Legislation for effective post‐disaster reconstruction

New Zealand is vulnerable to natural disasters. When disasters occur, the effects can be devastating on the built environment. As one aspect of a major programme of research in New Zealand, the authors address the recovery issue in terms of how legislation either facilitates or hinders reconstruction. The results of a survey to building control officers and other disaster practitioners in New Zealand on the application of the Building Act 2004 post‐disaster are presented in this paper. There are indications that the New Zealand Building Act 2004 will not be supportive or enabling in post‐disaster reconstruction environments, particularly in large‐scale disaster events. Key problems found were procedural constraints as a result of high consenting standards and logistic considerations. The desire is to create the best possible conditions that will encourage rapid rebuilding of lives and communities after large‐scale disasters in New Zealand and that can only be done within a supportive legislative environment. Santruka Infrastruktūros tinklai Naujojoje Zelandijoje platūs, miestai išbarstyti, tačiau tankiai apgyvendinti, tad stichines nelaimes gali pridaryti žalos. Tokios nelaimes gali nusiaubti gamtine ir užstatyta aplinka. Bendruomene tam turetu pasiruošti iš anksto, o ne pasikliauti operatyviu atkūrimo procesu po ivykio. Kaip viena iš Naujojoje Zelandijoje vykstančios stambios tyrimu programos aspektu autoriai pasirinko atkūrimo klausima ir ji nagrineja analizuodami, kaip istatymai padeda arba trukdo atstatymo projektams ir programoms. Iprastoms statyboms taikomi istatymai numato saugu infrastruktūros, kapitalo investiciju ir žemetvarkos pletojima, užtikrindami aplinkosauga, tačiau dažnai jie netinka atstatymo po stichiniu nelaimiu projektams. Šiame darbe pristatomi rezultatai, gauti apklausus Naujosios Zelandijos statybu kontroles pareigūnus ir kitus stichiniu nelaimiu specialistus del Statybu istatymo (2004) taikymo po stichiniu nelaimiu. Yra ženklu, kad Naujosios Zelandijos statybu istatymas (2004) nebus palankus arba sudarantis galimybes nuo stichiniu nelaimiu nukentejusioms teritorijoms atstatyti, ypač kai stichines nelaimes yra stambaus masto. Apklausos rezultatai rodo, kad tebekyla iššūkiai, kaip pagal ši istatyma atstatymo uždavinius ivykdyti veiksmingai. Daugiausia demesio tarp iškeltu klausimu skirta procedūriniams suvaržymams, susijusiems su aukštais kvalifikaciniais standartais ir kitomis logistikos aplinkybemis. Būtinas nemenkas demesys, norint taikyti Statybu istatyma reagavimo i nelaimes ir aplinkos atkūrimo srityje. Siekiama sukurti geriausias imanomas salygas, kurios skatins spartu gyvenamosios aplinkos ir bendruomenes infrastruktūros atstatyma po stambiu stichiniu nelaimiu Naujojoje Zelandijoje ir kurios imanomos tik palankioje teisineje aplinkoje. First Publish Online: 18 Oct 201

Where are we? : The anatomy of the murine cortical meninges revisited for intravital imaging, immunology, and clearance of waste from the brain

Rapid progress is being made in understanding the roles of the cerebral meninges in the maintenance of normal brain function, in immune surveillance, and as a site of disease. Most basic research on the meninges and the neural brain is now done on mice, major attractions being the availability of reporter mice with fluorescent cells, and of a huge range of antibodies useful for immunocytochemistry and the characterization of isolated cells. In addition, two-photon microscopy through the unperforated calvaria allows intravital imaging of the undisturbed meninges with sub-micron resolution. The anatomy of the dorsal meninges of the mouse (and, indeed, of all mammals) differs considerably from that shown in many published diagrams: over cortical convexities, the outer layer, the dura, is usually thicker than the inner layer, the leptomeninx, and both layers are richly vascularized and innervated, and communicate with the lymphatic system. A membrane barrier separates them and, in disease, inflammation can be localized to one layer or the other, so experimentalists must be able to identify the compartment they are studying. Here, we present current knowledge of the functional anatomy of the meninges, particularly as it appears in intravital imaging, and review their role as a gateway between the brain, blood, and lymphatics, drawing on information that is scattered among works on different pathologies

