The symptom experience of people living with HIV and AIDS in the Eastern Cape, South Africa

<p>Abstract</p> <p>Background</p> <p>Symptom management for persons living with HIV (PLHIV) or AIDS is an important part of care management. Limited information about symptom prevalence exists about HIV infected persons in South Africa, in particular in the context of antiretroviral treatment (ART). The aim of this study was to assess HIV symptoms and demographic, social and disease variables of people living with HIV in South Africa.</p> <p>Methods</p> <p>In 2007 607 PLHIV, sampled by all districts in the Eastern Cape Province and recruited through convenience sampling, were interviewed by PLHIV at health facilities, key informants in the community and support groups.</p> <p>Results</p> <p>Two-thirds of the PLHIV (66%) classified themselves with being given an AIDS (advanced stage of HIV) diagnosis, 48% were currently on ART, 35% were currently on a disability grant for HIV/AIDS and for 13% the disability grant had been stopped. Participants reported that on the day of the interview, they were experiencing an average of 26.1 symptoms out of a possible 64. In a regression model with demographic and social variables, higher HIV symptom levels were associated with lower educational levels, higher age, urban residence and not on a disability grant, lack of enough food and having a health insurance, and in a regression model with demographic, social and disease variables only being on ART, lack of enough food and having a health insurance were associated with HIV symptoms.</p> <p>Conclusion</p> <p>Symptom assessment provides information that may be valuable in evaluating AIDS treatment regimens and defining strategies to improve quality of life. Because of the high levels of symptoms reported, the results imply an urgent need for effective health care, home- and community-based as well as self-care symptom management to help patients and their families manage and control AIDS symptoms.</p

Three-Nucleon Force Effects in Nucleon Induced Deuteron Breakup: Comparison to Data (II)

Selected Nd breakup data over a wide energy range are compared to solutions of Faddeev equations based on modern high precision NN interactions alone and adding current three-nucleon force models. Unfortunately currently available data probe phase space regions for the final three nucleon momenta which are rather insensitive to 3NF effects as predicted by current models. Overall there is good to fair agreement between present day theory and experiment but also some cases exist with striking discrepancies. Regions in the phase space are suggested where large 3NF effects can be expected.Comment: 33 pages, 24 ps figures, 9 gif figure

Controlling the Outgrowth and Functions of Neural Stem Cells: The Effect of Surface Topography

Neural stem cells (NSCs) are self-renewing cells that generate the major cell types of the central nervous system, namely neurons, astrocytes and oligodendrocytes, during embryonic development and in the adult brain. NSCs reside in a complex niche where they are exposed to a plethora of signals, including both soluble and physical signals such as compressive and shear stresses, but also discontinuities and differences in morphology of the extracellular environment, termed as topographical features. Different approaches that incorporate artificial micro- and nano-scale surface topographical features have been developed aiming to recapitulate the in vivo NSC niche discontinuities and features, particularly for in vitro studies. The present review article aims at reviewing the existing body of literature on the use of artificial micro- and nano-topographical features to control NSCs orientation and differentiation into neuronal and/or neuroglial lineage. The different approaches on the study of the underlying mechanism of the topography-guided NSC responses are additionally revised and discussed

Cosmic ray oriented performance studies for the JEM-EUSO first level trigger

JEM-EUSO is a space mission designed to investigate Ultra-High Energy Cosmic Rays and Neutrinos (E > 5 ⋅ 1019 eV) from the International Space Station (ISS). Looking down from above its wide angle telescope is able to observe their air showers and collect such data from a very wide area. Highly specific trigger algorithms are needed to drastically reduce the data load in the presence of both atmospheric and human activity related background light, yet retain the rare cosmic ray events recorded in the telescope. We report the performance in offline testing of the first level trigger algorithm on data from JEM-EUSO prototypes and laboratory measurements observing different light sources: data taken during a high altitude balloon flight over Canada, laser pulses observed from the ground traversing the real atmosphere, and model landscapes reproducing realistic aspect ratios and light conditions as would be seen from the ISS itself. The first level trigger logic successfully kept the trigger rate within the permissible bounds when challenged with artificially produced as well as naturally encountered night sky background fluctuations and while retaining events with general air-shower characteristics

