Non-compliance with treatment by epileptic patients at George Provincial Hospital

Non-compliance with anti-epileptic drug treatment in the George area, resulting in recurrent seizures and visits to the emergency department of the George Provincial Hospital, has been identified as a social and economic problem. The aim of this study was to determine the socio-economic and medical factors, the information given to patients by healthcare workers, and the understanding of patients living with epilepsy who presented to the emergency department with seizures. Methods A descriptive study design was employed and the data-collection tools were a questionnaire and structured interview. Results The median age of the study population was 32 years. The patients had suffered from epilepsy for a median of two years and visited a clinic for a median of seven times a year. The median education level was primary school and three quarters had no employment or government grant. The majority did not understand the disease, the side effects of the medication and why they should be on medication. In addition, it became apparent from patient reports that healthcare workers showed a lack of counselling skills, time and appropriate knowledge. Conclusions There is a general lack of understanding of epilepsy by the patient. Not only were the patients uninformed, but they also showed apathy towards the management of their condition.South African Family Practice Vol. 49 (9) 2007: pp. 1

Perceptions of mental health care consumers regarding their conditions

Background: Distress is experienced, understood, expressed and communicated differently across various cultures. Individuals assign meaning to their mental health problems from their own personal, social and cultural context. Mental healthcare consumers (MHCCs) often attribute their symptoms to a cultural or spiritual cause, and as a result, tend to visit spiritual or traditional healers before attending psychiatric units. Aim: The aim of the study was to determine patients’ perspectives on mental health – what they perceived to be the cause of mental problems and what they believed the most appropriate treatment options would be. The role of culture, religion and spirituality in patients’ understanding of and coping with mental problems was explored, as well as their attitudes toward their treatment and the perceived effectiveness and appropriateness of the different treatment modalities. Methods: A quantitative survey was done using a questionnaire designed to explore and analyse patients’ cultural and religious beliefs about mental illness and the actions they take in their search for recovery from mental disturbances. The questionnaire was compiled by incorporating demographic information, together with certain items of the World Health Organisation Quality of Life Spiritual, Religious and Personal Beliefs questionnaire, the Cultural Formulation Interview, the Rating of Medication Influences Scale, and the South African Traditional Beliefs Scale. Results: Ninety-four patients (58.5% male) were included in the study, with a mean age of 36 years. The majority of the participants (75.5%) were black people; most were Christian (79.8%), followed by African traditionalists (17.0%), and 41.4% indicated that they were actively involved in their religious communities. Although most (72.0%) believed that faith in God and help from religious leaders (34.4%) could contribute to their mental wellbeing, 29.0% reckoned that keeping their ancestors happy would protect them from sickness and bad luck. Approximately one quarter (22.3%) believed that traditional medicine could be the only cure for mental illness related to bewitchment, and 29.0% believed that Western medicine could worsen such problems. Roughly a third of participants (30.9%) were of the opinion that Western medicine cannot cure mental illness caused by angry ancestors. Conclusion: The impact cultural and religious belief systems have on MHCCs’ perceptions of mental illness has been demonstrated and appeals to the availability of accepta ble mental health care services. Mental healthcare providers’ sensitivity to cultural and religious beliefs will enrich the therapeutic relationship; hence healthcare providers should receive training focusing on the influence these belief systems have on patients’ perceptions of mental illness and their consequent help-seeking behaviour. Likewise, findings of the current study suggest a need for the incorporation of complementary and alternative treatment strategies in the rendering of mental healthcare services. Such inclusion acknowledges MHCCs’ preferences and may reduce the time required to obtain remission and recovery. Although its application has limitations, future research may provide useful insight for the formulation and implementation of interventions that MHCCs believe to be effective

Supporting Treatment for Anti-Retroviral Therapy (START) together: protocol for a pilot, randomized, couple-based intervention to promote women's ART adherence and men's engagement in HIV care in KwaZulu-Natal, South Africa

