Medical audit of the management of cryptococcal meningitis in HIV-positive patients in the Cape Winelands (East) district, Western Cape

Background: Cryptococcal meningitis (CM) has become the most common type of community-acquired meningitis. CM has a poor outcome if the initial in-hospital treatment does not adhere to standard guidelines. The aim of this audit was to improve the quality of the care of human immunodeficiency virus (HIV) positive patients with CM in the Cape Winelands District.Method: Following an initial audit in 2008, the researchers and a new audit team introduced interventions, and planned a second audit cycle. The folders of 25 HIV-positive adults (admitted to three district hospitals, one regional hospital, and one tuberculosis hospital) were audited.Results: Spinal manometry was performed more consistently in the regional hospital, than in the district hospitals. Reasons for failing to reach the 14-day amphotericin B target were in-patient deaths, drug stock problems, and renal impairment. The renal monitoring of amphotericin B treatment was suboptimal. The quality of care at district hospitals appeared to be comparable to that found at the regional hospital. The in-patient referral for antiretroviral treatment (ART) counselling wasbetter in the district hospital setting. However, both levels of care had difficulty in achieving the four-week target between the onset of amphotericin B and onset of ART.Conclusion: Deficiencies in the quality of care remained. Between the prior and current audit cycles, there was no consistent improvement in care at the regional hospital. An integrated care pathway document has been developed, and adopted as policy in the Cape Winelands district. Its impact on the quality of care will be evaluated by a dedicated audit team in the future

New antiretrovirals: What\'s in it for southern Africa

The rise of novel antiretrovirals (ARVs) has introduced a new evolutionary phase in HIV care. In developed countries, the 1980s and early 1990s were characterised by palliative care and opportunistic infection prophylaxis; the late 1990s by an attempt to use a limited and toxic antiretroviral arsenal effectively while cycling through high levels of resistance; and finally, the first half of this decade by working out the easiest-to-take regimens, using the steadily rising number of safer drugs. At present, there are 8 nucleoside analogues (NRTIs), 3 non-nucleoside analogues (NNRTIs), 10 protease inhibitors (PIs), and one each of the fusion, entry and integrase inhibitors to choose from, along with a new drug pipeline that targets both existing and new targets in the viral replicative cycle. The choice may seem quite vast, but the reality is that many of these drugs cannot be used simultaneously or in patients with extensive drug resistance. In addition, some drugs have unacceptable toxicities and are not favoured in current treatment regimens. Southern African Journal of HIV Medicine Vol. 9 (4) 2008: pp. 44-4

A model to optimize payloads at PFG Building Glass

While improving customer service by allowing user definable mixed load orders of their plate glass product, PFG Building Glass was confronted with a problem of calculating the feasibility and optimum load layout for transporting the glass, without transgressing the regulatory requirements. In this article the development of an integrated solution is discussed, including the definition of a mathematical model that calculates the axle weights, the optimization model based on linear programming, as well as the user interface for their current information system. The solution enables the company to proceed with e-commerce service to clients, since the system can evaluate the transport feasibility and give real time feedback to clients.Die uitbreiding van kliëntediens by PFG Building Glass om bestellings van gemengde glasplaatprodukte per vrag te aanvaar, het die onderneming voor ‘n uitdaging geplaas om te bereken of sulke bestellings binne die wetlike regulasie vervoer sal kan word. Hierdie artikel bespreek die ontwikkeling van ‘n geïntegreede oplossing wat bestaan uit ‘n wiskundige model wat die gewig per as bereken, ‘n optimiseringsmodel wat die vraguitleg bepaal en op liniêre programmeringsbeginsels gebaseer is, sowel as die gebruikersintervlak met die onderneming se bestaande inligtingstelsel. Hierdie ontwikkeling stel die onderneming instaat om ‘n e-besigheidsdiens vir kliente daar te stel, aangesien terugvoer oor die uitvoerbaarheid van ‘n bestelling uit ‘n vervoeroogpunt intyds aan die kliënt gekommunikeer kan word.http://sajie.journals.ac.z

A call to action: Addressing the reproductive health needs of women with drug-resistant tuberculosis

Although there is substantial risk to maternal and neonatal health in the situation of pregnancy during treatment for rifampicin-resistant tuberculosis (RR-TB), there is little evidence to guide clinicians as to how to manage this complexity. Of the 49 680 patients initiated on RR-TB treatment from 2009 to 2014 in South Africa, 47% were women and 80% of them were in their reproductive years (15 - 44). There is an urgent need for increased evidence of the safety of RR-TB treatment during pregnancy, increased access to contraception during RR-TB treatment, and inclusion of reproductive health in research on the prevention and treatment of TB

Multilocus phylogenetics in a widespread African anuran lineage (Brevicipitidae: Breviceps) reveals patterns of diversity reflecting geoclimatic change