Does palliative care improve outcomes for patients with HIV/AIDS? A systematic review of the evidence

Background: The need for palliative care in HIV management is underlined by the high prevalence of pain and symptoms, the toxicity, side effects, and virological failure associated with antiretroviral therapy, emergence of co-morbidities, continued high incidence of malignancies, late presentation of people with HIV disease, and the comparatively higher death rates among the infected individuals. Methods: A systematic review was undertaken to appraise the effect of models of palliative care on patient outcomes. A detailed search strategy was devised and biomedical databases searched using specific terms relevant to models of palliative care. Data from papers that met the inclusion criteria were extracted into common tables, and evidence independently graded using well described hierarchy of evidence. Results: 34 services met the inclusion criteria. Of these, 22 had been evaluated, and the evidence was graded as follows: grade 1 (n = 1); grade 2 ( n = 2); grade 3 ( n = 7); grade 4 ( n = 1); qualitative ( n = 6). Services were grouped as: home based care ( n = 15); home palliative care/hospice at home ( n = 7); hospice inpatient ( n = 4); hospital inpatient palliative care ( n = 4); specialist AIDS inpatient unit ( n = 2); and hospital inpatient and outpatient care ( n = 2). The evidence largely demonstrated that home palliative care and inpatient hospice care significantly improved patient outcomes in the domains of pain and symptom control, anxiety, insight, and spiritual wellbeing. Conclusions: Although the appraisal of evidence found improvements across domains, the current body of evidence suffers from a lack of ( quasi) experimental methods and standardised measures. The specialism of palliative care is responding to the clinical evidence that integration into earlier disease stages is necessary. Further studies are needed to both identify feasible methods and evaluate the apparent beneficial effect of palliative care on patient outcomes in the post-HAART era

Normal sulfation levels regulate spinal cord neural precursor cell proliferation and differentiation

Abstract Background Sulfated glycosaminoglycan chains are known for their regulatory functions during neural development and regeneration. However, it is still unknown whether the sulfate residues alone influence, for example, neural precursor cell behavior or whether they act in concert with the sugar backbone. Here, we provide evidence that the unique 473HD-epitope, a representative chondroitin sulfate, is expressed by spinal cord neural precursor cells in vivo and in vitro, suggesting a potential function of sulfated glycosaminoglycans for spinal cord development. Results Thus, we applied the widely used sulfation inhibitor sodium chlorate to analyze the importance of normal sulfation levels for spinal cord neural precursor cell biology in vitro. Addition of sodium chlorate to spinal cord neural precursor cell cultures affected cell cycle progression accompanied by changed extracellular signal-regulated kinase 1 or 2 activation levels. This resulted in a higher percentage of neurons already under proliferative conditions. In contrast, the relative number of glial cells was largely unaffected. Strikingly, both morphological and electrophysiological characterization of neural precursor cell-derived neurons demonstrated an attenuated neuronal maturation in the presence of sodium chlorate, including a disturbed neuronal polarization. Conclusions In summary, our data suggest that sulfation is an important regulator of both neural precursor cell proliferation and maturation of the neural precursor cell progeny in the developing mouse spinal cord.</p

Patient reports of symptoms and their treatment at three palliative care projects servicing individuals with HIV/AIDS

Self-reports of 32 symptoms and their treatments were obtained, from patients of three palliative care programs that provide services to seriously ill HIV patients (&gt;= 95 % AIDS) in Alabama (n = 47), Baltimore (n = 91), and New York City (n = 117). On average, patients reported 10.9 (SD = 7.6) to 12.7 (SD = 6.2) symptoms. Pain, lack of energy, and worrying were reported by a majority of Patients at all sites, often with a high level of associated distress. For only four symptoms (pain, nausea, difficulty swallowing, and mouth sores) did half or more of patients at all sites experiencing the symptom also report treatment. Less than a third of patients experiencing 12 symptoms (five of six comprising a psychological subscale) reported treatment. Results show that despite the availability of more efficacious treatments, many HIV/AIDS patients continue to experience significant physical and psychological symptomatology. Many of those experiencing symptoms, however, do not perceive their symptoms as being treate