High prevalence of comorbidity and need for up-referral among inpatients at a district-level hospital with specialist tuberculosis services in South Africa – the need for specialist support

Objectives. To define the patient population at Cape Town’s district-level hospital offering specialist tuberculosis (TB) services, concerning the noted increase in complex, sick HIV-TB co-infected patients requiring increased levels of care. Methods. A cross-sectional study of all hospitalised adult patients in Brooklyn Chest Hospital (a district-level hospital offering specialist TB services) from 27 to 30 October 2008. Outcome measures were: type of TB and drug sensitivity, HIV co-infection, comorbidity, Karnofsky performance score, and frequency and reason for referral to other health care facilities. Results. More than two-thirds of patients in the acute wards were HIV-co-infected, of whom 98% had significant comorbidities and 60% had a Karnofsky performance score ≤30. Twenty-eight per cent of patients did not have a confirmed diagnosis of TB. In contrast, long-stay patients with multidrug-resistant (MDR), pre-extensively (pre-XDR) and extensively drug-resistant (XDR) TB had a lower prevalence of HIV co-infection, but manifested high rates of comorbidity. Overall, one-fifth of patients required up-referral to higher levels of care. Conclusions. District-level hospitals such as Brooklyn Chest Hospital that offer specialist TB services share the increasing burden of complex, sick, largely HIV-co-infected TB patients with their secondary and tertiary level counterparts. To support these hospitals effectively, outreach, skills transfer through training, and improved radiology resources are required to optimise patient care

Reservoir resilience of viscoelastic surfactants

Viscoelastic solutions are notoriously sensitive to temperature and ionic strength. In order to be applicable for use in oil reservoirs, they need to be resilient to higher temperatures as well as to saline content. We define the essential characteristics required. Refractory properties obtained under Couette testing do not necessarily provide the same performance under pressure-driven flow. Nonetheless, it is possible to formulate solutions which clearly indicate that subsurface application is practicable. We show examples where salinity enables significantly enhanced viscoelasticity above ambient temperatures

Trekking en tussentijdse aanpassing van de steekproef voor het LEI-boekhoudnet tuinbouw : theoretische achtergronden

Een beschrijving van de theoretische achtergronden van de steekproef voor het LEI-boekhoudnet Tuinbouw en de wijze waarop deze tussentijds wordt aangepast. Hiervoor zijn twee procedures voorgestel

Advice-taking as a bridge between decision neuroscience and mental capacity

A person's capacity to process advice is an important aspect of decision making in the real world. For example, in decisions about treatment, the way patients respond to the advice of family, friends and medical professionals may be used (intentionally or otherwise) as a marker of the “use or weigh” requirement of decision-making capacity. Here we explore neuroscientific research on decision-making to identify features of advice-taking that help conceptualize this requirement. We focus on studies of the neural and computational basis of decision-making in laboratory settings. These studies originally investigated simple perceptual decisions about ambiguous stimuli, but have more recently been extended to more complex “value-based” decisions involving the comparison of subjective preferences. Value-based decisions are a useful model system for capacity-related decision-making as they do not have an objectively ‘correct’ answer and are instead based on subjective preferences. In this context, advice-taking can be seen as a process in which new evidence for one or other option is integrated, leading to altered behaviour or choices. We use this framework to distinguish between different types of advice-taking: private compliance consists of updating one's privately held beliefs based on new evidence, whereas in the case of public compliance, people change their behaviour at a surface level without shifting their privately-held beliefs. Importantly, both types of advice-taking may lead to similar outcomes but rely on different decision processes. We suggest that understanding how multiple mechanisms drive advice-taking holds promise for targeting decision-making support and improving our understanding of the use and weigh requirement in cases of contested capacity

