Cluster Randomized Trail of the uptake of a take-home Infant dose of Nevirapine in Kenya

Objective: To test whether a single take home dose of infant nevirapine increased infant uptake without decreasing institutional deliveries. Design: Cluster randomized post-test only study with control group. Setting: Ten hospitals in urban areas of Coast, Rift Valley, and Western provinces, Kenya. Participants: Pregnant women with HIV, 18 years and older, and at least 32 weeks gestation recruited during antenatal care and followed up at home approximately one week after delivery. Intervention: In the intervention group, women were given a single infant’s dose of nevirapine to take home prior to delivery. In the control group, no changes were made to the standard of care. Main outcome measures: Mothers’ reports of infant uptake of nevirapine and place of delivery. Results: Uptake of the infant’s nevirapine dose was high, 94% in the intervention group and 88% in the control group (p=0.096). Among women who delivered at home, uptake was higher significantly among infants whose mothers got the take home dose compared to women who did not get the dose (93% vs. 53%, p<0.01). The intervention did not influence place of delivery. Providers were positive about the take home dose concept; difficulties were attributed to HIV-related stigma. Conclusions: Making take home infant nevirapine available either as a single dose administered within 72 hours of birth or as part of a more complex six week postnatal regimen, will increase infant uptake especially among women who deliver at home without affecting place of delivery.East African Medical Journal Vol. 87 No. 7 July 201

Technical Note: Fast two-dimensional GC-MS with thermal extraction for anhydro-sugars in fine aerosols

A fast two-dimensional gas chromatography (GC-MS) method that uses heart-cutting and thermal extraction (TE) and requires no chemical derivatization was developed for the determination of anhydro-sugars in fine aerosols. Evaluation of the TE-GC-GC-MS method shows high average relative accuracy (≥90%), reproducibility (≤10% relative standard deviation), detection limits of less than 3 ng/μL, and negligible carryover for levoglucosan, mannosan, and galactosan markers. TE-GC-GC-MS- and solvent extraction (SE)-GC-MS-measured levoglucosan concentrations correlate across several diverse types of biomass burning aerosols. Because the SE-GC-MS measurements were taken 8 years prior to the TE-GC-GC-MS ones, the stability of levoglucosan is established for quartz filter-collected biomass burning aerosol samples stored at ultra-low temperature (−50 °C). Levoglucosan concentrations (w/w) in aerosols collected following atmospheric dilution near open fires of varying intensity are similar to those in biomass burning aerosols produced in a laboratory enclosure. An average levoglucosan-mannosan-galactosan ratio of 15:2:1 is observed for these two aerosol sets. TE-GC-GC-MS analysis of atmospheric aerosols from the US and Africa produced levoglucosan concentrations (0.01–1.6 μg/m<sup>3</sup>) well within those reported for aerosols collected globally and examined using different analytical techniques (0.004–7.6 μg/m<sup>3</sup>). Further comparisons among techniques suggest that fast TE-GC-GC-MS is among the most sensitive, accurate, and precise methods for compound-specific quantification of anhydro-sugars. In addition, an approximately twofold increase in anhydro-sugar determination may be realized when combining TE with fast chromatography

Which activities threaten independent living of elderly when becoming problematic : inspiration for meaningful service robot functionality

Purpose: In light of the increasing elderly population and the growing demand for home care, the potential of robot support is given increasing attention. In this paper, an inventory of activities was made that threaten independent living of elderly when becoming problematic. Results will guide the further development of an existing service robot, the Care-O-bot®. Method: A systematic literature search of PubMed was performed, focused on the risk factors for institutionalization. Additionally, focus group sessions were conducted in the Netherlands, United Kingdom and France. In these focus group sessions, problematic activities threatening the independence of elderly people were discussed. Three separate target groups were included in the focus group sessions: (1) elderly persons (n = 41), (2) formal caregivers (n = 40) and (3) informal caregivers (n = 32). Results: Activities within the International Classification of Functioning domains mobility, self-care, and interpersonal interaction and relationships were found to be the most problematic. Conclusions: A distinct set of daily activities was identified that may threaten independent living, but no single activity could be selected as the main activity causing a loss of independence as it is often a combination of problematic activities that is person-specific. Supporting the problematic activities need not involve a robotic solution Read More: http://informahealthcare.com/doi/abs/10.3109/17483107.2013.840861Peer reviewe

