The development of a screening tool to evaluate infants who are HIV positive

HIV/AIDS continues to be one of the greatest health challenges which South Africa faces. The epidemic in children is closely linked to that in women, the prevalence of which continues to grow according to antenatal statistics from the South African Department of Health (DOH). HIV is known to invade the central nervous system at the time of infection, and causes widespead damage. In children, this leads to a well-researched condition known as HIV encephalopathy, which affects all areas of neurodevelopment. The effects of timely initiation of antiretroviral therapy on alleviating the impact of encephalopathy have been well described. Neurodevelopmental delay is a stage four disease indicator according to the World Health Organisation (WHO), and therefore is a criterion for initiation of Highly Active Antiretroviral Therapy (HAART). HAART is often only administered according to the virologic and immunologic status of a child, as standardised neurodevelopmental assessment tools are not widely available in South African clinics. When HAART initiation is dependent on immunologic status, it is often too late to prevent encephalopathy. To date, the only means of prevention of this condition is early initiation of HAART, which has not been widely available in South Africa. Stringent guidelines for the commencement of this therapy according to the WHO, and the South African Department of Health (DOH) have had to be followed, leading to late initiation of HAART, and widespread central nervous system encephalopathy. Studies which have been carried out in South African clinics have demonstrated the high prevalence of this condition. Once there is evidence of encephalopathy, children should be referred for assessments in all facets of development, and where necessary, for rehabilitation. A standardised developmental screening tool which is suitable for use in a developing country is therefore necessary in order to screen for neurodevelopmental delays to allow for further assessment and referral to rehabilitation services, as well as providing an additional assessment criterion for initiation of HAART. Paediatric HIV clinics in developing countries are understaffed, and children may be seen by junior staff or screened by nurses due to the high numbers of clinic attendees. This often results in neurodevelopment being inadequately assessed and children are therefore not referred for intervention services. A standardised screening tool, could be administered by clinic staff in order to ensure correct and timely referral of children for further assessment and intervention is therefore necessary. This is of importance both locally and internationally where a screening tool, which has been developed specifically for this purpose, does not exist. The aim of this study was therefore to evaluate the agreement between the Bayley-III Screening Test and the Bayley Scales of Infant Development (3rd version) in a population of HIV positive infants in order to evaluate its appropriateness for use in South Africa. The Bayley Scales of Infant Development have long been considered the ‘gold standard’ in infant developmental assessment, which is why this tool was chosen to evaluate the Bayley-III Screening Test against. The developmental scores in each facet (cognitive, motor or language) were evaluated to determine which should be included in an assessment tool for this population. Further objectives for the study were to adapt the screening tool to the needs of the population, or to develop a new screening tool shouldthe Bayley-III Screening Test not prove suitable for use in this population. In order to meet the aims and objectives, a cross-sectional study was conducted where 112 HIV positive infants between the ages of six and eighteen months were assessed using the Bayley-III Screening Test and the Bayley Scales of Infant Development (3rd version) (BSID III). The infants were stratified into four age groups namely 6-8 months, 9-12 months, 13-16 months, and 17-18 months. Children were recruited from Harriet Shezi Children’s