Efavirenz: A review of the epidemiology, severity and management of neuropsychiatric side-effects

South Africa has the highest proportion of HIV-positive people in the world. HIV cannot be cured; however, there are several major classes of drugs used in its management. Efavirenz is one such agent of the class non-nucleoside reverse transcriptase inhibitors which inhibits the replication of the virus. Efavirenz is associated with causing neuropsychiatric side-effects (NPSEs), with almost 50% of patients experiencing at least one NPSE while on treatment. The NPSEs tend to occur within the first few days of initiation of therapy and resolve spontaneously within the first 4 - 6 weeks, with the most commonly reported being dizziness, insomnia, headache, abnormal dreams and impaired concentration. The plasma level of efavirenz and genetic polymorphisms are thought to play a role in the development of such NPSEs. NPSEs need to be treated according to severity. If necessary, efavirenz may be replaced with nevirapine or lopinavir/ritonavir. It should be remembered that nevirapine may also produce some severe side-effects such as skin abnormalities and hepatotoxicity. The monitoring of patients receiving efavirenz therapy should be ongoing, with those with a history of mental illness requiring closer monitoring than others

The Revive Turbo Cleaner: Evaluating a product’s position and planning its launch in Germany

The Revive Turbo Cleaner is a cleaning fluid which removes carbon deposits from inside petrol or diesel engine systems. It is distributed internationally through wholesalers and sales agents to workshops and private car owners. After the acquisition of Revive Automotive Solutions Ltd by Bartec Auto ID Ltd in summer 2016, the new owners decided to further develop the brand and to move into the promising German automotive aftermarket, as the Cleaner had shown good sales figures in the home market UK and in a number of international markets. This paper examines environmental factors influencing the German marketplace, analyses Revive’s actual customer segments including consumers and business clients, provides profiles of its competitors and substituting technologies, regards the characteristics of the specific industry and defines the product’s qualities in order to draw a conclusion on the appropriate Marketing Mix to employ for the German market. In advance to the analytical work, the paper critically considers the range of theoretical frameworks used for the analysis, namely PESTEL, Porter’s Five Forces Analysis, the SWOT Analysis and the Marketing Mix in order to define and update original concepts as wells as adapt them to the research requirements

Dancing the Diaspora: Discovering the Influence of Traditional and Tribal African Dance in the History of African-American Social and Concert Dance in the Caribbean and the United States

The primary goal of this research project was to identify the influence of traditional African dance on African diasporic dance in the Caribbean and the United States. The study demonstrated how movement connects people and gives them the opportunity to share common experiences, ideas, and traditions. This qualitative and quantitative study was designed to answer four essential questions. Q1 What is traditional African dance? Q2 What is Black (Africanist) dance? Q3 How the elements of dance (Time, Space, Energy) can be used to help students make comparisons between African tribal dance and a variety of Africanist dance genres? Q4 How the elements of dance (Time, Space, Energy) might be used to create movements and dance phrases that represent various African and African diasporic dance genres? The research instruments used to analyze the data were pre-tests, posttests, and the researcher’s observation notes. This study was built around documents published by The Global Citizen Foundation, a non-profit organization that helps teachers develop values in their students. It is the Foundation’s belief that students need the ability to solve problems in real time, think and work creatively in both digital and nondigital environments to develop unique and useful solutions, think analytically, collaborate with others, and learn to be ethical and accountable (Wantabe-Crockett). One goal of the study was to provide dance educators with a standards-based dance curriculum that employs 21st Century Skills. Another objective was to make available a comprehensive unit for the dance study that was diverse, inclusive, and presented Africanist dance as a high form of artistic expression. One final objective of this study was to provide middle school dance educators with a unit of study that can be incorporated into a course of study for their dance classes. The study units were taught to approximately forty-five of the researcher’s middle school (grades six through eight) dance students; however, only seventeen completed and returned the required consent forms. Upon the conclusion of the study, the researcher noted several limitations were encountered that may have influenced the outcome. These limitations included unexpected severe weather, an acute outbreak of influenza, and the fact that the researcher was also the author, implementor, and observer in the study. Other limitations noted during the study included the research participants’ prior relationship with the researcher as her students and the large amount of material covered in the study. The outcome demonstrated the use of culturally inclusive dance education enriched participant learning. Participants increased ability to articulate their knowledge about Africanist dance was evident. Additionally, the researcher noted a greater confidence in the participants’ ability to create dance phrases that were representative of Africanist dance genres. Participants refined their 21st Century skills throughout the study using small group discussions, peer feedback, and group choreography collaborations. Further research is recommended to solidify current outcomes and to discover alternative outcomes as well

Notes per a la cronologia del cicle de l'Ars compendiosa inveniendi veritatem

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Examining Rural To Urban Migration, Crime And Characteristics Of Rural Migrants Offenders -- An Exploratory Study On The Relationship Between Rural Migration And Criminal Offenses Utilizing The Online Judicial Dataset In Guangdong Province