Absolute Energy Calibration of X-ray TESs with 0.04 eV Uncertainty at 6.4 keV in a Hadron-Beam Environment

A performance evaluation of superconducting transition-edge sensors (TESs) in the environment of a pion beam line at a particle accelerator is presented. Averaged across the 209 functioning sensors in the array, the achieved energy resolution is 5.2 eV FWHM at Co $K_{\alpha}$ (6.9 keV) when the pion beam is off and 7.3 eV at a beam rate of 1.45 MHz. Absolute energy uncertainty of $\pm$0.04 eV is demonstrated for Fe $K_{\alpha}$ (6.4 keV) with in-situ energy calibration obtained from other nearby known x-ray lines. To achieve this small uncertainty, it is essential to consider the non-Gaussian energy response of the TESs and thermal cross-talk pile-up effects due to charged-particle hits in the silicon substrate of the TES array.Comment: Accepted for publication in J. Low Temperature Physics, special issue for the proceedings of the Low Temperature Detectors 16 conferenc

The combined diabetes and renal control trial (C-DIRECT) - a feasibility randomised controlled trial to evaluate outcomes in multi-morbid patients with diabetes and on dialysis using a mixed methods approach

Background: This cluster randomised controlled trial set out to investigate the feasibility and acceptability of the “Combined Diabetes and Renal Control Trial” (C-DIRECT) intervention, a nurse-led intervention based on motivational interviewing and self-management in patients with coexisting end stage renal diseases and diabetes mellitus (DM ESRD). Its efficacy to improve glycaemic control, as well as psychosocial and self-care outcomes were also evaluated as secondary outcomes. Methods: An assessor-blinded, clustered randomised-controlled trial was conducted with 44 haemodialysis patients with DM ESRD and ≥ 8% glycated haemoglobin (HbA1c), in dialysis centres across Singapore. Patients were randomised according to dialysis shifts. 20 patients were assigned to intervention and 24 were in usual care. The C-DIRECT intervention consisted of three weekly chair-side sessions delivered by diabetes specialist nurses. Data on recruitment, randomisation, and retention, and secondary outcomes such as clinical endpoints, emotional distress, adherence, and self-management skills measures were obtained at baseline and at 12 weeks follow-up. A qualitative evaluation using interviews was conducted at the end of the trial. Results: Of the 44 recruited at baseline, 42 patients were evaluated at follow-up. One patient died, and one discontinued the study due to deteriorating health. Recruitment, retention, and acceptability rates of C-DIRECT were generally satisfactory HbA1c levels decreased in both groups, but C-DIRECT had more participants with HbA1c < 8% at follow up compared to usual care. Significant improvements in role limitations due to physical health were noted for C-DIRECT whereas levels remained stable in usual care. No statistically significant differences between groups were observed for other clinical markers and other patient-reported outcomes. There were no adverse effects. Conclusions: The trial demonstrated satisfactory feasibility. A brief intervention delivered on bedside as part of routine dialysis care showed some benefits in glycaemic control and on QOL domain compared with usual care, although no effect was observed in other secondary outcomes. Further research is needed to design and assess interventions to promote diabetes self-management in socially vulnerable patients