AimTo investigate models assessing the influence of geomorphology and climatic shifts on species diversification in sub‐Saharan Africa by reconstructing the pattern and timing of phylogenetic relationships of rain frogs (Brevicipitidae: Breviceps).LocationSub‐Saharan Africa, south of the Congo Basin.MethodsMultilocus sequence data were generated for near complete species‐level sampling of the genus Breviceps. Phylogenetic relationships were inferred via Bayesian inference and maximum likelihood analyses on both concatenated and single‐gene datasets. Network analyses identified locus‐specific reticulate relationships among taxa. Bayesian methods were used to infer dates of divergence among Breviceps lineages, and niche modelling was used to identify possible adaptive divergence.ResultsBreviceps is monophyletic and comprised of two major, largely allopatric subclades. Diversity within each subclade is concentrated in two areas with contrasting geologic and climatic histories: the arid/semiarid winter rainfall zone in the south‐western (SW) Cape, and the semitropical East Coast that receives predominantly summer rainfall. Recognized species diversity in the SW Cape based on phenotypic variation is consistent with observed genetic patterns whereas the East Coast is shown to harbour unexpectedly high genetic diversity and up to seven putative, cryptic species. Niche models show significant overlap between closely related species.Main conclusionsDating analyses indicate that diversification of Breviceps occurred rapidly within the Miocene, with only a moderate decline over the Plio‐Pleistocene, suggesting that this process might be slowed but ongoing. Our findings suggest that a combination of two models, a landscape barrier model and climate fluctuation model, can explain patterns of diversification in Breviceps. This demonstrates that Miocene epeirogenic events and climatic shifts may have had a considerable influence on contemporary patterns of biodiversity. Topographic complexity and relative geoclimatic stability in the East have promoted cryptic diversification in allopatry, and this area clearly harbours numerous undescribed taxa and is in need of detailed biotic investigation.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145569/1/jbi13394.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/145569/2/jbi13394_am.pd

Consensus statement: Management of drug-induced liver injury in HIV-positive patients treated for TB

Drug-induced liver injury (DILI) in HIV/tuberculosis (TB) co-infected patients is a common problem in the South African setting, and re-introduction of anti-TB drugs can be challenging for the healthcare worker. Although international guidelines on the re-introduction of TB treatment are available, the definition of DILI is not uniform, management of antiretroviral therapy (ART) in HIV co-infection is not mentioned, and the guidance on management is not uniform and lacks a practical approach. In this consensus statement, we summarise important aspects of DILI and provide practical guidance for healthcare workers for different patient groups and healthcare settings on the re-introduction of anti-TB drugs and ART in HIV/TB co-infected individuals presenting with DILI

Nanorg Microbial Factories: Light-Driven Renewable Biochemical Synthesis Using Quantum Dot-Bacteria Nanobiohybrids

Living cells do not interface naturally with nanoscale materials, although such artificial organisms can have unprecedented multifunctional properties, like wireless activation of enzyme function using electromagnetic stimuli. Realizing such interfacing in a nanobiohybrid organism (or nanorg) requires (1) chemical coupling via affinity binding and self-assembly, (2) the energetic coupling between optoelectronic states of artificial materials with the cellular process, and (3) the design of appropriate interfaces ensuring biocompatibility. Here we show that seven different core−shell quantum dots (QDs), with excitations ranging from ultraviolet to near-infrared energies, couple with targeted enzyme sites in bacteria. When illuminated by light, these QDs drive the renewable production of different biofuels and chemicals using carbon-dioxide (CO2), water, and nitrogen (from air) as substrates. These QDs use their zinc-rich shell facets for affinity attachment to the proteins. Cysteine zwitterion ligands enable uptake through the cell, facilitating cell survival. Together, these nanorgs catalyze light-induced air−water−CO2 reduction with a high turnover number (TON) of ∼106-108 (mols of product per mol of cells) to biofuels like isopropanol (IPA), 2,3-butanediol (BDO), C11−C15 methyl ketones (MKs), and hydrogen (H2); and chemicals such as formic acid (FA), ammonia (NH3), ethylene (C2H4), and degradable bioplastics polyhydroxybutyrate (PHB). Therefore, these resting cells function as nanomicrobial factories powered by light

Aspirations and human development interventions

What role can aspirations play in small-scale human development interventions? In this paper, we contribute to answering that question with both conceptual and empirical work. Aspirations can play at least two roles in small-scale human development interventions: the capabilities-selecting role and the agency-unlocking role. While aspirations also face the challenge of adaptation to adverse circumstances and unjust social structures, we argue that this challenge can be met by embedding the formulation and expression of aspirations within a setting of public discussion and awareness-raising activities, and that adaptation can be further countered by including a commitment to action. We then report on field research done in Khayelitsha, a township in Cape Town, South Africa, where a group of women went through a process of voicing, examining, and then realizing their aspirations. The action research confirms our theoretical hypotheses. We also do not find any evidence of adaptation of the women’s aspirations, and argue that the absence of such adaptation might be a result of active capability selection, reflection, deliberation, and the exercise of agency throughout the action research programme.Web of Scienc

The Category of Node-and-Choice Forms, with Subcategories for Choice-Sequence Forms and Choice-Set Forms

The literature specifies extensive-form games in many styles, and eventually I hope to formally translate games across those styles. Toward that end, this paper defines $\mathbf{NCF}$, the category of node-and-choice forms. The category's objects are extensive forms in essentially any style, and the category's isomorphisms are made to accord with the literature's small handful of ad hoc style equivalences. Further, this paper develops two full subcategories: $\mathbf{CsqF}$ for forms whose nodes are choice-sequences, and $\mathbf{CsetF}$ for forms whose nodes are choice-sets. I show that $\mathbf{NCF}$ is "isomorphically enclosed" in $\mathbf{CsqF}$ in the sense that each $\mathbf{NCF}$ form is isomorphic to a $\mathbf{CsqF}$ form. Similarly, I show that $\mathbf{CsqF_{\tilde a}}$ is isomorphically enclosed in $\mathbf{CsetF}$ in the sense that each $\mathbf{CsqF}$ form with no-absentmindedness is isomorphic to a $\mathbf{CsetF}$ form. The converses are found to be almost immediate, and the resulting equivalences unify and simplify two ad hoc style equivalences in Kline and Luckraz 2016 and Streufert 2019. Aside from the larger agenda, this paper already makes three practical contributions. Style equivalences are made easier to derive by [1] a natural concept of isomorphic invariance and [2] the composability of isomorphic enclosures. In addition, [3] some new consequences of equivalence are systematically deduced.Comment: 43 pages, 9 figure