Treating an intervention level 1 patient: futile or brave?

An ethical dilemma describes conflicting opinions by different members of the care team. This article focuses on AJ, a five-year-old child with cerebral palsy, who was born deaf and blind as a result of having contracted rubella in utero. The case is examined against Sokol’s four-quadrant analysis of ethical issues, giving a framework designed to facilitate the systematic identification and analysis of clinical ethical problems. The issue is whether the medical team should have palliated AJ, or continued with invasive therapy and feeding. The conclusion is that paediatric palliative care is often difficult, but that the dietitian has a duty to contribute his or her knowledge to benefit the patient.Keywords: futile treatment, cerebral palsy, gastro-oesophageal reflux disease, palliative care, nasogastric feeding, nasojejunal feedin

Knowledge and attitudes of nursing staff and mothers towards kangaroo mother care in the eastern sub-district of Cape Town

Objectives: To determine the knowledge and attitude of nursing staff and mothers towards kangaroo mother care (KMC) in the eastern sub-district of Cape Town.Design: A cross-sectional descriptive study.Setting and subjects: A multi-stage sample of 30 kangaroo care mothers admitted to the Helderberg District Hospital (HDH); six nurses from the HDH; and nine nurses from the seven antenatal clinics that the mothers attended. The respondents were interviewed using a pretested questionnaire.Outcome measures: Knowledge, attitudes and acceptability of KMC.Results: Data were analysed using CDC Epi Info version 3.3.2, and Microsoft Excel software programmes. The majority of the mothers (83.3%) did not have prior knowledge of KMC. Sixty per cent of the nursing staff did not have any KMC training. The majority of the mothers were committed to KMC, were satisfied with the results (with regard to the weight gain of the infant), and indicated that they would continue to practise KMC at home. The majority of the hospital nursing staff was very positive toward KMC, and agreed that it was beneficial to both mother and infant.Conclusion: Most of the mothers lacked prior knowledge of KMC, and were only informed about it when they were admitted to the KMC ward. All of the nursing staff who were engaged in KMC (n = 15) had a positive attitude towards it.Keywords: kangaroo mother care, low birthweight infants, nursing staf

A Solution to the Graceful Exit Problem in Pre-Big Bang Cosmology

We examine the string cosmology equations with a dilaton potential in the context of the Pre-Big Bang Scenario with the desired scale factor duality, and give a generic algorithm for obtaining solutions with appropriate evolutionary properties. This enables us to find pre-big bang type solutions with suitable dilaton behaviour that are regular at $t=0$, thereby solving the graceful exit problem. However to avoid fine tuning of initial data, an `exotic' equation of state is needed that relates the fluid properties to the dilaton field. We discuss why such an equation of state should be required for reliable dilaton behaviour at late times.Comment: 16 pages LaTeX, 5 figures. To appear in Physical Review

Tuberculous meningitis in children: reducing the burden of death and disability

Tuberculous meningitis disproportionately affects young children. As the most devastating form of tuberculosis, it is associated with unacceptably high rates of mortality and morbidity even if treated. Challenging to diagnose and treat, tuberculous meningitis commonly causes long-term neurodisability in those who do survive. There remains an urgent need for strengthened surveillance, improved rapid diagnostics technology, optimised anti-tuberculosis drug therapy, investigation of new host-directed therapy, and further research on long-term functional and neurodevelopmental outcomes to allow targeted intervention. This review focuses on the neglected field of paediatric tuberculous meningitis and bridges current clinical gaps with research questions to improve outcomes from this crippling disease

Caustics of Compensated Spherical Lens Models

We consider compensated spherical lens models and the caustic surfaces they create in the past light cone. Examination of cusp and crossover angles associated with particular source and lens redshifts gives explicit lensing models that confirm previous claims that area distances can differ by substantial factors from angular diameter distances even when averaged over large angular scales. `Shrinking' in apparent sizes occurs, typically by a factor of 3 for a single spherical lens, on the scale of the cusp caused by the lens; summing over many lenses will still leave a residual effect.Comment: 21 pages, 5 ps figures, eps

