Viral suppression following switch to second-line antiretroviral therapy: associations with nucleoside reverse transcriptase inhibitor resistance and subtherapeutic drug concentrations prior to switch.

BACKGROUND: High rates of second-line antiretroviral treatment (ART) failure are reported. The association with resistance and nonadherence on switching to second-line ART requires clarification. METHODS: Using prospectively collected data from patients in South Africa, we constructed a cohort of patients switched to second-line ART (1 January 2003 through 31 December 2008). Genotyping and drug concentrations (lamivudine, nevirapine, and efavirenz) were measured on stored samples preswitch. Their association with viral load (VL) <400 copies/mL by 15 months was assessed using modified Poisson regression. RESULTS: One hundred twenty-two of 417 patients (49% male; median age, 36 years) had genotyping (n = 115) and/or drug concentrations (n = 80) measured. Median CD4 count and VL at switch were 177 cells/µL (interquartile range [IQR], 77-263) and 4.3 log10 copies/mL (IQR, 3.8-4.7), respectively. Fifty-five percent (n = 44/80) had subtherapeutic drug concentrations preswitch. More patients with therapeutic vs subtherapeutic ART had resistance (n = 73): no major mutations (3% vs 51%), nonnucleoside reverse transcriptase inhibitor (94% vs 44%), M184V/I (94% vs 26%), and ≥ 1 thymidine analogue mutations (47% vs 18%), all P = .01; and nucleoside reverse transcriptase inhibitor (NRTI) cross-resistance mutations (26% vs 13%, P = .23). Following switch, 68% (n = 83/122) achieved VL <400 copies/mL. Absence of NRTI mutations and subtherapeutic ART preswitch were associated with failure to achieve VL <400 copies/mL. CONCLUSIONS: Nonadherence, suggested by subtherapeutic ART with/without major resistance mutations, significantly contributed to failure when switching regimen. Unresolved nonadherence, not NRTI resistance, drives early second-line failure

Die rekenmeestersprofessie en eksternaliteite - ’n oorsig

Since the first textbook on accounting was written approximately five centuries ago, the theory of accounting has changed and developed fundamentally. However, one field that has remained almost unchanged throughout the centuries is the accounting approach to externalities. The largescale interest in environmental issues has again placed the accounting approach to externalities under scrutiny. In this article an oven'iew is given of the development of the concept of externalities. The possible future influence of externalities on accounting and the accounting profession are also focused on

Trustworthiness of South African sustainability reports : an overview

Published ArticleIt is widely assumed that sustainability reporting is a mechanism that companies can use to demonstrate their trustworthiness with regard to development in a sustainable manner. This article uses the Mayer, Davis and Schoorman trust model as basis to discuss how sustainability reporting can enhance trustworthiness in a sustainable development context. The study also uses a survey-questionnaire, sent to South African sustainability reporters, to explore whether they are finding sustainability reporting useful for enhancing companies' trustworthiness among stakeholders in a sustainable development context. Respondents indicate, amongst other things, that sustainability reporting in South Africa has a role to play in enhancing trustworthiness, more so among contractual stakeholders than among community stakeholders. To entrench trust benefits in the long term will however require long term strategies. Such strategies should focus on increasing the engagement of community stakeholders, authentic use of the GRI and implementing effective control systems that prevent the misuse of sustainability reports, while not preventing the formation of real trust

The use of risk management principles in planning an internal audit engagement

With the current growth in awareness of the value of internal audit services, the increased demand from various stakeholders, and the scarcity of competent internal auditors, the profession needs a new mindset, particularly in respect of the execution of internal audit activities. Although risk-based internal auditing is a fairly new concept, its implementation could assist internal auditors to audit ‘smarter’, that is, more effectively and efficiently. However, it is unclear whether the current concept of a risk-based internal audit engagement is in line with modern business practices, such as enterprise-wide risk management principles. Furthermore, it is also uncertain whether internal auditors share a single set of risk management principles and concepts, and how (or even if) these should be included in the internal audit engagement. This article explores the common understanding of what the planning phase of a risk-based internal audit engagement should entail when based on risk management principles, and identifies the organisational elements that should be in place that would make it easier for internal auditors to implement such a risk-driven approach when conducting engagements. The research methodology involved a literature review and structured interviews with chief audit executives of risk-mature organisations. The findings support the existence of uncertainty among chief audit executives regarding the use of risk management principles when performing risk-based internal audit engagements. Chief audit executives also appeared uncertain how to apply these principles to the planning and execution of internal audit engagements. Gaps and shortcomings identified by the research should be addressed by the Institute of Internal Auditors through developing more comprehensive guidance for their members.Key words: risk management, key risks, internal auditing, risk-based internal auditing, internal audit engagemen

