Antiretroviral therapy and anaesthesia

HIV has reached pandemic proportions in Southern Africa. Great emphasis is placed on the prevention and containment of HIV transmission by suppressing virus replication using highly active anti-retroviral therapy (HAART). HAART has proven to be highly effective if taken correctly, and has lead to increased life expectancy. Increasing numbers of HIV-positive patients on antiretroviral (ARV) therapy or HIV-exposed individuals taking prophylaxis present for surgery and critical care management. The anaesthesiologist should be familiar with the anaesthetic implications of HIV as well as the possible drug interactions while on ARV treatment. This article focuses specifically on the anaesthetic implications of the patient on HAART. HAART is HIV treatment with a combination of three or more ARV drugs from five broad classes. The specific HAART regimen in use in South Africa is considered in detail in this article. The pharmacokinetics of the ARV drugs is complex, and subject to interactions at many different sites. Serious drug interactions are possible, including drugs commonly used in anaesthesia. Drug interactions and recommendations are discussed in detail. ARVs are known to cause multiple systemic side effects, including lactic acidosis, Immune Reconstitution Inflammatory Syndrome (IRIS), premature atherosclerosis and increased cardiovascular risk, hyperlipidaemia, insulin resistance, skeletal disorders, hepatotoxicity, lipodystrophy, mitochondrial abnormalities, allergic reactions and pancreatitis. Non-compliance is common, and leads to the rapid development of resistance. The anaesthesiologist may inadvertently exacerbate this in the perioperative period. Recommendations regarding the interruption of treatment and fasting are made. Alternative routes for HAART administration are also explored. The management of the critically ill patient on a HAART regimen is discussed

Aircraft Height Estimation using 2-D Radar

A method to infer height information from an aircraft tracked with a single 2-D search radar is presented. The method assumes level flight in the target aircraft and a good estimate of the speed of the aircraft. The method yields good results for medium to high altitudes, though performs weaker at low altitudes. The method can distinguish between high and low targets on a normal 2-D radar, and can reach a height resolution of 100 m provided the 2-D radar is optimised to the task.Defence Science Journal, 2010, 60(1), pp.100-105, DOI:http://dx.doi.org/10.14429/dsj.60.11

Adherence to isoniazid prophylaxis among HIV-infected children: a randomized controlled trial comparing two dosing schedules

<p>Abstract</p> <p>Background</p> <p>Tuberculosis contributes significantly to morbidity and mortality among HIV-infected children in sub-Saharan Africa. Isoniazid prophylaxis can reduce tuberculosis incidence in this population. However, for the treatment to be effective, adherence to the medication must be optimized. We investigated adherence to isoniazid prophylaxis administered daily, compared to three times a week, and predictors of adherence amongst HIV-infected children.</p> <p>Methods</p> <p>We investigated adherence to study medication in a two centre, randomized trial comparing daily to three times a week dosing of isoniazid. The study was conducted at two tertiary paediatric care centres in Cape Town, South Africa. Over a 5 year period, we followed 324 HIV-infected children aged ≥ 8 weeks. Adherence information based on pill counts was available for 276 children. Percentage adherence was calculated by counting the number of pills returned. Adherence ≥ 90% was considered to be optimal. Analysis was done using summary and repeated measures, comparing adherence to the two dosing schedules. Mean percentage adherence (per child during follow-up time) was used to compare the mean of each group as well as the proportion of children achieving an adherence of ≥ 90% in each group. For repeated measures, percentage adherence (per child per visit) was dichotomized at 90%. A logistic regression model with generalized estimating equations, to account for within-individual correlation, was used to evaluate the impact of the dosing schedule. Adjustments were made for potential confounders and we assessed potential baseline and time-varying adherence determinants.</p> <p>Results</p> <p>The overall adherence to isoniazid was excellent, with a mean adherence of 94.7% (95% confidence interval [CI] 93.5-95.9); similar mean adherence was achieved by the group taking daily medication (93.8%; 95% CI 92.1-95.6) and by the three times a week group (95.5%; 95% CI 93.8-97.2). Two-hundred and seventeen (78.6%) children achieved a mean adherence of ≥ 90%. Adherence was similar for daily and three times a week dosing schedules in univariate (odds ratio [OR] 0.88; 95% CI 0.66-1.17; <it>P </it>= 0.38) and multivariate (adjusted OR 0.85; 95% CI 0.64-1.11; <it>P </it>= 0.23) models. Children from overcrowded homes were less adherent (adjusted OR 0.71; 95% CI 0.54-0.95; <it>P </it>= 0.02). Age at study visit was predictive of adherence, with better adherence achieved in children older than 4 years (adjusted OR 1.96; 95% CI 1.16-3.32; <it>P </it>= 0.01).</p> <p>Conclusion</p> <p>Adherence to isoniazid was excellent regardless of the dosing schedule used. Intermittent dosing of isoniazid prophylaxis can be considered as an alternative to daily dosing, without compromising adherence or efficacy.</p> <p>Trial registration</p> <p>Clinical Trials NCT00330304</p

'n Klimaatstreekindeling van die Suidwes-Kaaplandse wynbougebiede

Thesis (MScAgric)--Stellenbosch University, 1974.ENGLISH ABSTRACT: no abstract availableAFRIKAANSE OPSOMMING: geen opsommin

Intertwining Laplace Transformations of Linear Partial Differential Equations

We propose a generalization of Laplace transformations to the case of linear partial differential operators (LPDOs) of arbitrary order in R^n. Practically all previously proposed differential transformations of LPDOs are particular cases of this transformation (intertwining Laplace transformation, ILT). We give a complete algorithm of construction of ILT and describe the classes of operators in R^n suitable for this transformation. Keywords: Integration of linear partial differential equations, Laplace transformation, differential transformationComment: LaTeX, 25 pages v2: minor misprints correcte

