Parenting, Attachment and Support Network Experiences of Mothers Diagnosed with HIV and Psychosis

Schuengel, C. [Promotor]Rensburg, E. van [Promotor]Sterkenburg, P.S. [Copromotor

Scale-dependent perspectives on the geomorphology and evolution of beachdune systems

Despite widespread recognition that landforms are complex Earth systems with process-response linkages that span temporal scales from seconds to millennia and spatial scales from sand grains to landscapes, research that integrates knowledge across these scales is fairly uncommon. As a result, understanding of geomorphic systems is often scale-constrained due to a host of methodological, logistical, and theoretical factors that limit the scope of how Earth scientists study landforms and broader landscapes. This paper reviews recent advances in understanding of the geomorphology of beach-dune systems derived from over a decade of collaborative research from Prince Edward Island (PEI), Canada. A comprehensive summary of key findings is provided from short-term experiments embedded within a decade-long monitoring program and a multi-decadal reconstruction of coastal landscape change. Specific attention is paid to the challenges of scale integration and the contextual limitations research at specific spatial and/or temporal scales imposes. A conceptual framework is presented that integrates across key scales of investigation in geomorphology and is grounded in classic ideas in Earth surface sciences on the effectiveness of formative events at different scales. The paper uses this framework to organize the review of this body of research in a 'scale aware' way and, thereby, identifies many new advances in knowledge on the form and function of subaerial beach-dune systems. Finally, the paper offers a synopsis of how greater understanding of the complexities at different scales can be used to inform the development of predictive models, especially those at a temporal scale of decades to centuries, which are most relevant to coastal management issues. Models at this (landform) scale require an understanding of controls that exist at both ‘landscape’ and ‘plot’ scales. Landscape scale controls such as sea level change, regional climate, and the underlying geologic framework essentially provide bounding conditions for independent variables such as winds, waves, water levels, and littoral sediment supply. Similarly, an holistic understanding of the range of processes, feedbacks, and linkages at the finer plot scale is required to inform and verify the assumptions that underly the physical modelling of beach-dune interaction at the landform scale

Precocious Natural Mummification in a Temperate Climate (Western Cape, South Africa)

The general process and pattern of decomposition is well-documented and understood. However, specific environmental conditions may alter this pattern and prematurely terminate the decay process. An example of this is natural mummification – a preservative process characterized by desiccation, brittleness and shrinkage of the skin and body tissues. It is important to understand how, when, and where such variations may occur, and for this reason environmentally-specific studies of decay are required. The aim of the present study was the establish baseline data on soft-tissue decomposition in two terrestrial habitats in the Western Cape. A total of 16 pig carcasses serving as analogues for humans were deployed in these habitats during two successive winters and summers between 2014 and 2016. The rate and pattern of decomposition were assessed via measurement of weight loss over time and scoring the decomposition process using Megyesi et al. (2005) Total Body Score system and study-specific criteria for mummification. Carcasses typically followed the expected pattern of decay with a few exceptions, most notably instances of rapid natural mummification. Natural mummification, as defined by Megyesi et al. (2005), was observed to occur as early as 17 days postmortem, with five carcasses mummifying in less than one month. The timing of natural mummification varies widely, from a few days to several years, averaging around three months in temperate regions. Natural mummification occurring in less than one month is termed precocious mummification and is rarely observed in temperate regions. With only three reports globally, this study’s findings are globally significant, highlighting the importance of regionally-specific decomposition studies. Two local forensic cases wherein precocious mummification has been observed are also presented and, considered together with the study’s results, a possible mechanism driving this process is proposed

Early cost-utility analysis of general and cerebrospinal fluid-specific Alzheimer's disease biomarkers for hypothetical disease-modifying treatment decision in mild cognitive impairment

Introduction: The study aimed to determine the room for improvement of a perfect cerebrospinal fluid (CSF) biomarker and the societal incremental net monetary benefit of CSF in subjects with mild cognitive impairment (MCI) assuming a hypothetical disease-modifying Alzheimer's disease (AD) treatment. Methods: A decision model compared current practice to a perfect biomarker and to two strategies positioning CSF as add- on test when current practice concluded the presence or absence of AD. Results: The simulated MCI population was aged on average 68.3 and 49% had AD. The room for improvement by the perfect CSF test was 0.39 quality adjusted life years, V33,622 ($ 43,372) savings, 2.0 potential beneficial treatment years, and 1.3-year delay in dementia conversion. Discussion: The results indicated more potential benefit from a biomarker positioned to verify subjects who are not expected to have AD (i.e., to prevent undertreatment) rather than to verify subjects expected to have AD (prevent overtreatment). Sensitivity analyses explored different CSF positions. (C) 2015 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved

Therapeutic approaches to disease modifying therapy for multiple sclerosis in adults: An Australian and New Zealand perspective Part 1 Historical and established therapies

Multiple sclerosis (MS) is a potentially life-changing immune mediated disease of the central nervous system. Until recently, treatment has been largely confined to acute treatment of relapses, symptomatic therapies and rehabilitation. Through persistent efforts of dedicated physicians and scientists around the globe for 160 years, a number of therapies that have an impact on the long term outcome of the disease have emerged over the past 20 years. In this three part series we review the practicalities, benefits and potential hazards of each of the currently available and emerging treatment options for MS. We pay particular attention to ways of abrogating the risks of these therapies and provide advice on the most appropriate indications for using individual therapies. In Part 1 we review the history of the development of MS therapies and its connection with the underlying immunobiology of the disease. The established therapies for MS are reviewed in detail and their current availability and indications in Australia and New Zealand are summarised. We examine the evidence to support their use in the treatment of MS

A new era in the treatment of multiple sclerosis

• Multiple sclerosis (MS) is an autoimmune disease of the central nervous system with a multifactorial aetiology and highly variable natural history. • A growing understanding of the immunopathogenesis of the condition has led to an expanding array of therapies for this previously untreatable disease. • While a cure for MS remains elusive, the potential to reduce inflammatory disease activity by preventing relapses and minimising disease progression is achievable. • The importance of early treatment in minimising long-term disability is increasingly recognised. • Most of the newer, more effective therapies are associated with risks and practical problems that necessitate an active management strategy and continuous vigilance. • While the initiation of these therapies is likely to remain the responsibility of neurologists, other specialist physicians and general practitioners will be involved in the identification and management of adverse effects