Community case study of long-term survival with oesophageal candidiasis: a primary healthcare nursing study of support for a patient receiving home self-administered intravenous amphotericin

HIV infection predisposes a person to fungal infections because of failure in the host's cell-mediated immunity, which may result in a variety of fungal infections (1,2). Candidiasis is commonly caused by Candida albicans which can become a multi-system problem affecting the patient's nails, mouth, oesophagus, lower gastrointestinal tract, genitalia and rectum. Candida oesophagitis is a condition diagnostic of AIDS and characterised by erythematous lesions, pseudomembranous areas and/or ulcerations of the oesophagus. The condition may cause difficulty in swallowing, retrosternal pain, nausea and vomiting. Significant weight loss may also develop secondary to the characteristic symptoms of oesophageal candidiasis (3). Reports to date suggest therapy failure, incomplete response and decreasing susceptibility to azole medications such as ketoconazole, fluconazole and itraconazole (4). Whilst amphotericin remains the standard treatment for systemic or resistant mycoses (1), hospital experience with amphotericin toxicity may be a limiting factor against initiating homebased therapy (1). We report the outcomes for a clinically responding patient with a falling CD4 count diagnosed with oesophageal candidiasis receiving intravenous amphotericin at home for a continuous seventeen month period. This case fulfils current definitions of long-term survival (5,6). The patient initially presented over three years previously with HIV-related thrombocytopenia, a diagnosis made after counselling and HIV antibody testing showed HIV infection. Over successive years the patient received out-patient follow up including quarterly CD4 monitoring, treatment with Zidovudine, prophylaxis with Cotrimoxazole against Pneumocystis carinii pneumonia, psychological counselling, oral and dental, care and social welfare interventions. The out-patient service included written information for the patient's General Medical Practitioner after each out-patient visit, on patient request. On presentation with oesophageal candidiasis due to Candida albicans three years later, the patient requested homebased care in association with the General Medical Practitioner (GP) and the rest of the primary healthcare team. The patient wished to keep hospital stays and out-patient visits to a minimum. The blood results for the patient's serum creatinine, urea and potassium are shown in Figures 1-3, respectively, for a total period of seventeen months during which amphotericin was administered. The data covers both the two week period of hospital based induction therapy and the following seventeen months of homebased maintenance therapy

Comparison of Magnetic Flux Distribution between a Coronal Hole and a Quiet Region

Employing Big Bear Solar Observatory (BBSO) deep magnetograms and H${\alpha}$ images in a quiet region and a coronal hole, observed on September 14 and 16, 2004, respectively, we have explored the magnetic flux emergence, disappearance and distribution in the two regions. The following results are obtained: (1) The evolution of magnetic flux in the quiet region is much faster than that in the coronal hole, as the flux appeared in the form of ephemeral regions in the quiet region is 4.3 times as large as that in the coronal hole, and the flux disappeared in the form of flux cancellation, 2.9 times as fast as in the coronal hole. (2) More magnetic elements with opposite polarities in the quiet region are connected by arch filaments, estimating from magnetograms and H${\alpha}$ images. (3) We measured the magnetic flux of about 1000 magnetic elements in each observing region. The flux distribution of network and intranetwork (IN) elements is similar in both polarities in the quiet region. For network fields in the coronal hole, the number of negative elements is much more than that of positive elements. However for the IN fields, the number of positive elements is much more than that of negative elements. (4) In the coronal hole, the fraction of negative flux change obviously with different threshold flux density. 73% of the magnetic fields with flux density larger than 2 Gauss is negative polarity, and 95% of the magnetic fields is negative, if we only measure the fields with their flux density larger than 20 Gauss. Our results display that in a coronal hole, stronger fields is occupied by one predominant polarity; however the majority of weaker fields, occupied by the other polarity

Systematic Review and Meta-Analysis of Brief Cognitive Instruments to Evaluate Suspected Dementia in Chinese-Speaking Populations

Background: Chinese is the most commonly spoken world language; however, most cognitive tests were developed and validated in the West. It is essential to find out which tests are valid and practical in Chinese speaking people with suspected dementia. Objective: We therefore conducted a systematic review and meta-Analysis of brief cognitive tests adapted for Chinese-speaking populations in people presenting for assessment of suspected dementia. Methods: We searched electronic databases for studies reporting brief (≤20 minutes) cognitive test's sensitivity and specificity as part of dementia diagnosis for Chinese-speaking populations in clinical settings. We assessed quality using Centre for Evidence Based Medicine (CEBM) criteria and translation and cultural adaptation using the Manchester Translation Reporting Questionnaire (MTRQ), and Manchester Cultural Adaptation Reporting Questionnaire (MCAR). We assessed heterogeneity and combined sensitivity in meta-Analyses. Results: 38 studies met inclusion criteria and 22 were included in meta-Analyses. None met the highest CEBM criteria. Five studies met the highest criteria of MTRQ and MCAR. In meta-Analyses of studies with acceptable heterogeneity (I2 <  75%), Addenbrooke's Cognitive Examination Revised III (ACE-R ACE-III) had the best sensitivity and specificity; specifically, for dementia (93.5% 85.6%) and mild cognitive impairment (81.4% 76.7%). Conclusions: Current evidence is that the ACE-R and ACE-III are the best brief cognitive assessments for dementia and mild cognitive impairment in Chinese-speaking populations. They may improve time taken to diagnosis, allowing people to access interventions and future planning

