HIV-associated multi-centric Castleman’s disease with multiple organ failure: cuccessful treatment with rituximab

Introduction: Multicentric Castleman's Disease (MCD), a lymphoproliferative disorder associated with Human Herpes Virus-8 (HHV-8) infection, is increasing in incidence amongst HIV patients. This condition is associated with lymphadenopathy, polyclonal gammopathy, hepato-splenomegaly and systemic symptoms. A number of small studies have demonstrated the efficacy of the anti-CD20 monoclonal antibody, rituximab, in treating this condition. Case presentation: We report the case of a 46 year old Zambian woman who presented with pyrexia, diarrhoea and vomiting, confusion, lymphadenopathy, and renal failure. She rapidly developed multiple organ failure following the initiation of treatment of MCD with rituximab. Following admission to intensive care (ICU), she received prompt multi-organ support. After 21 days on the ICU she returned to the haematology medical ward, and was discharged in remission from her disease after 149 days in hospital. Conclusion: Rituximab, the efficacy of which has thus far been examined predominantly in patients outside the ICU, in conjunction with extensive organ support was effective treatment for MCD with associated multiple organ failure. There is, to our knowledge, only one other published report of its successful use in an ICU setting, where it was combined with cyclophosphamide, adriamycin and prednisolone. Reports such as ours support the notion that critically unwell patients with HIV and haematological disease can benefit from intensive care

Achieving the WHO/UNAIDS antiretroviral treatment 3 by 5 goal: what will it cost?

The "3 by 5" goal to have 3 million people in low and middle income countries on antiretroviral therapy (ART) by the end of 2005 is ambitious. Estimates of the necessary resources are needed to facilitate resource mobilisation and rapid channelling of funds to where they are required. We estimated the financial costs needed to implement treatment protocols, by use of country-specific estimates for 34 countries that account for 90% of the need for ART in resource-poor settings. We first estimated the number of people needing ART and supporting programmes for each country. We then estimated the cost per patient for each programme by country to derive total costs. We estimate that between US5.1 billion dollars and US5.9 billion dollars will be needed by the end of 2005 to provide ART, support programmes, and cover country-level administrative and logistic costs for 3 by 5

Stationarity, soft ergodicity, and entropy in relativistic systems

Recent molecular dynamics simulations show that a dilute relativistic gas equilibrates to a Juettner velocity distribution if ensemble velocities are measured simultaneously in the observer frame. The analysis of relativistic Brownian motion processes, on the other hand, implies that stationary one-particle distributions can differ depending on the underlying time-parameterizations. Using molecular dynamics simulations, we demonstrate how this relativistic phenomenon can be understood within a deterministic model system. We show that, depending on the time-parameterization, one can distinguish different types of soft ergodicity on the level of the one-particle distributions. Our analysis further reveals a close connection between time parameters and entropy in special relativity. A combination of different time-parameterizations can potentially be useful in simulations that combine molecular dynamics algorithms with randomized particle creation, annihilation, or decay processes.Comment: 4 page

Applicability of ERTS-1 to lineament and photogeologic mapping in Montana: Preliminary report

A lineament map prepared from a mosaic of western Montana shows about 85 lines not represented on the state geologic map, including elements of a northeast-trending set through central western Montana which merit ground truth checking and consideration in regional structural analysis. Experimental fold annotation resulted in a significant local correction to the state geologic map. Photogeologic mapping studies produced only limited success in identification of rock types, but they did result in the precise delineation of a late Cretaceous or early Tertiary volcanic field (Adel Mountain field) and the mapping of a connection between two granitic bodies shown on the state map. Imagery was used successfully to map clay pans associated with bentonite beds in gently dipping Bearpaw Shale. It is already apparent that ERTS imagery should be used to facilitate preparation of a much needed statewide tectonic map and that satellite imagery mapping, aided by ground calibration, provides and economical means to discover and correct errors in the state geologic map

A study of the social and physical environment in catering kitchens and the role of the chef in promoting positive health and safety behaviour

This is the account of a mixed method study of chefs and their kitchens in order to identify the nature of their workplace and how this affects their ability to manage health and safety in the kitchen. It included extended periods of observation, monitoring of physical parameters, analysis of records of reported accidents, and a series of reflexive interviews. The findings were integrated and then fed back in a smaller number of second interviews in order to test whether the findings fitted in with the chefs' understanding of their world. Major factors identified included survival in a market environment, the status of the chef (and the kitchen) within organisations, marked autocracy of chefs, and an increasing tempo building up to service time with commensurate heat, noise, and activity. In particular during the crescendo, a threshold shift in risk tolerance was identified. The factors, their interplay, and their implications for health and safety in the catering kitchen are discussed

