Nevirapine- and efavirenz-associated hepatotoxicity under programmatic conditions in Kenya and Mozambique.

To describe the frequency, risk factors, and clinical signs and symptoms associated with hepatotoxicity (HT) in patients on nevirapine- or efavirenz-based antiretroviral therapy (ART), we conducted a retrospective cohort analysis of patients attending the ART clinic in Kibera, Kenya, from April 2003 to December 2006 and in Mavalane, Mozambique, from December 2002 to March 2007. Data were collected on 5832 HIV-positive individuals who had initiated nevirapine- or efavirenz-based ART. Median baseline CD4+ count was 125 cells/μL (interquartile range [IQR] 55-196). Over a median follow-up time of 426 (IQR 147-693) days, 124 (2.4%) patients developed HT. Forty-one (54.7%) of 75 patients with grade 3 HT compared with 21 (80.8%) of 26 with grade 4 had associated clinical signs or symptoms (P = 0.018). Four (5.7%) of 124 patients with HT died in the first six months compared with 271 (5.3%) of 5159 patients who did not develop HT (P = 0.315). The proportion of patients developing HT was low and HT was not associated with increased mortality. Clinical signs and symptoms identified 50% of grade 3 HT and most cases of grade 4 HT. This suggests that in settings where alanine aminotransferase measurement is not feasible, nevirapine- and efavirenz-based ART may be given safely without laboratory monitoring

Large K-exciton dynamics in GaN epilayers: the non-thermal and thermal regime

We present a detailed investigation concerning the exciton dynamics in GaN epilayers grown on c-plane sapphire substrates, focussing on the exciton formation and the transition from the nonthermal to the thermal regime. The time-resolved kinetics of LO-phonon replicas is used to address the energy relaxation in the excitonic band. From ps time-resolved spectra we bring evidence for a long lasting non-thermal excitonic distribution which accounts for the rst 50 ps. Such a behavior is con rmed in di erent experimental conditions, both when non-resonant and resonant excitation are used. At low excitation power density the exciton formation and their subsequent thermalization is dominated by impurity scattering rather than by acoustic phonon scattering. The estimate of the average energy of the excitons as a function of delay after the excitation pulse provides information on the relaxation time, which describes the evolution of the exciton population to the thermal regime.Comment: 9 pages,8 figure

WHO Clinical Staging of HIV Infection and Disease, Tuberculosis and Eligibility for Antiretroviral Treatment: Relationship to CD4 Lymphocyte Counts.

SETTING: Thyolo district, Malawi. OBJECTIVES: To determine in HIV-positive individuals aged over 13 years CD4 lymphocyte counts in patients classified as WHO Clinical Stage III and IV and patients with active and previous tuberculosis (TB). DESIGN: Cross-sectional study. METHODS: CD4 lymphocyte counts were determined in all consecutive HIV-positive individuals presenting to the antiretroviral clinic in WHO Stage III and IV. RESULTS: A CD4 lymphocyte count of < or = 350 cells/microl was found in 413 (90%) of 457 individuals in WHO Stage III and IV, 96% of 77 individuals with active TB, 92% of 65 individuals with a history of pulmonary TB (PTB) in the last year, 91% of 89 individuals with a previous history of PTB beyond 1 year, 81% of 32 individuals with a previous history of extra-pulmonary TB, 93% of 107 individuals with active or past TB with another HIV-related disease and 89% of 158 individuals with active or past TB without another HIV-related disease. CONCLUSIONS: In our setting, nine of 10 HIV-positive individuals presenting in WHO Stage III and IV and with active or previous TB have CD4 counts of < or = 350 cells/microl. It would thus be reasonable, in this or similar settings where CD4 counts are unavailable for clinical management, for all such patients to be considered eligible for antiretroviral therapy

Improving domiciliary robotic services by integrating the ASTRO Robot in an AmI Infrastructure

