A study of patient attitudes towards decentralisation of HIV care in an urban clinic in South Africa

<p>Abstract</p> <p>Background</p> <p>In South Africa, limited human resources are a major constraint to achieving universal antiretroviral therapy (ART) coverage. Many of the public-sector HIV clinics operating within tertiary facilities, that were the first to provide ART in the country, have reached maximum patient capacity. Decentralization or "down-referral" (wherein ART patients deemed stable on therapy are referred to their closest Primary Health Clinics (PHCs) for treatment follow-up) is being used as a possible alternative of ART delivery care. This cross-sectional qualitative study investigates attitudes towards down-referral of ART delivery care among patients currently receiving care in a centralized tertiary HIV clinic.</p> <p>Methods</p> <p>Ten focus group discussions (FGDs) with 76 participants were conducted in early 2008 amongst ART patients initiated and receiving care for more than 3 months in the tertiary HIV clinic study site. Eligible individuals were invited to participate in FGDs involving 6-9 participants, and lasting approximately 1-2 hours. A trained moderator used a discussion topic guide to investigate the main issues of interest including: advantages and disadvantages of down-referral, potential motivating factors and challenges of down-referral, assistance needs from the transferring clinic as well as from PHCs.</p> <p>Results</p> <p>Advantages include closeness to patients' homes, transport and time savings. However, patients favour a centralized service for the following reasons: less stigma, patients established relationship with the centralized clinic, and availability of ancillary services. Most FGDs felt that for down-referral to occur there needed to be training of nurses in patient-provider communication.</p> <p>Conclusion</p> <p>Despite acknowledging the down-referral advantages of close proximity and lower transport costs, many participants expressed concerns about lack of trained HIV clinical staff, negative patient interactions with nurses, limited confidentiality and stigma. There was consensus that training of nurses and improved health systems at the local clinics were needed if successful down-referral was to take place.</p

A Tabletop X-Ray Tomography Instrument for Nanometer-Scale Imaging: Integration of a Scanning Electron Microscope with a Transition-Edge Sensor Spectrometer

X-ray nanotomography is a powerful tool for the characterization of nanoscale materials and structures, but is difficult to implement due to competing requirements on X-ray flux and spot size. Due to this constraint, state-of-the-art nanotomography is predominantly performed at large synchrotron facilities. Compact X-ray nanotomography tools operated in standard analysis laboratories exist, but are limited by X-ray optics and destructive sample preparation techniques. We present a laboratory-scale nanotomography instrument that achieves nanoscale spatial resolution while changing the limitations of conventional tomography tools. The instrument combines the electron beam of a scanning electron microscope (SEM) with the precise, broadband X-ray detection of a superconducting transition-edge sensor (TES) microcalorimeter. The electron beam generates a highly focused X-ray spot in a metal target, while the TES spectrometer isolates target photons with high signal-to-noise. This combination of a focused X-ray spot, energy-resolved X-ray detection, and unique system geometry enable nanoscale, element-specific X-ray imaging in a compact footprint. The proof-of-concept for this approach to X-ray nanotomography is demonstrated by imaging 160 nm features in three dimensions in a Cu-SiO2 integrated circuit, and a path towards finer resolution and enhanced imaging capabilities is discussed.Comment: The following article has been submitted to Physical Review Applie

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio

Sterilization Resistance of Bacterial Spores Explained with Water Chemistry

Bacterial spores can survive for long periods without nutrients and in harsh environmental conditions. This survival is influenced by the structure of the spore, the presence of protective compounds, and water retention. These compounds, and the physical state of water in particular, allow some species of bacterial spores to survive sterilization schemes with hydrogen peroxide and UV light. The chemical nature of the spore core and its water has been a subject of some contention and the chemical environment of the water impacts resistance paradigms. Either the spore has a glassy core, where water is immobilized along with other core components, or the core is gel-like with mobile water diffusion. These properties affect the movement of peroxide and radical species, and hence resistance. Deuterium solid-state NMR experiments are useful for examining the nature of the water inside the spore. Previous work in our lab with spores of Bacillus subtilis indicate that, for spores, the core water is in a more immobilized state than expected for the gel-like core theory, suggesting a glassy core environment. Here, we report deuterium solid-state NMR observations of the water within UV- and peroxide-resistant spores from Bacillus pumilus SAFR-032. Variable-temperature NMR experiments indicate no change in the line shape after heating to 50 °C, but an overall decrease in signal after heating to 100 °C. These results show glass-like core dynamics within B. pumilus SAFR-032 that may be the potential source of its known UV-resistance properties. The observed NMR traits can be attributed to the presence of an exosporium containing additional labile deuterons that can aid in the deactivation of sterilizing agents

