Building the bastard : confidence through preparation in Shakespeare\u27s King Lear.

This thesis is to chart my discovery that confidence is essential to an actor’s craft. This thesis focuses on my performance as Edmund in King Lear, as well as my production the previous summer playing Hussein in Ayad Akhtar’s Disgraced. I draw from a variety of sources, such as meditation and formal acting exercises, to achieve confidence. Most importantly, I distill my missteps as an actor for a better understanding of what hinders confidence when building a role for performance

Effects of Hip and Ankle Moments on Running Stability: Simulation of a Simplified Model

In human running, the ankle, knee, and hip moments are known to play different roles to influence the dynamics of locomotion. A recent study of hip moments and several hip-based legged robots have revealed that hip actuation can significantly improve the stability of locomotion, whether controlled or uncontrolled. Ankle moments are expected to also significantly affect running stability, but in a different way than hip moments. Here we seek to advance the current theory of dynamic running and associated legged robots by determining how simple open-loop ankle moments could affect running stability. We simulate a dynamical model, and compare it with a previous study on the role of hip moments. The model is relatively simple with a rigid trunk and a springy leg to represent the effective stiffness of the knee. At the hip we use a previously established proportional and derivative controlled moment with pitching angle as feedback. At the ankle we use the simplest ankle actuation, a constant ankle torque as a rough approximation of the net positive work done by the ankle moment during human locomotion. Even in this simplified model, we find that ankle and hip moments can affect the center of mass (COM) and pitching dynamics in distinct ways. Analysis of the governing equations shows that hip moments can directly influence the upper body balance, as well as indirectly influence the center of mass translation dynamics. However, ankle moments can only indirectly influence both. Simulation of the governing equations shows that the addition of ankle moment has significant benefits to the quality of locomotion stability, such as a larger basin of attraction. We also find that adding the ankle moments generally expands the range of parameters and velocities for which the model displays stable solutions. Overall, these findings suggest that ankle moments would play a significant role in improving the quality and range of running stability in a system with a rigid trunk and a telescoping leg, which would be a natural extension of current springy leg robots. Further, these results provide insights into the role that ankle moments might play in human locomotion

HIV and depression in a primary care clinic in Johannesburg, South Africa

As rapidly expanding HIV care and treatment programs are implemented in sub-Saharan Africa, maintaining engagement in HIV care is proving to be a significant operational challenge. Depression is highly prevalent among HIV-infected people in sub-Saharan Africa and predicts a range of poor HIV-related clinical outcomes including faster disease progression and increased morbidity and mortality. Depression is strongly associated with non-adherence to anti-retroviral treatment (ART), and may also impact engagement in HIV care. Recognizing and treating depression among HIV-infected patients seeking care in primary health care settings, where most HIV testing and treatment takes place, could increase access to mental health services and may help to target patients at risk for negative outcomes. An observational study was conducted between September 2012 and April 2013 among 1683 randomly selected adult patients undergoing routine, opt-out HIV counseling and testing (HCT) at Witkoppen Health and Welfare Center (WHWC), a high-HIV burden primary care clinic in Johannesburg, South Africa. Patients were screened for depression immediately prior to HCT using the Patient Health Questionnaire-9 (PHQ-9), a 9-item brief screening tool administered by lay health workers. A subset of 400 patients was included in a blinded diagnostic validation study of the PHQ-9 (Aim 1). Sensitivity and specificity of the PHQ-9 were calculated with the Mini International Neuropsychiatric Interview (MINI) as the reference standard, and receiver operating characteristic (ROC) curve analyses were performed. Patients who tested positive for HIV were followed and linkage to care, defined as returning to WHWC within 3 months to obtain a CD4 count result, was assessed (Aim 2). Among patients who collected a CD4 count, ART initiation within 3 months was assessed. Multivariable Poisson regression with a robust variance estimator was used to assess the association between depression and linkage to care or ART initiation. Nearly all patients completed depression screening and 82% (n=1386) subsequently tested for HIV. Of the patients who tested for HIV and were of unknown HIV status prior to testing, 26% (n=340) were found to be HIV-infected. Nearly a quarter of all patients (22%) were depressed. Similar to other studies, depression was more common among patients who tested positive for HIV compared to those who tested negative for HIV (30.3% versus 19.7%, p<0.0001). In the validation sample included in Aim 1, the prevalence of depression was 11.8% and one-third of participants tested positive for HIV. Using the standard cut-off score of &#8805;10, the PHQ-9 demonstrated a sensitivity of 78.7% (95% CI: 64.3-89.3) and specificity of 83.4% (95% CI: 79.1-87.2) for identifying major depressive disorder. The area under the ROC curve was 0.88 (95% CI: 0.83-0.92). Test characteristics did not vary by HIV status or language and in sensitivity analyses, reference test bias associated with the MINI appeared unlikely. The PHQ-9 was easily implemented by lay health workers. The instrument performed reasonably well and may be a useful depression screening tool in high HIV-burden sub-Saharan African primary health care settings. Of the HIV-infected patients included in Aim 2, 30% were depressed. The proportion who linked to care was 80% among depressed patients and 73% among patients who were not depressed (Risk ratio: 1.08; 95% confidence interval: 0.96, 1.23). Of the participants who linked to care, 81% initiated ART within 3 months in both depressed and not depressed groups (Risk ratio: 0.99; 95% confidence interval: 0.86, 1.15). Conducting this study in a clinic-based population may have selected for patients who are high-utilizers of health care and unlikely to be at high risk for loss to HIV care. These unexpected results highlight the importance of population selection and the timing of HIV testing relative to depression screening when studying the complex relationship between depression and engagement in HIV care.Doctor of Philosoph

