Differences in access and patient outcomes across antiretroviral treatment clinics in the Free State province: A prospective cohort study

Objective. To assess differences in access to antiretroviral treatment (ART) and patient outcomes across public sector treatment facilities in the Free State province, South Africa. Design. Prospective cohort study with retrospective database linkage. We analysed data on patients enrolled in the treatment programme across 36 facilities between May 2004 and December 2007, and assessed percentage initiating ART and percentage dead at 1 year after enrolment. Multivariable logistic regression was used to estimate associations of facility-level and patient-level characteristics with both mortality and treatment status. Results. Of 44 866 patients enrolled, 15 219 initiated treatment within 1 year; 8 778 died within 1 year, 7 286 before accessing ART. Outcomes at 1 year varied greatly across facilities and more variability was explained by facility-level factors than by patient-level factors. The odds of starting treatment within 1 year improved over calendar time. Patients enrolled in facilities with treatment initiation available on site had higher odds of starting treatment and lower odds of death at 1 year compared with those enrolled in facilities that did not offer treatment initiation. Patients were less likely to start treatment if they were male, severely immunosuppressed (CD4 count ≤50 cells/μl), or underweight

Conservation Laws in Cellular Automata

If X is a discrete abelian group and B a finite set, then a cellular automaton (CA) is a continuous map F:B^X-->B^X that commutes with all X-shifts. If g is a real-valued function on B, then, for any b in B^X, we define G(b) to be the sum over all x in X of g(b_x) (if finite). We say g is `conserved' by F if G is constant under the action of F. We characterize such `conservation laws' in several ways, deriving both theoretical consequences and practical tests, and provide a method for constructing all one-dimensional CA exhibiting a given conservation law.Comment: 19 pages, LaTeX 2E with one (1) Encapsulated PostScript figure. To appear in Nonlinearity. (v2) minor changes/corrections; new references added to bibliograph

Exploring the anthelmintic properties of Australian native shrubs with respect to their potential role in livestock grazing systems

We measured in vitro anthelmintic activity in extracts from 85 species of Australian native shrub, with a view to identifying species able to provide a degree of worm control in grazing systems. Approximately 40% of the species showed significant activity in inhibiting development of Haemonchus contortus larvae. The most active extracts showed IC50 values of 60–300 mg/ml. Pre-incubation with polyvinylpolypyrrolidine removed the activity from some extracts, implicating tannins as the bioactive agent, while in other cases the pre-incubation had no effect, indicating the presence of other anthelmintic compounds. Plant reproductive maturity (onset of flowering or fruiting) was associated with increasing anthelmintic activity in some species. Variability was observed between plants of the same species growing in different environments, while variation between individual plants of the same species within a single field suggests the existence of distinct chemotypes. Significant activity against adult H. contortus worms in vitro was also demonstrated in a limited number of extracts tested against this life stage. Our study indicates that there is potential for Australian native shrubs to play an anthelmintic role in grazing systems, and highlights some plant biology factors which will need to be considered in order to maximize any anthelmintic effects.A. C. Kotze, J. O’Grady, J. Emms, A. F. Toovey, S. Hughes, P. Jessop, M. Bennell P. E. Vercoe and D. K. Revel

The Short-term Influence of a Mediterranean-type Diet and Mild Exercise with and without Red Wine on Patients with the Metabolic Syndrome

