Successful paediatric HIV treatment in rural primary care in Africa

<p>Objective: Clinical outcomes of HIV-infected children on antiretroviral treatment (ART) in a decentralised, nurse/counsellor-led programme.</p> <p>Design: Clinical cohort.</p> <p>Setting: KwaZulu-Natal, South Africa.</p> <p>Patients: HIV-infected children aged <= 15 years on ART, June 2004-2008.</p> <p>Main outcome measures: Survival according to baseline characteristics including age, WHO clinical stage, haemoglobin and CD4%, was assessed in Kaplan-Meier analyses. Hazard ratios for mortality were estimated using Cox proportional hazards regression and changes in laboratory parameters and weight-for-age z scores after 6-12 months' treatment were calculated.</p> <p>Results: 477 HIV-infected children began ART at a median age of 74 months (range 4-180), median CD4 count (CD4%) of 433 cells/mm(3) (17%) and median HIV viral load of log 4.2 copies/ml; 105 (22%) were on treatment for tuberculosis and 317 (76.6%) were WHO stage 3/4. There were significant increases after ART initiation in CD4% (17% vs 22%; p<0.001), haemoglobin (9.9 vs 11.7 g/l; p <= 0.001) and albumin (30 vs 36 g/l; p <= 0.001). 32 (6.7%) children died over 732 child-years of follow-up (43.7 deaths/1000 child-years; 95% CI 32.7 to 58.2), 17 (53.1%) within 90 days of treatment initiation; median age of death was 84 (IQR 10-181) months. Children with baseline haemoglobin <= 8 g/l were more likely to die (adjusted HR 4.5; 95% CI 1.6 to 12.3), as were those aged <18 months compared with >60 months (adjusted HR 3.2; 95% CI 1.2 to 9.1).</p> <p>Conclusions Good clinical outcomes in HIV-infected children on ART are possible in a rural, decentralised service. Few young children are on ART, highlighting the urgent need to identify HIV-exposed infants.</p&gt

Dar Al Gani 896: A unique picritic achondrite

Accepted versio

Computer Programs for Calculating and Plotting the Stability Characteristics of a Balloon Tethered in a Wind

Computer programs for calculating the stability characteristics of a balloon tethered in a steady wind are presented. Equilibrium conditions, characteristic roots, and modal ratios are calculated for a range of discrete values of velocity for a fixed tether-line length. Separate programs are used: (1) to calculate longitudinal stability characteristics, (2) to calculate lateral stability characteristics, (3) to plot the characteristic roots versus velocity, (4) to plot the characteristic roots in root-locus form, (5) to plot the longitudinal modes of motion, and (6) to plot the lateral modes for motion. The basic equations, program listings, and the input and output data for sample cases are presented, with a brief discussion of the overall operation and limitations. The programs are based on a linearized, stability-derivative type of analysis, including balloon aerodynamics, apparent mass, buoyancy effects, and static forces which result from the tether line

Agreement between methods of measurement with multiple observations per individual

Limits of agreement provide a straightforward and intuitive approach to agreement between different methods for measuring the same quantity. When pairs of observations using the two methods are independent, i.e., on different subjects, the calculations are very simple and straightforward. Some authors collect repeated data, either as repeated pairs of measurements on the same subject, whose true value of the measured quantity may be changing, or more than one measurement by one or both methods of an unchanging underlying quantity. In this paper we describe methods for analysing such clustered observations, both when the underlying quantity is assumed to be changing and when it is not

Magnetoswitching of current oscillations in diluted magnetic semiconductor nanostructures

Strongly nonlinear transport through Diluted Magnetic Semiconductor multiquantum wells occurs due to the interplay between confinement, Coulomb and exchange interaction. Nonlinear effects include the appearance of spin polarized stationary states and self-sustained current oscillations as possible stable states of the nanostructure, depending on its configuration and control parameters such as voltage bias and level splitting due to an external magnetic field. Oscillatory regions grow in size with well number and level splitting. A systematic analysis of the charge and spin response to voltage and magnetic field switching of II-VI Diluted Magnetic Semiconductor multiquantum wells is carried out. The description of stationary and time-periodic spin polarized states, the transitions between them and the responses to voltage or magnetic field switching have great importance due to the potential implementation of spintronic devices based on these nanostructures.Comment: 14 pages, 4 figures, Revtex, to appear in PR

