Vitamin D: the role of the sunshine vitamin

The importance of vitamin D in physical disorders has been well documented. Deficiency in this vitamin is associated with a wide range of physical and mental disorders that include, heart problems, hypertension, stroke, diabetes, various cancers, and asthma. In mental health vitamin D deficiency is associated with schizophrenia, depression, anxiety, Alzheimer’s disease among others. Risk factors for vitamin D deficiency include darker skin, lack of adequate sun exposure, autoimmune diseases, influenza, old age and the use of certain medicines like anticonvulsants. Vitamin D is likely to play an important role in the management and prevention of various mental health problems. In particular, adequate vitamin D during the perinatal stage is likely to impact positively on the long term mental health of a person

The challenge of integrated water resource management for improved rural livelihoods: Managing risk, mitigating drought and improving water productivity in the water scarce Limpopo Basin

The Challenge of Integrated Water Resource Management for Improved Rural Livelihoods: Managing Risk, Mitigating Drought and Improving Water Productivity in the Water Scarce Limpopo Basin: Integrated Water Resources Management (IWRM) is a systems approach to water management, based on the principle of managing the full water cycle. It is required, not only to balance water for food and nature, but also to unlock paths to sustainable development. A global hotspot area in terms of water for food and improved livelihoods is in the poverty stricken rural areas of water scarce semi-arid tropics, such as in the Limpopo basin. The improvement in resilience that the IWRM approach can impart to rural livelihood systems has been shown by a series of case studies in the Limpopo Basin

Comparative Cost of Early Infant Male Circumcision by Nurse-Midwives and Doctors in Zimbabwe

BACKGROUND: The 14 countries that are scaling up voluntary male medical circumcision (VMMC) for HIV prevention are also considering early infant male circumcision (EIMC) to ensure longer-term reductions in HIV incidence. The cost of implementing EIMC is an important factor in scale-up decisions. We conducted a comparative cost analysis of EIMC performed by nurse-midwives and doctors using the AccuCirc device in Zimbabwe. METHODS: Between August 2013 and July 2014, nurse-midwives performed EIMC on 500 male infants using AccuCirc in a field trial. We analyzed the overall unit cost and identified key cost drivers of EIMC performed by nurse-midwives and compared these with costing data previously collected during a randomized noninferiority comparison trial of 2 devices (AccuCirc and the Mogen clamp) in which doctors performed EIMC. We assessed direct costs (consumable and nonconsumable supplies, device, personnel, associated staff training, and waste management costs) and indirect costs (capital and support personnel costs). We performed one-way sensitivity analyses to assess cost changes when we varied key component costs. RESULTS: The unit costs of EIMC performed by nurse-midwives and doctors in vertical programs were US$38.87 and US$49.77, respectively. Key cost drivers of EIMC were consumable supplies, personnel costs, and the device price. In this cost analysis, major cost drivers that explained the differences between EIMC performed by nurse-midwives and doctors were personnel and training costs, both of which were lower for nurse-midwives. CONCLUSIONS: EIMC unit costs were lower when performed by nurse-midwives compared with doctors. To minimize costs, countries planning to scale up EIMC should consider using nurse-midwives, who are in greater supply than doctors and are the main providers at the primary health care level, where most infants are born

The extent of and factors associated with self-reported overdose and self-reported receipt of naloxone among people who inject drugs (PWID) in England, Wales and Northern Ireland.

BACKGROUND: Overdose is a major cause of death among PWID, and for opioid overdoses naloxone administration can reduce harm. However, globally there is limited national level data on the extent of non-fatal overdose and naloxone uptake. The first national level data on the extent of self-reported overdose and self-reported receipt of naloxone among UK PWID, providing a baseline to monitor the impact of the recent policy change regarding naloxone availability, is presented. METHODS: Data on self-reported overdose and receipt of naloxone during the preceding year for 2013-2014 from a national survey of PWID was analysed. Participants who reported injecting during the preceding year were included. RESULTS: Participants (3850) were predominantly male (75%); mean age was 36 years. The most commonly injected drugs were: heroin (91%), crack (45%) and amphetamine (29%). 15% (591) reported overdosing during the preceding year. There were no differences in the proportion reporting overdose by age or gender, but overdose was more common among those who: injected multiple drugs; recently ceased addiction treatment; injected with used needles/syringes; ever had transactional sex; had used a sexual health clinic or emergency department and lived in Wales or Northern Ireland. Among those reporting an overdose during the preceding year, a third reported two to four overdoses and 7.5% five or more overdoses; half reported receiving naloxone. Those reporting naloxone receipt in the preceding year were more likely to: live in Wales or Northern Ireland; ever received used needles/syringes; ever been imprisoned; and less likely to have injected two drug types. CONCLUSION: These data provide a baseline for monitoring the impact of the 2015 UK policy change to improve take-home naloxone access. Interventions tackling overdose should promote naloxone awareness and access, and target those who; are poly-drug injectors, have ceased treatment, share needles/syringes and whose drug use links to sexual activity