Clinic at Chris Hani Baragwanath Hospital in Soweto. The agreement between the Bayley-III Screening Test and the Bayley Scales of Infant Development (3rd version) was analysed using Kappa, for the overall group, and for each age group. Overall agreement between the tools was as follows: K=0.58 for the Cognitive facet, K=0.82 for the Expressive Communication facet, K=0.76 for the Receptive Communication facet, K=0.44 for the Fine Motor facet and K=0.57 for the Gross Motor facet. These values indicate that the Bayley-III Screening Test is therefore not acceptable for clinical use, as excellent agreement (k≥0.75) in all facets would be necessary for this purpose. A new screening tool therefore had to be developed. The infant’s developmental scores from the BSID III were analysed to determine which facets of development were most severely affected, and therefore which facets should be included in a new screening tool. Gross motor function was demonstrated to be the area which was most severely affected, followed by cognitive function. A gross motor screening tool would therefore be suitable for use in this population, as no equipment would be necessary. Gross motor development is the most universally similar aspect of development, which is not completely dependent on cultural or socioeconomic factors which often have an influence on language and cognitive development. Item selection from the BSID III was undertaken to determine which items should be included in a brief screening tool. In each of the four age groups, item selection occurred as follows: Two items which discriminated the At-Risk, from Emerging and Competent groups (less than 20% in the At-Risk group, and 100% in the other groups) were selected. Two items, which discriminated between children in the ‘Emerging’ and ‘Competent’ categories on the BSID III were selected (0-5% of children who were At-Risk obtained credit, 30-50% of the Emerging group obtained credit, and 100% of the Competent group obtained credit). Lastly, two items were selected which discriminated the Competent group from the other two groups (100% or as high as possible in the Competent group, and 0% in the other groups). The new gross motor screening tool was assembled using the selected items, scoring was allocated, and it was tested against the scores obtained on the Gross Motor facet of the BSID III for the initial 112 infants. Agreement between the tools was analysed using Kappa, and refinements were made according to the discrepancies. This was done three times, until the Kappa value revealed excellent agreement between the tools (k = 0.87). A panel of experts was then invited to examine the new gross motor screening tool, and to comment on it, and further adjustments were made accordingly. Preliminary concurrent validity testing of the new gross motor screening tool was then carried out against the Gross Motor facet of the BSID III on 60 children, who were recruited from the Harriet Shezi Children’s Clinic at Chris Hani Baragwanath Hospital in Soweto. Statistical analysis revealed that the agreement between the BSID III and the new screening tool was excellent (k=0.85). The diagnostic properties of the new gross motor screening tool were as follows: sensitivity 97.4%, specificity 85.7%, positive predictive value 92.7%, and negative predictive value 94.7%. These values indicate that the statistical properties of the tool are excellent, and the tool will not be predisposed to underreferrals or over-referrals. Preliminary reliability testing was carried out on 15 children for test-retest/intrarater reliability and 15 children for interrater reliability. Interrater, test-retest and intrarater reliability were excellent (r=1, r=0.98, r=0.98 respectively). Further testing of reliablity and validity should be undertaken in order to establish these properties, and standardisation should also be carried out on healthy children. Given the need for an assessment tool of this nature in South Africa and other developing countries, and the statistical properties thus far, the tool may be used clinically for the purposes for which it was developed

