The perspectives of users of antiretroviral therapy on structural barriers to adherence in South Africa

Background: The effectiveness of antiretroviral therapy (ART) and the importance of adherence to treatment regimens are widely known. Yet, suboptimal adherence to ART and retention in care of patients still persists and, by many accounts, is fairly widespread. The aim of this study was to identify the structural barriers that influenced adherence among patients who were enrolled in the national ART programme in South Africa.Method: In this qualitative study, semi-structured interviews were conducted with a sample of 10 patients receiving ART at a public hospital in South Africa.Results: The results of the interviews were categorised according to poverty-related, institution-related and social barriers to clinic attendance and pill-taking, which collectively formed the structural barriers to adherence. The chief structural barriers to clinic attendance were time away from work, transport expenses, long waiting times and negative experiences with clinic staff. The chief barriers to pill-taking were food insecurity, stigma and discrimination.Conclusion: The barriers to adherence are discussed. Attention is called to the extraindividual factors that influenced ART adherence. We conclude that contextual factors, such as a healthcare-enabling environment, might play an important role in influencing healthcare-promoting behaviour among patients

Die hermeneuse van die skrif met die oog op hedendaagse kerklik-etiese vraagstukke

Ons verstaan Hermeneutiek in die tradisionele sin. Ons gebruik die term dus nie in die sin van die sg. Nuwere Hermeneutiek, wat bykans die hele teologie onder “Hermeneutiek” as die hele proses van “verstaan” van die Skrifte wil insluk nie

Editorial

Intellectual disability in the Esidimeni tragedy: Silent death

The pressure fl ow relationship of the internal mammary artery after offpump anastomosis to the left anterior descending coronary artery

Objective: To assess the pressure flow relationship of the internal mammary artery (IMA) in situ, after skeletonisation and after anastomosis to the left anterior descending (LAD) coronary artery, using either halothane, sevoflurane or propofol as an anaesthetic agent. Methods: 15 Pigs were used in total, five received halothane, five sevoflurane and five propofol as an anaesthetic agent. The flow in the internal mammary artery in each of the pigs, was measured at various arterial pressures. This was done with the IMA in situ, then after dissecting the artery off the chest wall using the skeletonisation technique and finally after offpump grafting to the left anterior descending coronary artery. Results: The pressure flow relationship of the internal mammary artery after skeletonisation was found to be linear (r=0.8650). The pressure flow correlation after grafting the skeletonised internal mammary artery to the left anterior descending coronary artery was found to be similarly linear (r=0.8766). In the sevoflurane subgroup, with the IMA still in situ, a degree of autoregulation was found to be present, but after skeletonisation this was subsequently lost (p=0.011). Conclusions: The pressure flow relationship in the internal mammary artery after skeletonising the vessel and after OPCAB anastomosis to the LAD was found to be linear. In the subgroup of pigs receiving sevoflurane, some degree of autoregulation was demonstrated in the in situ IMA. This remnant of autoregulation was lost after skeletonisation and after grafting of the vessel to the left anterior descending coronary artery. SAHeart 2009; 6:222-22

Towards a Robuster Interpretive Parsing

The input data to grammar learning algorithms often consist of overt forms that do not contain full structural descriptions. This lack of information may contribute to the failure of learning. Past work on Optimality Theory introduced Robust Interpretive Parsing (RIP) as a partial solution to this problem. We generalize RIP and suggest replacing the winner candidate with a weighted mean violation of the potential winner candidates. A Boltzmann distribution is introduced on the winner set, and the distribution’s parameter $T$ is gradually decreased. Finally, we show that GRIP, the Generalized Robust Interpretive Parsing Algorithm significantly improves the learning success rate in a model with standard constraints for metrical stress assignment

Impact of oral meloxicam administered alone or in combination with gabapentin on experimentally induced lameness in beef calves

