Holographic (De)confinement Transitions in Cosmological Backgrounds

For type IIB supergravity with a running axio-dilaton, we construct bulk solutions which admit a cosmological background metric of Friedmann-Robertson-Walker type. These solutions include both a dark radiation term in the bulk as well as a four-dimensional (boundary) cosmological constant, while gravity at the boundary remains non-dynamical. We holographically calculate the stress-energy tensor, showing that it consists of two contributions: The first one, generated by the dark radiation term, leads to the thermal fluid of N = 4 SYM theory, while the second, the conformal anomaly, originates from the boundary cosmological constant. Conservation of the boundary stress tensor implies that the boundary cosmological constant is time-independent, such that there is no exchange between the two stress-tensor contributions. We then study (de)confinement by evaluating the Wilson loop in these backgrounds. While the dark radiation term favours deconfinement, a negative cosmological constant drives the system into a confined phase. When both contributions are present, we find an oscillating universe with negative cosmological constant which undergoes periodic (de)confinement transitions as the scale of three space expands and re-contracts.Comment: 31 pages, 5 figures, v2: Reference adde

Medicines availability among hypertensive patients in primary healthcare facilities in a rural province in South Africa

Background: Control of blood pressure (BP) remains a challenge among patients in the public health system in South Africa. The objective was to assess availability of all prescribed antihypertensive medicines among patients with raised BP on the day they attended rural primary healthcare facilities (PHCs) and determine the association between medicines availability, the number of prescribed antihypertensive medicines and BP control. Methods: Secondary data from an operational study from rural PHCs in South Africa including patients’ demographics and BP, as well as data on medicine availability. Data analysis included descriptive and inferential statistics. Results: 55 black African patients were assessed, with 89.1% being female. Some data were not available for all 55 patients. The mean age was 61.3 years, and 54.6% did not have formal education. Two thirds (67.2%) of patients received all their antihypertensive medications whilst 25.5% received some of their medicines during the three months study period with no record in 7.3% of the patients. There was no significant relationship between receiving all antihypertensive medicines and BP control. The majority of patients on one antihypertensive had better BP control; however, this did not reach significance (p=0.069). Concerns with the lack of BP recording on all occasions in some patients (20%). Conclusion: One third of patients went home without all their antihypertensive medicines from the PHC facilities. Other concerns included the lack of routine BP monitoring and the number of prescribed medicines. Studies are ongoing to explore key issues with medicines availability and concerns with adherence and BP control

Formulary management activities and practice implications among public sector hospital pharmaceutical and therapeutics committees in a South African province

Introduction: The World Health Organization identified Pharmaceutical and Therapeutics Committees (PTCs) at district and hospital levels as one of the pivotal models to promote rational use of medicines (RUM). This is endorsed by the Government in South Africa. Formulary development and management is one of the main functions of PTCs. This study aimed to describe the formulary management activities among PTCs in public hospitals in Gauteng Province, South Africa, following initiatives to promote RUM in South Africa. Methods: Qualitative, nonparticipatory, observational study, observing 26 PTC meetings. Data were coded and categorized using NVivo9 ® qualitative data analysis software. Themes and sub-themes were developed. The themes and sub-themes on formulary management are the principal focus of this paper. Results: More than half of the observed PTCs reviewed their formulary lists. There was variation in the review process among institutions providing different levels of care. Various aspects were considered for formulary management especially requests for medicines to be added. These included cost considerations (mainly focusing on acquisition costs), evidence-based evaluation of clinical trials, patient safety, clinical experience and changes in the National Essential Medicines List (NEML). The tertiary PTCs mostly dealt with applications for new non-EML medicines, while PTCs in the other hospitals mainly requested removal or addition of EML medicines to the list. Conclusion: This is the first study from Gauteng Province, South Africa, reporting on how decisions are actually taken to include or exclude medicines onto formularies within public sector hospitals providing different levels of care. Various approaches are adopted at different levels of care when adding to- or removing medicines from the formulary lists. Future programs should strengthen PTCs in specialized aspects of formulary management. A more structured approach to formulary review at the local PTC level should be encouraged in line with the national approach when reviewing possible additions to the NEML

A countrywide point prevalence study in South Africa – using technology to determine use and appropriateness