Quadratic-linear duality and rational homotopy theory of chordal arrangements

To any graph and smooth algebraic curve $C$ one may associate a "hypercurve" arrangement and one can study the rational homotopy theory of the complement $X$. In the rational case ($C=\mathbb{C}$), there is considerable literature on the rational homotopy theory of $X$, and the trigonometric case ($C = \mathbb{C}^\times$) is similar in flavor. The case of when $C$ is a smooth projective curve of positive genus is more complicated due to the lack of formality of the complement. When the graph is chordal, we use quadratic-linear duality to compute the Malcev Lie algebra and the minimal model of $X$, and we prove that $X$ is rationally $K(\pi,1)$.Comment: v1: 22 pages; v2: 25 pages, generalized to higher genus curve

The extent of delay of language, motor and cognitive development in HIV posititive infants

In South Africa, a total number of 5.7 – 6.2 million individuals had acquired HIV infection by 2004 (Department of Health, 2004). It is estimated that 3.3 million females, 2.8 million males, and 104 963 babies had been infected with HIV in South Africa by 2004 (Department of Health, 2004). It has been found that HIV-positive children have significantly greater neurological dysfunction in eight domains (activity, language, cranial nerve, fine motor, gross motor, cerebellar, sensory and primitive reflexes) than their HIV negative counterparts (Belman et al, 1996). There has been very little research conducted in Africa regarding the extent of delay of language, motor, and cognitive development in HIV positive infants. The main aim of this study is to determine the extent of delay in acquisition of language, cognitive and motor skills of HIV positive children. The Bayley Scales of Infant Development II (BSID II) were used to determine performance in each section of the child’s age group. These results were transferred to the facet scoring section, which analyse in greater detail, with respect to cognitive, language and motor development. Baseline BSID II assessments of HIV infected children currently enrolled in a longitudinal study of neurodevelopmental delay were analysed to determine which facets of development are most delayed. The Mental and Psychomotor Developmental Indices (MDI and PDI) of the BSID II were used to determine the extent of mental and motor delays in this sample. Mean cognitive development was 7.63 months delayed, which was statistically significant (p<0.01) and 97.5% of the sample were functioning below the expected cognitive age. Mean motor development was 9.65 months delayed (p<0.01), and 97.5% of the sample were functioning below expected motor age. Gross motor skills were more affected than fine motor skills, and 85% of the sample demonstrated gross motor delays on descriptive analysis. Language was descriptively analysed, revealing language delays in 82.5% of the sample. The infants in this study demonstrated significant mental and motor delays, as well as delays in language. It is postulated that motor delays may be attributed to decreased strength, as the most adversely affected skill in this sample was gross motor development. The cognitive delays noted may be due to disease progression and structural damage to the brain, as well as socio-economic factors. The language delays noted could be due to neurological impairment, cognitive delay or environmental deprivation. Children with HIV have significant delays in mental and motor development, and language is delayed in most children with HIV. The results of this study are similar to findings in other parts of the world, which indicates a global trend in HIV and neurodevelopmental delay. The results of this study are important, particularly for those involved in motor and language rehabilitation, as an awareness of potential problems in these infants is needed in order to provide them with the best management and care possible

Poetry Audio/Video Library Phase 2

The University of Arizona Poetry Center currently provides patrons access to its unparalleled collection of poetry recordings-thousands of hours of audio and video material dating from the 1960s forward-using a proprietary database and storage system. When this application-the Audio/Video Library (AVL)-was begun in 2006, its first phase involved basic data entry and a desktop-only interface. Its second phase, beginning in March 2010, will add a Web 2.0 component to make the entire collection available to the general public. This Level II grant would fund this phase, which has three goals: 1)Develop a web-accessible interface, giving scholars, students, and the public direct on-line access to the collection from anywhere in the world; 2)Enhance the application's search tools so to increase the collections's value to scholars; 3)Develop a user-comment module to allow poets, scholars Poetry Center staff, and the public to share and store their knowledge about the collection's contents

Terricolous Spiders (Araneae) of Insecticide-Treated Spruce-Fir Forests in West-Central Maine

Spiders of 12 families, 42 genera, and at least 62 species were captured in linear-pitfall traps placed in insecticide-treated (Sevin-4-Oil®, Dipel 4L ®, Thuricide 16B®) and untreated spruce-fIr forests of west-central Maine. Species richness per family ranged from 1 (Theridiidae, Araneidae, Salticidae) to 19 (Erigonidae). Most trapped species were web-spinners (67.2%); most trapped individuals were hunters (75.2%). Lycosidae accounted for 66.1 % of all (n = 887) captured spiders. Total trapped spiders varied among insecticide treatments, sampling dates, and study sites. However, comparison of mean prespray and postspray trap catches indicated no significant reduction (ANOVA, ANCOVA, P 0.05) in terricolous spiders following insecticide treatments. Increases in spider abundance during postspray sampling periods may have masked detection of treatment effects

Temporary

A prose stor

Undone

A prose stor

Recovering Lost Local History: The Daily Record Project

This practitioner perspective describes a collaboration between students and teachers at three middle schools, along with community partners, to recover and digitize news stories from The Daily Record, an African American owned newspaper that was attacked and burned in the 1898 Wilmington coup d’état