Retention in an antiretroviral therapy programme during an era of decreasing drug cost in Limbe, Cameroon

<p>Abstract</p> <p>Background</p> <p>In 2002, Cameroon initiated scale up of antiretroviral therapy (ART); on 1 October 2004, a substantial reduction in ART cost occurred. We assessed the impact of this event and other factors on enrolment and retention in care among HIV-infected patients initiating ART from February 2002 to December 2005 at the single ART clinic serving the Southwest Region in Limbe, Cameroon.</p> <p>Methods</p> <p>We retrospectively analyzed clinical and pharmacy payment records of HIV-infected patients initiating ART according to national guidelines. We compared two cohorts of patients, enrolled before and after 1 October 2004, to determine if price reduction was associated with enhanced enrolment. We assessed factors associated with retention and survival by Cox proportional hazards models. Retention in care implied patients who had contact with the healthcare system as of 31 December 2005 (including those who were transferred to continue care in other ART centres), although these patients may have interrupted therapy at some time. A patient who was not retained in care may have dropped out (lost to follow up) or died.</p> <p>Results</p> <p>Mean enrolment rates for 2920 patients who initiated ART before and after the price reduction were 46.5 and 95.5 persons/month, respectively (p < 0.001). The probabilities of remaining alive and in care were 0.66 (95% CI 0.64-0.68) at six months, 0.58 (95% CI 0.56-0.60) at one year, 0.47 (95% CI 0.45-0.49) at two years and 0.35 (95% CI 0.32-0.38) at three years; they were not significantly different between the two cohorts of patients enrolled before and after the price reduction over the first 15 months of comparable follow up (hazard ratio 1.1; 95% CI 0.9-1.2, p = 0.27). In multivariable analysis using multiple imputations to compensate for missing values, factors associated with dropping out of care or dying were male gender (HR 1.33 [1.18-1.50], p = 0.003), treatment paid by self, family or partly by other (HR 3.05 [1.99-4.67], p < 0.001), and, compared with residents of Limbe, living more than 150 km from Limbe (HR 1.41 [1.18-1.69], p < 0.001), or being residents of Douala (HR 1.51 [1.16-1.98], p < 0.001).</p> <p>Conclusions</p> <p>Reducing the cost of ART increased enrolment of clients in the programme, but did not change retention in care. In a system where most clients pay for ART, an accessible clinic location may be more important than the cost of medication for retention in care. Decentralizing ART clinics might improve retention and survival among patients on ART.</p

Incoherent tunnelling through two quantum dots with Coulomb interaction

The Ohmic conductance and current through two quantum dots in series is investigated for the case of incoherent tunnelling. A generalised master equation is employed to include the discrete nature of the energy levels. Regions of negative differential conductance can occur in the I-V characteristics. Transport is dominated by matching energy levels, even when they do not occur at the charge degeneracy points.Comment: RevTeX + epsf.sty + 13 figure

Transport via a quantum shuttle

Published versio

Expression of oncoproteins and the amount of eosinophilic and lymphocytic infiltrates can be used as prognostic factors in gastric cancer. Dutch Gastric Cancer Group (DGCG).

Preoperative staging of gastric cancer is difficult. Several molecular markers associated with initiation and progression of cancer seem promising for obtaining preoperative prognostic information. To investigate whether these markers are indicative especially for the presence of lymph node metastases in patients with gastric cancer, we have examined primary tumour specimens from 105 patients with primary adenocarcinoma of the stomach entered in a surgical trial. In this trial, lymph node status was determined by strictly quality-controlled lymph node dissection and examination. The selected markers were growth regulators (p53, Rb and myc), metastasis-suppressor gene product (nm23), adhesion molecules (Ep-CAM, E-cadherin, CD44v5 and CD44v6) and urokinase-type plasminogen activator (u-PA). Also, the amount of eosinophilic and lymphocytic infiltrates available post-operatively was analysed with respect to its prognostic value for lymph node status. Moreover, the association of these parameters with survival and disease-free period (DFP) was evaluated. Of all molecular markers investigated, only Rb expression had a significant association with the presence of lymph node metastasis in both univariate and multivariate analysis. For curative resectability, a significant association was found with Rb and E-cadherin expression, while in multivariate analysis Rb and myc were selected as the combination with additional independent prognostic value, and E-cadherin had no additional independent value. For overall survival in univariate analysis, the amount of both eosinophilic and lymphocytic infiltrates and Rb and myc expression were of significant prognostic value. Only the amount of lymphocytic infiltrate had a prognostic significance for DFP. In stepwise multivariate analysis, TNM stage (I + II) and marked lymphocytic infiltrate were associated with better overall survival and longer DFP. We conclude that, if these results are confirmed in a larger series of patients, molecular markers can provide useful prognostic information