Background: Antimicrobial resistance (AMR) is a serious world-wide health concern and a direct threat to future patient safety, with the misuse and overuse of antimicrobials increasing AMR rates. Consequently, it is imperative to measure current antibiotic utilisation within hospitals to guide future quality initiatives. However, data on antimicrobial utilization among public hospitals and primary health care centres (PHCs) in South Africa (SA) is currently lacking and needs to be addressed. Objectives: To describe and quantify how AMs are currently utilised in selected public sector hospitals and PHC centres in SA; to determine how mHealth techniques can be used to monitor AM utilisation in selected public sector hospitals and PHC centres in SA; to assess current programmes among public sector hospitals and PHC centres to improve AM prescribing as part of AMSPs and pharmacy and therapeutics committee (PTC) activities; to develop interventions, including mHealth techniques, to enhance the role and activities of AMSPs and PTCs; to measure prescriber compliance to STGs for ID in public sector hospitals and PHC centres in SA; to develop interventions, including mHealth techniques, to monitor and enhance prescribing compliance to STGs; to determine the utilisation, uptake and timeliness of vaccines (EPI and seasonal influenza) in selected public and private sector facilities across SA, as part of an AMS strategy to reduce AMR; finally, to develop interventions, including mHealth techniques, that can be used to enhance the appropriate use of vaccines in selected public and private sector facilities across SA. Methods: A web-based application tool was developed in South Africa based on previous PPS studies conducted in Botswana and South Africa using paper-based collection tools,and evaluated during July 2017. Key variables measured included antimicrobial utilisation patterns and appropriateness of treatment for sepsis in the Intensive Care Units (ICUs) and paediatric diarrhea in the CHCs Results: Preliminary results will include data from three provinces with 2455 patient files reviewed with all of their antimicrobial therapy and related results Conclusions: The PPS method offers a standardized tool that can be used to identify targets for quality improvement programmes in hospitals. The development of a web-based application (APP) has allowed the team to collect large datasets throughout Southern Africa

Astro2020 Science White Paper: Toward Finding Earth 2.0: Masses and Orbits of Small Planets with Extreme Radial Velocity Precision

Having discovered that Earth-sized planets are common, we are now embarking on a journey to determine if Earth-like planets are also common. Finding Earth-like planets is one of the most compelling endeavors of the 21st century - leading us toward finally answering the question: Are we alone? To achieve this forward-looking goal, we must determine the masses of the planets; the sizes of the planets, by themselves, are not sufficient for the determination of the bulk and atmospheric compositions. Masses, coupled with the radii, are crucial constraints on the bulk composition and interior structure of the planets and the composition of their atmospheres, including the search for biosignatures. Precision radial velocity is the most viable technique for providing essential mass and orbit information for spectroscopy of other Earths. The development of high quality precision radial velocity instruments coupled to the building of the large telescope facilities like TMT and GMT or space-based platforms like EarthFinder can enable very high spectral resolution observations with extremely precise radial velocities on minute timescales to allow for the modeling and removal of radial velocity jitter. Over the next decade, the legacy of exoplanet astrophysics can be cemented firmly as part of humankind's quest in finding the next Earth - but only if we can measure the masses and orbits of Earth-sized planets in habitable zone orbits around Sun-like stars.Comment: Science White Paper Submitted to the Astro2020 Decadal Survey (35 co-signers in addition to co-authors

Potential ways to address antimicrobial resistance across India and wider exacerbated by COVID-19 : AMR and COVID-19

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Feasibility of using point prevalence surveys to assess antimicrobial utilisation in public hospitals in South Africa : a pilot study and implications

OBJECTIVES: There is currently a lack of data regarding antimicrobial use among public hospitals in South Africa. This is a concern given their growing use and increasing antimicrobial resistance rates in South Africa. Consequently, the objectives of this study were to firstly determine the appropriateness of point prevalence survey (PPS) data collection instruments for performing antimicrobial utilization studies among public sector hospitals in South Africa; secondly, to determine current antimicrobial utilization in a public sector hospital, and thirdly evaluate the prescribing of antimicrobials with those contained within the national Essential Medicines List and Standard Treatment Guidelines (EML/STGs). The findings will be used to guide future activities in South Africa. METHODS: A PPS was conducted in Dr George Mukhari Academic Hospital. For each in-patient ward, all patients' files were completely surveyed on a single day. The number of patients who were on antimicrobials served as the numerator and the denominator comprised the total number of patients in the ward. RESULTS: 39 wards and 512 patient files were surveyed. The overall prevalence of antimicrobial use was 37.7%, highest in the ICUs. Beta lactamase inhibitors and antimicrobials for tuberculosis were the most prevalent antimicrobials. More than two thirds (83%) of antimicrobial treatment was modified following culture sensitivity test results when requested, and 98% of antimicrobials prescribed were contained within the current EML/STGs. In 10.8% of occasions, antimicrobials appear to have been prescribed other than for treatment, i.e. no systemic infection. There were concerns though with the lack of IV to oral switching. CONCLUSION: The PPS method offers a standardized tool that can be used to identify targets for quality improvement. However, there were concerns with the time taken to conduct PPS studies, which is an issue in resource limited settings. This is being addressed alongside concerns with the lack of IV to oral switching

