Exploring the Diagnostic Journey of Individuals Living with Parkinson Disease: A Qualitative Inquiry

Background: Parkinson’s Disease is a progressive neurological disorder. Criteria and guidelines have been established to improve the accuracy of diagnosis with the present accuracy of diagnosis being approximately 82%. Receiving a diagnosis of an incurable and disabling disease is a stressful life event. Accurate and timely information affects the patient’s acceptance of the disease and potential treatments. The objective of the research project was to explore the experiences of patients living with PD and to give voice to the patient’s perspectives related to their experiences while awaiting a diagnosis, which can take years. We explored experiences related to the individuals’ physical and emotional health. Methods: Ethics was sought and granted through Cape Breton University. Following informed consent, purposive and snowballing approaches were used to recruit adult participants living with PD in the community setting. Qualitative data were collected using semi-structured interviews to support five individuals to openly share their experiences. Data was typed verbatim, and a thematic analysis approach was used to compare similarities across the data. Results: Participants’ experiences related to their diagnostic journey were thematically analyzed and the following three themes emerged: 1) background of diagnosis, 2) healthcare support, and 3) challenges associated with the experience. Conclusion: The results of this study contribute to a deeper understanding of the journey and experiences of individuals diagnosed with Parkinson’s Disease. The findings emphasize the effects on an individuals’ life and the importance of receiving a clinical diagnosis

Revertibility of me-1 alleles

Revertibility of me-1 allele

Using the health action process approach to predict and improve health outcomesin individuals with type 2 diabetes mellitus

Background: The purpose of this study was to explore the predictive utility of the Health Action Process Approach (HAPA) and test a HAPA-based healthy eating intervention, in adults with type 2 diabetes mellitus. Materials and methods: The study employed a prospective, randomized, controlled trial design. The 4-month intervention consisted of self-guided HAPA-based workbooks in addition to two telephone calls to assist participants with the program implementation, and was compared to “treatment as usual”. Participants (n=87) completed health measures (diet, body mass index [BMI], waist circumference, blood pressure, blood glucose levels, lipid levels, and diabetes distress) and HAPA measures prior to the intervention and again upon completion 4 months later. Results: The overall HAPA model predicted BMI, although only risk awareness and recovery self-efficacy were significant independent contributors. Risk awareness, intentions, and self-efficacy were also independent predictors of health outcomes; however, the HAPA did not predict healthy eating. No significant time × condition interaction effects were found for diet or any HAPA outcome measures. Conclusion: Despite the success of HAPA in predicting health outcomes for those with type 2 diabetes mellitus, the intervention was unsuccessful in changing healthy eating or any of the other measured variables, and alternative low-cost health interventions for those with type 2 diabetes mellitus should be explored

Prevalence and predictors of kaposi sarcoma herpes virus seropositivity: a cross-sectional analysis of HIV-infected adults initiating ART in Johannesburg, South Africa

<p>Abstract</p> <p>Background</p> <p>Kaposi sarcoma (KS) is the most common AIDS-defining tumour in HIV-infected individuals in Africa. Kaposi sarcoma herpes virus (KSHV) infection precedes development of KS. KSHV co-infection may be associated with worse outcomes in HIV disease and elevated KSHV viral load may be an early marker for advanced HIV disease among untreated patients. We examined the prevalence of KSHV among adults initiating antiretroviral therapy (ART) and compared immunological, demographic and clinical factors between patients seropositive and seronegative for KSHV.</p> <p>Results</p> <p>We analyzed cross-sectional data collected from 404 HIV-infected treatment-naïve adults initiating ART at the Themba Lethu Clinic, Johannesburg, South Africa between November 2008 and March 2009. Subjects were screened at ART initiation for antibodies to KSHV lytic K8.1 and latent Orf73 antigens. Seropositivity to KSHV was defined as positive to either lytic KSHV K8.1 or latent KSHV Orf73 antibodies. KSHV viremia was determined by quantitative PCR and CD3, 4 and 8 lymphocyte counts were determined with flow cytometry. Of the 404 participants, 193 (48%) tested positive for KSHV at ART initiation; with 76 (39%) reactive to lytic K8.1, 35 (18%) to latent Orf73 and 82 (42%) to both. One individual presented with clinical KS at ART initiation. The KSHV infected group was similar to those without KSHV in terms of age, race, gender, ethnicity, smoking and alcohol use. KSHV infected individuals presented with slightly higher median CD3 (817 vs. 726 cells/mm³) and CD4 (90 vs. 80 cells/mm³) counts than KSHV negative subjects. We found no associations between KSHV seropositivity and body mass index, tuberculosis status, WHO stage, HIV RNA levels, full blood count or liver function tests at initiation. Those with detectable KSHV viremia (n = 19), however, appeared to present with signs of more advanced HIV disease including anemia and WHO stage 3 or 4 defining conditions compared to those in whom the virus was undetectable.</p> <p>Conclusions</p> <p>We demonstrate a high prevalence of KSHV among HIV-infected adults initiating ART in a large urban public-sector HIV clinic. KSHV viremia but not KSHV seropositivity may be associated with markers of advanced HIV disease.</p

Condom Access in South African Schools: Law, Policy, and Practice

Juliana Han and Michael L. Bennish discuss their experience developing a policy on condom distribution for Mpilonhle, a South African nongovernmental organization involved in HIV prevention in schools