This study examined the pharmacokinetics and analgesic effect of oral meloxicam (MEL) administered alone or in combination with gabapentin (GABA) in an experimental bovine lameness model. Eighteen male British × Continental beef calves aged 4 to 6 mo and weighing 297 to 392 kg were randomly assigned to receive either 1) 0.5 mg/kg lactose monohydrate placebo (PLBO; n = 6), 2) 0.5 mg/kg MEL (n = 6), or 3) 0.5 mg/kg MEL combined with 15 mg/kg GABA (MEL-GABA; n = 6) once daily for 4 d. The first treatment was administered 4 h after a chemical synovitis/arthritis was induced with injection of 15 mg amphotericin B into the left hind lateral distal interphalangeal joint. Changes in activity were evaluated continuously with pedometers. Contact force, contact area, contact pressure, impulse, and stride length were recorded once daily with a pressure mat and visual lameness scores were determined by a masked observer using a 5-point scale. Cortisol and drug concentrations were determined daily by immunoassay and HPLC-mass spectrometry, respectively. Outcomes were compared statistically using a random effects mixed model and analysis of covariance. There was a positive association between lameness scores and serum cortisol concentrations (P = 0.02) and a negative association between lameness score and step count (P \u3c 0.0001), total force (P = 0.001), force applied to the lateral claw (P= 0.02), contact pressure (P = 0.005), and impulse of the lateral claw (P = 0.01). Step count was greater in MEL calves compared with PLBO (P = 0.008) and MEL-GABA (P = 0.04) calves. Impulse was greater in the MEL-GABA calves compared with the PLBO calves (P = 0.03). There was an inverse relationship between plasma MEL concentrations and lameness score (P = 0.02) and a positive association between MEL concentrations and force applied to the lateral claw (P = 0.03), total contact pressure (P = 0.03), and impulse on the lateral claw (P = 0.02). There was a tendency towards a positive association between GABA concentrations, total impulse, and impulse on the lateral claw (P = 0.08) and a negative associate between GABA concentrations and step count (P = 0.08). The results of this study suggest that MEL administered alone or in combination with GABA reduced the severity of lameness in calves following induction of lameness with amphotericin B. These findings have implications for developing analgesic protocols in lame calves that address both production and welfare concerns

Local forage fish abundance influences foraging effort and offspring condition in an endangered marine predator

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this record.All data will be archived in the Dryad Digital Repository and BirdLife Seabird Tracking Database.1. Understanding the functional relationship between marine predators and their prey is vital to inform ecosystem-based management. However, collecting concurrent data on predator behaviour and their prey at relevant scales is challenging. Moreover, opportunities to study these relationships in the absence of industrial fishing are extremely rare. 2. We took advantage of an experimental fisheries closure to study how local prey abundance influences foraging success and chick condition of Endangered African penguins Spheniscus demersus in the Benguela Ecosystem. 3. We tracked 75 chick-provisioning penguins with GPS-time-depth devices, measured body condition of 569 chicks, quantified the diet of 83 breeding penguins and conducted 12 forage fish hydro-acoustic surveys within a 20 km radius of Robben Island, South Africa, over three years (2011–2013). Commercial fishing for the penguins’ main prey, sardine Sardinops sagax and anchovy Engraulis encrasicolus, was prohibited within this 20 km radius during the study period. 4. Local forage fish abundance explained 60% of the variation in time spent diving for 14 penguins at sea within 2 days of a hydro-acoustic survey. Penguin foraging effort (time spent diving, number of wiggles per trip, number of foraging dives and the maximum distance travelled) increased and offspring body condition decreased as forage fish abundance declined. In addition, quantile regression revealed that variation in foraging effort increased as prey abundance around the colony declined. 5. Policy implications. Our results demonstrate that local forage fish abundance influences seabird foraging and offspring fitness. They also highlight the potential for offspring condition and the mean-variance relationship in foraging behaviour to act as leading indicators of poor prey abundance. By rapidly indicating periods where forage resources are scarce, these metrics could help limit seabird-fisheries competition and aid the implementation of dynamic ocean managemen

Antibiotic prescribing practices in the presence of Extended-spectrum β-lactamase (ESBL) positive organisms in an adult intensive care unit in South Africa – a pilot study

Introduction: Antimicrobial resistance is one of the most severe health threats globally. Extended spectrum β-lactamases (ESBLs) are enzymes produced by a variety of gram-negative bacteria, which lead to an increase in resistance to commonly used antibiotics and are associated with higher morbidity and mortality. Objectives: Assess the prescribing practices prior to, and after, positive ESBL producing microbiology cultures in an adult ICU setting, according to sensitivity reports obtained from the clinical laboratories from January 2013 until January 2014. Subsequently use the findings to guide future practice. Method: Retrospective study at a private hospital in Pretoria, Gauteng Province. All adult patients older than 18 years of age that were admitted to either the MICU or the TICU with a positive producing ESBL culture during their hospitalised stay were assessed. Results: During the study period, 39 patients in the MICU and TICU had positive ESBL microbiology results. The majority of positive ESBL results were due to Klebsiella pneumonia isolates. Antibiotics prescribed post ESBL positive culture were appropriate according to the sensitivity report in 64% of patients. 22 patients survived and 17 patients died. All the patients that died were on invasive ventilatory support. Conclusion: Clinically it appears as if patients who received appropriate therapy according to the microbiology results showed a better clinical outcome than those with inappropriate therapy. This underlines the importance of appropriate prescribing practices in combination with co-morbid conditions. Invasive ventilatory support can be identified as a clear risk for contracting an infection due to an ESBL producing organism