On Multifractal Structure in Non-Representational Art

Multifractal analysis techniques are applied to patterns in several abstract expressionist artworks, paintined by various artists. The analysis is carried out on two distinct types of structures: the physical patterns formed by a specific color (``blobs''), as well as patterns formed by the luminance gradient between adjacent colors (``edges''). It is found that the analysis method applied to ``blobs'' cannot distinguish between artists of the same movement, yielding a multifractal spectrum of dimensions between about 1.5-1.8. The method can distinguish between different types of images, however, as demonstrated by studying a radically different type of art. The data suggests that the ``edge'' method can distinguish between artists in the same movement, and is proposed to represent a toy model of visual discrimination. A ``fractal reconstruction'' analysis technique is also applied to the images, in order to determine whether or not a specific signature can be extracted which might serve as a type of fingerprint for the movement. However, these results are vague and no direct conclusions may be drawn.Comment: 53 pp LaTeX, 10 figures (ps/eps

Using honey to heal diabetic foot ulcers

Diabetic ulcers seem to be arrested in the inflammatory/proliferative stage of the healing process, allowing infection and inflammation to preclude healing. Antibiotic-resistant bacteria have become a major cause of infections, including diabetic foot infections. It is proposed here that the modern developments of an ancient and traditional treatment for wounds, dressing them with honey, provide the solution to the problem of getting diabetic ulcers to move on from the arrested state of healing. Honeys selected to have a high level of antibacterial activity have been shown to be very effective against antibiotic-resistant strains of bacteria in laboratory and clinical studies. The potent anti-inflammatory action of honey is also likely to play an important part in overcoming the impediment to healing that inflammation causes in diabetic ulcers, as is the antioxidant activity of honey. The action of honey in promotion of tissue regeneration through stimulation of angiogenesis and the growth of fibroblasts and epithelial cells, and its insulin-mimetic effect, would also be of benefit in stimulating the healing of diabetic ulcers. The availability of honey-impregnated dressings which conveniently hold honey in place on ulcers has provided a means of rapidly debriding ulcers and removing the bacterial burden so that good healing rates can be achieved with neuropathic ulcers. With ischemic ulcers, where healing cannot occur because of lack of tissue viability, these honey dressings keep the ulcers clean and prevent infection occurring

Die Erkenning van Inkomste in die Openbare Sektor in Suid-Afrika: Politieke en Sosiale Dilemmas versus Rekeningkundige Realiteite

The outstanding debtors of local authorities in South Africa have been increasing at an alarming rate for several years. Together with this, many local authorities do not make sufficient provision for doubtful debts, and the “culture of non-payment” is jeopardising the sustainability of services that are provided (or should be provided) by local authorities. In the time during which the preceding took place, there were drastic changes and development of Generally Accepted Accounting Practice (GAAP). The primary purpose of this article is to try to answer the key question whether the current requirements of GAAP against a “culture of non-payment” do not create certain irreconcilable problems. The main focus in this article will be on one of these possible problems, namely the accounting principle of “recognition of income and debtors” in cases of a culture of non-payment for such services. For purposes of achieving the aim of this article, the focus will be on local authorities in South Africa. Other government and semi-government institutions such as water councils and institutions that provide electricity and other services, and that also experience the problem of misrepresentation of their services, may similarly experience the problem. In this article a brief overview is firstly given of the “culture of non-payment” for services provided by local authorities together with an overview of the worrying increase in outstanding debtors of local authorities in South Africa. Subsequently the principles of “recognition of income and debtors” and the present requirements in this regard from an accounting viewpoint are discussed, and it is also shown that the “culture of non-payment” and the accounting principles of “recognition of income and debtors” give rise to serious misrepresentations in the annual financial statements of local authorities. Finally a summary also provides an indication of the implications that this possible misrepresentation has for various role-players

Sosiale rekeningkunde: agtergrond en problematiek

The necessity for the accountant to report on the social responsibility of an enterprise, and in particular its responsibility towards the environment, has come into prominence lately. Nevertheless, there is probably no other field in accounting in which the accounting profession has failed to show process for so long. Since the time of the industrial Revolution social accounting has been regarded as essential, but especially during the late sixties and the seventies various authors have endeavoured to develop techniques and models for social accounting. Some of the most important problems encountered have however been the lack of acceptable uniform definitions, the fact that the accounting profession mostly reacts pragmatically and that as a result of pressure towards rapid development, fundamental questions have not been fully considered. The accounting profession should contribute to the development and application of social accounting and social audit as part of an interdisciplinary group of experts

Fractal Holography: a geometric re-interpretation of cosmological large scale structure

The fractal dimension of large-scale galaxy clustering has been demonstrated to be roughly $D_F \sim 2$ from a wide range of redshift surveys. If correct, this statistic is of interest for two main reasons: fractal scaling is an implicit representation of information content, and also the value itself is a geometric signature of area. It is proposed that the fractal distribution of galaxies may thus be interpreted as a signature of holography (``fractal holography''), providing more support for current theories of holographic cosmologies. Implications for entropy bounds are addressed. In particular, because of spatial scale invariance in the matter distribution, it is shown that violations of the spherical entropy bound can be removed. This holographic condition instead becomes a rigid constraint on the nature of the matter density and distribution in the Universe. Inclusion of a dark matter distribution is also discussed, based on theoretical considerations of possible universal CDM density profiles.Comment: 13 pp, LaTeX. Revised version; to appear in JCA