This work describes the ECHORD Experiment ASTROMOBILE, a project aimed to design, develop and test a system for favourable independent living, improved quality of life and efficiency of care for senior citizens in domestic environments. The system, composed of a mobile robotic platform (called ASTRO) and an Ambient Intelligent Infrastructure that actively cooperated between them and with the end-user, was designed and implemented with a user-centred design approach, involving different stakeholders. The system was designed to deliver services to users, like drug delivery, stand support, reminding, info-entertainment. The design took advantages of the integration of robotic platforms with smart environments, to provide to users higher quality and localization based services. Senior end-users were involved in the experimentation of the system in the DomoCasa Living Lab and feedbacks were gathered for the technology assessment. Particularly, this paper demonstrates the general feasibility of the ASTROMOBILE system and thanks to users feedbacks its acceptability and usability

Relationship between aerobic fitness and metabolic power metrics in elite male soccer players

The aim was to assess the relationship between aerobic fitness and metabolic power metrics in elite male soccer players, and the possible differences that playing positions might impose during match play over new metabolic power metrics. Sixty-two elite professional male soccer players (13 central backs, 13 side backs, 22 midfielders, and 14 forwards) took part in the study. Players were monitored during eleven months of full training (including pre-season and in-season) and over all official matches (Serie A matches, Italy Cup matches). Aerobic fitness tests were conducted one week after the start of the preseason, and 8, 24 and 36 weeks after the beginning of the Championship. Players' aerobic fitness and metabolic power metrics were considered as the mean of all seasonal testing and of pooling data of 38 championship matches and 3 or 6 Italy Cup matches for all the calculations respectively. The velocity at 4 mmol·L-1 (VL4) was significantly related to metabolic power metrics match variables with correlation ranging from trivial to very large (r = 0.32 to r = 0.89). Receiver-operating-characteristic (ROC) analysis showed that speed at VL4 was sensitive in detecting high metabolic power distance (HMPD) changes in all but central back players as revealed by area under the curve (central back .78, 95%CI .47 to .95; full back .93, 95%CI .64 to 0.99; midfielder .88, 95%CI .67 to 0.98; forward .90, 95%CI .62 to 0.99). This study's findings provide further evidence for the ecological validity of aerobic fitness in elite male soccer players. Players having a HMPD cut-off equal to or higher than &gt; 1450 m for central backs, &gt; 1990 m for full backs, &gt; 2170 m for midfielders and &gt; 1670 m for forwards may be considered as possessing superior aerobic fitness status. In light of this study's findings, the VL4 test may be considered a valid test to evaluate meaningful information for direct generic aerobic training in soccer players

An unprecedented case of cranial surgery in Longobard Italy (6th–8th century) using a cruciform incision

The Longobard necropolis of Castel Trosino dates from the 6th to the 8th century CE. Among the tombs excavated, the skull of an older female shows the first evidence of a cross-shaped bone modification on a living subject. Macroscopic, microscopic, and CT scan analyses revealed signs of at least two sets of scraping marks. Specifically, SEM analysis shows that perimortem bone-scraping traces are present on the skull. Both healed and non-healed defects suggest that the woman has received at least twice intentional bone modifications to address her condition. This is the first evidence of a cross-shaped therapeutic intervention on a living subject

How people-centred health systems can reach the grassroots: experiences implementing community-level quality improvement in rural Tanzania and Uganda

Background Quality improvement (QI) methods engage stakeholders in identifying problems, creating strategies called change ideas to address those problems, testing those change ideas and scaling them up where successful. These methods have rarely been used at the community level in low-income country settings. Here we share experiences from rural Tanzania and Uganda, where QI was applied as part of the Expanded Quality Management Using Information Power (EQUIP) intervention with the aim of improving maternal and newborn health. Village volunteers were taught how to generate change ideas to improve health-seeking behaviours and home-based maternal and newborn care practices. Interaction was encouraged between communities and health staff. Aim To describe experiences implementing EQUIP’s QI approach at the community level. Methods A mixed methods process evaluation of community-level QI was conducted in Tanzania and a feasibility study in Uganda. We outlined how village volunteers were trained in and applied QI techniques and examined the interaction between village volunteers and health facilities, and in Tanzania, the interaction with the wider community also. Results Village volunteers had the capacity to learn and apply QI techniques to address local maternal and neonatal health problems. Data collection and presentation was a persistent challenge for village volunteers, overcome through intensive continuous mentoring and coaching. Village volunteers complemented health facility staff, particularly to reinforce behaviour change on health facility delivery and birth preparedness. There was some evidence of changing social norms around maternal and newborn health, which EQUIP helped to reinforce. Conclusions Community-level QI is a participatory research approach that engaged volunteers in Tanzania and Uganda, putting them in a central position within local health systems to increase health-seeking behaviours and improve preventative maternal and newborn health practices