Antiretroviral Therapy outcomes among adolescents and youth in rural Zimbabwe

Around 2 million adolescents and 3 million youth are estimated to be living with HIV worldwide. Antiretroviral outcomes for this group appear to be worse compared to adults. We report antiretroviral therapy outcomes from a rural setting in Zimbabwe among patients aged 10-30 years who were initiated on ART between 2005 and 2008. The cohort was stratified into four age groups: 10-15 (young adolescents) 15.1-19 years (adolescents), 19.1-24 years (young adults) and 24.1-29.9 years (older adults). Survival analysis was used to estimate rates of deaths and loss to follow-up stratified by age group. Endpoints were time from ART initiation to death or loss to follow-up. Follow-up of patients on continuous therapy was censored at date of transfer, or study end (31 December 2008). Sex-adjusted Cox proportional hazards models were used to estimate hazard ratios for different age groups. 898 patients were included in the analysis; median duration on ART was 468 days. The risk of death were highest in adults compared to young adolescents (aHR 2.25, 95%CI 1.17-4.35). Young adults and adolescents had a 2-3 times higher risk of loss to follow-up compared to young adolescents. When estimating the risk of attrition combining loss to follow-up and death, young adults had the highest risk (aHR 2.70, 95%CI 1.62-4.52). This study highlights the need for adapted adherence support and service delivery models for both adolescents and young adults

Positive attitudes to pediatric HIV testing: findings from a nationally representative survey from Zimbabwe.

Early HIV testing and diagnosis are paramount for increasing treatment initiation among children, necessary for their survival and improved health. However, uptake of pediatric HIV testing is low in high-prevalence areas. We present data on attitudes towards pediatric testing from a nationally representative survey in Zimbabwe

Diagnosis and treatment of TB patients with rifampicin resistance detected using Xpert(®) MTB/RIF in Zimbabwe.

SETTING: In Zimbabwe, there are concerns about the management of tuberculosis (TB) patients with rifampicin (RMP) resistance diagnosed using Xpert(®) MTB/RIF. OBJECTIVE: To assess linkages between diagnosis and treatment for these patients in Harare and Manicaland provinces in 2014. DESIGN: A retrospective cohort study. RESULTS: Of 20 329 Xpert assays conducted, 90% were successful, 11% detected Mycobacterium tuberculosis and 4.5% showed RMP resistance. Of 77 patients with RMP-resistant TB diagnosed by Xpert, 70% had samples sent to the reference laboratory for culture and drug susceptibility testing (CDST); 53% of the samples arrived. In 21% the samples showed M. tuberculosis growth, and in 17% the DST results were recorded, all of which confirmed RMP resistance. Of the 77 patients, 34 (44%) never started treatment for multidrug-resistant (MDR) TB, with documented reasons being death, loss to follow-up and incorrect treatment. Of the 43 patients who started MDR-TB treatment, 12 (71%) in Harare and 17 (65%) in Manicaland started within 2 weeks of diagnosis. CONCLUSION: Xpert has been rolled out successfully in two Zimbabwe provinces. However, the process of confirming CDST for Xpert-diagnosed RMP-resistant TB works poorly, and many patients are either delayed or never initiate MDR-TB treatment. These shortfalls must be addressed at the programmatic level

Dynamics of FitzHugh-Nagumo excitable systems with delayed coupling

Small lattices of $N$ nearest neighbor coupled excitable FitzHugh-Nagumo systems, with time-delayed coupling are studied, and compared with systems of FitzHugh-Nagumo oscillators with the same delayed coupling. Bifurcations of equilibria in N=2 case are studied analytically, and it is then numerically confirmed that the same bifurcations are relevant for the dynamics in the case $N>2$. Bifurcations found include inverse and direct Hopf and fold limit cycle bifurcations. Typical dynamics for different small time-lags and coupling intensities could be excitable with a single globally stable equilibrium, asymptotic oscillatory with symmetric limit cycle, bi-stable with stable equilibrium and a symmetric limit cycle, and again coherent oscillatory but non-symmetric and phase-shifted. For an intermediate range of time-lags inverse sub-critical Hopf and fold limit cycle bifurcations lead to the phenomenon of oscillator death. The phenomenon does not occur in the case of FitzHugh-Nagumo oscillators with the same type of coupling.Comment: accepted by Phys.Rev.

Exploring how to use scenarios to discover requirements

This paper investigates the effectiveness of different uses of scenarios on requirements discovery using results from requirements processes in two projects. The first specified requirements on a new aircraft management system at a regional UK airport to reduce its environmental impact. The second specified new work-based learning tools to be adopted by a consortium of organizations. In both projects scenarios were walked through both in facilitated workshops and in the stakeholders’ workplaces using different forms of a scenario tool. In the second project, scenarios were also walked through with a software prototype and creativity prompts. Results revealed both qualitative and quantitative differences in discovered requirements that have potential implications for models of scenario-based requirements discovery and the design of scenario tools