Deviation Between δ13C and Leaf Intercellular Co2 in Salix Interior Cuttings Developing Under Low Light

This is the publisher's official version. It is also available electronically from: http://www.jstor.org/stable/10.1086/322892.Leaf δ13C values of perennial species are sometimes less negative than model‐predicted δ13C values derived from instantaneous measures of pi/pa. It has been hypothesized that the less negative δ13C values could be caused by 13C‐enriched stored carbon imported during the early stages of leaf growth. The δ13C values of newly emerging leaves could thus represent δ13C values of stem‐stored carbohydrates and may also provide integral measures of pi/pa at the end of the past growing season. We tested these hypotheses by sprouting cuttings of Salix interior under wet and dry soil‐moisture conditions in a controlled environmental chamber. Plants were defoliated after 56 d, and watering treatments were then reversed for half of the plants in each treatment. The δ13C values of newly emerging leaves did not correlate with pi/pa ratios of newly emerging leaves or of mature leaves prior to defoliation, thereby indicative that δ13C values of newly emerging leaves are not a simple reflection of prior pi/pa. Also, the δ13C values of newly emerging leaves were more enriched in 13C relative to the δ13C values of stem carbohydrates in the treatments where water regimes were reversed. Newly emerging leaves after defoliation had higher δ13C values despite the lower instantaneous water‐use efficiency and similar values of pi/pa to older photosynthetic leaves. Large differences between observed and model‐predicted pi/pa values also occurred in older, more mature leaves, and this may be because large proportions of their total mass were derived from carbon import

Cosmic rays beyond the boundary of the heliosphere

In August of 2012 the Voyager 1 space probe has left the solar-wind bubble of ionized gas we call the heliosphere and entered the denser and colder environment of the interstellar cloud surrounding the solar system. Energetic charged particles underwent dramatic changes past the heliopause: the heliospheric ions disappeared completely, while the galactic cosmic rays were for the first time measured in their unmodulated state. The interstellar medium turned out to be almost entirely devoid of turbulent magnetic fluctuations, therefore the transport of cosmic rays is governed by a large-scale geometry of the magnetic field. We discuss observations of heliospheric ions, including anomalous cosmic rays, near the heliopause transition, and propose interpretations of the measured intensities and pitch-angle distributions based on gradient drift in a weakly nonuniform magnetic field. The heliopause transition appears to be permeated by magnetic flux tubes connected to the interstellar space and facilitating particle escape. These flux tubes may be a product of interchange instability driven by a plasma pressure gradient across the heliopause. The curvature of magnetic field lines and the anti-sunward gradient in plasma kinetic pressure provide conditions favorable for an interchange. The two flux tube crossings by the spacecraft allowed an indirect measurement of the plasma radial velocity near the heliopause

Energetic Particle Anisotropies at the Heliospheric Boundary. II. Transient Features and Rigidity Dependence

In the preceding paper, we showed that large second-order anisotropies of heliospheric ions measured by the Voyager 1 space probe during the August 2012 boundary crossing event could be explained by a magnetic shear across the heliopause preventing particles streaming along the magnetic field from escaping the inner heliosheath. According to Stone et al., the penetration distance of heliospheric ions into the outer heliosheath had a strong dependence on the particle's Larmor radius. By comparing hydrogen, helium, and oxygen ions with the same energy per nucleon, these authors argued that this effect must be attributed to larger cyclotron radii of heavier species rather than differences in velocity. We propose that gradient drift in a nonuniform magnetic field was the cause of both the large second-order anisotropies and the spatial differentiation based on the ion's rigidity. A latitudinal gradient of magnetic field strength of about 10% per AU between 2012.7 and 2012.9 could have provided drift motion sufficient to match both LECP and CRS Voyager 1 observations. We explain the transient intensity dropout observed prior to the heliocliff using flux tube structures embedded in the heliosheath and magnetically connected to interstellar space. Finally, this paper reports a new indirect measurement of the plasma radial velocity at the heliopause on the basis of the time difference between two cosmic-ray telescopes measuring the same intensity dropout

Comment on “The biosphere: A homogeniser of Pb-isotope signals” by C. Reimann, B. Flem, A. Arnoldussen, P. Englmaier, T.E. Finne, F. Koller and Ø. Nordgulen

Reimann et al. (2008) recently published a study on Pb-isotope signature along a 120 km long transect cutting the city of Oslo. Based on concentration but also isotope data, they misinterpret Pb concentration of the biosphere in rural places and explain these large enrichments of Pb as being due to natural processes. The study ignores numerous previous studies either on local, regional or global scales (see reviews by Shotyk and Le Roux, 2005 and Callender, 2003, and references therein), which clearly demonstrate that anthropogenic Pb emitted in the atmosphere from different sources (leaded gasoline, coal burning, metallurgy, etc.) was and is dispersed worldwide. The study also ignores work on Norway by the Steinnes and colleagues group (Harmens et al., 2008, Steinnes et al., 2005a, Steinnes et al., 2005b and Åberg et al., 2004), and measurements and modelling by the EMEP network (www.emep.int/, EMEP, 2005). The study also neglects numerous works on preanthropogenic Pb deposition rate and isotopic signature using continental archives of atmospheric deposition like peat bogs (Shotyk et al., 1998, Klaminder et al., 2003, Kylander et al., 2005 and Le Roux et al., 2005). These studies have shown that preanthropogenic Pb atmospheric deposition rate and its Pb isotopic signature is regionally defined, but also that those signals are negligible compared to past 2 ka and recent Pb atmospheric fluxes (Table 1)