Nile crocodile (Crocodylus niloticus) : egg mass relative to egg component mass in unbanded and fertile eggs

Crocodylus niloticus eggs are a useful starting point to study reproduction in this species. Using samples collected from a single farm during a single breeding season, the present research aimed to describe and compare the masses of unbanded and fertile eggs and their components. The clustering effect of clutch on egg and egg component mass was investigated, and the relationship between the mass of unbanded eggs and their components, together with the effect of possible confounding variables was explored. Estimated egg volume (ellipsoid volume) was strongly positively correlated with egg mass. A strong positive linear relationship existed between egg mass and the combined mass of the foetus and intra-abdominal yolk, as well as between egg mass and the isolated yolk-free foetal mass. If egg mass and incubation period were kept constant, foetal mass increased by 1.1 g for each gram that yolk decreased. The wet yolk and dried shell masses of fertile eggs were significantly lower than those of size-matched unbanded eggs. Clutch had a strong clustering effect on all component masses, particularly total egg mass and hatchling mass. Unbanded egg mass and its individual component masses tended to be similar within a clutch, however some variability existed which should not be discounted. The mass of an egg was strongly positively linearly correlated with the mass of each of its components. The period within the laying season an egg was laid had no effect on its mass nor the mass of any of its components, whereas the breeding pond in which the female resided did affect these measurements. The strong clustering effect of clutch on total egg mass and the masses of all egg components must be accounted for when selecting samples for future studies. The potential confounding effect of breeding pond of origin (which related to female size in the current study) should be considered, particularly where the age or size of females differ among ponds.The University of Pretoria in the form of a bursary to the first author, and by the South African National Research Foundation (NRF) in the form of an incentive fund for rated researchers to the last author.http://www.elsevier.com/ locate/aqua-online2020-04-30hj2019ChemistryProduction Animal Studie

Implementation of an electronic monitoring and evaluation system for the antiretroviral treatment programme in the Cape Winelands district, South Africa: a qualitative evaluation

BACKGROUND: A pragmatic three-tiered approach to monitor the world's largest antiretroviral treatment (ART) programme was adopted by the South African National Department of Health in 2010. With the rapid expansion of the programme, the limitations of the paper-based register (tier 1) were the catalyst for implementation of the stand-alone electronic register (tier 2), which offers simple digitisation of the paper-based register. This article engages with theory on implementation to identify and contextualise enabling and constraining factors for implementation of the electronic register, to describe experiences and use of the register, and to make recommendations for implementation in similar settings where standardisation of ART monitoring and evaluation has not been achieved. METHODS: We conducted a qualitative evaluation of the roll-out of the register. This comprised twenty in-depth interviews with a diverse sample of stakeholders at facility, sub-district, and district levels of the health system. Facility-level participants were selected across five sub-districts, including one facility per sub-district. Responses were coded and analysed using a thematic approach. An implementation science framework guided interpretation of the data. Results & DISCUSSION: We identified the following seven themes: 1) ease of implementation, 2) perceived value of an electronic M&E system, 3) importance of stakeholder engagement, 4) influence of a data champion, 5) operational and logistical factors, 6) workload and role clarity, and 7) importance of integrating the electronic register with routine facility monitoring and evaluation. Interpreting our findings through an implementation theory enabled us to construct the scaffolding for implementation across the five facility-settings. This approach illustrated that implementation was not a linear process but occurred at two nodes: at the adoption of the register for roll-out, and at implementation at facility-level. CONCLUSION: In this study we found that relative advantage of an intervention and stakeholder engagement are critical to implementation. We suggest that without these aspects of implementation, formative and summative outcomes of implementation at both the adoption and coalface stages of implementation would be negatively affected

Cardiovascular pharmacogenetics

Human genetic variation in the form of single nucleotide polymorphisms as well as more complex structural variations such as insertions, deletions and copy number variants, is partially responsible for the clinical variation seen in response to pharmacotherapeutic drugs. This affects the likelihood of experiencing adverse drug reactions and also of achieving therapeutic success. In this paper, we review key studies in cardiovascular pharmacogenetics that reveal genetic variations underlying the outcomes of drug treatment in cardiovascular disease. Examples of genetic associations with drug efficacy and toxicity are described, including the roles of genetic variability in pharmacokinetics (e.g. drug metabolizing enzymes) and pharmacodynamics (e.g. drug targets). These findings have functional implications that could lead to the development of genetic tests aimed at minimizing drug toxicity and optimizing drug efficacy in cardiovascular medicine.http://www.elsevier.com/locate/pharmther

