Adherence to medicines in patients with type 2 diabetes

Type 2 diabetes is a common chronic condition associated with co-morbid hypertension and hyperlipidaemia. Multiple medicines are usually prescribed to manage these conditions. However, regimens containing multiple medicines are difficult to manage and their necessity may not be understood. As a result adherence can become a problem. This article discusses the impact of multiple medicines on adherence and the way adherence issues can be tackled during general practice consultations

Monopoles contra vortices in SU(2) lattice gauge theory?

We show that the scenario of vortex induced confinement of center--projected SU(2) lattice gauge theory is not necessarily in conflict with the findings in the positive plaquette model.Comment: 3 pages, LaTeX, comment to be published in Phys. Rev.

Advanced passive communication satellite systems comparison studies. Volume 1 - Summary Final report

Passive communication satellites feasibility for Comsat system - Vol.

An investigation into the time-saving benefits of using a computerised taxation program

Software programs designed to calculate the tax liability of individuals and other types of tax entity are being designed and used with increasing frequency. Research done in the United States of America appears to indicate that these programs do not achieve any saving in time and, in fact, may take longer to use than to complete a tax return by hand. As the South African revenue collection system appears to be moving closer to a self-assessment system, where the calculation of tax owing will be the responsibility of the taxpayer, the research essay sets out to determine whether there is a saving in time when calculating a tax liability using a tax software program, instead of calculating it by hand. In addition, the research aims to determine how much time, on average, is saved or lost, using such a program, and whether there is any correlation between the time taken to perform a calculation by hand and that using the software program. It does so by comparing the average estimated time it would take to complete tax calculations for individuals by hand with the average time taken to complete the same tax calculations using a tax software program. The average time taken to do the calculations by hand is based on the time allocation given for questions by the authors of a published question bank for university students. The time taken using software is determined by using a stop-watch to time each question being processed. The results, subject to assumptions made in carrying out the research, show that there is a substantial saving in time using the software program. Based on the data, however, the results indicate a weak correlation between the estimated time taken to do a calculation by hand and the estimated time using the software program. Possible reasons for the weak correlation are discussed. A recommendation is also made for the standardization and certification of existing tax calculation software

The deductibility of interest

The deduction of interest expenditure, for the purpose of calculating the South African taxable income on which normal tax is levied, must satisfy the requirements of the preamble to section 11 and section 11(a) of the Income Tax Act 58 of 1962, read with section 23(g), unless a particular section makes specific provision for its deduction. There appears to be a presumption that if interest expenditure is incurred in the production of income derived from carrying on a trade, it is deductible and we need look no further. This presumption may underlie the 2005 amendment of sub-section (2) of section 24J, which provides that interest is deductible provided it has been incurred “in the production of income” and “for the purposes of trade” (sections 11(a) and 23(g)). This paper discusses the deductibility of interest and, in particular, whether there are circumstances in which interest paid on a loan used to acquire a capital asset could be of a capital nature. The provisions of the Income Tax Act and court decisions relating to the deductibility of interest, as well as opinions expressed by authoritative writers on tax, are subjected to critical analysis. The paper first distinguishes the tests for determining whether an expense has been incurred “in the production of income” and whether the expense is “of a capital nature”. Specific court decisions relating to the deductibility of interest are then analysed. The research considers section 24J of the Act, to determine whether its provisions have settled the debate, and refers briefly to the provisions of section 11(bB), in the context of the research question. The conclusion reached in the research is that there are occasions where the courts appear to have confused the tests for determining whether interest expenditure was incurred “in the production of income” and whether it is “of a capital nature”, in certain instances have also failed to address the question of the capital or revenue nature of the interest expenditure under scrutiny, and that the matter does not appear to be settled that interest incurred on funds used to acquire a capital asset used to produce trade income is automatically deductible

Advanced passive communication satellite systems comparison studies. Volume 2 - Technical discussion Final report

Passive communication satellites feasibility for Comsat system - Vol.

