Effects of calcium antagonists on hypertension and diastolic function

Calcium antagonists are known to decrease blood pressure acutely and chronically in hypertensive patients with hypertensive heart disease, and also to improve their systolic function. However, disorders of diastolic function may occur early in hypertensive heart disease. The improvement of diastolic function by nifedipine and diltiazem is described, although it was difficult to exclude systolic unloading as a cause of the improvement. It is emphasised that diastolic dysfunction can exist in hypertensive heart disease, and that the calcium antagonists nifedipine and diltiazem can improve diastolic dysfunction.S Afr Med J 1989; 76: 89-9

Practice patterns of radiation therapy technology in Australia: results of a national audit

Introduction: This article presents the results of a single-day census of radiation therapy (RT) treatment and technology use in Australia. The primary aim of the study was to ascertain patterns of RT practice and technology in use across Australia. These data were primarily collated to inform curriculum development of academic programs, thereby ensuring that training is matched to workforce patterns of practice. Methods: The study design was a census method with all 59 RT centres in Australia being invited to provide quantitative summary data relating to patient case mix and technology use on a randomly selected but common date. Anonymous and demographic-free data were analysed using descriptive statistics. Results: Overall data were provided across all six Australian States by 29 centres of a possible 59, yielding a response rate of 49% and representing a total of 2743 patients. Findings from this study indicate the increasing use of emerging intensity-modulated radiotherapy (IMRT), image fusion and image-guided radiation therapy (IGRT) technology in Australian RT planning and delivery phases. IMRT in particular was used for 37% of patients, indicating a high uptake of the technology in Australia when compared to other published data. The results also highlight the resource-intensive nature of benign tumour radiotherapy. Conclusions: In the absence of routine national data collection, the single-day census method offers a relatively convenient means of measuring and tracking RT resource utilisation. Wider use of this tool has the potential to not only track trends in technology implementation but also inform evidence-based guidelines for referral and resource planning

Novel coronavirus mitigation measures implemented by radiotherapy centres in low and middle-income countries: a systematic review.

Background: The aim of the study was to identify strategies adopted by radiotherapy centres in low- and middle-income countries (LMICs) to mitigate the effects of COVID-19. Studies summarising COVID-19 mitigation strategies designed and implemented by radiotherapy centres in LMICs to avoid delays, deferrments and interruptions of radiotherapy services are lacking. Materials and methods: A systematic review was conducted and reported in accordance with the preferred reporting items for systematic review and meta-analysis guideline. Ovid Embase, Ovid MEDLINE and CINAHL were searched for peer-reviewed articles that reported measures adopted by radiotherapy centres in LMICs to reduce the risk of COVID-19. Information on different strategies were extracted from the included studies and textual narrative synthesis was conducted. Results: Of 60 articles retrieved, eleven were included. Majority of the studies were conducted in China. Ten of the included studies employed a qualitative design. Four themes were identified: preparing and equipping staff; reinforcing infection prevention and control policies; strengthening coordination and communication; and maintaining physical distancing. Studies reported that radiotherapy centres had: formed COVID-19 response multidisciplinary team; maximised the use of telehealth; adjusted the layout of waiting areas; divided staff into teams; dedicated a room for isolating suspected cases; and adopted triage systems. Conclusions: Local adaptation of established global strategies coupled with timely development of guidelines, flexibility and innovation have allowed radiotherapy leaders to continue to deliver radiotherapy services to cancer patients in LMICs during the COVID-19 crisis. Robust data collection must be encouraged in LMICs to provide an evidence-based knowledge for use in the event of another pandemic

Establishing local reference intervals for full blood count and white blood cell differential counts in Cape Town, South Africa

Background. Accurate laboratory reference intervals (RIs) are essential to differentiate between health and disease. There are variations in haematological indices within populations relating to gender, age, ethnicity and environment. Iron deficiency is common, has a wide range of clinical morbidities and affects red cell indices. Locally derived RIs for full blood count (FBC) parameters are needed for the Western Cape region of South Africa, after the exclusion of iron deficiency. In addition, information regarding the prevalence of iron deficiency in first-time blood donors would inform blood transfusion services regarding policies to screen for and treat iron deficiency.Objectives. To establish locally derived RIs for FBC and white blood cell (WBC) differential count parameters in healthy adults in the Cape Town area, by including first-time blood donors and excluding those with iron deficiency and thalassaemic indices. These new locally established RIs could update those in use by the local National Health Laboratory Service. A secondary objective was to establish the prevalence of iron deficiency in first-time blood donors. This would inform blood donation policies regarding screening and appropriate iron supplementation in high-risk groups prior to blood donation.Methods. This was a prospective, descriptive study with direct convenience sampling. Participants were prospective voluntary blood donors aged between 18 and 60 years, presenting for first-time blood donation. Ethnicity was self-identified. Participants who tested positive for HIV or hepatitis B and/or C viruses were excluded. Prospective participants with iron deficiency, defined by serum ferritin levels below the RI, and those with red cell indices suggestive of an underlying thalassaemia trait were excluded. FBC samples were analysed using a Sysmex XN-1000 cell counter. Statistical non-parametric methods were used to calculate the RIs, according to international guidelines.Results. Of the 774 participants screened, 82 (11%) had iron deficiency and were excluded. Six hundred and sixty-two patients were included for analysis, 409 (62%) female and 253 (38%) male. The majority of the participants, 348 (53%), were between 20 and 29 years of age, with a mean age of 29 years for females and 28 years for males. Participants comprised a mix of the various ethnic groups residing in Western Cape Province. The mean haemoglobin concentration for females was lower than that for males (p<0.0001). There were significant gender differences for total WBC count, absolute neutrophil count and platelet count, with females having higher counts than males.Conclusions. Locally established, population-specific RIs are essential for the accurate interpretation of haematological indices. This study established locally derived gender-specific RIs for the Cape Town region, after exclusion of iron deficiency. These new RIs have implications for the accurate diagnoses of cytopenias, cytoses and other blood count abnormalities. Iron deficiency is common in first-time blood donors, and screening for iron deficiency using point-of-care testing should be considered