Clastic vs. primary precipitated evaporites in the Messinian sicilian Basins

The Messinian stratigraphy of Sicily has a particular importance for the comprehension ofthe Messinian salinity crisis as its successions bear the greatest similarity with those of thedeep Mediterranean basins. Despite the large number of studies carried out in the last 30years, we believe that the true time and genetic relationships between the different evaporiticand non evaporitic rock bodies are still not well established. This is probably due to thelimited, partial view offered by the central Sicilian basin, despite its complete Messinianstratigraphic record.Clastic and chaotic evaporitic deposits emplaced by tectonically-driven small to largescaleresedimentation processes form an important part of the MSC record of Sicily in theBelice and Caltanissetta basins. Facies characteristics of clastic evaporites, the stratigraphicrelationships with the other Messinian deposits, their possible significance in the regionalgeological evolution and the implications at a Mediterranean scale will be discussed in thefield. Attention also will be paid to primary precipitated facies of Lower and UpperEvaporites.The main aim of this field trip is to visit and discuss, beside some of the classic localitiesof the Caltanissetta basin, other less known outcrops of western Sicily (Belice basin), inorder to have a more complete regional geological framework of the MSC events in Sicily.This will give the participants the opportunity to discuss many of the still open problemsconcerning the MSC. In this section we suggest some topics for discussion during the fieldtrip

Roles and Responsibilities in Newborn Care in four African Sites.

To explore roles and responsibilities in newborn care in the intra- and postpartum period in Nigeria, Tanzania and Ethiopia. Qualitative data were collected using in-depth interviews with mothers, grandmothers, fathers, health workers and birth attendants and were analysed through content and framework analyses. We found that birth attendants were the main decision-makers and care takers in the intrapartum period. Birth attendants varied across sites and included female relatives (Ethiopia and Nigeria), traditional birth attendants (Tanzania and Nigeria), spiritual birth attendants (Nigeria) and health workers (Tanzania and Nigeria). In the early newborn period, when the mother is deemed to be resting, female family members assumed this role. The mothers themselves only took full responsibility for newborn care after a few days or weeks. The early newborn period was protracted for first-time mothers, who were perceived as needing training on caring for the baby. Clear gender roles were described, with newborn care being considered a woman's domain. Fathers had little physical contact with the newborn, but played an important role in financing newborn care, and were considered the ultimate decision-maker in the family. Interventions should move beyond a focus on the mother-child dyad, to include other carers who perform and decide on newborn care practices. Given this power dynamic, interventions that involve men have the potential to result in behaviour change

The Stem Species of Our Species: A Place for the Archaic Human Cranium from Ceprano, Italy

One of the present challenges in the study of human evolution is to recognize the hominin taxon that was ancestral to Homo sapiens. Some researchers regard H. heidelbergensis as the stem species involved in the evolutionary divergence leading to the emergence of H. sapiens in Africa, and to the evolution of the Neandertals in Europe. Nevertheless, the diagnosis and hypodigm of H. heidelbergensis still remain to be clarified. Here we evaluate the morphology of the incomplete cranium (calvarium) known as Ceprano whose age has been recently revised to the mid of the Middle Pleistocene, so as to test whether this specimen may be included in H. heidelbergensis. The analyses were performed according to a phenetic routine including geometric morphometrics and the evaluation of diagnostic discrete traits. The results strongly support the uniqueness of H. heidelbergensis on a wide geographical horizon, including both Eurasia and Africa. In this framework, the Ceprano calvarium – with its peculiar combination of archaic and derived traits – may represent, better than other penecontemporaneous specimens, an appropriate ancestral stock of this species, preceding the appearance of regional autapomorphic features