Clinical validity of hearScreen™ smartphone hearing screening for school children

OBJECTIVES : The study aimed to determine the validity of a smartphone hearing screening technology (hearScreen™) compared with conventional screening audiometry in terms of (1) sensitivity and specificity, (2) referral rate, and (3) test time. DESIGN : One thousand and seventy school-age children in grades 1 to 3 (8 ± 1.1 average years) were recruited from five public schools. Children were screened twice, once using conventional audiometry and once with the smartphone hearing screening. Screening was conducted in a counterbalanced sequence, alternating initial screen between conventional or smartphone hearing screening. RESULTS : No statistically significant difference in performance between techniques was noted, with smartphone screening demonstrating equivalent sensitivity (75.0%) and specificity (98.5%) to conventional screening audiometry. While referral rates were lower with the smartphone screening (3.2 vs. 4.6%), it was not significantly different (p > 0.05). Smartphone screening (hearScreen™) was 12.3% faster than conventional screening. CONCLUSION : Smartphone hearing screening using the hearScreen™ application is accurate and time efficient.National Research Foundation (NRF).http://journals.lww.com/ear-hearing2016-09-30hb201

Bench-to-bedside review: The evaluation of complex interventions in critical care

Complex interventions, such as the introduction of medical emergency teams or an early goal-directed therapy protocol, are developed from a number of components that may act both independently and inter-dependently. There is an emerging body of literature advocating the use of integrated complex interventions to optimise the treatment of critically ill patients. As with any other treatment, complex interventions should undergo careful evaluation prior to widespread introduction into clinical practice. During the development of an international collaboration of researchers investigating protocol-based approaches to the resuscitation of patients with severe sepsis, we examined the specific issues related to the evaluation of complex interventions. This review outlines some of these issues. The issues specific to trials of complex interventions that require particular attention include determining an appropriate study population and defining current treatments and outcomes in that population, defining the study intervention and the treatment to be used in the control group, and deploying the intervention in a standardised manner. The context in which the research takes place, including existing staffing levels and existing protocols and procedures, is crucial. We also discuss specific details of trial execution, in particular randomization, blinded outcome adjudication and analysis of the results, which are key to avoiding bias in the design and interpretation of such trials

In vivo imaging of trypanosome-brain interactions and development of a rapid screening test for drugs against CNS stage trypanosomiasis.

HUMAN AFRICAN TRYPANOSOMIASIS (HAT) MANIFESTS IN TWO STAGES OF DISEASE: firstly, haemolymphatic, and secondly, an encephalitic phase involving the central nervous system (CNS). New drugs to treat the second-stage disease are urgently needed, yet testing of novel drug candidates is a slow process because the established animal model relies on detecting parasitemia in the blood as late as 180 days after treatment. To expedite compound screening, we have modified the GVR35 strain of Trypanosoma brucei brucei to express luciferase, and have monitored parasite distribution in infected mice following treatment with trypanocidal compounds using serial, non-invasive, bioluminescence imaging. Parasites were detected in the brains of infected mice following treatment with diminazene, a drug which cures stage 1 but not stage 2 disease. Intravital multi-photon microscopy revealed that trypanosomes enter the brain meninges as early as day 5 post-infection but can be killed by diminazene, whereas those that cross the blood-brain barrier and enter the parenchyma by day 21 survived treatment and later caused bloodstream recrudescence. In contrast, all bioluminescent parasites were permanently eliminated by treatment with melarsoprol and DB829, compounds known to cure stage 2 disease. We show that this use of imaging reduces by two thirds the time taken to assess drug efficacy and provides a dual-modal imaging platform for monitoring trypanosome infection in different areas of the brain

Households, fluidity, and HIV service delivery in Zambia and South Africa – an exploratory analysis of longitudinal qualitative data from the HPTN 071 (PopART) trial