Preventing mental health problems in offspring by targeting dietary intake of pregnant women

The concept of \u27early life programming\u27 considers the importance of very early environmental exposures throughout the gestational period on the subsequent health outcomes of offspring. The role of maternal dietary intake, specifically, has been highlighted after recent studies have shown maternal diet quality to predict mental health problems in offspring. Even in the pre-conception period, maternal nutrition can have permanent and sustained phenotypic consequences for offspring

Designing multiplayer games to facilitate emergent social behaviours online

This paper discusses an exploratory case study of the design of games that facilitate spontaneous social interaction and group behaviours among distributed individuals, based largely on symbolic presence 'state' changes. We present the principles guiding the design of our game environment: presence as a symbolic phenomenon, the importance of good visualization and the potential for spontaneous self-organization among groups of people. Our game environment, comprising a family of multiplayer 'bumper-car' style games, is described, followed by a discussion of lessons learned from observing users of the environment. Finally, we reconsider and extend our design principles in light of our observations

Legume seed production for sustainable seed supply and crop productivity: case of groundnut in Tanzania and Uganda

Improvingagriculturalproductivityandproductionisaprerequisite to sustain rural livelihoods in developing countries of sub-Saharan Africa SSA).Thisrequiresincreaseduseofqualityseedofimproved and well-adapted crop varieties. Legumes are particularly critical in ensuring food and nutritional securities of the majority of farming households. However, their productivity has been constrained because of limited availability of quality seed, jeopardizing henceforth food security and rural livelihoods. The lack of interest in productionoflegumeseedsbypotentialseedproducers,especially the private sector, is attributable to limited information on the cost and profitability of producing these seeds. Using primary data collectedfromTanzaniaandUganda,weanalyzedthecoststructureof improved groundnut (Arachis hypogaea L.) seed production to assess viability. We adopted cost-benefit analysis framework to evaluate different seed production models. Results showed that groundnutseedpricevariedbetween1and2US$kg−1 forcertified andqualitydeclaredseedandbetween2and3.5US$kg−1 forearly generationseed.Overall,upto50%increaseintotalseedproduction costsresultedinreduceddropinthegrossmarginearned.However, when production costs increased by 75–100%, the gross margin droppedbyabout18%and50%inTanzaniaandinUganda,respectively. These findings indicated that groundnut seed could be providedtofarmersinremotecommunitiesatanaffordablepricewhile still keeping seed producers profitably in business. Availing these seeds to smallholder producers is a major step in achieving food securityandnutritionalhealthindevelopingcountries inSSA

The Disunity of Consciousness

It is commonplace for both philosophers and cognitive scientists to express their allegiance to the "unity of consciousness". This is the claim that a subject’s phenomenal consciousness, at any one moment in time, is a single thing. This view has had a major influence on computational theories of consciousness. In particular, what we call single-track theories dominate the literature, theories which contend that our conscious experience is the result of a single consciousness-making process or mechanism in the brain. We argue that the orthodox view is quite wrong: phenomenal experience is not a unity, in the sense of being a single thing at each instant. It is a multiplicity, an aggregate of phenomenal elements, each of which is the product of a distinct consciousness-making mechanism in the brain. Consequently, cognitive science is in need of a multi-track theory of consciousness; a computational model that acknowledges both the manifold nature of experience, and its distributed neural basis

Technocamps: Advancing Computer Science Education in Wales

Computer science education in the UK has undergone substantial scrutiny over the past five years. In particular, from September 2014, we have seen the implementation and delivery of a new computing curriculum in England. However, in Wales -- one of the four devolved nation in the UK -- numerous political, geographical and socio-technical issues have hindered any substantive educational policy or curriculum reform for computer science. This is despite the widespread efforts to address the failings of computer science education in schools since at least 2003 through Technocamps, a pan-Wales university-based schools outreach programme.In this paper we outline the history (and pre-history) of Technocamps, contextualised by the devolved nature of education in the UK, positioning Wales with its specific issues and challenges. Furthermore, we present evidence both in support of this university engagement and intervention model as well as its wider positive effect on promoting and supporting computer science education in Wales, a nation about to take its first steps on the path of a large-scale national curriculum review and significant educational reform