Acute hospitalisation needs of adults admitted to public facilities in the Cape Town Metro district

INTRODUCTION: Public health care delivery in South Africa aims to provide equitable access at the most appropriate level of care. We studied to what extent the acute health care needs of adults admitted to public hospitals in the Cape Town Metropole were being appropriately met. METHODS: A retrospective study was conducted of the hospital records of adults admitted to medical beds in public hospitals in Cape Town between August and November 2008. Intensive care unit patients were not included. RESULTS: Of 802 beds in use, the estimated occupancy was at least 95%. The average time elapsed since admission was 7.9 days; 94.3% of medical admissions were acute; 45% were severely to critically ill on admission; and co-morbid disease was present in 78.1%. Of all admissions, 31.9% were HIV-positive, and 17% had active tuberculosis. At least 396 (51.6%) patients were deemed to have required specialist or subspecialist consultation to expedite appropriate care; 386 (50.3%) accessed the appropriate level of medical care required; 339 (44.2%) accessed a more sophisticated level of care than required; and 42 (5.5%) did not access an adequate level of care. CT scan and ultrasound accounted for 59% of all restricted tests done. CONCLUSIONS: Our findings support the plan to provide more primary care hospital facilities in the metropolitan area. Most patients needing specialised care are accessing such care, and most patients accessing a higher level of care than needed can be addressed by ensuring that they first access primary care and are referred according to protocols

Soft X-ray seeding studies for the SLAC Linac Coherent Light Source II

We present the results from studies of soft X-ray seeding options for the LCLS-II X-ray free electron laser (FEL) at SLAC. The LCLS-II will use superconducting accelerator technology to produce X-ray pulses at up to 1 MHz repetition rate using 4 GeV electron beams. If properly seeded, these pulses will be nearly fully coherent, and highly stable in photon energy, bandwidth, and intensity, thus enabling unique experiments with intense high-resolution soft X-rays. Given the expected electron beam parameters from start to end simulations and predicted FEL performance, our studies reveal echo enabled harmonic generation (EEHG) and soft X-ray self-seeding (SXRSS) as promising and complementary seeding methods. We find that SXRSS has the advantage of simplicity and will deliver 5-35 times higher spectral brightness than EEHG in the 1-2 nm range, but lacks some of the potential for phase-stable multipulse and multicolor FEL operations enabled by external laser seeding with EEHG

Calculation of the Coherent Synchrotron Radiation Impedance from a Wiggler

Most studies of Coherent Synchrotron Radiation (CSR) have only considered the radiation from independent dipole magnets. However, in the damping rings of future linear colliders, a large fraction of the radiation power will be emitted in damping wigglers. In this paper, the longitudinal wakefield and impedance due to CSR in a wiggler are derived in the limit of a large wiggler parameter $K$. After an appropriate scaling, the results can be expressed in terms of universal functions, which are independent of $K$. Analytical asymptotic results are obtained for the wakefield in the limit of large and small distances, and for the impedance in the limit of small and high frequencies.Comment: 10 pages, 8 figure

Coupled-Bunch Beam Breakup due to Resistive-Wall Wake

The coupled-bunch beam breakup problem excited by the resistive wall wake is formulated. An approximate analytic method of finding the asymptotic behavior of the transverse bunch displacement is developed and solved.Comment: 8 page

Primary Oral Tuberculosis as an Indicator of HIV Infection

We present a case of primary oral tuberculosis that led to the diagnosis of HIV infection. Our patient had clinically nonspecific ulcers on the labial mucosa and on the ventral surface of the tongue which were diagnosed as being tuberculous only on histological examination. This raised the suspicion of HIV infection that was subsequently confirmed by blood tests. The oral lesions resolved after 4 weeks of antituberculosis treatment. Some aspects of the pathogenesis of HIV-tuberculosis coinfection are discussed

Impact of the Wiggler Coherent Synchrotron Radiation Impedance on the Beam Instability

Coherent Synchrotron Radiation (CSR) can play an important role by not only increasing the energy spread and emittance of a beam, but also leading to a potential instability. Previous studies of the CSR induced longitudinal instability were carried out for the CSR impedance due to dipole magnets. However, many storage rings include long wigglers where a large fraction of the synchrotron radiation is emitted. This includes high-luminosity factories such as DAPHNE, PEP-II, KEK-B, and CESR-C as well as the damping rings of future linear colliders. In this paper, the instability due to the CSR impedance from a wiggler is studied assuming a large wiggler parameter $K$. The primary consideration is a low frequency microwave-like instability, which arises near the pipe cut-off frequency. Detailed results are presented on the growth rate and threshold for the damping rings of several linear collider designs. Finally, the optimization of the relative fraction of damping due to the wiggler systems is discussed for the damping rings.Comment: 10 pages, 7 figure

Lower protein-to-carbohydrate ratio in maternal diet is associated with higher childhood systolic blood pressure up to age four years