Why compliance to national prescribing guidelines is important especially across sub-Saharan Africa and suggestions for the future

There are concerns with high prevalence rates for both infectious and non-infectious disease in sub-Saharan Africa, as well as patients with joint co-morbidities. This requires consideration of multiple guidelines simultaneously to improve the care of patients. Adherence to guidelines is increasingly seen as a key criteria for assessing the quality of prescribing in ambulatory care versus the WHO/INRUD targets. These typically represent activity (volume) or performance (cost) indicators rather than quality indicators. However, guideline adherence is currently variable across sectors, diseases areas and African countries. Factors impacting on adherence rates include their routine availability, ease of access and referencing, the extent of consensus on their content, extent of training of their use, monitoring of subsequent prescribing against agreed suggestions and whether regularly updated. Multiple initiatives are typically more successful with changing prescribing habits versus single approaches. Any quality indicators developed as part of prescribing targets must be robustly developed, accepted by physicians and practical to administer. We are likely to see a growth in robust guidelines and indicators across Africa to reduce morbidity and mortality from both infectious and non-infectious diseases

Adverse drug reactions in HIV-infected patients registered at four sentinel sites in South Africa

Background: HIV and TB are common infections in sub-Saharan Africa. Due to HIV’s suppression of the immune system, infected patients are prone to opportunistic infections. Co-treatment of HIV and TB places patients at risk of adverse drug reactions (ADRs) and drug interactions. This study aimed to determine the incidence and risk factors for ADRs in HIV-infected patients and those co-infected with TB. Methods: Data from patients (aged >15 years) enrolled on the Medunsa National Pharmacovigilance Centre’s database from March 2007 to May 2017 were analysed. Censoring targeted the first incident of ADRs in HIV-TB co-infected patients and those not co-infected. A Cox-proportional hazard model was used to determine associations of dependant variables and identify predictors for developing ADRs. Results: 3608 HIV-infected patients were included. 12% (n=437) had HIV-TB co-infection. Overall prevalence of ADRs was 31% (n=1 131). Of these, 12% were experienced by patients with HIV and TB co-infection and 885 by patients with no co-infection. Higher rates of ADRs were found to be significantly associated with patients initiated on stavudine (aHR=9.4; 95% CI 7.4-12.1; p<0.001) and non-standardised regimens (aHR=6.6; 95% CI 4.5-9.8; p<0.001). Peripheral neuropathy and skin rash were the most common ADRs. Patients initiated on a CD4+ count <350 cells/mm3 (aHR=1.3; 95% CI 1.1-1.4, p<0.001) and cigarette smokers (aHR=1.4; 95% CI 1.1-1.7, p=0.015) were at higher risk of developing ADRs. Conclusion: Overall, results suggested a modest incidence of ADRs amongst HIV- and TB co-infected, with no significant association between ADRs and TB-coinfection. A pharmacovigilance surveillance system remains essential

Perceptions of managerial staff on the patient safety culture at a tertiary hospital in South Africa

Background: Hospital managers are best suited and located to enhance patient safety culture within their institutions. Aim: This study sought to provide insight on the perceptions of 10 managerial staff regarding the patient safety culture at a tertiary academic hospital in South Africa. Method: In-depth interviews were conducted with strategic and operational managers within high-risk units in order to determine their perceptions regarding patient safety culture. Findings: Participants described diverse aspects of the hospital's patient safety culture including an overview of patient safety, implementation of patient safety initiatives, challenges to patient safety, current management of patient safety issues, as well as ways to improve the patient safety culture of the hospital. Conclusion: The findings highlighted a number of areas to improve on to advance patient safety within the South African context. These include improving basic services, strengthening the infrastructure, improving staff attitudes and implementation of patient safety initiatives. Further research and development of quality improvement plans are essential to enhance patient safety