South Africa has embarked on major health policy reform to deliver universal health coverage through the establishment of National Health Insurance (NHI). The aim is to improve access, remove financial barriers to care, and enhance care quality. Health technology assessment (HTA) is explicitly identified in the proposed NHI legislation and will have a prominent role in informing decisions about adoption and access to health interventions and technologies. The specific arrangements and approach to HTA in support of this legislation are yet to be determined. Although there is currently no formal national HTA institution in South Africa, there are several processes in both the public and private healthcare sectors that use elements of HTA to varying extents to inform access and resource allocation decisions. Institutions performing HTAs or related activities in South Africa include the National and Provincial Departments of Health, National Treasury, National Health Laboratory Service, Council for Medical Schemes, medical scheme administrators, managed care organizations, academic or research institutions, clinical societies and associations, pharmaceutical and devices companies, private consultancies, and private sector hospital groups. Existing fragmented HTA processes should coordinate and conform to a standardized, fit-for-purpose process and structure that can usefully inform priority setting under NHI and for other decision makers. This transformation will require comprehensive and inclusive planning with dedicated funding and regulation, and provision of strong oversight mechanisms and leadership.

Passive microwave satellite observations are used to identify the presence of surface meltwater across Antarctica at daily intervals from July 1979 to June 2020, with a focus on ice shelves. Antarctic Peninsula ice shelves have the highest number of annual days of melt, with a maximum of 89 days. Over the entire time period, there are few significant linear trends in days of melt per year. High melt years can be split into two distinct categories, those with high melt days in Dronning Maud Land and Wilkes Land, and those with high melt days in the Antarctic Peninsula and the Bellingshausen Sea sector of West Antarctica. The first pattern coincides with significant negative correlations between melt days and spring and summer Southern Annular Mode. Both patterns also form the primary modes of spatial and annual variability in the dataset observed by Principal Component Analysis. Areas experiencing extended melt for the first time in years tend to show large decreases in subsequent winter microwave emissions due to structural changes in the firn. We use this to identify the impact of novel melt events, particularly over the austral summers of 1991/92 and 2015/16 on the Ross Ice Shelf.

The study investigates sex differences in the prevalence of undernutrition in sub-Saharan Africa. Undernutrition was defined by Z-scores using the CDC-2000 growth charts. Some 128 Demographic and Health Surveys (DHS) were analysed, totalling 700,114 children under-five. The results revealed a higher susceptibility of boys to undernutrition. Male-to-female ratios of prevalence averaged 1.18 for stunting (height-for-age Z-score <−2.0); 1.01 for wasting (weight-for-height Z-score <−2.0); 1.05 for underweight (weight-for-age Z-score <−2.0); and 1.29 for concurrent wasting and stunting (weight-for-height and height-for-age Z-scores <−2.0). Sex ratios of prevalence varied with age for stunting and concurrent wasting and stunting, with higher values for children age 0–23 months and lower values for children age 24–59 months. Sex ratios of prevalence tended to increase with declining level of mortality for stunting, underweight and concurrent wasting and stunting, but remained stable for wasting. Comparisons were made with other anthropometric reference sets (NCHS-1977 and WHO-2006), and the results were found to differ somewhat from those obtained with CDC-2000. Possible rationales for these patterns are discussed.

Background: Infections are a frequent cause of hospital (re)admissions for older adults receiving home health care (HHC) in the United States. However, previous investigators have likely underestimated the prevalence of infections leading to hospitalization due to limitations of identifying infections using Outcome and Assessment Information Set (OASIS), the standardized assessment tool mandated for all Medicare-certified HHC agencies. By linking OASIS data with inpatient data from the Medicare Provider Analysis and Review (MedPAR) file, we were able to better quantify infection hospitalization trends and subsequent mortality among HHC patients. Method: After stratification (by census region, ownership, and urban or rural location) and random sampling, our data set consisted of 2,258,113 Medicare beneficiaries who received HHC services between January 1, 2013, and December 31, 2018, from 1,481 Medicare-certified HHC agencies. The 60-day HHC episodes were identified in OASIS. Hospital transfers reported in OASIS were linked with corresponding MedPAR records. Our outcomes of interest were (1) hospitalization with infection present on admission (POA); (2) hospitalization with infection as the primary cause; and (3) 30-day mortality following hospitalization with infection as the primary cause. We identified bacterial (including suspected) infections based on International Classification of Disease, Ninth Revision (ICD-9) and ICD-10 codes in MedPAR. We classified infections by site: respiratory, urinary tract, skin/soft tissue, intravenous catheter-related, and all (including other or unspecified infection site). We also identified sepsis diagnoses. Result: From 2013 through 2018, the percentage of 60-day HHC episodes with 1 or more hospital transfers ranged from 15% to 16%. Approximately half of all HHC patients hospitalized had an infection POA. Over the 6 years studied, infection (any type) was the primary cause of hospitalization in more than a quarter of all transfers (25.86%–27.57%). The percentage of hospitalizations due to sepsis increased from 7.51% in 2013 to 11.49% in 2018, whereas the percentage of hospitalizations due to respiratory, urinary tract, or skin/soft-tissue infections decreased (p <0.001). Thirty-day mortality following a transfer due to infection ranged from 14.14% in 2013 to 14.98% in 2018; mortality rates were highest following transfers caused by sepsis (23.14%-26.51%) and respiratory infections (13.07%-14.27%). Conclusion: HHC is an important source of post-acute care for those aging in place. Our findings demonstrate that infections are a persistent problem in HHC and are associated with substantial 30-day mortality, particularly following hospitalizations caused by sepsis, emphasizing the importance of infection prevention in HHC. Effective policies to promote best practices for infection prevention and control in the home environment are needed to mitigate infection risk.