SHELF-LIFE ASSESSMENT OF EUPHORBIA ANTIQUORUM LINN., EUPHORBIA CADUCIFOLIA HAINES, EUPHORBIA NIVULIA BUCH. HAM AND EUPHORBIA TIRUCALLI LINN. LATEX

Objective: In the present study, an attempt was made to assess the shelf life of the Snuhi latex which is frequently used in fresh condition for the preparation of Ksharasutra, a medicated thread, used in Ayurveda. Methods: The latex of E. antiquorum, E. caducifolia, E. nivulia and E. tirucalli were collected individually and stored in air tight glass vials during the month of May, 2018. Physical attributes like Colour, odour, appearances, pH and microbial load of all four samples were assessed as per standard protocol. Assessment was made every day, 9 AM, for 7 d in room temperature and for 10 d in refrigerated samples. Results: Result shows that, pH range (start-end day) was 4.25-5.18, 4.79-5.12, 4.48-4.76 and 4.40-5.42 in case of E. antiquorum, E. caducifolia, E. nivulia and E. tirucalli at room temperature. It was found that, Aspergillus niger was found in Euphorbia antiquorum, Euphorbia caducifolia whereas Candida albicans was found in Euphorbia tirucalli latex in fungal culture on the 7th day after collection, when the samples were stored at room temperature. All the samples were free from microbial growth up to 10thday when stored at 4-5 °C in a refrigerator. Conclusion: Temperature, and moisture affects the quality of fresh snuhi latex. The latex remains free from microbial growth up to six days in room temperature and up to 10 d under at refrigerated temperature (4-5 °C)

Neural, renal and retinal hamartomas with cutis vertis gyrata a rare presentation in tuberous sclerosis complex

Tuberous sclerosis complex characterised by multiple benign tumours, is caused by mutation in the genes TSC1 and TSC2 coding for Hamartin and Tuberin respectively. We report a case of a 17 year old female patient who presented with classical Vogt’s triad characterized by seizures, mental retardation and adenoma sebaceous. She presented with Cutis Vertis Gyrata in addition to multiple retinal astrocytic hamartomas in her right eye with retinal pigment epithelium changes in both eyes and a normal anterior segment examination.  Magnetic resonance imaging (MRI) of the brain showed subependymal giant cell astrocytomas and cortical tubers. Ultrasound of the abdomen showed bilateral renal angiomyoliposis. We are presenting this case as retinal hamartomas with five Major criteria are seen along with secondary Cutis Vertis Gyrata which is an extremely rare presentation of Tuberous sclerosis. Absence of most of the Minor criteria is not to be excluded