Immunological investigations and immunotherapy in lung cancer

This thesis examines the value of immunological methods in the treatment, diagnosis and assessment of prognosis of lung cancer.Delayed hypersensitivity skin tests and laboratory tests of immunological function were performed in patients with operable lung cancer who were then randomly allocated to the autograft or non-autograft groups. In a pilot trial in 15 patients, the autograft group received intradermal injections of autologous irradiated tumour cells and BCG. during three weeks after operation. In this trial only, both groups of patients were given radiotherapy to the mediastinum three weeks after operation. In the subsequent main trial in 83 patients, both groups received one pre¬ operative percutaneous injection of BCG.. The autograft group only were given serial injections of autologous irradiated tumour cells and percutaneous BCG. during the three weeks after operation.While the prevalence of positive tuberculin tests among the lung cancer patients before operation was similar to that of controls, sensitisation after challenge by DNCB. was less common in the lung cancer patients, suggesting that there is some impairment of the afferent limb of the immunological response in this condition. Lymphocyte transformation by PPD. but not PHA. or pokeweed mitogen was depressed. Relative depression of certain immunological tests was seen in patients with more advanced disease and a poorer prognosis (total lymphocytes, DNCB.reactivity) and in squamous cell carcinoma (tuberculin test). The main immunological effect of postoperative immunotherapy was a prolonged increase in tuberculin reactivity.By constructing actuarial life table curves for survival and duration of freedom from tumour recurrence and by measuring the median times for these, it was shown that DNCB. positive autograft group patients and those with stage I tumours had better clinical results than non-autograft patients (p = 0.02 to p = 0.09)« Although a higher proportion of stage I patients in the autograft group survived free of tumour recurrence two years after operation, the difference was not statistically significant. Adjuvant specific autologous immunotherapy thus seemed, at best, to have only a weak therapeutic action in operable lung cancer.In a separate study, circulating levels of tumour markers in unselected lung cancer patients were compared with those of control patients with benign pulmonary disease. Elevated levels of carcinoembryonic antigen (CEA.) were found in 17%» of pregnancy-associated a^-glycoprotein (a^-PAG.) in 16%, of casein in 1 b°/o, of human chorionic gonadotrophin in 6°/o and of a-foetoprotein in 1.5%• CEA. levels were higher in patients with extensive disease (23%) • There was discordance between raised levels of CEA. and a^-PAG.. Elevated levels of one or more markers were found in kG'/o of patients in whom four or more markers were measured. In a different series of unselected lung cancer patients, circulating levels of immunoreactive ACTH. were raised in 2k°/o of patients with small cell carcinoma but only in 3°/° of patients with non-small cell carcinoma. Elevated levels were commoner in small cell carcinoma patients with extensive disease.The results showed that when the upper limit of "normal" was that of patients with benign pulmonary disease, the prevalence of elevated levels of tumour markers was much lower than that claimed by other authors. Hence measurement of these markers is of little or no diagnostic value in lung cancer

Cadherin composition and multicellular aggregate invasion in organotypic models of epithelial ovarian cancer intraperitoneal metastasis.

During epithelial ovarian cancer (EOC) progression, intraperitoneally disseminating tumor cells and multicellular aggregates (MCAs) present in ascites fluid adhere to the peritoneum and induce retraction of the peritoneal mesothelial monolayer prior to invasion of the collagen-rich submesothelial matrix and proliferation into macro-metastases. Clinical studies have shown heterogeneity among EOC metastatic units with respect to cadherin expression profiles and invasive behavior; however, the impact of distinct cadherin profiles on peritoneal anchoring of metastatic lesions remains poorly understood. In the current study, we demonstrate that metastasis-associated behaviors of ovarian cancer cells and MCAs are influenced by cellular cadherin composition. Our results show that mesenchymal N-cadherin-expressing (Ncad+) cells and MCAs invade much more efficiently than E-cadherin-expressing (Ecad+) cells. Ncad+ MCAs exhibit rapid lateral dispersal prior to penetration of three-dimensional collagen matrices. When seeded as individual cells, lateral migration and cell-cell junction formation precede matrix invasion. Neutralizing the Ncad extracellular domain with the monoclonal antibody GC-4 suppresses lateral dispersal and cell penetration of collagen gels. In contrast, use of a broad-spectrum matrix metalloproteinase (MMP) inhibitor (GM6001) to block endogenous membrane type 1 matrix metalloproteinase (MT1-MMP) activity does not fully inhibit cell invasion. Using intact tissue explants, Ncad+ MCAs were also shown to efficiently rupture peritoneal mesothelial cells, exposing the submesothelial collagen matrix. Acquisition of Ncad by Ecad+ cells increased mesothelial clearance activity but was not sufficient to induce matrix invasion. Furthermore, co-culture of Ncad+ with Ecad+ cells did not promote a 'leader-follower' mode of collective cell invasion, demonstrating that matrix remodeling and creation of invasive micro-tracks are not sufficient for cell penetration of collagen matrices in the absence of Ncad. Collectively, our data emphasize the role of Ncad in intraperitoneal seeding of EOC and provide the rationale for future studies targeting Ncad in preclinical models of EOC metastasis

What does a primary care annual review for RA include? A national GP survey

Letter to the edito