The prenatal environment can influence development of offspring blood pressure (BP), which tracks into adulthood. This prospective longitudinal study investigated whether maternal pregnancy dietary intake is associated with the development of child BP up to age four years. Data are from 129 mother-child dyads enrolled in the Women and Their Children\u27s Health study. Maternal diet was assessed using a validated 74-item food frequency questionnaire at 18 to 24 weeks and 36 to 40 weeks, with a reference period of the previous three months. Child systolic and diastolic BP were measured at 3, 6, 9, 12, 24, 36 and 48 months, using an automated BP monitor. Using mixed-model regression analyses adjusted for childhood growth indices, pregnancy intakes of percentage of energy (E%) polyunsaturated fat (β coefficient 0.73; 95% CI 0.003, 1.45; p = 0.045), E% omega-6 fatty acids (β coefficient 0.89; 95% CI 0.09, 1.69; p = 0.03) and protein-to-carbohydrate (P:C) ratio (β coefficient -14.14; 95% CI -27.68, -0.60; p = 0.04) were associated with child systolic BP trajectory up to 4 years. Child systolic BP was greatest at low proportions of dietary protein (<16% of energy) and high carbohydrate (>40% of energy) intakes. There may be an ideal maternal macronutrient ratio associated with optimal infant BP. Maternal diet, which is potentially modifiable, may play an important role in influencing offspring risk of future hypertension

Sensory integration intervention and the development of the premature infant: A controlled trial

Background. Premature infants are at risk of sensory processing difficulties and developmental delays due to an immature central nervous system and possible episodes of medical instability, discomfort, pain and stress during the first weeks or months after birth.Objective. To investigate the effect of Ayres Sensory Integration (ASI) on the development of premature infants in the first 12 months of life.Methods. A pre-/post-test experimental design was used to randomly divide 24 premature infants from a low socioeconomic setting in Bloemfontein, South Africa, into experimental and control groups after being matched by corrected age and gender. Developmental status was determined with the Bayley III Scales of Infant and Toddler Development, the Test of Sensory Functions in Infants and the Infant/Toddler Sensory Profile. The experimental group received 10 weeks of ASI intervention.Results. ASI intervention had a positive effect on the sensory processing and development of premature infants, especially in terms of cognitive, language and motor development.Conclusions. ASI intervention at an early age enhances the developmental progress of premature infants.

Concomitant HIV infection in newly diagnosed multiple myeloma patients is hard to recognise and should be tested for routinely in areas of high endemicity

Background. Over the past three decades much has changed in the treatment and outcomes of patients suffering concurrently from both multiple myeloma (MM) and HIV. While the prevalence of MM appears to be higher in HIV-positive individuals than in those who are uninfected, early recognition of patients suffering from both diseases is difficult and little information is available on their demographics and clinical presentation.Objective. To compare the presenting features of HIV-positive patients diagnosed with MM with those of HIV-negative patients.Methods. A single-centre, retrospective cohort study included 16 HIV-positive and 73 HIV-negative patients diagnosed with MM, in order to compare variables related to the clinical presentation of both conditions.Results. HIV-positive patients presented with MM at a significantly younger age, and had fewer osteolytic lesions, less renal impairment and lower neutrophil counts. Disease stage, gender, pathological fractures, bone marrow plasmacytosis, plasmacytomas and lymphocyte counts were comparable, emphasising the difficulty of identifying these patients. The HIV-positive patients had relatively high CD4 counts and a low prevalence of abnormal Freelite kappa/lambda ratios. All HIV-positive patients presented with paraproteins of the immunoglobulin G (IgG) type, implying a possible relationship between MM and an IgG response to HIV antigens.Conclusions. On the basis of our findings and literature on the treatment of both diseases, we suggest that HIV be tested for routinely in younger MM patients, especially in areas with a high prevalence of HIV. The integration of our results into the sparse knowledge on the role of HIV infection-related MM provides possible new insights into the interaction between these diseases.

The development and preliminary validation of the Challenge and Threat in Sport (CAT-Sport) Scale

This paper outlines the development and preliminary validation of a sport-specific measure of athletes’ experience of challenge and threat. Three independent studies assess the content validity, factor structure, criterion validity and internal consistency of the Challenge and Threat in Sport (CAT-Sport) Scale. In study 1, a group of 25 athletes and two experts assessed the content validity of items derived from existing measures of challenge and threat. Participants examined a pool of 25 items, and were asked to rate the items’ applicability to their experiences of challenge and threat in sport. Items failing to reach applicability of 50% were excluded from further analysis. In study 2, 197 runners completed the 21 items retained from study 1 before competition. A principal components analysis with an oblique, direct oblimin rotation yielded a 12-item, two component solution with items indicative of athletes’ experiences of challenge and threat. In study 3, 201 shooters completed the 12-item CAT-Sport before competition. Confirmatory factor analysis indicated that a 12-item 2-factor correlated model provided acceptable model fit with good internal consistency and criterion validity. Collectively these studies provide support for the CAT-Sport as a measure of athletes’ experience of challenge and threat in anticipation of sport competition