Z' Bosons at Colliders: a Bayesian Viewpoint

We revisit the CDF data on di-muon production to impose constraints on a large class of Z' bosons occurring in a variety of E_6 GUT based models. We analyze the dependence of these limits on various factors contributing to the production cross-section, showing that currently systematic and theoretical uncertainties play a relatively minor role. Driven by this observation, we emphasize the use of the Bayesian statistical method, which allows us to straightforwardly (i) vary the gauge coupling strength, g', of the underlying U(1)'; (ii) include interference effects with the Z' amplitude (which are especially important for large g'); (iii) smoothly vary the U(1)' charges; (iv) combine these data with the electroweak precision constraints as well as with other observables obtained from colliders such as LEP 2 and the LHC; and (v) find preferred regions in parameter space once an excess is seen. We adopt this method as a complementary approach for a couple of sample models and find limits on the Z' mass, generally differing by only a few percent from the corresponding CDF ones when we follow their approach. Another general result is that the interference effects are quite relevant if one aims at discriminating between models. Finally, the Bayesian approach frees us of any ad hoc assumptions about the number of events needed to constitute a signal or exclusion limit for various actual and hypothetical reference energies and luminosities at the Tevatron and the LHC.Comment: PDFLaTeX, 24 pages, 7 figures. Version with improved tables and figure

Tibet, the Himalaya, Asian monsoons and biodiversity - In what ways are they related?

Prevailing dogma asserts that the uplift of Tibet, the onset of the Asian monsoon system and high biodiversity in southern Asia are linked, and that all occurred after 23 million years ago in the Neogene. Here, spanning the last 60 million years of Earth history, the geological, climatological and palaeontological evidence for this linkage is reviewed. The principal conclusions are that: 1) A proto-Tibetan highland existed well before the Neogene and that an Andean type topography with surface elevations of at least 4.5 km existed at the start of the Eocene, before final closure of the Tethys Ocean that separated India from Eurasia. 2) The Himalaya were formed not at the start of the India-Eurasia collision, but after much of Tibet had achieved its present elevation. The Himalaya built against a pre-existing proto-Tibetan highland and only projected above the average height of the plateau after approximately 15 Ma. 3) Monsoon climates have existed across southern Asia for the whole of the Cenozoic, and probably for a lot longer, but that they were of the kind generated by seasonal migrations of the Inter-tropical Convergence Zone. 4) The projection of the High Himalaya above the Tibetan Plateau at about 15 Ma coincides with the development of the modern South Asia Monsoon. 5) The East Asia monsoon became established in its present form about the same time as a consequence of topographic changes in northern Tibet and elsewhere in Asia, the loss of moisture sources in the Asian interior and the development of a strong winter Siberian high as global temperatures declined. 6) New radiometric dates of palaeontological finds point to southern Asia's high biodiversity originating in the Paleogene, not the Neogene

Reliability and validity of the ESRD Symptom Checklist – Transplantation Module in Norwegian kidney transplant recipients

BACKGROUND: The aim of the study was to validate the Norwegian version of a self-administered 43-item questionnaire designed to assess quality of life in kidney transplant recipients, the End-Stage Renal Disease Symptom Checklist – Transplantation Module (ESRD-SCL). METHODS: In total, 53 kidney transplant recipients from one university-affiliated hospital responded to a questionnaire including the ESRD-SCL and the Short Form 36 (SF-36). We assessed internal consistency reliability and test-retest reliability with 2 weeks between assessments. Construct validity was assessed by correlations of the ESRD-SCL subscales with related and unrelated SF-36 scales, demographic, and clinical characteristics. RESULTS: Subscales of the ESRD-SCL showed good internal consistency reliability (Cronbach's = 0.72–0.81) and for the aggregate total scale α was 0.94. Test-retest reliability median 14 days apart was excellent with intraclass coefficients ranging from 0.87 to 0.95. The pattern of correlations of the ESRD-SCL scales with related and unrelated scales SF-36 scales and demographic and clinical characteristics gave support to the construct validity of the ESRD-SCL. CONCLUSION: The Norwegian translation of the ESRD-SCL showed satisfactory internal consistency reliability, test-retest reliability and construct validity, at the level of the original German version