Secondary and Tertiary Hyperparathyroidism:A Narrative Review

End-stage renal disease is often complicated by the occurrence of secondary and eventually tertiary hyperparathyroidism, characterized by increased parathormone, calcium, and phosphate concentrations. Related symptoms include pruritus and osteodynia, concentration difficulties, and feelings of depression may be present. In the long-term, end-stage renal disease patients with hyperparathyroidism have an increased risk of all-cause and cardiovascular mortality. Among treatment options are vitamin D supplements, phosphate binders, calcimimetics, and surgical parathyroidectomy. Determining the optimal treatment for the individual patient is challenging for nephrologists and endocrine surgeons. This review resumes the pathogenesis of hyperparathyroidism, clinical presentation, required diagnostic work-up, and discusses indications for the available treatment options for patients with secondary and tertiary hyperparathyroidism

Marketing of exotic and out-of-season fresh fruit and vegetables in the European Common Market

In een 10-tal bijdragen wordt informatie verschaft bedoeld voor exporteurs in ontwikkelingslanden ter verkenning van de EG-markt. Onderwerpen komen hierin aan de orde als: factoren die de produktie en consumptie beinvloeden, marktmechanisme, distributiekanalen, import en export van exotische vruchten, handelsbarrieres voor ontwikkelingslanden, handelstermen, handelskoste

In Conversation with Mubin Shaikh: From Salafi Jihadist to Undercover Agent inside the "Toronto 18" Terrorist Group

This interview with former undercover agent Mubin Shaikh can help academics and security practitioners understand the key role played and the challenges faced by covert human intelligence sources within domestic terrorist groups. The interview highlights the identity crisis, the personal factors, and the allure of jihadi militancy that initially drove Shaikh to join a Salafi jihadist group. It investigates Shaikh’s process of disengagement from the Salafi jihadist belief system and his rediscovery of a moderate, inclusive, and benevolent form of Islam. It explores his work as an undercover agent for the Canadian Security Intelligence Service, the Royal Canadian Mounted Police, and the Integrated National Security Enforcement Team responsible for disrupting domestic terrorist groups. The “Toronto 18” terrorist cell, the key role played by undercover agents in preventing terrorist action, and the challenges posed by entrapment are also discussed

Beyond Speculative Robot Ethics

In this article we develop a dialogue model for robot technology experts and designated users to discuss visions on the future of robotics in long-term care. Our vision assessment study aims for more distinguished and more informed visions on future robots. Surprisingly, our experiment also lead to some promising co-designed robot concepts in which jointly articulated moral guidelines are embedded. With our model we think to have designed an interesting response on a recent call for a less speculative ethics of technology by encouraging discussions about the quality of positive and negative visions on the future of robotics.

Warm and hot circumstellar gas in V1647 Ori during the 2008-2009 outburst

The pre-main sequence star V1647 Ori started a new outburst in August 2008. From October 2008 to February 2009 we monitored V1647 Ori, obtaining quasi-simultaneous VLT-CRIRES near-IR spectroscopy, VLT-VISIR mid-IR spectroscopy and VLT-FORS2 optical spectroscopy. We studied the evolution of H2 and CO emission from hot and warm gas and Hα and forbidden line-emission during the initial outburst phase of V1647 Ori. Hα is observed in emission displaying P-Cygni profiles with blue-shifted absorption up to -700 km/s, suggesting the presence of a high velocity wind (Fig. 1a). [OI] emission at 6300 Å is observed displaying a blue-shifted emission shoulder, indicating the presence of material moving away from the star (Fig. 1b). We detect H2 1-0 S(1) and CO (P4 to P14 and P30-P38) ro-vibrational lines centered at the velocity of the star at all epochs (Fig. 1c & d). This strongly suggests that the H2 and CO emission originates from a disk and not from a warm outflow. The H2 1-0 S(0) and 2-1 S(1) ro-vibrational lines at 2.22 and 2.24 μm and the pure-rotational H2 0-0 S(1) and 0-0 S(2) lines at 17 and 12 μm were not detected in our spectra. Changes in the Hα and [OI] profiles and the H2 and CO emission observed do not correlate. We modeled the H2 and CO line profiles assuming emission from a flat disk in keplerian rotation with line intensity decreasing with radius (I ~ I0(R/Rmin)−α). We found that the disk of V1647 Ori is observed nearly face-on and that the line emission is produced within a fraction of an AU of the star (Fig. 1d