Recent developments in Tuberculous meningitis pathogenesis and diagnostics [version 2; peer review: 1 approved]

The pathogenesis of Tuberculous meningitis (TBM) is poorly understood, but contemporary molecular biology technologies have allowed for recent improvements in our understanding of TBM. For instance, neutrophils appear to play a significant role in the immunopathogenesis of TBM, and either a paucity or an excess of inflammation can be detrimental in TBM. Further, severity of HIV-associated immunosuppression is an important determinant of inflammatory response; patients with the advanced immunosuppression (CD4+ T-cell count of 150 cells/μL. Host genetics may also influence outcomes with LT4AH genotype predicting inflammatory phenotype, steroid responsiveness and survival in Vietnamese adults with TBM. Whist in Indonesia, CSF tryptophan level was a predictor of survival, suggesting tryptophan metabolism may be important in TBM pathogenesis. These varying responses mean that we must consider whether a “one-size-fits-all” approach to anti-bacillary or immunomodulatory treatment in TBM is truly the best way forward. Of course, to allow for proper treatment, early and rapid diagnosis of TBM must occur. Diagnosis has always been a challenge but the field of TB diagnosis is evolving, with sensitivities of at least 70% now possible in less than two hours with GeneXpert MTB/Rif Ultra. In addition, advanced molecular techniques such as CRISPR-MTB and metagenomic next generation sequencing may hold promise for TBM diagnosis. Host-based biomarkers and signatures are being further evaluated in childhood and adult TBM as adjunctive biomarkers as even with improved molecular assays, cases are still missed. A better grasp of host and pathogen behaviour may lead to improved diagnostics, targeted immunotherapy, and possibly biomarker-based, patient-specific treatment regimens

Brane Dynamics in the Randall-Sundrum model, Inflation and Graceful Exit

We study the averaged action of the Randall-Sundrum model with a time dependent metric ansatz. It can be reformulated in terms of a Brans-Dicke action with time dependent Newton's constant. We show that the physics of early universe, particularly inflation, is governed by the Brans-Dicke theory. The Brans-Dicke scalar, however, quickly settles to its equilibrium value and decouples from the post-inflationary cosmology. The deceleration parameter is negative to start with but changes sign before the Brans-Dicke scalar settles to its equilibrium value. Consequently, the brane metric smoothly exits inflation. We have also studied the slow-roll inflation in our model and investigated the spectra of the density perturbation generated by the radion field and find them consistent with the current observations.Comment: Revised version, Accepted in Class. Quant. Gravit

Bacille Calmette-Guerin (BCG) vaccine and the COVID-19 pandemic : responsible stewardship is needed

CITATION: Schaaf, H. S. et al. 2020. Bacille Calmette-Guerin (BCG) vaccine and the COVID-19 pandemic : responsible stewardship is needed. International Journal of Tuberculosis and Lung Disease, 4(7):732-734, doi:10.5588/ijtld.20.0267.The original publication is available at https://www.theunion.org/what-we-do/journals/ijtldWe believe that responsible stewardship of the bacille Calmette-Guérin (BCG) vaccine in the context of the COVID-19 epidemic is urgently needed. Live attenuated BCG is currently the only licensed vaccine to protect against tuberculosis (TB). Neonatal BCG vaccination has proven efficacy in protecting infants and young children against life-threatening disseminated forms of TB, including TB meningitis and miliary TB.Post-prin

Density growth in Kantowski-Sachs cosmologies with cosmological constant

In this work the growth of density perturbations in Kantowski-Sachs cosmologies with a positive cosmological constant is studied, using the 1+3 and 1+1+2 covariant formalisms. For each wave number we obtain a closed system for scalars formed from quantities that are zero on the background and hence are gauge-invariant. The solutions to this system are then analyzed both analytically and numerically. In particular the effects of anisotropy and the behaviour close to a bounce in the cosmic scale factor are considered. We find that typically the density gradient in the bouncing directions experiences a local maximum at or slightly after the bounce.Comment: 33 pages, 17 picture