Background: South Africa currently has the greatest number of people with HIV globally. The country has not yet met its 95-95-95 goals, with different gaps in the HIV care cascade for women and men. This paper reports on a protocol to pilot test a couple-based intervention designed to improve women's antiretroviral therapy (ART) adherence and men's engagement in care in heterosexual couples living in the Vulindlela area of KwaZulu-Natal, South Africa. Study goals are two-fold: (1) assess the acceptability, feasibility, and fidelity of the experimental intervention, START Together, and (2) collect efficacy data on START Together for women's ART adherence, men's engagement in HIV care, and the couple's relationship functioning. Methods: Women (N = 20) who were not engaged with ART adherence (defined via self-reported ART difficulties, record of missed clinic visits, or viral non-suppression) are the target patients; male partners are not required to know or disclose their HIV status to be part of the study. Couples are randomized 1:1 to the experimental treatment (START Together) or treatment as usual (referrals to the local clinic to support ART adherence or any other HIV-related care). START Together is a 5-session intervention based in cognitive-behavioral couple therapy, which is a skill-based intervention focusing on communication and problem-solving skills, and Life Steps, a problem-solving intervention identifying barriers and solutions to medication adherence. Couples are assessed at baseline, post-treatment (8 weeks post-randomization), and follow-up (12 weeks post-randomization). Conclusion: This study will provide preliminary implementation and efficacy data on whether this novel approach has potential to improve women and men's HIV and healthcare-related needs

Cooperation between Referees and Authors Increases Peer Review Accuracy

Peer review is fundamentally a cooperative process between scientists in a community who agree to review each other's work in an unbiased fashion. Peer review is the foundation for decisions concerning publication in journals, awarding of grants, and academic promotion. Here we perform a laboratory study of open and closed peer review based on an online game. We show that when reviewer behavior was made public under open review, reviewers were rewarded for refereeing and formed significantly more cooperative interactions (13% increase in cooperation, P = 0.018). We also show that referees and authors who participated in cooperative interactions had an 11% higher reviewing accuracy rate (P = 0.016). Our results suggest that increasing cooperation in the peer review process can lead to a decreased risk of reviewing errors

The song of the dunes as a self-synchronized instrument

Since Marco Polo (1) it has been known that some sand dunes have the peculiar ability of emitting a loud sound with a well defined frequency, sometimes for several minutes. The origin of this sustained sound has remained mysterious, partly because of its rarity in nature (2). It has been recognized that the sound is not due to the air flow around the dunes but to the motion of an avalanche (3), and not to an acoustic excitation of the grains but to their relative motion (4-7). By comparing several singing dunes and two controlled experiments, one in the laboratory and one in the field, we here demonstrate that the frequency of the sound is the frequency of the relative motion of the sand grains. The sound is produced because some moving grains synchronize their motions. The existence of a velocity threshold in both experiments further shows that this synchronization comes from an acoustic resonance within the flowing layer: if the layer is large enough it creates a resonance cavity in which grains self-synchronize.Comment: minor changes, essentially more references

Sustainability transitions for smallholder farmers: How can government, research and development programs support profitable goat markets in Tete?

For Mozambique the goat sector provides huge opportunities for reducing rural poverty levels, improving food security and contributing to the national economy. Mozambique has a huge demand for goat meat and products. Large and medium size buyers fail to source enough goats of the right quality and supply consistently to feed the growing demand in urban markets. Despite its potential, the goat sector is not fully developed. Improved goat production can provide an additional annual income of US$50 million at the national level. In the short term farmers can double their income from goats. Though farmers realize the critical role of goats as source of saving and possible source of investment, they do not invest much in goats and are not able to make an adequate profit from selling their goats. Mortality rates of around 15%, poor quality of goats being sold to markets, and livestock theft are losses to entire rural economies. There are many causes for the low productivity, the primary reasons being: a) Lack of a market structure through which farmers and the private sector can interact; b) Absence of a grading system that rewards farmers for their investments in quality production; and c) Livestock theft that destroys community trust, and eventually hampers collective action among farmers..

The damage-associated molecular pattern HMGB1 is released early after clinical hepatic ischemia/reperfusion.

OBJECTIVE AND BACKGROUND: Activation of sterile inflammation after hepatic ischemia/reperfusion (I/R) culminates in liver injury. The route to liver damage starts with mitochondrial oxidative stress and cell death during early reperfusion. The link between mitochondrial oxidative stress, damage-associate molecular pattern (DAMP) release, and sterile immune signaling is incompletely understood and lacks clinical validation. The aim of the study was to validate this relation in a clinical liver I/R cohort and to limit DAMP release using a mitochondria-targeted antioxidant in I/R-subjected mice. METHODS: Plasma levels of the DAMPs high-mobility group box 1 (HMGB1), mitochondrial DNA, and nucleosomes were measured in 39 patients enrolled in an observational study who underwent a major liver resection with (N = 29) or without (N = 13) intraoperative liver ischemia. Circulating cytokine and neutrophil activation markers were also determined. In mice, the mitochondria-targeted antioxidant MitoQ was intravenously infused in an attempt to limit DAMP release, reduce sterile inflammation, and suppress I/R injury. RESULTS: In patients, HMGB1 was elevated following liver resection with I/R compared to liver resection without I/R. HMGB1 levels correlated positively with ischemia duration and peak post-operative transaminase (ALT) levels. There were no differences in mitochondrial DNA, nucleosome, or cytokine levels between the two groups. In mice, MitoQ neutralized hepatic oxidative stress and decreased HMGB1 release by ±50%. MitoQ suppressed transaminase release, hepatocellular necrosis, and cytokine production. Reconstituting disulfide HMGB1 during reperfusion reversed these protective effects. CONCLUSION: HMGB1 seems the most pertinent DAMP in clinical hepatic I/R injury. Neutralizing mitochondrial oxidative stress may limit DAMP release after hepatic I/R and reduce liver damage

