The Vaccine and Cervical Cancer Screen project 2 (VACCS 2): Linking cervical cancer screening to a two-dose HPV vaccination schedule in the South- West District of Tshwane, Gauteng, South Africa

Background: Cervical cancer is a preventable disease with a high prevalence in South Africa (SA), where screening is opportunistic. Primary prevention is now possible through HPV vaccination. In VACCS 1 the feasibility of linking cervical cancer with HPV vaccination was demonstrated.Objectives: To investigate the feasibility of linking HPV self-testing with a two-dose HPV vaccination schedule and to compare results with VACCS 1.Methods: The project was conducted in five schools in the South-West District of Tshwane, Gauteng, SA. Leaflet information on cervical cancer and screening was provided, with requests for consent and assent for a two-dose HPV vaccination of schoolgirls. Female caregivers were invited to take part in HPV self-screening.Results: Of 965 girls invited for vaccination, 519 (53.7%) had full consent and 518 (99.8%) received at least one vaccine dose. The invited uptake rate was 53.7% and 495 girls received both doses, giving a completion rate of 95.4% v. 82.6% in VACCS 1. Of 1 135 self-screen kits handed out, 560 (49.3%) were not returned. The mean age (standard deviation) of the 160 women who participated in self-screening was 38.7 (7.7) years. HPV testing was negative in 116 women (72.5%), 15 women (9.4%) tested positive for HPV 16 and/or 18, and 27 (16.9%) were positive for non-16/18 oncogenic HPV.Conclusion: Data from the VACCS projects suggest that school-based vaccine programmes can be successfully implemented. A two-dose schedule allowed for higher completion rates. Linking self-collected HPV screening to HPV vaccination is feasible, is a promising and viable screening strategy, and reached the appropriate age group for screening

Help-seeking by substance dependants presenting to healthcare professionals in the Free State Province

Introduction. Current data regarding treatment needs in South Africa for substance dependence are based on admissions to specialised treatment centres. The data therefore do not include patients presenting to independent healthcare workers and state hospitals. Aim. The aim of this study was to investigate help-seeking behaviour for substance dependence disorders from the perspective of healthcare professionals at various levels of the referral chain in Free State Province. Design. A descriptive study was performed. Setting. Treatment environments in Free State Province accessible to substance-dependent persons. Participants. General practitioners, private psychiatrists, prescribing healthcare professionals at state hospitals and treatment centres, and non-prescribing therapists responsible for management of substance-dependent persons. Measurements. A questionnaire was used to determine the level of help-seeking experienced by the participants regarding various classes of psycho-active substances. Findings. The presentation of alcohol, cannabis, opioid, benzodiazepine, ecstasy, cocaine and inhalant dependency at general practitioners, private psychiatrists, treatment centres and non-prescribing therapists was compared. Different patterns of help-seeking for substance dependence from the various professional groups were detected. Regarding alcohol dependence, 40.3% of private general medical practitioners reported being confronted with alcohol dependence at least once per month, compared with 100% of treatment centre representatives and private psychiatrists, 70.6% of state hospitals and 53.8% of non-prescribers. State hospitals reported the highest frequency for contact with cases of cannabis dependence, compared with the other professional groups, while psychiatrists reported the highest contact with cases involving benzodiazepine, cocaine and ecstasy. Therapists reported a higher level of contact with inhalant dependence, while this group virtually never presented at general practitioners and private psychiatrists. Conclusion. Help-seeking data can be used in conjunction with other data, such as treatment demand data, to inform and adapt policies and practice. Variations in the manifestation of help-seeking behaviour at various groups may be important pointers to conditions that influence help-seeking, and therefore should be investigated further

Phase I of the DiaVACCS screening trial: Study design, methods, population demographics and baseline results

Background. Human papillomavirus (HPV)-based primary screening guidelines are based on screening test performance and prevalence data generated in high-resource areas with low HIV infection rates. There is an urgent need for local data on infection and disease prevalence, as well as screening test performance, among both HIV-positive and HIV-negative South African (SA) women, in order to inform updated screening guidelines. Objectives. This study describes the baseline characteristics of participants in the cross-sectional phase of the multicentric DIAgnosis in Vaccine And Cervical Cancer Screen (DiaVACCS) screening trial. The objective was to determine the prevalence of positive screening and pre-invasive disease using different tests and strategies in the SA HIV-positive and HIV-negative population.Methods. A total of 1  104 women aged 25 - 65 years and eligible for screening were included, 465 HIV positive and 639 HIV negative. Visual inspection and molecular and cytological screening tests were done on self-sampled and healthcare worker-collected specimens. All participants who screened positive and 49.1% of those who screened negative were invited for colposcopy and biopsy, and those qualifying for treatment were recalled for large loop excision of the transformation zone as part of the trial. The worst histology result for each participant was used, and for untested women, multiple imputation was used to estimate verification biasadjusted histology values.Results. Visual inspection was positive in 50.4% of HIV-positive v. 20.9% of HIV-negative women, cytology (atypical squamous cells of undetermined significance) in 39.9% v. 17.0%, and high-risk HPV DNA in 41.2% v. 19.6%. Overall, high-grade squamous intraepithelial lesion-positive cytology peaked in the age group 30 - 39 years at 16.7%. After adjustment for verification bias, histological diagnosis of cervical intraepithelial neoplasia (CIN)2+ was suspected in 44.7% v. 23.5% and CIN3+ in 23.3% v. 10.2% of HIV-positive and negative women, respectively. Invasive cancer was diagnosed in 15 women (1.95% of histological studies performed), and verification bias adjustment suggested 20 cases (1.8% of the study population).Conclusion. The baseline findings from the DiaVACCS trial confirm a high prevalence of HPV-related cervical pathology in the SA HIV-negative screening population, showing a clear need to reach these women with a screening programme. Among HIV-positive women, prevalence values were almost doubled. The prevalence of existing invasive cervical cancer was 1 - 2% of all women. Further analysis of the performance of single and multiple screening tests between the two subgroups will contribute to the choice of the most effective strategies to identify women at risk of developing invasive cancer