Homotopy on spatial graphs and generalized Sato-Levine invariants

Edge-homotopy and vertex-homotopy are equivalence relations on spatial graphs which are generalizations of Milnor's link-homotopy. Fleming and the author introduced some edge (resp. vertex)-homotopy invariants of spatial graphs by applying the Sato-Levine invariant for the constituent 2-component algebraically split links. In this paper, we construct some new edge (resp. vertex)-homotopy invariants of spatial graphs without any restriction of linking numbers of the constituent 2-component links by applying the generalized Sato-Levine invariant.Comment: 16 pages, 13 figure

The K2-ESPRINT Project VI: K2-105 b, a Hot-Neptune around a Metal-rich G-dwarf

We report on the confirmation that the candidate transits observed for the star EPIC 211525389 are due to a short-period Neptune-sized planet. The host star, located in K2 campaign field 5, is a metal-rich ([Fe/H] = 0.26$\pm$0.05) G-dwarf (T_eff = 5430$\pm$70 K and log g = 4.48$\pm$0.09), based on observations with the High Dispersion Spectrograph (HDS) on the Subaru 8.2m telescope. High-spatial resolution AO imaging with HiCIAO on the Subaru telescope excludes faint companions near the host star, and the false positive probability of this target is found to be <$10^{-6}$ using the open source vespa code. A joint analysis of transit light curves from K2 and additional ground-based multi-color transit photometry with MuSCAT on the Okayama 1.88m telescope gives the orbital period of P = 8.266902$\pm$0.000070 days and consistent transit depths of $R_p/R_\star \sim 0.035$ or $(R_p/R_\star)^2 \sim 0.0012$. The transit depth corresponds to a planetary radius of $R_p = 3.59_{-0.39}^{+0.44} R_{\oplus}$, indicating that EPIC 211525389 b is a short-period Neptune-sized planet. Radial velocities of the host star, obtained with the Subaru HDS, lead to a 3\sigma\ upper limit of 90 $M_{\oplus} (0.00027 M_{\odot})$ on the mass of EPIC 211525389 b, confirming its planetary nature. We expect this planet, newly named K2-105 b, to be the subject of future studies to characterize its mass, atmosphere, spin-orbit (mis)alignment, as well as investigate the possibility of additional planets in the system.Comment: 11 pages, 9 figures, 4 tables, PASJ accepte

Do stellar magnetic cycles influence the measurement of precise radial velocities?

The ever increasing level of precision achieved by present and future radial-velocity instruments is opening the way to discovering very low-mass, long-period planets (e.g. solar-system analogs). These systems will be detectable as low-amplitude signals in radial-velocity (RV). However, an important obstacle to their detection may be the existence of stellar magnetic cycles on similar timescales. Here we present the results of a long-term program to simultaneously measure radial-velocities and stellar-activity indicators (CaII, H_alpha, HeI) for a sample of stars with known activity cycles. Our results suggest that all these stellar activity indexes can be used to trace the stellar magnetic cycle in solar-type stars. Likewise, we find clear indications that different parameters of the HARPS cross-correlation function (BIS, FWHM, and contrast) are also sensitive to activity level variations. Finally, we show that, although in a few cases slight correlations or anti-correlations between radial-velocity and the activity level of the star exist, their origin is still not clear. We can, however, conclude that for our targets (early-K dwarfs) we do not find evidence of any radial-velocity variations induced by variations of the stellar magnetic cycle with amplitudes significantly above ~1 m/s.Comment: Accepted for publication in A&A (revised version following minor language corrections

Population attributable fractions for risk factors for dementia in low-income and middle-income countries: an analysis using cross-sectional survey data

BACKGROUND: Nine potentially modifiable risk factors (less childhood education, midlife hearing loss, hypertension, and obesity, and later-life smoking, depression, physical inactivity, social isolation, and diabetes) account for 35% of worldwide dementia, but most data to calculate these risk factors come from high-income countries only. We aimed to calculate population attributable fractions (PAFs) for dementia in selected low-income and middle-income countries (LMICs) to identify potential dementia prevention targets in these countries. METHODS: The study was an analysis of cross-sectional data obtained from the 10/66 Dementia Research surveys of representative populations in India, China, and six Latin America countries (Cuba, Dominican Republic, Mexico, Peru, Puerto Rico, and Venezuela), which used identical risk factor ascertainment methods in each country. Between 2004 and 2006 (and between 2007 and 2010 for Puerto Rico), all residents aged 65 years and older in predefined catchment areas were invited to participate in the survey. We used risk factor prevalence estimates from this 10/66 survey data, and relative risk estimates from previous meta-analyses, to calculate PAFs for each risk factor. To account for individuals having overlapping risk factors, we adjusted PAF for communality between risk factors, and used these values to calculate overall weighted PAFs for India, China, and the Latin American sample. FINDINGS: The overall weighted PAF for potentially modifiable risk factors for dementia was 39·5% (95% CI 37·5-41·6) in China (n=2162 participants), 41·2% (39·1-43·4) in India (n=2004), and 55·8% (54·9-56·7) in our Latin American sample (n=12 865). Five dementia risk factors were more prevalent in these LMICs than worldwide estimates, leading to higher PAFs for dementia: less childhood education (weighted PAF of 10·8% in China, 13·6% in India, and 10·9% in Latin America vs 7·5% worldwide), smoking (14·7%, 6·4%, and 5·7%, respectively, vs 5·5% worldwide), hypertension (6·4%, 4·0%, and 9·3%, vs 2·0%), obesity (5·6%, 2·9%, and 7·9%, vs 0·8%), and diabetes (1·6%, 1·7%, and 3·2%, vs 1·2%). INTERPRETATION: The dementia prevention potential in India, China, and this sample of Latin American countries is large, and greater than in high-income countries. Less education in early life, hypertension, hearing loss, obesity, and physical inactivity have particularly high PAFs and could be initial targets for dementia prevention strategies