainly from STPs impacted by hospital activities.

Looking for Shakespeare: The global and the local in Mauritian Shakespeare adaptation and classroom practice

This article considers manifestations of both global and local Shakespeares in Mauritius. It starts with Dev Virahsawmy’s Shakespeare adaptations – Toufann (1991) in particular – as a well-known point of reference, placing the globalisation of Shakespeare in a localised (Mauritian) space into perspective via a discussion of language and context. The authors then reflect on the use of YouTube in the teaching of Shakespeare in undergraduate classes at the University of Mauritius, with selected adverts and music videos exemplifying a new ‘mash-up’ form of Shakespeare. Both Shakespeare and YouTube are carriers/channels of culture; while Shakespeare remains an emblematic figure, however, tertiary level classroom practice challenges the notion that his works are ‘timeless’ and ‘universal’.

Using YouTube Videos to Enhance Learner Autonomy in Writing: A Qualitative Research Design

YouTube videos play a vital role as powerful educational resources for language learning and cultural understanding. Using authentic YouTube videos to develop students’ writing skills is not often applied, especially at tertiary level. The paper discusses the reasons YouTube should be used as inside and outside of classroom writing activities. Then the research design offers a review of literature relating to the use of YouTube videos in various fields of language education. Methods to implement the research including research tools and steps taken for data analysis are also recommended. The article ends with limitation of the use of YouTube videos and suggestions for further studies of the topic.