Ground-layer wavefront reconstruction from multiple natural guide stars

Observational tests of ground layer wavefront recovery have been made in open loop using a constellation of four natural guide stars at the 1.55 m Kuiper telescope in Arizona. Such tests explore the effectiveness of wide-field seeing improvement by correction of low-lying atmospheric turbulence with ground-layer adaptive optics (GLAO). The wavefronts from the four stars were measured simultaneously on a Shack-Hartmann wavefront sensor (WFS). The WFS placed a 5 x 5 array of square subapertures across the pupil of the telescope, allowing for wavefront reconstruction up to the fifth radial Zernike order. We find that the wavefront aberration in each star can be roughly halved by subtracting the average of the wavefronts from the other three stars. Wavefront correction on this basis leads to a reduction in width of the seeing-limited stellar image by up to a factor of 3, with image sharpening effective from the visible to near infrared wavelengths over a field of at least 2 arc minutes. We conclude that GLAO correction will be a valuable tool that can increase resolution and spectrographic throughput across a broad range of seeing-limited observations.Comment: 25 pages, 8 figures, to be published in Astrophys.

The present and future system for measuring the Atlantic meridional overturning circulation and heat transport

of the global combined atmosphere-ocean heat flux and so is important for the mean climate of the Atlantic sector of the Northern Hemisphere. This meridional heat flux is accomplished by both the Atlantic Meridional Overturning Circulation (AMOC) and by basin-wide horizontal gyre circulations. In the North Atlantic subtropical latitudes the AMOC dominates the meridional heat flux, while in subpolar latitudes and in the subtropical South Atlantic the gyre circulations are also important. Climate models suggest the AMOC will slow over the coming decades as the earth warms, causing widespread cooling in the Northern hemisphere and additional sea-level rise. Monitoring systems for selected components of the AMOC have been in place in some areas for decades, nevertheless the present observational network provides only a partial view of the AMOC, and does not unambiguously resolve the full variability of the circulation. Additional observations, building on existing measurements, are required to more completely quantify the Atlantic meridional heat transport. A basin-wide monitoring array along 26.5°N has been continuously measuring the strength and vertical structure of the AMOC and meridional heat transport since March 31, 2004. The array has demonstrated its ability to observe the AMOC variability at that latitude and also a variety of surprising variability that will require substantially longer time series to understand fully. Here we propose monitoring the Atlantic meridional heat transport throughout the Atlantic at selected critical latitudes that have already been identified as regions of interest for the study of deep water formation and the strength of the subpolar gyre, transport variability of the Deep Western Boundary Current (DWBC) as well as the upper limb of the AMOC, and inter-ocean and intrabasin exchanges with the ultimate goal of determining regional and global controls for the AMOC in the North and South Atlantic Oceans. These new arrays will continuously measure the full depth, basin-wide or choke-point circulation and heat transport at a number of latitudes, to establish the dynamics and variability at each latitude and then their meridional connectivity. Modeling studies indicate that adaptations of the 26.5°N type of array may provide successful AMOC monitoring at other latitudes. However, further analysis and the development of new technologies will be needed to optimize cost effective systems for providing long term monitoring and data recovery at climate time scales. These arrays will provide benchmark observations of the AMOC that are fundamental for assimilation, initialization, and the verification of coupled hindcast/forecast climate models

The declining representativeness of the British party system, and why it matters

In a recent article, Michael Laver has explained ‘Why Vote-Seeking Parties May Make Voters Miserable’. His model shows that, while ideological convergence may boost congruence between governments and the median voter, it can reduce congruence between the party system and the electorate as a whole. Specifically, convergence can increase the mean distance between voters and their nearest party. In this article we show that this captures the reality of today’s British party system. Policy scale placements in British Election Studies from 1987 to 2010 confirm that the pronounced convergence during the past decade has left the Conservatives and Labour closer together than would be optimal in terms of minimising the policy distance between the average voter and the nearest major party. We go on to demonstrate that this comes at a cost. Respondents who perceive themselves as further away from one of the major parties in the system tend to score lower on satisfaction with democracy. In short, vote-seeking parties have left the British party system less representative of the ideological diversity in the electorate, and thus made at least some British voters miserable