Global oral cholera vaccine use, 2013-2018

Vaccination is a key intervention to prevent and control cholera in conjunction with water, sanitation and hygiene activities. An oral cholera vaccine (OCV) stockpile was established by the World Health Organization (WHO) in 2013. We reviewed its use from July 2013 to all of 2018 in order to assess its role in cholera control. We computed information related to OCV deployments and campaigns conducted including setting, target population, timelines, delivery strategy, reported adverse events, coverage achieved, and costs. In 2013-2018, a total of 83,509,941 OCV doses have been requested by 24 countries, of which 55,409,160 were approved and 36,066,010 eventually shipped in 83 deployments, resulting in 104 vaccination campaigns in 22 countries. OCVs had in general high uptake (mean administrative coverage 1st dose campaign at 90.3%; 2nd dose campaign at 88.2%; mean survey-estimated two-dose coverage at 69.9%, at least one dose at 84.6%) No serious adverse events were reported. Campaigns were organized quickly (five days median duration). In emergency settings, the longest delay was from the occurrence of the emergency to requesting OCV (median: 26days). The mean cost of administering one dose of vaccine was 2.98 USD. The OCV stockpile is an important public health resource. OCVs were generally well accepted by the population and their use demonstrated to be safe and feasible in all settings. OCV was an inexpensive intervention, although timing was a limiting factor for emergency use. The dynamic created by the establishment of the OCV stockpile has played a role in the increased use of the vaccine by setting in motion a virtuous cycle by which better monitoring and evaluation leads to better campaign organization, better cholera control, and more requests being generated. Further work is needed to improve timeliness of response and contextualize strategies for OCV delivery in the various settings

CD9 Expression by Human Granulosa Cells and Platelets as a Predictor of Fertilization Success during IVF

Objective. To determine whether CD9 expression on human granulosa cells (GCs) and platelets could predict the success of conventional fertilization of human oocytes during in vitro fertilization (IVF). Methods. Thirty women undergoing IVF for nonmale factor infertility participated. Platelets from venous blood and GCs separated from retrieved oocytes were prepared for immunofluorescence. Flow cytometry quantified the percent of GCs expressing CD9, and CD9 surface density on GCs and platelets. Fertilization rate was determined for the total number of oocytes, and the number of mature oocytes per patient. Correlations tested for significant relationships (P < .05) between fertilization rates and CD9 expression. Results. CD9 surface density on human GCs is inversely correlated with fertilization rate of oocytes (P = .04), but the relationship was weak. Conclusion. More studies are needed to determine if CD9 expression on GCs would be useful for predicting conventional fertilization success during IVF

Multilocus sequence typing (MLST) analysis of Vibrio cholerae O1 El Tor isolates from Mozambique that harbour the classical CTX prophage.

Vibrio cholerae O1 isolates belonging to the Ogawa serotype, El Tor biotype, harbouring the classical CTX prophage were first isolated in Mozambique in 2004. Multilocus sequence typing (MLST) analysis using nine genetic loci showed that the Mozambique isolates have the same sequence type (ST) as O1 El Tor N16961, a representative of the current seventh cholera pandemic. Analysis of the CTX prophage in the Mozambique isolates indicated that there is one type of rstR in these isolates: the classical CTX prophage. It was also found that the ctxB-rstR-rstA-rstB-phs-cep fragment was PCR-amplified from these isolates, which indicates the presence of a tandem repeat of the classical CTX prophage in the genome of the Mozambique isolates. The possible origin of these isolates and the presence of the tandem repeat of the classical prophage in them implicate the presence of the classical CTX phage

Chemokine receptor CCR5 promotes leukocyte trafficking to the brain and survival in West Nile virus infection

The molecular immunopathogenesis of West Nile virus (WNV) infection is poorly understood. Here, we characterize a mouse model for WNV using a subcutaneous route of infection and delineate leukocyte subsets and immunoregulatory factors present in the brains of infected mice. Central nervous system (CNS) expression of the chemokine receptor CCR5 and its ligand CCL5 was prominently up-regulated by WNV, and this was associated with CNS infiltration of CD4+ and CD8+ T cells, NK1.1+ cells and macrophages expressing the receptor. The significance of CCR5 in pathogenesis was established by mortality studies in which infection of CCR5−/− mice was rapidly and uniformly fatal. In the brain, WNV-infected CCR5−/− mice had increased viral burden but markedly reduced NK1.1+ cells, macrophages, and CD4+ and CD8+ T cells compared with WNV-infected CCR5+/+ mice. Adoptive transfer of splenocytes from WNV-infected CCR5+/+ mice into infected CCR5−/− mice increased leukocyte accumulation in the CNS compared with transfer of splenocytes from infected CCR5−/− mice into infected CCR5−/− mice, and increased survival to 60%, the same as in infected CCR5+/+ control mice. We conclude that CCR5 is a critical antiviral and survival determinant in WNV infection of mice that acts by regulating trafficking of leukocytes to the infected brain