Spotted owls and forest fire: Comment

Western North American forest ecosystems are experiencing rapid changes in disturbance regimes because of climate change and land use legacies (Littell et al. 2018). In many of these forests, the accumulation of surface and ladder fuels from a century of fire suppression, coupled with a warming and drying climate, has led to increases in the number of large fires (Westerling 2016) and the proportion of areas burning at higher severity (Safford and Stevens 2017, Singleton et al. 2018). While the annual area burned by fire is still below historical levels (Taylor et al. 2016), some forest types in the west are burning at higher severities when compared to pre- European settlement periods (Mallek et al. 2013, Safford and Stevens 2017). As such, they face an increased risk of conversion to non-forest ecosystems (e.g., shrublands, non-native grasslands) following large, severe fires because of compromised seed sources, post-fire soil erosion and loss, high-severity re-burn, and climatic thresholds (Coppoletta et al. 2016, Stevens et al. 2017, Rissman et al. 2018, Shive et al. 2018, Wood and Jones 2019). Restoration methods such as mechanical thinning and prescribed and managed wildland fire that reduce accumulated surface and ladder fuels (e.g., removal of smalland medium-sized trees, especially non-fire adapted species) may reduce the spatial extent of severe fires and increase forest resilience to fire in a changing climate (Agee and Skinner 2005, Stephens et al. 2013, Hessburg et al. 2016, Tubbesing et al. 2019) and, in doing so, promote key ecosystem services (Hurteau et al. 2014, Kelsey et al. 2017, Wood and Jones 2019). ... The existing body of evidence suggests that spotted owls respond largely in a neutral or positive manner to lower-severity fire and smaller patches of high-severity fire that fall within the historical range of variability but that spotted owls can respond negatively to larger patches of high-severity fire. Thus, management actions that can demonstrably reduce the extent of severe fire within spotted owl habitat in a changing climate may contribute to owl conservation if those actions do not remove critical structural habitat elements positively associated with spotted owl vital rates (e.g., large, old trees) (Jones et al. 2016, 2018, Jones 2019). It is critical that future analyses examining the effects of fire on spotted owls provide sufficient context and nuance to ensure they will be beneficial to scientists and managers seeking to understand how to minimize the loss of essential owl nesting and roosting habitat to the increasing threat of high-severity fire in a changing climate

Elevational gradients strongly mediate habitat selection patterns in a nocturnal predator

Abstract Mountain ecosystems contain strong elevational gradients in climate and vegetation that shape species distributions and the structure of animal communities. Nevertheless, studies of habitat selection for individual species rarely account for such gradients that often result in species being managed uniformly across their range, which may not improve conservation as intended. Therefore, we characterized variation in nocturnal habitat selection by 18 GPS‐tagged California spotted owls (Strix occidentalis occidentalis) along a 1400‐m elevational gradient in the Sierra Nevada, California. We characterized three‐dimensional forest structure with light detection and ranging data that we used in mixed‐effects resource‐ and step‐selection analyses of owl habitat selection. At lower elevations, owls selected stands with shorter trees, sites closer to hard edges between tall forests and open areas, sites with less diversity in forest seral types and sites with more ridge and southwest aspects. In contrast, owls at higher elevations selected the opposite. Within public forests that had taller trees and within their home range core (45% kernel density estimate of GPS points) areas, owls selected forests with less and more canopy cover at low and high elevations, respectively. Outside of their core areas, owls selected areas with fewer and more tall trees at low and high elevations, respectively. These findings may be explained by elevational gradients in prey distribution and variation in owl diet because owls consume more woodrats (Neotoma spp; earlier seral species) at lower elevations and more flying squirrels (Glaucomys sabrinus; older forest species) at higher elevations. Thus, at low elevations and in areas unlikely to support nesting, spotted owls could benefit from management that promotes woodrat habitat by encouraging oak regeneration and creating small brushy openings within forests with shorter (younger) trees. Conversely, at higher elevations, (1) enhancing flying squirrel habitat by promoting large trees and denser canopy on mesic sites and (2) managing for greater cover type diversity on southwest‐facing slopes and ridgetops is more likely to improve foraging habitat quality for spotted owls. The patterns of owl selection over elevational gradients has not been explicitly considered in most habitat management plans but clearly would improve management throughout mountain ecosystems