Decision rules for determining terrestrial movement and the consequences for filtering high-resolution global positioning system tracks: a case study using the African lion ( Panthera leo )

The combined use of global positioning system (GPS) technology and motion sensors within the discipline of movement ecology has increased over recent years. This is particularly the case for instrumented wildlife, with many studies now opting to record parameters at high (infra-second) sampling frequencies. However, the detail with which GPS loggers can elucidate fine-scale movement depends on the precision and accuracy of fixes, with accuracy being affected by signal reception. We hypothesized that animal behaviour was the main factor affecting fix inaccuracy, with inherent GPS positional noise (jitter) being most apparent during GPS fixes for non-moving locations, thereby producing disproportionate error during rest periods. A movement-verified filtering (MVF) protocol was constructed to compare GPS-derived speed data with dynamic body acceleration, to provide a computationally quick method for identifying genuine travelling movement. This method was tested on 11 free-ranging lions (Panthera leo) fitted with collar-mounted GPS units and tri-axial motion sensors recording at 1 and 40 Hz, respectively. The findings support the hypothesis and show that distance moved estimates were, on average, overestimated by greater than 80% prior to GPS screening. We present the conceptual and mathematical protocols for screening fix inaccuracy within high-resolution GPS datasets and demonstrate the importance that MVF has for avoiding inaccurate and biased estimates of movement

Statistical Reviewers Improve Reporting in Biomedical Articles: A Randomized Trial

BACKGROUND: Although peer review is widely considered to be the most credible way of selecting manuscripts and improving the quality of accepted papers in scientific journals, there is little evidence to support its use. Our aim was to estimate the effects on manuscript quality of either adding a statistical peer reviewer or suggesting the use of checklists such as CONSORT or STARD to clinical reviewers or both. METHODOLOGY AND PRINCIPAL FINDINGS: Interventions were defined as 1) the addition of a statistical reviewer to the clinical peer review process, and 2) suggesting reporting guidelines to reviewers; with “no statistical expert” and “no checklist” as controls. The two interventions were crossed in a 2×2 balanced factorial design including original research articles consecutively selected, between May 2004 and March 2005, by the Medicina Clinica (Barc) editorial committee. We randomized manuscripts to minimize differences in terms of baseline quality and type of study (intervention, longitudinal, cross-sectional, others). Sample-size calculations indicated that 100 papers provide an 80% power to test a 55% standardized difference. We specified the main outcome as the increment in quality of papers as measured on the Goodman Scale. Two blinded evaluators rated the quality of manuscripts at initial submission and final post peer review version. Of the 327 manuscripts submitted to the journal, 131 were accepted for further review, and 129 were randomized. Of those, 14 that were lost to follow-up showed no differences in initial quality to the followed-up papers. Hence, 115 were included in the main analysis, with 16 rejected for publication after peer review. 21 (18.3%) of the 115 included papers were interventions, 46 (40.0%) were longitudinal designs, 28 (24.3%) cross-sectional and 20 (17.4%) others. The 16 (13.9%) rejected papers had a significantly lower initial score on the overall Goodman scale than accepted papers (difference 15.0, 95% CI: 4.6–24.4). The effect of suggesting a guideline to the reviewers had no effect on change in overall quality as measured by the Goodman scale (0.9, 95% CI: −0.3–+2.1). The estimated effect of adding a statistical reviewer was 5.5 (95% CI: 4.3–6.7), showing a significant improvement in quality. CONCLUSIONS AND SIGNIFICANCE: This prospective randomized study shows the positive effect of adding a statistical reviewer to the field-expert peers in improving manuscript quality. We did not find a statistically significant positive effect by suggesting reviewers use reporting guidelines