Workspace and Singularity analysis of a Delta like family robot

Workspace and joint space analysis are essential steps in describing the task and designing the control loop of the robot, respectively. This paper presents the descriptive analysis of a family of delta-like parallel robots by using algebraic tools to induce an estimation about the complexity in representing the singularities in the workspace and the joint space. A Gr{\"o}bner based elimination is used to compute the singularities of the manipulator and a Cylindrical Algebraic Decomposition algorithm is used to study the workspace and the joint space. From these algebraic objects, we propose some certified three dimensional plotting describing the the shape of workspace and of the joint space which will help the engineers or researchers to decide the most suited configuration of the manipulator they should use for a given task. Also, the different parameters associated with the complexity of the serial and parallel singularities are tabulated, which further enhance the selection of the different configuration of the manipulator by comparing the complexity of the singularity equations.Comment: 4th IFTOMM International Symposium on Robotics and Mechatronics, Jun 2015, Poitiers, France. 201

Coherent Stranski-Krastanov growth in 1+1 dimensions with anharmonic interactions: An equilibrium study

The formation of coherently strained three-dimensional islands on top of the wetting layer in Stranski-Krastanov mode of growth is considered in a model in 1+1 dimensions accounting for the anharmonicity and non-convexity of the real interatomic forces. It is shown that coherent 3D islands can be expected to form in compressed rather than in expanded overlayers beyond a critical lattice misfit. In the latter case the classical Stranski-Krastanov growth is expected to occur because the misfit dislocations can become energetically favored at smaller island sizes. The thermodynamic reason for coherent 3D islanding is the incomplete wetting owing to the weaker adhesion of the edge atoms. Monolayer height islands with a critical size appear as necessary precursors of the 3D islands. The latter explains the experimentally observed narrow size distribution of the 3D islands. The 2D-3D transformation takes place by consecutive rearrangements of mono- to bilayer, bi- to trilayer islands, etc., after exceeding the corresponding critical sizes. The rearrangements are initiated by nucleation events each next one requiring to overcome a lower energetic barrier. The model is in good qualitative agreement with available experimental observations.Comment: 12 pages text, 15 figures, Accepted in Phys.Rev.B, Vol.61, No2

Relativistic supersymmetric quantum mechanics based on Klein-Gordon equation

Witten's non-relativistic formalism of supersymmetric quantum mechanics was based on a factorization and partnership between Schroedinger equations. We show how it accommodates a transition to the partnership between relativistic Klein-Gordon equations. In such a class of models the requirement of supersymmetry is shown to lead to a certain "exceptional-point" instability of ground states.Comment: 20 page

The Keldysh action of a multi-terminal time-dependent scatterer

We present a derivation of the Keldysh action of a general multi-channel time-dependent scatterer in the context of the Landauer-B\"uttiker approach. The action is a convenient building block in the theory of quantum transport. This action is shown to take a compact form that only involves the scattering matrix and reservoir Green functions. We derive two special cases of the general result, one valid when reservoirs are characterized by well-defined filling factors, the other when the scatterer connects two reservoirs. We illustrate its use by considering Full Counting Statistics and the Fermi Edge Singularity.Comment: 13 pages, 2 figures, submitted to PR

Bi-stability in voltage-biased NISIN structures

As a generic example of a voltage-driven superconducting structure we study a short superconductor connected to normal leads by means of low transparency tunnel junctions, with a voltage bias $V$ between the leads. The superconducting order parameter $\Delta$ is to be determined self-consistently. We study the stationary states of the system as well as the dynamics after a perturbation. We find a region in parameter space where there are two stable stationary states at a given voltage. These bi-stable states are distinguished by distinct values of the superconducting order parameter $\Delta$ and of the current between the leads. We have evaluated (1) the multi-valued superconducting order parameter $\Delta$ at given $V$; (2) the current between the leads at a given V; and (3) the critical voltage at which superconductivity in the island ceases. With regards to dynamics, we find numerical evidence that the stationary states are stable and that no complicated non-stationary regime can be induced by changing the voltage. This result is somewhat unexpected and by no means trivial, given the fact that the system is driven out of equilibrium. The response to a change in the voltage is always gradual, even in the regime where changing the interaction strength induces rapid anharmonic oscillations of the order parameter.Comment: 15 pages, 11 figures, submitted to Phys. Rev.