Prisoner's Dilemma cellular automata revisited: evolution of cooperation under environmental pressure

We propose an extension of the evolutionary Prisoner's Dilemma cellular automata, introduced by Nowak and May \cite{nm92}, in which the pressure of the environment is taken into account. This is implemented by requiring that individuals need to collect a minimum score $U_{min}$, representing indispensable resources (nutrients, energy, money, etc.) to prosper in this environment. So the agents, instead of evolving just by adopting the behaviour of the most successful neighbour (who got $U^{msn}$), also take into account if $U^{msn}$ is above or below the threshold $U_{min}$. If $U^{msn}<U_{min}$ an individual has a probability of adopting the opposite behaviour from the one used by its most successful neighbour. This modification allows the evolution of cooperation for payoffs for which defection was the rule (as it happens, for example, when the sucker's payoff is much worse than the punishment for mutual defection). We also analyse a more sophisticated version of this model in which the selective rule is supplemented with a "win-stay, lose-shift" criterion. The cluster structure is analyzed and, for this more complex version we found power-law scaling for a restricted region in the parameter space.Comment: 15 pages, 8 figures; added figures and revised tex

Mercury enrichment in anthrosols and adjacent coastal sediments at a Classic Maya site, Marco Gonzalez, Belize

Elevated concentrations of total mercury (THg) are found in the surface soils and flanking wetland sediments at the Classic Maya coastal site of Marco Gonzalez, Belize. Significant concentrations (up to 1.3 µg·g−1 dry mass) of THg occur in leaf litter-rich soils, as well as in the artefact-rich anthrosol spread over the vegetated mound site of structures and occupation debris. The abundance and spatial pattern of major and trace elements measured in the surface soils indicate both site-scale controlling factors of topography, structures and vegetation on soil geochemistry as well as local highs in concentration compared with background, due to human activity. Geochemical stratigraphy of wetland sediment cores shows that a shift from carbonate-reef sediments to mangrove peat in the 13th century AD was attended by an input of allogenic (mineral) elements, including mercury. A THg concentration peak (0.8 μg·g−1) in brackish pool sediment is 210Pb-dated to 1960–1970 AD, but the incorporation of mercury in multiple cores adjacent to the site shows increasing mercury inputs to have occurred before, during Classic-period Maya occupation and following the sites abandonment. Analysis of element values from site-scale soil sampling, combined with results from off-site cores, provides a numerical framework upon which outlier values of THg and other element spatial patterns can be assessed, especially the spatial co-association of elements related to differences in soil–sediment matrices. Geochemical results from active soils developing from occupation deposits (anthrosols) and sediment cores open up questions concerning contemporary and past mercury accumulation at coastal Mayan sites, and the wider interaction of human and natural biogeochemical processes that occur in human-modified soils and coastal wetland sediments

The Marco Gonzalez Maya site, Ambergris Caye, Belize: assessing the impact of human activities by examining diachronic processes at the local scale

Research at the Maya archaeological site of Marco Gonzalez on Ambergris Caye in Belize is socio-ecological because human activities have been a factor in the formation and fluctuation of the local marine and terrestrial environments over time. The site is one of many on Belize's coast and cayes that exhibit anomalous vegetation and dark-coloured soils. These soils, although sought for cultivation, are not typical 'Amazonian Dark Earths' but instead are distinctive to the weathering of carbonate-rich anthropogenic deposits. We tentatively term these location-specific soils as Maya Dark Earths. Our research seeks to quantify the role of human activities in long-term environmental change and to develop strategies, specifically Life Cycle Assessment (LCA), that can be applied to environmental impact modelling today

Alginate inhibits iron absorption from ferrous gluconate in a randomized controlled trial and reduces iron uptake into Caco-2 cells

Previous in vitro results indicated that alginate beads might be a useful vehicle for food iron fortification. A human study was undertaken to test the hypothesis that alginate enhances iron absorption. A randomised, single blinded, cross-over trial was carried out in which iron absorption was measured from serum iron appearance after a test meal. Overnight-fasted volunteers (n=15) were given a test meal of 200g cola-flavoured jelly plus 21 mg iron as ferrous gluconate, either in alginate beads mixed into the jelly or in a capsule. Iron absorption was lower from the alginate beads than from ferrous gluconate (8.5% and 12.6% respectively, p=0.003). Sub-group B (n=9) consumed the test meals together with 600 mg calcium to determine whether alginate modified the inhibitory effect of calcium. Calcium reduced iron absorption from ferrous gluconate by 51%, from 11.5% to 5.6% (p=0.014), and from alginate beads by 37%, from 8.3% to 5.2% (p=0.009). In vitro studies using Caco-2 cells were designed to explore the reasons for the difference between the previous in vitro findings and the human study; confirmed the inhibitory effect of alginate. Beads similar to those used in the human study were subjected to simulated gastrointestinal digestion, with and without cola jelly, and the digestate applied to Caco-2 cells. Both alginate and cola jelly significantly reduced iron uptake into the cells, by 34% (p=0.009) and 35% (p=0.003) respectively. The combination of cola jelly and calcium produced a very low ferritin response, 16.5% (p<0.001) of that observed with ferrous gluconate alone. The results of these studies demonstrate that alginate beads are not a useful delivery system for soluble salts of iron for the purpose of food fortification