Higher-Order Results for the Relation between Channel Conductance and the Coulomb Blockade for Two Tunnel-Coupled Quantum Dots

We extend earlier results on the relation between the dimensionless tunneling channel conductance $g$ and the fractional Coulomb blockade peak splitting $f$ for two electrostatically equivalent dots connected by an arbitrary number $N_{\text{ch}}$ of tunneling channels with bandwidths $W$ much larger than the two-dot differential charging energy $U_{2}$. By calculating $f$ through second order in $g$ in the limit of weak coupling ($g \rightarrow 0$), we illuminate the difference in behavior of the large-$N_{\text{ch}}$ and small-$N_{\text{ch}}$ regimes and make more plausible extrapolation to the strong-coupling ($g \rightarrow 1$) limit. For the special case of $N_{\text{ch}}=2$ and strong coupling, we eliminate an apparent ultraviolet divergence and obtain the next leading term of an expansion in $(1-g)$. We show that the results we calculate are independent of such band structure details as the fraction of occupied fermionic single-particle states in the weak-coupling theory and the nature of the cut-off in the bosonized strong-coupling theory. The results agree with calculations for metallic junctions in the $N_{\text{ch}} \rightarrow \infty$ limit and improve the previous good agreement with recent two-channel experiments.Comment: 27 pages, 1 RevTeX file with 4 embedded Postscript figures. Uses eps

Semiclassical theory for many-body Fermionic systems

We present a treatment of many-body Fermionic systems that facilitates an expression of the well-known quantities in a series expansion of the Planck's constant. The ensuing semiclassical result contains to a leading order of the response function the classical time correlation function of the observable followed by the Weyl-Wigner series, on top of these terms are the periodic-orbit correction terms. The treatment given here starts from linear response assumption of the many-body theory and in its connection with semiclassical theory, it makes no assumption of the integrability of classical dynamics underlying the one-body quantal system. Applications of the framework are also discussed.Comment: 18 pages, Te

Josephson current in s-wave superconductor / Sr_2RuO_4 junctions

The Josephson current between an s-wave and a spin-triplet superconductor Sr$_2$RuO$_4$ (SRO) is studied theoretically. In spin-singlet / spin-triplet superconductor junctions, there is no Josephson current proportional to $\sin \phi$ in the absence of the spin-flip scattering near junction interfaces, where $\phi$ is a phase-difference across junctions. Thus a dominant term of the Josephson current is proportional to $\sin 2\phi$ . The spin-orbit scattering at the interfaces gives rise to the Josephson current proportional to $\cos\phi$, which is a direct consequence of the chiral paring symmetry in SRO

Posttraumatic growth as positive personality change: evidence, controversies and future directions

This target article focuses on the construct of post-traumatic growth—positive psychological change experienced as a result of the struggle with highly challenging life circumstances. Prominent theories of post-traumatic growth define it in terms of personality change, and as a result, this area of research should be of great interest to personality psychologists. Despite this fact, most of the research on this topic has not been sufficiently informed by relevant research in personality psychology, and much of the extant research suffers from significant methodological limitations. We review the literature on post-traumatic growth, with a particular focus on how researchers have conceptualized it and the specific methodological issues associated with these conceptualizations. We outline some ways in which personality science can both be enriched by the study of this phenomenon and inform rigorous research on post-traumatic growth and provide a series of guidelines for future research of post-traumatic growth as positive personality change