China has experienced massive internal migration in the past three decades. The rapidly growing urban population, especially the rural to urban migrant population, is the primary social concern with respect to public health and social stability that China is facing in recent decades. Both the public and private sectors have hastened to respond to the emerging needs of this socially, economically and politically marginalized group. In the current dissertation, the author utilizes judicial decisions from the Intermediate Level Courts in the Guangdong province, China, in order to examine the characteristics of rural migrant offenders, and to explore the relationship between rural migration and crime. The current study shows that rural migrants are overrepresented in the criminal defendant population in the Intermediate level of courts. Compared to urban offenders, rural migrant offenders are disproportionately represented as offenders who have committed typical street crimes. Rural migrant offenders are predominantly undereducated and underemployed at the time of offenses, and they have received relatively harsher fixed term sentences for the same type of offense compared to urban offenders. Theoretical interpretations and implications of the studyâs findings are discussed

Evaluating neuropsychiatric symptomology in HIV-positive patients on efavirenz in public-sector clinics and psychiatric hospitals

Background: South Africa has the highest number of people living with human immunodeficiency virus (HIV) infection in the world. In 2014, an estimated 10.2% of the population was HIV-positive which amounted to 5.51 million people. Efavirenz forms part of the triple therapy backbone used in South Africa and is part of the firstline treatment for HIV. Efavirenz has been strongly associated with causing neuropsychiatric side effects in at least 50.0% of patients to whom it is prescribed. These side effects cause hesitation amongst healthcare professionals to prescribe this agent to patients with active mental illnesses. Aim: The aim of the study was to evaluate the neuropsychiatric side effects of efavirenz in HIV-positive psychiatric and non-psychiatric patients and to determine whether this drug may be recommended for use in an HIV-positive psychiatric patient population. Method: The study was divided into two parts, namely a quantitative portion and a qualitative portion. The quantitative study was a prospective drug utilisation study, while the qualitative portion consisted of semi-structured interviews carried out with healthcare professionals working with people living with HIV/AIDS (PLWHA). The study included five municipal clinics in the Nelson Mandela Metropole as well as two public-sector psychiatric facilities in the Eastern Cape where medical records were reviewed to obtain the information required. Patients were followed in both instances for a period of 24 weeks with follow-up assessments carried out at two, four, 12 and 24 week intervals. In terms of the qualitative study, nurses at the clinics and doctors at the hospitals were contacted and appointments for interviews were made. The interviews were recorded using a voice recorder and were transcribed and analysed using theoretical framework analysis. Results: The review of 126 medical records at the clinics revealed that no patient had suffered from or complained of a neuropsychiatric side effect. This may indicate that patients were not suffering from clinically significant side effects, side effects were not being adequately recorded by healthcare staff, or the healthcare staff were not questioning patients regarding side effects. A total of 26 hospitalised patients were followed for 24 weeks in the psychiatric facilities. Almost half of the patients using efavirenz experienced an improvement in symptoms to the extent that they were iii discharged from the facility. The majority of patients (66.7%) not on an efavirenzcontaining regimen did not improve to the point of discharge. Healthcare staff were vague when providing a definition of neuropsychiatric side effects. There were conflicting ideas on whether or not efavirenz should be used in patients with an active psychiatric illness. Conclusions: Further studies need to be performed in public-sector institutions to obtain a clearer picture of the side effects experienced by patients using efavirenz. Healthcare staff need to be encouraged to keep complete records to allow for meaningful analysis. The further integration of mental health services into existing HIV programmes is essential for holistic treatment. Patients in psychiatric hospitals demonstrated that even patients with psychiatric disorders on efavirenz can experience positive outcomes and stabilisation of psychiatric symptoms, which may indicate that these may not have due to efavirenz use. Further elucidation concerning the use of efavirenz in patients with psychiatric disorders, a description of the neuropsychiatric side effects, as well as management strategies must be provided in subsequent HIV guidelines

Catalog of infrared observations including: Bibliography of infrared astronomy and index of infrared source positions

The Catalog of Infrared Observations and its Far Infrared Supplement summarize all infrared astronomical observations at infrared wavelengths published in the scientific literature between 1965 and 1982. The Catalog includes as appendices the Bibliography of infrared astronomy which keys observations in the Catalog with the original journal references, and the index of infrared source positions which gives source positions for alphabetically listed sources in the Catalog. The Catalog data base contains over 85,000 observations of about 10,000 infrared sources, of which about 2,000 have no known visible counterpart

Polityka bezpieczeństwa energetycznego Niemiec w XXI wieku

Praca recenzowana / Peer-reviewed paperZasadniczym celem monografii jest pogłębiona analiza procesu kształtowania i realizacji polityki bezpieczeństwa energetycznego Niemiec. Jest to zagadnienie o dużym znaczeniu teoretycznym i praktycznym, z implikacjami dla bezpieczeństwa energetycznego zarówno na poziomie Unii Europejskiej, jak również poszczególnych państw członkowskich. Powyższa problematyka wydaje się szczególnie ważna w Polsce ze względu na bezpośrednie sąsiedztwo z Niemcami i wyzwania wynikające z wdrażania pakietu energetyczno- -klimatycznego Unii Europejskiej w zakresie zmiany struktury zaopatrzenia energetycznego, uwzględniającego wymogi ochrony środowiska naturalnego.Projekt został zrealizowany ze środków przyznanych przez Narodowe Centrum Nauki (NCN)

Highly Pathogenic Avian Influenza A(H5N1) Virus in Wild Red Foxes, the Netherlands, 2021

We detected infection with highly pathogenic avian influenza A(H5N1) virus clade 2.3.4.4b in 2 red fox (Vulpes vulpes) cubs found in the wild with neurologic signs in the Netherlands. The virus is related to avian influenza viruses found in wild birds in the same area