Discrete emotion-congruent false memories in the DRM paradigm

Research has shown that false memory production is enhanced for material that is emotionally congruent with the mood of the participant at the time of encoding. So far this research has only examined the influence of generic negative affective mood states and generic negative stimuli on false memory production. In addition, much of the research is limited as it focuses on valence and arousal dimensions, and fails to take into account the more comprehensive nature of emotions. The current study demonstrates that this effect goes beyond general negative or positive moods and acts at a more discrete emotional level. Participants underwent a standard emotion induction procedure before listening to negative emotional or neutral associative word lists. The emotions induced, negative word lists and associated non-presented critical lures, were related to either fear or anger, two negative valence emotions that are also both high in arousal. Results showed that when valence and arousal are controlled for, false memories are more likely to be produced for discrete emotionally congruent compared to incongruent materials. These results support spreading activation theories of false remembering and add to our understanding of the adaptive nature of false memory production

Threshold Resummation for W-Boson Production at RHIC

We study the resummation of large logarithmic perturbative corrections to the partonic cross sections relevant for the process pp -> W^+- X at the BNL Relativistic Heavy Ion Collider (RHIC). At RHIC, polarized protons are available, and spin asymmetries for this process will be used for precise measurements of the up and down quark and anti-quark distributions in the proton. The corrections arise near the threshold for the partonic reaction and are associated with soft-gluon emission. We perform the resummation to next-to-leading logarithmic accuracy, for the rapidity-differential cross section. We find that resummation leads to relatively moderate effects on the cross sections and spin asymmetries.Comment: 25 pages, 15 figures as eps files. One reference added and typo correcte

Human resources needs for universal access to antiretroviral therapy in South Africa: a time and motion study

<p>Background - Although access to life-saving treatment for patients infected with HIV in South Africa has improved substantially since 2004, treating all eligible patients (universal access) remains elusive. As the prices of antiretroviral drugs have dropped over the past years, availability of human resources may now be the most important barrier to achieving universal access to HIV treatment in Africa. We quantify the number of HIV health workers (HHWs) required to be added to the current HIV workforce to achieve universal access to HIV treatment in South Africa, under different eligibility criteria.</p> <p>Methods - We performed a time and motion study in three HIV clinics in a rural, primary care-based HIV treatment program in KwaZulu-Natal, South Africa, to estimate the average time per patient visit for doctors, nurses, and counselors. We estimated the additional number of HHWs needed to achieve universal access to HIV treatment within one year.</p> <p>Results - For universal access to HIV treatment for all patients with a CD4 cell count of ≤350 cells/μl, an additional 2,200 nurses, 3,800 counselors, and 300 doctors would be required, at additional annual salary cost of 929 million South African rand (ZAR), equivalent to US$141 million. For universal treatment (‘treatment as prevention’), an additional 6,000 nurses, 11,000 counselors, and 800 doctors would be required, at an additional annual salary cost of ZAR 2.6 billion (US$ 400 million).</p> <p>Conclusions - Universal access to HIV treatment for patients with a CD4 cell count of ≤350 cells/μl in South Africa may be affordable, but the number of HHWs available for HIV treatment will need to be substantially increased. Treatment as prevention strategies will require considerable additional financial and human resources commitments.</p&gt

Rapid testing may not improve uptake of HIV testing and same day results in a rural South African community: a cohort study of 12,000 women

<p>Background: Rapid testing of pregnant women aims to increase uptake of HIV testing and results and thus optimize care. We report on the acceptability of HIV counselling and testing, and uptake of results, before and after the introduction of rapid testing in this area.</p> <p>Methods and Principal Findings: HIV counsellors offered counselling and testing to women attending 8 antenatal clinics, prior to enrolment into a study examining infant feeding and postnatal HIV transmission. From August 2001 to April 2003, blood was sent for HIV ELISA testing in line with the Prevention of Mother-to-Child Transmission (PMTCT) programme in the district. From May 2003 to September 2004 women were offered a rapid HIV test as part of the PMTCT programme, but also continued to have ELISA testing for study purposes. Of 12,323 women counselled, 5,879 attended clinic prior to May 2003, and 6,444 after May 2003 when rapid testing was introduced; of whom 4,324 (74.6%) and 4,810 (74.6%) agreed to have an HIV test respectively. Of the 4,810 women who had a rapid HIV test, only 166 (3.4%) requested to receive their results on the same day as testing, the remainder opted to return for results at a later appointment. Women with secondary school education were less likely to agree to testing than those with no education (AOR 0.648, p<0.001), as were women aged 21–35 (AOR 0.762, p<0.001) and >35 years (AOR 0.756, p<0.01) compared to those <20 years.</p> <p>Conclusions: Contrary to other reports, few women who had rapid tests accepted their HIV results the same day. Finding strategies to increase the proportion of pregnant women knowing their HIV results is critical so that appropriate care can be given.</p&gt