Funding: No

Disclosures: None

Ethnohistoric accounts indicate that the people of Australia's Channel Country engaged in activities rarely recorded elsewhere on the continent, including food storage, aquaculture and possible cultivation, yet there has been little archaeological fieldwork to verify these accounts. Here, the authors report on a collaborative research project initiated by the Mithaka people addressing this lack of archaeological investigation. The results show that Mithaka Country has a substantial and diverse archaeological record, including numerous large stone quarries, multiple ritual structures and substantial dwellings. Our archaeological research revealed unknown aspects, such as the scale of Mithaka quarrying, which could stimulate re-evaluation of Aboriginal socio-economic systems in parts of ancient Australia.

Political polarization and generational politics are important topics in contemporary political science classrooms. This article presents an approach to teaching political polarization in an introduction to politics course. Coauthored by two Generation Z students from the course and their Boomer Generation professor, the article provides conflicting views of young people and politics as found in the work of Robert Putnam and Russell Dalton. The article presents survey data on affective and issue political polarization from the course, including discussion by the two student coauthors of the survey results interpreting their generation’s political polarization. The course approaches the introductory politics course using cognitive psychology concepts including confirmative bias, motivated reasoning, and other cognitive biases. Teaching from this micro-level perspective helps students to reflect on their own political biases. The article provides concepts and readings for political science professors to use in replicating the course.

It is increasingly common for models of shallow-layer overland flows to include equations for the evolution of the underlying bed (morphodynamics) and the motion of an associated sedimentary phase. We investigate the linear stability properties of these systems in considerable generality. Naive formulations of the morphodynamics, featuring exchange of sediment between a well-mixed suspended load and the bed, lead to mathematically ill-posed governing equations. This is traced to a singularity in the linearised system at Froude number ${\textit {Fr}} = 1$ that causes unbounded unstable growth of short-wavelength disturbances. The inclusion of neglected physical processes can restore well posedness. Turbulent momentum diffusion (eddy viscosity) and a suitably parametrised bed load sediment transport are shown separately to be sufficient in this regard. However, we demonstrate that such models typically inherit an associated instability that is absent from non-morphodynamic settings. Implications of our analyses are considered for simple generic closures, including a drag law that switches between fluid and granular behaviour, depending on the sediment concentration. Steady morphodynamic flows bifurcate into two states: dilute flows, which are stable at low ${\textit {Fr}}$, and concentrated flows which are always unstable to disturbances in concentration. By computing the growth rates of linear modes across a wide region of parameter space, we examine in detail the effects of specific model parameters including the choices of sediment erodibility, eddy viscosity and bed load flux. These analyses may be used to inform the ongoing development of operational models in engineering and geosciences.

In recent years, a variety of efforts have been made in political science to enable, encourage, or require scholars to be more open and explicit about the bases of their empirical claims and, in turn, make those claims more readily evaluable by others. While qualitative scholars have long taken an interest in making their research open, reflexive, and systematic, the recent push for overarching transparency norms and requirements has provoked serious concern within qualitative research communities and raised fundamental questions about the meaning, value, costs, and intellectual relevance of transparency for qualitative inquiry. In this Perspectives Reflection, we crystallize the central findings of a three-year deliberative process—the Qualitative Transparency Deliberations (QTD)—involving hundreds of political scientists in a broad discussion of these issues. Following an overview of the process and the key insights that emerged, we present summaries of the QTD Working Groups’ final reports. Drawing on a series of public, online conversations that unfolded at www.qualtd.net, the reports unpack transparency’s promise, practicalities, risks, and limitations in relation to different qualitative methodologies, forms of evidence, and research contexts. Taken as a whole, these reports—the full versions of which can be found in the Supplementary Materials—offer practical guidance to scholars designing and implementing qualitative research, and to editors, reviewers, and funders seeking to develop criteria of evaluation that are appropriate—as understood by relevant research communities—to the forms of inquiry being assessed. We dedicate this Reflection to the memory of our coauthor and QTD working group leader Kendra Koivu.1