The metabolic syndrome is a target for the dietary prevention of cardiovascular disease. The effect of adding redwine to the diet has not been fully investigated. This study examined whether a Mediterranean-type dietcomplemented with red wine and mild exercise had an impact on patients with the metabolic syndrome in the shortterm. Twelve patients with the metabolic syndrome consumed a Mediterranean-type diet for four weeks withoutand with red wine respectively and performed mild exercise. We implemented the diagnostic criteria for themetabolic syndrome as formulated by the Adult Treatment Panel III (ATP III) in 2001. The patients were alsoscreened for multiple genetic markers implicated in cardiovascular disease. Weight, body mass index, abdominalcircumference and blood pressure were measured, as well as various biochemical, haematological andinflammatory markers. There was a significant decrease in the body weight (p = 0.04) and an increase in ORACvalue (p = 0.035) after the dietary intervention. A significant decrease in systolic blood pressure (p = 0.045) wasobserved. Red wine had no additional benefits. Although diet reduced weight and blood pressure, the lipoproteinand pro-coagulant profiles of patients with the metabolic syndrome were not affected in this study. These findingsmay be explained partly by the diverse genetic profile identified among the study participants, as 50% hadmutations involved in lipid metabolism that may influence the response to dietary intervention and alcoholconsumption

A Novel High Throughput Assay for Anthelmintic Drug Screening and Resistance Diagnosis by Real-Time Monitoring of Parasite Motility

Parasitic worms cause untold morbidity and mortality on billions of people and livestock. Drugs are available but resistance is problematic in livestock parasites and is a looming threat for human helminths. Currently, new drug discovery and resistance monitoring is hindered as drug efficacy is assessed by observing motility or development of parasites using laborious, subjective, low-throughput methods evaluated by eye using microscopy. Here we describe a novel application for a cell monitoring device (xCELLigence) that can simply and objectively assess real time anti-parasite efficacy of drugs on eggs, larvae and adults in a fully automated, label-free, high-throughput fashion. This technique overcomes the current low-throughput bottleneck in anthelmintic drug development and resistance detection pipelines. The widespread use of this device to screen for new therapeutics or emerging drug resistance will be an invaluable asset in the fight against human, animal and plant parasitic helminths and other pathogens that plague our planet

Continuity of care of outpatients with schizophrenia in Pretoria

Objective. To study the needs of outpatients suffering from schizophrenia and their primary caregivers. Methods. A qualitative descriptive design was selected to study the needs of a non-probability purposive sample of 50 outpatients with schizophrenia and their primary caregivers. Data were collected on their compliance-related needs as well as psychosocial and aftercare treatment needs. Results. Compliance needs: Eighty-three per cent of the participants supported their medication treatment and aftercare, but needed more information on the illness than they had received or had managed to gather. Psychosocial needs: Participants had difficulty in accepting the illness and in understanding its consequences for their everyday functioning. Ninety-seven per cent of patients were aware that their illness had affected the health of their primary caregiver. The majority of participants had lost friendships since the diagnosis of schizophrenia. Eighty-eight of the primary caregivers supported the patient financially, despite the fact that many were over 60 years of age. Aftercare treatment needs: A strong need was expressed for services such as day-care centres, workshops, and psycho-educational and social work services. Conclusions. As South African health policy is moving towardsde-institutionalisation and treating mental health as part of primary care, support must be improved for sufferers of schizophrenia and their primary caregivers. Many people are prepared to face up to the challenge of caring for a mentally ill family member, yet are faced with significant needs that should be addressed

IGR J19552+0044: A new asynchronous short period polar: "Filling the gap between intermediate and ordinary polars"

Based on XMM--Newton X-ray observations IGR J19552+0044 appears to be either a pre-polar or an asynchronous polar. We conducted follow-up optical observations to identify the sources and periods of variability precisely and to classify this X-ray source correctly. Extensive multicolor photometric and medium- to high-resolution spectroscopy observations were performed and period search codes were applied to sort out the complex variability of the object. We found firm evidence of discording spectroscopic (81.29+/-0.01m) and photometric (83.599+/-0.002m) periods that we ascribe to the white dwarf (WD)\ spin period and binary orbital period, respectively. This confirms that IGR J19552+0044 is an asynchronous polar. Wavelength-dependent variability and its continuously changing shape point at a cyclotron emission from a magnetic WD with a relatively low magnetic field below 20 MG. The difference between the WD spin period and the binary orbital period proves that IGR J19552+0044 is a polar with the largest known degree of asynchronism (0.97 or 3%).Comment: 9 pages, 10 figures, A&A accepte