CITATION: Hoddinott, G., et al. 2018. Households, fluidity, and HIV service delivery in Zambia and South Africa – an exploratory analysis of longitudinal qualitative data from the HPTN 071 (PopART) trial. Journal of the International AIDS Society, 21(4):e25135, doi:10.1002/jia2.25135.The original publication is available at https://onlinelibrary.wiley.comIntroduction: Population distributions, family and household compositions, and people’s sense of belonging and social stability in southern Africa have been shaped by tumultuous, continuing large-scale historical disruptions. As a result, many people experience high levels of geographic and social fluidity, which intersect with individual and population-level migration patterns. We describe the complexities of household fluidity and HIV service access in South Africa and Zambia to explore implications for health systems and service delivery in contexts of high household fluidity. Methods: HPTN 071 (PopART) is a three-arm cluster randomized controlled trial implemented in 21 peri-urban study communities in Zambia and South Africa between 2013 and 2018. A qualitative cohort nested in the trial included 148 purposively sampled households. Data collection was informed by ethnographic and participatory research principles. The analysis process was reflexive and findings are descriptive narrative summaries of emergent ideas. Results: Households in southern Africa are extremely fluid, with people having a tenuous sense of security in their social networks. This fluidity intersects with high individual and population mobility. To characterize fluidity, we describe thematic patterns of household membership and residence. We also identify reasons people give for moving around and shifting social ties, including economic survival, fostering interpersonal relationships, participating in cultural, traditional, religious, or familial gatherings, being institutionalized, and maintaining patterns of substance use. High fluidity disrupted HIV service access for some participants. Despite these challenges, many participants were able to regularly access HIV testing services and participants living with HIV were especially resourceful in maintaining continuity of antiretroviral therapy (ART). We identify three key features of health service interactions that facilitated care continuity: disclosure to family members, understanding attitudes among health services staff including flexibility to accommodate clients’ transient pressures, and participants’ agency in ARTrelated decisions. Conclusions: Choices made to manage one’s experiential sense of household fluidity are intentional responses to livelihood and social support constraints. To enhance retention in care for people living with HIV, policy makers and service providers should focus on creating responsive, flexible health service delivery systems designed to accommodate many shifts in client circumstances.https://onlinelibrary.wiley.com/doi/full/10.1002/jia2.25135Publisher's versio

Households, fluidity, and HIV service delivery in Zambia and South Africa - an exploratory analysis of longitudinal qualitative data from the HPTN 071 (PopART) trial.

INTRODUCTION: Population distributions, family and household compositions, and people's sense of belonging and social stability in southern Africa have been shaped by tumultuous, continuing large-scale historical disruptions. As a result, many people experience high levels of geographic and social fluidity, which intersect with individual and population-level migration patterns. We describe the complexities of household fluidity and HIV service access in South Africa and Zambia to explore implications for health systems and service delivery in contexts of high household fluidity. METHODS: HPTN 071 (PopART) is a three-arm cluster randomized controlled trial implemented in 21 peri-urban study communities in Zambia and South Africa between 2013 and 2018. A qualitative cohort nested in the trial included 148 purposively sampled households. Data collection was informed by ethnographic and participatory research principles. The analysis process was reflexive and findings are descriptive narrative summaries of emergent ideas. RESULTS: Households in southern Africa are extremely fluid, with people having a tenuous sense of security in their social networks. This fluidity intersects with high individual and population mobility. To characterize fluidity, we describe thematic patterns of household membership and residence. We also identify reasons people give for moving around and shifting social ties, including economic survival, fostering interpersonal relationships, participating in cultural, traditional, religious, or familial gatherings, being institutionalized, and maintaining patterns of substance use. High fluidity disrupted HIV service access for some participants. Despite these challenges, many participants were able to regularly access HIV testing services and participants living with HIV were especially resourceful in maintaining continuity of antiretroviral therapy (ART). We identify three key features of health service interactions that facilitated care continuity: disclosure to family members, understanding attitudes among health services staff including flexibility to accommodate clients' transient pressures, and participants' agency in ART-related decisions. CONCLUSIONS: Choices made to manage one's experiential sense of household fluidity are intentional responses to livelihood and social support constraints. To enhance retention in care for people living with HIV, policy makers and service providers should focus on creating responsive, flexible health service delivery systems designed to accommodate many shifts in client circumstances